Healthcare Professional’s Attitudes Towards Caring for Children with Disabilities: A Mixed-Method Systematic Review

Healthcare Professional’s Attitudes Towards Caring for Children with Disabilities: A Mixed-Method Systematic Review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Healthcare Professional’s Attitudes Towards Caring for Children with Disabilities: A Mixed-Method Systematic Review Entehaj Alhabshi, Dawn Ritchie, Pippa Hemingway This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7397117/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 3 You are reading this latest preprint version Abstract Background : The attitudes of pediatric healthcare professionals towards children with disabilities play a critical role in shaping the quality of care and support these children receive. Positive attitudes can foster inclusive healthcare environments, while negative perceptions may affect the quality of care. Investigating these attitudes is essential to identifying gaps, improving training programs, and promoting holistic quality care for children with disabilities. Objective : The objective of this review is to systematically summarize, appraise and synthesize available quantitative, qualitative, and mixed methods research to identify pediatric healthcare professionals’ attitudes towards children with disabilities in healthcare settings. Inclusion criteria : Pediatric healthcare professionals who provide direct care for children with disabilities with varying levels of experience, from diverse clinical and educational backgrounds. Methods : A mixed method systematic review was conducted to identify the healthcare professionals’ attitudes towards children with disabilities in healthcare settings based on Joanna Briggs Institute methodology for mixed-method systematic reviews (JBI) and utilizing Covidence software for systematic review. Six electronic databases (CINAHL (Ebsco), Medline (Ovid), PsycINFO (Ovid), Web of Science, Applied Social Sciences Index and Abstracts (ASSIA) (ProQuest), and Allied and Complementary Medicine (AMED) (Ovid) will be searched, using keywords, truncation and MeSH terms from each database with Boolean operators. The search will be limited to English language. Quantitative, qualitative, and mixed-methods studies reporting on pediatric healthcare professionals’ attitudes towards children with disabilities will be eligible for inclusion. Covidence software will be used for screening, selecting, and extracting data from the selected studies. The selected studies will be appraised based on their methodological quality. The review will utilize a data-based convergent integrated design. The quantitative data will be transformed into qualitative data and analyzed using thematic synthesis. Registration: PROSPERO: CRD42024537564 . Attitude child disability healthcare professional Background Disability is defined as: ‘an umbrella term covering impairments, activity limitations and participation restriction’ (1). According to the estimates of the World Health Organization (2011), over one billion people worldwide live with some type of disability, accounting for approximately 16% of the total global population. Globally, people with disabilities include up to 190 million (4.8% of the total) people who are under the age of 15 years, with between two and four percent of these children facing significant difficulties in functioning (2). According to the WHO (2011), almost 10% of children (i.e. 200 million) have a type of disability (3). Kuwait’s Public Authority for Disabled Affairs (PADA) (3), state that there are more than 66,000 people affected by different types of disabilities, with the highest prevalence for intellectual (26%), motor (22.4%), and physical disabilities (17.4%), respectively. Although there are no updated statistics about the estimated numbers of children with disabilities in Kuwait, the Ministry of Education has 25 special schools, accommodating 1,427 students with disabilities, including both Kuwaiti and non-Kuwaiti citizens (4). Attitude Definition and Theories Historically, scholars have described the definition of attitude as a hypothetical concept that has evolved and shaped within the contexts of various professional fields. As early as the 1930s it was commonly defined by Allport as a cognitive and neurological condition shaped by past experiences, which exerts a significant impact on how an individual responds to various things and situations (5). The definition of attitude as a personal experience-shaped cognitive or neural state that guides or influences an individual’s reactions to all associated objects and situations continued to be clinically prevalent in later decades (6). More nuanced perspectives have emerged, and Burns (2007) referred to attitudes as hypothetical constructs that represent individual perceptions of positive, negative, or neutral phenomena, composed of cognitive, behavioural, and affective responses, which can be altered through experience and persuasion (7). Despite the differences between these definitions, they all emphasise the notion that reporting an attitude involves the expression of an evaluation and judgement about an object, person, or issue. Different theories, models, and approaches appear to aim to understand attitude, and more specifically, how to predict someone’s behaviour, and how to measure attitude. For example, Eagly and Chaiken’s (1993) studies of the affective, behavioral, and cognitive attitudinal component (CAB) (8), the Theory of Reasoned Action (TRA) (9,10), and the theory of planned behaviour (TPB) that was introduced by Ajzen’s (1991) framework for understanding attitude (11). The TPB is the most suitable theory for describing the intention to perform a particular behaviour (12,13). The theory explains how the intention to perform a behaviour is the key predictor of actual behaviour, based on three factors: (1) attitude towards the behaviour, (2) subjective norms related to the behaviour, and (3) perceived behavioural control (12,13). Paediatric Healthcare Professionals’ Attitudes Evidence demonstrates that healthcare professionals’ (HCPs), problematic or (negative) attitudes towards children with disabilities have persisted for decades (14–18) and have continued to be a primary concern (19–22). However, the preliminary search for studies on children with disabilities revealed a scarcity in literature, and a preponderance of quantitative studies (19,21,22) compared to a dearth of qualitative (20) or mixed-method studies. Moreover, the initial search revealed a scarcity of research evidence from Middle Eastern countries. An experimental study on nursing students was conducted by Cervasio and Fatata-Hall (2013) in the United States to investigate the attitudes of senior nursing students towards children with disabilities by introducing disability education material (19). Eighty-eight nursing students were randomly distributed between the control and experimental groups. The Attitude Towards Disabled People (ATDP) (23) scale was