Exploring Conceptualizations of Disability Using Story-Completion Methods

Abstract

This study explored conceptualizations of disability pertaining to peer relationships versus romantic relationships, as well as type of physical disability, using story-completion methods. Seventy-four graduate and undergraduate students from a Canadian university completed one of two versions of a story stem featuring an individual with a physical disability who was either a classmate or a potential romantic partner. Through the process of thematic analysis, three themes were generated as patterns across stories: (1) assumptions about disability present from first glance; (2) uncertainty in navigating negative assumptions of disability; and (3) from discomfort to acceptance of disability through social connection. Storylines differed depending on the type of relationship (i.e., peer or romantic) in both story length and outcome of the relationship. Findings suggest the usefulness of the relatively infrequently used method of story completion for assessing students’ narratives and discussion of meanings surrounding differing relationships with persons with a disability. This study further develops our understanding of cultural norms of disability, as well as highlights the importance of disability knowledge and interaction between persons with and without a disability, to foster positive change in representations and perceptions of disability.

1. Introduction

Social activities—including contact with peers and developing romantic relationships—are important aspects of daily living and development amongst young adults. Experiences with peers and dating enable young adults to develop interaction skills and discover desires regarding fulfilment of relationships throughout adulthood [1]. Social inclusion and interactions with others are particularly essential for social development and well-being among persons with disabilities [2]. Disability can be explained, understood, and referred to in different ways across various disciplines and countries. However, there is no consensus on the best approach to understanding disability given the strengths and criticisms of different approaches (for an overview, see the article by Smith and Bundon [3]). In this paper, we define disability according to the biopsychosocial model of disability, whereby disability is understood as any impairment or functional limitation that, in interaction with an environmental or contextual barrier, hinders a person’s full and equal participation in society [4]. In other words, this definition acknowledges that people are disabled by both their impairment (medical model of disability) and the social, cultural, and environmental barriers (social model of disability) that restrict participation in everyday life. In line with the biopsychosocial model of disability used in Canada (where the study took place), we will use person-first language when referring to disability (i.e., persons with disabilities; [4]). We recognize that individuals ascribing to other models of disability (i.e., the social model of disability) would use disability-first language (i.e., disabled persons).

Persons with disabilities experience high rates of avoidance and social isolation due to stigma surrounding disability stemming from ableist beliefs [5,6]. Further, persons with disabilities may be hindered in the development of social and romantic relationships due to various factors, including stigma surrounding disability, feelings of low self-worth, and attractiveness stemming from their relationships with others [5,6]. For example, in a classroom environment, students’ interactions with a person with a disability are often described as “helping” rather than reciprocal friendships [7]. In addition, persons with disabilities have socially been viewed as asexual and undesirable [8], and therefore are less likely to have a romantic partner. Further, persons without disabilities predominantly have negative attitudes towards persons with disabilities [9], potentially stemming from negative cultural representations of disability in the media [6,10]. Type of disability also has been shown to have an impact on attitudes towards disability. Barr and colleagues [11] investigated if contact with individuals with specific disabilities has an effect on attitudes toward other disabilities. Results of this study found that participants reported most contact with individuals with physical disabilities and the most negative attitudes towards individuals with developmental disabilities. As negative stereotypes of equity-deserving groups, including persons with disabilities, can lead to prejudice and discrimination [2], an understanding of underlying conceptualizations of disability can point to strategies that can be used to alter individuals’ attitudes about disability [2].

Perceptions of disability are at the forefront of how any individual may think about, act towards, and the type of relationship that they may pursue with, persons with disabilities. Socio-cultural discourses operating within society play an important role in informing individual perceptions of disability [12]. For example, socio-cultural discourses within the media, such as fairy tale storylines, typically portray individuals with disabilities as villains [13,14,15]. Discourses are not essential truths; they are ways in which individuals learn to talk about the world and their place in it, which are fundamentally the products of the particular society that we live in [16]. Thus, these socio-cultural discourses can create the idea that individuals with disabilities are undesirable [13]. In addition to wider culture and media sources, perceptions about disability can also stem from a lack of knowledge (i.e., not having taken a course about disability [10,17,18,19] and personal relationships (i.e., having a family member or a close friend with a disability [12].

