Abstract
Background: Dyslexia is one of the most common learning disorders among students who might suffer from many problems such as stigma. Some nurses with dyslexia harm their practice, which might affect the patients’ safety.
Aim: This study aims to assess the awareness level of dyslexia and its relation to stigma among nursing students at King Abdulaziz University (KAU).
Methodology: It is a quantitative cross-sectional study using two self-administered questionnaires: the scale of anticipated stigma and Knowledge and Beliefs about Developmental Dyslexia Scale (KBDDS). Data will be collected virtually from nursing students of the Nursing Faculty at KAU using the online google form. Data will be analyzed by conducting frequencies and Chi-square test was used to examine the relationship between the demographic variables and the research variables through the latest Statistical Package for the Social Sciences (SPSS).
Conclusion: The study results will be the first to assess the awareness level of dyslexia and its relation to stigma among nursing students. Hence, findings will enhance the empirical evidence and raise the awareness of dyslexia among nursing students in Saudi Arabia.
Background
Dyslexia is one of the most common learning disorders among students, affecting up to 10% of the global population (Ali, 2020). Dyslexia is a learning difficulty in word-level reading skills that is not due to blindness, deafness, or intellectual disability and occurs despite sufficient effort and opportunity (Grimes, Southgate, Scevak, & Buchanan, 2020). Dyslexia is a lifelong condition; its particular course and clinical expression may vary according to task demands and support provided and the range and severity of the individual’s abilities and difficulties (Handler, 2016). Nevertheless, the practical problems on a child when learning how to read may persist into adolescence and adulthood (López-Escribano, Suro Sánchez, & Leal Carretero, 2018). There are a lot of studies assessing the awareness level of dyslexia among teachers but little among students. For example, according to Ansari et al. (2019), there is a lack of awareness regarding dyslexia among sixteen teachers, and there were only four teachers were conscious of dyslexia disability.
Furthermore, the results from another study revealed that the level of teachers” training and their perception of their ability to manage dyslexia in their classrooms showed that teachers of elementary schools are well aware of dyslexia and most of the teachers were able to identify dyslexic students in their classrooms ( Khaliq, 2017). However, there is no study conducted in Saudi Arabia to assess the awareness level of dyslexia among the students themselves. In Saudi Arabia, about 31.4% of the students have dyslexia in primary schools (Ewaine, 2017). Students with dyslexia might suffer from many problems such as enacted stigma, anticipated stigma, and self-stigma (Grimes, Southgate, Scevak,& Buchanan,2020). Hence, assessing and raising the awareness level of dyslexia among students is of great importance.
Stigma is the impression of being imperfect and, along these lines, socially unsatisfactory given an individual or actual trademark (Stoeber,2021). There are three main types of stigma. Enacted stigma is the degree to which people have faced prejudice in the past (Grimes, Southgate, Scevak, & Buchanan,2020). Anticipated stigma, which will be our focus in this study, refers to the level at which an individual is being stereotyped and negatively discriminated by the public (Grimes, Southgate, Scevak, & Buchanan, 2020). Finally, a self-stigma refers to the individual’s feelings of embarrassment or shame due to their disability (Grimes, Southgate, Scevak, & Buchanan,2020).
Many students do not disclose their learning disability to their peers and teachers due to a lack of awareness about their disability and fear of being treated differently (Grimes, Southgate, Scevak, & Buchanan, 2020). Furthermore, there is a lack of studies that focus on students facing stigma on their learning disabilities, specifically dyslexia (Trunk, 2020). According to Mather, White, & Youman (2020), dyslexia is not fully known in certain countries, and individuals who have dyslexia are stigmatized. Another study conducted on 123 medical students showed that half of the students received negative comments, either in public or private, about people having dyslexia (Hennessy, Shaw, and Anderson, 2020). In addition, the results of a study that was conducted on 12 participants of nurses students to investigate the effect of dyslexia during clinical practice and their coping mechanism showed that the participants have helpful strategies to cope with the impact of dyslexia in clinical practice like memory joggers organizing strategies, documentation strategies, and poster guidelines (Crouch, 2019). According to Major & Tetley (2019), it is essential to promote disclosure about learning disabilities for both students and nurses to achieve patient’s safety. Therefore, awareness of dyslexia might support the early detection of the disability, which will benefit the therapeutic process. Although the literature on dyslexia is comprehensive, dyslexia is little recognized at the individual, family, and societal level (Livingston, 2018). Therefore, it is evident that there is a need to explore the awareness of dyslexia among nursing students and its relationship to stigma.