administered three times: pre-disability education, immediately after disability education, and after one month of disability education. The disability module lasted four hours and covered children with disabilities resources and teaching, including lectures, discussions, films, several websites and case studies. Data was collected on nursing care, medical equipment, medications, school services, legal implications, and community resources. The major findings were that the experimental group, which received the educational intervention, had a pre-test mean score of 111.77 on the ATDP scale. This score increased to 144.93 immediately post-intervention and slightly decreased to 128.59 at the one-month follow-up; however, it remained higher than the pre-test score. In contrast, the control group, which did not receive the intervention, had a pre-test mean score of 113.80, which decreased to 109.07 post-test and was 111.50 at follow-up, indicating no significant improvement over time . The study shows that following education, attitudes towards nursing are significantly more positive, which puts pressure on nursing faculties to deliver more curriculum content on assessment of children with disabilities. The study also provided evidence that attitudes can change among nursing students with new knowledge, information, and education (19). Furthermore, a qualitative study on nurse attitudes regarding people with disabilities in the US conducted by Lourdes Charles and Marsala-Cervasio (2020) and a qualitative study by Erawati and Keliat (2018) in Indonesia discovered that ‘communication’ was the prominent qualitative theme (20,24). Lourdes Charles and Marsala-Cervasio (2020) examined nursing staff of people (adult)with disabilities, whereas Erawati and Keliat (2018) examined nursing students' views towards children with disabilities. Communication is a major difficulty for nursing staff and students, and it may alter nursing attitudes towards people with disabilities and children with disabilities (20,24). A preliminary search for systematic reviews examining paediatric HCPs' attitudes toward children with disabilities ended with no results. The only relevant systematic review identified was conducted by Cervasio in 2010, which focused on the attitudes of nursing students and registered nurses toward children with disabilities (25). These scoping searches review was limited to studies on nursing as a discipline and studies that fall between 2000 and 2010. This review highlighted a scarcity of research in this area, identifying only two studies published between 2000 and 2010, both conducted in Greece by the same primary author(21,22). Both focused on attitude on nursing studies and professionals towards children with disabilities. Therefore, there is an enduring call for a systematic review which aims to explore paediatric HCPs’ attitudes towards children with disabilities by combining empirical evidence from quantitative, qualitative, and mixed-method studies. In addition, to identify the various research designs, theories, and scales used in assessing the attitudes of paediatric HCPs towards children with disabilities to identify research gaps and determine areas for future research and recommendations Review question(s) The formulated review question formulated was based on the ‘sample, phenomenon of interest, design, evaluation, research’ (SPIDER) framework for formulating research questions (26). The SPIDER framework was utilized in formulating the research question, identifying the search keywords, and selecting the inclusion and exclusion criteria. Table 1 below provides the SPIDER component and specific criteria followed by the review question. Table 1 Applying SPIDER to the review question SPIDER heading Specific Criteria S- Sample HCPs providing paediatric care PI- Phenomena of Interest Attitude(s) towards children with disabilities D- Design Various types of qualitative, quantitative and mixed methods of research designs. E- Evaluation Attitude (all reported outcomes and themes) R- Research type Qualitative, quantitative and mixed methods Review question : What are paediatric HCPs attitudes towards caring for Children with disabilities in a healthcare setting?’ Inclusion criteria Population The review will consider studies: (1) that include pediatric HCPs who provide care for pediatric patients. (2) studies reporting a variety of disabilities. (3) studies that include a single diagnosis. Phenomena of Interest The review will consider: (4) all studies that discuss attitude outcomes and/or attitude themes. Context The review will consider: (5) studies conducted in hospital units, outpatient clinical settings, or community healthcare settings amongst others that provide direct pediatric care. Types of studies The review will consider: (6) quantitative, qualitative, or mixed methods design that report an attitude outcome and themes and (7) studies published in the English language only. Methods The proposed systematic review will be conducted in accordance with the JBI methodology for mixed methods systematic reviews (27) and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (28). This protocol has been registered in PROSPERO (ID number CRD42024537564). Any protocol changes made to the current protocol will be reported in PROSPERO and in the final review manuscript. Search strategy The search strategy will aim to locate published and peer-reviews studies. An initial limited search of Ovid MEDLINE was undertaken to identify articles on this topic. An example of the search strategy conducted by Ovid MEDLINE database can found in appendix 1. An expert subject librarian at the University of Nottingham will be consulted to improve the key-word selection and search strategy. The search strategy, including all identified keywords and index terms will be adapted for each included information source. The reference list of all selected for critical appraisal will be screened for additional studies. The search will be limited to studies published in English to ensure data extraction and interpretation consistency, accuracy, and reduced translation biases. Studies published from the start of the database to the present will be included; no limitation to the date range will be implemented. The databases to be searched include CINAHL (Ebsco), Medline (Ovid), PsycINFO (Ovid), Web of Science, Applied Social Sciences Index and Abstracts (ASSIA) (ProQuest), and Allied and Complementary Medicine (AMED) (Ovid). All chosen studies’ reference lists will be screened. Sources of unpublished studies and gray literature will include Google Scholar (focusing on the first 100 results for time efficiency), e-theses and dissertations will be searched through databases (ProQuest, the Networked Digital Library of Theses and Dissertations, and Nottingham University e-theses). Study selection Following the search, all identified citations will be loaded into Covidence software (29) and duplicates will be removed automatically. Covidence is a web-based collaboration software