Greek Employers’ Attitudes to Employing People with Disabilities: Effects of the Type of Disability

A BSTRACT The aim of this cross-sectional study was to answer two central research questions: (i) what are Greek employers’ attitudes to employing people with a range of disabilities; and (ii) do employers’ attitudes differ according to the type of disability? The study sample comprised 102 local employers with small-sized retail trade and ser v ice businesses located in semi-urban areas of Les v os and Chios, Greek islands in the North Aegean Sea. The results show that employers’ attitudes differed depending on the type of disability; most respondents belie v ed that it would be easier for people with diabetes, thalassaemia or renal insufficiency to gain employment than those with schizophrenia, blindness, learning disability or depression. A cross-sectional research design was used to explore this study investigated the potential role on the of employers’ employing practices regarding workers with disabilities. Their reactions were explored in relation to nine different types of disability; learning disability (mild to moderate), mobility impairment, blindness, deafness, renal insufficiency, thalassaemia, diabetes, depression and hospitalization for schizophrenia. Thalassaemia is an inherited disease of the red blood cells, classified as a haemoglobinopathy.

The revision of the constitution of the Greek Democracy that was completed in 2001 explicitly safeguards at the utmost institutional level the principles of the social state and social protection. Article 25/2 of the Greek constitution declares that ''the rights of man as an individual and as a member of the social group and the principle of the social state of Right'' are guaranteed by the social state. Therefore, any type of discrimination is a violation of constitutional rights, while special emphasis is placed on people with disabilities, as reflected in Article 21/6, which stresses that ''people with disabilities have the right to take advantage of measures that secure their autonomy, their vocational integration and their participation in the social, economic and political life of the country''. The National Action Plans For Employment as well as the National Plans For Social Integration are harmonized with the normative regulations of the European Commission, aiming at promoting equal integration of people with disabilities into Correspondence: Anastasia Zissi, 25 Mitropoleos Str., Department of Sociology, University of the Aegean, 81 100 Mytilene, Lesvos, Greece. Email: A.Zissi@soc.aegean.gr vocational and social life, and thus enhancing social participation and coherence.
Despite these institutional regulations and policies, the state of employment of people with disabilities in Greece is particularly discouraging, reflecting their poor integration into the labour market. According to the National Statistics Service of Greece (2003), 18.2% of the country's population has some type of ill-health or disability, and most of these people (84%) are economically inactive. These estimates do not diverge significantly from the corresponding ones in the EU or the USA (Mayhew 2003). A large body of research shows that people with disabilities face unemployment and under-employment or, at best, occupy professional positions that are under-paid or of low status with few opportunities for career development (Anthony & Blanch 1987). Workers with disabilities are facing double exclusion since they are the last to get jobs when the economy is booming and the first to be laid off during recessions (Kruse & Schur 2003). Interestingly, the reasons for this have little to do with disability per se, but are related to the lack of rehabilitative and training programs, limited facilities for people with disabilities, and especially, the reserved attitudes of employers to workers with disabilities (Wilgosh & Skaret 1987, Greenwood & Johnson 1987, Hernandez 2000. Indeed, employers' attitudes to employees with disabilities, worldwide, are among the strongest social obstacles to their full social and vocational participation (Pope & Tarlov 1991). In a relatively recent review of studies regarding employers' attitudes to workers with disabilities from 1987 to mid-1999mid- , Hernandez (2000 reported that, even though employers have expressed positive attitudes to workers with disabilities in principle, these attitudes were less positive when their actual employment practices regarding workers with disabilities were assessed. She notes that employers' verbally-expressed willingness to employ applicants with disabilities exceeds their actual employment practices. Other researchers point out that, although the majority of employers may agree with employing people with disabilities, this agreement may not translate to a willingness to employ these individuals in their own company (Gibson & Groeneweg 1986, Unger 2002. Lamentably, Greek research in this area is very limited. Only recently within the framework of European programs, such as Equal, has there been a growing research interest in examining employers' attitudes to employees with disabilities. For example, a Greek Equal program, called Proteas, conducts a research project investigating the state of employment of people with mobility impairment in Greece and found that only 42 companies, of a sample of 800, had employed such workers. The present study was designed to answer two central research questions: (i) what are the Greek employers' attitudes to employing workers with a range of disabilities; and (ii) do attitudes vary according to the type of disability? Disability is used as an umbrella term for impairments or activity limitations, acknowledging however, that a person's disability is a dynamic interaction between conditions of health and contextual factors.
Greek Attitudes to Employing People with Disabilities 15

