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Acceptance of dog guides and daily stress levels of dog guide users and nonusers.

Abstract: The degree of acceptance of dog guides at public facilities, which is required by law in Japan, was investigated, and evidence of rejection was found. Japanese people with visual impairments who used dog guides reported higher daily stress levels than did those who did not use dog guides.

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As of July 2006, only 958 dog guides were working in Japan (National Federation of All Japan Guide Dog Training Institutions, 2006b). This number is relatively small compared with the number in Western countries. For example, there are more than 8,000 working dog guides in the United States and more than 4,600 in the United Kingdom (National Federation of All Japan Guide Dog Training Institutions, 2006a), Moreover, the number of working dog guides in Japan is small compared with the estimated 7,800 people with visual impairments who want to use dog guides (Research Committee on Dog Guides, 1998). Although almost half the people with visual impairments in Japan have no habit of going out, 30.2% go out "every day" and 26.6% go out "a few times a week," but only 33.6% of those who go out do so by themselves; this figure is the lowest of any group of people with disabilities in Japan (Ministry of Health, Labor, and Welfare, 2002). This situation may be partially accounted for by the disparity between the number of working dog guides and the number of people with visual impairments and may therefore be countered by the introduction of new methods for training and promoting dog guides.

Many advantages of dog guide use have already been demonstrated. The walking speed of a dog guide user is almost the same as that of sighted people (Clark-Carter, Heyes, & Howarth, 1986), and new dog guide users go out more frequently, enjoy going out, and relate to the community much more than before they obtained dog guides (Research Committee on Dog Guides, 1998).

In Japan, many refusals of access to ryokan (Japanese-style hotels), restaurants, and public transportation by people who use dog guides have been reported, in spite of the government's notice of acceptance (Committee for the Promotion of Assistant Dog Development, 2002; Research Committee on Dog Guides, 1998). As a result of efforts by users of assistance dogs (defined as dog guides, service dogs, and hearing dogs for people with physical impairments) and others, the Law Concerning Assistance Dogs was passed in 2002 (Japan Minister of Health, Labor, and Welfare, and Prime Minister, 2002). One of the main purposes of this law is to enable people with disabilities to lead independent and fulfilling lives as active members of the society. To achieve this goal, the law requires highly public facilities, such as national institutions and public transportation, to allow access to people with physical impairments who are accompanied by assistance dogs. In 2003, one year after the law's initial enforcement, the facilities included under this law were widened to include those that are accessible to the general public, such as hotels, restaurants, and department stores. (Author's note: The 2003 amended law was revised a second time in April 2008, and it will be executed in October 2008. The new legislation requires employers who employ more than 56 people to accept assistance dog users as employees.)

In the wake of the new law, it is expected that refusals of access have decreased in number and that accessibility for people with physical impairments has improved. However, the law requires only that people with physical impairments who are accompanied by assistance dogs be allowed access to the facilities, and there are no penalties for violating the law and no remedial agencies. Therefore, the present situation concerning accessibility for people with physical impairments accompanied by assistance dogs needs to be definitively ascertained.

To investigate the effect of the 2003 law, we conducted research on the degree of acceptance of assistance dogs since the law was passed. Three groups were polled: users of assistance dogs, owners of facilities that are obliged to allow entry to users of assistance dogs, and members of the general public who do not own assistance dogs. The study presented here was a part of this larger research and investigated the degree of acceptance of dog guides in Japan. Furthermore, we compared the stress levels of people with visual impairments who use dog guides with those of people with visual impairments who do not use dog guides, to ensure that the law has been effective in improving the lifestyles of dog guide users.

As per the stated purpose of the law, the daily stress levels of dog guide users are expected to be lower than those of nonusers with visual impairments. Matsunaka (1997) investigated three factors that affect the daily stress levels of people with visual impairments: "mobility and asking for help situations," "disturbing and conflicting situations," and "with- sighted-people situations." The participants in Matsunaka's survey were not dog guide users, and most of them were found to feel stress when walking. Given the many advantages of the use of dog guides, the level of mobility stress of guide dog users would be lower than that of nonusers if dog guide users are adequately accepted in the community.