platform that streamlines the production of systematic and other literature reviews (29). The screening process of title and abstract will be conducted by two independent reviewers by voting with either ‘yes’, 'no', or 'maybe’. Studies that are eligible for full-text review will be screened independently by team members (at least two independent reviewers). Reasons for exclusion of full-text studies that do not meet the inclusion criteria will be recorded and reported in the systematic review. Covidence supports conflict resolution by blinding all votes during full text screening to minimize any bias; if there is any disagreement between the reviewers; Covidence will flag the study for discussion (29). Following discussion, only studies agreed by the team members will be included. The results of the search will be reported in full in the final review and presented in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram (28). Assessment of methodological quality Quantitative papers (and the quantitative component of mixed methods papers) and qualitative papers (and the qualitative component of mixed methods papers) selected for retrieval will be assessed by two independent reviewers for methodological validity prior to inclusion in the review using the mixed methods appraisal tool (MMAT) version 2018 (30). Authors of the papers will be contacted to request missing or additional data for clarification, where required. Any disagreements that arise between the reviewers will be resolved through discussion or with a third reviewer. The results of critical appraisal will be reported in narrative format and in a table with tabulate. Regardless of the methodological quality; all studies will be included in the review for transparency. Data extraction Quantitative and qualitative data will be extracted from studies included in the review by two independent reviewers using the Covidence software proposed tool (29). Covidence proposed a data extraction tool based on PICO structure, however, the template will be modified to fit unique review requirements. The studies included will be presented on a table. The potential data extraction will include specific details about the populations, study methods, study aim, geographical location, disability type, sample size/ sampling strategy, attitude measurement, and attitude-related results and themes. Any disagreements that arise between the reviewers will be resolved through discussion or with a third reviewer. Authors of the papers will be contacted within four weeks to request missing or additional data, where required. Data transformation The quantitative data will then be converted into “qualitized” data. This will involve transformation into textual descriptions or narrative interpretation of the quantitative results in a way that answers the review questions. Data synthesis and integration This review will follow a convergent integrated approach according to the JBI methodology for mixed methods systematic reviews (27). This will involve assembling the qualitized data with the qualitative data. Assembled data are categorized and pooled together based on similarity in meaning to produce a set of integrated findings in the form of line of action statements. (31) Declarations Acknowledgments We would like to extend my sincere thanks to Dr David Charnock, whose support in the stages of screening, reviewing and developing the themes for this systematic review was invaluable. Although he has since retired, his contributions are gratefully acknowledged and deeply appreciated. Furthermore, we would like to thank Sara Beach, a subject librarian at the University of Nottingham, for kindly responding to queries, assisting in identifying relevant databases, and helping to create a search strategy for this review. This review contributes toward a Doctor of Philosophy thesis for the primary author (EA). Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Availability of data and materials Not applicable. Competing interests The authors declare no conflict of interest. Funding No funds are required for the preparation and completion of the systematic review. Author contributions All authors were involved in creating this systematic review. EA drafted the manuscript. EA, PH, and DC screened all the studies for eligibility. EA performed data extraction of the included studies, and results were compared for consistency. EA and PH assessed the methodological quality of studies. PH and DR provided critical revisions and regular feedback on the manuscript. All authors have read and approved the final manuscript. References World Health Organization. World Health Organization. 2022. Disability. Available from: https://www.who.int/health-topics/disability#tab=tab_1 World report on disability [Internet]. [cited 2025 Feb 6]. Available from: https://www.who.int/publications/i/item/9789241564182 Pada.gov.kw [Internet]. 2024. Statistics. Available from: https://www.pada.gov.kw/en/information-center/statistics/ OHCHR [Internet]. [cited 2025 Feb 7]. Committee on the Rights of Persons with Disabilities examines the initial report of Kuwait. Available from: https://www.ohchr.org/en/press-releases/2019/09/committee-rights-persons-disabilities-examines-initial-report-kuwait Allport GW. Attitudes’ in Murchison, C (ed.) Handbook of Social Psychology. Clark University Press, Worchester, MA. 1935;798:844. Fazio RH, Jackson JR, Dunton BC, Williams CJ. Variability in Automatic Activation as an Unobtrusive Measure of Racial attitudes: a Bona Fide pipeline? Journal of Personality and Social Psychology. 1995;69(6):1013–27. Burns K. selfgrowth.com. 2007 [cited 2024 Jan 1]. Definition: Attitude. Available from: http://www.selfgrowth.com/articles/definition_attitude.html Eagly AH, Chaiken S. The Psychology of Attitudes. Wadsworth Cengage Learning; 1993. Ajzen I, Fishbein M. Attitude-behavior relations: A theoretical analysis and review of empirical research. Psychological Bulletin. 1977;84(5):888–918. Ajzen I. Understanding Attitudes and Predictiing Social Behavior. Englewood cliffs [Internet]. 1980 [cited 2025 Feb 4]; Available from: https://cir.nii.ac.jp/crid/1572543024551612928 Ajzen I. The Theory of Planned Behavior. Organizational Behavior and Human Decision Processes. 1991;50(2):179–211. Ajzen I. The theory of planned behavior: Frequently asked questions. Human Behavior and Emerging Technologies. 2020;2(4):314–24. Ajzen I. The theory of planned behavior. Organizational Behavior and Human Decision Processes. 1991 Dec 1;50(2):179–211. Thaman AM, Barclay a. Physicians’ Attitudes toward Institutionalization of Mentally Retarded Children. Missouri medicine. 1965;62:209. Wolraich ML. Pediatric Practitioners Knowledge of Developmental Disabilities. Journal of Developmental & Behavioral Pediatrics. 1980;1(4):147–51. Roberts CM. Illness stigma, body image dissatisfaction, thwarted belongingness, and depressive symptoms in youth with inflammatory bowel disease.YR - 2023. p. No Pagination Specified. Goodman JF, Cecil HS. Referral Practices and Attitudes of Pediatricians toward Young Mentally Retarded Children. Journal of Developmental & Behavioral Pediatrics. 