Research Design
A cross-sectional research design was used to explore local employers' attitudes to employing people with disabilities. Given the evidence that the type and severity of disability may have an impact on the extent to which people with disabilities are included in the workforce (Hernandez 2000, Unger 2002, this study investigated the potential role of the type of disability on the formation of employers' employing practices regarding workers with disabilities. Their reactions were explored in relation to nine different types of disability; learning disability (mild to moderate), mobility impairment, blindness, deafness, renal insufficiency, thalassaemia, diabetes, depression and hospitalization for schizophrenia. Thalassaemia is an inherited disease of the red blood cells, classified as a haemoglobinopathy.

Sample
The study sample comprised 102 local employers with small-sized retail trade and service businesses located in semi-urban areas of Lesvos and Chios, Greek islands in the North Aegean Sea. These areas were chosen for logistic reasons; the present research is part of an EU-funded specific region program (North Aegean) called Equal, which aims to promote equal opportunities for disadvantaged social groups for vocational integration. Of the sample, 60 were males and 42 were females, with a mean age of 35 years. A large proportion of the sample (44%) were college graduates, while 39% were secondary school graduates. The experience of the respondents with the issue of disability was explored because there is evidence that employers who had previous experiences with disabilities reported more favourable attitudes to employing people with disabilities (Gibson & Groeneweg 1986). However, when they were asked if they had ''ever employed a person with disability before'', only eight of the sample responded affirmatively. The level of awareness and knowledge of laws and policies concerning the employment of people with disabilities among the employers in this study was found to be poor. Only 14 of the sample were informed about these issues, while the vast majority reported a lack of adequate information concerning the federal provisions to employers in order to prohibit discrimination against people with disabilities.

Measures
Given that very little research has been conducted in Greece on employers' perceptions of employing people with disabilities, the present research group developed a pilot instrument with 28 closed-and open-ended questions, which were divided into three sections. The first section comprised questions that dealt with employer and business characteristics, such as type of business, number of employees, years of activation, employing policies, previous experience of employing a person with a disability, awareness of laws and policies concerning the employment of workers with disabilities.
In the second section, employers were presented with nine types of disability and, then were asked whether they thought ''a person with a specific type of disability would be able to attain employment'' and to express their willingness to employ workers with such disabilities in their own business. The emphasis was placed on examining employers' reactions to different types of disability, due to the evidence that the public does not hold a single general model of disability but differentiates its responses according to the type of disability (Gilbride et al. 2000). The employers' responses were scored on a four-point Likert type scale, ranging from 10/''definitely yes'' to 4 0/''definitely no''. This type of scale was used to eliminate employers' ability to choose the middle point.
Finally, the third section included open-ended questions that encouraged respondents to express, in their own words, their concerns regarding the potential difficulties of employing workers with disabilities in their own business. This instrument was designed more as a guide for conducting faceto-face interviews with the employers themselves, as an in-person interview is considered the most effective method to achieve a high participation rate (Unger 2002).

