INTRODUCTION
Around the world, the field of special education has developed significantly in recent years, but specifically in the Kingdom of Saudi Arabia. The Kingdom of Saudi Arabia has sought to help people with disabilities by granting them rights in many areas, as well as establishing housing services aimed at increasing their quality of life by providing a supportive environment designed to meet their needs (Hassan et al., 2021). Taking care of special education groups has become necessary, as they have a right to access educational opportunities that are compatible with their capabilities. For special education programmes to be designed in a way that will meet the needs of people with disabilities, they should take into consideration economic, political, and social trends (Alshatti and Almursi, 2020). One of the most important priorities of special education is to establish specific standards for the services and programmes provided to people with disabilities in order to ensure the quality of those services reaches the required level (Merghany and Ibrahim, 2020). Housing and hospitality are among the services provided by the centres in which people with intellectual disabilities and autism spectrum disorders reside. A study by Ibrahim (2017) confirmed that the availability of residential environments is the most important psychological requirement for people with disabilities, and that such residential environments may address the necessary social determinants of health, which play an important role in improving the quality of life (Oliver et al., 2020).
It is important for families of those with disabilities to make decisions regarding where they live and how they should receive activities and programmes that affect their lives, by adapting the environment according to the type and severity of their disability (Connellan, 2015). Despite the efforts of educational decision-makers to establish organisations and institutions dedicated to people with intellectual disabilities and autism spectrum disorders, these organisations and institutions are deficient in their provision of services. Studies by Ahmad (2018) and Abdelaal (2018) confirmed that there is a disregard for meeting the needs of people with disabilities through initiatives such as residential services, including teaching everyday life skills to increase their independence. Accordingly, this study aims to determine the reality of housing and hospitality services for people with intellectual disabilities and autism spectrum disorders and to identify the strengths and weaknesses of these services from the perspective of their families and caregivers.
LITERATURE REVIEW
Although past studies have used the mixed-methods approach to explore this topic, none has done this with the aim of studying the positive and negative aspects of housing and hospitality services, which is the aim of the current study. For example, a study by McGill et al. (2006) aimed to uncover parents’ perceptions of the services their children receive in housing and hospitality centres. The results showed that parents were critical of the services and support they received before their children entered boarding education, as well as being unhappy with its distance from the family home, which had a significant impact on the frequency of visits. Likewise, Dunn et al. (2010) showed that alternative decision-making by housing staff is informed by their caring role and aim to assist residents with disabilities to live a “vibrant life”. In the same vein, the findings of Niemeijer et al. (2010) showed that the application and use of monitoring techniques in the residential care of vulnerable people generates significant ethical debate. This is corroborated in a later study by Niemeijer et al. (2015), which highlighted two recurring themes: adaptation to new spaces involving clients, and resistance to the use of surveillance technology because clients feel stigmatised and do not like being watched.
Previous studies have focused on adults with intellectual disabilities solely from the perspective of caregivers, while the current study participants are organised by age. Similarly, a study by Mushaharah and Kanaana (2011) concluded that housing and hospitality institutions focus on ensuring the presence of a healthy positive role model for children, represented by a guide playing the role of a father or an older brother, and a guide playing the role of a mother or an older sister. This previous study differs from the current study in that it did not specify whether or not the children concerned were disabled. A study by Alabadi and Aljabri (2015) found that the level of psychological security among the participants was average, and that there were no statistically significant differences in psychological security based on gender or on the type of disability among children with disabilities residing in housing and hospitality institutions and those enrolled in day-care programmes.
The results of the study by Hallrup (2014) indicate the need to pay attention to what adults with intellectual disabilities say about their daily lives when they live in a permanent residential care environment. The current study notes the lack of interest in the previous studies in nutritional programmes and physical activity as aspects of housing and hospitality services for people with intellectual disabilities and autism spectrum disorders. This is supported by a study by Chow et al. (2016) that found that housing and hospitality services may lead to a reduction in behavioural problems among people with learning disabilities and autism spectrum disorders; this was also supported by the results of a study by Sulaiman et al. (2016). The results of the study by Larson et al. (2012) state that 7 out of 11 studies of a meta-analysis reported that persons with learning disabilities who moved to community-based residential settings had statistically improved adaptive behaviour skills compared to those who remained in lodging and hospitality institutions. Of the 27 longitudinal studies, 15 reported a statistically significant improvement in adaptive behaviour. This has informed the current study’s understanding of the reality of housing and hospitality services for people with intellectual disabilities and autism spectrum disorders, along with their strengths and weaknesses in serving people in this category and their families. Sheth et al. (2019) highlighted that there are significant differences in how residential and community care experiences are rated, with reports of higher satisfaction, personal safety, and access to services in the community setting, confirming that there is an unexplored research gap in this regard, providing the rationale and motivation for this study.
METHODOLOGY
This study adopts an explanatory sequential design, a common research design within the mixed-method approach, which is based on using a combination of quantitative and qualitative methods, using qualitative data and analysis to interpret the results of the quantitative research stage (Tashakkori et al., 2020). To this end, a set of tools were utilised to understand all aspects of the studied phenomenon and to produce accurate results. Two tools, a questionnaire and individual semi-structured interviews, were used to collect quantitative and qualitative data. The study population consisted of all families of people with intellectual disabilities and autism spectrum disorders, and their caregivers. One housing and hospitality centre was chosen for the quantitative stage, from where the study sample was selected, based on the desire to participate, consisting of 42 families out of 48 and 14 out of 14 caregivers. For the qualitative stage, the sample was selected using purposive sampling, after the first quantitative stage had been carried out, where families and caregivers signed a form indicating that they were willing to participate, which had been distributed to them. The number of families willing to participate was seven, as well as five caregivers.
