The Effects of Education and Direct Contact on
Explicit and Implicit Attitudes Towards Older
People
A submission presented in partial fulfilment of the
requirements of the University of Glamorgan/Prifysgol Morgannwg
for the degree of Doctor of Philosophy
April 2011
Paul Nash
University of Glamorgan
Acknowledgements
‘At times our own light goes out and is rekindled by a spark from another person.
Each of us has cause to think with deep gratitude of those who have lighted the flame
within us.’
(Albert Schweitzer – Theologian)
As I am sure is the case for all PhD candidates, upon reflection a doctorate is just as
much about the process as it is about the completed product. The journey to
completion has encompassed both good times -that I will remember forever because
they were aplenty, and not-so-good times- that I will remember forever because of the
unwavering support I have received. This assiduous hike would have remained
untrodden had it not been for the tremendous help and support I gratefully received
from many individuals as highlighted below.
Prof. Ian Stuart-Hamilton, my Director of Studies, deserves special thanks. Not only
has he provided continued academic support and advice but he has always had the
right words of encouragement (most of which could not be repeated), given when
needed most. Dr Peter Mayer, as my Second Supervisor, has acted as mediator and
voice of reason when Prof. Stuart-Hamilton and I have been swept away at tangents
intangible to anyone else. Without him I fear this thesis may have reflected a
somewhat chaotic mindset. As a friend, confidante and academic sounding board Dr
Rachel Taylor has never failed to be there for me both at times when requested but
more often than not without any request being needed. Without the support of these
three fantastic individuals I would not have known where to start, where to finish or
which path to take to get there. Thank you.
2
Data collected in this thesis has been the culmination of efforts from a number of
people. Without Jill Kneath-Jones in the nursing school at the University of
Glamorgan, my access to the Nursing students population would have been
impossible. She has provided continued support for the duration of the longitudinal
study and for this I am truly thankful. Thanks are also extended to the University of
Glamorgan and the Aneurin Bevan Health Board who have facilitated data collection
at different stages of the thesis. I would also like to extend my thanks to all of my
participants without whose time, none of this would have been possible.
In addition to the academic side of the PhD, my friends and family have provided
support and understanding from the first days of proposal writing until the final edits
before submission. I have a plethora of friends who have shown understanding when
things have been hard for me. I cannot mention by name all of those who have
supported me, however, special mention needs to be given to Katy Walden, Joe
Draper and Dr Ian Pepper. Katy is a true ray of light, always there with a smile so
infectious you can’t help but have your mood lightened by her. Joe has more recently
been of support; functionally looking after me when I have been writing, ensuring that
I have remained fed, watered and that a life exists outside the thesis. Ian has been
there to boost my confidence and ensured that I take a realistic perspective on all
things academic and personal. He has been my most ardent supporter and my fiercest
critic, but above all else I know I can count on him. Thanks for keeping me sane!
Foremost however, my family have been the one constant source of support from
undergraduate through post graduate studies. Despite their geographical distance I
3
couldn’t feel closer to them. My Parents have provided financial and emotional
support, never questioning my chosen path, simply ensuring they have been with me
at every turn. My sister has always been close to me, knowing me better than many
others and as such her understanding and guidance has been invaluable. Without my
family I would not have been able to get this far and it is with their continued strength
that I strive to go much further.
I have mentioned but a few, however, my thanks extend to many others whom it
would be impossible to name individually. Each and every one of these people has
rekindled that spark within me in their own way and without that help this
accomplishment would not have been half as sweet.
4
Table of Contents
Page
List of Tables ……………………………………………………………………
9
List of Figures …………………………………………………………………...
9
Chapter One
Attitudes …………………………………………………………………
10
Implicit Attitudes …………………………………………..........
15
The Implicit Association Test ……………………………………...........
20
Predicting Behaviour ……………………………………………
28
Prejudice ………………………………………………………………...
34
Stereotypes ……………………………………………………...
40
Chapter Two
Chapter Three
Chapter Four
Ageism …………………………………………………………………... 48
Chapter Five
General Methodology …………………………………………………… 70
Materials ………………………………………………………… 70
Ethical Considerations …………………………………………..
76
Procedure …………………………………………………..........
77
Scoring ……………………………………………………..........
78
5
Chapter Six
Empirical Studies ………………………………………………………..
81
A Longitudinal Cohort Study with Nursing and Psychology
Undergraduate Students
Introduction ……………………………………………..
84
Participants ………………………………………………
86
Methodology …………………………………………….
87
Results …………………………………………………...
88
Discussion ……………………………………………….
92
Conclusions ……………………………………………...
100
A Cross-sectional Study Using Early Years Students to Ascertain
Directional Preference in the IAT
Introduction ……………………………………………...
103
Participants ……………………………………………....
105
Methodology …………………………………………….
105
Results …………………………………………………...
105
Discussion ……………………………………………….
106
Conclusions ……………………………………………...
110
A Cross-sectional Study Assessing Attitudes Held by Hospital Nurses
working in A&E and Geriatric Medicine
Introduction ……………………………………………...
111
Participants ………………………………………………
114
Methodology …………………………………………….
114
Results …………………………………………………...
114
Discussion ……………………………………………….
116
Conclusions ……………………………………………...
119
6
A Cross-sectional Study Assessing the Effects of Higher Level
Education on Implicit and Explicit Attitudes Towards Older People
Introduction ……………………………………………...
121
Participants ………………………………………………
122
Methodology …………………………………………….
123
Results …………………………………………………...
123
Discussion ……………………………………………….
125
Conclusions ……………………………………………...
128
A Longitudinal Study Assessing the Effects of Specific Age Education
on Attitudes Towards Older People
Introduction ……………………………………………...
130
Participants ………………………………………………
132
Methodology …………………………………………….
132
Results …………………………………………………...
133
Discussion ……………………………………………….
135
Conclusions ……………………………………………...
141
A Cross-sectional Study Assessing the Levels of Implicit and Explicit
Ageism Held by Older People
Introduction ……………………………………………...
142
Participants ………………………………………………
145
Methodology …………………………………………….
145
Results …………………………………………………...
146
Discussion ……………………………………………….
147
Conclusions ……………………………………………...
150
7
A Meta-analysis of Study One-Six Data
Introduction ……………………………………………...
152
Participants ………………………………………………
153
Methodology …………………………………………….
153
Results …………………………………………………...
154
Test of Counterbalancing ………………………………..
159
Implicit vs Explicit Measures …………………………...
160
Discussion ……………………………………………….
161
Conclusions ……………………………………………...
168
Chapter Seven
General Discussion ……………………………………………………… 170
General Implicit Ageism ………………………………………...
172
General Explicit Ageism ………………………………………...
175
Effects of Education on Attitudes Towards Older People ……....
177
Effects of Direct Contact on Attitudes Towards Older People ….
183
Test Stability Over Time ………………………………………...
184
Future Research Directions ……………………………………… 188
References ……………………………………………………………………….
193
Appendices ………………………………………………………………………
229
8
List of Tables
Table 1
- A tabular depiction of the IAT programme ……………………
19
Table 3
- The order of presentation for the IAT …………………………
75
Table 4
- Table of longitudinal means …………………………………...
88
Table 5
- Table of Nursing students explicit measure correlations ……...
91
Table 6
- Table of Psychology students explicit measure correlations …..
91
Table 7
- Table of Nursing students implicit measure correlations ……...
92
Table 8
- Table of Psychology students implicit measure correlations ….
92
Table 9
- Table of comparable means for Psychology and Nursing
Students ………………………………………………………….
Table 10
- Table of comparable means for Qualified Nurses and
Nursing Students ………………………………………………...
Table 11
106
115
- Table of aggregated comparable means for Qualified
Nurses and Nursing Students ……………………………………. 116
Table 12
- Table of means comparing the effects of education …………...
Table 13
- Table of means comparing Psychology of Ageing course and
General Adult data sets ………………………………………….
Table 14
124
133
- Table of means comparing the effects of ageing on attitudes
towards older people …………………………………………….
146
Table 15
- Table of means for each sample population …………………...
154
Table 16
- Table of significance values between samples for the implicit
D-Score Measure ………………………………………………... 155
Table 17
- Table of significance values between samples for the FSA
Explicit Measure ………………………………………………...
Table 18
156
- Table of significance values between samples for the
non-normed implicit scores ……………………………………...
158
Fig 1
- A screenshot of the congruent condition IAT …………………
22
Fig 2
- Graph illustrating explicit longitudinal data …………………...
89
Fig 3
- Graph illustrating implicit longitudinal data …………………... 90
List of Figures
9
Chapter One
Attitudes
An attitude may be defined as an internal affective orientation explaining an
individual’s action (Reber, 1995). An attitude is constructed of four components;
cognitive, affective, evaluative, and conative. The cognitive component refers to the
opinions / schema held about an object. The affective component refers to the emotion
or salience towards the attitude object. The evaluative component refers to the
direction of the feeling, whether the object evokes a positive or negative emotion.
Finally, the conative component of the attitude is the disposition for action (Maio,
Esses & Bell, 2000). It is the combination of these components that determines the
attitude held by an individual.
There are also several characteristics that define an attitude within the above
framework. First, an attitude is learned. Attitudes can be learned in many ways, the
most prominent being personal experience, observation of salient others and societal
influence. Each of the aforementioned methods exposes the individual to attitudes and
information about the attitude object, which they then appraise within their own belief
systems (and those held within society and salient in-groups) to form and update their
own opinions and attitudes (Ruys & Stapel, 2009). Second, attitudes are
predispositions. Attitudes are inclinations and tendencies for action, thus, an attitude
and its direction contain motivational qualities. If the attitude is such that the salience
towards the attitude object is high and the object is encountered, then be it negative or
positive, as long as the conative response is satisfied, an individual will act upon their
10
held beliefs. However, this is a predisposition and the association with behaviour is
not a causal one (Ruys & Stapel, 2009). Third, attitudes are consistent. This does not
mean that attitudes cannot be changed (discussed within the Ageism chapter, pp.48),
just that they have a consistency in expression and measurement over time and across
contexts. The way in which the attitudes are expressed may however change,
dependent on the social situation and on the pervasive attitudes of any salient others in
the same social setting1 (Krosnick, 1988). Finally, attitudes are directed towards an
object that is referred to as the attitude object. This does not mean to say that an
attitude is formed only with respect to a tangible item, but can also be a characteristic
i.e. attitude objects can be physical like cars or non-physical like sarcasm.
There are several theories of attitude formation, but two have become prominent.
These are the summation (Fishbein & Ajzen, 1974) and averaged (Anderson, 1971)
models. The summation approach argues that an attitude is the sum of evaluations
associated with salient outcomes of observed behaviours (Betsch, Kaufmann, Lindow,
Plessner, & Hoffman, 2006). Thus, the attitude (either positive or negative) is the
result of the total exposure to an attitude object / target. Using this approach, an
attitude can be equally strong if the salience and outcome are high but observed
infrequently, or if the salience and outcome are low but the frequency of observation
is high. This approach would appear to lend support to the mere exposure effect
(Zajonc, 1968; Auty & Lewis, 2004). This refers to the contact an individual has with
a particular attitude object. The more frequent the exposure or contact with the object,
the stronger the associated attitude becomes. The effect is observable for both positive
and negative attitudes and affects both explicit and implicit attitude formation and
1
social desirability and self presentation are discussed further within the ageism framework in the
Ageism chapter on pg. 48
11
maintenance. Another facet of the mere exposure effect is that unlike other methods
of acquiring information and behaviours, it is simply the exposure that builds the
effect and that there need not be any explicit reward or reinforcement.
In contrast, the averaged model proposes that attitudes are subject to a process of
normalisation. Thus, the attitude is formed from the average evaluations of the
attributes associated with an attitude object. Rather than the summation theory that
simply adds together all of the experiences, this theory posits that the direction of the
attitude is a reasoned average based on evaluations from each exposure. This theory,
unlike the summation approach, would incorporate outlier responses or opinions and
‘dilute’ them into the previously held knowledge about a certain attitude object. More
recently it has been established that there are, however, differences in effects of
different exposure types. Prestwich, Kenworthy, Wilson and Kwan-Tat (2008)
demonstrated that in terms of racist attitudes, exposure to the target group did indeed
alter the attitudes held. They found that the quantity of the contact improved an
individual’s implicit attitude and the quality of said contact affected the explicitly
expressed attitudes. This has also been shown to be the case more specifically in the
field of ageing. With an intergenerational study, Tam, Hewstone, Harwood, Voci and
Kenworthy (2006) illustrated the same pattern of implicit and explicit attitude change
based on quality and quantity of contact. This is important when considering that
implicit attitudes reflect spontaneous behaviour and explicit attitudes are predictive of
planned behaviour. In order to improve the implicit attitudes towards older people and
the resulting behaviour, it is important that there is a high quantity of planned quality
exposure and contact time.
12
In a review of the literature, Betsch, Plessner and Schallies (2004) argue that both
models are only applicable in certain circumstances, and an integrated model is more
appropriate. They called this the value-account model, which argues that implicit
attitudes are formed by summation and explicit attitudes by the averaged procedure.
Betsch et al. state that the model is applicable in any situation where the stimulus has
the potential to evoke an affective reaction. The model also takes into consideration
the four components of attitudes, explaining the salience and motivational aspects of
attitudes whilst centring on the cognitive evaluations made by the individual, and their
awareness of the process.
The value-account model (Betsch et al., 2004) appears to create an inclusive model of
attitude formation, stating that intuitive evaluative judgments reflect the total value of
prior encounters. But what of measures of attitudes themselves? Much of the existing
body of research is based on self report measures. These are typically Likert-style
questionnaires with positive and negative statements towards an attitude object (e.g.
smoking, racial issues, gender issues). These measures generally have high levels of
consistency and reliability. However, they only measure explicit attitudes whereas
attitudes can also be implicit as well as explicit. As defined by Greenwald and Banaji
(1995, p.8), implicit attitudes are ‘introspectively unidentified (or inaccurately
identified) traces of past experience that mediate favourable or unfavourable feeling,
thought or action toward social objects’. Conversely, explicit attitudes are defined as
‘consciously expressed actions, thoughts or feelings under the performer’s control’
(Greenwald & Banaji, 1995, p.8). Perugini (2005) demonstrated that implicit attitudes
are stable and enduring, allowing prediction of spontaneous behaviour after exposure
to unexpected stimuli. He also demonstrated that explicit attitudes were less enduring,
13
more malleable and predicted only planned behaviour. He believed that because the
two attitude types predicted behaviour at different times, they may in fact be
manifestations of a single root attitude. This research does not suggest that explicit
measures are incorrect, nor that the implicit measures are innately better. The research
emphasises that the ability now exists to collect data on both forms of attitude and as
such, allows collection of the complete attitude as opposed to one or other subset.
Explicit attitude testing uses self report measures and as such is prone to self
presentational bias (Goffman, 1959). When reporting information about oneself, an
individual is more likely to tell the other person: (i) what it is that they believe they
want to hear; and/or (ii) what will place the speaker in the most socially acceptable
light. Jones and Pittman (1982) observed self-monitoring and impression management
in self reporting measures. They demonstrated that when reporting details about
themselves, participants were careful about what information they volunteered and
monitored the answers given to provide a consistently positive view.
Explicit attitudes can be measured in several ways, including Likert scale self report
questionnaires, semi-structured interviews, and focus groups. The latter two methods
allow for further probing into answers and as such, by using a qualitative approach,
provide a deeper insight into proclaimed attitudes, but socially desirable rather than
truthful responding is still possible. These findings support the theory of reasoned
action (Fishbein & Ajzen, 1975) which posits that in addition to the individual’s
belief, an attitude is heavily influenced by the subjective norm. The subjective norm is
the belief that attitudes are often influenced by the expectations of others as well as
14
the individual’s desire to engage in actions that are favourably viewed by significant
others.
The other subset of attitude is implicit. This is different to the explicit attitudes as it is
not under the conscious control of the individual and as such is not as easily
measured, assessed or altered.
Implicit Attitudes
‘I cannot totally grasp all that I am… For that darkness is lamentable in which the
possibilities in me are hidden from myself: so that my mind, questioning itself upon
its own powers, feels that it cannot rightly trust in its own report’
St. Augustine, Confessions
Despite being written around 397AD the above quotation from the Confessions of St
Augustine could have been taken from work within social psychology of the 21 st
century. He suggests that there are parts of himself that he is not totally aware of and
that this in turn means that his self report (explicit attitudes) cannot be wholly
believed. From more recent works this idea has been expanded as understanding
grows and much more is understood about the implicit side to attitude formation and
expression.
Implicit attitudes are “introspectively unidentified (or inaccurately identified) traces
of past experience that mediate favourable or unfavourable feeling, thought or action
toward social objects”
Greenwald & Banaji, 1995 p.8
15
Greenwald and Banaji illustrate here that an implicit attitude may indeed reveal
thoughts, feelings and emotions that may normally be explicitly rejected as they
conflict with outwardly held values and beliefs. Alternatively, they may be hidden as
their explicit expression may have negative social consequences. More likely,
however, is that implicit attitudes reveal information which is not available to the
individual through introspection however motivated or able a person is (Wilson,
Lindsey & Schooler, 2000). An example of this can be seen in ageism. Where an
individual genuinely believes they are not ageist and outwardly expresses accepting
explicit attitudes, they may harbour negative implicit attitudes based on subtle
reinforces from their social interactions and environments.
Implicit measures by their very nature are not subject to the same shortfalls as explicit
measures. In part this is because implicit attitude measures are often relatively
opaque. By this it is meant that unlike explicit tests where it is often clear what is
being measured and what socially acceptable responses are, implicit tests are less
obvious. In addition, implicit measures assess automatic social cognition, and
participants are unaware of the causal underpinnings of their performance even if they
can guess that their performance was influenced by underlying associations. They
have been shown to be less biased by deliberate attempts to conceal the attitude and in
turn reflect the attitude which may indeed be unknown to the individual (Dovidio &
Fazio, 1992; Greenwald & Banaji, 1995). It is exactly this quality of the implicit test
that enables them to measure thoughts and processes outside of the conscious control
of the individual (De Houwer & Moors, 2007).
16
There are several types of implicit measure that have been developed, namely: the
Affective Priming Task where primes are introduced to assess the valence of
decisions and influence the evaluation of target concepts (Fazio, Jackson, Daunton &
Williams, 1995). The Implicit Association Test where response latencies are
measured for pairings between congruent and incongruent pairings of targets and
evaluations (IAT – Greenwald & Banaji, 1995). The Extrinsic Affective Simon Task
(EAST) which is similar to the IAT, however, in affective Simon studies, participants
are asked to choose between a positive or negative response on the basis of a nonevaluative feature of valenced words. For instance, they might be asked to respond
“GOOD” whenever a person word is presented and to respond “BAD” when an
animal word is presented (De Houwer & Eelen, 1998). Also there is the Go/ No-go
Association Task (GNAT) which is again similar to the IAT, however, the IAT
requires that an attitude toward one category (insects) be assessed relative to a second
category (flowers). With the GNAT, experimenters can vary whether insects are
evaluated in the context of a single category (flowers), a superordinate category
(animals), a generic category (objects), or with no context at all (Nosek & Banaji,
2001).
Nosek, Greenwald & Banaji (2007) conducted a review of research using implicit
measures in the seven years following the release of the IAT. They identified that
each test varied in different measures of reliability and consistency mainly depending
on the type of stimuli being used e.g. pictures, words and pairing categories. They
concluded that when no comparable opposite category to the attitude object can be
found e.g. attitudes towards television (single category assessments) the Go/No-go
association task or the Extrinsic Affective Simon Task provide superior results even
17
when compared to the IAT. When there are comparable categories (e.g. old/young)
the IAT provides results superior to the others in power, reliability, validity and
replicability. Some evaluative priming measures demonstrated weak internal
consistency with a split-half r = .06 (Olson & Fazio, 2003). The Go/No-go
Association Test (GNAT) has also demonstrated similarly weak reliability when
implementing its signal detection method (split-half r = .20; Nosek & Banaji, 2001).
The IAT, however, has observed split-half internal consistency scores consistently
recording r = .69 (Bosson et al., 2000). On average, the internal consistency estimates
for the IAT have been shown to range from .7 to .9 (Schmuckle & Egloff, 2004).
When looked at in direct comparison, the IAT significantly outperforms the EAST in
measures of reliability (EAST a = .19; IAT a > .75; Teige, Schnabel, Banse &
Asendorpf, 2004). It is clear from this that the IAT far outperforms other latencybased implicit measures and as such demonstrates far greater reliability.
In a review, Monteith, Voils & Ashburn-Nardo (2001) found the IAT to be different
from the other implicit measures in that participants were often aware of the
difference in time taken in responding to congruent and incongruent pairings. Their
results revealed strong implicit racial biases that were moderately related to explicit
prejudice but unrelated to proneness to discrepancies. By this it is meant that IAT
scores were moderately linked to the explicit measures but not to the differences
between what participants explicitly stated and their IAT scores. The majority of
participants detected this bias, and they felt guilty about it to the extent that they
attributed the bias to race-related factors. Participants with smaller discrepancies were
more prone to misattribute their IAT bias to non-racial factors and not feeling guilty.
These latter findings suggest that people who typically experience success at avoiding
18
prejudiced responses might, paradoxically, be least likely to detect subtle racial biases
when they do occur. Thus, the IAT not only allows researchers to assess implicit
biases but also gives participants the ability to ‘observe’ their own biases. Due to this
and other qualities discussed below, this study and review will centre on the IAT.
19
Chapter Two
The Implicit Association Test (IAT)
The IAT as developed by Greenwald, McGhee and Schwartz (1998) is a tool for
measuring the strength of associations between concepts of an attitude. By this it is
meant that response latencies are measured between category pairings within an
attitude object. In this case response latencies between categorisations of old and
young faces. When a score has been calculated (described below) then the strength
and direction of the association can be identified thus illustrating the strength and
direction of the attitude held.
The test involves sorting stimuli (words and/or pictures) from four concepts (two sets
of opposite concepts i.e. old/young and good/bad) using two response options, each
assigned two of the concepts. A representation of the IAT programme is displayed in
Table 1. The premise behind the IAT is that sorting stimuli in categories where the
concepts are more strongly associated will be quicker than those where the association
is weaker.
20
Table 1: A tabular depiction of the IAT programme
Block No. of Trials Items Assigned to Left Key Items Assigned to Right Key
B1
12
Old Faces
Young Faces
B2
16
Good Words
Bad Words
B3
28
Old Faces + Good Words
Young Faces + Bad Words
B4
28
Old Faces + Good Words
Young Faces + Bad Words
B5
12
Young Faces
Old Faces
B6
28
Young Faces + Good Words
Old Faces + Bad Words
B7
28
Young Faces + Good Words
Old Faces + Bad Words
The IAT requires participants to categorise target concepts with descriptors
representing positive and negative poles of an attribution dimension. When a pairing
appears between a concept and a congruent descriptor, mapping them to the same
response key is considerably easier than if the pairing is incongruent. An example of
which would be a quicker response time for pairing a picture of a young person into
the category ‘young/good’ rather than ‘young/bad’. It is also important to note that
there are equal numbers of congruent and incongruent pairings in each of the trail
blocks.
21
Fig 1: A screenshot of the congruent condition IAT
Figure 1 shows a screen shot taken from the IAT which illustrates the way in which
participants would see the categorisation options. The stimulus (picture of a young or
old face or a positive/good or negative/bad word) is presented in the centre of the
screen and the categories are static in the top left and right corners of the screen. The
example above is that of an old face presented in a congruent condition where young
and good are categorised together.
The response latency difference measures the extent to which positive and negative
evaluations are attributed to the target concepts. This is calculated by summing the
response times for the congruent and incongruent pairings and then taking the time for
the congruent pairings away from the incongruent condition. The larger the time
difference, the more negative the attitude is towards the target concept.
The IAT has been widely accepted in social psychology as a measure of implicit
attitudes. It is not however a tool used only within this field; it is a measure that has
been used in a variety of disciplines. It has been used in cognitive psychology where
22
the underlying constructs measured in implicit cognition are identified (Fazio &
Olsen, 2003). The IAT has been used in developmental psychology where implicit
pro-White/anti-Black bias was evident even in the youngest group, with self reported
attitudes revealing bias in the same direction. In 10-year-olds and adults, the same
magnitude of implicit race bias was observed, although self reported race attitudes
became substantially less biased in older children and vanished entirely in adults, who
self reported equally favourable attitudes toward Whites and Blacks (Baron & Banaji,
2006). Further it has been used in clinical psychology where the IAT was identified as
an accurate tool for measuring fear-related automatic associations (Teachman, Gregg
& Woody, 2001). Neuroscientists have also used the IAT where it was established
that even though amygdala activation to Black versus White faces is correlated with
performance on indirect measures of race bias, the amygdala is not critical for normal
performance on the IAT and as such expression of implicit attitudes (Phelps et al,
2000). Finally it has been used extensively in health psychology where strong implicit
anti-fat attitudes and stereotypes were demonstrated using the Implicit Association
Test, despite no explicit anti-fat bias (Teachman et al, 2003). It has also shown its use
in practical applications outside the spheres of psychology, most prominently in the
market research domain where IAT test results have been used to shape marketing
campaigns based upon the positive or negative associations by consumers (Maison,
Greenwald & Bruin, 2001).
These studies have illustrated that the IAT assesses internal constructs that are often
distinct from the corresponding constructs measured using explicit self report
measures. It is this distinction that has proven to be the IAT’s strength as it measures
the implicit cognition associated with those unidentified or unreported implicit
23
attitudes (Fazio & Olsen, 2003; Teachman et al, 2003; Baron & Banaji, 2006). It is
however, worth noting that the IAT does not set out to, or propose that it does,
measure the beliefs held by an individual. The IAT simply measures the associations
involved in certain beliefs and it is from these associations that indirect evidence is
collated for the presence of certain beliefs and attitudes (De Houwer, 2002). Equally,
it has been said that as the IAT measures ‘only’ associations, these measurements can
be reflections of societal exposure to stimuli and even if attitudes are reflected, it is
the societal attitude reflected, not that of the individual. De Jong et al. (2000) found
that the scores reported on an IAT for spiders were equally low for those people who
were fearful and for those people who were not. From this they concluded that the
negative association was a societal norm and not reflective of the attitude held by the
individual. What de Jong et al. failed to consider was that the level of fear was self
reported so could have been flawed, as well as the possible desire for some of the
participants to appear unafraid of spiders as this was what they believed to be
acceptable. Most results suggest that the IAT measures more than just societal views.
Banse et al. (2001) examined attitudes towards homosexuality in heterosexual and
homosexual men and women. Despite the report that there was a negative general
attitude towards homosexuality in 2001, they found that IAT scores of the
homosexual participants demonstrated a significantly more positive attitude than
those heterosexual participants. This, they concluded, demonstrates that the IAT
measures at least in part the attitudes of the individual rather than the societal norm.
The design of the IAT itself requires careful selection of the category labels that
define the concepts for measurement as well as of the stimuli materials. To ensure that
the test measures what it sets out to do, Nosek et al. (2007) outline the criteria that
24
must be addressed. The categories for each stimulus must be clear. If the stimuli used
exhibit characteristics for both of the categories then the participant might not
categorise the stimuli using the correct characteristic and as such the test would not
measure what it set out to.
The stimuli thus need to be distinctive. Each stimulus used must have a single
distinctive characteristic for categorisation and not allow for cross-categorisation
using different characteristics. As such it must be difficult to distinguish the two
categories of a single nominal dimension (e.g. men or women) using any other
characteristic except the nominal feature (gender). Therefore, controls are put in place
for attractiveness, gender, race, expression, age etc when using faces, depending on
what the measurement of the IAT is.
The IAT has shown to be a reliable test of implicit cognition with split half internal
consistency being reported where r = .69 (Bosson et al, 2000) and internal consistency
estimates consistently ranging from .7 to .9 (Greenwald & Nosek 2001). As already
noted, these figures are more impressive when taken in the context of alternative
latency-based measures where Fazio and Olson (2003) report r = .06 and Nosek and
Banaji (2001) report r = .20 for the Go/No-go test. Further to this, Schmukle and
Egloff (2004) conducted a thorough test of internal consistency and test-retest
reliability. They concluded that the IAT demonstrated satisfactory test-retest results (r
= .56) and showed evidence of both trait and occasion specific variation. In a recent
review of existing literature, Perugini (2005) has illustrated that the IAT has shown
consistently high internal consistency scores (α = 0.80). In addition to this he also
25
highlighted the fact the IAT has consistently given reasonable test-retest values (R =
0.60).
The IAT has also been shown not to be susceptible to several possible confounding
extraneous influences which have been criticisms of other implicit measures.
Greenwald et al. (1998) highlight the fact that whether a category is assigned to either
the left or right response key, the results show very little difference. This is also
supported by Greenwald and Nosek (2001) who identified that it made no difference
to response times and subsequent results whether the participant was either left or
right handed. It is however of note that best practice adopts the procedure of
counterbalancing as a failsafe to prevent this as a variable for any individual study.
The IAT is often delivered in tandem with an explicit measure either for comparison
or for a combined result. One possible influence is the delivery order of measures. In
a meta-analysis of IAT studies, Hofmann et al. (2005) found that there were no order
effects observed.
There are three variables which have been proved to influence the first version of the
IAT. These variables are: cognitive fluency, participant age and IAT experience.
Greenwald et al. (2003) developed the improved algorithm (as detailed in the thesis
methodology) called the D-measure which overcame each of these variables or at
least reduced their effects. Cognitive fluency is a phenomenon where those
participants who perform the task more slowly overall tend to show a higher IAT
effect (either positive or negative). Those slower responders have higher raw scores
on all of the measures (congruent and incongruent), resulting in larger overall scores
which can exaggerate effects. By using block means and standard deviation
26
calculations Greenwald et al. (2003) demonstrated that this effect can be minimised.
Similarly, older participants tend to show larger IAT response times which can again
be reduced and the results made more comparable when using the D Score calculation
(Greenwald et al, 2003). Greenwald and Nosek (2001) identified the decline in effect
magnitude with repeat administration of the IAT. When using the D Score this effect
also decreases, however this is one extraneous variable that should be considered if
using multiple IATs in a single session or repeated measures IAT over a short period
of time.
Nonetheless, the IAT is a robust measure of attitude. For example, it is difficult to
fake, in part because automatic responses are a key part of the participant response
and these are hard to control. For example, Kim (2003) tested the controllability of the
IAT in two studies using racism as the measure and flowers and insects as a control.