1987;8(2):97???105. Richardson HB, Guralnick MJ. Pediatric Residents and Young Handicapped Children. Academic Medicine. 1978;53(6):487–92. Cervasio, Kathleen. Attitudes of Nurses toward Children with Disabilities: the Attitudes of Nursing Students toward Children with Disabilities: an Experimental Design. International Journal of Physical Medicine & Rehabilitation. 2013;01(05). Erawati E, Keliat BA. Nursing Students Experiencing Caring Children with Disabilities: a Qyalitative Study. International Journal of Indonesian Education and Teaching. 2018;2(2):187–93. Mantziou, Brocalaki I, Andrea S, Ktenas E, Chatira K, Kotzabassaki S. Children’s nursing. Attitudes of registered nurses and student nurses to disabled children. British Journal of Nursing. 2002 Sep 26;11(17):1141–6. Matziou V, Perdikaris P, Petsios K, Gymnopoulou E, Galanis P, Brokalaki H. Greek students’ knowledge and sources of information regarding sex education. International Nursing Review. 2009 Sep;56(3):354–60. Yuker HE. The Measurement of Attitudes toward Disabled Persons. 1970; Lourdes Charles M, Marsala-Cervasio K. Attitudes of Registered Nurses Caring for Adults with Intellectual and Developmental Disabilities in an Acute Care setting: a Mixed Method Study. SCIREA Journal of Clinical Medicine. 2020;7(4):262–6. Cervasio k. Systematic Literature Review of Nursing Students and Nurses Attitudes toward Children with Disabilities. Journal of Health Sciences. 2010;1(9). Cooke A, Debbie S, Booth A. Beyond PICO: the SPIDER tool for qualitative evidence synthesis. Qual Health Res. 2012;11(10):1435–43. Lizarondo L, Stern C, Carrier J, Godfrey C, Rieger K, Salmond S, et al. Mixed methods systematic reviews. In: Aromataris E, Lockwood C, Porritt K, Pilla B, Jordan Z, editors. JBI Manual for Evidence Synthesis [Internet]. JBI; 2024 [cited 2025 Feb 3]. Available from: https://jbi-global-wiki.refined.site/space/MANUAL/355829175/8.+Mixed+methods+systematic+reviews Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. Updating Guidance for Reporting Systematic reviews: Development of the PRISMA 2020 Statement. Journal of Clinical Epidemiology. 2021;134(134):103–12. Covidence. Covidence. 2024. Covidence Systematic Review software, Veritas Health Innovation, Melbourne, Australia. Available at www.covidence.org. Available from: https://www.covidence.org/ Hong QN, Fàbregues S, Bartlett G, Boardman F, Cargo M, Dagenais P, et al. The Mixed Methods Appraisal Tool (MMAT) Version 2018 for Information Professionals and Researchers. Education for Information. 2018;34(4):285–91. Sandelowski M, Voils CI, Barroso J. Defining and Designing Mixed Research Synthesis Studies. J Dev Behav Pediatr. 2006;13(1):29. Supplementary Files Appendix.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 07 Feb, 2026 Editor assigned by journal 20 Nov, 2025 First submitted to journal 29 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7397117","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":587539082,"identity":"0e8e6a7b-665e-402e-abd7-8ceadc6047b8","order_by":0,"name":"Entehaj Alhabshi","email":"data:image/png;base64,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","orcid":"https://orcid.org/0009-0007-4384-128X","institution":"Nottingham University Press: University of Nottingham","correspondingAuthor":true,"prefix":"","firstName":"Entehaj","middleName":"","lastName":"Alhabshi","suffix":""},{"id":587539083,"identity":"e54def9c-256a-43fc-96c5-cc25c337f5c1","order_by":1,"name":"Dawn Ritchie","email":"","orcid":"","institution":"University of Nottingham","correspondingAuthor":false,"prefix":"","firstName":"Dawn","middleName":"","lastName":"Ritchie","suffix":""},{"id":587539084,"identity":"bd423d06-8e2a-49e6-8bbc-37df65224aee","order_by":2,"name":"Pippa Hemingway","email":"","orcid":"","institution":"University of Nottingham","correspondingAuthor":false,"prefix":"","firstName":"Pippa","middleName":"","lastName":"Hemingway","suffix":""}],"badges":[],"createdAt":"2025-08-18 07:54:25","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7397117/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7397117/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102962192,"identity":"c024ee30-a579-4af5-a71c-73993ea991d5","added_by":"auto","created_at":"2026-02-19 04:05:17","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":549593,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7397117/v1/d3c898d8-cd64-4dfd-be7b-6f99ba16ed5f.pdf"},{"id":102583610,"identity":"df2e0c56-fe31-4f9e-ab5c-a9015b6a3eac","added_by":"auto","created_at":"2026-02-13 09:50:38","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":25146,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix.docx","url":"https://assets-eu.researchsquare.com/files/rs-7397117/v1/2191a04f9614c5437d1d6d7a.docx"}],"financialInterests":"","formattedTitle":"Healthcare Professional’s Attitudes Towards Caring for Children with Disabilities: A Mixed-Method Systematic Review","fulltext":[{"header":"Background","content":"\u003cp\u003eDisability is defined as: \u0026lsquo;an umbrella term covering impairments, activity limitations and participation restriction\u0026rsquo; (1). According to the estimates of the World Health Organization (2011), over one billion people worldwide live with some type of disability, accounting for approximately 16% of the total global population. Globally, people with disabilities include up to 190 million (4.8% of the total) people who are under the age of 15 years, with between two and four percent of these children \u0026nbsp;facing significant difficulties in functioning (2). According to the WHO (2011), almost 10% of children (i.e. 200 million) have a type of disability (3).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Kuwait\u0026rsquo;s Public Authority for Disabled Affairs (PADA) (3), state that there are more than 66,000 people affected by different types of disabilities, with the highest prevalence for intellectual (26%), motor (22.4%), and physical disabilities (17.4%), respectively. Although there are no updated statistics about the estimated numbers of children with disabilities in Kuwait, the Ministry of Education has 25 special schools, accommodating 1,427 students with disabilities, including both Kuwaiti and non-Kuwaiti citizens (4).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAttitude\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDefinition and Theories\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHistorically, scholars have described the definition of attitude as a hypothetical concept that has evolved and shaped within the contexts of various professional fields. As early as the 1930s it was commonly defined by Allport as a cognitive and neurological condition shaped by past experiences, which exerts a significant impact on how an individual responds to various things and situations (5). The definition of attitude as a personal experience-shaped cognitive or neural state that guides or influences an individual\u0026rsquo;s reactions to all associated objects and situations continued to be clinically prevalent in later decades (6).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMore nuanced perspectives have emerged, and Burns (2007) referred to attitudes as hypothetical constructs that represent individual perceptions of positive, negative, or neutral phenomena, composed of cognitive, behavioural, and affective responses, which can be altered through experience and persuasion (7). Despite the differences between these definitions, they all emphasise the notion that reporting an attitude involves the expression of an evaluation and judgement about an object, person, or issue.\u003c/p\u003e\n\u003cp\u003eDifferent theories, models, and approaches appear to aim to understand attitude, and more specifically, how to predict someone\u0026rsquo;s behaviour, and how to measure attitude. For example, Eagly and Chaiken\u0026rsquo;s (1993) studies of the affective, behavioral, and cognitive attitudinal component (CAB) (8), the Theory of Reasoned Action (TRA) (9,10), and the theory of planned behaviour (TPB) that was introduced by Ajzen\u0026rsquo;s (1991) framework for understanding attitude (11). The TPB is the most suitable theory for describing the intention to perform a particular behaviour (12,13). The theory explains how the intention to perform a behaviour is the key predictor of actual behaviour, based on three factors: (1) attitude towards the behaviour, (2) subjective norms related to the behaviour, and (3) perceived behavioural control (12,13).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePaediatric Healthcare Professionals\u0026rsquo; Attitudes\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEvidence demonstrates that healthcare professionals\u0026rsquo; (HCPs), problematic or (negative) attitudes towards children with disabilities have persisted for decades (14\u0026ndash;18) and have continued to be a primary concern (19\u0026ndash;22). However, the preliminary search for studies on children with disabilities revealed a scarcity in literature, and a preponderance of quantitative studies (19,21,22) compared to a dearth of qualitative (20) or mixed-method studies. Moreover, the initial search revealed a scarcity of research evidence from Middle Eastern countries.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAn experimental study on nursing students was conducted by Cervasio and Fatata-Hall (2013) in the United States to investigate the attitudes of senior nursing students towards children with disabilities by introducing disability education material (19). Eighty-eight nursing students were randomly distributed between the control and experimental groups. The Attitude Towards Disabled People (ATDP) (23) scale was administered three times: pre-disability education, immediately after disability education, and after one month of disability education. The disability module lasted four hours and covered children with disabilities resources and teaching, including lectures, discussions, films, several websites and case studies. Data was collected on nursing care, medical equipment, medications, school services, legal implications, and community resources.\u003c/p\u003e\n\u003cp\u003eThe major findings were that the experimental group, which received the educational intervention, had a pre-test mean score of 111.77 on the ATDP scale. This score increased to 144.93 immediately post-intervention and slightly decreased to 128.59 at the one-month follow-up; however, it remained higher than the pre-test score. In contrast, the control group, which did not receive the intervention, had a pre-test mean score of 113.80, which decreased to 109.07 post-test and was 111.50 at follow-up, indicating no significant improvement over time\u003cem\u003e.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe study shows that following education, attitudes towards nursing are significantly more positive, which puts pressure on nursing faculties to deliver more curriculum content on assessment of children with disabilities. The study also provided evidence that attitudes can change among nursing students with new knowledge, information, and education (19).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFurthermore, a qualitative study on nurse attitudes regarding people with disabilities in the US conducted by Lourdes Charles and Marsala-Cervasio (2020) and a qualitative study by Erawati and Keliat (2018) in Indonesia discovered that \u0026lsquo;communication\u0026rsquo; was the prominent qualitative theme (20,24). Lourdes Charles and Marsala-Cervasio (2020) examined nursing staff of people (adult)with disabilities, whereas Erawati and Keliat (2018) examined nursing students\u0026apos; views towards children with disabilities. Communication is a major difficulty for nursing staff and students, and it may alter nursing attitudes towards people with disabilities and children with disabilities (20,24).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA preliminary search for systematic reviews examining paediatric HCPs\u0026apos; attitudes toward children with disabilities ended with no results. The only relevant systematic review identified was conducted by Cervasio in 2010, which focused on the attitudes of nursing students and registered nurses toward children with disabilities (25). These scoping searches review was limited to studies on nursing as a discipline and studies that fall between 2000 and 2010. This review highlighted a scarcity of research in this area, identifying only two studies published between 2000 and 2010, both conducted in Greece by the same primary author(21,22). Both focused on attitude on nursing studies and professionals towards children with disabilities.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTherefore, there is an enduring call for a systematic review which aims to explore paediatric HCPs\u0026rsquo; attitudes towards children with disabilities by combining empirical evidence from quantitative, qualitative, and mixed-method studies. In addition, to identify the various research designs, theories, and scales used in assessing the attitudes of paediatric HCPs towards children with disabilities to identify research gaps and determine areas for future research and recommendations\u003c/p\u003e\n\u003ch2\u003eReview question(s)\u003c/h2\u003e\n\u003cp\u003eThe formulated review question formulated was based on the \u0026lsquo;sample, phenomenon of interest, design, evaluation, research\u0026rsquo; (SPIDER) framework for formulating research questions (26). The SPIDER framework was utilized in formulating the research question, identifying the search keywords, and selecting the inclusion and exclusion criteria. Table 1 below provides the SPIDER component and specific criteria followed by the review question.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 1 Applying SPIDER to the review question\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSPIDER heading\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSpecific Criteria\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eS- Sample\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eHCPs providing paediatric care\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003ePI- Phenomena of Interest\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eAttitude(s) towards children with disabilities\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eD- Design\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eVarious types of qualitative, quantitative and mixed methods of research designs.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eE- Evaluation\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eAttitude (all reported outcomes and themes)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eR- Research type\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eQualitative, quantitative and mixed methods\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eReview question\u003c/strong\u003e: What are paediatric HCPs attitudes towards caring for Children with disabilities in a healthcare setting?\u0026rsquo;\u003c/p\u003e\n\u003ch2\u003eInclusion criteria\u003c/h2\u003e\n\u003ch2\u003ePopulation\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eThe review will consider studies:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e(1) that include pediatric HCPs who provide care for pediatric patients.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e(2) studies reporting a variety of disabilities.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e(3) studies that include a single diagnosis.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003ePhenomena of Interest\u003c/h2\u003e\n\u003cp\u003eThe review will consider:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e(4) all studies that discuss attitude outcomes and/or attitude themes.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eContext\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eThe review will consider:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e(5) studies conducted in hospital units, outpatient clinical settings, or community healthcare settings amongst others that provide direct pediatric care.\u003c/p\u003e\n\u003ch2\u003eTypes of studies\u003c/h2\u003e\n\u003cp\u003eThe review will consider:\u003c/p\u003e\n\u003cp\u003e(6) quantitative, qualitative, or mixed methods design that report an attitude outcome and themes and\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;(7) studies published in the English language only.\u0026nbsp;\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe proposed systematic review will be conducted in accordance with the JBI methodology for mixed methods systematic reviews (27) and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (28). This protocol has been registered in PROSPERO (ID number CRD42024537564). Any protocol changes made to the current protocol will be reported in PROSPERO and in the final review manuscript.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eSearch strategy\u003c/h2\u003e\n\u003cp\u003eThe search strategy will aim to locate published and peer-reviews studies. An initial limited search of Ovid MEDLINE was undertaken to identify articles on this topic. An example of the search strategy conducted by Ovid MEDLINE database can found in appendix 1. An expert subject librarian at the University of Nottingham will be consulted to improve the key-word selection and search strategy. The search strategy, including all identified keywords and index terms will be adapted for each included information source. The reference list of all selected for critical appraisal will be screened for additional studies. The search will be limited to studies published in English to ensure data extraction and interpretation consistency, accuracy, and reduced translation biases. Studies published from the start of the database to the present will be included; no limitation to the date range will be implemented.\u003c/p\u003e\n\u003cp\u003eThe databases to be searched include CINAHL (Ebsco), Medline (Ovid), PsycINFO (Ovid), Web of Science, Applied Social Sciences Index and Abstracts (ASSIA) (ProQuest), and Allied and Complementary Medicine (AMED) (Ovid). All chosen studies\u0026rsquo; reference lists will be screened. Sources of unpublished studies and gray literature will include Google Scholar (focusing on the first 100 results for time efficiency), e-theses and dissertations will be searched through databases (ProQuest, the Networked Digital Library of Theses and Dissertations, and Nottingham University e-theses).\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eStudy selection\u003c/h2\u003e\n\u003cp\u003eFollowing the search, all identified citations will be loaded into Covidence software\u0026nbsp;(29)\u0026nbsp;and duplicates will be removed automatically. Covidence is a web-based collaboration software platform that streamlines the production of systematic and other literature reviews\u0026nbsp;(29). The screening process of title and abstract will be conducted by two independent reviewers by voting with either \u0026lsquo;yes\u0026rsquo;, \u0026apos;no\u0026apos;, or \u0026apos;maybe\u0026rsquo;. Studies that are eligible for full-text review will be screened independently by team members (at least two independent reviewers). Reasons for exclusion of full-text studies that do not meet the inclusion criteria will be recorded and reported in the systematic review. Covidence supports conflict resolution by blinding all votes during full text screening to minimize any bias; if there is any disagreement between the reviewers; Covidence will flag the study for discussion\u0026nbsp;(29). Following discussion, only studies agreed by the team members will be included. \u0026nbsp;The results of the search will be reported in full in the final review and presented in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram\u0026nbsp;(28).\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eAssessment of methodological quality\u003c/h2\u003e\n\u003cp\u003eQuantitative papers (and the quantitative component of mixed methods papers) and qualitative papers (and the qualitative component of mixed methods papers) \u0026nbsp;selected for retrieval will be assessed by two independent reviewers for methodological validity prior to inclusion in the review using the mixed methods appraisal tool (MMAT) version 2018\u0026nbsp;(30). Authors of the papers will be contacted to request missing or additional data for clarification, where required. Any disagreements that arise between the reviewers will be resolved through discussion or with a third reviewer. The results of critical appraisal will be reported in narrative format and in a table with tabulate. Regardless of the methodological quality; all studies will be included in the review for transparency. \u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eData extraction\u003c/h2\u003e\n\u003cp\u003eQuantitative and qualitative data will be extracted from studies included in the review by two independent reviewers using the Covidence software proposed tool\u0026nbsp;(29). Covidence proposed a data extraction tool based on PICO structure, however, the template will be modified to fit unique review requirements. The studies included will be presented on a table. The potential data extraction will include specific details about the populations, study methods, study aim, geographical location, disability type, sample size/ sampling strategy, attitude measurement, and attitude-related results and themes. Any disagreements that arise between the reviewers will be resolved through discussion or with a third reviewer. Authors of the papers will be contacted within four weeks to request missing or additional data, where required.\u003c/p\u003e\n\u003ch2\u003eData transformation\u003c/h2\u003e\n\u003cp\u003eThe quantitative data will then be converted into \u0026ldquo;qualitized\u0026rdquo; data. This will involve transformation into textual descriptions or narrative interpretation of the quantitative results in a way that answers the review questions.\u003c/p\u003e\n\u003ch2\u003eData synthesis and integration\u003c/h2\u003e\n\u003cp\u003eThis review will follow a convergent integrated approach according to the JBI methodology for mixed methods systematic reviews (27). This will involve assembling the qualitized data with the qualitative data. Assembled data are categorized and pooled together based on similarity in meaning to produce a set of integrated findings in the form of line of action statements. (31)\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAcknowledgments\u003c/h2\u003e\n\u003cp\u003eWe would like to extend my sincere thanks to Dr David Charnock, whose support in the stages of screening, reviewing and developing the themes for this systematic review was invaluable. Although he has since retired, his contributions are gratefully acknowledged and deeply appreciated. Furthermore, we would like to thank Sara Beach, a subject librarian at the University of Nottingham, for kindly responding to queries, assisting in identifying relevant databases, and helping to create a search strategy for this review. This review contributes toward a Doctor of Philosophy thesis for the primary author (EA).\u003c/p\u003e\n\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch2\u003eConsent for publication\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch2\u003eAvailability of data and materials\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch2\u003eCompeting interests\u003c/h2\u003e\n\u003cp\u003eThe authors declare no conflict of interest.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eNo funds are required for the preparation and completion of the systematic review.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eAuthor contributions\u003c/h2\u003e\n\u003cp\u003eAll authors were involved in creating this systematic review. EA drafted the manuscript. \u0026nbsp; EA, PH, and DC screened all the studies for eligibility. EA performed data extraction of the included studies, and results were compared for consistency. EA and PH assessed the methodological quality of studies. PH and DR provided critical revisions and regular feedback on the manuscript. All authors have read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization. World Health Organization. 2022. Disability. Available from: https://www.who.int/health-topics/disability#tab=tab_1\u003c/li\u003e\n\u003cli\u003eWorld report on disability [Internet]. [cited 2025 Feb 6]. Available from: https://www.who.int/publications/i/item/9789241564182\u003c/li\u003e\n\u003cli\u003ePada.gov.kw [Internet]. 2024. Statistics. Available from: https://www.pada.gov.kw/en/information-center/statistics/\u003c/li\u003e\n\u003cli\u003eOHCHR [Internet]. [cited 2025 Feb 7]. Committee on the Rights of Persons with Disabilities examines the initial report of Kuwait. Available from: https://www.ohchr.org/en/press-releases/2019/09/committee-rights-persons-disabilities-examines-initial-report-kuwait\u003c/li\u003e\n\u003cli\u003eAllport GW. Attitudes\u0026rsquo; in Murchison, C (ed.) Handbook of Social Psychology. Clark University Press, Worchester, MA. 1935;798:844. \u003c/li\u003e\n\u003cli\u003eFazio RH, Jackson JR, Dunton BC, Williams CJ. Variability in Automatic Activation as an Unobtrusive Measure of Racial attitudes: a Bona Fide pipeline? Journal of Personality and Social Psychology. 1995;69(6):1013\u0026ndash;27. \u003c/li\u003e\n\u003cli\u003eBurns K. selfgrowth.com. 2007 [cited 2024 Jan 1]. Definition: Attitude. Available from: http://www.selfgrowth.com/articles/definition_attitude.html\u003c/li\u003e\n\u003cli\u003eEagly AH, Chaiken S. The Psychology of Attitudes. Wadsworth Cengage Learning; 1993. \u003c/li\u003e\n\u003cli\u003eAjzen I, Fishbein M. Attitude-behavior relations: A theoretical analysis and review of empirical research. Psychological Bulletin. 1977;84(5):888\u0026ndash;918. \u003c/li\u003e\n\u003cli\u003eAjzen I. Understanding Attitudes and Predictiing Social Behavior. Englewood cliffs [Internet]. 1980 [cited 2025 Feb 4]; Available from: https://cir.nii.ac.jp/crid/1572543024551612928\u003c/li\u003e\n\u003cli\u003eAjzen I. The Theory of Planned Behavior. Organizational Behavior and Human Decision Processes. 1991;50(2):179\u0026ndash;211. \u003c/li\u003e\n\u003cli\u003eAjzen I. The theory of planned behavior: Frequently asked questions. Human Behavior and Emerging Technologies. 2020;2(4):314\u0026ndash;24. \u003c/li\u003e\n\u003cli\u003eAjzen I. The theory of planned behavior. Organizational Behavior and Human Decision Processes. 1991 Dec 1;50(2):179\u0026ndash;211. \u003c/li\u003e\n\u003cli\u003eThaman AM, Barclay a. Physicians\u0026rsquo; Attitudes toward Institutionalization of Mentally Retarded Children. Missouri medicine. 1965;62:209. \u003c/li\u003e\n\u003cli\u003eWolraich ML. Pediatric Practitioners Knowledge of Developmental Disabilities. Journal of Developmental \u0026amp; Behavioral Pediatrics. 1980;1(4):147\u0026ndash;51. \u003c/li\u003e\n\u003cli\u003eRoberts CM. Illness stigma, body image dissatisfaction, thwarted belongingness, and depressive symptoms in youth with inflammatory bowel disease.YR - 2023. p. No Pagination Specified. \u003c/li\u003e\n\u003cli\u003eGoodman JF, Cecil HS. Referral Practices and Attitudes of Pediatricians toward Young Mentally Retarded Children. Journal of Developmental \u0026amp; Behavioral Pediatrics. 1987;8(2):97???105. \u003c/li\u003e\n\u003cli\u003eRichardson HB, Guralnick MJ. Pediatric Residents and Young Handicapped Children. Academic Medicine. 1978;53(6):487\u0026ndash;92. \u003c/li\u003e\n\u003cli\u003eCervasio, Kathleen. Attitudes of Nurses toward Children with Disabilities: the Attitudes of Nursing Students toward Children with Disabilities: an Experimental Design. International Journal of Physical Medicine \u0026amp; Rehabilitation. 2013;01(05). \u003c/li\u003e\n\u003cli\u003eErawati E, Keliat BA. Nursing Students Experiencing Caring Children with Disabilities: a Qyalitative Study. International Journal of Indonesian Education and Teaching. 