Attitudes Toward Dating People with Disability Amongst Young People in Australia and Hong Kong

This paper explores attitudes toward dating people with disability amongst young people in Australia and Hong Kong. Data relating to disability were extracted from an e-survey that investigated young people’s (n = 2208) experiences of and attitudes toward dating. Quantitative data were analysed using descriptive statistics while open ended responses were subjected to interpretive content analysis. When asked about preferred characteristics for potential dates, young people identified factors that were unlikely to be negatively influenced by disability, such as loyalty, honesty, dedication, humour, and kindness. Yet when asked whether disability would influence their dating choices, most said that it would and expressed an unwillingness to date people with disability. Young adults in Hong Kong expressed less openness to dating people with disability than those in Australia. Physical disability and mental health issues were seen as less of a barrier to dating than intellectual or developmental disability. Despite recent gains in public attitudes toward people with disability, improvements are needed in terms of young people in the general population viewing people with disability as suitable partners and thus, allowing them to enjoy equal rights to relationships and sexuality. Culture is an important determinant, indicating a potential for change.


Introduction
Sexual rights are an aspect of human rights that encompass more than just the right to experience pleasurable sexuality [1]. Romantic relationships, as a core part of sexuality, are a mechanism to: fulfil sexual desires; feel loved; experience companionship, social support and intimacy; and enable individuals to partner and have children [2]. They are part of a diverse range of sexual and non-sexual relationships. Being able to love and be loved is a basic need, important for all people, including those with disability [3][4][5].
However, people with disability (PWD) may experience more difficulties finding partners and forming intimate relationships than people without disability (PWOD) [6]. The sexual rights of PWD are often ignored due to discomfort or a belief that sexuality is not important to PWD [7,8]. Where opportunities for the expression of sexuality by PWD are considered or addressed, this is usually through interventions aimed at providing education to or changing the behaviour of PWD. For example, in a systematic review of interventions to support adults with brain injuries, learning disabilities and autistic spectrum disorders in dating or romantic relationships [9], the included interventions sought to educate PWD about sexual functioning and birth control; conversation and listening skills, and understanding the impact of disability on their ability to engage in relationships. These interventions, while useful, locate the problem, and thus the responsibility to change, within the person with disability and fail to acknowledge the role of wider societal issues such as lack of social opportunity, stigma and inequality which impact the potential for PWD to participate in dating activities [10].
The idea that challenges PWD experience when dating is rooted in wider societal attitudes is not new. General attitudes towards PWD position them as asexual [11], degendered [12], incapable of sexual relationships [13] and lacking capacity to have successful long-term intimate relationships [14]. Research suggests that PWOD are resistant towards establishing intimate relationships with PWD [15][16][17][18]. For PWOD, the idea of dating a person with a disability is often seen as too much work, socially awkward and unlikely to be sexually satisfying [17]. Conversely, Rainey [10] notes that if PWOD form intimate relationships with PWD, they are either viewed with suspicion or as martyrs.
While existing studies suggests that PWOD seek to avoid intimate relationships with PWD, there are a number of limitations that must be considered. First, many of the studies have relied upon small convenience samples, frequently university students, thus limiting the generalisability of findings to the wider population. Second, the majority of studies have been conducted in Western contexts. Less is known about attitudes towards dating PWD in other cultural contexts and different methods and samples make direct comparison across cultures difficult. This is an important omission since culture has been shown to influence both attitudes to dating [19] and attitudes to PWD [20]. Furthermore, most studies have focused on attitudes toward disability when selecting potential intimate partners, but no studies could be identified that considered how disability fits within a broader approach to identification and selection of potential intimate partners. Our study addresses these gaps in knowledge through exploring how young adults (aged 18-35 years) living in Hong Kong and Australia think about disability when selecting intimate partners. Specifically, we sought to understand: (1) whether the characteristics or attributes that young people value when selecting potential dates inherently exclude or include people with disability; (2) to what extent the presence of physical disability, mental health issues or intellectual disability affect young adults' dating choices; and (3) whether differences exist between young people in Australia and Hong Kong in relation to attribute preference and willingness to consider PWD as potential dates.