He found that in both cases the results from the IAT could not be controlled / faked
even if under instruction to do so. Kim demonstrated that the only way to control
answers was to be told how to do so (responding slowly to a subset of the stimuli). He
also identified that even after multiple trials, participants did not spontaneously
discover the strategy for controlling their responses. From this he concluded that the
IAT was a robust measure, and is clearly more so than explicit measures which have
been shown to be susceptible to self presentational bias as well as capturing more
subtle biases that may be undetectable using self report measures (Dasgupta et al.,
2000). These findings have been supported by Banse et al. (2001) who identified that
the IAT could only be reasonably ‘controlled’ by participants upon instruction on how
to do so and with multiple exposures to the IAT format. It can further be argued that
as the IAT often reveals associations not explicitly endorsed by participants that it is
27
resistant to deliberate alteration and manipulation. This point is demonstrated by
Nosek (2002) who demonstrated that many white participants showed a consistent
implicit preference for black relative to white despite the explicit desire not to do so.
To cement this point, the same study also showed that many of the black participants
do not show implicit preference for black relative to white despite the explicit desire
to do so. Nosek et al (2007) further posit that as IAT measures are often so weakly
correlated to explicit attitude measures it is likely that deliberate faking is not a
substantial issue under typical study conditions.
Predicting Behaviour
The IAT has been shown to be a valid and reliable measure of associations and from
that an indicator of relative implicit attitudes held. This in itself is a useful tool for
measuring and assessing the attitudes held by individuals, groups and the wider
society. However, how predictive of behaviour can IAT results be? Steffens, Schulze
and Konig (2006) used IATs to measure the ‘Big Five’ personality traits and tested
the IAT’s ability to predict spontaneous behaviour. They tested participants using
both implicit and explicit measures and found that IATs were predictive of
spontaneous behaviour where explicit measures were not. They also identified explicit
measures as being related to self ratings or behaviour where IATs were not.
These results can be explained when the processes behind the behaviour are examined
further. Automatic processes are based on an associative network that operates in a
fast, effortless and unintentional manner where controlled processes are in contrast
based on higher order mental processes of reasoning that influence behaviour in a
slower more intentional way (Evans, 2008). The opportunity and motivation to
28
control behaviour can mediate the amount of automatic and controlled process for any
behaviour. As controlled processes are time and resource intensive they will only
guide behaviour if the opportunity is given and if the individual is sufficiently
motivated to do so. If there is the absence of either opportunity or motivation,
automated processes will have a greater impact. As implicit measures assess
automatic processes, they should be successful in predicting behaviour to the extent
that automatic processes drive behaviour. As controlled processes are able to override
automatic processing, the predictive validity of implicit measures will decrease as
motivation and opportunity increase. Linked to the cognitively demanding nature of
controlled processes, those individuals with a higher working memory capacity
(WMC) should be better at overriding their automatic processes even in high demand
situations. Thus, the predictive validity of the IAT would be lower in these
circumstances. Barrett et al. (2004) similarly found that those with higher WMC were
more successful in enacting controlled goal-directed processing than individuals low
in WMC. It can therefore be suggested that those with higher WMC are able to
moderate the predictive ability of the IAT and other implicit measures but not the
attitude/associations that they measure. However, this said, the moderation can still
only occur when there is the motivation, opportunity and sufficient WMC, otherwise
the automatic processes return and the associated behaviour can be observed.
Another personality trait that can moderate the predictive ability of the IAT is control
over non-verbal behaviour. Controlling non-verbal behaviour is more difficult than
controlling verbal behaviour as it is an automatic response not requiring conscious
processes. However, control over these processes is not impossible (DePaulo, 1992).
Indeed, whereas most people are unaware of their body language, there are those who
29
are more aware and have become practised at controlling these cues (Dasgupta &
Rivera, 2006). From this it can also be implied that in addition to an individual’s
WMC, the more aware and higher the person’s ability to control their non-verbal
behaviours, the less predictive of non-verbal behaviour the IAT becomes.
Further to these individual traits, the following situational moderators also affect the
predictive ability of the IAT - cognitive capacity, processing time and alcohol
consumption. Cognitive capacity refers to the finite amount of processing capacity. If
there is increased cognitive load from multiple drains on the capacity, the influence of
controlled processes on behaviour will decrease and consequently the automatic
processes which are less susceptible to capacity constraints will increase. This has
been demonstrated succinctly by Friese, Hofmann and Wanke (2008) who conducted
a study using self report measures and IATs for chocolate and fruit. Half of the
participants were instructed to remember a one digit number (retaining their cognitive
capacity) and the other half were instructed to remember an eight digit number
(reduced cognitive capacity). Following the tests, participants chose either 5 pieces of
fruit or chocolate as their reward for participation. The IAT as expected predicted the
choice behaviour well for those people whose cognitive capacity had been diminished
and the explicit measure was predictive for those who retained their cognitive
capacity.
Processing time refers to the time available in which to process the information, make
a decision and act upon it. Similar to cognitive capacity, the shorter the time available
the increased cognitive demand and the more reliance on time and memory saving
strategies. Schemas, stereotypes and more easily available cues are used to make
30
decisions on behaviour than if under unconstrained conditions (Dijker & Koomen,
1996). When the available time is decreased the opportunity to engage in controlled
processing also decreases and as such it would be expected that the IAT would be a
better predictor of behaviour when the participant is under time constrained
conditions and reliant on automated processes rather than when no time pressure is
applied. This has been demonstrated when Friese, Wanke and Plessner (2006) found
that when placed under time constrained conditions, more than 60% of participants
followed their implicit preference as shown using an IAT. Conversely when no time
pressure was applied they found nearly all of the participants behaved as expected
from their explicit measure.
Finally, alcohol consumption also affects the predictive ability of the IAT. Alcohol
impairs functioning across many domains including working memory, attention and
self regulation (Giancola, 2000). That said, it has been shown that despite affecting
controlled processing, it leaves automatic processing largely unchanged (Fillmore et
al, 1999). From this it can be hypothesised that the IAT would be a better predictor of
behaviour for those individuals who have consumed alcohol when compared to those
who have not. Hofmann and Friese (2008) measured eating restraint using both
implicit and explicit measures using both participants who had consumed alcohol and
those who had not. They found that those who had consumed alcohol followed the
pattern of eating behaviour predicted by the IAT whereas those sober participants
were more likely to follow the predictions from the restraint questionnaire.
Thus, empirical evidence suggests that opportunity, motivation, situational and
individual factors all play a role in the predictive validity of the IAT. Each of these
31
factors can be linked to the central executive and how its impairment of function leads
to greater predictability using the IAT. The central executive is responsible for the
distribution of cognitive resources and information processing (Baddeley, 1996) and
to fulfil these functions must harness controlled processing. Time constraints, alcohol
consumption, low capacity etc are drains on the central executive and as such impair
controlled processes where automatic processes remain unaffected (Baddeley, 1996;
Fillmore et al, 1999; Hull & Sloane, 2004). Implicit measures will primarily predict
behaviour under conditions of low opportunity or motivation to control cognitive
processes (Friese, Hofmann & Schmitt, 2009). It is the lack of conscious control that
underpins spontaneous, unplanned behaviour that gives the IAT high predictive
validity in this area. It is in the area of planned behaviour when the individual is able
to and motivated enough to control their processes that explicit measures provide a
better predictor of behaviour.
The reason why the IAT is more successful than other implicit measures at predicting
this spontaneous behaviour is the dissonance caused by switching between congruent
and incongruent conditions and the increased time lag associated with the latter due to
increased cognitive load. When compared to its closest ‘rival’ (Extrinsic Affective
Simon Task – EAST), De Houwer and De Bruycker, (2007) concluded that the IAT is
a better measure of inter-individual differences in attitude than the EAST. This is an
especially pertinent point when considering that De Houwer was the psychologist
responsible for the construction of the EAST. This they concluded when analysing
consistency, reliability and predictability of future behaviours.
32
However, it is also important to note the main limitations of the IAT. Further to the
fact the IAT predicts only spontaneous rather than planned behaviour, the IAT is also
malleable in that it can be influenced by indirect means. Foroni and Mayr (2005)
demonstrated that by using a priming story, the IAT effect could be shifted and the
results changed. By this, what is meant is that participants’ attitudes could be changed
on the IAT if they were first presented with positive or negative priming stories for
the attitude object. This they found to be more effective than explicitly telling the
participant deliberately to alter their results. This should not cause problems in
controlled conditions but where additional stimulus material is presented even in the
form of an explicit tool with positive and negative statements, measures should be in
place to prevent this becoming an extraneous variable. To this end, the studies in this
thesis will present the explicit measure after the completion of the IAT so that the
implicit measure cannot be coloured.
In summary, the usefulness of the IAT is due to a number of factors: resistance to self
presentational bias (Egloff & Schmuckle, 2002); its adaptability to numerous forms of
concept measurement (Greenwald & Nosek, 2001); and its lack of dependence on
introspective access to the association strengths being measured (Greenwald et al.,
2002). Because of these, the IAT can be used as a flexible yet powerful measure of
implicit attitude. This flexibility gives researchers the opportunity to access implicit
attitudes and stereotypes over numerous categories, overcoming some of the
limitations presented by using self report methods.
33
Chapter Three
Prejudice
So far our focus has been on attitudes. However, although attitudes are central to the
formation of prejudicial thoughts and ultimately treatment, it is arguably the
stereotypes derived from attitudes that are the key factor in shaping behaviour. Eagly
and Diekman (2005) highlight role incongruity as the basis for prejudicial behaviour.
They propose that prejudice itself derives from the dissonance between beliefs about
the stereotyped attributes associated with a group and the beliefs about the attributes
that allow success in valued social roles. Prejudice is as the name suggests the process
of pre-judging a particular object (person, place or thing) by one or more of its
characteristics. It implies the arrival at a judgement before sufficient evidence has
been gathered. Nowicki (2008) presents prejudice in a similar manner to that of an
attitude in that it can be broken into component parts; cognitive, affective and
conative. Cognitive prejudice refers to the belief that an individual holds, that a
certain opinion or attitude is correct and true. Affective prejudice describes what the
individual likes or dislikes. Conative prejudice is similar to the conative component of
attitude, in that it refers to the propensity of the individual to act on their prejudice. It
is the inclination or predisposition and direction of action that it is aimed to measure
when assessing the attitudes held by an individual. Psychologically, these components
can be drawn together succinctly to define prejudice as:
“…the holding of derogatory social attitudes or cognitive
beliefs, the expression of negative affect, or the display of
34
hostile or discriminatory behaviour towards members of a
group on account of their membership to that group”
(Brown, 2001, p.8)
This highlights the fact that prejudice is the social orientation towards either a whole
group of people or towards individuals due to their belonging to a certain group.
Indeed, when judgements and assertions are made about certain social groups, the
person making the assertion is using one or more social categorisations as a starting
point to infer attributes towards the people in question. It is this process of social
categorisation that is so central to the operation of prejudice. Indeed Allport (1954)
argued it is the condition without which prejudice could not exist. Although central to
prejudice, categorisation is a process that occurs not only in unusual circumstances
but as Bruner (1957) posited, is an integral part of human existence.
Social categorisation is a useful phenomenon as it allows for the grouping of similar
characteristics enabling the world to be processed in a less arduous and more efficient
way. We do not have the processing capabilities to assess each characteristic
belonging to each person and object that we come across in our daily lives. As such
we rely on these grouping and categories to ease cognitive load. Put succinctly,
“…categories are nouns that cut slices through our environment” (Allport, 1954,
p.174).
In order for categorisation to work, however, there must be clear distinctions in the
characteristics held by each of the groups. This is also the basic premise behind the
formation of prejudice. As the categories help us to order and simplify groups of
35
stimuli/people, they also aid in the discrimination between those who do and do not
belong. Tajfel (1959) defined the formation of prejudice through categorisation,
creating two hypotheses regarding the consequences of this categorisation. First, he
stated that when a category is created which incorporates a set of stimuli (be they
objects or people etc.) which cause some of the stimuli to fall into either one group or
another, this will enhance any pre-existing differences between the two categories.
Second, as an extension to the first hypothesis, he stated that members of different
groups will be seen as more different from each other than they may truly be, with
members of the same group appearing more similar and therefore exaggerating
differences. Both facets of this were illustrated by Eiser (1971) who asked
participants to judge the permissiveness of a series of attitude statements concerning
recreational drug use. In the experimental condition, half of the statements were
attributed to one newspaper and half to another, whereas in the control group only
one source was stated. The perceived difference between the permissive and
restrictive statements was significantly greater in the experimental condition. This
finding clearly illustrates the importance of the relatively arbitrary assignment of
categories. McGarty and Penny (1988) used a similar design and repeated the
findings for both category differentiation and assimilation within groups. More
recently, in a meta-analysis of categorisation literature, Bigler and Patterson (2007)
highlight the importance of in-group bias as well as implicit attributions in the
development of stereotypes and prejudices towards and for salient social groupings.
Social categorisation and intergroup discrimination were demonstrated in a striking
way by Tajfel, Flament, Billig and Bundy (1971). The aim was to establish whether
simply belonging to a group might be enough to initiate behavioural prejudice
36
(establishment of in-group and out-group behavioural differences). It was during
these experiments that the researchers established the Minimal Group Paradigm
where the only difference known to the participant was that of the arbitrary grouping
with no categorical contexts. They found that over 70% of participants made choices
that favoured their own group as well as identifying the adoption of the ‘maximising
difference’ strategy (Turner, 1983) where intergroup differences are maximised often
to the detriment of the out-group. Similar results were reported by Sturmer, Snyder,
Kropp and Siem (2006) when looking at in-group empathic concern. They found
support for ‘in-group helping’ whereby helping behaviour was initiated for the
members of a perceived in-group and not the out-group members. Moreover, the level
of in-group empathy was directly linked to the level and salience of perceived
similarities of in-group members. These findings are important as they clearly
demonstrate the cognitive processes behind prejudice formation and the apparent
normalisation of this process. It is important to note, however, that personality
perspectives of prejudice formation (conative and affective) are more useful in
explaining the extremes forms of prejudice, a point covered later.
Addressed above are the results of categorisation along one domain (e.g. Old/Young,
Male/Female, British/Non-British). From a theoretical perspective what happens
when the activation of two of these domains is present and people span categories
making them partly in-group and partly out-group dependant on the dimension
observed? Doise (1976) argues that when two categories cut across each other (e.g.
age and gender) any difference in initial categories will be reduced because of
simultaneous between- and within-group effects on both dimensions. Essentially, the
processes of assimilation and differentiation should cancel one another out, reducing
37
or removing bias in terms of either age or gender. This theoretical finding has been
explored and supported on numerous occasions (Brown & Turner, 1979; Diehl, 1990;
Vanbeselaere, 1991; Pickett, Silver & Brewer, 2002). These results, however
interesting in the laboratory, could potentially provide significant inroads to reducing
prejudice in the real world. They seem to suggest that if situations can be arranged so
that two or more dimensions cross one another, the likelihood of prejudice between
groups being persistent is reduced. But is this the case when tested outside the
laboratory?
When tested in a real world environment, this model does not seem to work as well as
with basic laboratory-based concepts. The salience of one of the crossed categories
tends to take precedence over the other so that an equilibrium can be reached over the
incongruence caused by no clear cut in-group/out-group category. In essence this
means that one of the crossed categories has higher salience and to resolve any
disequilibrium, it is this category through which discrimination and group
categorisation occurs. Hewstone, Islam and Judd (1993) demonstrated this where the
crossing groups were religion (Muslim/Hindu) and nationality (Bangladeshi/Indian).
In this as with other similar studies (Brewer, Ho, Lee & Miller, 1987), if people were
seen to be sharing the same religion, they were always evaluated in a more positive
light. If the person did not share the same religion, regardless of nationality or
language spoken, they were always rated significantly lower. Similar findings were
also reported by Kang Fu (2007) who identified cultural salience as the overarching
mediating factor in inter-race/cultural/religion/class marriages in the USA. These
studies demonstrate that unlike in the laboratory, category salience is dependant on
38
the locale and the cross category encountered which in turn influence the evaluation
of in-group and out-group members.
Two fundamental aspects of the categorisation process are the exaggeration of the
intergroup differences and the enhancement of intragroup similarities. When looking
at everyday situations such as sporting clashes it is surprisingly the out-group
homogeneity that is emphasised rather than that of the in-group. For example,
Hamilton and Bishop (1976) observed the categorisation of ethnicity in these terms.
When speaking to residents of communities in America into which new families
moved, they found that six months after the new family moved in, only 11% of the
community knew the surname of the new family if they were black compared to 60%
if they were white. The remaining 89% referred to the new family as “the blacks”
with no distinguishing characteristics, whereas the white family were perceived more
individually. Similarly, Hutchinson, Jetten, Christian and Haycraft (2006) found that
higher in-group identifiers presented with a homogeneous in-group perceived more
in-group homogeneity when their group was under threat than did low identifiers.
This has also been found in the field of gerontology where, when questioned, both
residents of an older persons’ residential home and members of a younger student
group each rated the other’s age group as more homogenous than their own (Linville,
Fischer & Salovey, 1989). The process of out-group homogeneity is, however, not
universal. Brown (2001) emphasised that out-group homogeneity is observed when
the in-group is not just larger but is not a minority group. When minority groups were
observed, in-group homogeneity was significantly more salient and reported as such
by members. This is not to suggest that group size is the factor at play (Bartsch &
Judd, 1993) but instead that those in minority groups identify more strongly with their
39
in-groups than do members of less salient larger groups. An example of this would be
the BME communities within larger cities where their cultural background as a
minority is more salient than the sense of ‘Britishness’ is for the larger general outgroup population. The reason for this is that when in the minority, people strive to
make themselves more similar to their conception of when stereotypical in-group
member should be (Turner, Hogg, Oaks, Reicher & Wethrell, 1987).
In sum, it is fundamental for people to categorise due to the size and complexity of
the daily information processed. One outcome of this categorisation process is the
accentuation of intergroup differences and the reduction of intragroup differences,
both of which affect both evaluation of the out-group and intergroup perceptions,
attitudes and behaviour. When two or more of these categories cross, in a real world
environment, the more salient category is dominant. Once categorisation has
occurred, intergroup differences are accentuated with homogeneity dependent on the
minority status of the in-group. It is the salience attributed to the in-group
membership and often stereotyped differences between categories that determine the
basis for prejudice.
Stereotypes
Stereotypes are the belief that members of the same group indeed also share a certain
attribute. This assumption arises directly from the categorisation process through the
assimilation of in-group differences and as such the promotion of out-group
homogeneity. A cultural example of this can be seen in football supporters where
followers of a particular team will assume a group identity and norms differentiating
themselves from supporters of rival teams. Further to this they will also attribute a
40
different set of characteristics to the out-group supporters to further differentiate
themselves. Allport (1954) identified some key ways in which stereotypes were
formed simply through the way in which we are raised within our culture and
environment. He identified family socialisation, exposure to images in books,
television and newspapers as key contributing sources for potential prejudicial
stereotypes. Obviously in today’s world, the Internet and seemingly barrier-less
technology all feed into the process of stereotype formation (Kvieskaite, 2007).
Devine and Sherman (1992) propose an alternative to this view in that attitudes are
formed to serve an ideological function. It is in this function that they justify the way
in which certain groups of people are treated and endorse the dominant group’s right
to its privileged position. Both of these viewpoints suggest that stereotypes are not
only rooted in the cognitive processes of the individual but moreover are integral to
social constructs. Further to this, it has also been identified that stereotypes can be
formed from a cognitive bias, resulting in a perception-based correlation between
minority groups and infrequently occurring attributes (Stroessner, Hamilton &
Mackie, 1992; Rupp et al., 2005). The reason for this being adopted as a stereotypical
attribute of the minority group is due to both a categorical distinctiveness process
(increasing the in-group/out-group difference) and the distinctiveness of the attribute
occurring. An example of this would the perception of increased crime rates attributed
to members of BME communities in otherwise Caucasian majority areas.
So when do stereotypes become activated and when do they influence our behaviour?
Darley and Gross (1983) concluded that we use stereotypes not indiscriminately, but
rather we use them to create a platform from which we then seek out further
information. It is in the absence of additional information that we apply these
41
stereotypes, however hesitantly we may do this. It has been shown that the use of
stereotypes (especially gender) do affect people’s judgements even when additional
information is presented about the individual character of the person being judged
(Glick, Zion & Nelson, 1988). It has further been shown that both of these hypotheses
can be correct in that people tend to use the stereotype as a platform on which to base
their assumptions of a person. However, rather than seeking information generally
about the person, information is sought to confirm the stereotype rather than to cast
doubt on it (Stangor & Ford, 1992). There is still the ability, however, for individuals
to search for information to contradict the stereotype (Macrae, Millne &
Bodenhausen, 1994). As discussed previously the use of stereotypes, as with other
heuristic techniques, allow for increased processing capacity of other information
presented simultaneously. Linked to this, it has also to be considered that stereotype
use will also increase if people are cognitively or emotionally preoccupied with other
concerns. The reason for this is the inverse to that presented by Macrae et al. (1994) in
that these distractions create a higher cognitive load thus making it more efficient to
employ labour-saving stereotypes (Brown 2001). Further to this, Huntsinger, Sinclair,
Dunn and Clore (2010) identify not only emotional preoccupation but positive mood
state as a greater predictor of stereotype activation.
When observing stereotypes rather than influencing them, they can be used to make
sense of both in-group and out-group behaviour. Ross (1977) proposed the notion of
‘fundamental attribution error’ which states that people assume internal causes for
others behaviour but external causes for their own. Pettigrew (1979) expanded this
theory including group phenomenon to the ‘ultimate attribution error’. This posits that
negative behaviour by out-group members will be attributed to internal causes
42
whereas those behaviours by in-group members will be rationalised by external
influences. Similarly, when the out-group expresses positive behavioural traits it will
be seen as the exception that proves the rule instead of in-group members where it is
seen as an in-group characteristic. Ultimate attribution error has been shown in a
research setting by Beal, Ruscher and Schnake (2001) whereby they demonstrated
that subsequently presented mitigating explanations for negative acts did not temper
impressions of out-group members, and subsequently presented crediting explanations
for positive acts did not enhance impressions of out-group members. Brown (2001)
highlights from this that the more abstract a general stereotype construct is, the more
resistant to change in the light of new information it may be, whereas concrete
representations are more easily disconfirmed by one or two contrary instances. He
further explains that positive in-group and negative out-group stereotypes lean
towards abstraction whilst negative in-group and positive out-group images are
usually more concrete. From this it has to be of concern how negative stereotypes can
be addressed and changed.
Stereotypes can be changed through the presentation of contradictory information, but
how that information is presented (concentrated examples or sporadic) and the
affective nature (positive or negative) of the stereotype undergoing change are
integral factors to the extent and level of success of the modification. A growing body
of research (Allport, 1954; Cook, 1962, 1978; Pettigrew, 1979; Stephan & Stephan,
1984; Paolini, Hewstone, Cairns & Voci, 2004; King, Winter & Webster, 2009) has
shown that contact between groups can alter stereotypes and reduce prejudice
provided that it takes place under certain conditions.
43
The first of these conditions states that there should be a framework of social and
institutional support for the interventions designed to facilitate contact (Allport,
1954). By this it is meant that those in authority (actual or perceived) should
demonstrate unwavering support for the goals of the intervention. In doing this,
people are encouraged to act in a non-discriminatory way that should eventually lead
to them internalising these behaviours into their own attitudes. Festinger (1957) posits
this is because most people have a need to bring into line both their behaviour and
their beliefs so as to alleviate any possible dissonance.
The second of these conditions refers to the acquiescence potential. For contact to be
successful, it needs to be of sufficient frequency, duration and closeness to facilitate
meaningful relationships to develop between members of the groups concerned. As
Cook (1978) highlighted, this can be in stark contrast to the short burst of casual
contact in many intergroup contact situations.
Third, it is necessary for the two groups to meet where both are considered to have
equal status. Many of the stereotypes of out-groups are held as they are considered
lesser or inferior in a multitude of different ways. If, when meeting, this unequal
status is maintained then the likelihood is that existing negative stereotypes for both
groups will be strengthened rather than weakened (Blanchard, Weigel & Cook, 1975).
The final condition identified by Allport (1954) was that of co-operation. This follows
on from realistic group conflict theory (Sherif, 1954). Members of different groups
are dependent on one another for the achievement of a jointly desired goal and as such
must co-operate towards this from a unified platform. Ultimately, any solution to
44
reducing prejudice must be through minimising the destructive potential of division
maintenance whilst still allowing each of the groups to maintain their distinctive
identities.
Recent research (Tam, Hewstone, Harwood, Voci & Kenworthy, 2006; Prestwhich,
Kenworthy, Wilson & Kwan-Tat, 2008) has shown that this is not such a
straightforward process. Both studies have found that direct contact does indeed affect
the attitudes held. However, they have established that the perceived quality of the
contact affects the explicit attitude held where the quantity of contact is that factor
affecting the implicit attitudes expressed.
Some research on prejudice indicates a change from blatant to more subtle forms of
prejudice from the fear of reprisal as social norms change towards what might be
loosely termed ‘political correctness’ (Gaertner & Dovidio, 1986; McConahay 1986).
Specifically, with little conscious awareness or intent on action, individuals’ negative
associations that are consciously renounced can be rekindled and used as a benchmark
for responding to members of a stereotyped group (Bargh, Chen & Burrows, 1996;
Devine, 1989; Fazio, Jackson, Dunton & Williams, 1995; Greenwald, McGhee &
Schwartz, 1998; Legault, Green-Demers & Eadie, 2009; Mendoza, Gollwitzer &
Amodio, 2010). Now that these negative attitudes have been internalised and become
implicit, the attitude holder may indeed no longer be immediately aware that they
hold these attitudes. It is with the lack of conscious awareness that the negative
attitude now becomes the basis for unplanned responses to the attitude target. This
phenomenon can be observed with ageism in that the explicit bias is not expressed,
however, behaviour and language used precipitates the negative stereotypes
45
assimilated. This has been highlighted as a more dangerous form of prejudice as even
those outwardly expressing the best of intentions have difficulty trying to avoid
negative responses that are generated by implicit processes (Bargh, 1997). Since the
advent of the IAT, it has been possible to accurately measure the implicit attitudes
held by individuals. It is this technique that has led to the belief that racial prejudice is
in fact no less prevalent than it was in the 1940’s even if it is not explicitly expressed
(McConahay, 1986, Devine & Monteith, 1999).
Monteith, Voils & Ashburn-Nardo (2001) conducted a study with 79 participants
using both implicit (IAT) and explicit (Modern Racism Scale and a 32 point
discrepancy questionnaire) measures. The majority of their sample exhibited negative
implicit racial attitudes that were only moderately linked to their explicit measures.
They have suggested that this may not only show that the participants have negative
implicit attitudes but also that they either control their explicit attitudes to appear
socially acceptable or (as the discrepancy measure indicates) that the majority are
unaware that they harbour negative attitudes. The gulf between implicit and explicit
measures has also been highlighted by Fazio & Olsen (2003), who concluded that
implicit and explicit measures each report aspects of attitude that are unique and
interact as a predictor of behaviour in any given setting. By this they meant that both
measures of implicit and explicit attitudes are valid in so much as they measure
distinctly different concepts. It is only when combining data on both subsets of
attitude (implicit and explicit) that a holistic picture of attitudes can be obtained. This
is a troubling finding when it is recalled that implicit attitudes have been shown to be
accurate predictors of spontaneous behaviour and the explicit measure only as a
predictor of conscious deliberate behaviour (Perugini, 2005). Both points keenly
46
demonstrate the need to address not only one aspect of attitudes held but for
researchers to be mindful of both before conducting research and disseminating
findings.
47
Chapter Four
Ageism
In order to examine how realistic stereotypes of ageing are, we need to investigate
and identify what ageing constitutes. Sonnenschein and Brody (2005) predicted that
by 2050 almost 50% of the population will live past 85, whereas in 1900 only 25%
could expect to reach 65. The picture illustrated suggests that the average life
expectancy has and will continue to increase albeit at a diminishing rate. Despite
prejudice often being a largely irrational, with regard to older people some of the
prejudice can be based in biological and observable declines. There are both physical
and psychological losses associated with ageing, a fact that is universally accepted.
From a psychological point of view the key losses are associated with memory and
brain function. The subsets of dementia affect many older people but are not
necessarily associated specifically with ageing or indeed with affecting all older
people and as such will not be covered. One of the main areas of decline both studied
and associated with older people is that of intelligence. Intelligence is generally seen
as declining in later life. What truth is there in this? It should be stated at the outset,
that on most measures there is evidence for a decline, but the key question is the size
of this decline.
‘We are ... in the unpleasant and illogical condition of
extolling maturity and depreciating age’
Dewey’s paradox of ageing (Dewey, 1939, pp.4)
48
The problem with ageing is that societally it is seen as being simultaneously a time of
wisdom and a time of stupidity. Looked at more closely, what we are saying is that
people believe older adults are wiser and more knowledgeable, but that they are
slower and less efficient at dealing with the new and/or when they have to think on
their feet. Horn and Cattell (1967) identified an age related decline in fluid
intelligence (problem solving) whereas crystallised intelligence (facts) remained
stable. It is worth noting, however, despite the fact younger people do significantly
better than older people at fluid intelligence tests, fluid tests are generally against the
clock whereas crystallised tests have no time limit so people can take as long as they
like to produce their answers. In addition to this, it is the lack of practice of mental
skills causes the neural systems to deteriorate through lack of use rather than
specifically the ageing process (Stuart-Hamilton 2006).
When referring back to Dewey’s Paradox it seems that there is some truth in the
commonplace observation that old age brings wisdom at the expense of a loss of wit,
but the size of this change is open to debate. But the above points are still academic in
nature because should it or does it matter if in older age you are unable to analyse
problems in the same way as younger people? Should it or does it matter if you are no
longer able to remember what a Lammergeier is? To most people these things are not
important and to purpose that they are because they are important to ourselves takes a
narrow view of society. Klaczynski and Robinson (2000) demonstrated that older
people shift more to heuristics rather than addressing each problem as novel as a way
of coping with everyday tasks. It is in solving problems in everyday life that predict
49
an older person’s everyday functioning better than any traditionally used
psychometric test (Allaire and Marsiske, (2002).
In addition to cognitive declines, there are also agreed physical declines associated
with ageing. Vision is something often taken for granted as we go through life but
about 33% of people aged 65+ have one or more diseases relating to their eyes and
vision (Quillan, 1999). The most common decline is the inability to focus at different
distances due to the lens in the eye losing some of its elasticity. However, despite
observing the marked acuity decline associated with age, Corso (1981) noted that the
problem could be alleviated to that of a younger adult if visual displays had high
contrast in luminance (black writing on white display).
