FeatureHuman rights training impact onattitudes and kno.docx

Feature
Human rights training: impact on
attitudes and knowledge
Michelle Redman, Eleanor Taylor, Reuben Furlong, Ged Carney
and Beth Greenhill
Abstract
Purpose – People with learning disabilities are vulnerable to
human rights violations, creating a need for
human rights education for both services users and support
staff. This research paper aims to examine
factors contributing to effective human rights training for staff.
It seeks to investigate human rights
awareness training (HRAT) within an NHS setting and its effect
on human rights knowledge and attitudes
towards human rights.
Design/methodology/approach – A total of 23 support staff were
given HRAT, completing a ‘‘human
rights based approach knowledge quiz’’ and an ‘‘attitudes to
human rights questionnaire’’ before and
after training.

Findings – The results indicated that HRAT had a significant
effect on human rights knowledge scores;
however, training had no significant effect on attitudes towards
human rights and no significant
relationship between staff attitude and human rights knowledge
was found.
Research limitations/implications – Future training would
benefit from a greater focus on
psychological theories of attitudes and behaviour in the
planning, execution and evaluation of the
training. This may help to facilitate development of positive
attitudes towards human rights. A validation of
the measure of attitudinal change is needed. Training models
with a greater emphasis on staff’s emotional
responses, defences and the impact of organisational culture
may allow a deeper understanding of the
complexities of delivering effective human rights training.
Originality/value – This research paper highlights the need for
human rights training; one that
encompasses attitudinal change as well as basic education.
Without effective training to secure staff
engagement in organisational change, human rights legislation
is unlikely to create meaningful change
in the lives of people with learning disabilities.

Keywords Human rights, Staff training, Attitudes,
Organizational culture, Learning disabilities,
Psychological reactance
Paper type Research paper
Introduction
From the beginning of recorded history, people with disabilities
have been enslaved, abused and
neglected (Owen and Griffiths, 2009, p. 15).
The protections afforded by the 1998 Human Rights Act are
fundamental for vulnerable
groups such as those people with learning disabilities who face
victimisation, discrimination
and violation of their rights (Mazzucchelli, 2001; Department of
Health, 2008; Ministry of
Justice, 2008). Reports (Joint Committee on Human Rights,
2008) highlight abuse, lack of
privacy and difficulties arising from poor communication as
explicit concerns for service
users with learning disabilities. Within an NHS based explicitly
on human rights principles
(Department of Health, 2009), there is an urgent need to address
these issues.
PAGE 80 j TIZARD LEARNING DISABILITY REVIEW j VOL.

17 NO. 2 2012, pp. 80-87, Q Emerald Group Publishing
Limited, ISSN 1359-5474 DOI 10.1108/13595471211218811
Michelle Redman and
Eleanor Taylor are both
Assistant Psychologists,
Reuben Furlong is a
Community Residential
Services Manager, Ged
Carney is a Community
Learning Disability Nurse
and Beth Greenhill is a
Clinical Psychologist, all at
Mersey Care NHS Trust,
Liverpool, UK.
Due to a higher incidence of healthcare needs, people with
learning disabilities often have
more interaction with the healthcare system compared to the
general population (Owen and
Griffiths, 2009). Sutherland et al. (2002) suggest the limited

degree to which people with
learning disabilities are given the opportunity to actively
participate in their own healthcare
raises ethical concerns. Arguably, this combination of factors
leads to the very real every day
indignities and high-profile abuses in the lives of people with
learning disabilities such as
those identified in Death by Indifference (Mencap, 2007).
Commenting on the inquiries into human rights abuses in
healthcare settings, the Healthcare
Commission (2007) stated ‘‘institutional abuse occurs when the
rituals and routines of a
service result in the lifestyles and needs of individuals being
sacrificed in favour of the needs
of the institution’’ (cited in Healthcare Commission, 2007, p.8).
In this context, there is a clear
need for human rights education for both staff working with
people with learning disability
and individuals themselves. Individuals who are unaware of
their human rights are more
‘‘vulnerable to having them abused and often lack language and
conceptual framework to
effectively advocate for them’’ and furthermore ‘‘cannot
exercise them effectively’’ (Flowers,

1998, cited in Owen and Griffiths, 2009, p. 18).
Promoting a human rights culture: the need for human rights
training in organisations
Kinderman and Butler (2006) highlight the need for all frontline
staff to be trained in human
rights. Staff with greater familiarity with human rights, they
argue, are more likely to believe in
upholding rights and are also more committed to upholding the
rights of others (Tarulli et al.,
2004). Stoner et al. (2002) similarly report that support for
service users is most effective if
staff have knowledge of human rights. The Ministry of Justice
(2008) identified that specific
training on human rights was beneficial, not only to the member
of staff receiving the training,
but to the organisation and service users for and with whom
they work.
Effective human rights training in organisations
The Audit Commission (2003) recommends that to develop a
‘‘human rights culture’’,
awareness of human rights should be paramount throughout an
organisation. They also
state that prevention rather than cure is key to delivering human

rights and improving
services; human rights need to be seen to be proactively
embedded and not just invoked in
response to legal disputes. When public bodies were not found
to be responsive to the
Human Rights Act, this was usually due to competing priorities
and to negative responses to
the act engendered by the organisation only responding to legal
cases. The best
approaches identified were where organisations were positively
promoting human rights in
their equalities strategies, policies and practices.
Effective human rights training in public services
Within the limited literature available, there appear to be two
broad approaches to human
rights training; an ‘‘activist approach’’, characterised by
Flowers and a ‘‘psycho-educational
approach’’ advanced by Kinderman and Butler (2006). Flowers
(2000, p. 8) ‘‘challenges
students to ask what human rights mean to them personally and
encourages them to
translate caring into informed, nonviolent action’’, proposing
that a human rights education

‘‘promotes understanding of the complex global forces that
create abuses, as well as the
ways in which abuses can be abolished and avoided’’. In less
impassioned contrast,
Kinderman and Butler emphasise the importance of congruence
with participants’ pre-
existing ideas.
Butler (2005) adds that training for staff should not only
include rights and the FREDA
principles (Fairness, Respect, Equality, Dignity and Autonomy)
but should also be developed
around tools that can be disseminated to structure practice
(Greenhill and Whitehead, 2010).
As the training being evaluated was part of mandatory training
for the support staff attending,
it seemed more fitting to adopt Kinderman and Butler’s
approach. Human rights training can
be experienced by staff as contentious (see below for a
discussion of ‘‘psychological
reactance’’), even when they are implicitly using the approach
every day. Guidance for
Human Rights training in a UK context emphasises ‘‘working
from the point of connection’’
VOL. 17 NO. 2 2012 jTIZARD LEARNING DISABILITY

REVIEWj PAGE 81
rather than adopting a ‘‘radical activist’’stance which may risk
alienating staff(Kinderman and
Butler, 2006).
Human rights training for staff working in LD services
The Rights, Respect, Responsibility (3Rs) training education
programme (Owen et al., 2003)
in Canada informs service users with learning disabilities, and
the people who support them,
about their human rights. The main aim of the 3Rs programme
is for service users and staff to
distinguish rights, infringement of those rights and appropriate
ways to challenge violations.
It places emphasis on the use of personal experiences and active
trainee participation. The
training includes presentations, discussions of human rights
scenarios and a range of
activities to engage participants in examining the nature of each
of the rights to which the
organisation is committed. In evaluating this training, trainees
reportedly comment that
examples are beneficial, as they provide a link between taught

content and their own
professional experience. Following the training programme,
service users and staff have
shown significant development in the ability to identify human
rights and exercise them
effectively (Owen and Griffiths, 2009).
Attitude and behaviour change within human rights training
Kinderman and Butler (2006) suggest the key to using the
Human Rights Act to ensure the
respect of all service users is promoting change in attitude and
behaviour. They suggest
there are a number of components in the development and
implementation of positive
engagement with human rights, including prevention and
enforcement, strategy, planning
and evaluation, all underpinned by psychological theories of
attitude and behaviour.
Various insights into our understandings of the links between
attitude and behaviour have
been made by key theorists. Fishbein (1967) suggests that
individuals are more likely to act
in a specific way and uphold attitudes when the attitudes in
question are viewed as