Method

PARTICIPANTS

Of the 110 dog guide users who were invited to participate, 33 agreed to participate. The data for 30 of the 33 users were analyzed; the others were excluded because of missed answers. The 30 participants, 13 men and 17 women, ranged in age from 19 to 67 (mean age: 48.9 years). Of the 51 nonusers who were invited to participate from among students, aged 15 and older, at a school for people with visual impairments, all agreed to participate. The data for 50 of the 51 participants were analyzed; the remaining student was excluded for missed answers. The nonusers, 31 men and 19 women, ranged in age from 15 to 35 (mean age: 19.2 years).

QUESTIONNAIRES

Acceptance of dog guides

The questionnaire listed 16 kinds of facilities: hotels, ryokans (Japanese-style hotels), hospitals, clinics, restaurants, department stores, supermarkets, both food and nonfood retail stores, convenience stores, airlines, railroad companies, buses, taxis, amusement facilities, and educational establishments. Each facility was followed by a set of choices to be selected, based on the participants' experience of being accepted or rejected with their dog guides over the previous 12 months: "rejected," "conditionally accepted," accepted" and "no experience of use." The participants were asked to choose the relevant response for each answer. Reasons for rejection and conditions for acceptance were also solicited, when applicable, in the form of open-ended questions for each facility.

Increasing the acceptance of dog guides

The dog guide users were also asked to select up to three factors that might increase acceptance of dog guides from a list of eight possible choices: improvement of each facility's equipment, an increase in the number of employees, scientific evidence that there are no hygiene problems associated with dog guides, a greater number of dog guides, governmental assistance for each facility, public education to improve the general understanding of guide dogs, improvement in the users' manners, and "other."

Stress Checklist for People with Visual Impairments

Both the dog guide users and the nonusers were asked to rate their level of stress for each item in the Stress Checklist for People with Visual Impairments (SCLVI), described in Matsunaka (1997), on a 5-point scale (1 = not at all, 2 = not very, 3 = fair, 4 = stressful, and 5 = very stressful). If a participant did not experience the situation indicated by an item, he or she was asked to choose "not experienced." SCLVI has 3 categories: situations involving going out and asking for help ("mobility"), situations involving conflict and frustration ("conflicting"), and situations involving sighted people ("with sighted"). The first two categories consist of 10 items each, and the third consists of 4 items. The items listed under the mobility category include "when you have to go out to unfamiliar places by yourself," "when you have to ask for help while walking outside," "when you are lost," and so on. The conflicting category includes "when you are meddled with by your friend," "when you are pressed to talk about your worries," and "when you pretend to understand something that you don't actually understand." The with-sighted category includes "when you are looked at while you are using a cane," "when you go shopping with sighted people," and "when you go to meetings attended by many sighted people."

PROCEDURE

The research followed the tenets of the Declaration of Helsinki and the Ethical Codes of the Japanese Psychological Association. Approval for conducting the research was received from the Committee for the Promotion of Assistant Dog Development, Tokyo, and by the presidents of the dog guide users' associations and of the school that the volunteer participants attended. All the participants were given explanations about the aim of the study and were informed that their answers to the questions were for research purposes only by the teacher of the school or the presidents of the dog guide users' associations. Only students aged 15 and older and members of the associations who agreed to the terms of the study participated.

The questionnaires were distributed to the participants in November 2004, one year after the assistance dogs law was amended. The nonusers were given questionnaires at their school after they had received information about the study and agreed to participate. All the questions were read aloud and were answered in braille or in written script, according to the participants' preference.

Consent from participants who were dog guide users was received through the All Japan Guide Dog Users Association, and the questionnaires were e-mailed to these individuals. Only the dog guide users were asked to assess the level of acceptance of dog guides in each of the 16 types of facilities covered under the 2003 law and to judge the need to promote the acceptance of dog guides. Since we did not work for the schools at which the participants were trained, it may be assumed that we did not affect the results.