Similar to that of visual deterioration, auditory decline has been linked to ageing
throughout the adult lifespan too with people as young as 50 being impaired in at least
some circumstances (Bromley, 1988). Research has identified that of those people
aged 70-80, 32% would have serious hearing impairment but further, of those aged
over 80, 50% would have severe auditory impairment (Herbst, 1982).
It is clear that both physical and psychological changes occur as one enters later life.
What is generally believed and what forms the basis of stereotypes and societal norms
might at times be at variance with this. Ageism appears to have a base in
physiological and psychological fact, however, little or no account is taken of the
compensation method adopted by older people to minimise the effects of age related
loss. Similarly little importance is placed on the positive aspects of ageing which are
similarly integral to an older person but counter the existing accepted heuristics and as
50
such are often overlooked or cast aside. From these disparate viewpoints, a legitimate
question arises in whether the objective views of ageing (which are generally
negative) are therefore likely to cue negative attitudes in students who take ageingrelated courses. This is a distinctly under-researched area but one of great importance.
If attitudes become worse the more educated a person becomes in the field of ageing,
what does this say for the state of care for older people? What has to also be reflected
on is whether these negative views of ageing are necessarily ‘wrong’ since the wealth
of objective evidence is generally negative. With old age inevitably leading to some
degree of cognitive and physical decline, is it not warranted to view old age in a
negative light especially when compared to youth? This thesis examines in detail both
the effects of specific and general higher level education on attitudes towards older
people. Amassing a research base for training and policy decisions in this area is
crucial in the delivery of key objectives surrounding dignity in care in later life.
The term ageism is one originally coined by Butler (1969) to describe the observed
discrimination and prejudice directed towards older people specifically because of
their age. Palmore (1999) furthered this concept by explaining that ageism involved
both cognitive (stereotypes and attitudes) and affective (prejudice and discrimination)
processes. Like other forms of prejudice (e.g. racism and sexism), ageism is a way of
pigeon-holing people into heuristic categories that ignore individuality and apply
accepted groups’ norms to all group members. Cummings et al. (2000) have identified
that common forms of modern ageism include devaluing the contributions made by
older people and viewing the pathologic processes sometimes associated with later
life as normal components of the ageing process. Angus and Reeve (2006) have
further identified that this socially ingrained ageism actively promotes stereotypes of
51
social isolation, physical and cognitive decline, lack of physical activity and economic
burden. Gerontophobia is a narrower band of ageism that specifically refers to a
phobia (irrational / unreasonable fear) of older people. Lynch (2000) identified ageing
anxiety as a major component of gerontophobia and more widely ageism. Ageing
anxiety was explained as the “combination of people’s concerns or fears about getting
older” (Lynch, 2000. p. 533). These fears were based on concerns over loss of social
contact, reduction in cognitive abilities, changes in physical appearance, declines in
overall health and financial hardships that are themselves stereotyped characteristics
of the ageing process. In addition to these somewhat irrational fears, it is the
knowledge that simply by living life we will become a member of this out-group, a
process and transition whose path cannot be altered or avoided. The inevitability of
the transition itself is stressful and causes anxiety amongst those who hold these
negative stereotypes. Cummings et al. (2000) found that people with a greater
knowledge of the ageing process actually held fewer of the stereotyped opinions of
the ageing process and as such exhibited significantly lower levels of ageing anxiety
and worries about later life.
The prevalence of all forms of ageism has increased past those of sexism and racism
(Banaji, 1999; Kite & Wagner, 2002) although it is typically harder to measure due to
the implicit ways it is conducted (Levy & Banaji, 2002). This has increased to such a
degree due to the change in societal ethos regarding prejudice. It is now much less
socially acceptable to be sexist, racist or homophobic, however, to be ageist is not
seen in the same way. Ageism is prominent in advertising, media, comedy and in the
way in which older people are generally viewed. It is due to this prominence that
acceptance surrounding ageism has occurred. It is often seen as humorous and based
52
in some degree of fact, this negating any negative effects or outcomes. Due to the
‘humorous’ nature of ageism, the aforementioned negative effects on the older person
(self-esteem, disablement, self-isolation) are generally ignored by the wider public. A
problem arises, however, when trying to measure the ‘colloquially’ clear prevalence.
As previously mentioned, on explicit measures, people will present themselves in
what they see as the most socially acceptable light. Because of this self presentational
bias, the explicit measure of ageism (unless very subtle) is not truly capturing the full
picture of ageism. Spontaneous behaviour and that not consciously thought about is
influenced by implicit attitudes. Due to the difficulty of accessing the implicit
constructs of attitudes, these are often overlooked. However, as discussed, they form
an integral part of the overall attitude. Implicit tests often require computer
programmes (IAT, EAST, GNAT) to measure accurate response latencies and as such
it is prohibitive to conduct them in public spaces.
So, why should ageism be singled out as an important area for research? Ageism is
different from all other prejudices in one key way. A racist will never change skin
colour, a misogynist will never change sex, but an ageist person will become that
which they hate should they live long enough. As such, every person should be
conscious of the fact that if discrimination against older people is tolerated, one day it
could be directed towards them. This causes issues around self-esteem and wellbeing
in older adults, as well as resulting in costs to the wider society as well as the
individual. There are negative consequences both personal and societal associated
with prominent ageist attitudes. In the workplace discrimination due to age is
increasing (McCann & Giles, 2002) which affects the company and the victim alike.
The practice of discrimination has been shown to cause lowered self-efficacy,
53
decreased productivity and cardiovascular stress (Levy, Ashman & Dror, 2000). This
is costly to the individual and to the company and due to the symptoms described
(decreased productivity), can lead to the perpetuation of ageist attitudes. For the
companies involved there can be costly lawsuits for age discrimination, ranging from
a few thousand dollars up to $58.8 million (McCann & Giles, 2002) as well as having
the associated costs of decreased morale, segregated workforces and decreased per
capita productivity.
Most of the early research conducted into ageism was conducted using scales which
measure commonly held opinions or a person’s knowledge about ageing. These range
from the infrequently used Old People Questionnaire (Tuckman & Lorge, 1953) to the
still often used Facts on Ageing Quiz, or FAQ (Palmore, 1977). The FAQ consists of
25 true or false items which measure a person’s knowledge of the ageing process. As
it measures knowledge rather than individual opinion it cannot be classed as a pure
attitude measure, however, it is useful in gauging the actual level of knowledge and
the level of misinformation upon which attitudes can be based. More frequently used
as an explicit attitude measure is the Fraboni Scale of Ageism – FSA (Fraboni et al.,
1990).
The FSA was developed to fill the hole Fraboni et al. (1990) believed existed in that
the previous scales only measured the cognitive components of ageism. The FSA
aimed to be a more complete measure of ageism including items to measure
antagonistic, discriminatory attitudes and the tendency toward avoidance. The scale
includes three factors for a complete measure: Antilocution (antagonism and apathy
fuelled my misconceptions and misinformation), Avoidance (withdrawal from social
54
contact with older people) and Discrimination (discriminatory opinions regarding the
political rights, segregation and activities of older people) (Rupp et al., 2005). There
had been sparse empirical evidence to support the validity and reliability of the FSA
further than the establishing theory. However, Rupp et al. (2005) conducted an indepth analysis of the scale and concluded that the scale was a valid and reliable
multidimensional measure of ageism. They conducted a confirmatory factor analysis
that supported the multidimensional nature of FSA scores that emphasised both
cognitive and affective facets of attitude measurement. Finally they also identified
that younger individuals and men had significantly higher ageism scores on the FSA
than older individuals and women. These were similar to the findings by Kalavar
(2001) who had previously identified that male college students displayed more ageist
attitudes than female college students. In a practical context, Mueller-Johnson et al.
(2007) provided 94 undergraduates with the same testimony given by a 79-year-old
male or female witness, and they were then asked to complete the FSA and the
Ageing Semantic Differential. Participants who evidenced stronger ageing stereotypes
on these measures rated the witness less favourably than did participants who were
less prejudiced. This experiment demonstrated a clear link between perceived
credibility of older adults and ageist attitudes.
Discussed above are two established ageism measures. This study, as with the
majority of other current studies, has used the Fraboni Scale of Ageism. The reasons
for this are succinctly demonstrated by Stuart-Hamilton and Mahoney (2003) when
they collected data from two hundred British participants in an age awareness
workshop. The participants were given the Palmore Ageing Quiz (PAQ) and the
Fraboni Scale of Ageism (FSA) immediately prior to the workshop and one month
55
after the event. Post-event testing demonstrated a significant improvement in PAQ
scores, reflecting retained knowledge acquired at the workshop. Scores on the FSA
were unaltered, though there was a significant lowering in scores on the Antilocution
section of the test. In combination, these results indicate an increased awareness of
ageing issues may alter factual knowledge and increase awareness of politically
correct language, but attitudes toward older people and ageing remain essentially
unaltered. This and similar studies (Gething et al., 2004; Rupp et al., 2005) question
whether the PAQ is a valid choice of tool for measuring changes in attitudes to
ageing, since PAQ performance can improve independent of measures of attitudinal
change.
Despite there being apparently equal amounts of positive and negative stereotypes
pertaining to older people (Hummert et al., 1994), the pervasive attitudes present in
research suggest higher negative attitudes than positive ones (Kite & Johnson 1988).
This finding is also repeated in measures of implicit attitudes (Perdue & Gurtman,
1990). Isaacs and Bearison (1986) have shown that children as young as six exhibit
ageist prejudices present in their cultures. Unlike other prejudices mentioned, ageist
attitudes are still openly prevalent in society. In television comedies, elderly people
are depicted, defined by stereotyped negativities regarding physical decline and both
physical and mental incompetencies (Zebrowitz & Montepare, 2000). When the age
stereotypes have been acquired, they will be easily activated by the presence of an
elderly person (Banaji & Hardin, 1996; Perdue & Gurtman, 1990). This will result in
the generalisation of elderly people to the stereotyped schema held. Once acquired,
these attitudes are maintained and strengthened when encountering elderly people
even if they do not exhibit characteristics associated to the stereotypes held (Levy et
56
al., 2000; Murphy, Monahan & Zajonc, 1995). Challenging these negative attitudes
also proves harder for ageism than other forms of prejudice. Hill et al. (1990)
demonstrated that even when encountering contradictory evidence, attitudes towards
older people were resistant to change and in most cases did not alter. As with most
negative associations, if younger people can avoid spending time with older people
and encountering evidence that may either support or challenge their beliefs about
them, they will do. Purdue and Gurtman (1990) observed that young people are
actively seeking ways to refrain from engaging in social meetings with elderly people.
This avoidance only reinforces the implicitly held beliefs as it prevents the individual
from having ‘meaningful’ encounters with elderly adults that may in fact cause
inconsistencies in schema to be noticed and re-evaluations of attitudes to take place.
Much of the ageing literature on attitudes relates to the explicit attitudes held
(Cummings, Kropf & DeWeaver, 2000; Catterall & Maclaran, 2001; Depaola, Griffin,
Young & Neimeyer, 2003). As already discussed, this is acceptable when measuring
attitudes to predict behaviour in planned situations but in novel situations or with
prolonged exposure, what attitudes or behaviours would be expressed? Levy and
Banaji (2002) conducted a review on implicit ageism illustrating a pervasive and wide
reaching proliferation of negative ageist attitudes. They found that as well as older
examples of ageism such as within fairytales like Hansel and Gretel where older
people are portrayed as sinister and evil, more modern equivalents exist. They
highlighted the fact that in modern media, older adults appear in comical roles or
where stereotypes of ageing such as physical decline or incompetence are used
(Zebrowitz & Montepare, 2000). This highlights the fact that ageism has deep roots in
the social unconscious and from an early age is instilled into the thoughts of younger
57
children. The continual reinforcement of these implicit stereotypes is not questioned
by children as they see it having no relevance to their emerging selves as they are not
referring to their in-group (Levy & Banaji, 2002). Due to the lengthy process of
ageing, children’s concept of older people is more abstract and when little
contradictory evidence is presented, the negative characteristics are assumed. It is
then continued exposure to negative stereotypes throughout the lifespan that causes
this preponderance of ageism. Repeated exposure to the primes/negative associations
increase the strength of the negative implicit attitude whilst often leaving the explicit
attitude unaffected (Levy et al., 2000).
Further to the review by Levy and Banaji (2002), research has continually
demonstrated that implicit attitudes towards older people demonstrate a wide reaching
ageist bias. In the same year, Jelenec and Steffens (2002) found that in using both
community and university samples, implicit ageism was recorded at a significantly
high level. They further analysed the data produced during the IAT and demonstrated
that not only were younger target stimuli judged more positively but also that those
data pertaining to older people were judged more negatively. This trend has continued
to become more evident over the years, most recently demonstrated by Turner and
Crisp (2010). They found that the pervasive implicit attitude towards older people was
negative. In addition to this, they found that both with actual and perceived contact
with older people, the implicit attitude improved. This is in support of Tam,
Hewstone, Harwood, Voci and Kenworthy (2006) who also found contact to improve
implicit attitudes towards older people.
58
These findings were not only in the young. Negative implicit ageist attitudes are held
by older people themselves (Levy & Banaji, 2002). The reasoning given for this is
that elderly people have acquired the same implicit prejudices throughout their lives
and have not had sufficient time or opportunity to develop the mechanisms to defend
against this.
There are negative consequences for elderly people as a result of the ageist attitudes
held as they are not only subjected to ageist prejudices from others but also internalise
these implicit biases (Nemmers, 2005). As people progress through the life span their
age schema become more elaborate as more information both about others and
themselves becomes incorporated. As they age, the number of traits, categories and
subcategories they have within the schema grows, however, core elements are still
retained. Research does support this developmental approach, finding that despite
having a more complex picture of ageing, older people do not necessarily hold more
positive views. Hummert et al. (1994) found that older people did indeed hold more
stereotypes about older people but they had more negative ones as well as having
more positive ones. Some studies further report that older people do judge their age
category more favourably than younger people do, however, that is only more
positively as a comparison but both groups have generally negative attitudes towards
older age (Kite et al., 1991). Levy (1996) found that elderly people who exhibited
higher negative implicit attitudes also performed significantly worse on memory
tasks. She found that the perceptions of older adults could also be affected by implicit
self stereotyping. She concluded that implicit age stereotypes can influence the views
of older adults both towards others as well as upon themselves.
59
Levy’s (1996) research supports previous research findings that when elderly people
adopt these societal stereotypes, they see decline as inevitable and that becoming a
less active member of society as the only option (Rodin & Langer, 1980). Similarly,
Butler (1987) found that when adopted, these stereotypes became a self-fulfilling
prophecy, reinforcing stereotypes through the inaction and deficits resulting from
their initial belief and internalisation. Although some physical decline through
arthritis, heart disease, etc, is related to ageing, much of the widely held belief about
age changes in health are over-pessimistic (Rowe & Kahn, 1987). Ageing should not
be viewed in simple terms of losses and gains but more within the Selection,
Optimisation, Compensation (SOC) model proposed by Baltes and Baltes (1990). In
this model it is accepted that losses are associated with ageing but that successful
ageing is less to do with these and more reflected by the way in which the older
person adapts. The model suggests that first, salient goals are selected, strategies and
techniques for achieving these goals are optimised and those losses associated with
ageing that may hinder goal attainment are compensated for. In a review of literature,
Rowe and Kahn (1987) also found that psychological wellbeing and social
interactions affected the physical wellbeing of the elderly. They showed that with
decreased social support often associated with old age, mortality and morbidity rates
increased as did the adherence to previously well maintained health-promoting
regimes. One of the most common prejudices against the elderly comes from the
perceived cognitive decline associated with ageing. The most important concept
concerning cognitive ability is that of perceived control. Older people see physical
and mental deterioration as something they cannot control; it is this perception that
results in the reduction in active coping mechanisms (Rodin, 1986). He also
demonstrated that this perceived helplessness is directly associated with the decrease
60
in motivation and self esteem and eventually with the increase in illness, mortality
rates and memory problems. Similarly, Rodin (1986) showed that the opposite is true;
with the provision of activity to increase perceived self control a marked improvement
in memory, alertness, activity and physical health was observed. This point has been
echoed by Coleman and O’Hanlon (2008) who highlight that successful ageing /
optimal ageing is achieved not only through acknowledgement of the associated
losses (as with other stages of the lifespan) but also the successful adaptation and
coping with the stresses and changes in life. It is taking control of those challenges
and adapting through acquired life skills that is fundamental to mental, psychological
and emotional health at all stages in the lifespan.
With an increasingly ageing population this pervasive negative attitude clearly has
negative effects on a growing proportion of UK residents. Over 65’s account for a
substantial proportion of the hospital admissions in England and Wales. In the year
April 2008 – March 2009 22.8% of the total admittance to NHS A&E departments in
England was for those people aged 60 and over (Hospital Episode Statistics, 2010).
With there being a pervasive negative attitude towards older people, it is possible that
the care of these individuals may indeed be less than that given to a younger person.
Gatz and Pearson (1988) believed that despite negative attitudes towards ageing not
being global within the healthcare profession, there were specific biases that affected
the way in which older patients received care. Duerson, Thomas, Chang and Stevens
(1992) indicated that the attitudes held by staff can affect the treatment received and
the way in which elderly people are treated. This was succinctly demonstrated where
older people were not receiving the same diagnosis based on the same symptoms as
younger people where the only differentiating feature was that of the patient’s age.
61
Not only that, but they also refer to findings that health care workers in general have
been shown to hold negative attitudes towards older people. They cite Coccaro and
Miles, (1984) who conducted a series of explicit measures demonstrating that ageism
was a widespread issue even in the early 1980’s. James and Haley (1995) reviewed
ageism in the German healthcare system and found several cases where clinicians
considered psychotherapy with depressed elderly patients to be ineffective with no
assessment other than initial categorisation by age. Similarly, Filipp and Schmitt
(1995) found that medical professionals were refraining from treating patients with
mental impairments because due to their age the conditions were considered
irreversible. It is apparent that the unfavourable and stereotypic view of older people
held by some clinicians is the crucial factor behind the inadequate treatment often
being received. This is an enduring phenomenon and continues a long tradition which
is by no means new in origin. Freud was reluctant and often refused to treat older
patients because he didn’t believe that they had the remaining life span in which to
experience the benefits (Woodward, 1991).
As with the preponderance of research in this area, Duerson et al. (1992) conducted a
series of attitude tests to medical students using explicit measures (Palmore’s Facts on
Ageing Questionnaire (FAQ i&ii)). Primarily this questionnaire is employed to assess
the knowledge of ageing but it is also accepted as an explicit measure of ageist
attitudes. Duerson et al. (1992) found that the scores were no higher than those
reported in the general population and no real increase was measured from pre to post
educational training. They concluded that this was a reflection on the lack of specific
geriatric training. Duerson suggested that in order to improve this knowledge and
sensitise them to the growing needs of the elderly, medical students required more
62
specific geriatric training not simply training which focussed on the losses associated
with ageing. She also highlighted that direct contact with older people and patients
would help student clinicians improve their perceptions. This is a point also
highlighted by Tam et al. (2006) who identified direct contact with older people as a
factor improving implicit attitudes towards older people. Further they established that
quality of contact can be the precursor to changing the explicit attitudes held. They
identified that simply encountering and being exposed to older people could improve
the implicit attitudes towards older people. This was under the condition that during
this exposure, no overtly stereotypical experiences occurred such as a frail older
person falling over. It was only when quality time was spent with an older person
such as in conversation or a prearranged activity that an individual’s explicit attitudes
were improved. This is a revision from Gatz and Pearson (1988) who identified that
simple exposure to elderly people and ageing issues had been shown to reduce
ageism.
This point was reiterated by Grant (1996) who suggested that ageing texts often
referred only to the problems rather than the successes with ageing and describing
elderly people as suffering from multiple handicaps. She draws on the fact that this
specific education should be given as a matter of course in institutions offering health
care courses to increase the level of understanding and care given to elderly patients.
The question remains, if the attitudes presented are clear within society and
specifically within the health care system, can they be altered? It is difficult but not
impossible to change attitudes and there are several ways in which attitudes can be
changed or modified which fit into different categories.
63
Weakly held and less salient attitudes are easier to change than strongly held attitudes
and as such, stronger attitudes are developed in areas which an individual (or in-group
to which they belong) considers to be of higher salience. These strongly held attitudes
can be either positive or negative but are usually clearly polar. In areas of limited or
questionable importance, attitudes tend to be weakly held, ambivalent or neutral
which means that they are more susceptible to change.
There are six basic categories of attitude change strategies:
•
Changing the basic motivational function. These strategies are based on the
theory that attitudes serve four basic functions: utilitarian, ego-defensive,
value-expressive and knowledge.
By changing the basic motivational
function, the attitude towards the product can be changed (Sarnoff & Katz,
1954).
•
Associating the attitude object with a special group, event or cause.
Attitudes can be altered by indicating the attitude object’s relationship to
particular groups, events or causes. Concern for the environment has been
one cause used recently (Petty, Wegener & Fabrigar, 1997).
•
Relating to conflicting attitudes. Generally people do not like dissonance
and strive to reconcile this. If they can be shown that their attitude towards an
attitude object is in conflict with another attitude, they may be induced to
change one of the attitudes (Petty, Wegener & Fabrigar, 1997).
64
•
Altering components in the multi-attribute model. These strategies attempt
to change the evaluation of attributes by upgrading or downgrading significant
attributes; change beliefs by introducing new information; and by adding an
attribute, or by changing the salience ratings (Mitchell & Olson, 1981).
•
The elaboration likelihood model. This model suggests that attitudes can be
changed by either central or peripheral routes to persuasion. In the central
route, attitude change occurs because an individual seeks and evaluates
additional information about the attitude object.
In this case, motivation
levels are high and the individual is willing to invest the time and effort to
gather and evaluate the information, indicating a high level of involvement.
Multi-attribute models are based on the central route to persuasion as attitudes
are believed to be formed on the basis of important attributes/features and
beliefs. In the peripheral route, individuals are either unwilling or unable to
seek additional information. Involvement is low, so they must be offered
secondary inducements in an attempt to influence attitude change. (Jones et
al., 2003)
It is of note that all of these strategies take the traditional view that attitude precedes
behaviour, and use the relationship between attitude and behaviour to effect attitude
change. Also each of these strategies can be used in an educational setting to impart
knowledge and cause disequilibrium in the current schema held to force a reassessment of existing attributes and evaluations to modify the existing ageist
attitude. This has been shown by Kite et al. (2005) who demonstrated that upon
providing information about a person that countered existing negative ageist
stereotypes, the negative attitudes can be diminished. An example of this would be
65
providing participants with pictures or video clips of older people participating in
competitive sport. These images would be contrary to those stereotypes held and
cause a re-evaluation to occur. More recently in an educational context,
Westmoreland et al. (2009) demonstrated that through a well structured educational
based on the psychological principles above, attitudes towards older people can be
changed. They demonstrated, using a longitudinal study, that attitude change was
possible and that reflexive accounts also illustrated a conscious awareness of this on
the part of the students involved.
It is in the utilisation of these strategies in the training of nurses and people involved
in the care of older people that the pervasive negative attitudes can be challenged. In
challenging these stereotypes and commonly held misconceptions the inequalities in
care can also be addressed. The first step in this process is to assess the current
standing and efficacy of existing gerontological awareness/training. From here, future
studies can identify the gaps in training and trial interventions can be developed,
tested and implemented.
In summary, previous research has found that there are pervasive and ingrained
negative implicit attitudes towards older people (Levy & Banaji, 2002). It has further
demonstrated that those negative attitudes are also recorded on explicit measures of
ageism (Depaola, Griffin, Young & Meimeyer, 2003). Exposure to older people can
improve attitudes, however it occurs in differing ways. Contact in and of itself can
improve implicit attitudes whereas only quality contact time can improve a person’s
explicit attitude towards older people (Tam, Hewstone, Harwood, Voci & Kenworthy,
2006). These attitudes are not solely confined to the general populace but are also
present in the medical profession where caring for older people is integral to their
66
daily routines (Duerson et al., 1992). Filipp and Schmitt (1995) also highlighted that
medical professionals were refraining from treating older patients with mental
impairments because due to their age the conditions were considered irreversible. It
has been shown that these attitudes (implicit and explicit) can be altered in the favour
of older people. Westmoreland et al. (2009) demonstrated that through a well
structured educational based on the psychological principles above, attitudes towards
older people can be changed.
Despite there being research on attitudes towards older people, the quantity is
representatively small and restricted in nature. Most of the studies use either implicit
or explicit measures and as such only collect data on one facet of attitudes towards
older people. The studies that have been done have generally used students and have
used this group as a representative sample of the wider population without making
due consideration for the effects of education on individuals’ implicit and explicit
attitudes. Considering that there are clear behavioural implications in the
manifestations of attitudes, there is surprisingly little research on care professionals
providing care for younger and older people on a daily basis. Studies one and three
will assess the attitudes of nurses in training and qualified nurses working in hospital
environments to try and build a knowledge base in this gap. The studies will assess
the effects of nurse training on attitudes towards older people as well as looking at the
progression from this stage, post-training, when nurses are in situ caring for the
general populous and those specifically caring for older people. This should aid the
understanding of the training required to ensure that attitudes towards older people are
more positive and that the care older people receive is of the same standard expected
for other patient groups. Following this, two educational classroom based courses will
67
be assessed, looking at the effects of education about older people and ageing (Study
Five) and of younger people (Study Two). This will assess the current psychological
course content on two specific student groups enabling conclusions to be drawn about
the current levels of educational interventions and the direction that future
interventions may need to take. This is an important step because although there have
been successful intervention measures in other countries, none have been conducted
in the UK and none have to date influenced the content of training received by
healthcare professionals in the UK. Further, Study Four will provide information on
the effects of general higher level education on the implicit and explicit attitudes
towards older people. As previously mentioned studies are often conducted with
student samples and then generalise findings to the general populous. This is a
potentially problematic procedure because as yet there is little known about the
impact of general higher level education on attitudes towards older people. Finally as
each of the studies has used the same data collection instruments and procedures, a
meta-analysis will be conducted to assess the impacts of each of these variables on
both implicit and explicit measures of ageism. This is a unique angle as to date no
study has looked at both implicit and explicit measures of ageism with homogeneous
and heterogeneous populations to provide a comprehensive picture of ageism.
This thesis will present the following studies in order to address the gaps in existing
research presented above:
1. A longitudinal study assessing the impact of a three year undergraduate
nurse training degree on implicit and explicit attitudes towards older
people.
68
2. A cross-sectional study investigating the impact of an educational
intervention promoting younger people on implicit and explicit
measures of ageism
3. A cross-sectional study investigating the impact of contact with older
people in a nursing context on implicit and explicit measures of
ageism.
4. A cross-sectional study assessing the impact of general higher level
education on implicit and explicit attitudes towards older people
5. A longitudinal study assessing the effects of a Psychology of Ageing
module on implicit and explicit attitudes towards older people
6. A cross-sectional study to assess the levels of implicit and explicit
ageism of older people
7. A meta-analysis of all sample subsets
For each of the above studies the same implicit and explicit measures were used so
that there was parity between the scores returned in each of the samples. As the same
tests were used, a meta-analysis could be conducted to give a holistic picture of
attitudes towards older people. Further to this, it also allowed for a test-retest analysis
to be conducted on the longitudinal studies, thus enabling reliability and consistency
measures to be taken. It was important for there to be comparable scores so that the
differences that occurred between groups could be more easily compared and the
effects of any interventions more accurately reflected. Details of the procedure are
provided in the next section.
69
Chapter Five
General Methodology
All studies followed the same procedure, testing materials and controls. To this end, a
single comprehensive methodology section will be included to save repetition in the
description of each investigation. However, for each study, separate participant
information will be provided plus additional information regarding populations or
variations in the test manipulations.
Materials and Procedure
Two measures were used: an explicit measure, the Fraboni Scale of Ageism (Fraboni,
Saltstone & Hughes, 1990) and an implicit measure, the Implicit Association Test
(Greenwald, McGhee & Schwartz, 1998).
Explicit Measure:
Aspects of the FSA are described here for the sake of clarification, but a full
consideration of the relative merits is presented in Chapter Four.
The Fraboni Scale of Ageism (Fraboni, Saltstone & Hughes, 1990) was chosen as a
well established and well accepted explicit measure of ageism (Rupp, Vodanovich &
Credé 2005). The Fraboni Scale of Ageism (FSA) was developed in 1989 as a way of
building on past ageism scales which focused on age stereotypes and myths. The FSA
is a 29-item Likert scale which uses a specific operational definition of ageism based
on three of Allport's (1958) five levels of prejudice: "...antilocution (mere antipathetic
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talk); avoidance (avoiding members of the disliked group); and discrimination
(excluding members from the disliked group). The FSA requires participants to
respond to either negative or positive age-related statements using a 4-point Likert
scale (1=Strongly Disagree to 4=Strongly Agree). The total scores that can be
recorded on this scale range from 29 – 116 with higher scores illustrating higher
levels of ageism. Any score over 58 is illustrative of explicit ageism. To avoid
habitual response errors, some items are reverse coded. For example, item 26 reads:
"Most older people should not be allowed to renew their drivers licence." This was
reverse coded so that a response of 1 (strong agreement) became 4, to reflect a more
ageist response.
The Fraboni Scale of Ageism (FSA) has been shown to have good levels of internal
consistency with a Cronbach’s alpha coefficient of .86. (Fraboni et al., 1990). An
exploratory factor analysis supported the antilocution, avoidance, and discrimination
factors, these accounting for 23.3%, 7.2%, and 7.0% of the variance, respectively
(Fraboni et al., 1990). Reliability has been shown on each of the factors mentioned
with the following Cronbach’s coefficient alpha reliabilities: Antilocution (.76),
Avoidance (.77), and Discrimination (.65).
A copy of the scale presented to participants is in Appendix 1. The scale is an
untimed paper and pencil measure and the items are always presented in the same
order. This is in accordance with standardised instructions.
71
Implicit Measure:
Aspects of the IAT are described here for the sake of clarification, but a full
consideration of the relative merits of different implicit measures is presented in
Chapter Two.
Several implicit measures have been developed, the principal of which are: the
Affective Priming Task (Fazio, Jackson, Daunton & Williams, 1995), the Implicit
Association Test (IAT – Greenwald & Banaji, 1995) and the Extrinsic Affective
Simon Task (De Houwer & Eelen, 1998).
The IAT has scored well against other measures of reliability. In a recent review, De
Houwer & De Bruycker, (2007) demonstrated that the IAT has shown consistently
high internal consistency scores of .83. In addition to this Schultz et al. (2004) also
highlighted the fact the IAT produced stable test/re-test correlations of 0.46 over
immediate, 1 week and 4 week periods. As already noted in Chapter Two, the r values
for the IAT are significantly better than those returned on other comparable tests.
