The Importance of Positive Attitudes Toward Disability Among Future Health and Education Professionals: A Comparative Study

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

This paper provides a valuable contribution to the literature on inclusive education and attitudes toward disability in higher education. It offers novel insights into this area; however, several aspects require clarification or improvement, as detailed below.

Introduction

• Second paragraph of the introduction (from line 55): When referring to “more highly trained teachers,” does this mean teachers with greater experience or those with more advanced training? If the latter, what type of training is being referred to? Regarding secondary education, the 2013 reference is outdated. Over the last 11 years, Spanish curricula have significantly evolved, particularly following Royal Decree 822/2021. While the claim may still be valid, using an outdated reference to support it is problematic. Additionally, the last sentence of this paragraph is poorly written, making it difficult to understand.
• The introduction lacks clarity regarding the context: is the focus on Spain, or is it a global perspective? For instance, when discussing which fields of study display better attitudes toward disability, where do these findings apply? The references provided (Garabal-Barbeira et al., 2018; Polo et al., 2011; Polo Sánchez et al., 2018) should clarify their geographical contexts. If the findings apply solely to Spain, the text should highlight the potential cultural factors influencing these results. Furthermore, the study mentioned at the end of this paragraph (Atoche-Silva et al., 2021) was conducted in a Peruvian city, and its findings may not reflect the educational practices relevant to the sample in this study. Given the variations in university curricula worldwide, it is problematic to generalize findings across different contexts. A more suitable approach might be to focus the introduction on Spain and extend conclusions only to contexts with similar characteristics.
• The use of “however” on line 121 is unclear. The previous sentence emphasizes the ability of inclusive education to address the needs of all students, and the following one highlights its individualized approach. These ideas are not contradictory but rather complementary.
• The introduction does not reference studies addressing attitudes toward disability among professionals in the sports field. In contrast, it extensively discusses attitudes among future teachers and, to a lesser extent, occupational therapists. Why is there no similar emphasis on sports professionals?

Method

• The rationale for selecting students from these specific degree programs is unclear. Was it due to the convenience of administering the questionnaires? If the goal was to highlight results from education and healthcare fields, including students from Physical Activity and Sport Sciences (PASS) may not be the best choice, even though some may become teachers or engage with health topics during their studies. In fact, the results show differences between the attitudes of PASS students and those in the other two fields. If the intention was to contrast education- and health-related degrees with unrelated ones, degrees in engineering or architecture, as mentioned in the introduction, would have been more appropriate. That said, practical considerations often dictate such choices, and it would be helpful to explain these in the article.
  
  

Results

• The analysis presented in the results section is rigorous, with a meticulous approach that strengthens the validity of the findings. However, a key demographic variable is missing: the gender distribution within each degree program. This is critical because it could significantly impact the interpretation of the results.

  For example, in Physical Activity and Sport Sciences (PASS) programs, it is common to find a higher proportion of male students. The study highlights that students in this field display notably less favorable attitudes toward disability. This raises an important question: are these differences attributed to the nature of the degree program or to the gender composition of the cohort? Including gender distribution data would allow for a deeper analysis and help disentangle whether the observed variations stem from the chosen field of study or from gender differences.

  Gender has been widely recognized as a determinant factor in attitudes toward disability, as noted in previous research (Novo-Corti et al., 2015; López-Bastías & Moreno, 2019; Moreno Pilo et al., 2022). Therefore, failing to account for this variable leaves a gap in the study's explanatory power. Additionally, presenting these statistics would enable the authors to assess whether gender mediates or moderates the relationship between degree programs and attitudes toward disability, providing a more nuanced understanding of the results.

Other Considerations

• The DOI for the third reference (Atoche-Silva et al., 2021) is incorrect.
• Line 61 includes a number in brackets. What does this signify? It might refer to an author.
• Line 269: A parenthesis is left open. Correct formatting is needed: ECE students (-1.519, p = .043).

Author Response

Comment 1:

This paper provides a valuable contribution to the literature on inclusive education and attitudes toward disability in higher education. It offers novel insights into this area; however, several aspects require clarification or improvement, as detailed below.