The percentages of choices selected on the Dog Guide Acceptance questionnaire were calculated for each facility to investigate the level of acceptance in detail. With regard to the stress scores, each category's scores were averaged (the "not experienced" responses were excluded from this process); higher average scores indicate higher stress levels. Mann-Whitney U tests were conducted for each subscale of SCLVI. The analyzed sample of nonusers for the with-sighted category scores was 48 because of some missing data caused by missed answers.

Results

The extent of dog guide acceptance, which was rated by the users for each facility, is shown in Table 1. The dog guide users reported that the facilities that least accepted dog guides were restaurants, followed by taxis and ryokans. Although a hotel is the same as a ryokan in terms of accommodations, when the two were compared in terms of simple descriptive statistics, the rejection rate of hotels seemed to be lower than that of ryokans. Department stores were also reported to have a low rejection rate, but their acceptance of dog guides was usually conditional. Convenience stores and educational facilities were perceived to have the same rejection rate as department stores, but the rate of conditional acceptance of department stores was reported to be correspondingly high. Hotels, supermarkets, railways, and buses were reported to have high acceptance rates without any conditions. On the other hand, many dog guide users had no experience trying to use amusement facilities and ryokans.

Although dog guide users stated that the most common reason for rejection given by restaurant owners was the perceived nuisance to other customers, some dog guide users reported being told that it was a hygiene issue and that some restaurant owners stated that their establishments did not dare to accept people with dogs. Another common reason for refusal that hotels, ryokans, and taxis gave to the dog guide users was the amount of hair shed by dog guides. Some of the conditions requested by owners of such facilities before they granted entry to the guide dogs were the presence of an accompanying family member, keeping the dog guide outside while the user was inside, clothing the dog guides, and using a mat under the dog guide.

Before we compared the stress levels of the two groups of participants (dog guide users and nonusers), it was necessary to confirm that the age differences between the two groups has no effect on stress levels. To assess the relationship between age and stress levels, we calculated rank correlation coefficients between age and each category's daily stress score for all the participants. No significant correlation coefficients were found (mobility, r = 0.10, p = .082, n = 80; conflicting, r = -0.18, p = .101, n = 80; and with-sighted, r = -0.13, p = .279, n = 78).

The means and standard deviations (SDs) of SCLVI are shown in Figure 1. Although stress levels associated with the conflicting and with-sighted categories were almost the same for users and nonusers, mobility stresses were higher for users than for nonusers. To investigate the effect of using dog guides on scores for each stress subdivision, we conducted Mann-Whitney U tests between the two groups for each score. We found a significant difference in the mobility score (z = 2.208, p = .027), but not in the conflicting and with-sighted scores (z = 0.532, p = .595, and z = 0.954, p = .340, respectively). There were two or fewer answers of "no experience" for a few items in the mobility category; most of the items in this category had no answers of "no experience." In addition, we calculated mean scores and SDs for each item in the mobility category of each participant group to examine the stressful aspects of mobility in detail. In group comparisons, all the mean stress scores of the users were higher than those of the nonusers (see Table 2). Mann-Whitney U tests showed significant differences in three of the mobility items, indicating that rainy days, lavatories, and going to distant places were stressors for dog guide users.

[FIGURE 1 OMITTED]

Table 3 presents the factors that the dog guide users judged were crucial for promoting the acceptance of dog guides, chosen as up to three choices from the eight that were offered. The majority of users indicated that they perceived the need for public education to foster general understanding (76.3%) and for improvement in users' manners (71.1%). Half thought that governmental resources for each facility were also necessary.

Discussion

The first purpose of the study was to investigate the level of acceptance of dog guides after the 2003 law was passed. Since the study was conducted one year after the law was enacted, we expected that there would be a high level of acceptance at all the facilities that were included in the questionnaire. The results showed that rejections still occur, especially at restaurants, ryokans, and taxis. They suggest that owners of facilities, such as restaurants, that deal with food are concerned about the perceived hygiene risks that are associated with dog guides and that some hospitals and clinics granted only conditional acceptance because of this hygiene issue. Before the law was passed, it is likely that the users would have been rejected if they had gone to hospitals. In this case, even "conditional acceptance" can be considered an improvement. The law stipulates that the duty to accept dog guide users does not apply to cases in which dog guides harm the concerned facilities. It is difficult to judge from the findings whether entry should have been rejected on hygiene grounds but was permitted for other reasons or should have been accepted unconditionally. Both users and nonusers should understand the law with regard to whether a case should be accepted.