Exploring Conceptualizations of Disability Using Story Completion

Story completion is a novel qualitative method that is particularly useful for accessing participants’ assumptions and social understandings of a phenomenon. With story completion, participants are provided with the beginning sentences of a story about hypothetical circumstances, known as a story stem, and asked to complete the remainder of the story [20]. Story completion is open-ended, which allows for creativity within responses and provides participants with verbal freedom to express socially undesirable thoughts, given they can write about hypothetical situations in the third person [21,22,23]. Indeed, story completion has been used to explore perceptions, understandings, and social constructions towards sensitive topics such as sexuality [24], body hair [22], and infidelity [23]. The use of story completion in the realm of disability is in its infancy. The method has been used to explore the attitudes of individuals without disabilities towards dating people with physical disabilities using a vignette [9]. Hunt and colleagues’ [9] findings highlight that persons without disabilities have largely negative attitudes towards dating persons with disabilities. Their study also expands on the “myth of asexuality” among people with physical disabilities by showing that people with physical disabilities are actively de-sexualised by persons without disabilities. More research is needed to explore how beliefs and attitudes of people with physical disabilities are shaped [9,25]. More recently, Williams, Lozano-Sufrategui and Tomasone [25] used the method of story completion to explore students’ narrative imagination of physical activity and disability. The narrative insights highlighted the problematic dominant representations of persons with disabilities in incapability and supercrip stories underpinned by an ableist ideology, emphasizing the need to amplify counter-narrative resources to promote acts of social justice [25]. Beyond these two studies, to our knowledge, no studies have explored perceptions of disability with varying social contexts and types of disabilities. One way to explore perceptions of disability is through story-completion design.

Story completion can be used to explore narratives based on certain aspects that differ in the stems provided [26]. The design of the story stems should reflect the specific differences the researcher is exploring, resulting in multiple story stems (one for each proposed difference [21]). Previous studies have examined differences within stories when there is gender manipulation of the character in the story stem [27,28]; however, no studies have explored the different social relationships between characters in the story, such as peer and romantic relationships, while also exploring different types of disabilities within each social context. Given that peer relationships are inherently different from romantic relationships [29], it is possible that differences in stories may emerge depending on the type of relationship that the person with a disability has with the other character. Therefore, the outcome of the relationship between characters could depend upon the type of relationship. As such, the purpose of this study was to explore conceptualizations of disability pertaining to peer relationships versus romantic relationships, as well as the type of physical disability, using story completion.

2. Materials and Methods

2.1. Materials and Procedure

All participants gave their informed consent for inclusion before they participated in the study. The study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the General Research Ethics Board of Queen’s University. Participant recruitment took place from May to October 2019 at a single Canadian institution. Information about the study was circulated via posters on campus and social media posts. Interested participants were asked to contact the first author and were subsequently sent a link to the eligibility screening questionnaire. Individuals who were above the age of 18, able to read and write in English, and did not identify as having a physical or intellectual disability (as students with lived experiences of disability may tell different stories than those without lived experiences of disability [30]) were eligible to participate and were asked to complete a story-completion task. Participants were randomized to complete one of two story stems:

Stem A: Alex and Taylor met on an online dating platform and have been messaging for over a week. They decide that they want to meet each other for their first date. Upon arrival, Alex notices that Taylor has an amputated leg…

Stem B: Alex and Taylor have not met before and are randomly assigned to work together on an assignment. When they decide to meet to work on their assignment, Alex notices that Taylor is a wheelchair user…

“Visible” physical disabilities were used in both stems so that Alex notices Taylor’s disability before speaking to each other in person, to access participants’ assumptions and social understandings of disability. The type of disability differed in each story stem, as the authors wished to explore how participants wrote stories about different types of physical disabilities, and if the potential use (Stem A) vs. overt use (Stem B) of a mobility aid would change the perceptions of disability within participants’ stories.

To explore the type of relationship that may be developed after realizing that one character has a disability, participants had the freedom to write a story where two characters begin as strangers. Gender neutral names were used to focus on social contexts of disability rather than assigning a specific gender to the character with a disability. For example, the social construct of masculinity may be especially detrimental to men with disabilities [31]. Traditionally, men are expected to have a role of strength and independence, and many men with disabilities are therefore seen as weak and emasculated [32]. On the other hand, women with disabilities are viewed as deviant and inferior when compared to men [33] and face societal stigma regarding aspects of gender and physical impairment [34]. Therefore, the research team wanted to avoid preconceived notions at the intersection of disability and gender to allow participants creative freedom. Both story stems were pilot tested prior to data collection. This pilot testing process produced responses that offered variety of narratives of disability regardless of which story stem the pilot testing participants were given [26]; therefore, the story stems were not altered following pilot testing. Per the instructions, participants were asked to write a story that is approximately 200 words long, and there was no time limit to complete the story.