The IAT has also shown to be more of a robust measure of attitude (Dasgupta, 2000;
Kim, 2003, Nosek et al., 2007). Its supporters argue that it is difficult to fake, in part
because automatic responses are a key part of the participant response and these are
hard to control. As has already been noted, Kim (2003) tested the controllability of the
IAT in two studies using racism as the measure, and flowers and insects as a control.
He found that in both cases the results from the IAT could not be controlled / faked
even if under instruction to do so. Kim demonstrated that the only way to control
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answers was to be told how to do so (responding slowly to a subset of the stimuli). He
also identified that even after multiple trials, participants did not spontaneously
discover the strategy for controlling their responses. From this he concluded that the
IAT was a robust measure, and is clearly more so than explicit measures that have
been shown to be susceptible to self presentational bias as well as capturing more
subtle biases that may be undetectable using self report measures (Dasgupta et al.,
2000).
The usefulness of the IAT is due to a number of factors: resistance to self
presentational bias (Egloff & Schmuckle, 2002); its adaptability to numerous forms of
concept measurement (Greenwald & Nosek, 2001); and its lack of dependence on
introspective access to the association strengths being measured (Greenwald et al.,
2002). Because of these factors allowing the IAT to be used as a flexible yet powerful
measure of implicit attitude, it was chosen as the implicit measure for this
investigation.
The IAT requires participants to categorise target concepts with descriptors
representing positive and negative poles of an attribution dimension. It is argued that
when a pairing appears between a concept and a congruent descriptor, mapping them
to the same response key is considerably easier than if the pairing is incongruent. In
other words, if the participant believes that the image and the description match, they
will respond faster than when there is a mismatch. For example, for most people there
would be a quicker response time for pairing a picture of Adolf Hitler into the
category man/bad rather than man/good. The response latency difference measures
the extent to which positive and negative evaluations are attributed to the target
73
concepts. This is calculated by summing the response times for the congruent and
incongruent pairings and then taking the time for the congruent pairings away from
the incongruent condition. The greater the time difference, it is argued, the more
negative the attitude is towards the target concept (Greenwald et al., 2003). In
essence, when translated into real term scores produced from the IAT, positive scores
equate to negative implicit attitudes towards older people and the higher the number,
the more negative the attitude expressed.
The IAT used in these studies was presented using proprietary software (E-prime
created by Psychology Software Inc). The images and words used for the IAT were
supplied and previously tested for suitability and effectiveness by Banaji and her
research team. Their contribution and assistance is gratefully acknowledged.
The IAT consisted of both practice and test datasets. Initially the participants were
presented with simple pleasant/unpleasant categories and similarly old/young
categories: this was to familiarise both with the concepts being introduced and also
with the responses required from them. After the familiarisation, pairings were made
of either good/ young or good/old. For the purpose of internal counterbalancing, the
categories were then reversed and presented to participants with both practice and test
blocks. Each test had identical words and images; these were presented in a random
order of the programmes generation. Again as previously, a test set was presented first
to familiarise the participants with the concept of response pairings before the
measurement sets were presented. Table 2 is a representation of the order of
presentations used in the IAT programme (the order is reversed in the
counterbalanced trials).
74
Table 2: The order of presentation for the IAT
Block No. of Trials Items Assigned to Left Key Items Assigned to Right Key
B1
12
Old Faces
Young Faces
B2
16
Good Words
Bad Words
B3
28
Old Faces + Good Words
Young Faces + Bad Words
B4
28
Old Faces + Good Words
Young Faces + Bad Words
B5
12
Young Faces
Old Faces
B6
28
Young Faces + Good Words
Old Faces + Bad Words
B7
28
Young Faces + Good Words
Old Faces + Bad Words
A copy of the IAT is available upon request.
To produce scores for the implicit test, the D Score algorithm has been used. This
divides the differences between congruent and incongruent pairings by the individual
standard deviations to produce a normed implicit score. Full details of the algorithm
can be found in Appendix 4 on page 236.
Participants completed the implicit and explicit tasks either singly or as part of a
group with each participant working in a separate and isolated cubicle or booth. The
order of presentation of items was counterbalanced. The participants provided their
responses anonymously, but were given anonymised identification numbers so that:
(1) potential order of presentation effects could be measured; and
75
(2) it was possible to match participant responses in the longitudinal study component
of the research.
Ethical Considerations
Prior to the commencement of any research, the programme of study was submitted to
and approved by the University of Glamorgan Ethics Committee. It was considered
that there would be no psychological harm or distress caused to participants so no
special measures were observed. However, the following considerations were
implemented.
1) Confidentiality: Participant records were anonymised. All information
collected will be held in a secure location for a five-year period after
publication of results. This will then be destroyed in accordance with accepted
University procedures.
2) Right to withdraw: Participants were fully informed of their right to withdraw
at any stage, without penalty. They were also informed of their right to refuse
to answer any questions.
3) Informed consent: Participants were informed prior to commencing the study
about what they would be asked to do. They were not fully informed about the
hypotheses of the study in advance, because of concerns that this might bias
explicit responses. All groups were capable of providing their own informed
consent. No deception occurred at any point and all participants were
debriefed at the cessation of testing.
4) Full debrief: Participants were debriefed after completing both the implicit and
explicit measures to share with them the objectives of the research and to
76
allow discussion of their experiences. These are discussed within Chapter
Seven.
5) Potential distress:
There was little chance of the study creating distress.
Participants were asked to complete accepted IAT measures - no overtly
unpleasant or threatening imagery was involved. However, participants were
permitted to withdraw at any stage, as already stated.
6) Co-operation with participating institutions: The experimenter agreed to
comply with any further checks or other requirements imposed by
participating institutions (e.g. hospital, medical surgery and residential care
homes).
Procedure
Upon entering the computer laboratory, participants were spaced one computer apart
from each other so that they each had their own work space and maintained the
individual test area integrity. Each participant sat in front of a terminal with the
testing software pre-loaded and the IAT instruction screen visible. The participants
were initially given verbal instructions advising them how they should complete the
test, stressing that the computerised implicit section be completed first. This
instruction was included as it was considered that completing the explicit measure
first may indeed affect the participants due to the content of some statements. Further
on screen instructions were provided detailing the manner in which completion of the
IAT should occur. Participants were advised that if they were unclear of the procedure
after reading this additional information, clarification should be sought from the
experimenter in the room.
77
When the participants had completed the IAT, another information screen was
presented advising them to continue to the explicit paper measure. As part of the
initial procedural statement, participants were informed that the paper questionnaire
was to be completed by circling the most relevant answer category for each of the
statement items. This was again completed in silence. When each of the participants
had completed the two tests, they remained at their stations until all participants had
completed the test. All participants received a verbal debrief giving contact details of
experiment staff, supervisors and support services. In addition to this the relevant
certification (see appendix two) and debrief (see appendix three) were also given to
participants for their reference. In those longitudinal studies, participants were also all
reminded that they would be required to undertake a similar experiment at the end of
their academic programme and that the contact details they had provided to enable
contact at this stage would remain secure.
Scoring
Explicit Measure:
The Fraboni Scale of Ageism (FSA) requires participants to respond to either negative
or positive age related statements using a 4-point Likert-scale (1 representing strong
agreement with the statement and 4 representing strong disagreement). In order for
higher scores to reflect more ageism some items were reverse coded. The scores are
then summed for each participant to enable mean group population scores to be
calculated. Any score over 58 was a score denoting explicit ageism.
78
Implicit Measure:
Scoring for the IAT has been taken from the improved scoring algorithm devised by
Greenwald, Nosek and Banaji (2003).
The IAT programme collects the response latencies for all of the congruent and
incongruent pairings made by each participant. Each participant’s scores are then
collated and calculated separately prior to the group aggregation. Test scores/latencies
were used from Blocks B3, B4, B6 and B7 where previously only data collected in B4
and B7 were used. This change was made to double the overall amount of data
collected and after testing it was established that including these blocks which were
previously used only as practice blocks did not adversely affect the integrity of the
data.
Initially each of the congruent and incongruent pairing response latencies were
grouped so that mean scores could be calculated. In each of these groups, any
categorisation errors were removed with then an additional 600ms added to the
latency recorded when the correct category pairing was given. This error adjustment
yielded more significant results and removed the often quicker responses recorded
when a participant simply hit the keys to record a quick response without observing
the categories.
Any participant who returned a latency of over 10,000ms had that trial disregarded as
Greenwald et al. (2003) identified this group to have simply responded too slowly
either through distraction or lack of concentration and their response was no longer
reflective of their attitude.
79
When these data adjustments had been made, the mean congruent and incongruent
response latencies were calculated for each participant. The congruent latencies were
then taken from the incongruent scores and the higher the resulting number, the more
preference was shown towards younger people/stronger the ageist attitudes.
Normalisation of each of the participant’s scores was then undertaken whereby the
score was divided by the standard deviation of each individual’s responses. This was
done because magnitudes of differences between experimental treatment means are
often correlated with variability of the data from which the means are computed
(Greenwald, Nosek & Banaji, 2003). Using the standard deviation as a divisor adjusts
differences between means for this effect of underlying variability. This produces the
D score which has been shown to protect against cognitive skill confounds in
participants (Cai, Sriram & Greenwald, 2004) which was previously highlighted as an
issue with the IAT (McFarland & Crouch, 2002). Any positive score indicates a
preference for younger over older people and a negative score reflects a preference for
older over younger people. The computational scoring algorithm can be found in
Appendix Four on pp. 236
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Chapter Six
Empirical Studies
Prior to the advent of the IAT (Greenwald, McGhee & Schwartz, 1998) the
overwhelming majority of ageism (and other attitude) research centred on self report
explicit measures (Cummings, Kropf & DeWeaver, 2000; Catterall & Maclaran,
2001; Depaola, Griffin, Young & Neimeyer, 2003). These provided a picture of a
person’s or group’s expressed attitude but did not access their implicitly held
opinions. Since their advent, implicit measures, with the IAT being the forerunner,
have enabled researchers to access this previously inaccessible attitudinal construct.
This new ability was quickly adopted into many fields of research including: racism
(Baron & Banaji, 2006); clinical psychology (Teachman, Gregg & Woody, 2001);
neuroscience (Phelps et al., 2000); health psychology (Teachman et al., 2003) and
even in a more practical setting with customer preferences in market research
(Maison, Greenwald & Bruin, 2001). Despite ageing and ageism receiving a lot of
interest in research, policy, practice and in the population as a whole, the majority of
the research evidence base as shown in this review is rooted in explicit measure
research (Kalavar, 2001; Mueller-Johnson et al., 2007). Even when implicit measures
have been used, Levy & Banaji (2002) have shown these tend to be with single groups
or comparing homogeneous groups. By homogenous groups, it is meant those groups
with similar characteristics (i.e. age, gender, education etc). Studies that compare only
these groups are generally controlling for certain factors but in doing so are not
looking at factors such as age differences. By not looking at heterogeneous groups
81
(where key characteristics between groups are different) there are central variables not
being assessed thus leaving a wide research gap.
This research is not only addressing the lack of implicit evidence base in the field of
ageism but is also widening the scope of the research done. From a review of
literature, six main studies have been identified and conducted using eight different
participant populations. These populations are used in comparison for specific
investigation into the effects of direct contact and specific education on attitudes held.
In addition to this, a meta-analysis has been conducted to compare each of the groups
to ascertain where any group differences may lie. Further to this, as the testing
included the administration of the Fraboni Scale of Ageism, these comparisons
between groups can be repeated for explicit measures while clearly demonstrating the
dichotomy between the implicit and explicit scores. More unique to this study,
however, is the collection of data over a period of time with the same cohort. The vast
majority of studies, even when they have used implicit measures have relied solely on
the cross-sectional data available through single testing. This study includes two
longitudinal samples, one investigating the impact of university based nurse training
compared to other higher level education and the other investigating a specific geropsychology module. The longitudinal sample is important to accurately reflect any
changes in both individual and cohort attitudes (implicit and explicit) due to
interventions and situational variables.
Each set of results will be presented with their literature rationale and a description of
the sample, stating any deviations from the standard testing detailed in the
methodology section. In brief, the studies will look firstly at the effects of three year
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undergraduate nursing and psychology degree programmes on attitudes towards older
people. Second, the effects of a youth-centric education course will be assessed,
followed by the effects of direct contact with older people from working in different
nursing environments. The fourth study will look more generally at the effects of
higher level education on attitudes towards older people, whereas the fifth will
specifically look at the effects on attitudes of a Psychology of Ageing course. The
penultimate study will look at the attitudes of older people before a meta-analysis is
presented. The order of this has been chosen to present a coherent argument about
how attitudes are affected primarily by education. First, a longitudinal study enables a
picture to emerge on the effects of a non-specific higher education and a nursing
course on attitudes towards older people. From this it is of interest to understand the
directional nature of the IAT and the effects of undertaking education specifically on
the stimuli diametrically opposed to that which is being measured (youth-centric
course for ageism measure). Building on the literature review and the findings from
the nursing students, the direct contact hypothesis was tested in a nursing environment
which also allows for implications to be drawn about care of older people. With
knowledge gained specifically about two university courses, it is of interest to
ascertain more widely the impact of higher level education with participants who have
not undertaken higher or further education. Building on this, the effects of specific
age related education are assessed relative to the general adult population prior to
looking at the effects of ageing on attitudes towards older people when effects of
education have been controlled for. Finally a meta-analysis is presented to
retrospectively compare each of the groups, something that has not previously been
done and something that allows different factors to be assessed.
83
Study One – A longitudinal cohort study with Nursing and Psychology
undergraduate students
Introduction
The effects of education on self presentational bias in explicit measures have long
been established (Goffman, 1959); the more educated a person is, the more aware
they become of the subjective and societal norms against which they will measure
themselves and in turn be measured. How this affects the implicit attitudes held by a
person is not as well established, with no longitudinal data existing that follow cohorts
looking at this particular factor. Cross-sectional studies have been conducted that
suggest particular student cohorts have different attitudes towards older people
(Jelenec and Steffens, 2002). However, a key criticism of these studies could indeed
be that they are cross-sectional. As data have only been collected at one point, there is
no way of knowing for example, whether the results are due to individual differences
between the types of people attracted to these courses or whether the course itself has
influenced the attitudes. Similarly cross-sectional data have been collected illustrating
the differences between implicit and explicit attitudes (Betsch, Plessner & Schallies,
2004) but again few give any picture of changes over time.
Ageism in nursing care has been extensively researched, specifically with regard to
Nursing students (Duerson et. al., 1992; Gatz & Pearson, 1988; Grant, 1996).
Research findings indicate that generally negative attitudes towards older people are
held and expressed. Higgins, Van der Riet, Slater and Peek (2007) found this
pervasive negative attitude to be clearly apparent in Nursing students and expressed
through marginalisation, segregation and “Chinese whispers” style stereotyping.
84
Despite the less than rosy outlook, Cheong, Wong and Koh (2009) have identified
that through successful education, medical students in Singapore are reported to hold
positive attitudes towards older people. This is, however, a test with explicit measures
and a finding that could be culturally specific. More recently, Gonzales, MorrowHowell and Gilbert (2010) established that this is a tide that can be turned. By
implementing a bespoke training package, they have illustrated how the attitudes of
medical students can indeed be made more positive through a mixture of education
and contact with older people. Each of these studies has been conducted using explicit
measures as the key measure and with the exception of Gonzales, Morrow-Howell &
Gilbert, has employed a cross-sectional methodology. The measurement of Nursing
and Medical students’ attitudes towards older people is of high importance as
Duerson, Thomas, Chang and Stevens (1992) indicated that the attitudes held by staff
can affect the treatment received and the way in which elderly people are treated.
With increasing numbers of older people requiring hospitalisation or medical
treatment due to an ageing population, the attitudes and associated behaviours of
medical professionals will be of increasing importance. Previous studies have
indicated that the attitudes held by medical students are predominantly negative,
however, these have been single groups. It is also of importance to be able to compare
these groups to other students not undergoing medical training to ascertain whether it
is the medical training per se that is resulting in the negative attitudes flourishing.
The current study seeks to build upon the research base looking at the attitudes held
by Nursing students. This study sought to follow two cohorts of students, one
undertaking a higher education undergraduate degree level programme in psychology
and the other undertaking a higher education undergraduate degree level programme
85
in nursing. These two cohorts were chosen primarily to assess the efficacy of nurse
training in reducing ageism. Psychology students were selected as a base measure as
there is no specific gerontological education received during the programme, only
minimal content included in a developmental context. In addition to this, the gender
balance on both courses is very similar. Both implicit and explicit measures of
attitudes towards older people will be taken to track any changes caused by the
education programme being undertaken. The hypotheses to be tested are:
(H1) There will be a significant difference between the implicit and explicit scores
returned by each of the groups at each time point.
(H2) Explicit attitudes will not be significantly changed by the delivery of either
Nursing or Psychology undergraduate programmes.
(H3) There will be a significant change in the implicit attitudes of the Nursing
students between commencement and completion of their course.
Participants
The initial cohort comprised 74 students. Of this sample, 40 were Psychology students
(Mean age: 24.0, S.D.: 8.0) and 34 were Nursing students (Mean age: 22.6, S.D.: 7.6).
At mid-point testing, the cohort comprised of 65 students. Of these, 34 were
Psychology students (Mean age: 25.3, S.D.: 7.7) and 31 were Nursing students (Mean
age: 23.4, S.D.: 7.4). However, by the end of the course of study, due to course
attrition, withdrawal and non-attendance the sample for the full longitudinal analysis
was reduced to 52 students. Of these, 26 were Psychology students (Mean age: 28.0,
S.D.: 8.1) and were 26 Nursing students (Mean age: 25.2, S.D.: 7.9). Of the
Psychology students, 4 were male and 22 were female with an age range of 20-47
86
years. Of the Nursing students, 3 were male and 23 were female with an age range of
20-46 years. Results will be reported using all participants where appropriate and
when correlation analysis is being conducted only those students completing all three
testing phases will be included2. The initial sample was an opportunity sample of two
targeted undergraduate course programmes at the University of Glamorgan. In
addition to standard course content, none of the participants had received any
additional gerontological interventions or training prior to testing.
Methodology
The materials used and overall methodology were similar to those presented in the
General Methodology section (see pp. 70). The sole difference was that this study was
a longitudinal cohort study taking measures of implicit and explicit ageism at three
time points rather than on a single occasion. Measures were taken at the start of the
respective degree programmes, again in the second year to obtain midpoint data, and
finally again at the end of the courses. This method was chosen to gain a base
measure of attitudes and then to ascertain any effects caused by either the degree or
specific nurse training. Contact details (name, email, telephone number) for each of
the participants were taken at the start of the project and stored in a secure filing
cabinet in a locked storage room for the duration of the project so that participants
could be contacted again and linked to their participant numbers to allow for cohort
comparisons. The contact details and participant numbers were stored separately so a
theft or accidental release of a document would not lead to the identification of
participants.
2
Those Psychology students who undertook the psych-gerontological education module were not
included in this sample.
87
Results
The descriptive results for both groups at each time point are presented prior to
ANOVA tests being conducted. Further to this both correlations between implicit and
explicit measures and correlations over time are presented.
Table 3: Table of longitudinal means
Group
Psychology Students
Nursing Students
D-Score
D-Score
FSA Score
FSA
(mean)
S.D.
(mean)
S.D.
1
.4526
.428
54.4
10.13
2
.7588
.759
53.8
7.56
3
.7091
.710
54.2
9.36
1
.2631
.474
49.5
9.28
2
.7028
.610
47.3
9.07
3
.6206
.671
47.8
9.57
Year
The descriptive results above illustrate the mean scores received by each of the groups
(Nursing and Psychology students) at each measurement time in both implicit (DScore) and explicit (FSA) measures.
The explicit results are expressed in graphical form in Fig 2
88
Fig. 2: Graph illustrating explicit longitudinal data
At time point one there was no significant correlation between the implicit and
explicit measures (r= -0.094, p=0.495). Similarly at time two there was no significant
correlation (r= 0.149, p=0.247). Finally this finding was repeated at time three (r=
0.069, p=0.628).
Data were analysed using a mixed ANOVA on the PASW statistical package. This
showed a significant group difference in explicit scores (F(1,183)=19.157; p<0.0001).
The
within
participants
explicit
measure
was,
however,
not
significant
(F(2,183)=0.406; N.S.). Further to this the interaction was also not significant
(F(2,183)=0.160; N.S.). Post hoc analysis using the LSD test of pairwise comparisons
found that there were no significant differences between any of the years of study.
89
The implicit scores are shown graphically in Fig. 3
Fig 3: Graph illustrating implicit longitudinal data
The implicit data were analysed using a mixed ANOVA which found there was no
significant group difference (F(1,183)=1.338; N.S.). There was, however, a
significant within subjects difference for the implicit measure (F(2,183)=6.321;
p<0.01). There was also no significant interaction effect (F(2,183)=0.194; N.S.). Post
hoc analysis using the LSD test of pairwise comparisons found that there was a
significant difference in scores at time one and time two (p<.001) and times one and
three (p<0.05) but not between time two and three.
Overall model analysis using the Wilks’ Lambda indicates that there are both
significant within (F(6,362)=2.41; p<0.05) and between (F(3,181)=10.76; p<0.0001)
90
participant effects. However, no significant interaction was found (F(6,362)=0.694;
N.S.).
Due to the longitudinal nature of this study, the data were also analysed for
correlations between individuals’ scores over time using PASW. These are
summarised in Table 4.
Table 4: Table of Nursing students’ explicit measure correlations
Time 1
Time 2
Time 3
Time 1
-
.639**
.568**
Time 2
-
-
.707**
**. Correlation significant at the 0.01 level
The Nursing students’ explicit results correlated significantly at each time point.
Similar results have been recorded for the Psychology undergraduate cohort.
Table 5: Table of Psychology students’ explicit measure correlations
Time 1
Time 2
Time 3
Time 1
-
.611**
.714**
Time 2
-
-
.646**
**. Correlation significant at the 0.01 level
The Psychology students’ explicit results correlated significantly at each time point.
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Of further interest are the correlations for both groups in terms of their implicit scores
which do not reflect the consistency demonstrated by the explicit measures.
Table 6: Table of Nursing students’ implicit measure correlations
Time 1
Time 2
Time 3
Time 1
-
.405*
.367
Time 2
-
-
.204
*. Correlation significant at the 0.05 level
Table 7: Table of Psychology students’ implicit measure correlations
Time 1
Time 2
Time 3
Time 1
-
.169
.314
Time 2
-
-
.329
Neither set of implicit correlations show the same level of consistency as the explicit
measure, a point that will be discussed later. As illustrated, the explicit measures
correlate at each time point for both Psychology and Nursing students. However, there
are no time point correlations for Psychology students on the implicit measure and
only between time one and two for the Nursing students.
Discussion
As is evident from the descriptive statistics, there is a clear difference between the
implicit measures of ageism for both of the groups. As an overview, it is clear from
each time point that there is no correlation between implicit and explicit measures,
therefore, the results support the supposition that implicit and explicit attitudes are
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different constructs. It is further evident that explicit results stay the same over time
but there is a significant difference between groups such that Psychology students
have higher levels of expressed explicit bias. These differences are also stable over
time. On the other hand, there are no correlations between the implicit scores recorded
except at one time measure. The implicit measures start by showing an embedded
preference for young over old with attitudes getting worse in the second year and
staying high in the third. There are no significant differences between groups on the
implicit measures. The above allow for the first hypothesis (there will be a significant
difference between the implicit and explicit scores returned by each of the groups at
each time point) to be accepted. From the commencement of the undergraduate
university courses there is a significant shift in attitudes. This shift was not in the
expected direction where it may be assumed attitudes towards older people would
become better, instead the attitudes towards them became worse. This worsening of
attitudes is something that is common for both Psychology and Nursing
undergraduates. Despite the course having a larger overall effect on the Nursing
students, the attitudes expressed by them still remain less ageist than those expressed
by the Psychology students.
With regard to findings on explicit measures, it would appear that participants are
subject to self presentational bias (Goffman, 1959) whereby the individual is
expressing attitudes under conscious control to place themselves in the best possible
socially acceptable light. Subjective norms are adopted through expectation of this
acceptability and despite interventions, educational or otherwise, the understanding of
what is socially acceptable or expected is ingrained and as such expressed when
explicitly questioned. Unlike the implicit scores, the explicit scores are stable over the
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three data collection phases, which supports the second hypothesis (explicit attitudes
will not be significantly changed by the delivery of either Nursing or Psychology
undergraduate programmes) to be accepted. This is likely to be due to the acceptance
of what socially acceptable responses are and despite any internal changes,
participants are aware that social norm responses will hold them in better regard. This
point will be readdressed when analysing data from the adult population in Study
Four. This self presentational bias is also a possible explanation for the strong
correlations, something that will be discussed further later in the discussion.
Implicit attitudes are not, however, subject to the same self presentational bias and as
such, any interventions (including educational) that could change these would be
measurable through testing. As there is no significant difference in the implicit scores
between the groups and in fact they appear to change in a relatively consistent way, it
can be argued that the education received by Nursing students has no more of a
positive or negative effect than does the completion of a psychology undergraduate
course. The fact that in both courses the implicit test results demonstrate a worsening
attitude could seem to indicate one of two things. Either: higher level education in
general affects the implicit attitudes towards older people in a negative way; or, that
within higher education, the environment and lack of contact with older people causes
an increased preference for younger people rather than an implicit disliking for older
people per se. What is clear is that unless the intervention being used has been
specifically tailored to reduce negative attitudes towards older people (Gonzales,
Morrow-Howell & Gilbert, 2010), it does not appear to significantly influence the
implicit attitudes held.
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Of consideration is the progression of implicit attitudes over time. Unlike the explicit
attitudes which stayed relatively stable, there was a statistically significant increase in
the D-Measure score between time one and time two and between time one and time
three. This was expected for the Nursing students, allowing for the third hypothesis
(there will be a significant change in the implicit attitudes of the Nursing students
between commencement and completion of their course) to be accepted. In addition to
the predicted outcome, the same was also true with the Psychology undergraduate
students, something that will be discussed later. This increase in D-Score is
illustrative of an increase in implicit ageist attitude strength. The reasons for this
marked increase are discussed in detail below but in brief, could either be due to the
course content of the first year influencing the implicitly held beliefs or from the
immersion into student life through the first year of study. The reason for the plateau
from time two to three can again be explained through either of these theories. First, it
could be that the course content, despite still including age specific information, has
less of an impact in the final year than it did in the first as individuals had little
previous ageing knowledge base. Due to this, the effect on increasing or decreasing
implicit ageism during the final year is negligible (and not significant) as the
information which affects the attitude has in the main already been assimilated.
Second, the attitude may have stabilised in the final year due to the stability of the
living environment. There is a big change when moving into a university environment
with the sheer number of young people and the sheltered environment that this
affords. By the final year, the participants will have experienced this big change and
consequential shift in their attitude and any subsequent shift would be marginal.
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The first possibility outlined above would seem to suggest that higher level education
makes people more implicitly ageist. Although only a small part of the course, ageing
is covered in both courses from either a medical perspective or a developmental
context. It has been previously acknowledged that there was a minor element of
ageing content in the psychology course; it has to be further considered that this may
have affected the results. In psychology the approach is designed to give a reflective
account of the ageing process but will invariably always have more information on
the negative factors associated with ageing including the losses (memory, mobility
etc) and increased incidence of illness (Whitborne & Hulicka, 1990). It can be argued
that the weighting on negative ageing information causes the assimilation and
aggregation with pre-existing information/schema creating a more negative
impression than that which previously existed. The inclusion of this additional
information from the first year of study into existing schema could then strengthen the
pre-existing negative implicit bias and cause the marked increase in reaction times
differences evident from the data displayed.
Returning to the argument that the attitude measured does not in fact demonstrate a
worsening implicit ageist bias, but instead an increasing implicit preference for
younger people. At the commencement of this study, there were eight mature students
(over 25) in the Nursing sample and four in the Psychology sample. The rest of the
participants had come to university straight from A-levels (or equivalent) and of
those, the majority were in student accommodation. It is a safe assumption that the
majority of students living in university halls of residence will be under the age of 25
and as such would be for the purposes of the IAT, classified in the younger section.
These students will spend much if not all of their time with people of their own age,
96
creating new friendships and generally experiencing undergraduate life. This
increased exposure to younger people would increase the strength of the attitudes
held. Previous research by Auty and Lewis (2004) found increasing attitude strength
in which ever direction attitudes were previously held (unless experiences changed
the valence) which from time one data would suggest implicitly ageist.
To resolve this issue, future studies could include a longitudinal investigation but vary
the students and courses assessed. If the sample of students included both residential
and non-residential as well as ‘mature’ and school-leaver age students, there would be
control over the type of environment that the students were exposed to in addition to
the course content. The second factor to be controlled would be the courses being
undertaken. The current samples were chosen due to the sample homogeneity (age,
gender etc) which despite being a strength, has resulted in two courses being assessed
where age related content has been included. It would be of interest when teamed with
the improved sampling, to include undergraduate courses that do not include age
related information (e.g. computing, maths). By including these courses, the effect of
general higher level education could be seen as well as any mediating effects of living
with peers and being surrounded 24/7 only by people of a youth demographic. As an
extension to the study it may be of interest to assess the attitudes of those who
undertake a distance learning course (e.g. Open University) to assess the impact solely
of the traditional university environment on the implicit and explicit attitudes held.
The correlational data are of specific interest as it is clear that over time, the scores on
the explicit measures for each participant correlate significantly. This means that
when looking at the individual, their specific score at each time point correlates and
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this is true for both Psychology and Nursing students. When analysing the implicit
scores, however, it is clear that that scores returned by each individual participant do
not consistently correlate with other implicit scores they recorded at the other time
points. This disparity has two core possible explanations, concerning either the nature
of the constructs or the nature of the tests.
The explicit measure correlates significantly at each time period with each group and
although returning at times what are relatively low “r” values, these are nonetheless
significant and show that there is consistency in the way in which participants are
responding. This should, however, be taken in context. Kline (2000) states that
correlations should ideally be over .9 but should not fall below .7 for them to
demonstrate good internal reliability. The effect size (as measured by the size of the
correlation) is not particularly high (at least as required by Kline, 2000) but that
nonetheless, there is a consistently significant relationship between scores. As
previously explained, the reason for score consistency is likely to be due to the nature
of self presentational bias. The participants are aware of the socially acceptable
answer and as such at each time point they answer each of the statements on the FSA
in a way that would reflect these subjective norms. This answering strategy is possible
in most explicit measures and the FSA is no exception. The individual items are quite
clear in their intent so from this, a socially acceptable answer is easily provided. As
the measure is a straightforward one, despite the participants being unlikely to
remember the questions between data collection points, similar responses would be
easily provided thus explaining not only the strength and direction of the attitudes but
also their stability and correlation.
