Difficult, Challenging, and Worse Quality of Life: Health Care Professionals’ Beliefs about People with IDD

Posted on September 16, 2025

By Carli Friedman, CQL Director of Research

Health care professionals’ knowledge, beliefs, and attitudes contribute to the ways they provide services and supports to people with intellectual and developmental disabilities (IDD). It also has a significant impact on people with IDD’s outcomes, contributing to disparities among people with IDD. For these reasons, the aims of this study were to examine how health care professionals’ intersectional implicit attitudes about disability and race impact their beliefs about people with IDD. The second aim was to see if there are any differences in healthcare professionals’ intersecting implicit attitudes based on their demographics. To do so, I had 784 health care professionals take the Intersecting Disability and Race Attitudes Implicit Association Test (IDRA-IAT) and also answer questions about their beliefs about people with IDD.

There was a relationship between health care professionals’ implicit attitudes about disability and race, and their likelihood to believe that people with IDD are more difficult patients in health care, that people with IDD are more likely to exhibit challenging behaviors, and that people with IDD have a lower quality of life than nondisabled people. More specifically, the more health care professionals implicitly preferred nondisabled white people and nondisabled people of color, and the less they preferred disabled white people and disabled people of color, the more likely they were to think people with IDD are more difficult patients in health care. In addition, health care professionals were more likely to believe people with IDD are more likely to exhibit challenging behaviors when they implicitly favored nondisabled people and when they had negative implicit attitudes about disabled white people and disabled people of color. It was a bit different when it came to perceptions about quality of life. While more favorable attitudes about nondisabled white people were associated with health care professionals believing people with IDD have a worse quality of life, it was only their negative implicit attitudes towards disabled people of color, not disabled white people, that were associated with believing people with IDD have a worse quality of life.

In addition to examining the relationship between implicit attitudes and beliefs about people with IDD, I also examined if there were differences among health care professionals’ implicit attitudes. In doing so, I found differences based on occupational role, race, age, gender, education level, and family relationships with disabled people of color. Specifically,

• Occupational role:
  • People in ‘other’ allied health professions had more positive attitudes about disabled white people than people in general medicine, but more negative attitudes about nondisabled people of color.
  • People in nursing had more negative attitudes about nondisabled people of color than people in general medicine.
  • People in personal care/support had more negative attitudes about nondisabled people of color than those in general medicine, but more positive attitudes about disabled people of color.
• Race:
  • Asian health care professionals had more positive attitudes towards disabled people of color than health care professionals who were not Asian.
  • People from ‘other’ races had more negative attitudes towards nondisabled people of color.
• Age:
  • As health care professionals’ ages increased, they were more likely to have positive attitudes about nondisabled white people and more likely to have negative attitudes about disabled people of color.
• Gender:
  • Cisgender women had more negative attitudes about nondisabled white people than cisgender men, but they had more positive attitudes about disabled people of color.
• Education level:
  • People with high school degrees had more positive attitudes about nondisabled white people and more negative attitudes about disabled people of color than those with graduate degrees.
  • People with Bachelors degrees had more negative attitudes about disabled white people than people with graduate degrees.
• Family relationships:
  • Health care professionals who had close family that were disabled people of color had more positive attitudes about nondisabled people of color than health care professionals without these family relationships.

“Health care professionals’ biases impact how they treat and serve people with intellectual and developmental disabilities, as well as the outcomes of people with intellectual and developmental disabilities… Thus, intervening in health care professionals’ assumptions, stereotypes, and biases is critical for the health equity of people with intellectual and developmental disabilities. In this study, we found many of the assumptions health care professionals make about people with intellectual and developmental disabilities, which would likely go on to inform their interactions with people with intellectual and developmental disabilities and treatment decisions, were linked to their implicit attitudes not only about disability, but disability and race. The more we understand about how health care professionals’ biases work, the better equipped we are to work to improve these attitudes; intersectionality must be a cornerstone of doing so. Until we eradicate these biases, these biases will continue to threaten the health and quality of life of people with intellectual and developmental disabilities” (Friedman, 2025, p. 13).

This article is a summary of the following journal manuscript: Friedman, C. (2025) The relationship between health care professionals’ intersecting disability and race implicit attitudes and their beliefs about people with intellectual and developmental disabilities. Journal of Applied Research in Intellectual Disabilities, 38(5), e70116. https://doi.org/10.1111/jar.70116

This study was funded by a grant from the WITH Foundation.