Forty students completed Stem A (romantic relationship), and 34 students completed Stem B (peer relationship). A “story” was operationalized as a participant’s response to the story stem. Participants’ stories were of varying lengths, varying from six words to 656 words, with an average of 175 words per story. Stem A (romantic) stories ranged from six to 424 words per story (Mean = 156.2, SD = 86.9 words per story). Stem B (peer) stories ranged from 27 to 656 words per story (Mean = 197.8, SD = 119.7 words per story).

2.2. Data Analysis

Given that story completion offers participants freedom to express potentially contentious perceptions [21,22,23], and the aim of the study was to explore conceptualizations of disability, all stories were analysed regardless of length or level of detail provided, in line with story-completion literature, given they offered an account of the circulating narratives of disability that exist in society. The complete data set was subjected to reflexive thematic analysis, an analytic approach used when the aim is to identify patterns of meaning across qualitative datasets [35,36]. As thematic analysis is independent of theory, Braun and Clarke [35] argued that researchers should specify the theoretical assumptions that inform their use of thematic analysis. Accordingly, our work is informed by a contextualist paradigm, which is concerned with participants’ perspectives, but views their perspectives as partial, shaped by, and embedded within, the participants’ social context and particular social location [37]. Furthermore, it is important to recognize that the research team consisted of highly educated, white, women without disabilities, with research interests and training in disability studies. Therefore, it was critical to reflect on and discuss these positions for the research team to be aware of how they impacted the research process. It was important to challenge preconceived notions about how participants’ beliefs and values may differ from the authors’, and how this may impact the interpretation of participants’ stories.

The first and third author independently familiarized themselves with the data and began highlighting relevant segments of text pertinent to the research question using Microsoft Word. Next, the transcripts were independently reviewed and coded by the first and third authors (e.g., several initial codes included Pity, Judgement, Incapable, Empathy, and Comfort). Following the coding, the first and third authors acted as mutual critical friends by challenging each other’s interpretations of the data and encouraging reflection of alternative codes (e.g., Negative attitudes towards disability (Pity, Judgement, and Incapable) and Positive attitudes towards disability (Empathy and Comfort)) [38]. The first and third authors then collectively reviewed the coded data to highlight areas of similarity and overlap between codes, to then identify common ideas within the stories (e.g., Attitudes towards disability (Negative attitudes towards disability and Positive attitudes towards disability)). Once the ideas were grouped (i.e., forming initial candidate themes), another critical friend session took place involving all study authors. Authors 1 and 3 presented Authors 2 and 4 with the themes presented alongside the data, which sparked discussion amongst all authors around theme concision and patterns across the entire dataset. For example, Judgment at first sight: Perceptions of disability from the first glace (Attitudes towards disability). All authors agreed on which subthemes to collapse under main themes. Once themes were thoroughly discussed among all authors, Author one cross-referenced themes with all stories to ensure that the generated themes captured the most important and relevant elements of the stories. Finally, the themes were defined and named during the writing process.

To produce rigorous qualitative research, various relevant criteria in line with our contextualist paradigm were drawn upon [39]. Following the advice of Smith and McGannon [39], and the guidance from sets of criteria for excellence in qualitative research [40], a combination of criteria for quality were drawn upon including rich rigour, sincerity, and significancy. Rich rigour refers to the idea that the study uses “sufficient, abundant, and complex theoretical constructs, samples, and the process of which data are collected and analysed” [40] (p. 840). To ensure methodological rigour, a collaborative process was used to develop a study design, where study aims were matched to the approach and methods used. In addition, the story stems were pilot tested with graduate students to ensure clarity. Rigour was also sought through the use of critical friends to challenge the authors’ interpretations of the data and encourage reflection of alternative ideas [38].

To add to the sincerity and confirmability of qualitative research, researchers were careful to examine their subjective values, beliefs, and inclinations [40]. Specifically, the critical friend session with all authors allowed for discussion of whether a code or theme arose because of Authors’ 1 and 3 own biases about disability and whether the patterns seen across the dataset were representative of participants’ responses or the researchers’ own perceptions. To achieve sincerity through this research, prior to data collection, the research team identified their own positionality, while being transparent about the methods and procedures used [38].

Significant contribution refers to the theoretical, practical, or political contribution of a study [40]. The interpretations of the data are theoretically significant as it will provide valuable insight to understanding the differences in conceptualizations of disability pertaining to peer relationships versus romantic relationships using story-completion methods. This knowledge can be used to promote interactions with persons with disabilities and decrease the stigma associated with persons with disabilities.