Statement of the problem
Dyslexia is a sensitive and prevalent learning disability affecting nursing students (Ali,2019). Dyslexia stresses the students and requires more time and effort to keep pace with lectures and in-class activities. Furthermore, there is a lack of awareness about the signs of dyslexia among teaching staff and the students themselves (Ali, 2019). On the other hand, students diagnosed with dyslexia fear to disclose their disability because of the possibility of being stigmatized by their colleagues (Ali,2019). There’s a gap in the literature exploring the awareness of dyslexia among nursing students and the possible stigma faced by nursing students diagnosed with dyslexia. Hence, it is worth exploring the awareness level of dyslexia and its relationship to stigma to enhance the empirical evidence and raise the awareness of dyslexia among nursing students in Saudi Arabia.
Study Aim
This study aims to assess the awareness level of dyslexia and its relation to stigma among nursing students at King Abdulaziz University (KAU)
Research Questions
- What is the awareness level of dyslexia among nursing students at KAU?
- What is the relationship between dyslexia awareness and anticipated stigma?
Method
Research Design
The proposed study has an exploratory nature, and since there is not much known about the topic yet, a quantitative descriptive, correlational, cross-sectional design will be implemented. This design will aid in assessing the awareness level of dyslexia and its relation to stigma among nursing students at KAU. The descriptive study attempts to define a population, condition, or phenomenon accurately and systematically (Polit & Beck, 2018). A correlation design is used to investigate the interrelationships between variables of interest without involvement or implementation by a researcher (Polit & Beck, 2018). Moreover, the cross-sectional design used to collect information at one stage and often used to infer shift over time as data is collected from multiple age or developmental groups (Polit & Beck, 2018). Thus, the purpose of choosing this research design is to assess the awareness level of dyslexia and to explore the relationship between stigma and dyslexia among nursing students at KAU.
Study setting
This research study is affiliated with the Faculty of Nursing Jeddah, KAU, Saudi Arabia. Data will be collected virtually from nursing students of the Nursing Faculty at KAU using the google forms online tool.
Sampling and sample size
Participants will be nursing students recruited from the Nursing Faculty at KAU. Inclusion criteria will be (a) male and female nursing students from any level, (b) master’s degree nursing students, and (c) able to speak and read English. Because of the limited time in conducting this study, exclusion criteria will be nursing students (a) not from king Abdulaziz University and (b) unable to speak and read English.
The relationship between dyslexia and stigma has not been studied; hence, the relevant published effect size is not available. Therefore, the estimation for medium effect size was considered. According to Cohen (1992), the estimated medium effect size is.30 for correlations with two-tailed tests at a.05 level of significance and power of.80. Given the effect size of 0.3 and a power of 0.8, the required sample size for correlation is 84, calculated by G*Power 3.1.
Tool
Data on demographics will be collected, which include the age of nursing students, gender, the level of education (baccalaureate or master’s), level of education in the nursing program (second, third, or fourth year nursing students), marital status, and two questions, which are: have you ever been diagnosed with dyslexia, and do you know anyone with dyslexia (Appendix A). Moreover, two instruments will be utilized in this study.