98
As has shown to be the case throughout, the implicit measure provides a different
picture. There are no significant correlations within the groups between any of the
time points (except between time one and time two for nurses) and the correlations
returned are very weak. This suggests that the scores returned on an individual basis
fluctuate between time periods and as such are not a stable indicator of implicit
attitudes. It would be expected that each time point (similarly to the explicit measures)
would be correlated significantly to the other implicit data returned on an individual
level. An initial supposition from this could be that although the IAT performs well as
a group measure, this study does not support the IAT as a consistent measure of
individual implicit attitudes. The results would hold that individual fluctuations are
such over time that few predictions can indeed be made on an individual level about
future attitudes or behaviours. If true, this could be worth serious consideration prior
to using the IAT as an individual measure both in terms of academic research and
theory development but also in practical terms for marketing and screening tools. If
the fluctuations are such that only basic direction rather than strength of an attitude
can be accurately predicted, the use of the IAT for screening personality types or
attitudes held on an individual basis should be severely scrutinised.
There is, however, an alternative explanation for the differentiation of scores between
time points. The focus of this study was to investigate the effects of higher level
education and specifically undergraduate nurse training on attitudes to older people.
As such there is an educational course present that has been discussed throughout this
section. The education is not solely dedicated at any stage to the promotion of
innovative ageing or reducing ageism and as such there has not been an observable
flux in the explicit measurement scores. The implicit test is attempting to measure
99
attitudes outside of the conscious control of the participant and as such the effects of
any intervention or education could have a greater impact. The impact of education on
any one person is not a linear process and as such different methods and content can
affect different people in different ways. Due to the differing impact of the education
being received at each of the time points during the undergraduate programme, it
stands to reason that an individual’s score may not correlate as the scores fluctuate
(within the same valence). If this were indeed the case, the IAT itself could be
considered a stable measure all things being equal without the presence of an
intervention measure. The IAT has been shown to be a stable measure over time
(Perugini, 2005) even on an individual basis. However, in the meta-analysis
conducted by Perugini, none of the testing was with groups undergoing any form of
intervention. Similarly to the argument surrounding exposure and environment
detailed above, the nature of the university setting may also have positively affected
the preferences for younger persons as opposed to negatively affecting the attitudes
towards older people. So, as previously suggested, it would be prudent to conduct the
longitudinal data collection controlling for sample demographics and surrounding
environment to ascertain in this case whether the fluctuations in individual IAT scores
(lack of correlation over time) was due to the educational courses or environment. In
addition to those retests, a longitudinal control group should be employed to test the
correlation of time point data in a group where no manipulation/intervention is
present. If the results from this still suggest that there are no statistically significant
correlations at the different time points with all other things being equal then this
would support the initial supposition that the IAT should be used with caution on an
individual basis. There is, however another plausible explanation. Responses on the
IAT are in effect reaction time measures. Longitudinal studies (Lovden, Li, Shing &
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Lindenberger, 2007) have reported quite low inter-session correlations (.2 to .3
levels). Therefore, it is not surprising that the IAT shows low correlations between
test sessions. What matters is that the negative attitudes (which measure relative
differences between positive and negative responses) remain consistent. Thus, caution
must be used with the IAT as the absolute size of the score is almost certain to
fluctuate. What is important to note, however, is if this is the case, it does not
invalidate findings that look at relative differences between groups as they are
comparing a single time point. Either way, more investigation is needed to
conclusively support whether specific or general higher level education have an
impact on the implicit attitudes held about older people.
Conclusions
It can be concluded from these results that Psychology students have more negative
implicit and explicit attitudes towards older people than do Nursing students.
However, neither Nursing students nor Psychology students expressed explicitly
negative ageist attitudes. This explicit trend was stable throughout the testing period
which can be explained through higher level awareness and self presentational bias.
Implicitly, both groups expressed negative attitudes from the outset with a marked
increase in ageist scores following the completion of the first and second halves of
their degree programmes. This could be due to either situational or intervention
factors so further studies have been recommended to clarify this point. Individual IAT
test score correlations over time are weak and not significant, again possibly caused
by the intervention or situational factors so similarly additional tests have been
recommended for clarity purposes. Further to the latter tests, it is possible that the use
of the IAT for individual level attitude and preference assessment could be called into
101
question, therefore, longitudinal retest recommendations should be undertaken post
haste.
102
Study Two – A cross-sectional study using Early Years students to ascertain
directional preference in the IAT
Introduction
In Study One, it was noted that the increasingly negative implicit scores might be due
to increased negativity towards older adults, or conversely, could be explained by
increasingly positive attitudes towards younger people. The IAT measures attitude
strength and valence through paired associations using opposing words and images,
with the results illustrating an implicit preference. When measuring a cross-sectional
sample there are few issues with this. When assessing the impact of an intervention
measure or programme of education in a longitudinal setting, however, it becomes
apparent that the direction of the effect from the intervention is an important
consideration. Steinman and Karpinski (2008) have shown that through priming that
preference of one category can be increased to the detriment of the opposing category.
Of interest was that the rating per se of the second category did not decrease, simply
that it appeared to do so with the promotion of the first category. The previous study
illustrated this point. However, does the increase in apparent implicit ageism come
from the educational programmes’ content promoting youth development thus
increasing youth preference or from the ageing content reaffirming existing negative
ageist stereotypes? Alternatively, as was raised in the discussion of the previous
study, the university environment might increase youth preference, thus only
coincidentally appearing to indicate an increase in ageist attitudes.
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The current study addresses a key component of this question. If the educational
environment can have an effect, then is it possible for an educational programme to
negatively affect implicit ageist attitudes when no ageing research literature of any
kind is covered in the course? To address this question, the following study was
devised. A group of students were chosen with as similar a demographic background
as possible to the Nursing and Psychology students used in the previous study, but
who did not study ageing as any part of their course. The group in question all took
the Early Years degree at the same university. Educational and geographical
background was similar, and many of the lecturers on the Psychology course also
taught on the Early Years course. Thus, the environment was as close as was practical
without including an ageing component. Although the students were very similar in
many respects, a failsafe procedure was built into the analysis of the results. The DMeasure/Score algorithm is known to control for cognitive differences, which
otherwise might act as a confounding variable (Cai, Sriram & Greenwald, 2004).
The premise of this study is that by undertaking a programme of education based only
on early years/child development, a stronger implicit age bias can be developed. It is
supposed that through this course of study, preference for younger people will
increase due to the nature of the course but this will be reflected through the IAT as
an ageist attitude. This leads to the generation of the hypothesis:
(H1) That undertaking an undergraduate degree programme based on child
development will increase preferences for youth stimuli, resulting in a more implicitly
ageist IAT result.
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Explicit measures will also be taken as a broad measure of accepted explicit ageism as
a comparison.
Participants
Participants for this study were recruited via opportunity sampling from the Early
Years undergraduate degree programme at the University of Glamorgan. This course
was specifically selected due to the course content excluding material on older people
and specifically educating the participants in development of younger people. The
sample consisted of 16 students (1 male, 15 females) with an age range from 20-25
(Mean: 22.4, S.D.: 1.8) years.
Methodology
No amendments have been made to the standard methodology previously detailed on
pp. 70. The measures were taken at the end of the students’ programme of study as a
cross-sectional indicator for comparison with the scores returned by participants from
other undergraduate programmes.
Results
The descriptive results for all three comparative groups are presented prior to
ANOVA tests being conducted. Explicit and implicit inferential tests are presented
separately to illustrate group and test differences. Further to this both correlations
between implicit and explicit measures and correlations over time are presented.
105
Table 8: Table of comparable means for Psychology and Nursing Students
D-Score
D-Score
FSA Score
FSA
(Mean)
S.D.
(Mean)
S.D.
Psychology Students
.7091
.9539
54.2
9.36
Nursing Students
.6206
.6714
47.8
9.57
Early Years Students
2.4644
.8608
53.1
11.62
Groups
Results from the early years cohort indicate no significant correlation between
implicit and explicit measures (r=0.183, p=0.497).
The results were analysed using a one-way between-subjects ANOVA. In the case of
the explicit scores there was no significant main effect (F(2,65)=2.923; N.S). Post-hoc
LSD pairwise comparisons found the only significant difference in these groups to be
between the Psychology and Nursing students as reported in Study One. In the case of
the implicit scores, between-subjects ANOVA results indicated a significant main
effect (F(2,65)=28.604; p<.0001). Post-hoc LSD pairwise comparisons found that
there were significant differences between Early Years students and both Psychology
students (p<.0001) and Nursing students (p<.0001).
Discussion
As an overview, it is evident that the results from the Early Years cohort supports the
central argument that there is no correlation between implicit and explicit measures
and as such they measure different subsets of an attitude. It is also clear that there is a
significant difference between the implicit scores of the three groups with Early Years
students being significantly more ageist than either of the other student groups. The
106
explicit scores recorded are similarly non-ageist for each group with no significant
difference between Early Years students and either Psychology or Nursing students.
These results allow the hypothesis (that undertaking an undergraduate degree
programme based on child development will increase preferences for youth stimuli,
resulting in a more implicitly ageist IAT result) to be accepted.
As with the Psychology and Nursing students before, the Early Years students also
show a significant (p<0.001) difference in the implicit and explicit scores recorded.
This significant difference adds support to the understanding that implicit and explicit
attitudes are separate subsets of the same attitudinal construct. Two main reasons
could be presented to account for this; either the students are keenly aware of the
correct social response and respond in such a way to present themselves in line with
societal expectations or that they are truly not ageist and the strong IAT score is as a
result of their increased preference for younger people, however, not at the expense of
the older person. The latter point will be further discussed with suggestions for
clarification.
Because of the nature of this cohort and the course that they have undertaken, the
Early Years sample will not be directly compared to another cohort to assess the
impacts of general higher level education. The course they have undertaken was
measured to assess if there was an impact of directed education (youth-centric) on
attitudes towards older people. It has been demonstrated that there has been an effect
above and beyond that of general higher level education per se, thus comparing them
as if they were representative of higher education would be incorrect.
107
The results clearly indicate the expected direction, supporting the supposition that an
ageist IAT result can be influenced through interventions concentrating on the
opposite IAT category. At no point in the Early Years course was ageing in terms of
older people broached. Therefore, as similar environmental situations were
experienced to those of the Psychology and Nursing students, it can be argued that the
main effect is due to the difference in educational course content. This is an important
finding as it questions whether the ageism IAT is in this case actually measuring the
attitudes held towards older people or more accurately measuring an implicit
preference towards younger people. To illustrate this further, the following analogy
might be useful. It is perfectly possible for someone to prefer a person with particular
characteristics as a sexual partner, but that does not mean that they hate people who
do not possess these characteristics. Thus, a heterosexual man might have a strong
preference for blonde haired women, but that does not mean that he hates men with
dark hair. However, an IAT measure of such people with such groups set in
comparison with each other might well indicate a strong bias in favour of blonde
women. That cannot and should not be interpreted as indicating an anti-dark haired
men prejudice.
There are problems with this study that will need to be addressed if any firm
conclusions are to be made about what indeed is being measured by the IAT. First, the
tests need to be conducted prior to the commencement of the study and upon
completion in a similar manner to Study One. This is something that was omitted in
the current study but should be central to future intervention studies. In conducting a
longitudinal study it is possible to map the progression of the attitudes from the initial
108
base measure to ascertain whether there has been a change or whether the group itself
was more implicitly bias to start with. When viewed from this approach, the results
obtained in the current study support a case for further investigation. They do not,
however, stand alone to conclusively say whether increasing the preference for
younger people would in turn affect the implicitly expressed attitudes towards older
people. To improve the study in a similar vein to the previous longitudinal study, it
may be of interest to extend the sample to those partaking in a remote access course
whereby the university environment can be controlled for. As with the Study One, this
would allow for judgements to be made about the influence of interventions and
environment on implicitly held attitudes towards older people.
Second and of high importance is to develop a way of assessing which direction an
attitude is being influenced. It is distinctly possible to have a preference for younger
over older people but not to be ageist in your attitude or behaviour. To this end a way
of measuring the attitudes directly towards old and young categories rather than as a
preference for one over the other should be implemented. One such method of doing
so is the Single Category Implicit Association Test (SC-IAT) developed by Karpinski
& Steinman (2006). Where the standard IAT relies on categorisation using pairings
for both old and young simultaneously, the SC-IAT uses only one of those categories
at a time to elicit the underlying attitudes held for a specific target. This could be used
in conjunction with the existing IAT measure to ascertain base line and post
intervention measures. This would allow for accurate reporting not only of the
preferential attitude but also to demonstrate which aspect of the attitudes held have
been affected (positive liking or negative disliking). The SC-IAT has been shown to
be effective in eliciting implicit single concept attitudes (Bohner, Siebler, Gonzalez,
109
Haye & Schmidt, 2008; Steinman & Karpinski, 2008) and as such would be ideal
when paired with the current IAT to clarify the current outstanding questions.
Conclusions
Explicit attitudes in this group, as with any other, are subject to self presentational
bias should the individual be aware of what is being measured and/or the socially
accepted response. Alternatively, explicit attitudes could be a reflection of how an
individual truly thinks and as such are reflective of their consciously held beliefs.
Either way, the explicit results need to be taken within context and under due
consideration. This warning is also true when interpreting data from a standard IAT.
The IAT provides a score of preference between two opposing concepts and as such
provides an attitude along that dyadic continuum. The SC-IAT or similar measure
could be used to tease out whether the attitudes expressed on the IAT are indeed a
measure of negativity or of preference. These results indicate that there is a significant
effect of category preference due to the nature of the intervention undertaken.
However, before conclusive evidentiary support can be gained, a longitudinal study
will need to be conducted to ascertain a base measure and post intervention measure
for both IAT and SC-IAT measures. In addition to this, the study should be expanded
to include sample controls as outlined in Study One to minimise the confounding
variables.
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Study Three – A cross-sectional study assessing attitudes held by hospital nurses
working in A&E and Geriatric medicine
Introduction
A considerable body of research literature identifies Nursing students as holding
negative attitudes towards older people (Duerson et. al., 1992; Gatz & Pearson, 1988;
Grant, 1996; Higgins, Van der Riet, Slater & Peek, 2007). The initial longitudinal
study in this investigation has demonstrated that, albeit no worse than Psychology
undergraduates, Nursing students do exhibit negative implicit attitudes towards older
people.
Steffens & Schulze Konig (2006) conducted a review of literature suggesting that
implicit biases are expressed as actions when the stimulus presented to the agent is
spontaneous and unexpected. They also conducted an experiment to support their
review, finding that automatic aspects of behaviour are predicted better by IAT results
than explicit measures whilst the inverse is true for controlled behaviour involving
self-presentation. When this is placed in the sphere of ageing, it is of interest to see
what effect educational interventions can have on implicit attitudes (as shown in the
previous two studies). However, more serious concerns can be raised in the context of
caring for older people. It has been shown that Nursing students have a negative
implicit attitude towards older people and also that these implicit attitudes in turn
govern behaviour in spontaneous unplanned environments. Emergency and acute
medical treatment such as that provided in a hospital environment would in the vast
number of cases fall into the category of unplanned behaviour due to the reactionary
nature of the job. It can, therefore, be reasonably supposed that if these negative
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implicit attitudes continue through from their training, the nursing staff caring for
older people might indeed provide care that is substandard for older people. This type
of care ranges from withholding appropriate treatment as it would benefit a younger
person more, to simply not providing the level of care expected. If there are pervasive
negative attitudes towards older people then it can be argued that some form of
intervention such as those trialled successfully in Singapore (Cheong, Wong & Koh,
2009) and Australia (Gonzales, Morrow-Howell & Gilbert, 2010) should be
implemented in the UK. Successful interventions such as those trialled in Singapore
and Australia have demonstrated that they need to be tailored for the specific purpose
of reducing ageism, include both classroom and practical components and engage
students/participants with older people.
This current study takes a sample of qualified nurses working within a single hospital
in a South Wales (UK) NHS Trust. An opportunity sample of nurses working in an
Accident and Emergency (A&E) and Geriatric Medicine setting were recruited. These
two samples are important as the A&E nurses would encounter caring for older
people who are acutely ill and admitted quickly often in an emergency. The decisions
that are made by the nurses in this setting would be spontaneous, relying on implicitly
held attitudes and could result in life and death calls on treatment. In this environment
older people would only make up a proportion of the total number of patients cared
for so it is possible that discrimination between young and old could occur. Further to
this, in an A&E environment, nurses only see patients who are too ill to be cared for
in any other setting so would generally only see people (both young and old) while
very ill, before being transferred to other departments to fully recover. Exposure to
only the most ill patients could influence the implicitly held stereotypes associated
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with older people if this is the only contact they have with them. However, it can be
reasonably assumed that younger nurses (in the sample) would come into daily
contact both in work and outside of work with fit and healthy younger people, thus
balancing their negative stereotype assimilations.
Nurses working in dedicated geriatric medicine wards of the hospital were selected as
they have contact only with older people in their daily working lives. Zajonc’s (1968)
theory of mere exposure effect suggests that just from coming into contact with
something on a regular basis will make that object appear more favourable. A wealth
of research has supported this and the direct contact hypothesis in that contact
between groups where negative stereotypes have previously been held can itself help
reduce the negativity of the stereotype and associated attitude (Allport, 1954; Cook,
1962, 1978; Pettigrew, 1979; Stephan & Stephan, 1984; Paolini, Hewstone, Cairns &
Voci, 2004; King, Winter & Webster, 2009). From this it could be suggested that
those nurses working in a ward specifically for care of older people would hold less
negative (if not positive) attitudes towards older people than do those working in and
A&E environment. As a result, the proposed hypotheses are:
(H1) Those working in geriatric wards will have implicit attitudes less ageist than
those who are working in A&E departments
(H2) Nurses generally will hold negative implicit attitudes towards older people
(H3) Neither group of nurses will express explicitly ageist attitudes
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Participants
Participants were either: Nurses in an A&E medical environment and nurses who
work specifically on wards for care of older people. Each of the nurses for both
subsets was recruited from the same South Wales NHS trust. Nurses were informed of
the study and volunteers from each of the appropriate departments were tested. The
measures were taken from nurses with a minimum of 3 years post qualification so all
participants had experience of working in a ‘real world’ medical environment. The
sample consisted of 32 (30 female, 2 male) nurses specialising in emergency care
(Mean age: 35.1, S.D.: 7.4) medicine and 17 (16 female, 1 male) nurses specialising
in care of older people (Mean age: 34.0, S.D.: 5.4).
Methodology
No amendments have been made from the procedure described in the General
Methodology section (pp. 70).
Results
The descriptive results for all three comparative groups are presented prior to
ANOVA tests being conducted. Explicit and implicit inferential tests are presented
separately to illustrate group and test differences. Further to this both correlations
between implicit and explicit measures and correlations over time are presented.
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Table 9: Table of comparable means for Qualified Nurses and Nursing Students
D-Score
D-Score
FSA Score
FSA
(Mean)
S.D.
(Mean)
S.D.
Geriatric Nurses
1.011
.8131
51.1
7.39
A&E Nurses
0.973
.8502
52.3
9.12
Nursing Students
.621
.6714
47.8
9.57
Group
When combining the scores from both A&E and Geriatric nurses it is clear there is no
significant correlation between the implicit and explicit measures (r=-0.33, p=0.824).
The explicit results were analysed using a one-way between-subjects ANOVA. This
produced no significant main effect (F(1,47)=0.226; N.S) demonstrating that there
was no significant difference in explicit scores between the three groups. All LSD
post-hoc pairwise comparisons found no significant individual group differences.
Results from the between-subjects ANOVA using the implicit data also showed no
significant difference in main effect (F(1,47)=0.024; N.S), again demonstrating no
statistically significant difference between groups.
The Table overleaf shows the aggregated means of the two qualified nurses compared
again to the nursing students. This is to show the difference between student and
qualified nurses.
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Table 10: Table of aggregated comparable means for Qualified Nurses and Nursing
Students
D-Score
D-Score
FSA Score
FSA
(Mean)
S.D.
(Mean)
S.D.
Qualified Nurses
0.987
.8221
51.9
8.02
Nursing Students
0.621
.6714
47.8
9.57
Group
The results were analysed using a one-way between-subjects ANOVA. In the case of
the explicit scores there was no significant main effect (F(1,73)=0.243; N.S).
Results from the between-subjects ANOVA using the implicit data also showed no
significant difference in main effect (F(1,73)=0.029; N.S).
Discussion
As an overview, all groups recorded scores on the implicit measure suggesting high
levels of implicit ageism, however scores for the explicit measure suggest outwardly
non-ageist attitudes. There were no significant differences reported between the two
groups of nurses. In addition, when combining the two groups, results support the
assertion that implicit and explicit tests measure different subsets of the same attitude
as there is no significant correlation between measures.
The data recorded mean that the first hypothesis (Those working in geriatric wards
will have implicit attitudes less ageist than those who are working in A&E
departments) has to be rejected as there was no significant difference between the two
groups. The second hypothesis (that Nurses generally will hold negative implicit
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attitudes towards older people but no explicit ageism will be expressed) was accepted.
The third hypothesis (Neither group of nurses will express explicitly ageist attitudes)
was also accepted as all scores fell below 58, which is the point where explicit ageism
is recorded.
Despite the arguments presented in the rationale, there was no significant difference
in the implicit (or explicit) attitudes held between the two groups of qualified nurses.
It would have been expected that due to the larger amount of contact, those nurses
working in a dedicated ward for the care of older people would have implicit attitudes
less ageist than those who are working in A&E departments. However, research has
also indicated that even after taking selection and social desirability processes into
account, all types of exposure affect attitudes in a favourable direction (Lee, Farrell &
Link, 2004). When taking this into account and acknowledging that both types of
qualified nurse are likely to have contact with older people on a daily basis, it is
possible that the level of exposure to older patients in non-geriatric nursing might in
itself be sufficient to trigger the observed effects. Nurses working in a ward for the
care of older people have to deal with older patients on a day in day out basis,
encountering much that is supposed to be stereotypically ‘annoying’ about older
adults, whereas the A&E nurses see them only briefly, where their capacity to be
‘trying’ is far less. What this implies is that geriatric nurses’ level of negative implicit
feelings is surprisingly low. It is further probable that the exposure that both groups
experience accounts for the lack of significant difference between the two groups.
However, if exposure to older people made attitudes better then the question remains
as to why both groups held implicitly negative attitudes and indeed why they were
more so than the nursing students. This can be answered at least in part by looking at
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the type of contact and experience held. Although it can and has been argued in this
review that any exposure will make attitudes better, continual exposure to negative
information and experience of older people can negatively affect the schema held
regarding older people (Grant, 1996). It is a distinct possibility that those younger
nursing staff only come into contact with older people when they are at work and
seeing them in varying degrees of illness and/or infirmity. If this is the case then those
nursing staff will have only additional negative information to assimilate into their
schema for older people that will in turn affect their beliefs and attitudes about older
people. Auty and Lewis (2004) found similar results in that exposure to older people
changed the strength of the attitude held but in the direction that it currently existed,
except in the case of extreme experiences where the valence too was altered. As there
is a daily contact in both settings, it can be argued that the existing negative implicit
attitudes (gained as a societal norm and nurse training) are only strengthened from
working in that environment and with the absence of any extreme experience to alter
the valence of the attitude, it continues to become more negative. Negative attitudes
could be increased by day-to-day exposure to some of the traits associated with older
patients in care. These can include; wandering, forgetfulness, incontinence, accusing
nurses of stealing, etc. It is possible that this daily exposure and continual
reinforcement of negative associations would add to any preconceptions about older
adults that students and nurses might have.
The explicit scores again are expressing no such age bias as they are potentially
subject to self presentational bias (Goffman, 1959) whereby the individual is
expressing attitudes under conscious control to place themselves in the best possible /
socially acceptable light. Subjective norms are adopted through expectation of this
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acceptability and despite any contact or intervention, the understanding of what is
socially acceptable or expected is ingrained and as such expressed when explicitly
questioned. Expression of explicitly accepting attitudes is likely to be due to the
acceptance of what socially acceptable responses are. Despite any internal changes,
participants are aware that social norm responses will hold them in better regard. As
stated, implicit attitudes are not, however, subject to the same self presentational bias
and as such, any intervention and/or contact that could change these would be
measurable through testing.
What is important, however, is that the apparently pervasive negative implicit attitude
held by society generally (Levy and Banaji, 2002) is also present to a similar level
within the nursing community, including in those nurses specifically caring for older
people. This is of concern as it is these people who are charged with meeting the
needs of older people when they are at their most vulnerable and it is these people
who will have to make spontaneous treatment decisions, activating implicitly held
stereotypes and attitudes.
Conclusions
Nurses working in both A&E and geriatric medicine settings within a hospital
environment hold similar implicit and explicit attitudes towards older people. Neither
group expresses an explicit ageist bias, however, their implicit scores indicate a
relatively high ageist bias. This disparity is not uncommon in that it has been the trend
for each of the groups tested, however the negative implicit ageist bias is higher than
those nursing students sampled. Although the difference between nursing students’
and qualified nurses’ implicit bias is not quite significant, there is a clear increase. Of
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future interest would be to monitor the career pathway of nurses through either a
series of cross-sectional studies or with a longitudinal cohort to assess whether this is
a trend that continues throughout their careers.
The nature of the implicit attitudes held by both the nursing students and the qualified
nursing staff would seem to indicate that there is a need for systemic change. Training
interventions have been shown to be successful in reducing age bias in both students
and qualified nurses (Cheong, Wong & Koh, 2009; Gonzales, Morrow-Howell &
Gilbert, 2010) and should be adapted for a UK care context. As the population ages it
is imperative that a successful method of combating this issue is found so as to
minimise / eliminate ageism as a factor in care choices made for older people.
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Study Four – A cross-sectional study assessing the effects of higher level
education on implicit and explicit attitudes towards older people
Introduction
The previous studies in this investigation have identified that educational content can
affect a person’s implicit attitudes. This is specifically in the case of Early Years
students and more generally, for those Psychology and Nursing students. They have
also revealed that qualified nurses’ implicit attitudes are no better and are in fact
worse than their comparable student counterparts (albeit not quite at a significant
level). Each of these groups has undertaken post A-level (or equivalent) education.
However, with 44% of school leavers currently continuing into higher level education
(Department for Education & Skills, 2008), that still leaves the majority of people in
the UK who do not attend higher level education institutions. The figure for those
who have not been through higher education was higher in the past, so that amongst
40 yr olds, the proportion without a degree is circa 79%. When taken in the broader
sense, in 1980, only 21% of school leavers went to higher level education institutions
(Department for Education & Skills, 2008). When looking UK wide, this indicates
that the vast majority of those adults living in the UK have not undertaken higher
level education.
Preston and Feinstein (2004) found that the level of education received does affect the
attitudes held by participants. They established that those who underwent higher level
education were more likely to be open-minded and hold more accepting attitudes than
those who did not. With this in mind and considering the results from previous studies
in this thesis, the question remains, what effect does general higher level education
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have on specific attitudes to ageing? The literature would seem to suggest that the
attitudes of those who have not undertaken higher level education would be
significantly more negative than those who have (Hogan & Mallott, 2005).
The current study will measure the attitudes of a sample of adults who have not
undertaken higher level education and then compare them to those adult qualified
nurses who have undergone higher level education and those students currently
undertaking that education. The hypotheses being tested are:
(H1) Those adults who have not undertaken higher education will express more ageist
implicit attitudes than either those students undertaking, or those adults who have
undertaken, higher level education.
(H2) Those adults who have not undertaken higher education will express more ageist
explicit attitudes than either those students undertaking, or those adults who have
undertaken, higher level education.
Participants
The sample for this study consisted of 20 participants (4 males, 16 females) with an
age range of 20-48 years (Mean: 35.1, S.D.: 8.0). The sample was recruited through
the Human Resources department at the University of Glamorgan. Those staff who
were not university graduates but who had completed A-Levels were identified by
line managers across several departments and directly approached to participate in the
study. Staff were not made aware of the reasons pertaining to their selection, only the
key aims of the study in general so as not to cause angst or upset. Staff worked in a
mixture of environments in the university, some of which were front of house and
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dealing with students and others were more support/administration. Comparisons have
been made between this group, Nursing students and the General Adult sample. This
has been done to minimise the cohort effects regarding age and education. The
General Adult sample has been compared to the Qualified Nursing sample as they are
of a more comparable age than the other sample groups. Nursing Students have then
been used as a comparison group as they have undergone a higher education course
where a full longitudinal data set is available and being Nursing Students are
comparable to the Qualified Nurse sample. As such, the effects of higher level
education on attitudes towards older people can be assessed through the comparison
of these two groups with other sample comparisons provided in the meta-analysis.
Comparisons have not been made at this stage with Psychology Students as they are
similar to those Nursing Students and as such do not add anything to the argument at
this stage. Further to this comparisons have not been made with the Psychology of
Ageing cohort or the Early Years group. These groups have both undertaken specific
education (on ageing or youth) and as such are not representative of the effects of
higher education in general. As with the other cohorts, these will be included in the
meta-analysis. However, they do not add to the understanding of general higher level
education on attitudes towards older people.
Methodology
No amendments made, please see General Methodology section (pp. 70).
Results
The descriptive results for all three comparative groups are presented prior to
ANOVA tests being conducted. Explicit and implicit inferential tests are presented
123
separately to illustrate group and test differences. Further to this both correlations
between implicit and explicit measures and correlations over time are presented.
Table 11: Table of means comparing the effects of education
D-Score
D-Score
FSA Score
FSA
(Mean)
S.D.
(Mean)
S.D.
Qualified Nurses
0.987
.8221
51.9
8.02
Nursing Students
.621
.6714
47.8
9.57
General Adult Sample
1.093
.942
57.2
7.71
Group
Results from the General Adult population indicate no significant correlation between
the implicit and explicit measures of ageism (r=0.018, p=0.94).
The explicit data clearly shows a difference between the general adult population and
both qualified and student nurses. Nurses have been chosen as a comparison group as
they are of a similar age to the adult population and as such are the most directly
comparable group to ascertain the effects of education. The student nurses have
further been chosen to show the progression from training through to the work place.
Psychology students have not been included in the comparison at this stage (but are in
the meta-analysis on pp. 152) as the effects of higher education are reflected in the
undergraduate nursing course and the scores of these students are comparable. This
demonstrates not only the effects of education in the immediate context but also
shows the effects of working in a caring profession/hospital environment. The scores
in all cases are below that of explicit ageism (58 on the FSA), however, the general
adult sample comes close to the threshold.