3. Results

Across the dataset, three main themes were developed from the story narratives: (1) Assumptions about disability present from first glance; (2) Uncertainty in navigating negative assumptions of disability; and (3) From discomfort to acceptance of disability. Stories from both stems frequently identified that assumptions about disability were present from first glance; most often these assumptions, or way of understanding individuals with disabilities [40], were negative. These initial assumptions about disability that Alex (character without disability) held when meeting Taylor (character with a disability) for the first time were typically followed by Alex feeling uncertain about how to negative their negative assumptions of disability. A narrative shift in storylines was prominent in most stories—from initial discomfort with disability to acceptance of disability once the characters had a chance to interact. Each theme will be unpacked in turn.

3.1. Assumptions about Disability Present from First Glance

Responses to both story stems had a common storyline where Alex (able-bodied character) felt initial feelings of commiseration and empathy towards Taylor (character with a disability) upon their first interaction. Stories often mentioned that Alex evoked a sense of pity for Taylor simply due to the fact that Taylor had a disability, and, in most stories, Alex did not. Taylor was described as (having experienced) “a lot of suffering” (A11) as a result of their disability in six stories. For example, as written in one story:

“Alex is initially surprised to see this—probably attributed to a natural human response of seeing others struggling…He realizes that sometimes the kindest and most loving souls are ones who have gone through an immense amount of suffering.”

(B29)

Taylor’s assumed “suffering” caused Alex to feel pity, though this suffering was never mentioned by Taylor directly. Furthermore, when Alex learned more about how Taylor acquired their disability, this led Alex to “instantly [feel] bad for Taylor” (B02) in one story. Another story described how “Alex contemplates how lucky he is” (B03) for being a person without a disability who had not experienced traumatic events as Alex assumes Taylor may have.

Twelve stories followed a pattern of the need to accommodate for Taylor’s disability, as participants wrote about the initial feelings of pity Alex was feelings towards Taylor upon meeting. This idea was especially prevalent in Stem B (peer relationship), in which Taylor’s disability required the use of a wheelchair. Alex was commonly portrayed in a selfless manner. Holding the door open was the most frequently mentioned accommodation. However, other stories mentioned Alex providing accommodation for Taylor without being asked to do so. For instance, in one story, a participant wrote:

“Alex notices that the podium is too high for Taylor to reach, and so he goes to plug in the computer so she doesn’t have to, acting as if he would have done that regardless.”

(B19)

Many storylines followed similar patterns of Alex voluntarily accommodating in various ways for Taylor, due to their disability obstructing daily routines.

Further, Alex often described expressing feelings of sympathy and kindness towards Taylor, also attributed to the fact that Taylor had a disability. In one story, a participant wrote:

“But it causes Alex to think more sympathetically to Taylor because she is in a wheelchair. If Taylor was not in a wheelchair or did not have a disability, this sympathy probably wouldn’t be there for her partner on the project.”

(B23)

Alex’s reactions to Taylor pitied Taylor’s status as an individual with a disability, and they had an overall impact on the way Alex thought of, and treated, Taylor throughout the story narrative.

In some stories, Alex had lived experience of disability, which strengthened the characters’ relationship. For example, in one story, Alex also had a physical disability, which allowed Alex and Taylor to relate to each other quickly. As evidenced in one story:

“…and she is so relieved because she has cerebral palsy, which makes her a wheelchair user. In the past, Alex has had bad luck with dating because of her disability, so she was worried about what Taylor might think when they met. Thankfully, Taylor was in a similar situation, and they hit it off right away! Needless to say, they were both pleasantly surprised to see each other’s disability and immediately felt more comfortable about the date.”

(A12)

In other stories, Alex had a family member with a disability or similar health condition, which allowed Alex to be understanding of Taylor’s experience as an individual with a disability. For instance, two participants wrote about Alex having a family member with different disabilities and how it shaped Alex’s perceptions of disability from the outset:

“Alex, having had a little brother with a learning disability, is not phased by this. In fact, she is actually quite excited as she knows that it can be difficult to live with a disability, and she knows how to treat people with disabilities so that they do not feel uncomfortable.”

(A28)

“Alex’s father has diabetes, and although he has not had to amputate his leg, she understands the complications that arise from diabetes.”

(B03)

Experience with disability allowed Alex to empathize with Taylor from their first interaction. This mutual experience allowed the characters to understand each other deeper to build a sense of trust.

3.2. Uncertainty in Navigating Negative Assumptions of Disability

Across both stems, most stories mentioned Alex having ableist thoughts about Taylor’s disability, which were described by participants as Alex’s internal thoughts about disability having a negative undertone. Stories often mentioned new outlooks of being around an individual with a disability, which caused Alex to modify their behaviour when interacting with Taylor. Such modifications included deliberately avoiding bringing attention to Taylor’s disability, realizing the barriers that exist to persons with disabilities in the physical environment, and being surprised when Taylor independently performed activities of daily living.