The first instrument is a scale of Knowledge and Beliefs about Developmental Dyslexia Scale (KBDDS) developed by Ferrer and Bengoa (2014) Appendix B. The KBDDS measures knowledge and misconceptions about dyslexia in three specific areas: general information about the nature, causes, and outcome of dyslexia; symptoms/diagnosis of dyslexia; and the treatment of dyslexia (Ferrer, & Bengoa, 2014). The instrument consists of a 36-item scale to assess the awareness level of dyslexia rated on a 3-points Likert scale, which is 1=” true,” 2= “false”, and 0= “don’t know” (Ferrer, & Bengoa, 2014). This rating will make it possible to differentiate between what students do not know and their incorrect beliefs. The instrument’s items were reviewed by 89 teachers and established the instrument’s content validity (Ferrer & Bengoa, 2014). Furthermore, the scale had.76 internal consistency using Cronbach’s alpha achieved sufficient reliability (Ferrer & Bengoa, 2014).
The researchers develop the second instrument to assess anticipated stigma related to dyslexia. The instrument’s items were derived from the Consciousness Questionnaire-Learning Disabilities (SCQ-LD) that is valid and reliable (Daley, & Rappolt-Schlichtmann, 2018). The measure demonstrates stability across time, with test-retest reliability of =.76 Cronbach’s alpha (Daley, & Rappolt-Schlichtmann, 2018). External validity is demonstrated through a strong positive correlation with overall self-consciousness and a negative correlation with measures of self-concept or self-perception (Daley & Rappolt-Schlichtmann, 2018). Because the SCQ-LD was developed to assess the individual experiences of stigma consciousness, a determination of the used questions in the current study was made of which items comprised the anticipated stigma. There are 5-item/questions developed, which are: people treat individuals with dyslexia. Differently, people have negative views about individuals with dyslexia; people judge individuals with dyslexia, make negative assumptions about individuals with dyslexia and think there is something wrong with individuals with dyslexia. the items/questions will be rated on a 3-points likert scale, which are 1=“true”, 2=“false”, and 0=“don’t know ”. The higher mean indicates greater levels of anticipated stigma. (Appendix C)
Data collection procedure
There are several methods of collecting primary data; one of them is using a questionnaire, which is the one that was used in this study. The participants will be approached online using social media, including (WhatsApp, Facebook, Twitter). The questionnaire will be distributed using an online google forms tool. The questionnaire will be composed of demographics, the scale of anticipated stigma, and the KBDDS scale.
Ethical considerations
The study’s ethical approval will be obtained from the ethics and research committee from the Faculty of Nursing Jeddah, King Abdulaziz University, Saudi Arabia. Study enrollment will be voluntary, and data collection will be completely anonymous, as participants’ identities will not be requested. Detailed information about the study will be included on the first page of the online survey tool. Hence, before the participant starts filling the survey, he/she will have the chance to read the information provided and decide whether interested or not to be enrolled in the study. The informed consent will then be implied by the participants completing and submitting the survey.
Data analysis
Statistical Package (IBM SPSS Statistics 25) software was used for data entry and analysis. Cronbach’s Alpha test was used to check for the reliability and internal consistency of the study variables. The Cronbach Alpha scores for KBDDS with 36 variables was (0.73) and 0.77 for SCQ-LD with 5 variables.
Results
There were 154 participants enrolled in the study, 92.2% of them female and 7.8% were male. Most participants (66.9) were from the age group of 18 to 21 and 88.3% of them were single. The highest percentage (44.2%) of the participants enrolled was 4th year nursing students, while the lowest (10.4%) was master’s students. Tables 1 summarize the demographics and the characteristics of the study participants.
Table 1
About 150 out of 154 participants (97.4%) noted that they have never been diagnosed with dyslexia, and 123 participants (79.9%) indicated not knowing any family members, friends, colleagues, community staff, or anyone in general suffering from dyslexia.
KBDDS analysis
Overall, the number of correctly responded statements whither “false” or “true” was 18 (50%) out of 36, which was acknowledged by the percentages of the participants’ response being more than 50%. However, (50%) of the other statements were new to the participants as they got the response of “do not know” by most of the participants.