Capacity for Productivity and Gainful Employment
The great majority of respondents (93%) believed that people with diabetes would be able to participate productively in the workforce, as well as those with thalassaemia (89%), renal insufficiency (84%), mobility impairment (83%) and deafness (71%). Moreover, for the first three disabilities, the median is equal to one (1) and for the other two the median is equal to two (2). By contrast, a considerable proportion of the respondents expressed negative attitudes in relation to people with a hospitalization record for schizophrenia (52%), depression (42%), blindness (39%), and learning disability (mild to moderate) (34%). For these disabilities the median is equal to two (2), with the exception of the median for the people with a hospitalization record for schizophrenia, which is equal to three (3). These descriptive findings show a variation in employers' reactions depending on the type of disability; more favourable perceptions were expressed in relation to people with physical disabilities than to people with mental disabilities and blindness.

Job Opportunities
Employers were asked to assess in general to what extent employees with disabilities have opportunities to participate productively in the workforce of the country. Approximately half of the sample believed that people with diabetes (56%), thalassaemia (50%) and renal insufficiency (45%) have enough opportunities to attain employment in regular job positions.
Greek Attitudes to Employing People with Disabilities 17 Moreover, for the first two disabilities the median is equal to one (1) and for the other the median is equal to two (2). On the other hand, employers were found to express more pessimistic views regarding the other types of disability.
The majority assessed that people with the following mental disabilities have either few or no chances at all to find a regular job: learning disability (90%), record of hospitalization for schizophrenia (89%) and depression (84%). Similar reactions were obtained in relation to sensory (90%) and mobility impairment (82%). For these disabilities the median is equal to three (3). This vocational exclusion generated feelings of sympathy among the respondents. They stated that more opportunities should be given regardless of the type of disability in order to fully integrate people in the labour market.

Attitudes to Employing People with Disabilities
Respondents were asked to express their willingness to employ workers with disabilities in their own business. The results show that employers were more likely to endorse the employment of people with diabetes (82%) (median0/1), thalassaemia (81%) (median0/1) and renal insufficiency (73%) (median0/2) than people with blindness (18%) (median0/4), a hospitalization record for schizophrenia (27.5%) (median0/4), learning disability (30%) (median0/ 3), and depression (34%) (median0/3). Willingness to offer job positions to people with mobility impairment and deafness was assessed at a moderate level, 48% (median0/2.5) and 38% (median0/3), respectively. These results are also supported by employers' qualitative responses to the openended question ''which type of disability they consider as most appropriate for their own business''. Diabetes, thalassaemia and renal insufficiency were the three most frequent types of disabilities mentioned by the employers, while blindness, learning disability and schizophrenia were the three least frequent.
Employers were also asked to assess the reactions of co-workers to hypothetical scenarios of working with disabled people. With the exception of schizophrenia (46%) and depression (36%), respondents expressed less conservative opinions about co-workers' reactions to people with disabilities. They generally felt that co-workers would be sympathetic and supportive to those workers.