Numerous stories noted Alex hiding their judgement, expressing curiosity towards Taylor’s disability, and not knowing how they should act around someone with a disability. This uncertainty resulted in purposefully ignoring Taylor’s disability, or consciously attempting to avoid staring with the intent of sparing Taylor’s feelings. As stated in one story,

“However, he decides to not bring it up as he assumes that Taylor does not like attention brought to her chair.”

(B21)

The need to be “politically correct” (B18) when interacting with persons with a disability was also described, as was the need to consciously act “normal” (A04, A06, A13, A26). This was expressed through the portrayal of Alex’s character as kind and understanding for choosing to ignore Taylor’s disability.

Although not explicitly stated in the stems, Alex was described as an individual without a disability in the majority of stories and experienced many privileges that they were not aware of until their interaction with Taylor, such as accessibility of the environment. Given Taylor’s disability required the use of a wheelchair in Stem B (peer relationship), able-bodied privilege was discussed in this stem when Alex notices the lack of accessible spaces. Stories noted that Alex makes this realization after noticing that Taylor is a wheelchair user. For example, one story mentioned that:

“Alex immediately thinks about whether the project and locations they have decided to work at are wheelchair friendly. He concludes that his house is out of the question due to stairs up to the front door, so he suggests that he and Taylor work at the school library, where there is a ramp and easy accessibility.”

(B32)

In some stories, Alex’s assumption that Taylor would not have a disability may have stemmed from able-bodied privilege of living in an able-normative society and thus, they have not had to be concerned about the accessibility of the environment. In these stories, Alex’s interaction with Taylor caused self-reflection of their able-bodied privilege. As one story stated:

“Alex notices that many of the [wheelchair accessible tables] are occupied by able-bodied people. She herself has sat in this room many times without considering the space she was occupying.”

(B09)

Through interacting with an individual with a disability, Alex recognized their privilege as an individual without a disability who lives in an ableist society.

Another common topic described among story narratives was the capability of the individual with a disability. Capability has been defined as the extent of one’s physical and/or mental ability to perform an action successfully [41]. Most stories mentioned Taylor’s physical or mental capabilities in either a description of Taylor, or as a plot point in the interaction between the two characters. For stories written for Stem A (romantic relationship), these narratives had a heavier focus on Taylor’s physical limitations, as shown here:

“This was an unexpected surprise for Alex, who was hoping that they could go for a walk along the waterfront on their date, and was suddenly unsure if Taylor would be comfortable going for a long walk.”

(A02)

Unique to stories written in response to Stem B (peer relationship), Taylor was assumed to be incapable in both mental and physical capacities due to the nature of mental capabilities associated with academics. Six of the stories mentioned Alex’s concern for Taylor’s mental ability to complete the project effectively. One of these stories included the following:

“Having never worked before with anyone in a wheelchair, Alex wasn’t really sure what to expect. Would Taylor be capable of completing this assignment? Does their disability affect their mental capacities?… Alex begins to worry that they may have to complete the assignment on their own.”

(B34)

Alex expressed doubt in Taylor’s competencies in both a physical and mental aspect. The assumption of such incapability was made by Alex before conversing with Taylor (i.e., prejudice). However, Taylor’s true competence was frequently discussed after these false assumptions were made. Eight stories mention Alex’s surprise at Taylor’s capability, as highlighted below:

“As the project goes Alex realizes that Taylor is very good at making sure her part of the project is completed on time and is up to standards. Alex is again surprised by the work that Taylor is able to complete.”

(B23)

“WOW! Not only is Taylor able to drive the car without any problems despite his disability but he ends up winning the race and earning them an award for the project!”

(B35)

Throughout 11 stories, Alex’s assumption of Taylor’s incapability led to Taylor affirming their own competence. This narrative was found primarily in Stem B, as Taylor felt it was necessary to assure Alex of their ability to complete their project. For example, two stories written in response to Stem B showcased Taylor advocating for their cognitive ability:

“Taylor realizes what Alex is thinking, and reassures him that the wheelchair is there to help them move, but doesn’t impact anything else, like their grade on the assignment or their personality.”

(B30)

“Taylor begins to explain that they are not confined to the wheelchair, being able to walk for a short time but becoming easily exhausted when doing so. Taylor explains their disability and how it doesn’t affect their ability to think.”

(B34)

Generally, Taylor’s competence was described in both a positive and negative light. When Taylor displayed their ability to keep up with Alex’s physical and mental capacity, this was described with a sense of shock and sometimes admiration.