The study used a questionnaire to collect quantitative data, as this tool enables the researcher to collect as much information as possible and to explore scientific facts (Faiza, 2021). The closed portions of the questionnaire were prepared by the researchers in this study to learn about the opinions and attitudes of families of people with intellectual disabilities and autism spectrum disorders, and their caregivers. In addition, they sought to present the data in a clear way, as well as obtaining views on the provided housing and hospitality services held by families of persons with disabilities and their caregivers. To ensure the validity of the questionnaire, it was presented to five doctors who specialise in the field of special education for their opinions, until the final form of the tool was reached, which consisted of two parts, each with 12 questions. A five-point Likert scale was used, with each response given a corresponding score as follows: strongly agree (5), agree (4), neutral (3), disagree (2), and strongly disagree (1). To measure the reliability of the tool, Cronbach’s alpha coefficient (α) was used. The ratios of Cronbach’s alpha coefficient for the axes of the study were 0.729 and 0.647, which indicates that it had a high degree of reliability (Pallant, 2020).
The study used interviews to collect qualitative data, as this encourages the participants to have a dialogue and speak freely. In the interviews, the same areas as those mentioned in the questionnaire items were targeted, and open-ended questions formed for use in the individual semi-structured interviews. The interview questions were again presented to five doctors to obtain their opinions and recommendations, based on which some vocabulary was modified. The questions were then tested on the survey sample to verify their reliability and to ensure that the vocabulary was understood and that the interview questions were clear and appropriate. After consent had been obtained from seven families of persons with intellectual disabilities and autism spectrum disorders, and five caregivers to conduct and record the interview, an appointment was made with each participant to carry out the interview. The caregiver interviews were conducted in April 2022 at the same centre, during breaks at work. Based on the families’ desire to postpone their interviews, they were postponed until May 2022 and carried out remotely via Zoom due to the difficulty of conducting these in person, due to the distance between residences of the participants and the researchers in this study and their preference for this method. All interviews ranged between 30 and 47 minutes for each participant, both family members and caregivers. The qualitative data were analysed via thematic analysis using Braun and Clarke’s (2012) model, with the following stages: data preparation, data exploration, preliminary notes writing, data coding, and then summarising, analysing, and interpreting the results. Since the analysis process is iterative in nature and not linear, it depends on continuity and repetition; this is achieved by combining, analysing, and interpreting data (Sawan, 2018). To achieve reliability in this study, a set of methods and procedures were followed when collecting and analysing data, adhering to the standards of credibility, reliability, portability, and verifiability.
Ethical considerations were adhered to during the conducting of the study. The Internal Review Board approval at the Umm Al-Qura University for the use of human subjects was granted prior to conduct of the research and guidelines were adhered to throughout the research process. A consent form was also sent, signed, and returned via e-mail, by each participant. As part of this, a form was provided to participants containing information about the researchers, the aim of the study, and its contribution, to elicit consent to conduct the interview, giving them the freedom to choose an appropriate date for the interview, retaining the right to cancel, or, in the event of dissatisfaction with the interview on completion, to have their data deleted. In addition, care was taken to clarify that respect would be given to the privacy of the participants and that their names could be replaced with pseudonyms if they wished, and that the audio recordings would be destroyed upon research completion.
RESULTS OF THE QUANTITATIVE PHASE
Demographic data
Table 1 shows that the percentage of males (83.3%) is higher than that of females (16.7%). This may be attributed to parents’ assumption of responsibility for their sons/daughters with disabilities, and perhaps to the strength of their feelings towards disability and their families. In terms of age, the highest percentage (47.6%) of participants were between 30 and 49 years old; 38.1% were under 30 years old.
Detailed description of families of persons with intellectual disabilities and autism spectrum disorder according to their independent variables.
| Independent variable | Variable classes | Repetition | Percentage |
|---|---|---|---|
| Gender | Male | 35 | 83.3 |
| Female | 7 | 16.7 | |
| Total | 42 | 100 | |
| Age | Less than 30 years | 16 | 38.1 |
| From 30 to 49 | 20 | 47.6 | |
| Over 50 | 6 | 14.3 | |
| Total | 42 | 100 | |
| Qualification | High school and lower | 15 | 35.7 |
| Bachelors | 23 | 54.8 | |
| Higher studies | 4 | 9.5 | |
| Total | 42 | 100 | |
| Employment status | Working father | 12 | 28.6 |
| Working mother | 3 | 7.1 | |
| Working father and mother | 11 | 26.2 | |
| Working father/non-working mother | 14 | 33.3 | |
| Non-working father/working mother | 2 | 4.8 | |
| Total | 42 | 100 | |
| Income level per month | Less than 6000 SAR | 8 | 19.0 |
| From 6000 to 11,999 SAR | 19 | 45.2 | |
| Over 12,000 SAR | 15 | 35.7 | |
| Total | 42 | 100 | |
| Marital status | Married | 33 | 78.6 |
| Separated | 8 | 19.0 | |
| Widowed | 1 | 2.4 | |
| Total number of respondents | 42 | 100 |
The presence of an educated and understanding family helps to overcome many of the difficulties that may face people with intellectual disabilities and autism spectrum disorders. The results showed that the highest level of education for most families (54.8%) was a bachelor’s degree. The level of income is also key to a family’s ability to meet the needs of someone with intellectual disabilities and autism spectrum disorders, to help them acquire the skills needed to live independently. The income levels of the households ranged from 6000 to 11,999 riyals per month, with the highest proportion (45.2%) earning. The importance of the presence of both parents in the lives of people with intellectual disabilities and autism spectrum disorders is widely recognised, contributing to psychological stability. The divorce rate among participating families was not low, at 19.0%; this may affect the individuals concerned psychologically, and may make it difficult for effective communication to occur between the centre and the family.