Response 1:

Thank you for your valuable feedback and for taking the time to review our paper. We appreciate your recognition of our contribution to the field of inclusive education and attitudes toward disability in higher education.

We acknowledge the areas you've identified for clarification and improvement. We believe that your feedback will help us strengthen the paper and enhance its overall quality. We will carefully consider your suggestions and make the necessary revisions. Changes will be highlighted in blue letters during the new version of the paper.

Introduction

Comment 2:

Second paragraph of the introduction (from line 55): When referring to “more highly trained teachers,” does this mean teachers with greater experience or those with more advanced training? If the latter, what type of training is being referred to? Regarding secondary education, the 2013 reference is outdated. Over the last 11 years, Spanish curricula have significantly evolved, particularly following Royal Decree 822/2021. While the claim may still be valid, using an outdated reference to support it is problematic. Additionally, the last sentence of this paragraph is poorly written, making it difficult to understand.

 

Response 2:

Thank you for your insightful comments on our manuscript. We appreciate your attention to detail and your valuable suggestions.

Regarding the term "more highly trained teachers," we intended to refer to teachers with advanced training in inclusive education practices. This could include specialized training in areas such as assistive technology, curriculum adaptation, and differentiated instruction. This point is clarified in the revised manuscript as follow:

“Some researchers claim that more highly trained teachers, in the field of diversity attention measures, are dissatisfied with the current rigid academic curriculum in Spain for developing inclusive methodologies (Domingo Martos et al., 2019).”

We acknowledge that the 2013 reference regarding secondary education is outdated. The reference has been updated as well as the paragraph has been rewriting as follow:

“As demonstrated in recent international literature reviews (Quispe-Choque, et al., 2023) , in early childhood education, teachers typically demonstrate more positive attitudes toward inclusion, while in primary education, this attitudes remain generally favourable, teachers encounter greater challenges due to meet advanced curriculum requirements, furthermore, in secondary education, attitudes toward inclusion may become more cautious or hesitant, as educators face significant difficulties in adapting content and teaching methods to accommodate a more diverse student body with increasingly complex needs.”

We believe that incorporating these changes will significantly enhance the quality and relevance of our manuscript. Thank you once again for your valuable feedback.

 

Comment 3:

The introduction lacks clarity regarding the context: is the focus on Spain, or is it a global perspective? For instance, when discussing which fields of study display better attitudes toward disability, where do these findings apply? The references provided (Garabal-Barbeira et al., 2018; Polo et al., 2011; Polo Sánchez et al., 2018) should clarify their geographical contexts. If the findings apply solely to Spain, the text should highlight the potential cultural factors influencing these results. Furthermore, the study mentioned at the end of this paragraph (Atoche-Silva et al., 2021) was conducted in a Peruvian city, and its findings may not reflect the educational practices relevant to the sample in this study. Given the variations in university curricula worldwide, it is problematic to generalize findings across different contexts. A more suitable approach might be to focus the introduction on Spain and extend conclusions only to contexts with similar characteristics.

 

 

Response 3:

Thank you for your valuable feedback. We appreciate your keen observation regarding the geographical context of our study.

You are right, our initial draft of the introduction lacked clarity in terms of the geographical scope. To address this issue, we have revised the introduction explicitly stating that the study is primary focused on the Spanish context.

“Therefore, the attitudes towards disability among Spanish university students have been previously studied and analysed, students in Social Sciences, Law, or Health Sciences exhibited more positive attitudes towards disability compared to those in Architecture and Engineering (Garabal-Barbeira et al., 2018; Polo et al., 2011; Polo Sánchez et al., 2018).”

We will also acknowledge the potential influence of cultural factors on attitudes toward disability in higher education. By highlighting the specific cultural context of our study, we aim to provide a more nuanced understanding of the findings.