A third of the dog guide users selected scientific evidence that no such hygiene risks are posed, as a way to promote the acceptance of dog guides. Since dog guide users eat out and go to hospitals, they should be accepted without any conditions. On the other hand, facilities probably need some new resources to accept dog guides. Necessary resources may include information about dog guides and the law because many employees in facilities with a duty to accept dog guide users may assume that financial resources are required. In fact, only 25.7% of the employees of facilities knew both the content and the name of the law, and 46.1% of them knew only the name (Matsunaka & Koda, 2005); in other words, almost a third of them did not know even the name of the law. This finding suggests that information about dog guides is so lacking that many facilities are not ready to accept them. As for ryokans and amusement facilities, more than half the participants had no experience with them. Many users may have been discouraged from visiting ryokans because ryokans are known to have rejected dog guide users. Thus, users may dismiss the notion of using certain facilities before they have visited them. Considering the data, which show that almost half the people with visual impairments have no habit of going out, and the increased quality of life of dog guide users (Ministry of Health, Labor, and Welfare, 2002), it is necessary to facilitate the use of dog guides in every aspect of daily life.

The second purpose of the study was to compare the stress levels of dog guide users and nonusers. One purpose of the law is to foster the use of facilities by people with disabilities. If dog guide users were accepted adequately, the use of dog guides would increase, and the mobility of people with visual impairments could be enhanced. For this reason, we predicted that stress levels would be lower in dog guide users than in nonusers. The results, however, suggested the opposite; that is, the mobility stress rating of dog guide users was higher than that of nonusers. It is possible that there were other causes for greater stress than refusal at some facilities, but insufficient social acceptance is probably one cause.

In particular, the results showed that it is more stressful for dog guide users to go out on a rainy day, use a lavatory, or go on an outing than for nonusers. These situations are also considered to be stressful for nonusers and even for sighted people. However, some experience of being rejected may have caused the users to worry and feel stress in such situations. Some users are considered so careful to avoid being rejected because of accompanying dog guides that they feel considerable stress when they go out. Many of them do all kinds of things to avoid shedding by their dog guides, such as clothing them, and to avoid turning their dogs' faces toward people out of a concern about the dogs' running noses and salivating. It could not be determined whether the dog guide users who participated in this study were concerned about their dogs' behavior, although if they were, it would help explain their higher stress levels.

Problems with acceptance of dog guides are often connected with owners of facilities who are not dog guide users. Some employees are concerned that clients of their facilities may be bothered by the dogs and therefore will hesitate to use their facilities again. But if the dog guide users maintain good conditions of hygiene and keep their dogs' behavior under control, they are more likely to be accepted. Thus, the level of acceptance can be improved not only by changes in circumstances external to dog guide users, but by the users' own behavior. The law prescribes that users have a duty to ensure the hygienic condition and to control the behavior of their dog guides. Since the majority of the dog guide--using participants realized that users' manners were important for promoting acceptance, it is considered to be important and effective for users to be more conscious of their duty to their dog guides.

Although there are numerous problems regarding the acceptance of dog guides in Japan, many advantages of dog guide use have also been recognized. The advantages in traveling are not only greater speed (Gitlin, Mount, Lucas, Weirich, & Gramberg, 1997; Steffans & Bergler, 1998), but compensation for noise and the muffling effect of snow that interfere with the critical auditory component of travel orientation (Gitlin et al., 1997), early warning of obstacles to help avoid them, and safer ways of solving problems (Steffans & Bergler, 1998). These effects reduce tension and strain and allow users to be more relaxed when walking. Dog guide use has a positive effect not only on mobility, but on the quality of life and social interactions of dog guide users. Acquiring dog guides decreased users' feelings of helplessness, renewed their confidence (Sanders, 2000), and improved their perception of the quality of their lives (Refson, Jackson, Dusoir, & Archer, 1999). Dog guides are effective in initiating conversations in social situations (Gitlin et al., 1997) and in increasing social contact to enhance mental and physical well-being (Refson et al., 1999). Considering all these effects of dog guides, it is worthwhile for users to review their duties toward and the actual conditions of their dog guides. Doings so will also foster their acceptance at the facilities mentioned in this article.