Table 2 shows that the percentage of female caregivers (71.4%) is higher than that of males (28.6%). This is due to an increase in the number of female graduates of special education, and perhaps the speed with which they apply for vacant positions. As shown in the table, the most common level of educational qualification is a Bachelor of Special Education (78.6%), while two participants had a secondary educational qualification. This means that these two individuals have no prior experience. As for the experience variable, the most common response was 5 years or less, representing the largest proportion of participants at 92.9%. Two questionnaires were used to ask about housing and hospitality services, one to gain the perspectives of families of persons with intellectual disabilities and autism spectrum disorders, and one for their caregivers. Frequencies, percentages, means, and standard deviations were calculated for each of the two questionnaires. Regarding arithmetic averages, a five-point Likert scale was used.
Detailed description of caregivers in relation to the independent variables.
| Independent variable | Variable classes | Repetition | Percentage |
|---|---|---|---|
| Gender | Male | 4 | 28.6 |
| Female | 10 | 71.4 | |
| Total | 14 | 100 | |
| Qualification | High school | 2 | 14.3 |
| Special education diploma | 1 | 7.1 | |
| Bachelor of special education | 11 | 78.6 | |
| Total | 14 | 100 | |
| Years of experience | 5 years or less | 13 | 92.9 |
| Between 6 and 10 years | 1 | 7.1 | |
| 11 years or more | 0 | 0 | |
| The total number of respondents | 14 | 100 |
Regarding the main items as shown in Table 3, we see that items 1-3 have arithmetic averages of 3.60, 3.76, and 3.93. This indicates that the participants feel satisfied with the services provided to them, and with the level of privacy their son/daughter receives, and that the service provision has led to a reduction in the problematic behaviour of their sons/daughters. Item 11 achieved the highest arithmetic average, of 4.17; this indicates that the families’ perspective is consistent with the idea that housing and hospitality services contribute to alleviating the obstacles they may face. Item 6 achieved the lowest arithmetic average (3.07), indicating that the participants did not face problems with their sons/daughters adapting to housing and hospitality services. The arithmetic average for the item 4 was 3.33, indicating that the participants did not agree that their sons/daughters had acquired the skills necessary to live independently. Item 5 achieved an arithmetic average of 4.05, meaning that the participants agreed that the financial factor was important and was considered in the decision to enrol their sons/daughters in housing and hospitality services. It was also found that items 7-9 achieved arithmetic averages of 3.26, 3.10, and 3.36, indicating that the families had conflicting viewpoints regarding their difficulties in finding out about the development of their sons/daughters, their acquisition of basic skills that enable them to live independently, and the difficulty communicating with their sons/daughters and caregivers. Regarding the items 10 and 12, these had arithmetic averages of 3.55 and 3.64, respectively; this means that the families’ perspective confirms the positive impact of housing and hospitality services that contributed to the psychological stability of their sons/daughters, and their integration with society. In general, we see that the overall arithmetic average of the study tool designed for the families of people with intellectual disabilities and autism spectrum disorders was 3.568; this indicates that the participants were entitled to housing and hospitality services for people with intellectual disabilities and autism spectrum disorders from the perspective of their families; this will be further detailed in the qualitative analysis.
Housing and hospitality services for people with intellectual disabilities and autism spectrum disorders from the perspective of their families.