Nearly (58.8%) understand that dyslexia is a neurological disorder but do not know the root cause, as indicated by the (45.5%) response provided. About 63.3% of the participants noted that children with dyslexia suffer from mental and social disabilities but are equally gifted and successful. The participants’ attitude toward whether there is a brain difference between ordinary people and those with dyslexia was ranging between was ranging between false (31%), do not know (38%), and true (30%). Similarly, there was an equal attitude of true and do not know (26%) toward if dyslexia is hereditary higher number, whereas, (47%) stated not knowing. However, 61.7% participants acknowledge that dyslexia is a neurological condition in society, while 13.6% of the participants believe it is a mythical belief. Roughly 34.4% of the participants believed that the condition is most prevalent in males than females, while 54.8% indicated that they do not know the most affected gender.
Almost 46% of the participants believed that “seeing letters and words backwards is a basic characteristic of dyslexia” is true, while only 10% stated the statement is false and 44% did not know. There were 51.3%, 53.2%, and 50.6% of participants do not know whether colored lenses, medication, and the use of multisensory instructions, respectively, are suitable for people with dyslexia. However, (49.4%) acknowledged that the use of a modeled reading strategy as an effective method. Around 23.4% of participants disagree that people with a reading disability should be classified as dyslexic, while 59.1% of the 154 participants who agreed with the statement. Approximately 63% of the 154 participants supported that it is essential to apply a reading test to fully diagnose the disorders. The majority of the 154 participants noted that people with dyslexia have low self-esteem (59.7%) and have a problem in spelling and decoding words correctly, as indicated by 54.5% and 60.4% of participants (Table 2)
Table 2
SCQ-LD analysis
Nearly 70% of the participants believed that people have negative assumption about individuals with dyslexia, judge and treat them differently. (Table 3)
Table 3
KBDDS and SCQ-LD association
The Chi-square test was used and reveled P-value < 0.001, therefore, we reject the null hypothesis and accept the alternative, which is there is a difference regarding the knowledge level between Dyslexia scale and Stigma scale, as explained by Table 4 and the following figure.
Table 4
Discussion
Dyslexia is a learning disorder which is common among the general population, and nursing students, as well as practicing doctors, also experience its symptoms. The current explored the level of awareness among nursing students at King Abdulaziz University (KAU) about dyslexia and its association with stigma. The level of awareness was analyzed with the help of the Knowledge and Beliefs about Developmental Dyslexia Scale. In general. The respondents demonstrated a moderate level of awareness of dyslexia, with only 50% correct answers on average. The result is similar to the findings of studies conducted among other groups such as teachers (Echegaray-Bengoa, Soriano-Ferrer, & Joshi, 2017; Soriano-Ferrer, Echegaray-Bengoa, & Joshi, 2016). Such evidence demonstrates the fact that there are still problems with dyslexia awareness in many countries.
It is important to highlight the main misconceptions which students had about the disorder. One of them concerned a belief held by the majority of the students that dyslexia entailed perception of letters and words as reversed, which is incorrect. Yet, such misunderstanding of the issue is common and has been demonstrated by participants in other studies (Washburn et al., 2017; Wery & Diliberto, 2017). More than forty percent of the students did not know that dyslexia was a hereditary disorder, while 26% provided the wrong answer. It should be noted that such misconception has been demonstrated to be more prevalent in other research, such as one involving preschool teachers, where 54% of the respondents were incorrect (Ramli et al., 2019). The majority of students said that teachers received intensive training in working with dyslexic children, which is not true, but such a result is also present in a study conducted in India (Hemadharshini et al., 2020). It possible that respondents in both studies do not have an understanding of the situation due to not being involved in it.