Recruitment
Data for this study were taken from a larger study that examined dating behaviour among young people in Australia and Hong Kong [21]. Participants were recruited from both countries via flyers and social media platforms. Interested participants were provided with a link/QR code directing them to an online survey. Eligible participants were: (a) aged 18-35 years; (b) living in Australia or Hong Kong; (c) had been on at least one date; and (d) willing to complete the survey in either English or Chinese. Study design and reporting were guided by the Checklist for Reporting Results of Internet E-Survey (CHERRIES) [22] and were approved by the Human Research Ethics Committee at the University of Sydney (#2019/983). Consent to participate was implied by the submission of the survey and no incentives were offered.

Procedure
The online survey was hosted by Qualtrics, and participants could choose to complete the survey in English (n = 1435) or Traditional Chinese (n = 773). Forward and backward translation was used to ensure the translation of the survey and participant information statement was accurate [23]. Discrepancies between the original and back-translated versions were discussed with the research team and both translators to reach consensus. Responses to the following questions were analysed for the current paper. First, participants were asked, with no reference to disability, to provide a free text response describing things they valued about their current partner or desired in a future partner. This data were analysed to ascertain the extent to which these valued features might inherently exclude PWD. Later in the survey, participants were asked to indicate how important they considered a range of characteristics, including the presence of intellectual disability, physical disability, and mental health issues, to their choice of a partner. 1 Respondents rated these as important, a bit important, or unimportant. For characteristics rated as important or a bit important, respondents were asked to describe what they were looking for in free-text responses.

Data Analysis
Fixed choice and free-text responses were analysed using IBM SPSS Statistics Version 26 and NVivo Version 12 respectively. Demographic and fixed choice responses were explored using descriptive statistics to gain an overall understanding of the sample and inspected using visual bar charts. Free-text questions were analysed using interpretive content analysis [24]. Codes were inductively generated in English by the first researcher, who is a bilingual native Hong Konger, and both English and Chinese responses were coded at the same time. Frequencies with which these concepts were mentioned were counted, and Pearson Chi-Square Tests were used to compare differences between groups of participants.

Results
Participants were 2208 young adults whose ages ranged from 18 to 35 years old (M = 23.3, SD = 3.9). Around half were living in Australia (n = 1121) and half in Hong Kong (n = 1087). Many respondents (n = 1212, 55%) described themselves as being in an exclusive and committed relationship while others described themselves as single and not currently dating (n = 680, 31%), dating but not in an exclusive relationship (n = 230, 10%), in an open relationship (n = 40, 1.8%) or in a polyamorous relationship (n = 33, 1.5%). Unfortunately, only 60% of participants completed demographic questions at the end of the survey. Of these (n = 1338), 994 (74.3%) were female, 325 (24.3%) male, and 19 (1.4%) identified as having a non-binary gender. A total of 128 (9.6%) participants reported that they had a long-term health condition or disability. For additional information on participant demographics please refer to Ip et al. [21].

Desirable qualities or attributes in partner selection
A total of 2208 people responded to this question. Table 1 indicates the most frequently mentioned qualities seen as important in a partner among young adults from both countries. Very few of the top 20 most valued qualities could be interpreted as excluding PWD. A requirement to be "intelligent", for example, might be seen as excluding someone with intellectual disability, while "appearance" may be influenced by some physical disabilities. Loyalty, honesty, dedication, humour and kindness were the most valued qualities, none of which imply absence of disability.

