The impact of attitudinal and environmental barriers of persons with

disabilities in Harar city.

Adinan Sufiyan Abdela

ID No: Kppg /320/11

Department of psychology, Haramaya University

Spsy 6041: Community and developmental psychology

Endris Seid ( Assistant Professor )

October 4,2021
1. Executive summary…………………………………………………………1

2. Introduction ………………………………………………………………...2

3. Problem statement…………………………………………………………..6

4. Statistics , Incidence and prevalence………………………………………10

5. Review of the Ethiopian literature and other world view………………..13

6. The risk factors related to environmental and attitudinal barriers……..23

7. Factors Associated with Environmental barriers………………………..28

8. Description of the environment……………………………………………29

9. Reference …………………………………………………………………...31
1. Executive Summary
Ethiopia is one of the most populist country in the horn of Africa and developing country in
the horn region. It population data estimated around 110 million and the second largest
population in Africa. Among these population 17.6% are persons with disabilities who live
in the country. Disability is one of the least addressed social problems in Ethiopia.
Based on the analysis of the United Nations, it is estimated that about eight million people
in Ethiopia live with disabilities. That is about 10 percent of the total number of the
Ethiopian population. An estimated 95 percent of PWDs in Ethiopia live in poverty, which
is one of the manifestations of unemployment. Malnutrition accounts for 20 percent of the
disabilities in the country (Yohannes, 2012: 101-102).

“Disability is a difficulty in functioning at the body, person, or societal levels, in one or

more life domains, as experienced by an individual with a health condition in interaction
with contextual factors." - Leonardi, et al. (2006). Individual with disabilities relational
with family, parent, neighbor, sibling, school, religious congregation, working place may
affect his or her personality development.
Under the statement of attitudinal and environmental problem of persons with disability in
harar city impairment, activities limitation, participation restrictions, environmental and
attitudinal barriers are the major problem which is facing persons with disabilities in their
day to day activities. Negative attitude feeling of isolation due to this disempowering and
deviating from social activities and communities activities participation. The institutional
barriers like health extension, school, government service institution are the major.

Using survey data from 2021, nearly 19.4 million people in Ethiopia are estimated to live
with some form of disability, or 17.6 percent of the country’s total population. Of these, up
to 4.6 million people (2.4 percent) have very profound difficulties. The estimated number
of population in harar 310,000, from these data 160000 are men and 145000 are female.
Populations with disabilities are estimated around 54560 with profound, severe, mild,
moderate disabilities in Harar city. Among these men with disabilities are around 28152
and female with disabilities are 26625. There is a higher risk of disability at older ages. The
prevalence of severe disability is around 2 percent among adult women under 18-60 and
increases to 13 percent among people aged 60 years.

The evidence makes it clear that these inequalities are a result of barriers, rather than
any inherent limitations of people with disabilities (Heymann et al., 2014; Groce et al.,
2011; Morgon Banks & Polack, 2014; Groce & Kett, 2014; Groce & Bakhshi, 2011; Bruijn
et al., 2012; WHO & World Bank, 2011). Barriers to disability inclusion include:
attitudinal barriers; environmental barriers; institutional barriers; ‘internalized’
barriers; lack of participation; inadequate data, statistics and evidence on what works, and
inaccurate concerns over cost/difficulty of disability inclusion.
 Poverty, gender, age, education, job and income factors(contact to the disable, family,
knowledge about disability, personality and cognitive factors are related to the attitudinal
and environmental barriers.
Intervention that is putted in this five categories of health (promotion, medical care,
rehabilitation, assistive devices), educational (early child development, non formal,
primarily, secondary and higher, life long learning ), livelihood ( skills development, self
employment, waged employment, financial services, social protection), social
( relationship, marriage and family, personal assistance, culture, religion and arts, sports,
recreational, leisure, access to justice), empowerment ( social mobilization, political
participation, language and communication, self-help groups and disabled people’s
organization ) are the major intervention area to over come attitudinal and environmental
barriers.

2. introduction
According to world report on Disability, more than one billion people or 15% of the
world’s population live with some form of disability, of whom, nearly 200 million
experience considerable difficulties in functioning. In the years ahead, disability will be an
even greater concern because its prevalence is on the rise. This is due to ageing populations
and the higher risk of disability in older people as well as the global increase in chronic
health conditions such as diabetes, cardiovascular disease, cancer and mental health
disorders(World Bank and World Health Organization (WHO), 2011: xi and United
Nations’ Education, Social and Cultural Organization (UNICEF, 2013: 10).

Ethiopia is one of the most populist country in the horn of Africa and developing
country in the horn region. It population data estimated around 110 million and the second
largest population in Africa. Among these population 17.6% are persons with disabilities
who live in the country. Disability is one of the least addressed social problems in Ethiopia.
Persons with disabilities facing many challenge like lose opportunity to get education,
inability to interact with community, psychological inferiority and lose of appropriate
service on health facilities in their local area .They are also facing many barriers to hinder
full participation and inclusion like lack of accessible physical environment, lack relevant
assistive technology and negative attitude people toward disabilities. And also people with
disabilities are more likely to experience poverty, live in poor quality or insecure housing
and have low level of education and reduce productivity.

Using survey data from 2021, nearly 19.4 million people in Ethiopia are estimated to live
with some form of disability, or 17.6 percent of the country’s total population. Of these, up
to 4.6 million people (2.4 percent) have very profound difficulties. The estimated numbers
of population in harar 310,000, from these data 160000 are men and 145000 are female.
 Populations with disabilities are estimated around 54560 with profound, severe, mild,
moderate disabilities in Harar city. Among these men with disabilities are around 28152
and female with disabilities are 26625.

Harari region is one of the Ethiopian states, which locate in eastern part of the country in center of
eastern hararge zone of oromia region. It has nine-woreda and 19-kebele administration and well
known in Ethiopia by income touring of jogel historical site place. Moreover, the land size is311.25
km2.

In any given society there is diversity in color, ethnicity, educational back ground,
economic status and functionality attitude and environment also behind these. Disability is one
of the major social and economic problems globally and in Ethiopia Specifically. It is one of
the most overlooked areas where by according to the UN estimates there are about 15% of the
world population live with one or multiple kinds of impairments. Though there number
significantly high but there participation and full enjoyment of benefits of engagement in their
community is minimal. Contributing factors include lack of access to education, Health care,
and access to justice, vocational training, rehabilitation services and employment.

However, country have not sufficient enough knowledge about the reality of people with
disabilities, the country still untransformed on disabilities issue as some research study
showed, people with disabilities have had been living vicious circle of poverty, illiteracy and
health problem because they could not have chance to engage in community participation by
one or another. Attitudinal barrier are become the cause of marginalization, stereotyping,
prejudice for the people with disabilities.

Article 8 of the UN CRPD specifically requires ratifying States to promote awareness

throughout society about the rights and dignity of persons with disabilities and their
capabilities and potential contributions. It also requires them to combat stereotypes, prejudice
and activities that might harm people with disabilities. Measures to support these aims
include, among others, public awareness campaigns and awareness-raising training program
about disabled persons and their rights.

Article 27 of the UN CRPD recognizes the right of people with disabilities to earn a
living by work freely chosen or accepted in a labor market and work environment that is open,
inclusive and accessible to persons with disabilities. However, the right to choosing work and
labor market merely, without changing the attitude of community, individuals, and society
toward person with disabilities is meaningless.

The UN CRPD together with major international conventions such as ILO Vocational
Rehabilitation and Employment (Disabled Persons) Convention, 1983, (No.159), which
requires countries to adopt and implement a national policy based on the principles of equal
opportunity and equal treatment, provide a platform for advancing equal opportunity in the
world of work.

With absence of productive participation in the economic activities most of person with
disabilities live in abject poverty. Poverty and disability have causal relationship in developing
countries. especially in Ethiopia persons with disabilities excluded from community
participation and they think negatively toward their selves and society; they just take disability
as curse or punishment from God since disable person feeling of isolating from society and
loosing chance to improve their capacity to full participate in community engagement .

Community psychologists have much to learn from people with disabilities and their advocacy
organizations about how to change personal and environmental factors associated with independent
living.

People with disabilities in Ethiopia have, however, continued to face negative

attitudes, stigma, and discrimination (Mesfin, 1999). A study by Almaz (2011) found that
Ethiopian college students have negative attitude toward people living with disabilities. It
was contended that people are deliberately choosing not to socially include and interact
with people with disabilities, since the culture requires daily social and physical
interactions. According to Eleni (2016), women with disability in Ethiopia who are never
married face different challenges on their life. Unmarried women have less value for
themselves; they believed that no one would want to marry disabled woman. Furthermore,
they feared that the man might be mistreated by the society because of her when he was
seen with her.

Person who uses a wheelchair, wheelchair Confined or restricted to a wheelchair,

user wheelchair bound.
Person with a physical disability Invalid; handicapped person; cripple,
crippled, lame
Unable to speak, uses synthetic speech Dumb, mute
Lives with / has / experiences a disability / Suffers from
impairment
Accessible toilet / parking for persons with Disabled toilet/handicapped parking.
disabilities
Source: adapted from Al Ju’beh, 2015, pp. 28-29.

Disability is part of a human condition that can be experienced by any person at

some point in life, temporarily or permanently [1]. It is an umbrella term covering various
types of physical impairments, activity limitations, and participation restrictions. A person
can be considered to have a disability if and when his/her performance during activities is
limited in nature, function, or quality [2]. This might include physical or intellectual
disability or limitation in performing activities or roles expected of individuals within their
usual environment [3]. Hence, the issue of disability consistently relates to human dignity
and inclusion in society.
 Based on the analysis of the United Nations, it is estimated that about eight million
people in Ethiopia live with disabilities. That is about 10 percent of the total number of the
Ethiopian population. An estimated 95 percent of PWDs in Ethiopia live in poverty, which
is one of the manifestations of unemployment. Malnutrition accounts for 20 percent of the
disabilities in the country (Yohannes, 2012: 101-102). In contrary to this, as cited in
Yetneberish (2013:5), the estimate of 17.6% of Ethiopians is living with a disability,
contained in the World Report on Disability. Studies showed that this variation was
occurred due to the measurements taken to classify and categorize peoples with disability
and without disabled or due to the information gap during data collection. According to
Ethiopian National Disability Action Network (ENDAN, 2010:32) such inconsistency is
mainly explained by differences in conceptualizing disability as well as in measurements
and classifications used for collecting disability data and reluctant of families to expose
PwDs during the survey.

The ICF model comprises two parts: a part based on functioning and a part based on
context. The functioning part consists of three components: body functions and structures,
activity, and participation. The body functions and structures entail impairments in
physiological functions of body systems, including psychological functions, as well as the
anatomic parts of the body (Üstün, Chatterji, Bickenbach, Kostanjsek and Schneider, 2003;
Ploeg et al, 2004). The activity component involves the limitations in executing a task or
action. Participation comprises the restrictions people experience when trying to involve in
life situations (Üstün et al, 2003). The contextual part consists of two components:
environmental factors and personal factors. In short, the environmental factors comprise
physical, social and attitudinal environment in which people live (Üstün et al, 2003).
Personal factors include demographic factors, as well as motivation, self-esteem, self-
efficacy, culture and spiritual life (WHO, 2011). In line with this perception of disability,
this study chose the definition of Leonardi, Bickenbach, Üstün, Kostanjsek and Chatterji
(2006) to define disability:

“Disability is a difficulty in functioning at the body, person, or societal levels, in one or

more life domains, as experienced by an individual with a health condition in interaction
with contextual factors." - Leonardi, et al. (2006). Individual with disabilities relational
with family, parent, neighbor, sibling, school, religious congregation, working place may
affect his or her personality development.
3. Problem Statement

What is disability mean?

Disability results from the interaction between an individual with impairments and
barriers (contextual factors) they experience. Disability is the result of limitations in their
ability to participate fully in activities and effectively participate in society on an equal
basis with others. Here the point, what community psychologist deal with it because us we
have understand from the above statement impairment only is disabilities rather the
environment ( individual, family, community, society) barriers relationship with
impairment are created disability. So now community psychologist can enhance or
meliorate the individual capacity as he or she can play role in community engagement in
full participation. And empowerment of the individual with impairment is also among the
key in community psychology by here or there if the individual with impairment are
engaging full participation.

What is disability? Disability is a complex and multi-faceted concept, and

approaches to defining and measuring disability have evolved during the last few decades.
The International Classification of Functioning, Disability and Health (ICF) conceptualize
disability as an umbrella term covering impairments, activity limitations, and participation
restrictions.

■ Impairment: is a problem in body function or structure – for example, blindness or

paralysis.

■ Activity limitation: is a difficulty encountered by an individual in executing a task or

action – for example, walking or eating.

 Participation restriction: is a problem experienced by an individual in

involvement in life situations – for example, employment discrimination.

 Environmental barriers: These refer to physical barriers within the environment,

for example steps, holes in the pavement and lack of resources for disabled people, for
example lack of Braille and lack of sign language interpreters. It also refers to the ways
things are done, which may exclude disabled people, e.g. the way meetings are
conducted and the time allowed for tasks.

 Attitudinal barriers: These refer to the adverse attitudes and behavior of people
towards disabled people.

1. How could negative attitude become the cause of stereotyping?

2. Does community attitudinal barrier can affect women with disabilities on

education and labor?
 3. Why women with disabilities could frequently marginalized from community
participation?

4. What is impact of negative attitude toward student with disabilities?

5. Why environmental barriers related to attitudinal barriers of the community toward

persons with disabilities?

6. Which factors of the environment are most relevant for persons with mild,
moderate, or severe levels of disabilities?

7. To what extent does the relevance of environmental factors change depending on

the level of disabilities?

8. How could community value contribute to attitude barriers toward disabilities?

Disability is a heterogeneous and evolving concept, encompassing people with

long-term physical, mental, intellectual or sensory impairments (UN 2006). Persons with
disabilities may have acquired those impairments through injury, illness or congenital
conditions, and the impairments may have mild, moderate or severe impacts on a person’s
daily functioning, depending on the nature of the impairment as well as a range of personal
(e.g. age, gender, socioeconomic status, ethnicity) and environmental (e.g. physical,
social/cultural, political) factors. There is a growing consensus that understandings of
disability should reflect the interaction between the individual with a health condition and
contextual or environmental factors that pose significant challenges to people’s enjoyment
of their full human rights and potential (United Nations Convention on the Rights of
Persons with Disabilities (CRPD) 2006).

Researchers have pointed out mainstream psychology's failure to consider disability

populations in an inclusive, productive manner as well as the potential for community
psychology as a perfect venue for such an undertaking (Dowrick & Keys, 2001; Lawthom
& Goodley, 2005)

Negative attitudes are associated with avoidance and rejection, while positive
attitudes usually are associated with broader acceptance and comparatively more favorable
reactions (Yuker, Block, & Young, 1970). Non-acceptance of PWDs by nondisabled
people is globally consistent, and studies have indicated the importance of studying
attitudes and their basis when trying to establish opportunities and inclusion for PWDs
(Chan et al., 2002). The understanding and study of attitudes may benefit PWDs by
providing methods with which to develop procedures to address these attitudes as well as
providing appropriate assessment to measure the effects of interventions (Antonak &
Livneh, 2000). Antonak and Livneh (1995) argued that successful inclusion of PWDs in the
community is determined, in part, by the attitudes of the public. In the United States alone,
studies have uniformly indicated that non-acceptance and lack of full inclusion and
integration of PWDs continue to create societal barriers that hinder individuals with
disabilities from full participation in society (Bordiere & Drehmer, 1986; Campbell,
Hensel, Hudson, Schwartz, & Sealander, 1987; Elston & Snow, 1986; Greenwood &
Johnson, 1987; Holmes & McWilliams, 1981; Martin, Scalia, Gay, & Wolfe, 1982;
Minskoff, Sautter, Hoffman, & Hawks, 1987; Schriner, Greenwood, & Johnson, 1989;
Singh, 2003). Global attitudinal studies conducted by the Special Olympics (“Multinational
Study of Attitudes,” 2003) have also confirmed that people in many nations display
negative attitudes toward PWDs.

Three barriers that hinder the capacity persons with disabilities to full participate in
community engagement.

Attitudinal barriers

This is prejudice, discrimination and stigma towards people with disabilities who
are assumed incapable and inadequate, of low intelligence, in need of a ‘cure’, needing
‘special’ support and/or are dependent. Conversely they can be viewed as exceptionally
‘inspirational’, ‘exceptional’ and ‘heroic’ if they demonstrate abilities. Non-disabled people
can respond with fear, pity, repulsion, or a sense of superiority. These assumptions and
emotions are reinforced by the media. Negative language about people with disabilities
reflects and can reinforce prejudices – especially language that is offensive and inaccurate
– for example the term “dumb” is often used as part-description of someone with a hearing
impairment on-disabled people regard as ‘normal’.

Environmental barriers

These are physical infrastructure and communication barriers people with disabilities
encounter in areas including public transport, hospitals and clinics, schools and housing,
shops and marketplaces, offices and factories, places of worship, media and
communication and public information systems. Most people think of the physical barriers
in this category – for example a health clinic is inaccessible for wheelchair users if it has
steps and narrow doorways. It’s relatively easy to identify these – in consultation with
people with disabilities – once aware. But communications can also be disabling for those
with sensory and intellectual impairments – e.g. for deaf people if there’s no sign language;
for people with visual impairments if medication isn’t appropriately labeled, for people
with intellectual impairments if clear, simple language is not used to communicate key
messages.

Institutional

These barriers encompass laws, policies and belief systems that exclude or segregate
people with disabilities from many areas including legal processes, employment, electoral
processes, education, health services, social services, Plan/DermanSalifou [ Outside the
Circle • 17 ] religion and humanitarian/development agency work. Many of the systems are
not accessible to people with disabilities. Exclusion from them has many onward effects –
poorly regulated special education often makes fewer academic demands on pupils, and
smaller schools expose them to a limited range of cultural experiences. Exclusion of people
 with disabilities from teacher training colleges limits the number of qualified disabled
teachers who can act as role models for children (with and without disabilities) in
mainstream schools. Families make assumptions that their disabled child will never work
independently, so they don’t press the government to provide suitable formal education or
encourage their child to pursue a career. With such low expectations, people with
disabilities can easily become fatalistic about their own prospects.

The United Nations Convention on the Rights of Persons with Disabilities

(UNCRPD) indicates that persons with disabilities include those who have long-term
physical, mental, intellectual or sensory impairments which, in interaction with various
barriers, may hinder their full and effective participation in society on an equal basis with
others. Legislation and policies in Ethiopia have typically used a medical model approach,
without considering the social or human rights elements of the concept of disability. A
person with a disability was first defined in an imperial order in 1971 as “any person who,
because of limitations of physical or mental health, is unable to earn his livelihood and
does not have one to support him and shall include any person who is unable to earn his
livelihood because of young or old age”. The 1994 proclamation on the employment rights
of persons with disabilities refers to “a person who is unable to see, to hear to speak or
suffering from injuries to his limbs or from mental retardation, due to natural or manmade
causes; providing however, the term does not include persons, who are alcoholic, drug
addicts and those with psychological problems due to socially deviant behaviors.” More
recent policies acknowledge the role of contextual factors and align more closely with the
definition used in the Convention.

“Disability is reality for me, it is not inability but possible for everyone” this is not
internalized in most people mind. Disability is regards to be a curse, a punishment from
God, rather than considering if they got chance to participate in all without discrimination
they can contribute in country’s economy, socially, politically. The consequence of
disability is not limited to physical restriction, the agony escalates to hand cap a victim in
all aspects of personal development lower self-concept, deny social interaction , deprive
educational and employment opportunities to steadily structure a marginalized
socialization.

According to some psychologist suggest that illness and it may be disability can affect
patients physically 30% only out of 100% but patients psychologically affect him or herself
70%. This means in disability context the limitation of your body functionality can affect
your activities only 30% rather your distortion thought and community thought barriers can
affect your full participation.

The consequence of disability does not affect physical only but likely affect the
psychology of the person and her skill to develop and overcome life challenges. Disabilities are
vertical relationship with gender inequality and no possessing of participating to improve
economic activity of the women and girls in a community. Indeed if they are graduated from
college the chance to get job is rare because of vacancy criteria limit them to keep organizational
interest only exclude disable person from participation. Especially women with disabilities are
excluded from mainstream gender equality program. Those all are affect the person with disability
in developing country those who have negative attitude toward disability and make them live with
inferiority complex. Not only this but also technology is immature in a country more they are far
apart from technology because the chance to knowing about using technology are rare. The UN
Convention on the Rights of Persons with Disabilities (UNCRPD) that has been ratified by 20
countries since May 2008 will be an international legal instrument in paying proper attention for
persons with disabilities in the world. An effort is being made to make the process of
implementation of the Convention transparent, meaningful, and fully inclusive by lobbying for the
implementation of the Convention.

In Ethiopia similar to other societies, disability is regard to be a curse, a punishment from

God or a mythical phenomenon. The consequence of disability is not limited to functional
restriction, the agony escalates to handicap a victim in all aspects of personal development lower
self-concept, deny social interaction, deprive educational and employment opportunities to steadily
structure a marginalized social cluster.

People with disabilities constitute one of the most marginalized groups in Ethiopia.
Especially women with disabilities are excluded from mainstream gender equality programs. Most
disabled people do not have access to mainstream education and employment opportunities, which
results in a life of marginalization and exclusion. Despite such deep-rooted exclusion, few poverty
alleviation programs include provision for their participation and inclusion. Many people with
disabilities face discrimination through social, economic, physical and political barriers. Other
barriers such as the stigma of disability, poor understanding of the abilities and aspirations of
disabled persons, lack of rehabilitation opportunities and physical environments that suit primarily
to the physically able also act as added deterrents. This situation prevails in Ethiopia despite
increasing global level attention to disability over the past decade and a half.

The UN Convention on the Rights of Persons with Disabilities (UNCRPD) that has been
ratified by 20 countries since May 2008 will be an international legal instrument in paying proper
attention for persons with disabilities in the world. An effort is being made to make the process of
implementation of the Convention transparent, meaningful, and fully inclusive by lobbying for the
implementation of the Convention. Disability should be cross cutting issue that should be
addressed as gender and HIV/ AIDS through mainstreaming in the development efforts of the
country in the millennium.

Children with disabilities are the most forgotten part of the Ethiopian community. The
Ethiopian constitution establishes the right to equal access to publicly funded social services, urges
all Ethiopians to have access to public health and education, and emphasizes the need to allocate
resources and provide rehabilitative assistances to the disabled and other disadvantaged group.
This shows that policies and other directives issued in favor of marginalized sector of the
community have no legally binding impact.
 4. Statistics, incidence and prevalence
Using survey data from 2021, nearly 19.4 million people in Ethiopia are estimated to live
with some form of disability, or 17.6 percent of the country’s total population. Of these, up to 4.6
million people (2.4 percent) have very profound difficulties. The estimated number of population
in harar 310,000, from these data 160000 are men and 145000 are female. Populations with
disabilities are estimated around 54560 with profound, severe, mild, moderate disabilities in Harar
city. Among these men with disabilities are around 28152 and female with disabilities are 26625.
There is a higher risk of disability at older ages. The prevalence of severe disability is around 2
percent among adult women under 18-60 and increases to 13 percent among people aged 60 years
and above. However, adult women disability is likely to be under-reported because it is more easer
to measure disability among children, and elders and surveys in Ethiopia have not yet included
specific modules women with disabilities in harar city.

Based on the world report on disabilities jointly issued by the world bank and World
health organization , there are an estimated 15 million children, adult and elderly persons with
disabilities in Ethiopia representing 17.6 percent of the population. However the exact number
of persons with disabilities were not being clearly identified, because of the governments were
not ineffective to so.

The families of children with disabilities in Ethiopia hide their children at home, the
other is national statistic agency for 11years they did not process counting of population those
are among the reason. It has become increasingly clear over the past decade that meeting
international development goals will not be possible unless there is greater support for persons
with disabilities to realize their human rights. An estimated 80% of persons with disabilities
live in developing countries (Aguilar 2017; World Health Organization (WHO) and World
Bank 2011), and there is growing evidence on the role of disability in perpetuating the cycle of
exclusion and poverty (Walker 2013). People with disabilities are at greater risk of exclusion
from a wide range of dimensions that support the development of human capabilities: they are
more likely to experience food insecurity, more likely to lack access to safe water and
sanitation, more likely to be deprived of their rights to education and healthcare, more likely to
have poor housing, and to have poorer access to decent work, assets and financial services
(WHO and World Bank 2011; Mitra et al. 2013). So that is why community psychology greatly
deals with disabilities.

Disability is not rare, however it is hard to obtain an estimate of the number of people with
disabilities. There are big differences in the ways countries define and measure disability; the
quality and methods of data collection; the reliability of sources; and disclosure rates as families
may fear stigma and isolation (Al Ju’beh, 2015, p. 12; WHO & World Bank, 2011, pp. 21-24). In
low-income countries prevalence is often recorded as very low as a result of the use of weak
methodologies. The Washington Group Short Set of Questions has been designed to measure
disability consistently worldwide and is beginning to be used more widely.
 The World Report on Disability, 2011, is seen as the most reliable source to date on
disability data and statistics (Al Ju’beh, 2015, p. 12). It finds that there are over a billion people,
about 15 per cent of the world’s population, who have some form of disability (WHO & World
Bank, 2011; p. 44). A similar global figure of 14 per cent is found by Mitra & Sambamoorthi
(2014, p. 940) using a different methodology but the same data. They also find that disability
prevalence is higher: in low- and middle-income countries than in high-income countries; among
people aged 65 and above (39 per cent) than among working age adults (12 per cent); and among
women (18.5 per cent) than men (12.1 percent) (Mitra & Sambamoorthi, 2014, p. 940, 944).

Disability prevalence is likely to rise as a result of ‘ageing populations and the higher risk of
disability in older people as well as the global increase in chronic health conditions such as
diabetes, cardiovascular disease, cancer and mental health disorders’ (WHO & World Bank, 2011,
p. xi).

Table: The community and persons with disabilities appropriate use of language can create
positive image and attitude made them confident in community participation.

Do Use Don’t Use

Person with an impairment; person with The disabled, handicapped, PWD
disability, people with disabilities
Person without a disability, non-disabled Normal person
person, sighted person
Person with a psychosocial disability, or ‘Mental’ or ‘mad’
psychiatric impairment or person with mental
illness
Person with intellectual disabilities or Mental handicap or retarded
persons with learning disabilities
Person who is blind, person who has low The blind; the visually impaired
vision; partially sighted person
Person who is deaf, person who is hard of Suffers from hearing loss, the deaf, deaf and
hearing; a deaf person. dumb, deaf-mute.

Table 1: Age-sex standardized disability prevalence (per cent) among adults for all countries and
by country income group

At least One At least One No Disability

two severe or two moderate limitation (a)+(b)
severe or extreme moderate limitation (e)
extreme limitation limitations (d)
limitations (b) (c)
(a)
All 54 4.9 9.1 5.1 11.5 69.4 14.0
countries
High income 1.7 4.8 3.0 10.1 80.3 6.5
 countries
Upper middle 4.2 9.2 4.2 13.0 69.4 13.4
income
countries
Lower middle 7.8 12.1 6.8 10.9 62.3 19.9
income
countries
low income 4.8 7.8 5.0 10.8 71.6 12.6
countries
Source: Mitra & Sambamoorthi, 2014, p. 944

Table 2: Prevalence of limitations and disability (per cent) for all countries by demographic
characteristic.

At least One severe At least One No Disability

two severe or extreme two moderate limitation (a)+(b)
or extreme limitation moderate limitation (e)
limitations (b) limitations (d)
(a) (c)
Adults aged 18+
Women 7.0 11.5 6.3 13.5 61.8 18.5
Men 4.0 8.1 4.7 10.5 72.7 12.1
Working age adults (18-64)
All 3.6 8.4 4.7 11.6 71.6 12.0
Women 4.8 9.9 5.4 13.3 66.6 14.7
Men 2.4 6.7 3.9 9.8 77.1 9.1
Older adults (65+)
All 19.1 20.3 11.0 15.1 34.5 39.4
Women 22.2 22.0 11.9 14.7 29.3 44.2
Men 15.6 18.3 9.8 15.6 40.7 33.9
Source: Mitra & Sambamoorthi, 2014, p. 944

5. Review of the Ethiopian literature

People with physical disabilities have been written about since medieval times, a period in
which PWDs were seen as evil and their disabilities as a punishment from a deity. When they were
not being feared for their contagiousness or evil spirit, the disabled population was pitied for their
conditions. “From early Egyptian, Greek, and Chinese civilization to the present, negative attitudes
towards people with disabilities have been prevalent. These negative attitudes exist within most
cultures and nations” 20 (Arokiasamy, Rubin, & Roessler, 1995, p. 123). The continued
stereotyping of PWDs and their perceived lack of ability and limitations has only added to the
history of global devaluation and stigmatization of PWDs. The visible appearance of a disability
aids in identifying and marking those individuals (Wright, 1983), thus making them a noticeable
target for negative perceptions. Responses towards PWDs have been influenced by other factors,
such as economic conditions and socio-cultural norms and values of a particular society
(Arokiasamy et al., 1995). These factors contribute heavily to societal attitudes toward disabilities
in Ethiopia.

In Ethiopia, individuals with disabilities are viewed as outsiders and are not included in
daily cultural activities such as eating with family members, attending events, and socializing with
guests. These exclusions occur because there is still a great level of shame and stigma associated
with disabilities in Ethiopia; thus, family members who have disabilities are segregated from
others (Fitaw & Boersma, 2006). Fitaw and Boersma (2006) conducted their study in Ethiopia with
932 participants with disabilities: 528 males and 404 females. Only 23% of the participants
received a primary education (elementary level educations), and 56.9 % did not receive any formal
education. The participants reported that of those over the age of 7 years, about 70.7%, did not
attend school. The reasons given for those individuals not being involved in school were
disabilities (38.5%), lack of finances (30.9%), lack of physical access (15.2%), and family and
community influence (4.5%). Although Arokiasamy et al. (1995) noted that economic and socio-
cultural norms and values influence attitudes toward disabilities, the Fitaw and Boersma study
revealed how economic factors contributed to the small percentage of PWDs receiving an
education in addition to strong cultural beliefs and stigmas that segregated them from others. A
study conducted by Tekle-Haimanot et al. (1991) examined the attitudes of rural Ethiopians toward
physical disability, specifically epilepsy. The participants were interviewed regarding their
attitudes and perceptions on each of the disorders.

The attitudes of college students have yet to be examined. Tekle-Haimanot et al.’s 1991
study is an example of some of the research that has been conducted in Ethiopia. The study did not
employ attitudinal instruments to accurately measure attitudes and can only attribute the findings
to rural populations. One of the main issues with studies about disabilities in Ethiopia is that they
exclude future professionals who are currently college students who could begin to address societal
barriers such as policies and access to institutions. The following section will discuss definitions,
assessments, and measurements of attitudes.

Wright stated that negative attitudes toward physical disability arise from the inferior status
that society and individuals assign to the PWD (1980). Wright also suggested that an individual
with a physical disability often does not fit in with common societal expectations and, therefore, is
frequently devalued and perceived as inferior (Wright, 1980). Non-acceptance of PWDs in
Ethiopia is communicated through the non-presence of PWDs in public places, low employment
status, isolation, and other secondary mental health issues (Shilbre et al., 2001). Therefore,
negative attitudes toward people with disabilities in Ethiopia are socially learned (Fishbein &
Ajzen, 1972, 1975) and are a function of historical beliefs (Antonak & Livneh, 1988).

Ethiopians’ attitudes toward disabilities, as is true in all cultures, are inherently

embedded in their cultural and social beliefs, and hence, negative attitudes are often passed on
through social-cultural interactions. Attitudes about disabilities in Ethiopia are often based on
supernatural beliefs, which have proven to be negative (Alem, Desta, & Araya, 1995). These
beliefs include (a) possession by evil spirits or the devil or other demons that may be specific to a
tribe; and (b) curses, spells, or bewitchments by people who are believed to have supernatural
powers of “buda” (evil eye) (Kahana, 1985; Messing, 1958; Reminick, 1974). These beliefs have
affected Ethiopians in numerous ways, such as condoning social stigma, marginalizing individuals
who are believed to be physically or mentally ill, as well as limiting access to rehabilitation
services (Weldead, 2007). As a consequence, negative attitudes toward PWDs have become
socially acceptable attitudes to possess, and to have any differing opinions would be going against
the norm (Katz, 1960). The method by which attitudes have been taught and learned in Ethiopia is
through conditioning of what is acceptable for the cultural norm (De Houwer et al., 2001;
Winkielman et al., 2003) and general socialization (Newcomb, 1943), both of which have
contributed to the formation of negative attitudes toward PWDs. Although beliefs about attitudes
of the general population in Ethiopia are connected to supernatural beliefs, it is uncertain if
Ethiopian college students’ beliefs are informed by cultural socialization. What is certain is that the
beliefs of college students and professionals in general do affect PWDs. In fact, professionals who
are employed in the rehabilitation profession have a direct affect on an individual with a disability.

Cultural orientation is critical to examine because it influences people’s attitudes toward

disabilities. Researchers believe that stigmatizing attitudes are driven by sociocultural norms and
influences (Goffman, 1963). The cultural orientation of individuals affects what attitude they have
toward an object, because attitudes encompass certain cultural norms. Yang et al. (2007) suggested
that cultural norms influence what stigmatizing attitudes will be assumed by a community. For
example, researchers in Egypt found that people who held negative attitudes toward intellectual
disabilities in Egypt also endorsed cultural norms in that community (Coker, 2005). This form of
cultural orientation is collectivist, because the group’s values and norms supersede individual
opinion. Hui (1988) defined individualism as “(a) the self is the basic unit of survival; (b) have
high needs for autonomy. He defined collectivism as (a) hold the view that the unit of survival lies
in a group or in several groups and (b) have greater associative and nurturing needs” (p. 667).

Negative attitudes toward PWDs are often acquired early in development through cultural
conditioning. Even young children know how to categorize people with and without disabilities
due to what they have learned about PWDs (Harper, 1999; Maras, 1993; Richardson, Goodman,
Hastorf, & Dornbusch, 1961). Further studies have confirmed that children’s’ beliefs about
disabilities are inherited from socio-cultural conditioning (Lee & Rodda, 1994). Bandura’s Social
Learning Theory posits that people learn from one another via observation, imitation, and
modeling. The theory has often been called a bridge between behaviorist and cognitive learning
theories because it encompasses attention, memory, and motivation. This theoretical emphasis
forms the basis of how attitudes are acquired in this study.

Though there is an immense variation between World Report and Central Statistics
Agency of Ethiopia about the number of PwDs, in both cases there are a large number of persons
with disability in the country. The most important fact investigated was the strong relationship
between poverty and disability, where one caused the other and vice versa. According to Berhanu
(2015:179), there is a strong connection between disability and poverty due to many systemic
factors that promote a vicious circle. This may entail that the mutually reinforcing nature of
special needs and low socioeconomic status. This may suggest that people with disabilities are
significantly more likely to become impoverished; and people who are impoverished are
significantly more likely to become disabled.
Disability, poverty and illiteracy are encircled on one latitude this means women with
disabilities are become destitute because of their disabilities.
Various factors such as infectious diseases, malnutrition, war, episodes of drought and famine
and problems related to pre-and post natal care of mothers and children have dramatically
increased the number of disabled population in Ethiopia. Poverty and ignorance exacerbate the
problems. Knowingly and unknowingly disabled children are exploited and excluded from
normal family routines.

The challenges of physical barriers experienced by the three universities illustrate the
situation in most other universities in the country. The experiences reported here often result in
academic, social and emotional problems on the part of students with disabilities. Several
meanings could be derived from these situations. The leadership contributes to the situation by
its failure to facilitate and follow up education and life of students with disabilities. Instructors’
lack of understanding the needs and challenges of the students is another problem. Another
issue here is the practice of keeping students with motor problems in a separate building. The
leadership should do to the best of its level to reverse such practice so that the students are not
constrained in terms of educational and social interaction opportunities (Tirussew.T, etal ,
2014).

Women Entrepreneurs with Disabilities17 Women entrepreneurs with disabilities are

over represented among the poor. They face more discrimination because of their disability.
They are often marginalized, denied opportunities for employment, decision making and
leadership. There is very little awareness of disability and the rights and needs of people with
disabilities. The general public attitude regarding 17 ILO Developing Entrepreneurship among
Women with Disabilities 54 Studies Conducted on Women Entrepreneurs in Ethiopia women
entrepreneurs with disabilities at best is ‘pity’. Disabled women entrepreneurs face harassment,
verbal abuse and theft in the market this is among attitudinal barriers as well.

Women entrepreneurs with disabilities have very limited marketable skills and
training. Disabled women entrepreneurs are not targeted for training and are constrained by
accessibility issues (due to wheel chair use, sign language translation and Braille formatted
information) from participating in training, accessing credit or BDS. Vocational schools and
BDS providers need to be accessible to disabled people.

A study by CAWEE (2009) also shows that most banks are not accessible for persons
using wheel chairs. Entrepreneurs with hearing impairments cannot effectively communicate
 with banks as the latter do not have interpreters. Bank brochures, formats and books are not
suitable for visually impaired persons.

There is also a need for a public awareness campaign to change the image of disability.
There are an estimated 11% of persons with disabilities in Ethiopia which indicates the
potential market for products and services for disabled persons. Such services need to be
encouraged, rather than disabled people being stigmatized.

The Ethiopian National Plan of Action of Persons with Disabilities (2012-2021) estimates
that 95% of persons with disabilities in Ethiopia are living below the poverty line. Like the overall
population, 84% are assumed to live in rural areas and therefore have limited access to basic
services. Rehabilitation services in the country are also limited and concentrated in urban centers.

Ethiopia has ratified and adopted almost all of the relevant initiatives and international
legal texts on the rights of persons with disabilities including the UN Convention on the Rights of
Persons with Disabilities (UNCRPD) in 2010. On a national level, its Growth and Transformation
Plan, which is the leading document aiming for economic growth and development in Ethiopia and
already in its second phase (GTP II 2015- 2020), has various chapters and articles which refer
directly or indirectly to persons with disabilities, referencing for example special needs education
for children with disabilities, preventive, curative, emergency care and rehabilitative health
services, and the aim to expand social security services and participation in political decision
making.

Harmful traditional practices also play their part in raising the number of disabled
individuals. For girls, FGM, fistula caused by obstructed labor accompanying early marriage and
pelvic deformity, maternal related risks, incision of lower limbs, maternity related risks contribute
significantly to increasing the number of disabled women (Tirusew, 1993). In a national baseline
survey undertaken in 1995, among the 5085 households in which the questionnaire was
administered 14.7% had persons with disabilities. Most of the disabled persons fell under:
impaired vision (30.4%), mobility disorder (30.9%), and chronic health problems such as epilepsy
and leprosy (10.3%). Among these, close to 40% were women. The lower figure for female
disabled could be due to war induced disability that affects mainly the male population. xxv All
disabled individuals encounter attitudinal problems from able-bodied individuals.

Lack of education, training and employment opportunities; inaccessibility of social services;

and lack of implementation of laws and policies that ensure equal opportunities are added
problems.

Disabled women encounter special problems in addition to those commonly shared with
disabled men. Many researchers express this, as “double disability”. A study conducted in 1999 in
Addis Ababa, on persons with hearing, visual, and motor impairments, neither showed that, at
home female disabled are overburdened with household chores and many neither had the
opportunity to go to school nor got the permission and time to interact with other individuals. A
study conducted in six regions of Ethiopia on girls who have visual and hearing disability and
mental retardation showed that, visually and hearing impaired girls do not have early childhood
educational experiences. The problem was worse for visually impaired. In many instances,
institutions like the church and the Koran schools offer some services. However, public schools
and in some cases NGO supported schools were the major service providers for girls with visual
and hearing disability. Looking at access to education for visually and hearing impaired
individuals, the trend over the years shows that the attendance rate of girls was much lower than
that of boys. For example, for the academic years 1995/96, 1996/97, 1997/98, 1998/99 and
1999/00 the percentage of visually impaired female students in primary cycle, that is, from grades
1- 4 were 32.6%, 31.1%, 31.7%, 37.3%, and 37.9% respectively.

In addition to the limited opportunities girls have in terms of access to school, the
unfavorable school environment is another constraint they face. Unavailability of toilets, school
distance, unavailability of disability specific instructional materials, low qualification of teachers
were found to be some of the problems girls with disabilities encounter (Amare et al, 2001). In one
study girls with motor impairment and hearing impairment reported that inconsiderateness and
discouragement on the part of teachers to be serious constraints (Tirusew, 2001).

Studies show that disabled individuals face discrimination in employment. The magnitude is
severer for women. Similarly, once employed the opportunity for promotion, further training and
other privileges were found to be scarcer for female disabled than male disabled. Studies and
personal testimonies also reveal that disabled women have much more constraints in social
engagements and marital relationships than do male disabled. Several studies and day-to-day
observations show that disabled women are exposed to several forms of violence: physical
including sexual violence, psychological, as well as various forms of hard labor.

It is hardly possible to put a straight forward definition of disability (Wasserman et al. 2016a,
2016b). The definitions as well as the extent to which people considered to be living with disability
are included or excluded in major socio-economic activities vary from one culture to another
(Eskay et al. 2012; Bunning et al. 2017). Young (2010) defines disability as the disadvantage or
restriction of activity experienced by people living with impairments that result in exclusion and
marginalization of the group from the mainstream social, economic, and political participations.
According to WHO (1990), It is a restriction or inability (often due to denial of equal opportunity
by the society) to perform activities by persons with certain levels of psychological, anatomical or
physiological abnormalities in the way or within the range considered for a human being having
psychological, physiological, or anatomical states that are labeled to be normal.

Moreover, disability is physical or mental characteristic labeled or perceived as impairment

or dysfunction and some personal or social limitation associated with that impairment (Wasserman
et al. 2016a, 2016b). Since 1970s, there is a shift in the definition of disability from the medical
model- associating disability with impairment- to a social model in which states that social and
attitudinal barriers to inclusion are socially constructed phenomena and serve to create a disabling
condition to people with some kinds of impairments (IFPA 2007).

People with disabilities tend to be disempowered and deprived of economic and social
opportunities and security because of social and physical barriers in society (Wiman et al. 2002).
The images of people with disabilities in both Eastern and Western cultures provide the bias for
negative attitudes. Current assumptions combined with historical social portrayal of people with
disabilities as “sick and suffering” make it difficult for these individuals to meet the standards of
social norms and to be viewed independent of these images (Almaz, 2011).

Moreover, persons with disabilities are the most marginalized groups when it comes to
sexual and reproductive health issues (WHO 2009; Tanabe et al. 2015; Meza et al., 2017). In fact,
many persons with disabilities enjoy the experience of marriage and family life. However, because
of stigma and discrimination, lack of access to information and services, especially those on sexual
and reproductive health, many do not marry and have children. According to Good all et al.
(2017), young people with functional disabilities are more likely to experience adverse
employment, educational and relationship outcomes in the transition to adult life, with the greatest
disadvantage experienced by females.

Persons with disabilities face various hindrances to their sexuality which includes lack of
sexual self-esteem, failure to enjoy pleasurable sex, and failure to get sexual partners (Tepper
2000). The stereotype that ascribes asexuality to persons with disabilities is a general phenomenon
in most societies. The stigma of asexuality will depend on the kind and extent of disability (Miller
et al. (2009). It is not merely that the disabled body may not be aesthetically appealing according
to social meanings of attractiveness, though that may be part of the reason persons with disabilities
experience stigma. However, a major determining factor of the stigma is the extent to which the
physical or mental disability has the potential to, or actually challenges the dominant norms
governing sexuality.

Experiencing a limiting long-term illness, impairment or significant health problem is

associated with an increased likelihood for disabled adults of being Zewude and Habtegiorgis Life
Sciences, Society and Policy (2021) 17:5 Page 2 of 17 single/unmarried and an increased
likelihood of being divorced or separated: the potential implications of impairment for relationship
status have additionally been shown to be different for men and women at different points in the
life span (Clarke and Mckay 2008).

Women with disabilities are the most vulnerable and marginalized groups in today‘s society.
The disability stereotyping compounded with gender-role dynamics has made women with
disabilities the subject of double discrimination in many different facets of life (Eleni, 2016;
Mostert 2016; Beleza 2003). Family prejudices reinforce the idea that girls with disabilities have
neither sexual identity nor a right to find a partner. The fact that women with disabilities do not
match the physical model promoted in the media inhibits recognition of their right to sexuality.
Many men may find a sexual relationship with a woman with disabilities a difficult concept. This
may be through ignorance or belief that it is taboo. Having a family of one’s own and having one’s
entitlement to parenthood recognized can be the hardest things for a woman with a disability to
achieve in comparison with a woman who is not disabled and even with a man with a disability
(Council of Europe 2003). Women with disability in Ethiopia are vulnerable to discrimination,
rape, beating, verbal abuse, and physical neglect (Berhanu, 2015; Spratt 2017).

Across the world, people with disabilities face attitudinal barriers including prejudice, stereotypes,
and low expectations (Division for Social Policy and Development, 2016).

Communities may believe that people with disabilities lack the necessary qualities to make
successful marriage partners, and beliefs around disability being related to bad family spirits can
lead to concerns that they will bring evil or misfortune with them if they marry into the family
(Aley 2016). According to Haage (2017), the marital chances of people with disabilities are
significantly smaller compared to their non-disabled counterparts. Many nondisabled people may
doubt that people with disabilities can be fulfilling partners in any loving adult relationship
(Wasserman et al. 2016a, 2016b). In spite of this, Abed et al. (2015) found no significant
difference between handicapped and non-handicapped couples in compatibility and marital
satisfaction. In Ethiopia, the state of persons with disability in social situation can be explained by
the nature of prevailing understanding of disability, in terms of the conceptualization of its causes,
nature and consequences. As a matter of course, the birth of a child with disability has been
recorded as source of shame, disagreement as well as divorce among some families.

There is a general tendency to think of person with disability as weak, hopeless, dependent
and unable to learn and the subject of charity (Eleni, 2016). In Ethiopia, people with disabilities
often are not participants in society because of the overall belief that disabilities are a result of a
curse and/or are punishments from a deity (Mesfin, 1999). Because of their inability to perform
physical labor, individuals with disabilities are viewed as burdens to their immediate families for
not being able to contribute to the family’s income (Almaz, 2011). In some parts of Ethiopia, large
numbers of people also believe that disability is the result of contact with evil spirits or evil eye.
The family of the leper person is also called a cursed family and no one of “able bodied” had
interest to have marriage relationship with a family with a leper person (Beide, 2018).

A previously undertaken study by Miller et al. (2009) in Texas, America, indicated that
students were significantly more willing to have friendships and acquaintanceships with persons
with mild to moderate disabilities and persons with sensory, health, and physical impairments.
Students were least willing to marry or have a partnership with Persons with Disabilities,
especially if the Persons with Disabilities had cognitive and psychiatric impairments. The finding
was based on data collected from young Hispanic women preparing to work in humanities
professions such as social work and rehabilitation counseling. It implies that the willingness of
men to engage in personal relationships with disabled women was ignored in the study under
consideration. Above all, the absence of adequate published empirical literature on the subject
among other societies also made our knowledge very limited.

Understanding and recognizing that persons with disabilities are still exposed to and
oppressed by prejudice and discrimination may be the first step in reducing prejudice (Marks
1997). Besides the fact that there are only few previously published studies in Ethiopia regarding
the attitude of people living without disabilities towards those living with disabilities, most of the
already available ones are institutional (e.g. Almaz, 2011; Eleni, 2016). In addition, other than
revealing about the widely held stereotypes and negative attitudes towards persons living with
disabilities, previous studies were not able to address the specific question about the willingness of
persons without disabilities to engage in courtships with persons with disabilities. The purpose of
the present research was, therefore, to assess the willingness of non-disabled youth to date and
marry persons with disabilities in WolaitaSodo town.

Functioning, Disability and Health model (ICF) developed by the WHO, in order to gain a
better understanding of disability (Figure 2). The ICF model is a compromise between the medical
model and the social model and is promoted as the bio-psycho-social model (WHO, 2011). The
ICF model describes an individual’s functioning and disability as a complex and dynamic
interaction with personal and environmental factors (Ploeg, Beek, Woude and Mechelen, 2004).
This holistic approach fits the perception of disability used in this study. Besides this, the
ICFmodel is a tool to understand human functioning and disability for research and policy
development (Üstün, Chatterji, Bickenbach, Kostanjsek and Schneider, 2003).

In the community context

The evidence makes it clear that these inequalities are a result of barriers, rather than
any inherent limitations of people with disabilities (Heymann et al., 2014; Groce et al., 2011;
Morgon Banks & Polack, 2014; Groce & Kett, 2014; Groce & Bakhshi, 2011; Bruijn et al., 2012;
WHO & World Bank, 2011). Barriers to disability inclusion include: attitudinal barriers;
environmental barriers; institutional barriers; ‘internalized’ barriers; lack of participation;
inadequate data, statistics and evidence on what works, and inaccurate concerns over
cost/difficulty of disability inclusion. Attitudinal barriers are one of the greatest obstacles to
achieving equality of opportunity and social integration (Wapling & Downie, 2012; UNICEF,
2013; Heymann et al., 2014; Bruijn et al., 2012). The lack of rigorous and comparable data,
combined with lack of evidence on program that work, often impedes understanding and action on
disability inclusion (WHO & World Bank, 2011).

Some evidence and estimates indicate that disability inclusion could lead to increased
earnings and labor productivity; increased tax revenues; improved individual and family well-
being; and wider societal benefits through a more inclusive and accessible society for all
(Lamicchane, 2015; Morgon Banks & Polack, 2014; Heyman et al., 2014; Grider & Wydick, 2015;
WRC, 2015; WHO & World Bank, 2011).

Organizational change is needed for the successful inclusion of people with disabilities in
development/humanitarian projects (Bruijn et al., 2012; Wapling & Downie, 2011; Coe &
Wapling, 2010). This means the way of organizational relationship with persons with disabilities
should be contextual.

The medical (or biomedical) model of disability considers ‘disability a problem of the
individual that is directly caused by a disease, an injury, or some other health condition and
requires medical care in the form of treatment and rehabilitation’ (Mitra, 2006, p. 237). It assumes
that addressing the medical ailment will solve the ‘problem’ ‒ that disability needs to be fixed or
cured (Al Ju’beh, 2015, p. 20). This model is widely criticised on different grounds, including for
not considering the important roles of environmental and social barriers (Mitra, 2006, p. 237; 82;
Rimmerman, 2013, p. 27).

Medical and charity models of disability have led to ‘development interventions based
largely on impairment needs assessed by “expert” personnel, involving specialist services that are
often severely limited in geographical, age, and impairment reach, as well as generally being
expensive to run’ (Coe, 2012, p. 402).

The social model of disability developed as a reaction to the individualistic approaches of

the charitable and medical models (Al Ju’beh, 2015, p. 20; Rimmerman, 2013, p. 28). It is human
rights driven and socially constructed (Woodburn, 2013, p. 85). It sees disability as created by the
social environment, which excludes people with impairments from full participation in society as a
result of attitudinal, environmental and institutional barriers (Mitra, 2006, p. 237). It places
emphasis on society adapting to include people with disabilities by changing attitudes, practice and
policies to remove barriers to participation, but also acknowledges the role of medical
professionals (DFID, 2000, p. 8; Al Ju’beh, 2015, pp. 20-21, 83).

The social model has been criticized for ignoring the personal impact of disability and for its
emphasis on individual empowerment, which may be contrary to more collective social customs
and practices in many developing countries (Al Ju’beh, 2015, p. 83-86; Rimmerman, 2013, p. 30).

This model of disability is based on the social model and also seeks to transform unjust
systems and practices. It takes the UNCRPD as its main reference point and sees people with
disabilities as the ‘central actors in their own lives as decision makers, citizens and rights holders’
(Al Ju’beh, 2015).

The social and human rights models form the basis of many disability policies and
practices (Kett & Twigg, 2007, p. 88). As development professionals may identify with the
individual models of disability, it is important not to alienate them when introducing them to
disability as a human rights issue, but to ‘help [them] to see that barriers are a more helpful and
respectful lens with which to view disability’ (Al Ju’beh, 2015, p. 23).

Interactional models recognize that disability should be seen as neither purely medical nor
purely social, as people with disabilities can experience problems arising from the interaction of
their health condition with the environment (WHO & World Bank, 2011, p. 4).

The most commonly used interactional model is the model underlying the International
Classification of Functioning, Disability and Health (ICF) (WHO & World Bank, 2011, p. 5). This
views disability as arising from the negative interaction between health conditions and the context
– including environmental. Factors (products and technology; the natural and built environment;
support and relationships; attitudes; services, systems, and policies) and personal factors (e.g. age,
sex, motivation and self-esteem) (WHO & World Bank, 2011, p. 5).

Disability inclusive development ‘seeks to ensure the full participation of people with
disabilities as empowered self-advocates in development processes and emergency responses and
works to address the barriers which hinder their access and participation’ (Al Ju’beh, 2015, p. 49).

The overall pattern of impact of empowering community responses to disability issues, as

modeled by all five articles in this volume, is as follows: (1) people with disabilities having a
voice; (2) people with expertise in generating resources assisting that voice; (1+2) creating action
that makes an empowering difference in the lives of the original group of people.

5. The risk factor related to environmental and attitudinal barriers of persons with
impairment.

A. Risks and disadvantages faced by persons with disabilities and their families

1. Poverty and disadvantage

There is broad evidence that persons with disabilities are more likely to live in poverty than those
without (Banks and Polack, 2014; WHO and World Bank, 2011). A disability affects not only the person
who suffers from it but has an impact on all members of a household. According to Mitra, Posarac and Vick
(2013), households where a member has a disability were significantly more likely to be classified as living
in poverty in most of the developing countries studied (11 out of 15 countries) in the period from 2002 to
2004.

Poverty and disability reinforce one another. Poor health and nutrition, poor living conditions, poor
access to health services, environmental risks and injuries among persons living in poverty can lead to
disability. Equally, the onset of disability can have an adverse effect on education, employment and
earnings, increase living costs and result in higher rates of poverty (Groce and others, 2011; Mitra, Posarac
and Vick, 2013; WHO and World Bank, 2011; Yeo and Moore, 2003).
 Without accounting for disability-related costs, however, conventional poverty measures probably
underestimate the number of persons with disabilities living in poverty. Extra financial costs due to a
disability include those related to contracting and purchasing support services, assistive devices, residential
modifications and specialized health care. In China, for example, it is estimated that disability-related costs
represent between 8 per cent and 43 per cent of the income of adults with disabilities, and between 18
per cent and 31 per cent of the income of families with children with disabilities (Loyalka and others,
2014).

High levels of poverty go hand-in-hand with lower levels of education, poorer health and worse
employment prospects. Persons with disabilities are less likely to be employed full-time and more likely to
be unemployed (United Nations, 2016a and 2015c; ILO, 2014a). The most recent available census data
averaged over 27 developing and developed countries indicates that the labor force participation rate of
persons with disabilities is about 20 percentage points lower than that of persons without (United Nations,
2016a). Similarly, the average unemployment rate for persons with disabilities in OECD countries was 56
per cent in the period from 2000 to 2013, compared with 25 per cent for persons without disabilities
(OECD, 2013.

Demographic risk factor

a) Gender
A total of eight studies examined gender as an influential factor [10, 19, 20, 28–32]. Among them,
significant differences were found in attitude between men and women in six studies [10, 19, 20,
28, 29, 31], while two other studies reported that there is no relationship between gender and
attitudes toward people with disabilities [30, 32]. Particularly, within these six studies, five studies
found that males view persons with disabilities more negatively than females [19, 20, 28, 29, 31].
However, Morin et al [10] indicated that man could have more negative attitudes than women
regarding the discomfort index, whereas women had more negative attitudes regarding the
knowledge of capacity and rights index than men. This may also demonstrate that scores of female
tend to be more positive on behavior rather than cognition
b) Age
A total of 11 studies [10, 14, 19–23, 29, 31–33] examined the association between age and public
attitudes with nine of them [10, 14, 20–23, 29, 31, 32] reporting significant differences between
younger and older people in the score of the attitudes. Nevertheless, disparity exists in these studies,
among which four studies [21, 23, 29, 32] found that older people hold more positive attitudes than
younger people toward the disabled, whereas the remaining five others [10, 14, 20, 22, 31] reported
the opposite results.

c) Education
While two studies [19, 32] suggested a lack of evidence of an association between education level
and their attitudes, three others [10, 20, 33] found that lower education level appeared to be
associated with negative attitude towards disabled people.

d) Job and income factors

Two studies [30, 41] reported the impact of different professions on attitudes toward disabilities.
One study [41] suggested that music teachers are less likely to respond favorably to children with
 emotional and behavioral disorders, while physical education teachers often perceive children with
orthopedic defects less favorably. The other study 30 revealed that X-ray technicians have less
positive attitudes toward the people with disability than occupational therapists, nurses, family,
doctors and physical therapists. However, few study estimated the influence of income level to the
attitudes toward the disabled. It seems that personal income level has no relationship with attitudes
toward people with disabilities 10.

Exposure to the disabled

a) Contact to the disable
Eleven studies investigated the relationship between attitude provider’s personal contact with
the disabled people and attitude scores. Although these studies produced mixed results, the
most consistent finding was a positive relationship between attitudes and more contacts with
persons with disabilities.
b) Familiarity of the disabled
Many studies found that ever contact with persons with disabilities through that knowledge
about the policy act family, friends, social life, or elsewhere, does have a significant impact on
their attitudes. Five studies [20, 24, 25, 29, 40] reported that contacting with a disabled family
members, schoolmates, friends or colleagues was significantly associated with more favorable
attitudes. Yet, two other studies [22, 33] found no relationship between these variables.
Another study [23] surprisingly found that this association existed in the attitudes towards
physical disabilities but was not apparent towards intellectually disabled persons.

c) Knowledge about the disabled

People’s knowledge about the disabled was also investigated in several studies. Three of them
reported that people who have higher knowledge level would have better attitude toward
people with disabilities [22, 28] and minimize negative attitudes [26], however, one study [37]
found no relationship between attitudes and their knowledge of the policy act regarding
disabled people.

Personality and cognitive factors

Only one study [29] investigated personal self-esteem’s impact on their attitudes. Regarding behavior and
positive affection, the study reported that the higher the selfesteem status, the more positive their attitude
was toward peers with hearing and visual impairments, but this was not the case for paralyzed and
intellectually disabled peers; however, for cognition and negative affect items, self-esteem affected attitudes
toward all the disabled peer groups, except the paralyzed peers.

Factors related to the disabled people

Relationships between the variables related to the disabled and public’s attitudes toward them across eight
studies are demonstrated

Severity of the disability

Two studies [10, 18] estimated the extent to which the severity of disability on public attitude, which
reported a significant negative correlation between the level of severity and attitudes toward them.

Type of disability

There are six [29, 30, 34, 38, 41, 42] studies examined type of disability as an influential factor of attitudes.
Specifically, one research [29] found that regarding the behavioral and positive affective aspects of
attitudes, respondents have more positive attitudes toward the deaf, paralyzed, and blind than intellectually
disabled people. In the same study, regarding the cognitive and negative affective aspects of attitudes, both
the paralyzed and the intellectually disabled were regarded with a less positive attitude than the blind and
deaf. The other study [30] demonstrated that healthcare professionals showed lesser positive attitudes
toward disabled people caused by illness than by injury, but these attitude differences usually do not show
up during social contacts. Furthermore, there was greater public acceptance of people with physical
disabilities, compared to those with mood disorders and mental retardation [34]. When it comes to children
particularly, evidence shows that children depicted with facial anomalies received lower preference,
compared with other visible physical disabilities [42].

Gender

One study [30] found that attitudes toward female patients were more positive than those toward male
patients, although this result may not be consistent when responders are students.

Factors related to society

Only one study [27] reported relationships between media and public’s attitudes toward the disabled, which
showed that when controlling for gender, and contact, people who viewed the humorous media had
significantly more positive attitudes to the disabled than people who did not view it.

The findings from this review also indicated that gender was linked to attitudes, with men have a more
negative attitude toward the person with disability than women [10, 19, 20, 28, 29, 31]. This is likely due to
the nature of women’s work. To specify, with comparison to men, women are more likely to choose human
service professions and therefore have more opportunities in contacting with person with disabilities, which
could lead to more positive attitudes toward the disabled. Besides, maternal feelings and cultural differences
in the society may account for the higher attitude scores [28]. Of note, it seems that gender only influences
certain components of attitudes toward the person with disability. For instance, DeLaat et al. [29] found that
females had more negative attitudes on the cognition and negative affection, but not on behavior and
positive affection. The authors supposed the reason under this may be that girls act more aggressively
regardless of their beliefs and knowledge, while boys tend to act more in line with their beliefs [29]. This
difference between male and female therapists or professionals could have implications for healthcare
outcomes as well as attitudes towards the disabled and the decision to work with them.

Among all discussed factors, the finding concerning the relationship between “contact to the disabled” and
the attitudes is the most-frequently discussed one. The manifestation of contact include the time length,
frequency and the quality of contact with disabled people, or having friends, family members and
colleagues who are disabled (“Familiarity”). The majority of studies [10, 19, 21, 23, 24, 28, 29, 34–40] have
found that contacting with people with disabilities could lead to more positive attitudes towards them. This
finding may because more contact could help to reduce fear and anxiety, and create a more balanced and
realistic perspective about people with disability regarding to their functional capacity and ability [10, 20,
21]. Evidence shows that people who come into contact with the disabled would consider themselves more
valuable in the social life and thus would be less likely to approach the disabled with rejection [28].
However, it is worth noting that without controlling demographics variables and the quality of the contact,
the attitude toward disabled people would be negative. To illustrate, when the contact quality is not
specifically considered, greater exposure may unexpectedly lead to uncomfortable or unpleasant feelings,
and people may associate these bad experiences with the disabled people themselves [36]. Thus, it is
important to consider the quality and quantity of the contact together rather than mere quantity alone in
order to promote the attitudes. Although there are few studies [22, 33] found no significant difference
between attitude and contact, the reasons under that is explainable (i.e., the lack of planned relationships
between students and disabled. people, or the low frequency of such relationships). Therefore, we believe
that under certain contact conditions, advance knowledge about the disability may be necessary in order to
improve the attitude towards disability. The reduction of anxiety between groups and the creation of an
environment that could not only reduces prejudice, but also promote positive interactions in a more
enjoyable way, suggest a continuous cycle of benefits.

We found that almost all of the studies indicated a positive relationship between the education level and
attitudes. People with higher levels of education might be more liberal, open, and understanding of people
with disabilities and the related issues, which would let them have a better attitude towards people with
disabilities [43]. This tends to support the consideration that active interactive education could consider as a
means to enhance public awareness and acceptance of people with disabilities [44]. Therefore, cooperation
with disabled people can become an important part of education for the public in the future. More
importantly, developing and implementing disability-specific and high quality education curricula as a part
of healthcare providers’ professional program to enhance their attitude towards the disabled needs to be
considered by the decision-makers. Our results showed a lack of consistency on some factors. To illustrate,
the findings regarding the relationship between the age of the respondent and their attitudes are not
consistent. Some studies suggested that younger people hold more negative attitudes toward person with
disabilities than those of the older [20, 21, 23, 29, 32], while opposite findings were also reported in several
other studies [10, 14, 22, 31]. This may because the participants’ characteristics of each study [20, 29] are
not homogeneous, and more likely, the results were not controlled by other potential explanatory factors,
e.g., knowledge about the disabled, or the contact with them [21]. For example, some health professionals
were offered a series of programs which aims to eliminate stereotypes about disabled people, then their
previous experience in dealing with the disabled and their views on the disabled may explain the difference
in their attitudes compared others who weren’t trained [22, 31]. Previous researches have concluded that
knowledgeable about people with disabilities and related issues could lead people to have more favorable
attitudes toward the disabled [43]. The knowledge of the disabled might also inform selection to the medical
profession, or specific training programs within healthcare medicine. Therefore, these results could provide
an insight that we should pay more attention to the education of young people about issues related to
disabilities, and increase the duration of their contact with the disabled people appropriately as well. Thus,
in designing future evaluations, researchers should bear in mind that studies that random assignment of
participants to groups can provide reliable evidence about the effects of age.
With regard to other potential factors (such as religion, income and humorous media), religion and income
were found to have no effect on people’s attitudes towards disabled people, while humorous media have a
positive impact. Evidence suggest that humor may have a normalizing effect during an abnormal situation
[45], and its impact on reducing anxiety have been well documented in many fields in several studies [46–
48]. Another possible explanation could be that humorous introductions provide a non-threatening and
anxietyreducing means of incorporating constructive images of disability into mainstream culture to
communicate information about disability [49]. Thus, it is recommended to use a comprehensive humorous
approach to provide information on persons with disabilities, which could become an effective way to
change negative attitude[50].

In additional to the factors discussed above, it is found that public attitude is also dependent upon the
individual factor of the disabled, e.g., type of disability. Several studies [29, 34, 38] found that, among all
the disability types, attitudes toward persons with intellectually/mentally disabled are less positive than
those with other types. On the other hand, people tend to have less positive attitude toward the individuals
with more visible physical impairment [39, 42]. A possible reason behind this finding is based on the idea
that persons with intellectually disability could exhibit unpredictable behavior and therefore pose a threat
[10, 29]. Moreover, people tend to have less positive attitude toward the individuals with more visible
physical impairment [42]. To specify, public always hold less negative attitudes to the blind and deaf
compared to the paralyzed and the intellectually disabled [29], which maybe because a paralysis and
intellectual disability are more visible than deafness and blindness, and people with facial anomalies would
be less favorably perceived compared to those with other physical disabilities.

. Factors associated with the perception of environmental barriers outside the home environment by
individuals with permanent disabilities

Variable Odds ratio 95%CI p

Sex (reference: male)

Female 1.45 1.2–1.8 < 0.001
Age (reference: 18 to 59 years old)
≥ 60 1.11 0.9–1.4 0.43
Place of residence (reference: rural)
Urban 1.68 1.3–2.2 < 0.001
Education (reference: < 10 years)
≥ 10 years 1.17 0.9–1.6 0.34
Speaks an indigenous language (reference: no)
Yes 1.82 1.2–2.8 < 0.05
Self-perceived state of health (reference: very good or good)
Average 0.78 0.6–1.0 < 0.05
Poor or very poor 1.43 0.9–2.2 0.09
Emotional symptoms (reference: absent)
Present 1.61 1.3–2.0 < 0.001
Self-reported primary disability (reference: attention or learning)
Walking or mobility 4.33 2.3–8.1 < 0.001
Visual 2.82 1.5–5.3 < 0.001
Speaking or communication 2.23 1.0–4.9 < 0.05
Hearing 0.19 0.1–0.5 < 0.001
 Self-care 14.39 3.5–58.9 < 0.001
Number of difficulties (reference: 1)
≥2 1.01 0.8–1.3 0.94
Degree of severity of the primary disability (reference: mild)
Moderate 2.39 1.6–3.5 < 0.001
Severe or extreme 4.58 3.2–6.6 < 0.001
Cause of primary disability
(reference: birth)
Illness 2.09 1.4–3.1 < 0.001
Accident 1.08 0.7–1.6 0.69
Old age 1.70 1.1–2.6 < 0.05
Other 1.04 0.7–1.6 0.86
Unknown 0.43 0.2–0.8 < 0.05
Physical devices (reference: does not use
Uses 1.77 1.4–2.3 < 0.001
Assistance and care in the home environment (reference: does not receive)
Receives 1.86 1.4–2.4 < 0.001

6. Description of the intervention

Intervention Component (intervention Examples

category subcategory)
Health Promotion Parent/family training and education, support health
promotion campaigns and health care provider training
Prevention Improvement of the educational, economic and social
status of the least privileged groups; identification of
types of impairment and their causes within defined
geographical areas; introduction of specific intervention
measures through better nutritional practices;
improvement of health services, early detection and
diagnosis; prenatal and postnatal care; proper health care
instruction, including patient and physician education;
family planning; legislation and regulations;
modification of life‐ styles; selective placement services,
education regarding environmental hazards; and the
fostering of better informed and strengthened families
and communities.
Medical care Periodic health screening, evaluation of traumatic
injuries, access to early treatment
Rehabilitation Training in self‐care activities, including mobility,
communication and daily living skills, with special
provisions as needed, for example, for the hearing

Assistive devices
Education Early child development
Non-formal
Primary
Secondary and higher
Life‐long learning
Livelihood Skills development
Self‐employment
Waged employment
Financial services
Social protection
Social Relationship, marriage and Family planning accessible to disabled, media
family
Personal assistance
Culture, religion and arts
Sports, recreation and leisure Provision of adapted sports equipment, organization of
impaired, the visually impaired and the mentally
retarded, vocational rehabilitation services (including
vocational guidance), vocational training, cognitive
behavior therapy, cognitive stimulation, rehabilitation
and training, activity therapy center, supportive therapy,
stress‐management interventions/psychosocial support,
trauma informed therapy, acceptance and commitment
therapy, interpersonal therapy, modification of
environment, trauma informed therapies.
Provision of appliances (orthosthes, prostheses, hearing
aids, etc.), devices such as day calendars with symbol
pictures for people with cognitive impairment,
communication boards and speech synthesizers for
people with speech impairment.
Speech and language therapist, physiotherapy, gait
training, occupational therapy
Inclusive social services and child protection
Community‐based‐sports program, faith‐based schools,
home‐based learning, play groups
Inclusive early childhood education
Provision of learning material and special equipment
(Braille, audio cassettes, sign language, etc.)
Recruitment and training of specialized teachers
Resource rooms and Bypass intervention
Explicit social skills interventions, adult literacy
program, continuing education, life and survival skills
Training opportunities for jobs, home‐based trainings,
vocational training, training in mainstream institutions
and community‐based trainings
Income generation program
Realistic quota legislation in jobs and participation in
labor intensive public works program
Access to credit, health insurance coverage
International legislation like universal declaration of
human rights, Social insurance schemes, birth
registration, social assistance intervention, referral
services
campaigns and religious leaders
Accommodation support, home modifications, self‐help
groups and Disabled People Organizations (DPOs)
Promoting use of art for social change like positive
portrayal, silent theatres, complementary therapy in the
form of art, and music. Inclusive art education, diversity
trainings, encouraging inclusion in mainstream cultural
program, work with spiritual and religious leaders, and
groups
inclusive sports events, linking people with disabilities
to mainstream recreation and sporting

Access to justice
Empowerment Social mobilization
Political participation
Language and communication Speech and language therapy, deaf clubs, stroke clubs,
Self‐help groups and Disabled Creating joint resources like training material,
People’s Organizations
clubs/associations, positive media coverage of disability
recreation, using recreation and sport to raise awareness
about inclusion, advocate alongside disabled people’s
organizations and appropriate training
Legal awareness, identification of available resources
like local leaders, DPO’s, legal centre, legal aid.
Promoting legal rights and empowerment, inheritance
right, community, or legal aid centre
Find about the community Building trust and credibility
within community Raise awareness in the community
Motivate the community to participate Bringing
stakeholder together Capacity building Celebrating
achievements
Reservation of position in public and political institution
Development of political awareness Access to political
process Disability awareness within political system
self‐advocacy, interventions removing communication
barriers
community directories, advocating rights of persons
with disability, partnership with existing self ‐ help
groups

7. Reference

Sisay Belete S. Electoral participation as a fundamental political right of persons with disabilities in
Ethiopia; critical examination of the law and the practice. Master of Laws. Addis Ababa University. 2011.
128 p.

Teferra S., Shibre T., Fekadu A., Medhin G., Wakwoya A., Alem A., Kullgren G., Jacobsson L. « Five year
mortality in a cohort of people with schizophrenia in Ethiopia ». BMC Psychiatry. 2011. 9 p.

Teferra T. Resilience and successes of persons with disabilities in Ethiopia. An article extracted from the
book entitled "Disability in Ethiopia: Issues, Insights and Implications". Addis Ababa: Addis Ababa
Printing Press. 2005. 31.p.

Wazakili M., Wakeni D., Mji G., MacLachlan M. Did What? The African Policy on Disability &
Development (A-PODD) project in Ethiopia. Dublin: A Global Health Press. 2011. 13 p.
Wamocho F.I., Karugu G.K., Nwoye A. « Development of a guidance programme for students with special
educational needs in Kenya: a study on personal orientation ». British Journal of Special Education, 35
(4). 2008. p. 221-229 (Paying access)

Water Engineering and Development Centre. Why the water and sanitation sector in East Africa should
consider disabled people. Loughborough University: WEDC. 2006.

Wee J. « Examining factors impacting community based rehabilitation in a refugee camp – an exploratory
case study ». Asia Pacific Disability Rehabilitation Journal, 21 (2). 2010.

Yijälä, A., Lönnqvist, J., Jasinskaja-Lahti, I., & Verkasalo, M. (2012). Values as predictors of anticipated
socio-cultural adaptation among potential migrants from Russia to Finland. Journal of Community and
Applied Social Psychology, 22 (2), 95–110. doi: 10.1002/casp.1104
Yodanis, C. (2004). Gender inequality, violence against women, and fear: A cross-national test of the
feminist theory of violence against women. Journal of Interpersonal Violence, 19, 655–675.
Yoon, O., & Joo, H. (2005). A contextual analysis of crime rates: The Korean case. Crime, Law and
Social Change, 43, 31–55.
Multisystemic treatment of serious juvenile offenders: Long-term prevention of criminality and violence.
Journal of Consulting and Clinical Psychology, 63, 569-578. Browne, A. (1993).
Violence against women by male partners: Prevalence, outcomes, and policy implications. American
Psychologist, 48, 1077-1087. Corvo, K. N. (1997).
Community-based youth violence prevention: A framework for planners and funders. Youth & Society,
28, 291-316. Crowell, N. A., & Burgess, A. W. (Eds.). (1996).

Understanding violence against women. Washington, D.C.: National Academy Press. De Vos, E., Stone, D.
A., Goetz, M. A., & Dahlberg, L. L. (1996).

Evaluation of a hospital-based youth violence intervention. American Journal of Preventive Medicine, 12,
101-108.

Earls, F., Cairns, R. B., & Mercy, J. A. (1993). The control of violence and the promotion of nonviolence in
adolescents. In S. G. Millstein, A. C. Petersen, & E. O. Nightingale (Eds.), Promoting the health of
adolescents: New directions for the 21st century (pp. 285-304).

New York: Oxford University Press. Eron, L. D., Gentry, J. H., & Schlegel, P. (Eds.). (1994).

Reason to hope: A psychosocial perspective on violence and youth. Washington, D.C.: American
Psychological Association. Fox, J. A. (1996).
Trends in juvenile violence: A report to the United States Attorney General on current and future rates of
juvenile offending. Washington, D.C.: U.S. Department of Justice, Bureau of Justice Statistics. Gordon, J. S.
(1996). Community services for abused women: A review of perceived usefulness and efficacy. Journal of
Family Violence, 11, 315-329.

Gottfredson, M. R., & Hirschi, T. (1995). National crime control policies. Society, 32, 30-36. Grossman, D. C.,
Neckerman, H. J., Koepsell, T. D., Liu, P. Y., Asher, K. N., Beland, K., Frey, K., & Rivara, F. P. (1997).

Effectiveness of a violence prevention curriculum among children in elementary school. Journal of the
American Medical Association, 277, 1605-1611.

Guerra, N. G., Attar, B., & Weissberg, R. P. (1997). Prevention of aggression and violence among inner-city
YOllthS. In D. M. Stoff & J. Breiling (Eds.), Handbook of antisocial behavior (pp. 375-383).

New York: Wiley. Hammond, R., & Yung, B. (1993). Evaluation and activity report: Positive adolescents
choices training grant. Unpublished grant report, U.S. Maternal and Child Health Bureau. Hawkins, D.
(1995). Controlling crime before it happens: Risk focused prevention. National Institute of Justice Journal,
August, 10-18.

Hawkins, J. D., & Catalano, R. F. (1992). Communities that care: Action for drug abuse prevention. San
Francisco: Jossey-Bass. Henggeler, S. w., Cunningham, P. B., Pickrel, S. G., Schoenwald, S. K., & Brondino,
M. 1. (1996). Multisystemic therapy: An effective violence prevention approach for serious juvenile
offenders. Journal of Adolescence, 19, 47-61.

Henggeler, S. w., Melton, G. B., & Smith, L. A. (1992). Family preservation using multisystemic therapy: An
effective alternative to incarcerating serious juvenile offenders. Journal of Consulting and Clinical
Psychology, 60, 953-961.

LeBoeuf, D. (1996). Curfew: An answer to juvenile delinquency and victimization? Washington, D.C.: U.S.
Department of Justice, Office of Juvenile Justice and Delinquency Prevention. Levine, I. S., & Zimmerman, J.
D. (1996).

Using qualitative data to inform public policy: Evaluating "Choose to DeFuse." American Journal of
Orthopsychiatry, 66, 363-377. Limber, S., & Nation, M. (1998).

Violence within the neighborhood and community. In P. Trickett & C. Schellenbach (Eds.), Violence against
children in the family and the community (pp. 171-193).

Washington, D.C.: American Psychological Association. Loeber, R., & Hay, D. (1997).

Key issues in the development of aggression and violence from childhood to early adulthood. Annual
Review of Psychology, 48, 371-410.

Lonsway, K. A. (1996). Preventing acquaintance rape through education: What do we know? Psychology of
Women Quarterly, 20, 229-265.
 Mattaini, M. A., Twyman, J. S., Chin, w., & Nam Lee, K. (1996). Youth violence. In M. A. Mattaini & B. A.
Thyer (Eds.), Finding solutions to social problems: Behavioral strategies for change (pp. 75-111).

Washington, D.C.: American Psychological Association. McGuire, J. (1997). Psycho-social approaches to the
understanding and reduction of violence in young people. In V. Varma (Ed.), Violence in children and
adolescents (pp. 65-83).

Bristol, PA: Jessica Kingsley. Mulvey, E. P., Arthur, M. W., & Reppucci, N. D. (1993). The prevention and
treatment of juvenile delinquency: A review of the research. Clinical Psychology Review, 13, 133-167.

National Center for Injury Prevention and Control. (1998). Evaluation of specific youth violence
intervention projects. www.cdc.gov/ncipc/dvp/evalyv.htm. O'Donnell, L., Cohen, S., & Hausman, A. (1991).
Evaluation of community-based violence prevention programs. Public Health Reports, 106, 276-277.

Huck, (2004).Elementary Parent involvements, School Culture, and accountability scores.

ILO, (2009): The Economic Consequence of Excluding People with Disabilities from the World of Work,
Geneva.

ILO, (2011): Irish aid Partnership Program: moving towards disability inclusion, International labour
organization Addis Ababa, Ethiopia.

Kalkidan, Shimelis Tiruneh (2015). Social and Economic Challenges of Service Providers to Children with
Intellectual Disabilities: The Case of Mekane-Eyesus Center for Mentally Challenged Children, Addis
Ababa University.

Kassahun,Yibeltal ( 2013). Law and policy situation of persons with disabilities in Ethiopia: Federation of
Ethiopian National Associations of Persons with Disabilities presented at disability and risk management
conference. Addis Ababa, Ethiopia.

Kothari. C. R, (2004). Research Methodology, Method and Technique; New Age International (P) Limited,
Publishers 4835/24, Ansari Road, Daryaganj, New Delhi – 110002.

Mailos, George, and R.D. Michener (1967). An Introduction to Sampling: Dubuque, Iowa: Kendall/ Hunt
publishing Company.

Mwendwa,G. Mwitiki (2010). Performance of the Cerebral Palsy Society of Kenya (Cpsk) In Rehabilitation
of Children with Cerebral Palsy in Kenya, Nairobi.

Pandey Prabhat & Mishra Meenu Pandey (2015). Research Methodology: Tools and Techniques.

Robert Metts & Banque Mondiale (2004).Disability and Development, background paper for the World
Bank.

Swain, J. & French, S. (2000).Towards an affirmation model of disability. Disability and society.

UNICEF (2013).Children and young people with disabilities fact sheet-Unicef; https://www.unicef.org
disabilities fact sheet.
Wondwosen Mitiku, Yitayal Alemu & Semahegn Mengsitu (2014). Challenges and Opportunities to
Implement Inclusive Education: Special Needs Education. Asian Business Consortium/AJHA/. University of
Gondar, Ethiopia.

WHO (2002).Towards a Common Language for Functioning, Disability and Health: The International
Classification of Functioning, Disability and Health (ICF). World Health Organization, Geneva.

World Bank and World Health Organization (2011).World Report on Disability. 36. World Health
Organization (2008).World Report on Disability.

Yamane Taro (1967). Statistics, an Introductory Analysis: 2nd edition; New York: Harper and Row.

Yeshimebet Alemu (2014). Impacts of rehabilitation center on the psycho-social conditions of children with
physical impairment. Unpublished MA thesis Addis Ababa University.

Yetneberish Niguse (2013). General overview of Disability in Ethiopia, ECDD.

Yohannes Teressa (2012). Ensuring the right to equal employment opportunities of persons with
disabilities: Critical examination of the Ethiopian legal framework. Unpublished ,MA thesis Addis Ababa
University.