Regarding the study by Atoche-Silva et al. (2021), we agree that it may not be directly comparable to the Spanish context. We have therefore rephrased the concluding sentence of the paragraph to avoid generalizations:

 

“However, using the same questionnaire employed in this research, it has been demonstrated at a Spanish-speaking university that during this educational stage, there is a lack of intense curricular experiences that develop skills and attitudes in favour of diversity during this educational stage (Atoche-Silva et al., 2021).”

We believe that these revisions will significantly improve the clarity and relevance of our introduction. Thank you once again for your insightful feedback.

 

Comment 4:

The use of “however” on line 121 is unclear. The previous sentence emphasizes the ability of inclusive education to address the needs of all students, and the following one highlights its individualized approach. These ideas are not contradictory but rather complementary.

 

Response 4:

 

Thank you for pointing out the unclear use of "however" on line 121. You're right; the two sentences are not contradictory but rather complementary. We have changed de Word “however” as follow:

“Moreover, it underscores the importance of recognizing that each student requires individualized attention due to varying capacities, learning speeds, and needs (Martínez Martín & Bilbao León, 2013).”

We appreciate your careful reading of our manuscript and your helpful suggestions.

 

Comment 5:

The introduction does not reference studies addressing attitudes toward disability among professionals in the sports field. In contrast, it extensively discusses attitudes among future teachers and, to a lesser extent, occupational therapists. Why is there no similar emphasis on sports professionals?

 

Response 5:

Thank you for your comment. A specific paragraph has been included regarding physical education professionals. Previous review studies have identified a gap in the scientific literature, indicating that the number of articles analyzing attitudes towards disability among sports professionals, in general, is very limited, making it very difficult to find related scientific literature.

However, the introduction has been improved by adding the following paragraph:

In this way, physical education teachers’ perceptions, beliefs, and attitudes significantly influence the success of inclusive education initiatives, as they directly affect the adaptation of methodologies and the integration of students with disabilities into classroom activities (Gámez-Calvo, et al., 2024). Intervention programs in physical education lessons, such as those involving direct contact with individuals with disabilities, theoretical and practical training, or the use of adaptive sports, have shown varying levels of success in shifting attitudes toward inclusivity (Abellán-Hernández & Hernández-Martínez, 2016; Reina et al., 2022). However, studies reveal significant gaps, such as the limited scope of teacher training programs and a lack of consistent methodologies, which impede the widespread adoption of inclusive practices (Hodge et al., 2018).

Method

Comment 6:

 

The rationale for selecting students from these specific degree programs is unclear. Was it due to the convenience of administering the questionnaires? If the goal was to highlight results from education and healthcare fields, including students from Physical Activity and Sport Sciences (PASS) may not be the best choice, even though some may become teachers or engage with health topics during their studies. In fact, the results show differences between the attitudes of PASS students and those in the other two fields. If the intention was to contrast education- and health-related degrees with unrelated ones, degrees in engineering or architecture, as mentioned in the introduction, would have been more appropriate. That said, practical considerations often dictate such choices, and it would be helpful to explain these in the article.

 

Response 6:

 

The selection of students from the specific degree programs was guided by both practical considerations and the thematic alignment of the study's objectives. PASS students were included because their curriculum often integrates elements of education and health, such as adaptive physical activity, sports pedagogy, and health promotion. These elements make their perspectives relevant when exploring attitudes toward disability and inclusion, especially as many of these students go on to careers in teaching or health-related professions. The inclusion of PASS students aimed to capture this unique intersection between education and health, rather than focusing solely on strictly defined education or healthcare fields.

However, we acknowledge the observed differences in attitudes among PASS students compared to those in other fields. These differences offer valuable insights into how varying academic contexts shape perceptions of inclusion and disability.

This issue has been modified in the revised version as follow:

“A total of 446 University students from Extremadura, across PASS, OT, and ECE, participated in this comparative study. The selection of the PASS, OT, and ECE degrees was based on their close connection to the topic of attitudes toward people with disabilities. PASS students are trained in areas related to inclusion through adapted physical activity and inclusive sports. Furthermore, their curriculum often integrates elements of education and health, such as adaptive physical activity, sports pedagogy, and health promotion, creating a unique intersection between these two fields. Meanwhile, ECE students represent a key profile in shaping inclusive attitudes from the earliest stages of education, and OT students contribute a perspective focused on rehabilitation and supporting the autonomy of people with disabilities.

 

While including degrees unrelated to education or health (e.g., engineering or architecture) could provide a sharper contrast, practical considerations such as ease of access to participants and alignment with the study's focus influenced the selection process. To address this concern, a limitation paragraph was introduced in the discussion of the first version of the paper:

“The study's findings must be interpreted within the context of potential limitations. Firstly, the sample may limit the generalizability of the results to broader populations of students, especially beyond the regional scope or in other academic fields. Additionally, the reliance on self-reported measures to assess attitudes could be susceptible to social desirability bias, potentially influencing the accuracy of the results.”

And in future investigations, this issue is going to be consider.

Results

Comment 7:

The analysis presented in the results section is rigorous, with a meticulous approach that strengthens the validity of the findings. However, a key demographic variable is missing: the gender distribution within each degree program. This is critical because it could significantly impact the interpretation of the results.

For example, in Physical Activity and Sport Sciences (PASS) programs, it is common to find a higher proportion of male students. The study highlights that student in this field display notably less favorable attitudes toward disability. This raises an important question: are these differences attributed to the nature of the degree program or to the gender composition of the cohort? Including gender distribution data would allow for a deeper analysis and help disentangle whether the observed variations stem from the chosen field of study or from gender differences.

Gender has been widely recognized as a determinant factor in attitudes toward disability, as noted in previous research (Novo-Corti et al., 2015; López-Bastías & Moreno, 2019; Moreno Pilo et al., 2022). Therefore, failing to account for this variable leaves a gap in the study's explanatory power. Additionally, presenting these statistics would enable the authors to assess whether gender mediates or moderates the relationship between degree programs and attitudes toward disability, providing a more nuanced understanding of the results.

Response 7:

We appreciate the insightful observation regarding the potential influence of gender distribution on the interpretation of the results. This topic has been previously addressed by the authors. However, since the main objective of the study was to investigate the influence of career choice and academic progression on students' attitudes toward disability, this factor was not considered in the analyses. Additionally, the gender distribution across the different academic degrees reflects the current reality of both our participants and the university context. It is worth noting that this distribution does not vary across different years within the same degree program, meaning that the gender distribution is similar among first and fourth year students in the university degrees analyzed.

We recognize the importance of gender as a demographic variable and agree that its inclusion would provide additional depth to the discussion. To address this, we will consider including a supplementary analysis in future publications to offer a more nuanced understanding of the interplay between gender and academic program in shaping attitudes toward disability.

Other Considerations

Comment 8:

• The DOI for the third reference (Atoche-Silva et al., 2021) is incorrect.

• Line 61 includes a number in brackets. What does this signify? It might refer to an author.
• Line 269: A parenthesis is left open. Correct formatting is needed: ECE students (-1.519, p = .043).

 

Response 8:

Thank you for your comment. These considerations have been taken into account in the new version of the manuscript and highlighted in blue. On one hand, when using an automated reference manager, this DOI contained an error, which has been corrected. Similarly, considering the correction of line 61, when changing the citation style of the journal during the writing of the article, the authors failed to correct this reference, which has now been properly cited and referenced. Regarding the error in line 269, this has been corrected, including the missing parenthesis.

Reviewer 2 Report

Comments and Suggestions for Authors

The article examines the attitudes toward disability among university students from different disciplines, specifically Early Childhood Education, Occupational Therapy, and Physical Activity and Sport Sciences, at the University of Extremadura.

The study is relevant and highlights several socially significant aspects that can serve as a foundation for formulating new social policies. Although the sample context is somewhat limited, the results and discussions are valid. However, it is important to review the methodology used, as relying exclusively on questionnaires to measure attitudes may fail to capture the complexity of students' perceptions. The inclusion of qualitative methods, such as interviews or focus groups, could provide a deeper understanding of attitudes and experiences.