originating from the self or as pre-existing. Kinderman and
Butler (2006) argue that this is
particularly important when engaging staff around human rights.
Ajzen’s (1991) ‘‘Theory of
Planned Behaviour’’ proposes that a person’s attitude,
subjective norms and perceived
control of behaviour all influence their behaviour. This
indicates a need to assess attitude to
human rights as a means of changing staff’s behaviour.
Rose and Holmes (1991) provide an example of how training
can produce attitude change to
promote and maintain human rights. They evaluated two
workshops designed to change the
attitudes of staff towards the sexuality of people with learning
disabilities, e.g. risk taking
behaviour, freedom of choice and expression of sexuality.
Significant levels of change in staff
attitude were identified following workshops. A longer training
event created a significant
change in staff attitude, in a more ‘‘liberal’’ direction.
However, Rose and Holmes do not
specify which components of the workshops were most effective
in changing participants’
attitudes.

Potential barriers to effective human rights training: attitudes
and ‘‘Psychological Reactance’’
Kinderman and Butler (2006) set out certain guidelines when
training people around human
rights. One area they felt to be important was that human rights
should be seen as
complementary to current public service work. To prevent
‘‘reactance’’ to human rights
training, it is important that staff do not feel ‘‘railroaded’’ into
change, rather, that a human
rights approach can bring about service improvements
compatible with current working.
During training, enabling people to share their own experiences
and practice and retain a
sense of congruence with their own thoughts and beliefs are
important in reducing
‘‘psychological reactance’’ towards training and human rights
(Kinderman and Butler, 2006;
Owen et al., 2003; Ministry of Justice, 2008).
This is consistent with Rose and Holmes’ (1991) explanation for
possible attitude change.
They suggest workshops may provide an environment where
participants are able to

increase their knowledge whilst providing a platform for a full
and open expression of their
views. Post-test participants were able to express their views
more easily which is indicative
of attitude change.
PAGE 82jTIZARD LEARNING DISABILITY REVIEWj VOL.
17 NO. 2 2012
Summary
The above literature highlights the victimisation and
discrimination people with learning
disabilities face in respect of their basic human rights. It
suggests a need for a human rights
approach and for it to be proactively embedded within services.
Furthermore, it promotes
staff training as a means to accomplish this. However, training
is not without its own potential
difficulties in respect of psychological reactance and attitudes,
issues which can be
addressed and tackled.
The following study took place as part of one of five pilot sites
within the ‘‘Human Rights in
Healthcare’’ project, a Department of Health initiative aiming

to increase explicit use of
human rights in health care settings.
Method
This research study examined the impact of human rights
awareness training (HRAT) on
healthcare staff’s knowledge of human rights and attitudes
towards human rights, within a
learning disability service. The relationship between attitude
and knowledge was also
explored.
Ethics
This training was part of a larger service delivery and
evaluation project. Advice was sought
from within the NHS trust conducting the evaluation who
advised the study constituted
service evaluation. Central Office of Research Ethics
Committee permission was not
therefore necessary.
Participants were provided with a participant information sheet,
and were asked for their
informed consent. They were informed they could withdraw at
anytime without prejudice or

penalty. Anonymity was maintained.
Measures
A quiz was developed in-house by some of the authors (BG,
GC, MR), to measure
participant knowledge of human rights and a human rights-
based approach (HRBA). The
quiz was piloted with Community Learning Disability Team
staff. Some questions needed to
be changed to reduce high scores and were adapted accordingly.
The quiz consisted of
13 multiple choice questions which required participants to
circle the correct answer.
For example:
The framework that brings human rights into UK law is:
B The Bill of Rights.
B The UK constitution.
B The Human Rights Act.
Participants were given one point for each correct answer and
the sum of those points gave
the final score. High scores indicated higher levels of human
rights and HRBA knowledge.
The attitude questionnaire was developed by one of the authors

(BG) in collaboration with
Ipsos/MORI as literature searches suggested there were no other
tools available measuring
attitudes towards human rights. This questionnaire aimed to
measure participants’ thoughts
and feelings towards human rights. 12 items were rated using a
five-point Likert-type scale
ranging from ‘‘strongly agree’’ to ‘‘strongly disagree’’. Four
items reflecting an unfavourable
attitude were reverse scored. For example: ‘‘Human rights are
not useful or relevant to my
day-to-day work’’ (strongly disagree, disagree, neither agree
nor disagree, agree, strongly
agree). An attitude score was obtained by summing up each of
the individual item scores.
A high score indicated a positive attitude.
Procedure
The measures were arranged in a randomised order with each
participant completing them
individually and anonymously. At Time 1 (T1) participants also
completed a demographic
REVIEWj PAGE 83

data sheet and consent form. They were verbally prompted to
complete all the measures in
the order in which they found them in their pack. They then
took part in the HRAT. The training
consisted of a one-day course on human rights awareness which
included what human
rights are, why they are important, their relevance to healthcare
and an explanation of a
HRBA. A Clinical Psychologist (BG) and Community Learning
Disability Nurse (GC)
delivered the one-day course on two separate occasions and
employed both experiential
and didactic teaching methods, including various participant
exercises related to human
rights. Two service users were present on the second training
day.
Immediately after training, participants completed a training
evaluation sheet and repeated
the measures (Time 2 (T2)).
Some participants failed to complete all measures. Three
participants with incomplete
measureseitherat T1or T2wereomittedfrom theanalysis, thus
reducing thesamplesizeto 23.

Results
Preliminary analysis
As the attitude questionnaire was devised ‘‘in-house’’ a
statistical test was performed to
measure whether the questionnaire items produced similar
scores (‘‘internal consistency’’).
The Cronbach’s alpha for the questionnaire was 0.84 for T1 and
0.77 at T2 suggesting the
questionnaire was adequate for measuring attitude (Pallant,
2007).
HRAT and knowledge scores
Table I shows mean scores on the human rights knowledge-
based quiz before and after
training. Analysis indicated that there was a significant increase
in knowledge scores
following training (z ¼ 23.451, p ¼ 0.001).
HRAT and attitude scores
Differences between attitude scores at T1 and T2 were analysed.
There was no significant
difference between pre- and post-training attitude scores (t ¼
20.920, df ¼ 22, p . 0.05),
suggesting that the training did not affect attitude.

Relationship between attitude and knowledge scores
Statistical analysis revealed there was no significant
relationship between attitude and
knowledge at T1 (r ¼ 20.054, n ¼ 23, p . 0.05) or T2 (r ¼
0.363, n ¼ 23, p . 0.05).
Discussion
Overall results
It was anticipated that HRAT would increase knowledge scores.
A significant difference
between the pre- and post-training knowledge scores was found.
This is consistent with the
findings of the 3Rs training where staff showed significant
development in ability to identify
human rights (Owen and Griffiths, 2009).
It was also proposed HRATwould affect attitude scores.
Although there was a small increase
in mean attitude score at T2, there was no significance
difference between staff’s pre- and
post-training attitude scores. However, participants’ pre-
training scores were high so there
Table I Mean and standard deviations for the HRBA knowledge
quiz and the attitudes to human rights questionnaire pre-

and post-training
Knowledge pre-training Knowledge post-training Attitude pre-
training Attitude post-training
Total N 23 23 23 23
Mean 7.17 9.61 49.17 50.13
Standard deviation 1.99 2.37 4.80 5.52
17 NO. 2 2012
may not have been much margin for change. Moreover, adopting
Flowers’ more ‘‘activist
approach’’ may have produced greater attitude change than the
‘‘psycho-educational
approach’’ (Kinderman and Butler, 2006) used. Although Rose
and Holmes (1991) managed
to achieve attitude change within their training, it is important
to note that they were unable to
specify the components most responsible for this result.
Kinderman and Butler (2006) have suggested that human rights
training should be
presented as congruent with trainees’ existing values to
decrease psychological reactance.
Therefore, it was felt there may be a link between participants’
knowledge and attitude

towards human rights, as there may be fewer barriers to learning
in those well-disposed
towards the subject matter. However, analysis revealed there
were no significant correlations
between knowledge and attitude. This finding may have been
due to having a small sample.
The potentially complex interface between knowledge and
attitudes to human rights is an
area for further investigation.
It is suggested that there are a number of components needed to
facilitate positive attitudes
to human rights (Kinderman and Butler, 2006). It could be
argued that the content of the
HRAT emphasises cognitive change rather than emotional
responses which may not be
enough to promote personal reflection and therefore attitudinal
change, as implied by
Flowers (2000). This supports Kinderman and Butler (2006) and
further implies that some of
the components suggested for development of positive attitudes
may not have been
addressed within our planning and implementation of the human
rights training.

Group dynamics
Various dynamics were observed on the training days which
may have impacted on the
results. For instance, the presence of two service users on one
of the training days may have
affected the dynamics of the group and subsequent attitudes
divulged on the training day
and on the attitude questionnaire. It could be argued that, with
service users present, it may
have been harder for staff to fully and openly express their
views. Rose and Holmes (1991)
identify this as a necessary factor for the facilitation of attitude
change within their
workshops. Conversely, observations made over the two days of
training indicated that the
sessions were more focused and service user orientated when
service users were present.
This may be an area for further investigation.
Existing human rights concerns for specific participants within
their working roles may also
have had an effect on attitudes and the dynamics in the group.
However, Kinderman and
Butler (2006) identify a need for training groups to be made up
of a range of individuals so a

wider range of experiences are shared and the concept of
cooperative working instilled.
As Arthur et al. (2003) suggest, for training to impact and take
effect the working
environment needs to be receptive and supportive.
Methodological limitations
Although the questionnaire is unvalidated, the results from a
preliminary analysis of internal
consistency suggested the questionnaire was adequate in
measuring attitude. However, the
questionnaire could be improved by looking specifically at the
items that may not have been
as strong as others. Moreover, the difference in alpha values at
T1 (0.84) and T2 (0.77) may
be due to response set for the reversed items on the
questionnaire. At the end of the training
session (T2) participants were eager to leave which may have
led to them misreading the
negatively worded items (see ‘‘Measures’’ for example).
Although a significant difference in
human rights knowledge scores was found post-training, many
participants scored highly
prior to human rights training suggesting the quiz may have

been too easy. If the quiz is to be
used again researchers may have to revise some of the questions
to address this or lengthen
it to incorporate more questions further assessing knowledge of
human rights.
Future training recommendations
B As identified, a greater focus on psychological theories of
attitude in the development and
implementation of the HRAT is needed.
REVIEWj PAGE 85
B Using Fishbein’s (1967) concept of attitude originating from
the self, future training would
need to address potential pre-existing negative attitudes towards
human rights and
induce and enhance positive ones.
B Utilising Flowers’ approach, which somewhat echoes
Fishbein’s concept, may produce
attitudinal change.
B Ensuring the participation or perhaps co-facilitation of
service users at all training

sessions may maintain the session focus and promote positive
attitudes, although future
research needs to investigate the impact of service user
presence.
B The emotional impact of human rights may need to be
considered and addressed in
future training.
Further recommendations for future research
B Given that the training produced little effect on human rights
attitudes, future research
may want to consider how psychological theories of attitudes
and behaviour operate in
this context to facilitate development of positive attitudes
towards human rights.
B A validation of the attitudinal measure; exploring test-retest
reliability, identifying weaker
attitude questionnaire items and adapting the questionnaire to
make it more reliable.
B Replication of this study using a larger sample and the use of
a control group will help
increase the reliability/validity of the findings.
This study’s findings suggest numerous areas for further
exploration. These include

investigating if the presence of service users on training days
facilitates attitude change.
Furthermore, exploring trends between attitude and knowledge
and pre- and post-training
and also attitude trends pre- and post-training could be
valuable. Demographic factors that
may predict attitudes to human rights could also be researched.
Conclusion
Staff training interventions are widely used as a tool in learning
disability services to share
knowledge and create changes in organisational culture. In the
current study, HRAT
produced increased human rights knowledge; it did not create an
attitudinal change to
human rights as indicated by a newly developed measure. We
believe changes in both
knowledge and attitude are important for creating cultural shift.
Further validation of the
human rights attitudinal measure will help to establish whether
the lack of change in the
current study is an artefact related to the current methodology,
or a function of the training
package. In either case, theories of attitude may need to be more
carefully applied to future

training resources. Of course, it is also important to remember
that factors other than specific
training, such as the overall ethos of the organisation, are likely
to contribute substantially to
staff culture and behaviour (Ministry of Justice, 2008).
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Corresponding author
Beth Greenhill can be contacted at: [email protected]
To purchase reprints of this article please e-mail:
[email protected]
Or visit our web site for further details:
www.emeraldinsight.com/reprints
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