2018;2(2):187\u0026ndash;93. \u003c/li\u003e\n\u003cli\u003eMantziou, Brocalaki I, Andrea S, Ktenas E, Chatira K, Kotzabassaki S. Children\u0026rsquo;s nursing. Attitudes of registered nurses and student nurses to disabled children. British Journal of Nursing. 2002 Sep 26;11(17):1141\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eMatziou V, Perdikaris P, Petsios K, Gymnopoulou E, Galanis P, Brokalaki H. Greek students\u0026rsquo; knowledge and sources of information regarding sex education. International Nursing Review. 2009 Sep;56(3):354\u0026ndash;60. \u003c/li\u003e\n\u003cli\u003eYuker HE. The Measurement of Attitudes toward Disabled Persons. 1970; \u003c/li\u003e\n\u003cli\u003eLourdes Charles M, Marsala-Cervasio K. Attitudes of Registered Nurses Caring for Adults with Intellectual and Developmental Disabilities in an Acute Care setting: a Mixed Method Study. SCIREA Journal of Clinical Medicine. 2020;7(4):262\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eCervasio k. Systematic Literature Review of Nursing Students and Nurses Attitudes toward Children with Disabilities. Journal of Health Sciences. 2010;1(9). \u003c/li\u003e\n\u003cli\u003eCooke A, Debbie S, Booth A. Beyond PICO: the SPIDER tool for qualitative evidence synthesis. Qual Health Res. 2012;11(10):1435\u0026ndash;43. \u003c/li\u003e\n\u003cli\u003eLizarondo L, Stern C, Carrier J, Godfrey C, Rieger K, Salmond S, et al. Mixed methods systematic reviews. In: Aromataris E, Lockwood C, Porritt K, Pilla B, Jordan Z, editors. JBI Manual for Evidence Synthesis [Internet]. JBI; 2024 [cited 2025 Feb 3]. Available from: https://jbi-global-wiki.refined.site/space/MANUAL/355829175/8.+Mixed+methods+systematic+reviews\u003c/li\u003e\n\u003cli\u003ePage MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. Updating Guidance for Reporting Systematic reviews: Development of the PRISMA 2020 Statement. Journal of Clinical Epidemiology. 2021;134(134):103\u0026ndash;12. \u003c/li\u003e\n\u003cli\u003eCovidence. Covidence. 2024. Covidence Systematic Review software, Veritas Health Innovation, Melbourne, Australia. Available at www.covidence.org. Available from: https://www.covidence.org/\u003c/li\u003e\n\u003cli\u003eHong QN, F\u0026agrave;bregues S, Bartlett G, Boardman F, Cargo M, Dagenais P, et al. The Mixed Methods Appraisal Tool (MMAT) Version 2018 for Information Professionals and Researchers. Education for Information. 2018;34(4):285\u0026ndash;91. \u003c/li\u003e\n\u003cli\u003eSandelowski M, Voils CI, Barroso J. Defining and Designing Mixed Research Synthesis Studies. J Dev Behav Pediatr. 2006;13(1):29. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"systematic-reviews","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"sysr","sideBox":"Learn more about [Systematic Reviews](http://systematicreviewsjournal.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/sysr/default.aspx","title":"Systematic Reviews","twitterHandle":"@MedicalEvidence","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Attitude, child, disability, healthcare professional ","lastPublishedDoi":"10.21203/rs.3.rs-7397117/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7397117/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: The attitudes of pediatric healthcare professionals towards children with disabilities play a critical role in shaping the quality of care and support these children receive. Positive attitudes can foster inclusive healthcare environments, while negative perceptions may affect the quality of care. Investigating these attitudes is essential to identifying gaps, improving training programs, and promoting holistic quality care for children with disabilities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e: The objective of this review is to systematically summarize, appraise and synthesize available quantitative, qualitative, and mixed methods research to identify pediatric healthcare professionals’ attitudes towards children with disabilities in healthcare settings.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion criteria\u003c/strong\u003e: Pediatric healthcare professionals who provide direct care for children with disabilities with varying levels of experience, from diverse clinical and educational backgrounds.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: A mixed method systematic review was conducted to identify the healthcare professionals’ attitudes towards children with disabilities in healthcare settings based on Joanna Briggs Institute methodology for mixed-method systematic reviews (JBI) and utilizing Covidence software for systematic review. Six electronic databases (CINAHL (Ebsco), Medline (Ovid), PsycINFO (Ovid), Web of Science, Applied Social Sciences Index and Abstracts (ASSIA) (ProQuest), and Allied and Complementary Medicine (AMED) (Ovid) will be searched, using keywords, truncation and MeSH terms from each database with Boolean operators. The search will be limited to English language. Quantitative, qualitative, and mixed-methods studies reporting on pediatric healthcare professionals’ attitudes towards children with disabilities will be eligible for inclusion. Covidence software will be used for screening, selecting, and extracting data from the selected studies. The selected studies will be appraised based on their methodological quality. The review will utilize a data-based convergent integrated design. The quantitative data will be transformed into qualitative data and analyzed using thematic synthesis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRegistration: \u003c/strong\u003ePROSPERO: CRD42024537564\u003cem\u003e.\u003c/em\u003e\u003c/p\u003e","manuscriptTitle":"Healthcare Professional’s Attitudes Towards Caring for Children with Disabilities: A Mixed-Method Systematic Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-13 09:50:27","doi":"10.21203/rs.3.rs-7397117/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-02-07T19:49:57+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-20T06:06:21+00:00","index":"","fulltext":""},{"type":"submitted","content":"Systematic Reviews","date":"2025-09-29T05:59:33+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"systematic-reviews","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"sysr","sideBox":"Learn more about [Systematic Reviews](http://systematicreviewsjournal.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/sysr/default.aspx","title":"Systematic Reviews","twitterHandle":"@MedicalEvidence","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c49d9de9-9aa7-4065-bec6-ae53f6b7dda1","owner":[],"postedDate":"February 13th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-13T09:50:27+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-13 09:50:27","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7397117","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7397117","identity":"rs-7397117","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}