Effects of the Type of Disability
In order to explore the effects of the type of disability on employers' attitudes to employing individuals, a Wilcoxon signed-rank test was conducted with five variables, two of which were composite; mental disability (including learning disability, depression and schizophrenia), physical disability (including renal insufficiency, thalassaemia and diabetes), mobility impairment, blindness and deafness. The results are presented in Tables 1 and 2.
In no instance was the mental disability lower score than physical disability, in 67 instances the score of mental disability is greater than physical disability, and in 32 instances both groups have the same score. The distribution of mental disability differs significantly from the physical one (z0/(/7.228, pB/0.001). Similarly, the distribution of mental disability differs significantly from mobility impairment (z0/ (/3.444, p B/0.001) and deafness (z0/(/;5.638, p B/0.001). By contrast, the analysis showed no significant differences in relation to blindness (z0/1.239, ns). Greek These results indicate that people with mental disabilities or blindness are viewed more negatively by employers than people with the other types of disability. In addition, a x 2 test was used to test the independence. The five variables (mental disability, physical disability, mobility impairment, blindness and deafness) were recoded into two categories of variables (10/yes, 0 0/no, respectively) in order to avoid cells with less than five expected cases. The results are presented in Tables 3 and 4. There are statistically significant differences in relation to employers' attitudes to employing people with mental disabilities compared with people with physical disabilities (x 2 0/10.223, p B/0.01), mobility impairment (x 2 0/6.918, p B/0.01), deafness (x 2 0/30.950, p B/0.001) and blindness (x 2 0/17.973, p B/0.001). With the exception of blindness, these results support those obtained by the Wilcoxon signed-rank test.  Furthermore, Kendall's W concordance coefficient was used in order to test the agreement among employers' perceptions concerning the capacity of people with disabilities to participate productively in the workforce, the availability of job opportunities for those employees and their willingness to offer them employment in their own business. The results are presented in Table 5.
The results show that the highest degree of agreement was obtained in relation to blindness (w0/0.642), followed by deafness (w 0/0.541), learning disability (w0/0.535) and schizophrenia (w0/0.498). Mobility impairment and depression presented almost the same degree of agreement: (w0/0.425) and (w0/0.424), respectively. Renal insufficiency (w0/0.259), thalassaemia (w0/0.219) and diabetes (w0/0.196) obtained rather low degrees of agreement. These results indicate that different types of disability occasion different responses and that lay reactions are strongly influenced by the specific characteristics of different disabilities.

Qualitative Data
As mentioned above, open-ended questions were included in order to encourage the respondents to express in their own terms, thoughts in relation to the participation of people with disabilities in the workforce. A large number of respondents (n 0/63) were found to express doubts about the capacity of workers with disabilities for gainful employment in their own business. More specifically, employers were concerned about absenteeism and the ability of these employees to interact appropriately with co-workers and customers. Similar concerns have been reported by employers in a group of studies indicating negative attitudes (Schloss & Soda 1989, Tobias 1990). Moreover, when they were asked what types of guarantees they might need in order to endorse employment practices for workers with disabilities, almost one-third of respondents said that as they have no interest in employing such workers, no guarantees are needed. Of those who responded affirmatively, they asked for productivity, honesty and financial funding. The results of this study indicate that employers were positive about issues of principle, such as equality of employment opportunities for workers with disabilities, but were more conservative about specific issues with direct implications, such as employing them in their own business.