Overall, participants wrote that disability was a new experience for Alex, as Alex expressed curiosity and a sense of uncertainty of how to react to and treat Taylor. Taylor’s disability was described as near impossible for Alex to ignore and thus, prevented Alex from fully engaging in their interaction with Taylor.

3.3. From Discomfort to Acceptance of Disability through Social Connection

Throughout 14 stories, there was a narrative shift from new or negative feelings arising from interacting with a person who has a disability to the characters coming to accept those with disabilities. Acceptance of disability was seen from both Taylor and Alex, as the social connection became more important than the disability to both characters. This narrative tended to appear towards the end of each story, after the two characters had already interacted and fostered a connection.

Acceptance of disability was commonly described in stories as the characters recognizing that Taylor was “more than [their] physical condition” (A10). Seven stories also presented a narrative with feelings of acceptance and inclusion. Despite some stories presenting Taylor as ashamed of their disability, other stories displayed Taylor as prideful of their disability. For example, one narrative described Taylor as excited about their ability to compete as a competitive runner:

“[Taylor] bounded up and said ‘Let me show you something!’ He rummaged through his bags and showed her his prosthetic running leg—explaining how he still trained and ran, hoping to compete in the Paralympic Games in distance running.”

(A08)

Other stories described Taylor as being very comfortable with and proud of their disability. For example:

“During the conversation, Taylor makes a joke about her leg, and chuckles. She is obviously very comfortable about her disability.”

(A23)

“‘So, if you don’t mind me asking, what happened to your leg?’ Alex asks Taylor. ‘Well, I was actually born without this leg so nothing really ever happened to it, it’s just the way I am…’ Taylor responds pridefully.”

(A20)

These stories described Taylor as accepting of their disability, contrary to many of the other stories in which Taylor possessed negative feelings towards their own disability.

In 29 stories, Alex was also accepting of Taylor’s disability. However, this acceptance of Taylor’s disability was due to the “normal” (A26, A33, B30) behaviour exhibited by Taylor throughout the interaction. For example:

“Alex started to forget things about the leg under the table because Taylor is so talkative and humorous.”

(A11)

“Sure enough, she had a fantastic time during their first date—Taylor was just as funny in person as he was online—and it wasn’t until night time (cuddled with Taylor in bed watching Brooklyn Nine-Nine) that Alex remembered Taylor’s leg.”

(A08)

Taylor’s “normal” (A26, A33, B30) personality was seen as a shock and a relief to Alex in some stories, as Alex was able to “forget” (A03, A11, A26) about Taylor’s disability due to their attractive personality.

Another root of acceptance towards Taylor was due to similar interests between characters. Similarities between Alex and Taylor increased Alex’s interest in pursuing a relationship with Taylor, as one story stated:

“Throughout their conversation, Alex started to realize that she and Taylor had a lot in common. They both liked computer games, they were both interested in politics, and they both enjoyed outdoor hikes.”

(A35)

Another story romanticized Taylor’s disability by comparing them to a love interest from a fictional story:

“He reminds Alex of ‘The Prince Wooden Leg’ Tariq from Khaled Hosseini’s novel A Thousand Splendid Suns and of course the romantic story in that book. Would he be just like my Tariq?”

(A11)

Participants wrote that Alex’s admiration for Taylor resulted in Alex holding high regard for Taylor due to their disability. Further, seeing past Taylor’s physical condition was a common path towards acceptance in romantic partner stories:

“Alex understands her apprehension but assures Taylor that she has nothing to apologize for because she is much more than her physical condition.”

(A10)

“At the park an elderly man thanks Taylor for his service. The man is a refugee and was saved by Taylor in a war, the same war where Taylor lost his leg from an IED. [Alex] starts to like Taylor even more.”

(A13)

“Alex reassured Taylor, and said that just because she has an amputated leg doesn’t mean she thinks anything less of her.”

(A35)

After interacting with Taylor, Alex was able to experience many realizations with regards to how persons with disabilities interact in society. Eight stories suggested that Alex’s social connection with Taylor could provide a valuable opportunity to learn more about individuals with disabilities that may cause further reflection of one’s own prejudice towards disability, and a shift towards a more inclusive attitude towards persons with disabilities. Overall, acceptance of disability was seen from both Taylor and Alex, with this narrative appearing towards the end of each story, after the two characters had fostered a social connection and mutual understanding.

4. Discussion

The purpose of this study was to explore conceptualizations of disability pertaining to peer relationships versus romantic relationships, as well as type of physical disability, using story-completion methods. Three themes captured similar ideas across the two story stems. The stories written by participants relate to common societal beliefs about persons with disabilities in relation to assumptions of disability, uncertainty in navigating assumptions of disability, and moving from discomfort to acceptance of disability through social connection. Collectively, findings suggest that story completion can be used to identify how disability is constructed, and that the context of the relationship (peer vs. romantic) between characters and the type of physical disability has an impact on the stories written.