There has been progress in the external conditions of dog guide users. Requests have been submitted to the government to make it a duty of employers and landlords to accept assistance dog users as employees or occupants, since the government has issued only a notice of acceptance to these parties. This notice is considered to be inadequate because many instances of rejection are still reported in these situations. Moreover, it is important to develop an effective method of education. Enlightening stickers have already been put on the entrances of almost every facility with a duty to accept, but what is needed is further comprehensible information about dog guides.

Conclusion

The study showed that the acceptance of dog guides in all 16 types of facilities that were included in the study is insufficient and that the mobility stress levels of dog guide users are higher than those of nonusers, especially when the users go out on a rainy day, use a lavatory, or go on an outing. The findings suggest that the important role of dog guides will be facilitated by greater publicity about the law on the acceptance of dog guides (not only the name of the law, but its content) and the public seeing dog guide users fulfilling their duties.

The authors thank all the participants and volunteers, especially Mr. K. Shimizu of the All Japan Dog Guide Users Association, for their kindly cooperation. The research on which this article was based was funded by Sumitomo Life Insurance Company and commissioned by the Committee for the Promotion of Assistant Dog Development.

References

Clark-Carter, D. D., Heyes, A. D., & Howarth, C. I. (1986). The efficiency and walking speed of visually impaired people. Ergonomics, 29, 776-789.

Committee for the Promotion of Assistant Dog Development. (2002). Assistant dog fukyuu to rikai ni mukete [Assistance dog report for the popularization and understanding of assistance dogs]. Tokyo: Author.

Gitlin, L. N., Mount, J., Lucas, W., Weirich, L. C., & Gramberg, L. (1997). The physical costs and psychosocial benefits of travel aids for persons who are visually impaired or blind. Journal of Visual Impairment & Blindness, 91, 347-359.

Japan Minister of Health, Labor, and Welfare, and Prime Minister. (2002). Shintai shougaisha hojoken hou [Law Concerning Assistance Dogs]. Kanpou Gogai dai-109-gou [the Official Gazette, Extra No. 109], 56-58.

Matsunaka, K. (1997). Shikakushougaisha Nichijou Stressor Check List no Sakusei [The development of the Everyday Stressor Questionnaire for the Visually Impaired]. Journal of the Literary Association of Kwansei Gakuin University, 47, 159-168.

Matsunaka, K., & Koda, N. (2005). Shakai ni okeru shintaishougaisha hojokenhou no shuuchi to hojoken no ukeire [Social publicity of law concerning assistance dogs and acceptance of dog guides]. Nihon Shakai Fukushi Gakkai Dai 53kai Taikai Happyo Ronbunsyu [Proceedings of the 53rd Annual Conference of the Japanese Society for the Study of Social Welfare], 441.

Ministry of Health, Labor, and Welfare. (2002). Heisei 13-nenn shintai shougaiji-sha jittai chousa kekka [Survey on the actual states of people with physical disabilities]. Tokyo: Author. Retrieved March 8, 2008, from http://www.mhlw.go.jp/houdou/2002/ 08/h0808-2.html

National Federation of All Japan Guide Dog Training Institutions. (2006a). Moudoukenn no rekishi to ima [History of dog guides]. Tokyo: Author.

National Federation of All Japan Guide Dog Training Institutions. (2006b). Nihon no moudouken shiyoushasuu [The number of guide dog users in Japan]. Guide Dog Information, 50, 14-15.

Refson, K., Jackson, A. J., Dusoir, A. E., & Archer, D. B. (1999). The health and social status of guide dog owners and other visually impaired adults in Scotland. Visual Impairment Research, 1, 95-109.