| Expressions | Average | Standard deviation | Degree level | |
|---|---|---|---|---|
| 1 | I am satisfied with the services provided to my son/daughter in the housing and hospitality centre. | 3.76 | 1.078 | Agree |
| 2 | Housing and hospitality services have a role to play in mitigating my son’s/daughter’s unwanted behaviour. | 3.60 | 1.037 | Agree |
| 3 | I am satisfied with the level of privacy and security for my son/daughter during the provision of services at the housing and hospitality centre. | 3.93 | 1.068 | Agree |
| 4 | I believe that the housing and hospitality services have contributed to my son/daughter’s acquisition of the skills needed to live independently. | 3.33 | 1.119 | Neutral |
| 5 | The financial factor was one of the factors that was considered when my son/daughter joined the housing and hospitality centre. | 4.05 | 1.011 | Agree |
| 6 | I had a problem with my son/daughter’s adaptation while he/she was resident in the housing and hospitality centre. | 3.07 | 1.135 | Neutral |
| 7 | I had difficulty finding out about the development of my son/daughter while services were being provided at the housing and hospitality centre. | 3.26 | 1.363 | Neutral |
| 8 | I had difficulty communicating with my son/daughter, or with their caregivers. | 3.10 | 1.376 | Neutral |
| 9 | My son/daughter has acquired skills that have a positive impact in his/her daily life while he/she is enrolled in the housing and hospitality centre. | 3.36 | 1.008 | Neutral |
| 10 | Housing and hospitality services have improved the psychological stability of my son/daughter. | 3.55 | 1.017 | Agree |
| 11 | Housing and hospitality services have contributed to alleviating the obstacles we face as working families. | 4.17 | 1.010 | Agree |
| 12 | Housing and hospitality services contributed to my son/daughter’s integration with society. | 3.64 | 1.032 | Agree |
| Total | 3.568 | 1.105 | Agree |
We note from Table 4 that item 2 obtained the highest average (5.00), and had a standard deviation = 0.000. This indicates that all participants strongly agreed with the statement, meaning that housing and hospitality services contributed to expanding their thinking through their dealings with people with all categories of disabilities. Items 1 and 3 achieved similar averages (both 4.64), which indicates that the participants strongly agreed with the statement that housing and hospitality services helped them to increase their experience in dealing with people with intellectual disabilities and autism spectrum disorders, and that the experience of working as a caregiver contributed to raising their job performance level. It was also found that the items 4-7 achieved arithmetic averages of 3.36, 3.29, 3.21, and 3.36, respectively. This means that the perspective of the caregivers was neutral regarding the difficulties they faced while providing services to persons with different severities of disability, and regarding the tools necessary during the provision of these services, in addition to the difficulties they encountered in communicating with service users’ families. Item 8 had an arithmetic average of 3.64, indicating that the caregivers were not in agreement regarding the difficulties they encountered while dealing with aggressive or non-verbal persons with disabilities. The arithmetic mean for item 9 was 4.86, with a standard deviation = 0.363, suggesting that the participants benefited from working in the housing and hospitality centre providing services for people with intellectual disabilities and autism spectrum disorders. Items 10 and 11 had arithmetic averages of 3.21 and 2.93, respectively, indicating that the caregivers’ views on the management of the accommodation and hospitality centre meeting their needs were neutral, and that it helped them as caregivers to achieve job satisfaction. Regarding item 12, this achieved an arithmetic average of 4.29, suggesting that the housing and hospitality centre helped the participants to form positive relationships with people with intellectual disabilities and autism spectrum disorders. Finally, the overall arithmetic average for the study tool directed towards caregivers was 3.869, indicating that the caregiver participants agreed regarding the need to provide housing and hospitality services to people with intellectual disabilities and autism spectrum disorders; this will be further detailed in the qualitative analysis. It is also shown in Tables 5 and 6 that the overall average from the perspective of caregivers was higher than the overall average from the perspective of the families of those with intellectual disabilities and autism spectrum disorders, which indicates the great benefit they derive from working with these people.
Housing and hospitality services for people with intellectual disabilities and autism spectrum disorders from the perspective of caregivers.
| Item | Average | Standard deviation | Degree of | |
|---|---|---|---|---|
| 1 | Housing and hospitality services have a role in increasing my experience in dealing with people with intellectual disabilities and autism spectrum disorders. | 4.64 | 0.497 | Strongly agreement |
| 2 | I see that my dealings with people with disabilities have contributed to expanding my thinking in terms of the diversity of disability groups. | 5.00 | 0.000 | Strongly agree |
| 3 | I see that working in housing and hospitality services is among the experiences that have contributed to raising my performance level. | 4.64 | 0.633 | Strongly agree |
| 4 | I see that the necessary tools are available according to the category and severity of disability during the provision of services. | 3.36 | 1.216 | Neutral |
| 5 | I have encountered difficulties with people with mild or moderate intellectual disabilities and autism spectrum disorders while providing services. | 3.29 | 0.825 | Neutral |
| 6 | I have had trouble communicating with the families of people with intellectual disabilities and autism spectrum disorders. | 3.21 | 1.251 | Neutral |
| 7 | I have had difficulty providing services in general. | 3.36 | 1.216 | Neutral |
| 8 | I have had difficulty dealing with people with disabilities who were aggressive or non-verbal. | 3.64 | 1.008 | Agree |
| 9 | I have benefited from my experiences in providing housing and hospitality services to people with intellectual disabilities and autism spectrum disorders. | 4.86 | 0.363 | Strongly agree |
| 10 | The management of the centre meets all my needs so that I can provide services to people with intellectual disabilities and autism spectrum disorders as a caregiver. | 3.21 | 1.369 | Neutral |
| 11 | The housing and hospitality centre has contributed to my achieving job satisfaction. | 2.93 | 1.328 | Neutral |
| 12 | The housing and hospitality centre has contributed to the formation of positive relationships between caregivers and people with intellectual disabilities and autism spectrum disorders. | 4.29 | 1.267 | Strongly agree |
| Total | 3.869 | 0.914 | Agree |
Results of the arithmetic mean and standard deviation regarding housing and hospitality services for people with intellectual disabilities and autism spectrum disorders from the perspective of their families.