Attitudes towards disability in partner selection?
Participants were asked to indicate the extent to which physical disability and health conditions, mental health problems, and intellectual or developmental disability were important in selecting a dating partner. More than 80% of the young adults from both countries indicated that the presence of various disabilities is 'important' or 'a bit important' in selecting dating partners (see Fig. 1). Figures 2 and 3 show a different pattern of preferences in partner selection among those living in Australia and Hong Kong. People living in Hong Kong were more concerned about the presence of disability than those living in Australia. A Chi-square test for independence (with Post-hoc Bonferroni Correction) indicated that these differences were significant for all disability groups: intellectual and developmental disability (X 2 (1, n = 1806) = 31.6, p < 0.000), mental health problems (X 2 (1, n = 1806) = 63.9, p < 0.000), and physical disability and health conditions (X 2 (1, n = 1806) = 46.5, p < 0.000). Additionally, male participants generally expressed more concerns than female participants towards dating people with a physical disability or health conditions (X 2 (1, n = 1319) = 5.65, p = 0.017) or people with mental health issues (X 2 (1, n = 1319) = 5.95, p < 0.015).
People who indicated that disability was important or a bit important in their choice of dating partners, when asked to describe their preferences, reported two main attitudes. Most indicated that they would not or would prefer not to date someone with a disability. Others, however, indicated that they might be willing to date someone with a disability, but only under certain conditions, for example that the condition was mild, that the person managed it well, or that it did not impinge on the respondent's daily life or activities. Only two people indicated that they would prefer someone with disability, namely with mental health issues as they wanted their partners to understand their own mental health condition. Table 2 shows a summary of respondents' views on the presence of different health conditions or disabilities. Young adults appeared more open to date people with physical disability (34.5%) or people with mental health issues (34.4%) than people with intellectual or developmental disability (16.3%). Additionally, people from Australia who saw disability as important or a bit important in their decisions were more likely to be conditionally open to dating PWD than people from Hong Kong, physical disability: (X 2 (1, n = 2208) = 90.2, p < 0.000); mental health problems (X 2 (1, n = 2208) = 106.0, p < 0.000); intellectual or developmental disability (X 2 (1, n = 2208) = 113.4, p < 0.000).
A Chi-square test for independence (with Post-hoc Bonferroni Correction) indicated significant association between the presence of health conditions or disability 2 and the acceptance towards dating people with physical disability (X 2 (1, n = 2208) = 18.0, p < 0.000) and mental health issues (X 2 (1, n = 2208) = 20.8, p < 0.000). However, no significant association was found between the presence of health conditions or disability and the acceptance towards dating people with intellectual disability.