Additionally, on several occasions, the majority of respondents choose the “Don’t know” option. For instance, 55.8% did not provide their answer to the question about the occurrence of the disorder among males and females. Moreover, 51.3% of students did not know about the efficacy of colored lenses as therapy, and 53.2% of the respondents also did not know whether there are medications to counter dyslexia. All of the three results are similar to those discovered by Yin, Joshi and Yan (2020) in early literacy teachers in China. Based on the fact that the respondents universally struggled to answer the last two questions, it is possible to assume that there is a common lack of knowledge concerning dyslexia treatments. Large numbers of people also did not answer the questions about the problems with establishing laterality as the cause of dyslexia and the efficacy of multisensory instruction. Similar findings were identified by Soriano-Ferrer, Echegaray-Bengoa and Joshi (2016), who studied dyslexia awareness among Spanish-speaking teachers. The reason behind this phenomenon can concern the complexity of the aforementioned questions.
In general, the students often chose the “don’t know” option and did not give their answers to the questions. For instance, the majority of respondents refused to say whether dyslexia could be chronic and identifiable using intelligence tests and did not answer whether dyslexic children were impaired in phonemic awareness. In other studies, participants were more likely to choose “yes” and “no” in these questions (Echegaray-Bengoa, Soriano-Ferrer, & Joshi, 2017; Soriano-Ferrer, Echegaray-Bengoa, & Joshi, 2016). The second part of the research involved conducting the SCQ-LD analysis to identify stigma related to dyslexia. The majority of respondents exhibited an opinion that dyslexic people were subject to negative assumptions by others. Moreover, the Chi-square test to determine a KBDDS and SCQ-LD association demonstrated that there was a difference regarding the knowledge level between the Dyslexia scale and Stigma scale. The findings of the study contribute to the understanding of the perception of dyslexia by nursing students and show that anticipated stigma depends on the level of knowledge of the disorder.
Reference
Ali, K., Kisielewska, J., Subhan, M. M. F., & Tredwinmenta, C. (2020). How does dyslexia impact the educational experiences of healthcare students? A qualitative study. European Journal of Dental Education, 24(1), 154-162.
Ansari, S. A., Memon, F., & Khan, I. (2015). Exploring the level of awareness of dyslexia among private school teachers. The reason, 9.
Cohen, J. (1992). A power primer. Psychological Bulletin, 112(1), 155.
Crouch, A. T. (2019). Perceptions of the possible impact of dyslexia on nursing and midwifery students and of the coping strategies they develop and use to help them cope in clinical practice. Nurse education in practice, 35, 90-97.
Daley, S. G., & Rappolt-Schlichtmann, G. (2018). Stigma consciousness among adolescents with learning disabilities: Considering individual experiences of being stereotyped. Learning Disability Quarterly, 41(4), 200-212.
Echegaray-Bengoa, J., Soriano-Ferrer, M., & Joshi, R. M. (2017). Knowledge and beliefs about developmental dyslexia: A comparison between pre-service and in-service Peruvian teachers. Journal of Hispanic Higher Education, 16(4), 375–389.
Ewain, N. S., Alkhleb, A., Alhoshan, A., Qahtani, G. Al, Alotaibi, L., Kleib, L. Bin, Alatrash, M., Alqartun, N., Alomairi, R., & Alanazi, S. (2017). The Prevalence of Learning Difficulties and Its Academic Impact Among Elementary School Students in Riyadh, Saudi Arabia. 3(6), 263–265.
Grimes, S., Southgate, E., Scevak, J., & Buchanan, R. (2020). University Student Experiences of Disability and the Influence of Stigma on Institutional Non-Disclosure and Learning. Journal of Postsecondary Education and Disability, 33(1), 23-37.
Handler, S. M. (2016). Dyslexia: What you need to know. Contemporary Pediatrics, 33(8), 18.
Hemadharshini, S., George, N., Malaidevan, E., Britto, R., & George, M. (2020). Dyslexia: Literacy among school teachers in Perambalur, Tamil Nadu, India. International Journal of Medical Health Development, 25, 101–105.
Hennessy, L. R., Shaw, S. C. K., & Anderson, J. L. (2020). Medical Students’ Attitudes towards and Beliefs about Dyslexia : A Single- Centre Survey Study. 7(4), 69–79.
Juneja, P. (2018). Dyslexia: Challenging behaviors and characteristics. Indian Journal of Health and Wellbeing, 9(7), 964-967.