| No. | Phrases | Arithmetic mean | Standard deviation | Grade level |
|---|---|---|---|---|
| 1 | I feel satisfied with the services provided to my son/daughter in accommodation and hospitality. | 3.76 | 1.078 | I agree |
| 2 | Accommodation and hospitality services play a role in mitigating my son’s/daughter’s unwanted behaviours. | 3.60 | 1.037 | I agree |
| 3 | I feel satisfied with the level of privacy and security of my son/daughter when receiving services in accommodation and hospitality. | 3.93 | 1.068 | I agree |
| 4 | I believe that accommodation and hospitality services have contributed to my son/daughter gaining the skills they require to live independently. | 3.33 | 1.119 | Neutral |
| 5 | Financial aspect was one of the factors taken into account during my son’s/daughter’s enrolment in accommodation and hospitality. | 4.05 | 1.011 | I agree |
| 6 | I had trouble adjusting to my son/daughter joining accommodation and hospitality. | 3.07 | 1.135 | Neutral |
| 7 | I had difficulty learning about my son’s/daughter’s development when receiving services in accommodation and hospitality. | 3.26 | 1.363 | Neutral |
| 8 | I had difficulty communicating with my son/daughter, or with caregivers. | 3.10 | 1.376 | Neutral |
| 9 | My son/daughter has acquired skills that will be instrumental in his or her daily life by joining accommodation and hospitality. | 3.36 | 1.008 | Neutral |
| 10 | Accommodation and hospitality services have helped stabilise my son’s/daughter’s mental state. | 3.55 | 1.017 | I agree |
| 11 | Accommodation and hospitality services have contributed to alleviating the obstacles facing us as working families. | 4.17 | 1.010 | I agree |
| 12 | Accommodation and hospitality services have contributed to my son’s/daughter’s integration into society. | 3.64 | 1.032 | I agree |
| Total grade | 3.568 | 1.105 | I agree |
Results of the arithmetic mean and standard deviation of housing and hospitality services for people with intellectual disabilities and autism spectrum disorders from the perspective of caregivers.
| No. | Phrases | Arithmetic mean | Standard deviation | Grade level |
|---|---|---|---|---|
| 1 | Accommodation and hospitality services have played a role in increasing my experience dealing with people with intellectual disabilities and autism spectrum disorder. | 4.64 | 0.497 | I strongly agree |
| 2 | I believe that my dealings with people with disabilities have contributed to the expansion of my thinking in terms of the diversity of disability groups. | 5.00 | 0.000 | I strongly agree |
| 3 | I believe that accommodation and hospitality services are among the experiences that have raised my level of performance. | 4.64 | 0.633 | I strongly agree |
| 4 | I believe that the necessary tools are available depending on the category and severity of the disability during the provision of services. | 3.36 | 1.216 | Neutral |
| 5 | I have had difficulties with people with mild or moderate intellectual disability and autism spectrum disorder while providing services. | 3.29 | 0.825 | Neutral |
| 6 | I have had trouble communicating with the families of people with intellectual disabilities and autism spectrum disorder. | 3.21 | 1.251 | Neutral |
| 7 | I have had difficulty providing services in general. | 3.36 | 1.216 | Neutral |
| 8 | I have had difficulty dealing with people with disabilities who were aggressive, or non-verbal. | 3.64 | 1.008 | I agree |
| 9 | I have benefited from my experience providing services to people with intellectual disabilities and autism spectrum disorder in housing and hospitality. | 4.86 | 0.363 | I strongly agree |
| 10 | The centre’s management provides all I need to provide services to people with intellectual disabilities and autism spectrum disorder as a caregiver. | 3.21 | 1.369 | Neutral |
| 11 | Accommodation and hospitality have contributed to my job satisfaction. | 2.93 | 1.328 | Neutral |
| 12 | Accommodation and hospitality have contributed to the formation of positive relationships between caregivers and people with intellectual disabilities and autism spectrum disorder. | 4.29 | 1.267 | I strongly agree |
| Total grade | 3.869 | 0.914 | I agree |
RESULTS OF THE QUALITATIVE PHASE
The researchers analysed the data collected in the individual interviews to obtain a detailed understanding of the reality of housing and hospitality services for people with intellectual disabilities and autism spectrum disorders. The individual interview tool was built based on the initial analysis of the questionnaire results to obtain more in-depth knowledge to help answer the research questions. The results of the qualitative analysis resulted in the identification of two main themes: family experiences and caregiver-related factors. Table 7 provides details of the family members of persons with intellectual disabilities and autism spectrum disorders who participated in the interviews.
Details of the family members of persons with intellectual disabilities and autism spectrum disorders who participated in the interviews.
| Pseudonym | Relationship with the participant | Place of interview | |
|---|---|---|---|
| 1 | Sadiq | Father | Zoom |
| 2 | Rayan | Father | Zoom |
| 3 | Reem | Mother | Zoom |
| 4 | Rakan | Father | Zoom |
| 5 | Dania | Mother | Zoom |
| 6 | Abdulaziz | Father | Zoom |
| 7 | Maha | Mother | Zoom |
Details of caregivers who participated in the interviews.
| Pseudonym | Role | Place of interview | |
|---|---|---|---|
| 1 | Sami | Caregiver | The centre for housing and hospitality |
| 2 | Rawan | Caregiver | The centre for housing and hospitality |
| 3 | Muhamad | Caregiver | The centre for housing and hospitality |
| 4 | Sarah | Caregiver | The centre for housing and hospitality |
| 5 | Danah | Caregiver | The centre for housing and hospitality |
Family experiences
In the interviews, the participating family members described their experiences with housing and hospitality services. The results of the analysis showed two key issues related to services provided for people with intellectual disabilities and autism spectrum disorders. First was the type of disability, where the results highlighted the diversity of disabilities among the beneficiaries of housing and hospitality services. For example, five of the interview participants’ sons/daughters had been diagnosed with autism spectrum disorders and two with a learning difficulty. One of the participants said: “My son is 11 years old and has a mild, not severe, autism spectrum disorder” (Sadiq, 1). Another family member expressed: “My son has been diagnosed with an autism spectrum disorder with a degree of severity between moderate and severe” (Rayan, 2). The second issue was the type of benefit obtained from the centre, where there were differences between its advantages and its disadvantages. Some of the benefits mentioned by the families included: “I noticed, only, that his concentration increased a little” (Sadiq, 1). Another family said: “I don’t see that they have a lot of faults, and my daughter is benefiting from the centre more than she does from me” (Dania, 5). It was also found that the benefit of the centre was low, which may be due to the difficulties that families faced in finding out about the development of their sons/daughters, and in communicating with caregivers. It may also be due to the difficulty their sons/daughters experienced in adapting to life in the housing and hospitality centre; for example: “…there are still some behaviours present, such as nervousness, which is normal for children with autism spectrum disorders, but my son is very nervous. So, the nervousness is still there, as well as sleep disorders” (Rakan, 4). One family member described their experience, saying: “The experience did not suit me or suit my son” (Abdul Aziz, 6).