Historically, persons with disabilities have been pitied by, and been viewed as less competent than, persons without disabilities. These negative assumptions of disability are often deeply ingrained and automatic (i.e., assumed at a first glance) due to sociocultural discourses surrounding disability [18,42]. These sociocultural discourses of disability derive from negative depictions in the media, as well as little knowledge of and experience with persons with disabilities [43], ultimately perpetuating ableism through society [44]. As noted in the literature, increased knowledge about persons with disabilities can lessen negative perceptions of this group [45]. In addition, frequent and quality contact with persons with disabilities increases positive perceptions of disability, given contact between social groups may decrease prejudice [46]. Consistent with previous literature about the lack of knowledge of disability due to inexperience with persons with disabilities [10,17,18,19], most stories that mentioned Alex, a person without a disability, had a lack of knowledge of disability due to inexperience with disability, often leading to Alex’s discomfort around Taylor. However, after interacting with and fostering a social connection with Taylor, Alex’s initial negative perceptions changed. Alex only held positive assumptions of disability when they were described as having a lived experience of disability (i.e., being a person with a disability themselves or having a friend or family member who experiences disability). Indeed, more lived experience with disability and interactions with persons with disabilities fosters positive attitudes towards disabilities [12].

In addition to initial assumptions of disability, uncertainty in how to navigate negative perceptions of disability was commonly narrated across multiple stories. A common misconception about disability is that persons with disabilities have functional limitations beyond their primary impairment (e.g., persons with physical disabilities are considered to also have cognitive impairments [47,48]). Our analysis is in line with this previous literature, as many of the narratives had similar storylines of Alex assuming Taylor’s incapability of completing tasks unrelated to a physical disability. Additionally, many of these narratives went on to explain how once Taylor proved their capability to complete daily activities despite their disability, then Alex was impressed with this skill. This further emphasizes how individuals with disabilities are often viewed as incapable until proven otherwise [49].

Since people with disabilities tend to be rated high on dimensions of warmth by society [18], they often experience active facilitation behaviours, whereby people actively want to help them, act on their behalf, assist them, or defend them. For example, holding a door open for persons with disabilities is an active facilitation behaviour. Further, given persons with disabilities tend to be perceived as being high in warmth and low in competence, Fiske and colleagues [50] posit that this will elicit feelings of pity, which commonly appeared in some stories. The results of the study align with aspects of the Stereotype Content Model [50], which proposes that there are two dimensions within which we situate everyone we encounter: warmth (i.e., trustworthiness, friendliness) and competence (i.e., capability, assertiveness). From these dimensions, we proceed to make social evaluations of other people.

Interestingly, the social context/relationship between characters within the story stem influenced the narratives drawn upon within the stories, which caused participants’ stories to differ between stems. Within the context of a romantic relationship, the disability was seen as a “deal breaker”, a negative factor in the romantic relationship, causing the individual without a disability to withdraw from the relationship. In the 21st century, there is an emphasis on sexual encounters as part of romantic relationships [49,50]. However, persons with disabilities have been desexualized and made to believe that they are unattractive, leading to barriers to pursuing romantic partners in an ableist society [51].

A common societal belief is that disability is seen as undesirable in a sexual or romantic relationship [8,51,52,53]. The stories written by participants were consistent with this belief as Taylor’s disability was seen as a factor that Alex either could not accept, or took time to accept, when contemplating a romantic relationship with Taylor. Alex’s acceptance of Taylor’s disability was a more frequent storyline in the romantic relationship stem than the peer relationship stem. Acceptance of disability only occurred once a personal connection was fostered between the characters, aligning with findings of a story-completion study that explored dating and physical disability [9]. Further, some narratives expressed Taylor’s self-consciousness of their disability, providing rationale for Taylor withholding disability-related information prior to the initial interaction with Alex. The issue of disclosure prompts persons with a disability to determine the extent to which the embodied characteristics of impairment are part of their self-identity, and how this influences the type of information they include in their online dating profiles [54]. Therefore, when disability is displayed in the context of a romantic partnership within a story, many participants seem to draw upon ableist societal narratives.

As noted above, a common misconception of disability surrounds the capability of persons with disabilities beyond the functional limitations stemming from their disability [47,48]. In both story stems, Taylor was presented as having a physical disability. While Taylor’s physical capability was discussed in stories written for both stems, Taylor’s mental capability was only questioned by Alex in the story stem where Taylor was using a wheelchair. Thus, participants extrapolated Taylor’s functional limitations beyond the type of disability that was presented. The context of the peer relationship (completing a project) may have spurred this extrapolation; continuing to explore nuances between stories generated in different social settings warrants future research. Overall, our analysis highlights various social understandings of disability that exist within the narratives written, as some align with the medical model of disability and others with the social model of disability. As such, this study demonstrated that stories focusing on incapability of the person with a disability align with the medical model of disability, in addition to stories that draw upon ableist societal narratives. In addition, this study also highlights stories that focus on barriers that exist in society that impact persons with a disability, in addition to acceptance of disability, which align with the social model of disability. Overall, the results of this study add to the existing literature on disability and how perceptions of disability are shaped by people’s social context and sociocultural resources [13,14,49,55]. Further, promoting interactions with persons with disabilities can increase positive perceptions of disability and may reduce the stigma associated with persons with disabilities.

Our study builds upon previous work using story completion in the context of disability. Participants without disabilities in both the current and Hunt and colleagues’ [9] study wrote stories about barriers to dating a person with a disability; however, Hunt and colleagues’ [9] participants wrote about anxiety and concern for the burden that such a romantic relationship would place on them, whereas participants in our study wrote about the story characters having shared experiences with disability directly between characters or among characters’ family members. One explanation for this difference may be that Hunt and colleagues [9] matched the gender of the story characters with the gender of the participant, whereas our story stem used gender-neutral names and it was up to the participant whether or how they would assign gender. Compared to respondents in Williams and colleagues’ [25] study, who emphasized supercrip stories underpinned from an ableist ideology in their stories, respondents in the current study did not draw on the supercrip narrative in their stories. The difference here may also be due to gendered characters, as well as the focus on physical activity and platonic relationships (i.e., exerciser and exercise professional) in the story stems put forth in Williams and colleagues [25]. Both Hunt et al. [9] and Williams et al. [25] put forth story stems that are within the same social context within their studies, while this study examined two differing social contexts in the realm of disability. Thus, this study adds to the literature that story completion can be used to collect sociocultural information [23,26,37] in the context of disability [25], and that the social context of the story stem, and type of disability, matter when disability is the focus. Interestingly, on average, participants wrote longer stories (approximately 42 more words per story) and spent more time (approximately 8 more minutes) on stem B (peer relationship/wheelchair user) when compared to stem A (romantic relationship/person with amputated leg). It is possible that participants may have felt more comfortable writing about peer relationships or a person using a wheelchair than romantic relationships or a person with an amputated leg. Online data collection made it possible for participants to complete the story in a comfortable space, reducing barriers or inconvenience of completing the story-completion task in person [21]. Online data collection also allowed the research team to analyze data without the common barrier of illegible handwriting [21]. The analysis was strengthened through the use of critical friends to challenge assumptions and encouraged multiple perspectives to be considered and reflected in the write-up [38,39,56].

It is important to interpret the results in light of study challenges. First, it is not possible to conclude whether the actions of the characters within the stories are what actually occurs when individuals interact with persons with disabilities. As the purpose of this study was not to explore actual behaviour, the current study cannot infer from stories that participants would act the same ways in daily life [21]. Second, some stories included extreme events, otherwise known as fantasy stories [21]. Fantasy stories have little to do with the topic at hand [26]; for example, in our study, fantasy stories included a robbery occurring at the restaurant the couple eats at, leading to Alex being held hostage. These stories required coders to read “between the lines” to decipher codes related to conceptualizations of disability. As such, regardless of the detail of stories, all stories were analyzed, in line with story-completion literature, given that they offered an account of the circulating narratives of disability that exist in society. The results of our analysis support the idea that when using story completion as a method of data collection, some data pose as challenging to interpret depending on the research question [20]. Finally, race and ethnicity of participants were not collected in the demographic questionnaire as these variables were not pertinent to the study objectives. It may be interesting for future story-completion research to explore how participant demographics, such as race and ethnicity, may intersect to influence the disability narratives drawn upon.

5. Conclusions

Narratives shared in the stories resemble common misunderstandings and discourses about disability circulating in society; thus, this study suggests that story completion can be used to collect conceptualizations of disability. The results of our analysis suggest that depending on the social context (peer vs. romantic relationship) in which disability appears within a story, narratives may differ. Finally, the results of our analysis highlight the importance of disability knowledge in terms of negative and discriminatory sociocultural representations and discourses regarding disability, and the need for interaction and social connection between able-bodied individuals and persons with disability, to foster positive change in perceptions of disability.