Khaliq, S., Ramzan, I., & Aslam, J. (2017). Study about awareness of dyslexia among elementary school teachers regarding Pakistan elementary educational institutes. Int J Res Bus Stud Manag, 4, 18-23.
Lambert, R., Chun, M., Davis, J., Ceja, K. L., Aguilar, K., Moran, P., & Manset, L. (2019). “My Dyslexia is Like a Bubble”: How Insiders with Learning Disabilities Describe Their Differences, Strengths, and Challenges. Learning Disabilities: A Multidisciplinary Journal, 24(1).
Livingston, E. M., Siegel, L. S., & Ribary, U. (2018). Developmental dyslexia: Emotional impact and consequences. Australian Journal of Learning Difficulties, 23(2), 107-135
López-Escribano, C., Suro Sánchez, J., & Leal Carretero, F. (2018). Prevalence of developmental dyslexia in Spanish University Students. Brain sciences, 8(5), 82.
Major, R., & Tetley, J. (2019). Effects of dyslexia on registered nurses in practice. Nurse education in practice, 35, 7-13.
Mather, N., White, J., & Youman, M. (2020). Dyslexia Around the World: A Snapshot. Learning Disabilities: A Multidisciplinary Journal, 25(1), 1–17.
Polit, D., & Beck, C. (2018). Essentials of nursing research: Appraising evidence for nursing practice. 9th ed. Lippincott. W&W: New York.
Ramli, S., Idayu, I., Khairani, O., Dzalani, H., Shahlan, S., Yusni, M., & Nor, Z. (2019) Preschool teachers’ knowledge on dyslexia: A Malaysian experience. Malaysian Journal of Medicine and Health Sciences, 15, 134–139.
Soriano-Ferrer, M., & Echegaray-Bengoa, J. A. (2014). A scale of knowledge and beliefs about developmental dyslexia: Scale development and validation. Procedia-Social and Behavioral Sciences, 132, 203-208.
Soriano-Ferrer, M., Echegaray-Bengoa, J., & Joshi, R. M. (2016). Knowledge and beliefs about developmental dyslexia in pre-service and in-service Spanish-speaking teachers. Annals of Dyslexia, 66(1), 91-110.
Stoeber, J., & Rountree, M. L. (2021). Perfectionism, self‐stigma, and coping in students with dyslexia: The central role of perfectionistic self‐presentation. Dyslexia, 27(1), 62-78.
Trunk¹, D. J., Russo, C. J., & Trammell, J. (2020). Disability Stigma on Campuses: Helping Students with Psychiatric Impairments to Succeed. AHEADAssociation on, 33(2), 115.
Wagner, R. K., Zips, F. A., Edwards, A. A., Wood, S. G., Joyner, R. E., Becker, B. J.,… & Beal, B. (2020). The prevalence of dyslexia: a new approach to its estimation. Journal of Learning Disabilities, 53(5), 354-365.
Washburn, E. K., Mulcahy, C. A., Musante, G., & Joshi, R. M. (2017). Novice teachers’ knowledge of reading-related disabilities and dyslexia. Learning Disabilities: A Contemporary Journal, 15(2), 169–191.
Wery, J.J., & Diliberto, J.A. (2017). The effect of a specialized dyslexia font, OpenDyslexic, on reading rate and accuracy. Annals of Dyslexia, 67, 114–127.
Yin, L., Joshi, R. M., & Yan, H. (2019). Knowledge about dyslexia among early literacy teachers in China. Dyslexia, 26(3), 247–265.
Appendix A
Demographic data
Appendix B
Scale of Knowledge and Beliefs about Developmental Dyslexia
Please read and answer the following 36 questions about dyslexia with true, false, or do not know:
Appendix C
Anticipated Stigma toward dyslexia derived from Consciousness Questionnaire-Learning Disabilities (SCQ-LD)
Please read and answer the five following questions about stigma with true, false, or do not know: