Relationship between dyslexia awareness and stigma among nursing students in Saudi Arabia: A cross-sectional study

Background

Dyslexia is a learning disability that affects up to 10% of the global population (Ali et al., 2020). It is sometimes misdiagnosed as a visual-perceptual disorder, although it is a language-based reading impairment. Thus, parents and teachers may believe that dyslexia is a visual-perceptual deficit, leading to treatments and accommodations that are not supported by research, which can delay the child’s development (Peltier et al., 2020). In truth, dyslexia is a learning disorder characterized by difficulty in word-level reading skills despite appropriate effort and opportunity. Notably, dyslexia is not caused by deafness, blindness, or an intellectual disability (Grimes et al., 2020). Dyslexia has two distinct features: 1) it may differ according to age, education, and intelligence, and 2) it might impact an individual’s accomplishment of daily activities (Ramli et al., 2019). It is a chronic disorder with varying clinical manifestations, depending on the individual’s job demands and available assistance, as well as the breadth and severity of their talents and challenges (Handler, 2016). Nevertheless, difficulties with reading in childhood may persist through adolescence and into adulthood (Lopez-Escribano et al., 2018). Although the literature on dyslexia is abundant, this disability is rarely recognized at the individual, familial, or societal levels (Livingston et al., 2018).

Increasing awareness of dyslexia in the student population may allow for a better overall diagnosis of dyslexia. When students were asked to define dyslexia, their knowledge about it was ascertained to be minimal (Ewain et al., 2017). This lack of dyslexia awareness can have detrimental consequences for people with dyslexia, including misunderstandings and mental stress; along these lines, it can also negatively impact their learning processes and, consequently, their practice (Ewain et al., 2017). Although approximately 31.4% of primary school students in Saudi Arabia have dyslexia (Subramaniyan et al., 2020), no studies have yet assessed the levels of dyslexia awareness among Saudi nursing students.

Furthermore, limited research has explored the incidence of dyslexia in nursing students and registered nurses in the United States and Britain. For instance, a recent study investigated the effects of dyslexia on the clinical practice of 12 nursing students and examined their coping mechanisms. It revealed that nursing students with dyslexia had specific learning difficulties, which might have been affecting the quality and safety of their practice (Crouch, 2019). Nursing students with dyslexia reported several challenges during their practice involving documentation, difficulty in reading, slowness, and difficulty in medication administration (Crouch, 2019). Another study that explored the experiences of 14 registered nurses with dyslexia in Great Britain noted that they reported being easily distracted and tired, taking longer to complete their tasks, and facing difficulties in documentation and drug administration (Major & Tetley, 2019). Therefore, it is essential to promote disclosures of learning disabilities among students and nurses to achieve patient safety (Major & Tetley, 2019). In addition, the results of a study conducted on nursing students showed that participants had useful strategies to cope with the impact of dyslexia on clinical practice, such as memory joggers, organizing and documentation strategies, and poster guidelines (Grimes et al., 2020). Thus, dyslexia awareness might support the early detection of the disability, which may be beneficial in the therapeutic process.

Stigma is the impression of being stereotyped and negatively discriminated against by the public (Stoeber & Rountree, 2021). Developing methods to reduce negative public beliefs about dyslexia and replacing them with scientifically supported knowledge is crucial to counter discrimination (Peltier et al., 2020). Many students do not disclose their learning disabilities to their peers and teachers owing to a lack of awareness about their disability and fear of being treated differently (Grimes et al., 2020). Individuals with learning disabilities have reported embarrassment, isolation, and insecurity, and it has been reported that the memories of such events can have long-term consequences in adulthood (Livingston et al., 2018). Adolescents with dyslexia are twice as likely to experience emotional distress, including a higher risk of aggression and suicidal thoughts (Livingston et al., 2018). A study on 14 practicing nurses with dyslexia reported that they had been stigmatized and received negative comments from their colleagues and staff (Trunk et al., 2020). Moreover, a study on 123 medical students showed that half the students had witnessed negative comments, either in public or in private, about people with dyslexia (Hennessy et al., 2020). Along these lines, previous studies have conclusively indicated that individuals with dyslexia are stigmatized (Trunk et al., 2020) (Mather et al., 2020; Trunk et al., 2020). Stigmatization and lack of dyslexia awareness can lead to a lack of support (Major & Tetley, 2019) and negative psychological effects (Hennessy et al., 2020). However, most of these studies were qualitative and exploratory in nature (L’Ecuyer, 2019); thus, triangulating qualitative and quantitative studies is essential to support and improve the body of knowledge regarding dyslexia and stigma among nursing students. The current study addressed the need to explore dyslexia awareness among nursing students and its relationship with stigma in Saudi Arabia. The study was based on the hypothesis that increased dyslexia awareness is correlated with anticipating the stigmatization of dyslexic individuals, which fosters the desire to combat stigma.

Specifically, the study aimed to establish the relationship between increasing dyslexia awareness and decreasing the stigma associated with dyslexia through empirical evidence. Focusing on creating dyslexia awareness may improve the rate of early detection, thus aiding individuals with dyslexia who may face challenges in their nursing practice. Meanwhile, if stigma does decrease with increasing awareness, the number of nursing students or nurses disclosing their illnesses will increase. This would, in turn, allow the students to improve their practice by adopting coping techniques to deal with challenges, ultimately benefiting patients by enhancing the level of care they receive.

The research questions were as follows: 1) What is the level of dyslexia awareness among nursing students at King Abdulaziz University (KAU)? 2) What is the relationship between dyslexia awareness and stigma?

Methods

Results

Discussion

This study explored the level of dyslexia awareness among nursing students at KAU and its relation to awareness of the stigma individuals with dyslexia face. The former awareness level was analyzed using the KBDDS. Since the respondents demonstrated an average of 50% correct responses on KBDDS, a moderate level of awareness of dyslexia was assumed. This result is congruent with a study conducted in Malaysia, which showed that 64.4% of the study participants were not fully aware of dyslexia (Subramaniyan et al., 2020). When the KBDDS was applied to teachers, a medium level of dyslexia awareness was observed (Echegaray-Bengoa et al., 2017; Soriano-Ferrer et al., 2016). Such evidence demonstrates a lack of dyslexia awareness at both the student and teacher levels. Most participants in this study noted that they had never been diagnosed with dyslexia and did not know any family members, friends, colleagues, community staff, or anyone among the general population who had dyslexia. However, an earlier study found that many people with dyslexia, particularly students, are ashamed to admit their diagnosis publicly (Grimes et al., 2020). Therefore, among the 97.4% of participants who cited no prior diagnosis of dyslexia, some may have been diagnosed with dyslexia but have chosen to state the opposite in fear of public criticism (Wagner et al., 2020). Further, some might not be aware that the difficulties they face could be diagnosed as dyslexia.

It is important to highlight the main misconceptions that students have about dyslexia. Most students believed that dyslexia entailed the perception of letters and words as reversed, which is incorrect. However, such a misunderstanding of the issue is common and has been demonstrated by the participants in other studies (Washburn et al., 2017; Wery & Diliberto, 2017). Another misconception among the participants was regarding heredity and dyslexia. More than 40% of the students did not know if dyslexia was hereditary, while 26% gave the wrong answer. Notably, other studies have demonstrated that such misconceptions are highly prevalent, such as one involving preschool teachers, where 54% of the responses were incorrect (Ramli et al., 2019). The majority of the students in our study incorrectly believed that teachers received intensive training in working with individuals with dyslexia; a similar result was also reported in a study conducted in India (Hemadharshini et al., 2020). It is possible that in both studies, the respondents did not understand the situation because they were not involved in it.

Additionally, the majority of the respondents chose the “do not know” option on several occasions. For instance, 55.8% chose “do not know” as a response to the question about the occurrence of the disorder among men and women. Moreover, 51.3% of students did not know about the efficacy of colored lenses as therapy, and 53.2% of the respondents did not know whether there were medications to treat dyslexia. All three findings are consistent with a study conducted on teachers in China (Yin et al., 2020). Since the respondents universally struggled to answer the last two questions concerning dyslexia treatments, it can be assumed that there is a common lack of knowledge about dyslexia treatments. Several respondents also did not answer questions about the problems of establishing laterality as being caused by dyslexia and the efficacy of multisensory instruction as a treatment measure (Echegaray-Bengoa et al., 2017; Soriano-Ferrer et al., 2016). Soriano-Ferrer et al. (2016), who studied dyslexia awareness among Spanish-speaking teachers, reported similar findings. Additionally, the majority of the respondents in this study did not know if dyslexia could be chronic and identified using intelligence tests and if children with dyslexia were impaired in phonemic awareness. However, in other studies, participants were highly likely to choose “yes” and “no” rather than “do not know” as a response to these questions (Echegaray-Bengoa et al., 2017; Soriano-Ferrer et al., 2016).

The second part of the study involved conducting the SCQ-LD analysis to identify awareness about the stigma individuals with dyslexia face. Most respondents believed that people with dyslexia were subject to negative assumptions by others. Almost 70% believed that people behaved negatively and judgmentally toward individuals with dyslexia. No previous studies have examined dyslexia awareness and its association with awareness of stigma among non-dyslexic nurses; however, one study reported that dyslexic participants had experienced moderate stigma because of their disability (Trunk et al., 2020). Finally, the results revealed a significant relationship between the knowledge levels on the dyslexia and stigma awareness scales. The findings of the study contribute to understanding the perception of dyslexia among nursing students and show that anticipated stigma depends on the level of knowledge of the disorder. This result is consistent with those of several studies (Grimes et al., 2020; Hennessy et al., 2020; Major & Tetley, 2019). Grimes et al. (2020) explored the experiences of disability and the influence of stigma on learning; its results revealed that 28% of participants with dyslexia experienced negative feelings from their peers and being labeled as dumb or slow by their friends and family, which impacted their school performance and self-esteem. These findings highlight that education about dyslexia is needed to reduce negative attitudes and stigma.

Conclusion

This study aimed to assess the level of dyslexia awareness and its relation to the level of knowledge about the stigma associated with dyslexia among nursing students in Saudi Arabia. The findings of this study revealed that dyslexia awareness is at a medium level. Moreover, the results contribute to understanding the perception of dyslexia among nursing students and show that the anticipated stigma depends on the level of knowledge of the disorder. When dyslexia awareness is high, nursing students are more attentive to the stigma surrounding those with dyslexia. Thus, these results highlight the importance of raising dyslexia awareness among nursing students to fight associated stigma and foster an open culture for nurses with dyslexia to help them learn appropriate coping strategies for safer practice. Awareness of dyslexia and its consequences should be promoted in different contexts, such as schools, universities, and social media; notably, this can help individuals with dyslexia adopt strategies to manage their dyslexia and improve society’s understanding and acceptance of individuals with dyslexia without judgment. Consequently, individuals with dyslexia may experience less stigma throughout their careers.