A contextual analysis would also be interesting. Identifying the size of the population with some form of disability and their interaction with the broader population could influence behavior and foster greater empathy among citizens and students, potentially shaping the study's outcomes even before it begins. Therefore, other variables would need to be included as part of the study.

I believe that any research that draws attention to inclusion is significant. However, it must always be approached with care to avoid overlooking important aspects essential for the inclusion of individuals with disabilities.

Author Response

Comment 1:

The article examines the attitudes toward disability among university students from different disciplines, specifically Early Childhood Education, Occupational Therapy, and Physical Activity and Sport Sciences, at the University of Extremadura.

Response 1:

The authors appreciate the thoughtful feedback and suggestions, which provide valuable insights to improve and expand the scope of our study. Below, we address each point raised. Furthermore, every Change in the revised version have been highlighted in green.

Comment 2:

The study is relevant and highlights several socially significant aspects that can serve as a foundation for formulating new social policies. Although the sample context is somewhat limited, the results and discussions are valid. However, it is important to review the methodology used, as relying exclusively on questionnaires to measure attitudes may fail to capture the complexity of students' perceptions. The inclusion of qualitative methods, such as interviews or focus groups, could provide a deeper understanding of attitudes and experiences.

Response 2:

We acknowledge the limitations of relying exclusively on questionnaires to measure attitudes toward disability in the limitations of the study “Additionally, the reliance on self-reported measures to assess attitudes could be susceptible to social desirability bias, potentially influencing the accuracy of the results.”. Nevertheless, the included questionnaire was scored and adapted using a big sample from various fields and is one of the most scientifically accepted and widely used scales due to its high validity and reliability. Furthermore, due to the sample size it would be difficult to perform individual interviews.

Future follow ups of this study could benefit from incorporating qualitative methods, such as interviews or focus groups, to explore the nuances of students' attitudes and provide richer, more contextualized insights.

Comment 3:

A contextual analysis would also be interesting. Identifying the size of the population with some form of disability and their interaction with the broader population could influence behavior and foster greater empathy among citizens and students, potentially shaping the study's outcomes even before it begins. Therefore, other variables would need to be included as part of the study.

Response 3:

Including a contextual analysis of the population with disabilities and their interaction with the broader community is a valuable suggestion. This topic has been previously addressed by the authors. However, since the main objective of the study was to investigate the influence of career choice and academic progression on students' attitudes toward disability, this factor was not considered in the analyses. Nevertheless, the following paragraph has been added to the discussion section to enhance contextualization:

"Prior contact with people with disabilities before the university stage can be circumstantial. However, according to statistics from the National Institute of Statistics (INE, 2024), during the 2022-2023 academic year, approximately 10.6% of students in non-university education required specific educational support. Of this group, 262,732 students had special educational needs associated with some type of disability. This reality has enabled some current university students to have the opportunity to interact with people with disabilities in an educational setting, promoting inclusive experiences from early stages."

In future research, we aim to incorporate variables such as the prior contact with people with disabilities and exposure to inclusive practices, as these may influence the attitudes observed in our study.

Comment 4:

I believe that any research that draws attention to inclusion is significant. However, it must always be approached with care to avoid overlooking important aspects essential for the inclusion of individuals with disabilities.

Response 4:

We agree that inclusion-focused research must be approached with care to ensure that all relevant aspects are considered. Our current study focused on university students’ attitudes as a critical component of fostering inclusive environments, but we recognize the value of including broader variables. Future work could explore additional dimensions, such as gender, prior contact with people with disabilities and institutional support for inclusion, societal attitudes, and specific experiences of individuals with disabilities in these settings.

One more time, thank you for highlighting these critical points, which will help guide the continued development of this research area.

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you for the revisions you have made to the manuscript, which have significantly enhanced its clarity and overall quality. I also believe the manuscript provides important findings that contribute meaningfully to the literature. Congratulations on your excellent work. While a broader contextualization of the global and national situation regarding the topic could add further depth, the current level of detail is appropriate given the space limitations.