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These data illustrate that there is no appreciable difference between the general adult
population and qualified nurses, where both express comparably high levels of
implicit ageism. Unlike the qualified nurses, however, the student nurses have a
substantially different implicit score to the general adult population. When comparing
the students to the general adult population using a between-subjects ANOVA there
was a significant main effect returned for the explicit data (F(1,44)=12.84; p≤0.001)
and the implicit data was also approaching significance (F(1,44)=3.948; p=.053).
Further between-subjects ANOVAs revealed that there were no significant main
effect differences between Geriatric nurses and the general adult sample on the
implicit measure (F(1,35)=0.78; N.S) but there was on the explicit measure
(F(1,35)=6.058; p<.05). When comparing those nurses who worked in the A&E
department to the general adult population using the same ANOVA technique there
was similarly no main effect on the implicit measure (F(1,50)=.225; N.S.) and the
explicit measure was approaching significance (F(1,50)=4.016; p=.051).
Discussion
An overview of the results shows that there is no significant correlation between the
implicit and explicit measures of ageism. This supports the assertion that implicit and
explicit attitudes are different subsets of the overall attitude and are measured in
different ways with potentially different valence shown. Data also show those who
have not received higher level education are similarly as implicitly ageist as those
who have undertaken higher level education. Those adults who have not undertaken
higher level education, however, exhibit significantly worse explicit attitudes towards
older people. Of note is that despite being significantly worse, no group expresses
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attitudes on the explicit measure that when scored would suggest ageist attitudes.
There were also no significant differences in the explicit scores between the qualified
nurses and the adult population but there were significant differences in the explicit
scores. This difference showed nurses (both qualified and students) to have a less bias
explicit attitude than those who had not been through higher level education. Of note,
however, is that despite being significantly more explicitly ageist, the general adult
population similarly did not exhibit ageist attitudes (Scores above 58 on the FSA).
The results mean that the first hypothesis (Those adults who have not undertaken
higher education will express more ageist implicit attitudes than either those students
undertaking, or those adults who have undertaken, higher level education) is rejected.
The second hypothesis (Those adults who have not undertaken higher education will
express more ageist explicit attitudes than either those students undertaking, or those
adults who have undertaken, higher level education) has, however, been supported by
the analysis.
In terms of the implicit attitudes, there is a noticeable difference when the descriptive
statistics are observed. However, this difference is not significant for any of the
compared groups. Due to these differences falling short of the level of significance
required, the first hypothesis cannot be supported. There are possible methodological
reasons why the results just fell short of the required level of significance. The general
adult population sample was all taken from those who worked in the university.
Despite the fact that the majority of the adults were not working with students on a
daily basis (kitchen, clerical, grounds maintenance etc) they would still have been in a
general environment where they would have come into daily contact with them. As
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research has shown, (Lee, Farrell & Link, 2004) when in day to day contact, attitudes
towards the target group (in this case the students/young people) will become more
favourable. If this is the case then the implicit attitudes of those adults working at the
university would be more favourable regarding young people and not necessarily
worse with regards to older people. This means that it is not solely the effect from
lack of higher level education that is being observed. This leaves the same question as
was generated in Study One. Are the results which demonstrate an increased implicit
prejudice due to an increased preference for younger people or an increased prejudice
against older people? In addition to this is whether the same trends will be found in
the general adult population outside of the university environment or are the sample
that were selected influenced by their place of work?
To address the issues that have arisen with implicit testing, the following
improvements to methodology will need to be made: The sample will have to be
increased to allow for a wider distribution of responses; the sample will have to
include or comprise solely those people who have not received higher level education
and do not work in environments with young or older people (e.g. office workers) and
finally the use of a Single Category IAT (SC-IAT) in addition to the standard IAT
would allow for direction of preference to be shown too.
This is not, however, the full picture. The explicit results do show a significant
difference between the general adult sample and both students and qualified nurses.
Despite not quite demonstrating an explicit level of ageism, is can be said that they
are significantly explicitly more ageist than either of the other groups. When using the
general adult population as a comparison group, it becomes evident that the qualified
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nurses do not hold any more or less negative implicit attitudes than do those of a
similar age who have not undertaken higher level education. The main difference
between the nurses and the general adult sample was regarding their explicit scores
where those in the general population recorded significantly more ageist scores. This
in itself is quite an interesting finding as it can be hypothesised that those who have
not received higher level education are either more explicitly ageist or that they do not
have the same level of ability to monitor their expressed opinions. The latter
explanation would infer that self presentational bias increases as the level of education
increases. This supports early research by Goffman (1959) who stated the more
educated a person is, the more aware they become of the subjective and societal
norms against which they will measure themselves and in turn be measured. As this is
an explicit measure and it is the expression of the explicit attitude that is on interest,
the fact the adult sample work in a university environment should be of little
consequence. Unlike the implicit measure, if the explicit tests are repeated with
similar results in a wider sample, it will add support to an already solid finding rather
than clarifying the data already obtained. If this is the case and increased education
leads to increased self presentational bias, any study using only explicit measures
should consider this as a confounding variable.
Conclusions
It would appear that those adults who have not undergone higher level education are
more implicitly and explicitly ageist than their counterparts who have undertaken or
are currently undertaking higher level education. This result is in support of previous
research (Hogan & Mallott, 2005) in that increased education levels would appear to
decrease ageism. This would suggest that there is benefit (additional to that of
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increased knowledge) in embarking on further education as any of the courses would
seem to improve attitudes more so than if higher level education was absent. Despite
the implicit measure not producing significant results, the descriptive results illustrate
an observable difference that warrants further investigation. The improvements of the
investigation would include a larger sample inclusive of adults who do not work with
either young or older people and the addition of the SC-IAT for directional clarity. It
would also be of worth to include a range of student comparables rather than from a
single course. If it is simply higher level education that decreases implicit and explicit
age bias, the course content should be irrelevant and thus a span of courses needs to
be included for analysis. Results from the explicit measure indicate that those without
higher level education express a more ageist attitude. However, taken in isolation it is
apparent that they do not show an explicitly ageist attitude, just more of a leaning
towards it than those who have received additional education. Further to this it may
also suggest that those who do not receive higher level education are less able to
monitor the way in which they present themselves and the attitudes they express. In
addition to the implicit improvements suggested, further explicit data should be
collated to ensure this is a robust finding and additional self monitoring questions
should be included to assess whether education level affects an individuals’ ability to
present themselves in the most socially acceptable way.
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Study Five – A longitudinal study assessing the effects of specific age education
on attitudes towards older people
Introduction
The previous study has illustrated that higher level education has a significant effect
on explicit attitudes towards older people. Broader studies have been suggested to
strengthen the research findings. The current study seeks to specifically address this
and assess the effects of a Psychology of Ageing elective third year module that
would seek to give a rounded perspective of ageing.
Research suggesting that negative attitudes towards older people can be made worse
by existing educational interventions has been present for some time. Duerson et al.
(1992) concluded that to increase knowledge about ageing and to decrease ageist
attitudes, modern approaches to education need to be taken. They suggested that
formal classroom sessions should be teamed with planned experiences with older
people, both addressing the positive associations of ageing as well as the more widely
accredited losses. This research supports the analysis conducted by Whitborne and
Hulicka (1990) who reviewed the content of 139 psychology textbooks. They found
that little space was given over to ageing even in developmental texts where the
weighting was very much on development in early years. They found that where
ageing was mentioned, the focus was on problems rather than successes, describing
older people as suffering from multiple handicaps attributed solely to the ageing
process. The texts did not mention the difference between healthy ageing and that of
disease or how individuals can compensate for losses associated with ageing. It is this
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education practice which is widespread even today that exposes students to a narrow
and permanently fixed view of the ageing process that increases the implicit age bias.
Recent innovative training programmes have demonstrated that through an integrated
approach, attitudes towards older people can be improved. Cheong, Wong & Koh
(2009) identified that through successful education, medical students in Singapore are
expressing increasingly positive attitudes towards older people. This programme
included a balanced approach to ageing, presenting models of successful healthy
ageing as well as the ways older people compensate for those losses associated with
ageing thus maintaining their quality of life. In addition to the standard classroom
based education, Gonzales, Morrow-Howell & Gilbert (2010) demonstrated that
through adding contact with older people through activities outside of a classroom,
the attitudes of medical students improved significantly. Both of these interventions
show how psychological knowledge can be used to structure interventions to
effectively decrease negative attitudes towards older people.
The current study is longitudinal, assessing the effectiveness of an elective third year
module entitled “the Psychology of Ageing” in reducing implicit and explicit ageism.
This is a module developed to provide a rounded view of the ageing process which
may be overlooked in standard developmental psychology programmes where the
emphasis is on early lifespan development. Although there is no contact with older
people provided in the course, it is thought that the Psychology of Ageing module will
follow the successes in Singapore and reduce the age bias in those students electing to
complete the module.
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The hypotheses being proposed are:
(H1) Implicit attitudes following the completion of the Psychology of Ageing module
will be significantly less ageist than those recorded prior to commencement of the
course.
(H2) Explicit attitudes following the completion of the Psychology of Ageing module
will be significantly less ageist than those recorded prior to commencement of the
course.
Participants
This study sought to follow a complete cohort of participants undergoing a year of age
specific education (Psychology of Ageing module – undergraduate level). The initial
full cohort comprised of 23 students (5 male, 18 female) with an age range of 20-44
years (Mean: 25.9, S.D.: 5.7). However, by the end of the year due to course attrition,
withdrawal and non-attendance the sample for longitudinal analysis was reduced to 12
participants (4 male, 8 female) with an age rage of 20-34 years (Mean: 26.6, S.D.:
4.3). The initial sample was an exhaustive sample of a final year elective module on
an undergraduate psychology programme. In addition to the module undertaken, none
of the participants had received any additional gerontological interventions or
training.
Methodology
The materials used and overall methodology is the same as that presented in the
General Methodology section (pp. 70). The sole difference being that this study was a
small cohort study specifically identifying those students undertaking a module on the
Psychology of Ageing. Measures were taken in the first and last weeks of the course
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to gain a base measure of attitudes and then to ascertain any immediate effects of the
year course. Contact details (name, email, telephone number) for each of the
participants were taken at the start of the project and stored in a secure filing cabinet
in a locked storage room for the duration so that participants could be contacted again
and linked to their participant numbers to allow for cohort comparisons. The contact
details and participant numbers were stored separately so a theft or accidental release
of a document would not lead to the identification of participants.
Results
Descriptive results are displayed for the two time points of the Psychology of Ageing
course and a comparison is drawn to the General Adult sample. ANOVA results are
presented for the explicit and implicit scores as well as post hoc analysis prior to
giving correlational information on the implicit and explicit measures at both time
points.
Table 12: Table of means comparing the Psychology of Ageing course and General
Adult data sets
Group
Psychology of Ageing
General Adult Sample
Time
D-Score
D-Score
FSA Score
FSA
Point
(Mean)
S.D.
(Mean)
S.D.
1
0.710
.688
58.3
10.1
2
1.011
.651
55.8
8.95
1
1.093
.942
57.2
7.71
133
Data collected at time point one indicate that there is no significant correlation
between implicit and explicit measures (r=0.23, p=0.41). Similarly at time point two
there is no significant correlation (r=0.006, P=0.985).
Data for each time point were analysed using a mixed ANOVA on the PASW
statistical package. This showed that there was no significant difference between time
one and time two in either the implicit (F(1,25)=0.61; N.S.) or explicit scores
(F(1,25)=0.428; N.S.).
Post hoc analysis using the LSD test of pairwise comparisons found that there were no
significant differences in implicit or explicit scores between those who had undergone
the Psychology of Ageing course and those in the general adult sample.
When comparing the implicit scores at time one (prior to course but after two years of
higher level education) there is a distinct difference in descriptive statistics between
the students and general adult samples. Despite the noticeable difference, this is not
significant (p=0.193).
Similar to the longitudinal data set in Study One, it is of interest to ascertain whether
there is a correlation between the scores for each student at time one and time two.
The implicit measure did not correlate highly between time one and time two (r=.260,
N.S.), however, the explicit measure did (r=.750, p=0.01).
134
The explicit results correlate significantly at both time points indicating that provides
a stable prediction of the explicit attitudes held by those students. In addition to that,
the r value is strong enough to suggest that the explicit measure itself is robust.
Correlations on the implicit measure are neither strong nor significant.
Discussion
As an overview of the results, data at both time point one and time point two
demonstrate that there is no significant difference between implicit and explicit
measures. This supported the central theme of the thesis that implicit and explicit
attitudes are measured in different ways with sometimes different results as they
measure different subsets of the same attitude. Data also show that those participants
who underwent the Psychology of Ageing course started with a negative implicit
attitude towards older people and a non-ageist explicit attitude. Following the course,
explicit attitudes towards older people improved but implicit attitudes became worse.
However, neither of these changes was statistically significant. Further to this,
correlational analysis of the implicit and explicit measures indicated that the explicit
measure was both stable and reliable where the implicit measure was not.
The results mean that the hypotheses (Implicit attitudes following the completion of
the Psychology of Ageing module will be significantly less ageist than those recorded
prior to commencement of the course and Explicit attitudes following the completion
of the Psychology of Ageing module will be significantly less ageist than those
recorded prior to commencement of the course) have not been supported. Rather than
the expected direction, the attitudes towards older people (implicit) have become
135
markedly worse despite this change not being statistically significant. This finding
goes against the expected result and supporting literature, however, there are some
reasons for this and improvements that could be made to the methodology to
accurately reflect the effects of a rounded intervention measure.
Prior to the commencement of the study, the content of the course was not assessed.
Upon doing so post completion of testing, it became evident that there was
considerable time spent on the losses associated with ageing. The course comprised
the following topics of ageing: Demographics, biology, intelligence, memory, mental
health, personality and lifestyle and linguistics. Each of the 17 weeks of teaching
centred on the losses associated with ageing, reflecting the predominance of this in the
literature. This had the effect of maximising the differences between older and
younger people, potentially perpetuating the myths surrounding intergroup
characteristics. This in turn could have increased the strength of negative stereotypes
held and the associated negative attitudes. The course had attempted to reflect the
way in which older people can compensate for losses associated with ageing,
however, as an undergraduate third year course rather than a training course, much of
the additional information regarding the gains associated with ageing should have
been gathered by the students in wider reading outside of the classroom context. As
the measure for an intervention, all of the learning material should be presented to the
students so that they have all of the information to assimilate and there is not the
reliance on individual motivation to improve knowledge. As there was no measure of
the additional work that students had completed outside of the weekly lecture, it is not
known how rounded the information taken by the students was.
136
Another reason why the course may not have been successful is the method of course
delivery. Firstly, although classroom education alone has been shown to be effective
in Singapore (Cheong, Wong & Koh, 2009), the addition of direct contact/activities
with older people to this has shown to be more successful (Gonzales, Morrow-Howell
& Gilbert, 2010). It is the direct contact with older people that could in turn cause the
information being imparted to take on a real world context and more deeply affect the
students’ implicit attitudes. Second, the course consisted of one weekly lecture. It is
possible that a more intensive course, where the students would have less time
between exposures in which to forget the content, would be more successful in
promoting attitudinal shifts.
In conducting this study again, any intervention measure would firstly have to be
critiqued. By this it is meant that the intervention would have to present a positive
account of ageing reflecting the gains and achievements in ageing, something that
would be assured prior to the commencement of intervention testing. Further to this,
the recommendations about the course structure should be implemented in the
development of a new intervention measure for testing. The intervention should be
more intensive, either over a lesser period of time or more frequent contact time and
should include contact time with older people.
In adopting these improvements to the intervention measure and methodology, a more
accurate assessment of an intervention measure could be trialled. If the intervention
was shown to be successful, this could then be tested in a wider setting with a larger
sample prior to it being recommended as a general intervention to reduce implicit age
bias. This would be an important development with regards to the health care settings
137
as it could be included for mandatory continual professional development and tests
conducted to assess whether it improves attitudes and subsequent behaviours. To
assess the longevity of any changes in attitude, a year follow-up should be conducted
to assess whether any intervention is successful in long term attitudinal shifts.
These results do however indicate that if an education programme is not fully rounded
and inclusive of the positive aspects associated with growing old, it may have the
opposite effect to that which was intended. In presenting a course that was not
balanced with the positive aspects as well as the negative aspects of ageing, a course
was delivered that worsened the learners’ attitudes towards older people. This is
mirroring the warnings arising from the review of psychology texts by Whitborne and
Hulicka (1990). Further, the findings support the findings of Gonzales, MorrowHowell and Gilbert (2010) in that an intervention has to be specifically tailored to
reduce ageism in order for it to be successful.
Explicit data from time one to time two demonstrates a decrease in ageism despite
remaining relatively high when compared to the other student groups. Although it is
not statistically significant, it does give more support for further investigation to be
conducted looking into the effects of higher level education on self presentational
bias. In each of the studies where base measures have been taken, there has been a
clearly observable if not statistically significant decrease between start and end points.
This disparity between implicit and explicit scores which is more marked in those
who have received higher level education is additional support for the supposition that
self presentational bias increases with level of education. Of interest with the
Psychology of Ageing students is that they had higher explicit scores (more negative
138
attitudes) at the start point than did either the third point Nursing or Psychology
students or the General Adult sample. They had by this point undertaken two years of
higher level education and as such it would be expected that they would be expressing
more positive explicit attitudes towards older people. The fact that this finding is not
in line with those conclusions from the previous study, however, can be explained.
For timetabling reasons, some Psychology of Ageing students were taking the module
as no others were available to them with their other module choices. This meant that
those on the course, rather than selecting the module due to an interest in ageing, were
indeed taking it by default. From this it can be supposed that those ‘forced’ to take the
module might have a generally negative attitude towards the module per se and as
such would not be receptive to the course content. It could further be supposed that
they would (initially) extend their negative attitudes towards the content of the course,
i.e. older people, which was then reflected in the explicit scores. The trend of the
explicit scores, however, is in line with previous studies in that they decreased
(became less ageist) from time point one to time point two. This supports the central
argument that higher level education does result in decreasing scores on explicit
measures of ageism. As suggested in the previous study, this is something that should
be investigated further with self-monitoring scales being added as items in the explicit
measures given to participants.
Of potential interest is the comparison between the implicit scores for the general
adults and those of the time one Psychology of Ageing students. The results presented
show that despite not reaching significance, there is a distinct difference between the
two. This difference could be illustrative of the effects of general higher level
education as at point one there had been no specific Psychology of Ageing measure
139
trialled and the students had received two full years of university education. When
coupled with the data collected in the previous study, this would highlight the need
for further investigation of the effects of both specific and general higher level
education.
The last results to be displayed were those of the longitudinal data correlations for
both the implicit and explicit measures. These are of specific interest as it is clear that
over time, the scores on the explicit measures for each participant correlate
significantly. This means that when looking at the individual, their specific score at
each time point correlates, providing a stable measure. The “r” value falls below that
of .9 recommended by Kline (2000) but does fall above the .7 which he asserts to be
the minimum level. When analysing the implicit scores, however, it is clear that that
scores returned by each individual participant do not correlate with the other implicit
scores recorded at the second time point. This disparity has two core possible
explanations, either the nature of the constructs or the nature of the tests. Explanations
for these disparities are explained in the discussion for the first experiment and as
such will not be repeated in detail here. However, they will be summarised. In the
explicit measure, participants are aware of the socially acceptable responses and as
such respond in such a manner at each point which increases the correlation between
time points. The scores on the implicit measure could be caused by one of two
reasons, the IAT being an inaccurate measure for individual attitudes over time; or
that the course, as with other educational interventions, has had differing effects on
participants and as such would have affected the implicit scores at time two
differently.
140
Conclusions
Similar to other educational interventions already investigated in previous studies, the
explicit measure of ageism in this study decreases post course delivery. This decrease
supports the notion that as education level increases, so does the individuals’ self
presentational bias. As previously suggested this is important ground to be covered in
future studies to ascertain whether explicit measures can be accurately used to
measure the explicit attitudes of those people who have undertaken higher level
education. The current course has not shown to be an effective way of reducing
implicit ageist bias due to a number of factors outlined in the above discussion.
Additional studies need to be conducted to develop a more intensive and effective
intervention measure including both a positive curriculum and contact with older
people. It is important to develop and test this intervention further as it has been
established that interventions can affect the implicit attitudes held both positively and
negatively and in the case of nurses and medical professionals it is clearly a concept
of central importance. Individual IAT test score correlations over time are weak and
not significant possibly caused by the course or situational factors so the same tests
recommended in Study One should be undertaken for clarity purposes. Further to the
latter tests, it is possible that the use of the IAT for individual level attitude and
preference assessment could be called into question, therefore, longitudinal retest
recommendations should also be undertaken.
141
Study Six – A cross-sectional study assessing the levels of implicit and explicit
ageism held by older people
Introduction
The previous studies have investigated specifically the effects of higher level
education, specific education and direct contact on implicit and explicit attitudes
towards older people. In doing so a comparison group of adults who had not received
higher level education was sampled. This group was used as a control to see the
effects of each condition on the aforementioned attitudes. It was apparent, although
not always significantly, that those attitudes held by the general population sample
were the most explicitly ageist and except for those attitudes expressed by early years
students, the most implicitly ageist too. From this it can be rationalised that there is a
generally pervasive ageist attitude in the wider population.
Research has supported the initial conclusions made from these studies that there is a
generally negative attitude towards older people (Cummings, Kropf & DeWeaver,
2000; Catterall & Maclaran, 2001; Depaola, Griffin, Young & Neimeyer, 2003). The
cited research specifically looks at the explicit attitudes held by a cross sample of
people in the general population and conclude that this is a far reaching and deeply
instilled bias. Levy and Banaji (2002) conducted a review on implicit ageism which
also illustrated a pervasive and wide reaching proliferation of negative ageist
attitudes. This is something that has been supported continually since the introduction
of the IAT with more recent studies (Turner & Crisp, 2010) not only identifying the
same trend but also trying to address it. What was of concern, however, is that unlike
in other explicit studies, these findings are not only in the young. They found that
142
negative implicit ageist attitudes are held by the elderly themselves (Levy & Banaji,
2002). The reasoning given for this is that elderly people have acquired the same
implicit prejudices throughout their lives and have not had sufficient time or
opportunity to develop the mechanisms to defend against this.
There are negative consequences for elderly people as a result of the ageist attitudes
held as they are not only subjected to ageist prejudices from others but also internalise
these implicit biases. As people progress through the life span their age schema
become more elaborate as more information both about others and themselves
becomes incorporated. As they age, the number of traits, categories and subcategories
they have within the schema grows, however, core elements are still retained.
Research does support this developmental approach, finding that despite having a
more complex picture of ageing, older people do not necessarily hold more positive
views. Hummert et al. (1994) found that older people did indeed hold more
stereotypes about older people but they had more negative ones as well as having
more positive ones. Some studies further report that older people do judge their age
category more favourably than younger people do, however, that is only more
positively as a comparison but both groups have generally negative attitudes towards
older age (Kite et al., 1991).
Coleman and O’Hanlon (2008) highlight that successful ageing/optimal ageing is
achieved not only through acknowledgement of the associated losses (as with other
stages of the lifespan) but also the successful adaptation and coping with the stresses
and changes in life. It is taking control of those challenges and adapting through
acquired life skills that is fundamental to mental, psychological and emotional health
143
at all stages in the lifespan. They also posit that holding these negative attitudes can
indeed curtail adaptive thinking and coping strategies.
With an increasingly ageing population this pervasive negative attitude clearly has
negative effects on a growing proportion of UK residents. Over 65’s account for a
substantial proportion of the hospital admissions in England and Wales. In the year
April 2008 – March 2009 22.8% of the total admittance to NHS A&E departments in
England was for those people aged 60 and over (Hospital Episode Statistics, 2010).
With this negative attitude being held in the social conscious, it is possible that the
care of these individuals may indeed be less than may be given to a younger person.
This study is seeking to build upon previous research and ascertain whether older
people do indeed hold similar ageist attitudes to those expressed by the general adult
population. Research would suggest that older people are similarly affected by
societal opinions and stereotypes thus their implicit attitudes would reflect this. To
test the effects of pervasive societal ageism on older people’s attitudes, the following
hypotheses have been presented:
(H1) Older people will express implicit attitudes that are significantly ageist and that
these will be similar to those expressed by the general adult sample.
(H2) Older people will return scores that are not explicitly ageist and that their scores
will be less than those recorded by the general adult sample.
144
Participants
For this study there were 21 older people (aged 65+) who completed both the
questionnaire explicit measure and IAT implicit measure. These people were recruited
from local activity groups creating an opportunity sample and ranged from 65-84
years of age (Mean: 73.4, S.D. 5.7). Of the sample, 18 participants were female and 3
were male. This gender imbalance is reflective of the recruitment strategy and
membership of the selected activity groups. Further to this, none of the participants
had received any formal higher or further education past that of mandatory schooling.
This fact is of note so as to eliminate education as a factor affecting the outcome
results. None of the participants when asked reported having any pre-existing
conditions that may impair their ability to complete either section of the test.
Methodology
No substantial amendments were made to the methodology of this study. The only
variation was that rather than completing the study in a computer laboratory, the
testing was completed using two laptop computers. This method was used as it was
inappropriate to ask participants to travel to the campus when many did not drive and
no remuneration was being made. Each of the testing sessions was conducted in either
quiet areas or separate rooms at the venues for the meetings of the social groups. This
deviation in the methodology should have no discernible effect on the responses given
by participants.
145
Results
Comparative descriptive statistics are presented for the Older People sample and for
the General Adult sample. ANOVA results are then presented to investigate the
significance of any differences between the two groups.
Table 13: Table of means comparing the effects of ageing on attitudes towards older
people
D-Score
D-Score
FSA Score
FSA Score
(Mean)
S.D.
(Mean)
S.D.
Older People
1.0108
.759
51.5
9.58
General Adult Sample
1.093
.942
57.2
7.71
Group
Results from the Older Person cohort similarly illustrate no significant correlation
between implicit and explicit measures (r=-0.283, p=0.213).
When the descriptive data for the older person sample are taken in isolation, it is clear
that the explicit measure illustrates an attitude that is not ageist where the implicit
measure illustrates a distinctly ageist attitude.
The data comparing the general adult sample and the older persons sample were
analysed using a between-subjects ANOVA on the PASW statistical package. This
found that there was no significant group difference on the implicit measure
(F(1,39)=.096; N.S.). There was, however, a significant between subjects difference
for the explicit measure (F(1,39)=4.339; p<0.05).
146
Discussion
In short, the results from the current study illustrate a similar picture for older people
as to that of the general population. Results from implicit and explicit measures do not
correlate and as such support the central tenet that implicit and explicit attitudes are
separate constructs, subsets of the larger attitude concept. Older people also hold
similarly negative implicit attitudes towards older people at a level that is not
significantly different from the general adult population. The explicit attitude
expressed by older people is, however, significantly more positive than those
expressed by the general adult sample.
From the data collected, the first hypothesis (older people will express implicit
attitudes that are significantly ageist and that these will be similar to those expressed
by the general adult sample) can be accepted. The results clearly indicate that there is
an implicit ageist bias in the sample of older people. Also as there is no significant
difference between that sample and the general adult population, it can be concluded
that the attitudes held implicitly are relatively similar. The second hypothesis (older
people will return scores that are not explicitly ageist and that their scores will be less
than those recorded by the general adult sample) can also be accepted. This
hypothesis is supported as there is a clear and significant difference between the two
samples on the explicit measure.
The implicit scores as a stand alone measure support existing research suggesting that
older people also internalise the negative societal stereotypes of ageing. In adopting
these negative stereotypes, older people often ignore the way they actually feel and
replace these thoughts and behaviours with those they would expect from their
147
negative stereotypes. Levy (1996) found that elderly people who exhibited higher
negative implicit attitudes also performed significantly worse on memory tasks. She
found that the perceptions of older adults could also be affected by implicit self
stereotyping. She concluded that implicit age stereotypes can influence the views of
older adults both towards others as well as towards themselves. This supports
previous research findings that when elderly people adopt these societal stereotypes,
they see decline as inevitable and that becoming a less active member of society is the
only option (Rodin & Langer, 1980). Similarly, Butler (1987) found that when
adopted, these stereotypes became a self-fulfilling prophecy, reinforcing stereotypes
through the inaction and deficits resulting from their initial belief and internalisation.
This finding supports the argument that additional intervention measures need to be
developed not only for the medical community but also for a wider societal change
starting during compulsory schooling. Psychological theory can be used to design
interventions that can be used in an educational setting. These can be designed to
impart knowledge and cause disequilibrium in the current schema held to force a reassessment of existing attributes and evaluations to modify the existing ageist attitude.
This has been shown by Kite et al. (2005) who demonstrated that upon providing
information about a person that countered existing negative ageist stereotypes, the
negative attitudes can be diminished.
As a comparative measure, the implicit scores being so similar indicate that the
negative attitude expressed is not confined to a single group of people but is more
widely present within society. This is despite there being an explicit expression in the
opposite direction due to socially acceptable responses. The reasons why there is such
a pervasive negative implicit bias are many in number, however, daily contact with
148
media is seen as a major reinforcing factor. In television comedies for example,
elderly people are depicted, defined by stereotyped negativities regarding physical
decline and both physical and mental incompetencies (Zebrowitz & Montepare,
2000). The subtle reinforcement of the negative bias through socially acceptable
media only strengthens the ingrained attitudes and stereotypes. In addition to this,
once acquired, these attitudes are maintained and strengthened when encountering
elderly people even if they do not exhibit characteristics associated to the stereotypes
held (Levy et al., 2000; Murphy, Monahan & Zajonc, 1995). As such it is important
that these be addressed not only on an individual level but also that rather than
pushing the negative stereotypes of ageing within the wider media, more reflective
and counter (existing) stereotypical images and characters should be portrayed.
Scores on the explicit measure show a clear and significant difference between the
group of older people and the sample from the general adult study. This as predicted
could be due to the nature of the explicit measure. The items on the scale are varied
but generally centre on the desire to spend time with older people and their rights. For
the younger cohorts, it is possible to dissociate themselves from the category of older
person. They are able to create an in-group/out-group categorisation which in turn
enables them to explicitly express the implicit bias that they hold. The reason for
doing this would be to create a wider gap between the ‘them’ and ‘us’ categories. This
is done so that first, they do not see themselves as having those traits and
characteristics attributable to the out-group and second, that they do not see
themselves as an ageing/older person. It is a lifestyle threat to see oneself in a
transitional role from an in-group where one is comfortable to another lesser
perceived group which is currently an out-group. The reason why this is more
149
stressful with regards to ageing is that it is a transition that cannot be prevented and
the perceived disadvantages associated with being an older person far outweigh the
benefits. The older sample on the other hand would see themselves as having the
same rights as they have always had (e.g. the right to hold a driving licence over the
age of 65) and as such this would be reflected in the explicit measure. They do not
have the same desire or at least ability to dissociate themselves from the older person
category and as such exert the least ageist opinions in order to increase the perceived
worth of their in-group.