The qualitative data also showed two negative aspects in relation to services provided in the housing and hospitality centre: first, families complained about constant change and second, the scarcity of specialists. These two obstacles are among the most important that face people with intellectual disabilities and autism spectrum disorders in regard to the housing and hospitality centre and its interventions; in particular, the scarcity of specialists reduces the benefit the users derive from the services provided. In this context, one of the families mentioned the negative impact of continuous change, saying: “I see that the specialists change a lot, which is a problem” (Sadiq, 1). Another family member confirmed: “I have noticed that they change. I mean, sometimes the supervisor is with you and gives you her phone number so that you can communicate with her and ask about your child, then that woman leaves her job” (Reem, 3). One of the family members gave some examples related to the scarcity of specialists: “I see that the numbers are too high for the supervisor and the caregivers—nine students in one place is difficult for them to be able to control them. For us as mothers, just one child is hard to control” (Reem, 3). Another family member said: “They have a speech specialist here. They should increase the staff as much as they can to get results” (Maha, 7). In addition, the lack of specialists has a significant impact on people with intellectual disabilities and autism spectrum disorders in terms of unwanted behaviours, as mentioned by one of the family members: “Safety is very challenging, especially if the number of students is large and they need more follow-up” (Rayan, 2). Another family member confirmed: “My son, the last time I met him he had both of his eyes closed; he’d had a blow on his eye that had caused a wound to his cornea. I took him and he sat for a day and a half with his eyes closed” (Abdulaziz, 6).
The qualitative data highlighted two weaknesses in the training facilities that are intended to equip people with intellectual disabilities and autism spectrum disorders with essential skills, namely: weak training programmes, and inaccuracy in treatment the behaviours of people with intellectual disabilities and autism spectrum disorders. One of the families provided examples of the weakness and lack of diversity in the training programmes. This explains the decrease in the use of the housing and hospitality services that are provided, and may cause a decrease in residents’ social interaction, as indicated in the following quote: “When they send me the schedule each week, I do not see that there are any intensive programmes on it, and the behaviours have not changed” (Sadiq, 1). This was also indicated by another family member, who said: “Training programmes are not offered at all, nor is there anything suitable” (Reem, 3). As for the lack of accuracy in following up the behaviours of people with intellectual disabilities and autism spectrum disorder, it may lead to the continuity of unwanted behaviours, and also increases residents’ acquisition of these behaviours. One of the family members mentioned this, saying: “For example, he goes to the bathroom and turns on the water—with me, he doesn’t do this. They write to me that it is one of his negative behaviours, that he jumps on the bed, turns on the water and plays with it, but with me he doesn’t do it” (Dania, 5). Another family member said: “My daughter knows the bathroom, even when we go to the mall and ask her: What do you want? She points to her belly and says, ‘I want to go to the bathroom’. Now, when I take her away from the centre, I’ve found that she does it on herself” (Maha, 7).
The results of the interview analysis also revealed the families’ experiences of housing and hospitality services, and they provided examples and comments regarding the positive benefits they derived while their sons/daughters were at the housing and hospitality centre and receiving care, weekly reports, and a nutritional programme designed for people with intellectual disabilities and autism spectrum disorders. The qualitative data showed a pattern of caring for people with intellectual disabilities and autism spectrum disorders, specifically in regard to personal care, which improves their psychological well-being and enhances their self-confidence. One of the family members mentioned: “My daughter got better, and they took care of her appointments and her personal hygiene” (Dania, 5). Another family member said: “They are interested in my daughter and her cleanliness and mentality” (Maha, 7). Regarding the weekly reports, their importance for families lies in knowing about the development of their sons/daughters from social, health, educational, and rehabilitative perspectives. This was referred to by one of the family members, who said: “The most wonderful thing, frankly, is that they send us weekly reports” (Reem, 3). Another mentioned that, “They are not lacking, they send a report about my daughter every week and I see how much she has improved” (Dania, 5). One of the family members gave examples of how food programmes are provided, which is of great importance to the health of people with intellectual disabilities and physical autism spectrum disorders, in their experience with the housing and hospitality centre, summed up in the following quote: “The programmes they have are wonderful, such as those related to diet and the care they take with children’s meals” (Sadiq, 1). Another family member said: “The programme that is prepared, honestly, is a beautiful programme. They have lunch and dinner currently” (Rakan, 4).
The results of the interview analysis regarding the negative aspects that families encountered while their sons/daughters were enrolled at the housing and hospitality centre revealed the following issues: level of progress of persons with intellectual disabilities and autism spectrum disorders, the type of intervention needed, and general dissatisfaction. In regard to the level of progress, the data showed two patterns of change resulting from housing and hospitality services, namely: the lack of linguistic development, the importance of which lies in this group’s ability to express their needs, where a lack of development reduces the benefit they derive from the services. The data also showed a decrease in the language development of persons with intellectual disabilities and autism spectrum disorders, reported by all the families that were interviewed. One of the family members mentioned: “Up to now, the aspect of pronunciation and speaking has not changed” (Ryan, 2). In another example, an interviewee said: “My daughter is not lacking in anything except for speaking. When she came to me on Eid, she relapsed, as if she did not know how to speak” (Maha, 7). The lack of development among those with intellectual disabilities and autism spectrum disorder is a reason for the frustration and disappointment of family members on behalf of their sons/daughters. Relevant quotes include: “When she came home for Eid, I did not see any development, even with me at home, I did not see the correct development” (Reem, 3); “By Allah, I did not see any development, and I am a sensitive person in terms of my son, and I did not see any development in him. I honestly saw things that he had regressed in, and his bad behaviour increased, which he had not displayed before” (Abdulaziz, 6).
The qualitative data also highlighted medical intervention as the most important type of intervention. Giving an example of an incorrect medical intervention, a family member said: “I took my child to the hospital, and they said this treatment is not used anymore except for those whose condition is severe and who have hyperactivity. My son does not have hyperactivity; he loves to play and move around, which is normal, but he is not aggressive—rather, the opposite. The doctor told me they have stopped this treatment” (Abdulaziz, 6). Another family member said, “My son only has speech therapy, and I brought him to the centre so that he can benefit from this medical diagnosis, because hospitals are not negligent” (Sadiq, 1). The data further revealed two main types of dissatisfaction with housing and hospitality services, namely: the superiority of other centres, which may be because this centre is new and has not been fully completed; and a pattern of difficulty in communicating with caregivers, which indicates families’ lack of participation in the education, training, and rehabilitation of their sons/daughters. Giving an example of the superiority of other centres, one family member said: “My friend praises the centres in the Emirates and says there is a difference; he says about his children that they did not go to the bathroom, but after a while they changed. I went to the autism academy in Jordan and the same situation has developed, and you notice this within a short period. Why are we less than Jordan and the Emirates?” (Ryan, 2). Another example was given: “Autism requires them to be busy, and not have free time. Before Covid-19, I used to take her to the Assiut Governorate in Cairo. I only stayed for a short while, despite their capabilities and tools, but I got a better result than in the five years I spent here in Saudi centres” (Maha, 7). The analysis of the interviews also indicated an increase in communication difficulties for six out of seven families. This is considered one of the biggest problems with housing and hospitality centres that families face: “The problem is that communication between us is almost non-existent” (Reem, 3). “The administration enters us into a group, and the only ones who can talk are the supervisors. There is the supervisor of the residence, but if we call or send a message today, only after three days will I receive a reply” (Abdulaziz, 6).
Caregiver-related factors
In the interviews, carer participants shared their experiences of working in the housing and hospitality centre, providing examples of and comments about carer-related factors related to cognitive awareness, agency beliefs, and experience. Figure 1 shows the categories and codes resulting from the analysis of interviews related to caregivers working in the housing and hospitality centre. The qualitative data showed a pattern of increased cognitive awareness resulting from work in housing and hospitality, related to the needs of people with intellectual disabilities and autism spectrum disorders. The increase in cognitive awareness that appeared was evident in five caregivers through their knowledge of the needs of the service user group in all educational, rehabilitative, and psychological dimensions. The following aspects in particular were highlighted in the data. First, interest in understanding the personality of people with intellectual disabilities and autism spectrum disorders: “They have difficulty communicating what they want. If they want something, they have difficulty communicating their desires. Some of them express this very simply, using one word, and some express it by shouting. You must be able to know and understand this person and what exactly they want” (Mohamed, 3). Second, understanding their needs through dealing with them: “The first need is balance in dealing with the beneficiaries, and the second need is know what the beneficiaries want, even without them asking. You know when he needs to eat, even if he does not express his hunger when does he need to drink, and when does he need to use the toilet” (Rawan, 2).
Results of analysis of interviews related to caregivers while working in housing and hospitality.
The qualitative data showed a pattern of efficacy beliefs, which includes the ability to deal with people with intellectual disabilities and autism spectrum disorders, and this pattern appears in the methods of dealing with them. One of the caregivers described how they deal with this group: “There are people I come to with incentives: if you do this thing, I give you biscuits. For others, no, they must know that your personality is strong—this is for autism, they will not give up. For example, if they throw down a chair, you cannot stop asking until they return it to its place. If they do not, then you must hold them by the hand, even if they cry. The most important thing is to do what you want. Children with intellectual deficiencies are loved, but they are stubborn. I mean, they do whatever is in their heads, so we must tighten them up a little bit” (Rawan, 2). Another interviewee described the diversity of ways to deal with different groups of disabilities: “Dealing with intellectual deficiencies is completely different from dealing with autism. With autism, we use certain methods that are different to those we used with people with intellectual disabilities. We must be patient with autistic service users and not deal with them in a random way, because they need routine and any change can affect our ability to deal with them” (Sarah, 4).