Discussion
This study showed that employers' attitudes differed depending on the type of disability; most respondents believed that it would be easier for people with diabetes, thalassaemia and renal insufficiency to obtain employment than for people with a record of hospitalization for schizophrenia, blindness, learning disability or depression. In relation to mobility impairment and deafness, their reactions were assessed at a moderate level. Given the special characteristics of the participating sample (local employers with small-sized business with no previous experience with people with disabilities), the results should be considered illustrative of possible trends among local employers rather than as generalizable to the larger population of employers. However, the fact that small-sized self-employed businesses as the typical pattern of enterprise in Greece, allows us a degree of generalization. A series of investigations of the effects of the type of disability on employers' attitudes have produced similar results; employers express greater concerns about employing people with mental disabilities than employing those with physical disabilities (Fuqua, Rathburn & Gade 1984, McFarlin, Song & Sonntag 1991, Jones et al. 1991, Callahan 1994, Scheid 1999. In a more recent study, Gilbride et al. (2000), by demonstrating the Employer Hiring Practices and Perceptions Survey to 200 employers, found that it would be easier to employ people with a cancer diagnosis, heart impairment or living with HIV than it would be to employ people with a moderate or severe learning disability or blindness.
Despite the utility of this evidence, our knowledge about the sources of these views is limited. More research is needed to address the factors that determine the structure of the employers' attitudes to workers with disabilities. Lay misconceptions about the nature of mental illness may have an impact on employers' reactions. More specifically, in contrast to many types of physical disability, mental disorder is widely associated with stigma and negative stereotypes in which people with mental disorders are viewed as unpredictable, violent and dangerous (Appleby & Wessely 1988, Zissi 2000. The most common consequences of stigma for people with mental disorders, especially with schizophrenia, are rejection by the public and exclusion from equal housing and employment opportunities. A series of attitude surveys found people with psychiatric disabilities to be perceived as less acceptable by the public compared with other disability groups (Tringo 1970, Allbrecht, Walker & Levy 1982. With regard to employment, there is ample evidence that workers with mental disorders are the first to be fired and the last to be employed, mainly due to employers' discriminatory behaviour (Scheid 1999, Baron & Salzer 2002. Employers of workers with psychiatric disabilities have been found to report concerns included symptomatology, behavioural manifestations, and effects of medication (Diksa & Rogers 1996). In contrast to lay misconceptions, empirical findings consistently show that, within a supportive work environment, even people with a serious and persistent mental disorder are able to attain competitive employment (Lehman 1995, Bond et al. 1997). In addition, supported employment is reported as most promising and effective at helping people with severe mental illness to obtain competitive employment (Crowther et al. 2001).
Regarding learning disability, the employers in our study were found to be conservative; a relatively small proportion believed that people with mild to moderate learning disability are capable of gainful employment, and therefore no willingness to employ them was expressed. According to Hernandez (2000), studies addressing learning disabilities in particular revealed mixed to negative results. For example, in a number of studies, employers have been found to believe that workers with learning disability may require a greater amount of training, supervision and effort to be integrated into the workforce , Schloss & Soda 1989. However, reports of actual experiences of employing workers with learning disabilities indicate reliable attendance, low turn-over and an improved public image for organizations (Shafer et al. 1988, Nietupski et al. 1996, Olson et al. 2000. This evidence may assist in dispelling lay myths and misconceptions about employing people with learning disabilities. In relation to blindness, a majority of employers in this study were not willing to offer employment. Similarly, Gilbride et al. (2000) found employers to hold relatively unsupportive views towards blind people. According to the Royal National Institute for the Blind in the UK, despite the fact that blind and partially sighted people can obtain and retain paid employment, three out of four of working age are not in employment, mainly due to employers' discriminatory behaviour. More specifically, nine out of ten employers say that it would be difficult or impossible to employ someone with sight problems (Work Matters Campaign, RNIB 2000).
From a methodological point of view, the open-ended question section gave the respondents the opportunity to comment on the country's economic crisis, which they felt has an impact on employment practices in general. However, a gap between respondents' general attitudes in principle regarding the provision of equal opportunities to disabled individuals and their specific attitudes to employment practices is apparent. This gap between verbally expressed willingness to employ workers with disabilities and actual employment practices is evident in a number of studies (Cooper 1991, Scheid 1999. Employers' lack of previous experience with workers with disabilities may be a factor related to the relatively unsupportive expressed attitudes especially toward those with mental and sensory disabilities. A series of investigations have shown that employers who had previous experiences with workers with disabilities, reported more favourable attitudes to them (Unger 2002).
Furthermore, employers in this study were poorly informed about the measures and official policies that are implemented within the context of providing equal employment opportunities to people with disabilities. Given the evidence that a range of factors, such as type of disability, previous experience with workers with disabilities, size of business, and type of business, may influence the employers' responses, further research is needed to identify which specific factors facilitate or most inhibit the employment of people with disabilities. Attention also needs to be directed to the refinement of research methods capable of tapping the full complexity and multidimensionality of employers' attitudes in this area. Experimental or quasi-experimental studies that do not solely rely on questionnair techniques, but directly observe employers' actual employment practices would be of great importance for the design of effective strategies aiming at dispelling lay myths and preconceptions.
People with disabilities want to work, and moreover are capable of gainful employment. However, employers' reserved attitudes continue to be an obstacle to the full inclusion of those workers in the labour force. Supported employment is a relatively new and promising approach, with a positive impact on employment opportunities for people with disabilities. Social campaigns that designate this knowledge to employers would contribute to the vocational integration of people with disabilities.