Conclusions
Older people hold similarly negative implicit attitudes towards their own in-group to
those held by the general adult population. This is important as older people who
exhibited higher negative implicit attitudes also perform significantly worse on
memory tasks as well as measures of self-esteem and physical abilities (Levy, 1996).
This demonstrates that a pervasive negative attitude towards older people exists
within the wider population and that even when becoming part of that group, the
attitude remains due to the reinforcement of that negativity throughout the lifespan.
Explicit measures identify that as people grow older they become more outwardly
positive about older people. This is likely to be due to the desire to promote the status
of the in-group to which they belong. Both findings support the fact that measures
need to be taken on an individual level and on a wider societal platform. The
individual level would be to educate younger people accurately on the ageing process
and the positive associations with ageing. More widely a change is required in
mainstream media to curtail the barrage of reinforcing negative stereotypes of older
people. Neither task is simple but both are essential to improve the implicit attitudes
150
held by the general population, if not for the benefit of others, for the benefit of
themselves when they too become an older person.
151
Study Seven – A meta-analysis of study one-six data sets
Introduction
Prior to this investigation, most of the ageism literature had centred on explicit
measures (Cummings, Kropf & DeWeaver, 2000; Catterall & Maclaran, 2001;
Depaola, Griffin, Young & Neimeyer, 2003) with only one substantial review of the
existing implicit data (Levy & Banaji, 2002). This thesis has shown the effects of
specific educational interventions, direct contact, nurse training and general higher
level education on implicit and explicit attitudes towards older people. In addition to
this it has supported the understanding that implicit and explicit measures assess
distinct constructs of an attitudinal concept. Further still, it has added weight to both
arguments that there is a societal wide negative implicit bias against older people and
that older people also internalise this bias and associated stereotypes which in turn can
lead to a decline in their physical and cognitive wellbeing.
To date, there has not been a single study whereby a series of investigations has been
conducted either longitudinally or cross-sectionally that compares such a diverse set
of antecedents and their effects on attitudes. This affords this investigation a unique
opportunity to conduct a meta-analysis comparing the results from these interventions
to each other to provide the broadest picture of the attitudes held by each group and
the overall effects of different interventions.
In addition, correlational analyses have been conducted on the order of presentation
for congruent and incongruent test blocks. This has been done to assess equivalence
of different forms of the IAT and possible priming effects. This analysis is only
152
meaningful when comparing the whole sample of participants, rather than sub-groups
as this allowed a reasonable sample size as well as presenting a broader cross-section
of the population. Similarly, the comparison between implicit and explicit measures is
also presented with data from the whole sample as this affords greater weight to the
findings already presented.
Participants
Data from all 203 participants were collated and cross-tabulated. No additional
participants were sampled for this meta-analysis and where longitudinal data existed
for any sample, this was aggregated to create a single score for each group. There are
eight groups of participants whose data has been collated and compared:

Older people

Psychology of Ageing course

Student nurses

Psychology students

Early years students

A&E nurses

Gerontology nurses

General adult sample
Methodology
The data from all of the previous studies have been collated and a MANOVA test has
been conducted to find the mean results and to test overall differences between
implicit and explicit scorings. Further to this, LSD post-hoc pairwise comparisons are
displayed.
153
Results
Table 14: Table of means for each sample population
Group
D-Score
D-Score
FSA Score
FSA
(Mean)
S.D.
(Mean)
S.D.
Older People (1)
1.0108
.759
51.5
9.58
Psychology of Ageing
1.0108
.651
55.8
8.95
Psychology Students (3)
0.7091
.954
54.2
9.36
Nursing Students (4)
0.6206
.671
47.8
9.57
Early Years Students (5)
2.4644
.861
53.1
11.62
A&E Nurses (6)
0.9732
.85
52.3
9.12
Geriatric Medicine
1.0118
.813
51.1
7.39
1.0931
.942
57.2
7.71
Course (2)
Nurses (7)
General Adult (8)
Table 14 shows the implicit and explicit scores for each of the study samples included
in this investigation. These groups have been numbered to allow for ease of display
whilst comparing scores. The Table clearly indicates that each of the samples
included in the analysis possess a significant implicitly ageist attitude.
The Table also shows a large span of explicit scores with nursing students again being
the least ageist and the general adult sample returning the most explicitly ageist
scores. The main point of note, however, is that despite there being a difference
between the scores, none of the groups (when data are pooled) have shown an
154
explicitly ageist attitude. This demonstrates the core difference between implicit and
explicit attitudes which is central to the arguments of this thesis.
Table 15: Table of significance values between samples for the implicit D-Score
Measure
Group Numbers
Group Numbers
1
2
3
4
5
6
7
8
1
-
1.000
.216
.110
<.001***
.872
.997
.751
2
-
-
.298
.179
<.001***
.894
.997
.786
3
-
-
-
.701
<.001***
.229
.243
.121
4
-
-
-
-
<.001***
.109
.132
.057†
5
-
-
-
-
-
<.001***
<.001***
<.001***
6
-
-
-
-
-
-
.877
.612
7
-
-
-
.-
-
-
-
.766
8
-
-
-
-
-
-
-
-
†
. Correlation approaching significance
***. Correlation significant at the 0.001 level
The Table above shows a cross-tabulation of the p values for each of the groups
implicit D-Scores. This shows where there is a significant difference between any of
the groups.
155
Table 16: Table of significance values between samples for the FSA Explicit Measure
Group Numbers
Group Numbers
†
1
2
3
4
5
6
7
8
1
-
.199
.326
.172
.602
.771
.877
.050*
2
-
-
.611
.014*
.443
.257
.172
.686
3
-
-
-
.014*
.716
.434
.278
.275
4
-
-
-
-
.072†
.068†
.261
.001***
5
-
-
-
-
-
.766
.521
.190
6
-
-
-
-
-
-
.660
.063†
7
-
-
-
-
-
-
-
0.45*
8
-
-
-
-
-
-
-
-
. Correlation approaching significance
*. Correlation significant at the 0.05 level
***. Correlation significant at the 0.001 level
Table 16 shows a cross-tabulation of the p values for each of the groups’ explicit FSA
scores. This shows where there is any significant difference between any of the
groups. Unlike the implicit measures, there are several samples that show
significantly different scores on the explicit measure.
In addition to the individual groups, between subjects ANOVA reported significant
overall differences for both the implicit (F(7,162)=8.352, p<0.001) and explicit
(F(7.162, p<0.05) measures. This indicates that there are significant differences
between the groups in each of the two measures as an aggregate of the data presented
in Tables 15 and 16.
156
When calculating the implicit scores for each of the studies presented, the D-Score
algorithm has been used. This is the improved scoring algorithm as presented by
Greenwald, Nosek and Banaji (2003) whereby as the final calculation, the scores for
each person are divided by the standard deviation of their own data. This is a
fundamental change from the original scoring method, which omitted this final step.
This has shown to be an important change because magnitudes of differences between
experimental treatment means are often correlated with variability of the data from
which the means are computed. Using the standard deviation as a divisor adjusts
differences between means for this effect of underlying variability.
Overleaf, Table 17 shows the results of the implicit tests should the SD calculation
not be made.
157
Table 17: Table of significance values between samples for the non-normed implicit
scores
Group Numbers
Group Numbers
†
1
2
3
4
5
6
7
8
1
-
<.001***
<.001***
<.001***
<.001***
<.001***
.005**
.005**
2
-
-
.615
.931
.686
.068†
.060†
.039*
3
-
-
-
.600
.299
.003**
.005**
.002**
4
-
-
-
-
.561
.014*
.018*
.009**
5
-
-
-
-
-
.128
.111
.074†
6
-
-
-
-
-
-
.763
.635
7
-
-
-
-
-
-
-
.891
8
-
-
-
-
-
-
-
-
. Correlation approaching significance
*. Correlation significant at the 0.05 level
**. Correlation significant at the 0.01 level
***. Correlation significant at the 0.001 level
The above Table has been produced as an illustrative depiction of what the result
would have looked like prior to the D-Score algorithm and before variability had been
accounted for. The first thing to notice is that there are a lot more significant
differences especially with regards to older people who, it would appear are
significantly more implicitly ageist than any of the other groups tested. Prior to the DScore algorithm, similar calculations had been recommended for use in cognitive
ageing studies, in which treatment effects on latencies are often greater for elderly
subjects, who show both higher means and greater variability of latencies than young
subjects (Ratcliffe, Spieler & McKoon, 2000).
158
Cross-study comparisons of order effects
The analysis was conducted with 170 participants across the studies to give a large
data set for comparison purposes. Due to the fact data were taken across the studies,
the age range was 20-84years with approx. 80% of the sample being female (an
artefact of the sub-samples chosen as discussed in the individual studies). Using this
full cross-study sample, the ordering of the implicit test stimulus presentation
(congruent or incongruent first) was assessed. In each of the studies half of the sample
completed the IAT with the congruent condition first and half of the sample with the
incongruent pairings. As each of the studies was internally counterbalanced, if
cognitive priming does occur then there is a lesser, if any, consequential effect due to
the equal number of ordered presentations. In addition to this, the IAT was always
completed by participants first so that no additional priming or context could be
derived from the completion of the explicit measure. An ANOVA was conducted to
compare the mean latencies and D-Score measures produced for both congruent and
incongruent lead testing. Those IATs completed where a congruent condition was
presented first returned a mean response of 404ms (D=.834) and those with
incongruent initial presentations had a mean latency of 446ms (D=.788). When
compared in an ANOVA, there was no significant difference between scores returned
based on congruency of the initial presentation (p=.519). From this it can be taken
that there was no significant order effect and any order effect on an individual level
would be counterbalanced through the precautions taken in each of the individual
studies in addition to the general measure whereby the IAT was completed first.
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The structure of the IAT is repeated in each of the studies in the same way; as such,
the counterbalancing result is important in methodological justification in each of the
individual studies. The reason data were used from each of the studies was to
demonstrate that this is a result that is relevant to each of the studies and generalisable
to each of the sample populations used.
In the literature review it has been clearly shown that implicit and explicit tests
measure different subsets of the same attitude (Greenwald & Banaji, 1995). This has
been an important concept to justify the use of the two tests in measuring the
construct of ageism. It has further been shown that the two distinct subsets of attitude
(implicit and explicit) influence different types of behaviour (spontaneous and
planned, respectively). It is core to each of the studies detailed in this thesis that the
measures used for each of the samples similarly reflect this difference. Each of the
studies has independently shown that implicit and explicit tests measure different
components of the same overall attitude. As each study has shown this result, a metaanalysis was conducted using every participant’s data for each test. This meta-analysis
was important to illustrate the core theme that implicit and explicit attitudes are
indeed different and are measured in distinctly different ways due to their inherent
differences.
Implicit vs. Explicit measures
The implicit and explicit scores were compared using the same full study sample
detailed for the order effects analysis. A Pearson’s test shows that there is only a weak
positive correlation between the implicit and explicit scores with a co-efficient of
0.107. As the relationship between the two measures is so weak it can be taken that no
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discernable correlation exists between them. This result is also not significant
(p=.167) which would suggest that there is a large amount of variance/incidence of
chance in any correlation shown. Both of these results are important as they support
that supposition and basis of the testing that both measures are indeed testing two
separate constructs that are not controlled in the same way (conscious and
unconscious processes). If there was a stronger correlation which demonstrated a level
of significance then it could be argued that the two subsets of attitude being measured
are indeed linked and measure different aspects of the same construct. The results
support the rationale of these studies and support previous research which suggests
that there is no correlation between implicit and explicit measures (Hofmann,
Gawronski, Gschwendner, Le & Schmitt, 2005).
With both conditions satisfied, the data from each of the studies can be assumed to be
both internally valid and not subject to order effects.
Discussion
The meta-analysis has further clarified some of the existing findings and also
generated some others which had not been made apparent from analysing each of the
studies as stand alone data sets.
First, it is important to note that the overall effect was significant in that there are
significant differences between the implicit and explicit scores as well as significant
differences between the groups in both the implicit and explicit measures. The
implicit and explicit difference is important, as stated prior to the commencement of
the first study as it stands central to the understanding of implicit and explicit attitude
measurement. The difference shows that the two scores are measuring distinct subsets
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of attitude that combine to create the overall attitude held. This supports recent
research by Greenwald, Poehlman, Uhlmann and Banaji (2009) who identified that
for socially sensitive topics such as ageism, the predictive validity of self report
measures was remarkably low where the IAT scored consistently highly. They posited
that the reasons for this (especially in the more educated and socially aware
participants) were that first, people were more aware of the socially acceptable answer
even if this differed drastically from their own; and second, that participants wished to
express attitudes that presented themselves in the most socially acceptable light. The
results presented above illustrate that in this socially sensitive area, the two measures
are significantly different with the explicit results showing the more socially desirable
response. This not only shows that the two measures are probing different
components of attitude but also that those self report measures are clearly more
susceptible to self presentational bias.
Not only are the two measures significantly different, but they are also opposite in the
attitudes that have been expressed. It is evident from the descriptive statistics that the
implicit results show a clear and distinct negative attitude towards older people in
each of the eight participant groups sampled. This is not something that is
characteristic of only one group, moreover it is clearly a societal norm that is
exacerbated by other individual factors discussed later. The explicit measure on the
other hand reports scores of below 58 for each of the sample groups. Scores of this
nature (as detailed in the FSA methodology on pp. 70) indicate explicit attitudes that
are not ageist and are indeed reflective of the expressed social norm. Although there is
a significant difference between some of the groups which will be discussed later, the
difference is in the levels of expressed attitude and not in the overall direction.
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Looking at the implicit results separately it becomes clear that each of the participant
groups is ageist. The only significant difference is with the Early Years students who
express significantly more ageist implicit attitudes than do any of the other groups. No
one group (including those where the Psychology of Ageing course had been
implemented) show a significantly better implicit attitude than any other. This is an
important result as it demonstrates that the trailed courses have not significantly
improved the level of implicit bias in relation to other samples. Further to this,
because the implicit scores are that much worse for the Early Years students
compared to any of the other groups, certain questions are raised.
Those courses where content looked at the psychology or biology of ageing did not
affect the expressed implicit attitudes towards older people in any significant way to
differentiate them from any other group of participants. The only differentiation came
when participants were not shown an account of ageing (biased or not) but were
instead educated on the development of children. This course centred on the gains
associated with the formative years development as well as the development and
acquisition of skills and socialisation. This course did not portray a negative account
of ageing but simply a positive account of youth. As the IAT measures congruent and
incongruent association response latencies, this youth-centric educational course
would reasonably strengthen the congruent (youth/good) categorisations. In
strengthening the associations with young and good, the response latencies for this
pairing would likely decrease in the same way that increasing the negative
associations with older people would increase the incongruent (old/good) latencies.
The net effect of both of these scenarios is the same; a greater difference between the
163
two types of categorisation and the faster responses being associated with the
congruent condition. In the case of the Early Years students, the IAT results
demonstrate a significant preference for young people when compared to older
people, this is not in question. The question generated is whether this preference for
younger people is also reflective of a negative association for older people. Put
colloquially, all ageist people prefer younger people over older people, but are all of
those who prefer younger people over older people ageist? To resolve this, a way of
measuring the attitudes directly towards old and young categories rather than as a
preference for one over the other should be implemented.
One such method of doing so is the Single Category Implicit Association Test (SCIAT) developed by Karpinski & Steinman (2006). Where the standard IAT relies on
categorisation using pairings for both old and young simultaneously, the SC-IAT uses
only one of those categories at a time to elicit the underlying attitudes held for a
specific target. This could be used in conjunction with the existing IAT measure to
ascertain base line and post intervention measures. This would allow for accurate
reporting not only of the preferential attitude but also to demonstrate which aspect of
the attitudes held have been affected (positive liking or negative disliking). The SCIAT has been shown to be effective in eliciting implicit single concept attitudes
(Bohner, Siebler, Gonzalez, Haye & Schmidt, 2008; Steinman & Karpinski, 2008)
and as such would be ideal when paired with the current IAT to clarify the issue.
Other than this, this IAT has clearly illustrated an implicit ageist bias present
throughout each of the societal samples taken which it can be argued are then more
widely pervasive. The SC-IAT was not used in this study mainly because at the time
the studies were conceived it did not exist. Even to date there is still a comparatively
164
small literature on the SC-IAT when compared to the IAT. With there being
unanswered questions about the SC-IAT such as Richetin and Perugini (2008) who
demonstrated that the SC-IAT did not show robust predictive validity whereas the
IAT had an incremental validity for self reported behaviours, it was decided the IAT
was a better instrument to use at that stage.
The explicit scores, as previously mentioned, show the opposite valence to those
indicated in the implicit tests. Each of the groups express explicitly accepting
attitudes, however, the differences between some of these groups are illustrative of
two core concepts; higher level education increasing self presentational bias and older
people explicitly promoting the status of their in-group.
The significant differences between the General Adult population and the Nursing
students, Geriatric nurses and the approaching significance of the difference with
A&E nurses indicate an effect on explicit attitudes by nurse training. Throughout their
training nurses will be instructed on their duties of care in addition to the health
requirements and needs of different demographics of patients. This explicitly gained
information will inform the nurses of appropriate ways to act and that each patient
should be treated as an individual rather than as a stereotype. This education would
act only to reinforce the societal norms that prejudice is wrong and as such,
expressions of prejudice are not acceptable. As nurses will have undergone this
specific education as well having gone through higher education, they are not only
generally educated to a higher level and as such aware of presenting themselves in a
socially acceptable light, but also specifically in they would be aware that expression
of prejudice towards any one group of people would be even more unacceptable in
165
their profession. Although not affecting their implicit bias, the specific education that
they have received reduces the expressed explicit bias due to the heightened
awareness of social acceptability. As previously mentioned it is evident from the
descriptive statistics that the explicit scores of each of those sample groups who have
undertaken higher level education are lower than those who have not. This point
illustrates that the more educated people become, the higher the level of self
presentational bias due to the increased awareness of social acceptability. When this
level of education is not present, it appears that participants are unable to monitor to
the same degree the way in which their expressed opinions will reflect on them. This
follows the prediction based on the theory of self presentational bias (Goffman, 1959)
where it is stated the more educated a person is, the more aware they become of the
subjective and societal norms against which they will measure themselves and in turn
be measured. So in short, both general higher level education and more significantly
higher level nurse training increase an individual’s level of self presentational bias
and in turn decreases the levels of ageism expressed on explicit measures where
conscious mental representations can be made.
The significant difference in explicit scores between older people and those in the
General Adult population can be explained by older people explicitly promoting the
status of their in-group. The items on the scale are varied but generally centre on the
desire to spend time with older people and their rights. For the younger group, it is
possible to dissociate themselves from the category of older person. They are able to
create an in-group/out-group categorisation which in turn enables them to explicitly
express the implicit bias that they hold. The reason for doing this would be to create a
wider gap between the ‘them’ and ‘us’ categories. This is done so that first, they do
166
not see themselves as having those traits and characteristics attributable to the outgroup and second, that they do not see themselves as an ageing/older person. It is a
lifestyle threat to see oneself in a transitional role from an in-group where one is
comfortable to another lesser perceived group which is currently an out-group. The
reason why this is more stressful with regards to ageing is that it is a transition that
cannot be prevented and the perceived disadvantages associated with being an older
person far outweigh the perceived benefits. The older sample on the other hand would
see themselves as having the same rights as they have always had (e.g. the right to
hold a driving licence over the age of 65) and as such this would be reflected in the
explicit measure. They do not have the same desire or at least ability to dissociate
themselves from the older person category and as such exert the least ageist opinions
in order to increase the perceived worth of their in-group.
The reasons for presenting the results in Table 17 were to illustrate the differences in
the scores that are made through simply dividing by the standard deviation. The DScore algorithm was an appreciable development in scoring methods and the results
clearly illustrate this. Reaction times and variance have clearly made a huge
difference in which samples differ significantly with regards to the implicit age bias.
The fact that the results significantly alter, even between groups which on the surface
would appear to be similar/homogeneous, when this adjustment for response time is
made, support the change to the D-Score algorithm. There are three fundamental
reasons that the D-Score will have made such a difference even in apparently
homogeneous groups. First are simple levels of IQ. Less able groups have a lower
level of fluid intelligence and as such this will affect their response speed. This could
previously have meant that those less academically able groups appear more
167
prejudiced whereas in actuality they simply have longer response times. This result
from the current analysis supports Cai, Sriram and Greenwald (2004) who conclude
that the D-Score eliminated cognitive skill confounds as a mediating factor within the
IAT. Second are the effects of task recurrence. Both using a computer keyboard and
being versed in categorisation responses using push buttons will affect the response
times of participants. Undergraduate students are constantly barraged with pleas from
psychology students to participate in tests which often require keyboard responses. If
people are practiced in this type of procedure then responding to the categorisation
stimuli in the IAT would be easier than for those to whom this procedure was alien.
Without suitable weighting, this difference could again make those people who are
procedurally unfamiliar appear more prejudiced. Dutilh, Vandekerckhove, Tuerlinckx
and Wagenmakers (2009) reinforced this as a distinct possibility, highlighting that
being familiar with or repeating a set cognitive task would undoubtedly result in
decreasing response times. By dividing the score by the standard deviation in a similar
way to the Cohen’s d, the effect of familiarity can be eliminated. Third is the effect of
generally slow responses. As has shown to be the case for older people, some groups
are simply slower to make responses both in judgements and in actual time taken to
physically respond. As with the other conditions, the slower the response, the more
prejudice the raw IAT score would suggest. Through using the D-Score IAT measure,
this problem can be removed as a consideration.
Conclusions
The meta-analysis has led to several conclusions being made that would not have
otherwise come to light. The IAT demonstrated no significant order effect and any
order effect on an individual level would be counterbalanced through the precautions
168
taken in each of the individual studies. There is also a clear implicitly negative
attitude towards older people pervasive across all groups. The expression of this
implicitly negative attitude by older people as well as the other groups would suggest
that this is a pervasive societal negative attitude. The explicit scores indicate that there
is a tacit knowledge of social acceptability in response as no group is openly explicitly
ageist. As well as demonstrating a clear level of implicit ageism, the dissonance
between the two measures supports the fact that implicit and explicit tests measure
two distinct constructs. Trialled age education courses had no discernible effect of
implicit ageism. However, by promoting children’s development through education,
implicit attitudes towards older people became significantly worse than any other
group. This suggests the need for SC-IAT’s or similar measures to be implemented
when looking at the direction of an attitude rather than at the preference of one
category over another. Higher level education and specifically nurse training reduce
the explicit measure of ageism through increasing knowledge on social acceptability
and self presentational bias. Further to this, the explicit scores for older people are
also lower than those of other groups (excluding education as a factor increasing self
presentational bias) due to the explicit promotion of their in-group. Finally the metaanalysis has also provided overwhelming support for the use of the D-Score algorithm
over the previous conventional scoring methods.
169
Chapter Seven
General Discussion
All of the results displayed and discussed throughout the investigation and in turn in
this discussion have been based upon the D-Measure algorithm (Greenwald, Nosek &
Banaji, 2003). For comparison purposes, results were also displayed in the metaanalysis that were scored using the previous conventional algorithm. The fact that the
results altered significantly when the D-Measure was applied indicates a clear need to
adjust for the differences in response speed even in groups that superficially appear to
be homogeneous. There are three fundamental reasons that the D-Score will have
made such a difference even in apparently homogeneous groups. First are simple
levels of IQ. Less able groups have a lower level of fluid intelligence and as such this
will affect their response speed. Second are the effects of task recurrence. Both using
a computer keyboard and being versed in categorisation responses using push buttons
will affect the response times of participants. Third, is the effect of generally slow
responses where slower responses to all categories lead to larger proportional
differences and as such larger effect sizes. The improved scoring algorithm has shown
to account for these confounds as mediating factors and to strengthen the reliability
and applicability of the IAT (Cai, Sriram & Greenwald, 2004; Dutilh,
Vandekerckhove, Tuerlinckx & Wagenmakers, 2009). There are no outspoken
criticisms of using the D-Measure in calculating the IAT effect and these results
support the use of the D-Measure in every IAT study and not just those where
heterogeneous groups are being compared. A synopsis of the D-Measure scoring
process can be found in Appendix Four on page 236.
170
As an overall point, each of the studies has demonstrated significant differences
between the implicit and explicit scores. When added to the analysis presented at the
start of the results and again in each separate study whereby no significant correlation
was found between the two measures, it is clear that two distinct concepts are being
measured. These data support previous research which suggests that there is no
correlation between implicit and explicit measures (Hofmann, Gawronski,
Gschwendner, Le & Schmitt, 2005). This thesis does not suggest that explicit
measures are incorrect, nor that the implicit measures are innately better. The research
emphasises that the ability now exists to collect data on both forms of attitude and as
such, allows collection of the complete attitude as opposed to one or either subset.
The difference between the implicit and explicit measures is no more clear than when
the valence of these attitudes is considered. In each of the studies in this investigation,
the sample populations have always exhibited negative implicit attitudes towards
older people and positive explicit attitudes. This is a stable finding and is still evident
post exposure to any of the courses tested.
The difference between the implicit and explicit measures was also evident during the
debriefing procedure. All participants were informed of the overall aim of the
research and the difference between implicit and explicit attitudes. Further to this they
were also informed that no answers given were incorrect nor would any individual’s
scores be highlighted or separated from the aggregate totals. During the discussion
following the formal debrief there were some interesting trends emerging. Inline with
previous research (Monteith, Voils & Ashburn-Nardo, 2001) those participants who
171
responded slowest to incongruent pairings (good-old, young-bad) on the IAT were
often aware that this was the case. They voiced their opinions that this may be the
case, however, they did not report that they were concerned this was the case. All
participants who exhibited this degree of reflexivity said that the task caused them to
think more about the incongruent condition and they believed that it would be
reflected in their scores. After exploration and explanation of the procedure,
participants were happy that the scores were not easy to predict and that individual
scores would not be highlighted. At this point all participants were reminded if they
were unhappy they could remove their data from the experiment. No participant
withdrew at this point. In contrast to the implicit measure, all participants reflected
positively on the Fraboni Scale of Ageism. Even those participants who returned
higher scores did not seem concerned about portraying themselves as ageist. When
this was explored following the formal debriefing, the general consensus was that it
was clear what each of the statements were asking and that they ‘knew what the
answers were’. This indicates that the participants may very well have a preconceived
idea about what was expected / socially acceptable and that they responded in such as
way to comply with expectation. This further supports the supposition that the explicit
measure was subject to self presentational bias, something that was not evident with
the implicit measure.
General implicit ageism
The data indicate that all groups are implicitly ageist. But why is this so? As this
result is common to each of the groups irrespective of their backgrounds, gender,
occupation or level of education, it can be posited that the implicit ageist bias is
something that is more firmly ingrained into the wider society. Levy and Banaji
(2002) conducted a review on implicit ageism illustrating a pervasive and wide
172
reaching proliferation of negative ageist attitudes. The understanding that society
generally holds negative attitudes towards older people is long since established. Kite
and Johnson (1988) found that pervasive attitudes present in research suggest higher
negative attitudes than positive ones. This supported the startling findings by Isaacs
and Bearison (1986) that showed children as young as six exhibit ageist prejudices
present in their cultures. Unlike other prejudices, ageist attitudes are still openly
prevalent in society due to their wider implicit acceptance and the commonly held
misconception that these assertions are harmless. In television comedies, elderly
people are depicted, defined by stereotyped negativities regarding physical decline
and both physical and mental incompetencies (Zebrowitz & Montepare, 2000). When
these age stereotypes have been acquired, they are easily activated by the presence of
an elderly person (Banaji & Hardin, 1996; Perdue & Gurtman, 1990). This will result
in the generalisation of elderly people to the stereotyped schema held and as is the
case with implicit attitudes, will define the way in which older people are treated
when the consequence is outside of the actor’s conscious thoughts. Once acquired,
these attitudes are maintained and strengthened when encountering elderly people
even if they do not exhibit characteristics associated with the stereotypes held (Levy
et al., 2000; Murphy, Monahan & Zajonc, 1995).
Challenging these negative attitudes also proves harder for ageism than other forms of
prejudice. Hill et al. (1990) demonstrated that even when encountering contradictory
evidence, attitudes towards older people were resistant to change and in most cases
did not alter. This thankfully has been shown more recently to be surmountable with
improved training programmes designed to actively combat negative ageing
stereotypes (Cheong, Wong & Koh, 2009). As with most negative associations,
173
however, if encountering contact can be avoided then generally it is. Purdue and
Gurtman (1990) observed that young people are actively seeking ways to refrain from
engaging in social meetings with elderly people. This avoidance only reinforces the
implicitly held beliefs as it prevents the individual from having ‘meaningful’
encounters with elderly adults which may in fact cause inconsistencies in schema to
be noticed and re-evaluations of attitudes to take place.
These negative implicit attitudinal findings are not only characteristic of younger
generations. Negative implicit ageist attitudes are held by the elderly themselves
(Levy & Banaji, 2002). The reasoning given for this is that elderly people have
acquired the same implicit prejudices throughout their lives and have not had
sufficient time or opportunity to develop the mechanisms to defend against this. The
results from this investigation support the fact that older people hold these negative
implicit attitudes in the same way that other groups do too. Butler (1987) found that
when adopted, these stereotypes became a self-fulfilling prophecy, reinforcing
stereotypes through the inaction and deficits resulting from their initial belief and
internalisation. This finding in and of itself adds weight to the argument that
additional intervention measures need to be developed not only for the medical
community but also for a wider societal change starting during compulsory schooling.
Psychological theory can be used to design interventions that can be used in an
educational setting to impart knowledge and cause disequilibrium in the current
schema held to force a re-assessment of existing attributes and evaluations to modify
the existing ageist attitude. This has been shown by Kite et al. (2005) who
demonstrated that upon providing information about a person that countered existing
negative ageist stereotypes, the negative attitudes can be diminished. As the valence
174
of the results on the implicit tests are the same for all groups including older people,
support can be taken for the wide reaching nature of the negative implicit attitude.
The different groups in the investigation demonstrated varying degrees of implicit
ageism due to differing characteristics and courses tested. These will be reflected on
individually. However, the overall picture is one of a pervasive societal negative
attitude towards older people.