Research Committee on Dog Guides. (1998). Modokenni kansuru chosa kenkyu hokokusho [Research report on dog guides]. Tokyo: Nippon Foundation. Retrieved February 21, 2008, from http://nippon.zaidan.info/ seikabutsu/1998/00001/mokuji.htm

Sanders, C. R. (2000). The impact of guide dogs on the identity of people with visual impairments. Anthrozoos, 13, 131-139.

Steffans, M. C., & Bergler, R. (1998). Blind people and their dogs. In C. C. Wilson & D. C. Turner (Eds.), Companion animals in human health (pp. 149-157). Thousand Oaks, CA: Sage.

Kumiko Matsunaka, Ph.D., assistant professor, Kansai University of Welfare Sciences, 3-11-1, Asahigaoka, Kashiwara, Osaka, 582-0026, Japan; e-mail: <matsunaka@fuksi-kagk-u.ac.jp>. Naoko Koda, Ph.D., associate professor, Tokyo University of Agriculture and Technology; mailing address: 3-5-8 Saiwai-cho, Fuchu, Tokyo, Japan; e-mail: <koda@cc.tuat.ac.jp>.
Table 1
Acceptance of dog guides at each facility.

Answers Hotel Ryokan Hospital Clinic

Rejected 5.56 8.33 2.70 5.41
Conditionally
 accepted 0.00 2.78 10.81 8.11
Accepted 94.44 36.11 54.05 45.95
No experience 0.00 52.78 32.43 40.54

 Amusement Department
Answers Restaurant facility store Supermarket

Rejected 17.14 0.00 2.70 2.70
Conditionally
 accepted 0.00 2.78 97.30 0.00
Accepted 80.00 25.00 0.00 97.30
No experience 2.86 72.22 0.00 0.00

 Retail
 Convenience store Retail Educational
Answers store with food store establishment

Rejected 2.70 2.70 2.70 2.70
Conditionally
 accepted 5.41 0.00 2.70 5.41
Accepted 89.19 64.86 78.38 81.08
No experience 2.70 32.43 16.22 10.81

Answers Airline Train Bus Taxi

Rejected 2.70 2.70 2.70 8.57
Conditionally
 accepted 0.00 0.00 0.00 2.86
Accepted 62.16 97.30 89.19 80.00
No experience 35.14 0.00 8.11 8.57

Table 2
Means (SDs) and results of Mann-Whitney U tests on items in the
mobility category.

 Mean (SD)

Items in the Nonuser User
 mobility category (n = 50) (n = 30) p-value

When you have to ask for
 help while you are walking 2.59 (l.26) 2.86 (l.32) NS
When you buy a ticket for
 a train 2.20 (l.46) 2.73 (l.41) NS
When you have to go out to
 an unaccustomed place by
 yourself 3.10 (l.48) 3.70 (l.24) NS
When you have to go out
 when it is raining 3.24 (l.36) 4.05 (1.00) .013
When you go by yourself to
 an unfamiliar shop 2.96 (l.41) 3.36 (l.25) NS
When you are lost 3.69 (l.34) 3.70 (l.27) NS
When you go to a location
 you have no O&M
 training for 2.90 (l.66) 3.08 (1.30) NS
When you want to go to a
 lavatory while you are
 out by yourself 2.47 (1.55) 3.76 (l.34) .000
When you go on an outing 2.27 (l.27) 2.97 (l.14) .023
When you have to go
 shopping by yourself 2.08 (l.32) 2.38 (l.34) NS

Note: NS = not significant.

Table 3
Perceived need for greater acceptance of dog
guides by dog guide users (a maximum of three
for each participant) (N = 30).

Possible responses %

Public education to improve general
 understanding 76.32
Improvement of the users' manners 71.05
Governmental resources for each
 facility 50.00
Scientific evidence of no hygiene
 problem 36.84
Improvement of each facility's
 equipment 21.05
A greater number of dog guides 15.79
An increased number of employees 5.26
Other 10.53
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Author:Matsunaka, Kumiko; Koda, Naoko
Publication:Journal of Visual Impairment & Blindness
Geographic Code:9JAPA
Date:May 1, 2008
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