The qualitative data showed three types of experience related to the knowledge and skills the caregivers acquired from working in the housing and hospitality centre. The themes were: gaining new experience, previous experience, and tools that help people with intellectual disabilities and autism spectrum disorders to acquire necessary life skills. The analysis of the interview data showed a difference in the educational qualifications of all caregivers, which ranged from qualifications in intellectual disability, intellectual difficulties, kindergarten, family education, as well as high school graduates. One of the caregivers provided an example of gaining new experience, explaining that: “It is how I deal with every child and every situation, whether autistic or intellectually disabled, and how I distinguish between them” (Dana, 5). In another example, a caregiver stated: “I have gained a lot of experience. I am a graduate from the Covid-19 era, an intellectual disabilities major. I did not do practical studies right away, and I gained a lot of experience in how to deal with these service users” (Sarah, 4). One caregiver referred to their previous experience: “I mainly have people outside of work who are autistic, who I have dealt with before” (Sami, 1). Another mentioned the role of their previous experience in their knowledge of relevant strategies: “I have longstanding experience in dealing with people with disabilities, and I know what strategies can help them in their learning” (Rawan, 2). The results of the interview analysis also highlighted the availability or lack of tools, which may help caregivers to more easily communicate a skill or activity to people with intellectual disabilities and autism spectrum disorders. For example, “Tools were not readily available, which caused difficulties for many activities that were not available or appropriate to their capabilities; this was the most challenging thing for us” (Sami, 1). It appears that caregivers had difficulty in providing the necessary tools; some of them may purchase these themselves in order to teach skills to people with intellectual disabilities and autism spectrum disorders in the required manner, though “It is not always necessary that we provide the tools in order to do the thing that I want to teach” (Muhamad, 3).
DISCUSSION
The interviews revealed a discrepancy in the type of housing and hospitality services that are provided to and utilised by people with intellectual disabilities and autism spectrum disorders. This is also indicated in the quantitative results through the arithmetic averages, as there was agreement and neutrality on the statements related to the services provided. Families provided justifications for their sons/daughters not benefiting from housing and hospitality services, the most important of which was that undesirable behaviours were still shown by their sons/daughters. This may affect families’ demand for the centre and its services. These results are consistent with the study by McGill et al. (2006), where the results also highlighted the need for specialist equipment, especially training equipment, and with the study by Sulaiman et al. (2016), which indicated the impact of training programmes on improving behaviour and reducing unwanted behaviours among people with disabilities residing in housing and hospitality centres. The findings of the current study are in line with the study by Niemeijer et al. (2010) regarding the importance of using monitoring devices in housing and hospitality centres for people with disabilities, and with a later study by Niemeijer et al. (2015) in terms of the need to help people with disabilities adapt to new spaces, where they might be wandering, getting lost, and rushing. This was indicated in the quantitative results.
The results of the interview analysis also revealed the ability of caregivers to build knowledge and increase their understanding of the needs of people with intellectual disabilities and autism spectrum disorders. All caregivers reached the level of decision-making in how to deal with this group of users during their time at the housing and hospitality centre, and they benefited from learning about the diversity of methods for dealing with this group. It also appeared from the results of the interviews that previous experience plays a major role in this. This corroborates the findings of Dunn et al. (2010). All of these suggest that the reality of housing and hospitality services from the perspective of families is closely related to the availability of equipment that helps people with intellectual disabilities and autism spectrum disorders to live independently and reduces unwanted behaviours.
The results also showed that there are positive benefits to housing and hospitality services for people with intellectual disabilities and autism spectrum disorders, which positively affect their psyche, as confirmed by the families during the interview. These results support what was indicated by study by Hallrup (2014) of daily caring for people with disabilities when they join a housing and hospitality centre. This was indicated by the quantitative results. In the interviews, the families expressed their satisfaction with the weekly reports and nutritional programmes offered to people with intellectual disabilities and autism spectrum disorders. The findings agreed with those reported in the study by Mushaharah and Kanaana (2011), which indicated that housing and hospitality centres focus on modifying the behaviour of people with disabilities through the use of a positive model that is followed by and used with this group, in which the caregivers play the role of a big brother or sister. The results of the interviews revealed that there are some difficulties that may affect the provision of services for people with intellectual disabilities and autism spectrum disorders and cause dissatisfaction for their families, falling into three themes: a low level of progress for people with intellectual disabilities and autism spectrum disorders; a lack of development, especially linguistic development, possibly due to caregivers’ lack of sufficient experience in the field of special education and educational qualifications; and errors, where the wrong medical interventions are applied, a major reason for families’ aversion to using the housing and hospitality service. These findings support those reported in the study by Larson et al. (2012).
CONCLUSION
After analysing the data and discussing the results of the study in relation to its objectives, several recommendations are put forth. First, meetings should regularly be held between the families of persons with disabilities and their caregivers so that their family can find out about their son’s or daughter’s development. In addition, a timetable should be used to coordinate the communication between families of persons with disabilities and their caregivers. There is also a need to hold intensive training courses for caregivers in special education to raise their level of competence and to provide them with experiences and skills that better equip them to deal with persons with various categories of disability. These programmes should focus on rehabilitation and preparation for caregivers, and on qualifying and preparing staff to care for different groups. In addition, more studies should be conducted on special education centres—especially housing and hospitality centres—with particular regard to problems and solutions. There is also a need to increase the number of caregivers and supervisors employed in housing and hospitality centres in order to reduce the burden on them and enable them to focus on meeting the needs of people with intellectual disabilities and autism spectrum disorders. To this end, there is a further need to provide the necessary tools and means for caring for individuals with different categories of disability. Finally, caregivers should employ technologies and devices in education, training, and rehabilitation to help equip people with intellectual disabilities and autism spectrum disorders with the necessary skills to live independently.