General explicit ageism
In opposition to the implicit attitudes held and again in support of the measurement of
two distinct attitudinal concepts, the scores on all of the explicit tests denoted attitudes
that were accepting of older people/not ageist. As they are so polar opposite in each of
the studies, the question that presents itself is why? Explicit measures are subject to
self presentational bias (Goffman, 1959) whereby the individual is expressing
attitudes under conscious control to place themselves in the best possible / socially
acceptable light. Subjective norms are adopted through expectation of this
acceptability and despite interventions (educational or otherwise) the understanding of
what is socially acceptable or expected is ingrained and as such expressed when
explicitly questioned. The results of the explicit tests demonstrate an acceptance of
what socially acceptable responses are and despite any internal changes as shown by
implicit scores, these will still be outwardly expressed. As Goffman further posited,
however, level of education can also be a mediating factor in the level of explicit bias
shown. This is something that will be considered further later.
Also of note are the results on the explicit scores for the older people. As with the
other groups, they demonstrate a non-ageist attitude but they are also one of the lower
175
scores recorded. This suggests that comparably, older people hold less ageist explicit
attitudes than most of the other groups. When higher level education has been taken
into account as a mediating factor (a point discussed later) the scores for older people
on the explicit measure are not just lower but significantly so. When comparing older
people’s explicit scores to those of the general adult population there is a significant
difference with older people exhibiting a significantly lower level of prejudice
(though both are still not high enough to be classed as ageist on the measure). The
items on the explicit scale are varied but generally centre on the desire to spend time
with older people and their rights. For the younger cohorts, it is possible to dissociate
themselves from the category of older person. They are able to create an in-group/outgroup categorisation which in turn enables them to explicitly express the implicit bias
that they hold. The reason for doing this would be to create a wider gap between the
‘them’ and ‘us’ categories. This is done so that first, they do not see themselves as
having those traits and characteristics attributable to the out-group; and second, that
they do not see themselves as an ageing/older person. It is a lifestyle threat to see
oneself in a transitional role from an in-group where one is comfortable to another
lesser perceived group which is currently an out-group (Brandtstadter & Greve,
1994). The reason why this is more stressful with regards to ageing is that it is a
transition that cannot be prevented and the perceived disadvantages associated with
being an older person far outweigh the benefits. The older sample on the other hand
would see themselves as having the same rights as they have always and as such this
would be reflected in the explicit measure. They do not have the same desire or at
least ability to dissociate themselves from the older person category and as such exert
the least ageist opinions in order to increase the perceived worth of their in-group.
176
Effects of education on attitudes towards older people
Four of the six studies in the investigation were looking at educational courses to
assess whether they had an impact on attitudes towards older people. These studies
were looking at the effect of higher level education, specific nurse training and two
different age-related educational courses. Each of these studies provided additional
evidence that informs about the ways in which education affects attitudes towards
older people.
Higher level education per se was studied by individually looking at Psychology
students vs. Nursing students and by looking at the groupings of those people who
have been in education post A-Level to those in the general adult sample who have
not. As with the other samples, each illustrated a solid negative implicit attitude to
older people and scores on the explicit measure that were not considered ageist.
Despite not quite demonstrating an explicit level of ageism, it is evident that those not
educated to a higher level are significantly explicitly more prejudiced than either of
the other groups. It is also evident from the descriptive statistics that the explicit
scores of each of those sample groups who have undertaken higher level education are
lower than those who have not. This point illustrates that the more educated people
become, the higher the level of self presentational bias due to the increased awareness
of social acceptability. When this level of education is not present, it appears that
participants are unable to monitor to the same degree the way in which their expressed
opinions will reflect on them. This follows the prediction based on the theory of self
presentational bias (Goffman, 1959) where it is stated the more educated a person is,
the more aware they become of the subjective and societal norms against which they
will measure themselves and in turn be measured. This is a strong finding with
177
regards to the effects of education on the explicit attitudes towards older people and
an individual’s self presentational bias. Further to this it may also suggest that those
who do not receive higher level education are less able to monitor the way in which
they present themselves and the attitudes they express. These results, however, only
look at the effects of general higher level education from amassed student data. When
broken down to specific types of education, other results become apparent.
The significant differences in explicit scores between the General Adult population
and the Nursing students, Geriatric nurses and the approaching significance of the
difference with A&E nurses indicate an effect on explicit attitudes by nurse training.
Throughout their training nurses will be instructed on their duties of care in addition
to the health requirements and needs of different demographics of patients. This
explicitly gained information will inform the nurses of appropriate ways to act and
that each patient should be treated as an individual rather than as a stereotype. This
education would act only to reinforce the societal norms that prejudice is wrong and
as such, expressions of prejudice are not acceptable. As nurses will have undergone
this specific education as well having gone through higher education, they are not
only generally educated to a high level and as such aware of presenting themselves in
a socially acceptable light, but also specifically in that they would be aware that
expression of prejudice towards any one group of people would be even more
unacceptable in their profession. Although not affecting their implicit bias, the
specific education that they have received reduces the expressed explicit bias due to
the heightened awareness of social acceptability. Along with the effects of general
higher level education, the effects of nurse training need to be taken into consideration
178
when looking at explicit attitudinal scores especially those where the attitude being
measured is easily noticeable.
Educational interventions to reduce implicit and explicit ageism have in recent years
shown to be effective. Cheong, Wong & Koh (2009) identified that through successful
education, medical students in Singapore are expressing increasingly positive attitudes
towards older people. This programme included a balanced approach to ageing,
presenting models of successful healthy ageing as well as the ways older people
compensate for those losses associated with ageing, thus maintaining their quality of
life. In addition to the standard classroom based education, Gonzales, Morrow-Howell
& Gilbert (2010) demonstrated that through adding contact with older people through
activities outside of a classroom, the attitudes of medical students improved
significantly. Both of these interventions show how psychological knowledge can be
used to structure interventions to effectively decrease negative attitudes towards older
people. The current investigation looked at a psychology course as an intervention
measure and also the effects of a course not looking at ageing but instead, specifically
child development.
The Psychology of Ageing elective third year module was assessed to ascertain
whether in presenting a rounded perspective of ageing, attitudes towards older people
could be made more positive. Despite not producing any significant results, the
descriptive results did show an alarming trend. Rather than reducing any implicit
ageism that may have been present, the implicit attitudes towards older people
became markedly worse. There are a few possibilities as to why this may have been
the case when the course is measured against those previously mentioned successful
179
interventions. The course had attempted to reflect the way in which older people can
compensate for losses associated with ageing, however, as an undergraduate third
year course rather than a training course, much of the additional information
regarding the gains associated with ageing should have been gathered by the students
in wider reading outside of the classroom context. As the measure for an intervention,
all of the learning material should be presented to the students so that they have all of
the information to assimilate and there is not the reliance on individual motivation to
improve knowledge. As there was no measure of the additional work that students had
completed outside of the weekly lecture, it is not known how rounded the information
taken by the students was. Another reason why the course may not have been
successful is the method of course delivery. Firstly although classroom education
alone has been shown to be effective in Singapore (Cheong, Wong & Koh, 2009), the
addition of direct contact/activities with older people to this has shown to be more
successful (Gonzales, Morrow-Howell & Gilbert, 2010). It is the direct contact with
older people that could in turn cause the information being imparted to take on a real
world context and more deeply affect the student’s implicit attitudes. Second, the
course consisted of one weekly lecture. It is possible that a more intensive course,
where the students would have less time between exposures in which to forget the
content, would be more successful in promoting attitudinal shifts.
The other educational course that was measured was the Early Years course at the
University of Glamorgan. This is a course that does not look at older people in any
context and does not look at the losses or gains associated with ageing so should not
affect the attitudes held towards older people. This course centred on the gains
associated with the formative years development as well as the development and
180
acquisition of skills and socialisation. This course did not portray a negative account
of ageing but simply a positive account of youth. Results from the implicit tests
clearly illustrate that the implicit attitudes held by the early years students was
significantly more prejudiced than either of the two other student populations
(Psychology or Nursing). This is a worrying finding as these are the only students
who have not undertaken any formal education that should directly affect their
implicit attitudes towards older people. The IAT measures attitude strength and
valence through paired associations using opposing words and images. The IAT
results illustrate an implicit preference and when measuring a cross-sectional sample
there are few issues with this. The results would suggest that it is possible for an
intervention/educational programme to negatively affect implicit ageist attitudes when
no ageing literature is covered in the course. This suggests that through educating
about youth and improving attitudes to them, the opposing IAT categorisation and
associated negative attitude will also increase.
However, it is distinctly possible to have a preference for younger over older people
but not to be ageist in one’s attitude or behaviour. The argument follows that if a
preference for youth is cultivated through exposure, group membership or education,
the relative evaluation of the opposing category will decrease. Bohner, Siebler,
Gonzalez, Haye and Schmidt (2008) have shown this precise argument in an IAT/SCIAT measure of country preference. They found that when using the IAT measure,
Turkey had a more favourable evaluation than Germany, however, when using the
SC-IAT there was no significant difference in appraisal of the two countries. This
they argue shows that a negative attitude can be expressed towards an attitude object
where only a relative negative attitude exists. When only a single category is assessed
181
at any one time then both the preference for one category over the other can be
reduced/removed and the non-relative attitude can be assessed. To this end a way of
measuring the attitudes directly towards old and young categories rather than as a
preference for one over the other should be implemented. As previously discussed,
one such method of doing so is the Single Category Implicit Association Test (SCIAT) developed by Karpinski & Steinman (2006). Where the standard IAT relies on
categorisation using pairings for both old and young simultaneously, the SC-IAT uses
only one of those categories at a time to elicit the underlying attitudes held for a
specific target. This could be used in conjunction with the existing IAT measure to
ascertain base line and post intervention measures. This would allow for accurate
reporting not only of the preferential attitude but also to demonstrate which aspect of
the attitudes held have been affected (positive liking or negative disliking). The SCIAT has been shown to be effective in eliciting implicit single concept attitudes
(Bohner, Siebler, Gonzalez, Haye & Schmidt, 2008; Steinman & Karpinski, 2008)
and as such would be ideal when paired with the current IAT to clarify the direction
of expressed attitudes. It is important to reiterate an earlier point that the SC-IAT was
not used throughout this thesis mainly because at the time the methodologies were
formulated, agreed and approved, the SC-IAT did not exist. To date there are still
many unanswered questions surrounding the applicability of the SC-IAT (Richetin &
Perugini, 2008) and as such its appropriateness is not as widely accepted as that of the
IAT. Because of these factors and the widely accepted nature of the IAT it was
decided that the IAT would be used throughout with recommendations to include the
SC-IAT in future studies when further extensive testing has been conducted and more
about its validity is known.
182
Effects of direct contact on attitudes towards older people
Zajonc’s (1968) theory of mere exposure effect suggests that just from coming into
contact with something on a regular basis will make that object appear more
favourable. A wealth of research has supported this and the direct contact hypothesis
in that contact between groups where negative stereotypes have previously been held
can itself help reduce the negativity of the stereotype and associated attitude (Allport,
1954; Cook, 1962, 1978; Pettigrew, 1979; Stephan & Stephan, 1984; Paolini,
Hewstone, Cairns & Voci, 2004; King, Winter & Webster, 2009). From this it could
be suggested that those nurses working in a ward specifically for care of older people
would hold less negative (if not positive) attitudes towards older people than do those
people who do not have daily contact.
Results from the meta-analysis indicate that there was no significant difference in the
implicit (or explicit) attitudes held between the two groups of qualified nurses. It
would have been expected that due to the larger amount of contact, those nurses
working in a dedicated ward for the care of older people would have less negative
implicit attitudes than those working in A&E. However, research has also indicated
that even after taking selection and social desirability processes into account, all types
of exposure affect attitudes in a favourable direction (Lee, Farrell & Link, 2004).
When taking this into account and acknowledging that both types of qualified nurse
are likely to have contact with older people on a daily basis, it is probable that the
exposure that both experience accounts for the lack of significant difference between
the two groups. What is of note, however, is when comparing those nurses who have
specific daily contact with older people to those general adults, a significant
difference is apparent. Previous comparisons of contact could very well have been
183
mediated by the effects of higher level education on self presentational bias, however
this would not be the case for those adults who have not undertaken this level of
education. Despite there being a significant difference between these two groups there
are points of caution. No specific effect of contact was found between the two types
of nurses although this can be explained by undoubted contact with older people in
the A&E department. Also there is no significant difference between nurses working
in a geriatric ward and other groups of students who do not have this contact, although
this can be explained due to increased self presentational abilities from higher
education. The difference between the Geriatric nurses and the Adult sample could be
due to educational level alone, however, if this were the case there would be
significant differences for each of the groups with higher level education. The results
do not categorically support the contact hypothesis, however, they do support further
investigation to look at the mediating factors of education and direct contact on the
explicit attitudes held towards older people.
Test stability over time
Two of the studies in the investigation were longitudinal in nature in that they had a
base measure taken, an intervention introduced and a measure taken post intervention
with the same cohorts. Results of these tests have already been presented in the actual
results that they show, however, this type of test also allows for the consistency of the
measures used to be analysed.
In the first longitudinal study the explicit measure correlated significantly at each time
period with each group and although returning at times what are relatively low “r”
values, these are significant and show that there is consistency in the way in which
184
participants are responding. An explanation for this is the nature of self presentational
bias. The participants are aware of the socially acceptable answer and as such at each
time point they answer each of the statements on the FSA in a way that would reflect
these subjective norms. This answering strategy is possible in most explicit measures
and the FSA is no exception. The individual items are quite clear in their intent so
from this, a socially acceptable answer is easily provided. As the measure is a straight
forward one, despite the participants being unlikely to remember the questions
between data collection points, similar responses would be easily provided thus
explaining not only the strength and direction of the attitudes but also their stability
and correlation. Either way, the explicit measure is a stable predictor of the attitudes
held that would be expressed through behaviours in planned situations.
The implicit measure, however, provides a different picture. There are no significant
correlations within the groups between any of the time points and the correlations
returned are themselves very weak. This suggests that the scores returned on an
individual basis fluctuate between time periods and as such are not a stable indicator
of implicit attitudes. It would be expected that each time point (similarly to the
explicit measures) would be correlated significantly with the other implicit data
returned on an individual level. An initial supposition from this would be that
although the IAT performs well as a group measure, this study does not support the
IAT as a consistent measure of individual implicit attitudes. The results would hold
that individual fluctuations are such over time that few predictions can indeed be
made on an individual level about future attitudes or behaviours. If true, this could be
worth serious consideration prior to using the IAT as an individual measure both in
terms of academic research and theory development but also in practical terms for
185
marketing and screening tools. If the fluctuations are such that only basic direction
rather than strength of an attitude can be accurately predicted, the use of the IAT for
screening personality types or attitudes held on an individual basis should be severely
scrutinised. What also needs to be considered, however, is that previous longitudinal
research (Lovden, Li, Shing & Lindenberger, 2007) has demonstrated low test
correlations over time. They hypothesised the important distinction in longitudinal
studies is that the negative attitudes (which measure relative differences between
positive and negative responses) remain consistent. They advised that caution must be
used with the IAT as the absolute size of the score is almost certain to fluctuate.
There is, however, an alternative hypothesis to the differentiation of scores between
time points. The focus of the longitudinal studies was to investigate the effects of
higher level education and a Psychology of Ageing course on attitudes to older
people. The general higher level education is not solely dedicated at any stage to the
promotion of innovative ageing or reducing ageism and as such there has not been an
observable flux in the explicit measurement scores. The psychology course is
specifically looking at the effects of ageing, however, this is in the context of
undertaking other modules when ageing content is not present. The implicit test is
attempting to measure attitudes outside of the conscious control of the participant and
as such the effects of any intervention or education could have a greater impact. The
impact of education on any one person is not a linear process and as such different
methods and content can affect different people in different ways. Due to the differing
impact of the education being received at each of the time points during the
undergraduate programme, it stands to reason that an individual’s score may not
correlate as the scores fluctuate (within the same valence). If this were indeed the
186
case, the IAT itself could be considered a stable measure all things being equal
without the presence of an intervention measure. The IAT has been shown to be a
stable measure over time (Perugini, 2005) even on an individual basis, however, in the
meta analysis conducted by Perugini, none of the testing was with groups undergoing
any form of intervention. The results from this investigation are not conclusively
supportive of either possibility regarding the effectiveness of the IAT, however, they
do support further investigation as to the reliability of the IAT for predicting
behavioural intent on an individual rather than group level.
Despite some of the issues raised through analysis of data, this study has still
significantly furthered the understanding of attitudes towards older people. It has
furthered understanding of the prevailing implicit and explicit attitudes held by
different groups of people and through meta-analysis the wider society. In doing so it
has identified societal wide negative implicit attitudes towards older people and
conversely explicitly accepting attitudes. It has also supported the use of both implicit
and explicit measures of attitude measurement in obtaining a complete measure of an
attitude. Further to this it has looked in depth at the educational and situational factors
that affect attitudes towards older people and the implications for different subgroups.
Moreover it has identified ways in which existing courses have not been successful in
modifying attitudes as well as highlighting potential pitfalls in interpreting data from
the IAT.
To build on the research conducted in this study, further advancing the knowledge of
implicit attitude research and ageing research in general, future research and
directions have been suggested.
187
Future research directions
Each of the studies conducted in this investigation have highlighted possible
methodological improvements or directions that could be undertaken to further the
knowledge gained. Presented are a series of studies that would lend further support to
the current research and provide theoretical and practical advancement both on an
academic platform and in a practical context.
To gain a better picture of the effects of general higher level education, several
changes could be made to the methodology of the initial study presented. The study
should again be longitudinal in nature taking measures throughout the course
programme but it should vary the students and courses assessed. The current samples
were chosen due to the sample homogeneity (age, gender etc) which despite being a
strength, has resulted in two courses being assessed where age related content has
been included. It would be of interest, when teamed with the improved sampling, to
include undergraduate courses that do not include age related information (e.g.
computing, business). By including these courses, the effect of general higher level
education could be more accurately extracted. Further to the course content, sampling
issues and environmental contexts should be controlled to provide a more structured
framework for analysing mediating factors. If the sample of students included both
residential and non-residential as well as ‘mature’ and school-leaver age students,
there would be control over the type of environment that the students were exposed to
in addition to the course content. An extension of this would be to also assess the
attitudes of those who undertake a distance learning course (e.g. Open University) to
assess the impact solely of the university environment on the implicit and explicit
attitudes held. This would allow for any mediating effects of living with peers and
188
being surrounded 24/7 only by people of a youth demographic to be factored into the
analysis. In addition to those retests, a longitudinal control group should be employed
to
test
the
correlation
of
time
point
data
in
a
group
where
no
manipulation/intervention is present. If the results from this still suggest that there are
no statistically significant correlations at the different time points with all other things
being equal then this would support the initial supposition that the IAT should be used
with caution on an individual basis. Either way, more investigation is needed to
conclusively support whether specific or general higher level education have an
impact on the implicit attitudes held about older people.
A study of the general adult population would also further the understanding of the
effects of higher level education so as a study to run in conjunction with that outlined
above modifications to the current adult sample should be undertaken. For practical
reasons it was not possible to examine more sections of the population. Therefore
future research should expand to test other samples, stratified by education, socioeconomic status, etc. However, the fact that relatively few differences have been
observed in the samples tested indicates that this is unlikely to yield anything that has
not already been established here, only strengthen it. In addition to this, the general
adult population sample was all taken from those who worked in the university.
Despite the fact that the majority of the adults were not working with students on a
daily basis (kitchen, clerical, grounds maintenance, etc) they would still have been in
a general environment where they would have come into daily contact with them. As
research has shown, (Lee, Farrell & Link, 2004) when in day-to-day contact, attitudes
towards the target group (in this case the students/young people) will be affected. This
means that in the current study it is not solely the effect from lack of higher level
189
education that is being observed. The sample for future studies will have to include or
comprise solely those people who have not received higher level education and do not
work in environments with young or older people (e.g. office workers) and finally the
use of a Single Category IAT (SC-IAT) in addition to the standard IAT would allow
for direction of preference to be shown too.
The measurement of attitudes held by the early years students highlighted some other
methodological issues with the IAT that warrant additional investigation. It is
important to be able to assess the direction of the attitudes expressed rather than
seeing it as a preference of one category over another. Especially with regard to
measuring the effectiveness of intervention measures, it is important to be able to
assess the direction an attitude is being influenced. It is distinctly possible to have a
preference for younger over older people but not to be ageist in your attitude or
behaviour. To this end a way of measuring the attitudes directly towards old and
young categories rather than as a preference for one over the other should be
implemented. One such method of doing so is the SC-IAT developed by Karpinski &
Steinman (2006). This could be used in conjunction with the existing IAT measure to
ascertain base line and post intervention measures. This would allow for accurate
reporting not only of the preferential attitude but also to demonstrate which aspect of
the attitudes held have been affected (positive liking or negative disliking). When
conducted with a control group and using a longitudinal design, the true effects of any
intervention measure should be visible rather than making assumptions as is currently
the case with the IAT where only dyadic preference can be noted.
190
The implicit attitudes of nurses both in training and those who are qualified have been
shown to be significantly negative. This is of concern as it is reflective of the
behaviour expressed when in spontaneous situations such as emergency or acute care
of elderly patients. It is apparent that interventions need to be developed that follow
the directions shown by other successful programmes (Cheong, Wong & Koh, 2009;
Gonzales, Morrow-Howell & Gilbert, 2010). As the population ages it is imperative
that a successful method of combating this issue is found so as to minimise / eliminate
ageism as a factor in care choices made for older people. Once developed for a UK
care context, the same longitudinal technique as outlined above should be used to
assess its effectiveness. Of interest would be to monitor the career pathway of nurses
through either a series of cross-sectional studies or with a longitudinal cohort to assess
whether this is a trend that continues throughout their careers. In addition, post
intervention testing would demonstrate the longevity of any attitudinal change that
does occur.
Each of the future research directions outlined above would further the field of
psycho-gerontology and specifically the understanding of implicit and explicit
attitudes towards older people. The reason for conducting this research does have to
be placed in a practical context as this research is not just to increase theoretical
understanding. The population of the UK is ageing. Over the last 25 years the
percentage of the population aged 65 and over increased from 15% in 1983 to 16 per
cent in 2008, an increase of 1.5 million people in this age group. Over the same
period, the percentage of the population aged 16 and under decreased from 21% to
19%. This trend is projected to continue. By 2033, 23 per cent of the population will
be aged 65 and over compared to 18% aged 16 or younger. The fastest population
191
increase has been in the number of those aged 85 and over, the ’oldest old‘. Since
1983 when there were just over 600,000 people aged 85+ in the UK, the numbers
have more than doubled reaching 1.3 million in 2008. By 2033 the number of people
aged 85 and over is projected to more than double again to reach 3.2 million, and to
account for 5% of the total population (Office for National Statistics, 2009). In a
health care context, if attitudes towards older people remain as they currently are the
incidence of neglect and substandard care is likely to increase. The training of medical
and nursing students to reduce or eradicate their negative attitudes must be the
primary focus for the benefit of the wider society. Teamed with this, any intervention
should be trialled in the wider society along with the promotion of a paradigm shift in
the way in which advertising and the wider media portray older people. Despite these
being ambitious and outside of the influence of any one person or piece of research,
through the production of conclusive research and amassing a robust evidence base,
research has the power, when made known, to affect policy and effect societal change.
This is of central importance for several reasons. It is only through education of all
ages that the societal change will occur. It is possible to change the attitudes of a few
smaller groups like those of medical professionals; however this will not affect the
internalised negative societal stereotypes held by older people themselves. These
stereotypes have been shown to have a negative impact on cognition, mobility and
activities of daily living. If these are addressed then the quality of life for older people
will increase and future generations of older people will not be limited by the
stereotypes imposed on them through a lifetime of being subject to implicit
reinforcement through norms and media portrayals.
192
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Appendices
Page
Appendix One: Fraboni Scale of Ageism ……………………………………..
230
Appendix Two: Student nurse participation certificate ……………………..
234
Appendix Three: Psychology student debrief form ………………………….
235
Appendix Four: IAT D-Scoring algorithm …………………………………...
236
229
Appendix One: Fraboni Scale of Ageism
Part Two
Please can you complete the below questionnaire by clearly circling the response to
each question that is most appropriate for you
This questionnaire must be completed in silence and without conferring
1. Many old people are stingy and hoard their money and possessions
1
Strongly Disagree
2
Disagree
3
Agree
4
Strongly Agree
2. Many old people are not interested in making new friends, preferring instead the
circle of friends they have had for years
1
Strongly Disagree
2
Disagree
3
Agree
4
Strongly Agree
3
Agree
4
Strongly Agree
3. Many old people just live in the past
1
Strongly Disagree
2
Disagree
4. Most old people should not be trusted to take care of infants
1
Strongly Disagree
2
Disagree
3
Agree
4
Strongly Agree
5. Many old people are the happiest when they are with people their own age
1
Strongly Disagree
2
Disagree
3
Agree
4
Strongly Agree
6. Most old people would be considered to have poor personal hygiene
1
Strongly Disagree
2
Disagree
3
Agree
230
4
Strongly Agree
7. Most old people can be annoying because they tell the same stories over and over
again
1
Strongly Disagree
2
Disagree
3
Agree
4
Strongly Agree
8. Old people complain more than other people do
1
Strongly Disagree
2
Disagree
3
Agree
4
Strongly Agree
9. I would prefer not to go to an open house at a seniors club if invited
1
Strongly Disagree
2
Disagree
3
Agree
4
Strongly Agree
10. Teenage suicide is more tragic than suicide amongst the elderly
1
Strongly Disagree
2
Disagree
3
Agree
4
Strongly Agree
11. I sometimes avoid eye contact with old people when I see them
1
Strongly Disagree
2
Disagree
3
Agree
4
Strongly Agree
12. I don’t like it when old people try and make conversation with me
1
Strongly Disagree
2
Disagree
3
Agree
4
Strongly Agree
13. Complex and interesting conversation cannot be expected from most old people
1
Strongly Disagree
2
Disagree
3
Agree
4
Strongly Agree
14. Feeling depressed when around old people is probably a common feeling
1
Strongly Disagree
2
Disagree
3
Agree
231
4
Strongly Agree
15. Old people should find friends their own age
1
Strongly Disagree
2
Disagree
3
Agree
4
Strongly Agree
16. Old people should feel welcome at the social gatherings of young people
1
Strongly Disagree
2
Disagree
3
Agree
4
Strongly Agree
17. Old people don’t really need to use our community sports facilities
1
Strongly Disagree
2
Disagree
3
Agree
4
Strongly Agree
18. It is best that old people live where they wont bother anyone
1
Strongly Disagree
2
Disagree
3
Agree
4
Strongly Agree
19. The company of most old people is quite enjoyable
1
Strongly Disagree
2
Disagree
3
Agree
4
Strongly Agree
20. It is sad to hear about the plight of the old in our society these days
1
Strongly Disagree
2
Disagree
3
Agree
4
Strongly Agree
21. Old people should be encouraged to speak out politically
1
Strongly Disagree
2
Disagree
3
Agree
4
Strongly Agree
22. Most old people are interesting individualistic people
1
Strongly Disagree
2
Disagree
3
Agree
232
4
Strongly Agree
23. I personally would not want to spend much time with an old person
1
Strongly Disagree
2
Disagree
3
Agree
4
Strongly Agree
24. There should be special clubs set aside within sports facilities so that old people
can compete at their own level
1
Strongly Disagree
2
Disagree
3
Agree
4
Strongly Agree
25. Old people deserve the same rights and freedoms as do other members of our
society
1
Strongly Disagree
2
Disagree
3
Agree
4
Strongly Agree
26. Most old people should not be allowed to renew their drivers licence
1
Strongly Disagree
2
Disagree
3
Agree
4
Strongly Agree
3
Agree
4
Strongly Agree
27. Old people can be very creative
1
Strongly Disagree
2
Disagree
28. I would prefer not to live with an old person
1
Strongly Disagree
2
Disagree
3
Agree
4
Strongly Agree
29. Old people do not need much money to meet their friends
1
Strongly Disagree
2
Disagree
3
Agree
4
Strongly Agree
Thank you for completing the questionnaire.
Please indicate to the researcher that you have completed the questionnaire so that this
can be collected
233
Appendix Two: Student nurse participation certificate
Faculty of Humanities and Social Science
Cyfadran Dyniaethau a Gwyddorau Cymdetihasol
Certification of
Participation
This certificate does show that ………………………………. has taken part in a social
psychological study for the Humanities and Social Science Department at the University
of Glamorgan.
The study involved multi-modal testing to gauge a measure of both implicit and explicit
ageism attitudes.
The participant named above has given 30 minutes of their time and successfully
completed both sections of the test.
Researcher: Paul Nash
Supervisor:
Signed:
Prof. Ian Stuart-Hamilton
234
Appendix Three: Psychology student debrief form
Faculty of Humanities and Social Science
Cyfadran Dyniaethau a Gwyddorau Cymdetihasol
Research Participation
Sheet
Introduction/Background:
Attitudes are formed from exposure to attitude / target objects. This forms one of two
types of attitude, either explicit or implicit. Explicit attitudes are those which are openly
expressed and are good predictors of planned behaviour. Implicit attitudes are internalised
attitudes which give a good prediction of spontaneous behaviour. Current research is
interested in measuring and comparing both attitudes and assessing the effectiveness of
attitude change measures
Methodology:
A paper based explicit attitudinal measure has been used (Fraboni Ageism Scale) to be
compared with the implicit measure. The implicit measure used is a computer based
Implicit Association Test (IAT) which has been created especially for this study. The IAT
measures response time latencies between concordant and non-concordant category
pairings of words and pictures.
Predictions:
There will be a significant difference between the scores on the implicit and explicit
measures of ageism.
References:
Kim, D. (2003). Voluntary controllability of the implicit association test (IAT). Social Psychology Quarterly, 66 (1) pp.83-97
Monteith, M., Voils, C. & Ashburn-Nardo, L. (2001). Taking a look underground: Detecting, interpreting, and reacting to racial
biases. Social Cognition, 19 (4) pp.395-418
Perugini, M. (2005). Predictive models of implicit and explicit attitudes. The British Journal of Social Psychology, 44 (1) pp.29-46
Signed:
Researcher:
(Print):
Supervisor:
Paul Nash
235
(Print):
Ian Stuart-Hamilton
Appendix Four: IAT D-Scoring algorithm
Group Trial Blocks
Upper Tail Treatment
Error Penalty
Collate Score
Calculate Direction
Standardise
Block 3 & Block 4
Block 6 & Block 7
Delete if latency exceeds 10,000 ms
Replace errors: mean + 600ms
Mean of blocks 3 & 4
Mean of blocks 6 & 7
Congruent blocks – Incongruent blocks
Divide score by individual standard deviation (SD)
236