Discussion
This research is a large-scale study to explore contemporary attitudes to dating and disability across two cultures. Young people showed a considerable resistance towards dating PWD and several differences were observed between participants from Australia and Hong Kong. Male participants generally expressed less willingness than female participants towards dating PWD, which aligns with previous research findings [15,18,25].
The most valued attributes/qualities for a dating partner were things like honesty, loyalty, sense of humour and kindness. This finding is broadly in line with the findings of previous research about partner selection [17,26]. These valued characteristics are just as likely to be held by people with or without disability. However, possession of these qualities appears to be overridden by disability, with more than 80% of respondents indicating later in the survey that the presence of disability would affect their decision in dating.
The presence of each type of disability affected people's decision in selecting partners. Among the participants who indicated that the presence of disability was important, the majority would not or preferred not to date a person with disability. The discrepancy between people's unwillingness to date PWD and the lack of mention of factors that are likely to be inversely associated with disability in their desired attributes could indicate a failure to even consider PWD as part of the pool of potential dating options. This idea is in line with stereotypical conceptualisations of PWD as asexual or as unsuitable sexual partners [27,28]. Yet in a recent study nearly three-quarters of Australians agreed with the statement that "people believe that people with disability have the right to sexual relationships" [29], suggesting a mismatch between hypothetical beliefs and personal intentions around PWD and sexuality. Previous literature has found that PWOD express more positive attitudes to PWD in contexts such as work or friendship rather than in a dating context (e.g., [15,17,25,30]). Several studies have explored concerns amongst PWOD around dating PWD, including feeling awkward or offended at being approached by PWD, feeling guilty about not being nice to PWD, feeling anxious about the potential burden of care, believing PWD do not have the right to engage in sexual relationships or become parents, believing that dating PWD would be deviant or not fun, lack of physical attraction, and concern about the mechanics of physical intimacy and sexual satisfaction [15,17,31,32]. It was clear that the severity and type of the disability was important to people's dating preferences. We found that a proportion of respondents were open to date PWD if the condition was mild, well managed and did not impinge on their own life. Previous studies have also shown that people are more willing to date PWD whose disability is less severe [15,30]. This is consistent with the hierarchy of disability acceptability, where severe and noticeable disabilities that affect people's daily life or activities are less acceptable than disabilities that are less disabling [33,34]. However, the finding that participants were more accepting towards dating people with physical disability or mental health conditions than people with intellectual or developmental disability differs from past findings, where willingness to have a relationship was lowest for people with psychiatric disability compared to other groups [30,35]. This may reflect the phrasing used in the survey, which asked about "mental health issues" rather than "psychiatric impairment" [30] or "mental illness" [35]. However, it could also reflect increasing de-stigmatisation of mental health conditions, particularly common conditions such as anxiety and depression, especially amongst young adults [36].
Our research has found differences between the responses from Australia and Hong Kong. Firstly, respondents in Australia tended to provide longer lists of valued qualities than people from Hong Kong, and so most values/qualities are reported by more people from Australia than Hong Kong. However, people from Hong Kong reported valuing outer appearance more frequently than people from Australia (14% v 7%). This finding is surprising and warrants further investigation as previous studies of mate preference found that people from Asian cultures were similarly concerned or less concerned with physical appearance than people from western countries [37,38].
Second, our research found young adults from Australia were more open to date PWD than young adults from Hong Kong. This aligns with previous research which indicates more favourable attitudes to disability being held by people from Western backgrounds compared to Asian background [20]. In one of the few cross-cultural comparisons of attitudes to dating and disability, conducted 20 years ago, researchers found that young adults from the United States demonstrated more positive attitudes to dating PWD than people from either Singapore or Taiwan; and people from Singapore had more positive attitudes than those from Taiwan. The authors attributed this difference to Singapore being more 'Westernized' due to its British colonial history [18]. Cultural factors are likely to play a part. Although Confucian ideology stresses the importance of tolerance, harmony and social responsibility [39,40], PWD have traditionally been regarded as having the lowest status in social hierarchy [41]. Further, disability has been associated with parental wrongdoing in Asian culture, and thus PWD are often overlooked as they were associated with shame and guilt to the family, and there were concerns around the impact of disability on one's offspring [18,40]. This is consistent with the finding of a greater emphasis on appearance within the Hong Kong cohort as PWD may be seen as diverging from cultural beauty ideals [42].
The importance of culture in determining willingness to date PWD, along with previous evidence that attitudes about dating PWD vary based on factors like age, gender, level of education and work and study background [16], suggests that bias against PWD is not innate, but subject to environmental influences. This underscores the potential for a wide range of population level strategies designed to produce cultural shift. Changes require far more than educating people about disability. For example, they require a heightened visibility of diverse PWD in public life and media, including portrayals of PWD in romantic roles and as sexually agentic, active and desirable. Despite the efforts of disability advocates, these types of portrayals are currently vanishingly rare [43].

Conclusion
The Convention on the Rights of Persons with Disabilities aims to promote full rights and inclusion, including the sexual rights, of PWD [44]. However, our research shows that PWOD continue to be reluctant to consider dating PWD. Urgent action is required to address social attitudes which limit sexual possibilities for PWD. Failing to address these attitudes places the responsibility of integration on the shoulders of PWD. Broad social change is challenging, however, if we are serious about ensuring the rights of PWD, these conversations are critical.