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Advances in Social Sciences Research Journal – Vol. 10, No. 3
Publication Date: March 25, 2023
DOI:10.14738/assrj.103.14130.
Shah, A. P., & Gu, Y. (2023). Measuring Healthcare Cross-Cultural Competencies: A Pilot Survey with University Students. Advances
in Social Sciences Research Journal, 10(3). 1-15.
Services for Science and Education – United Kingdom
Measuring Healthcare Cross-Cultural Competencies:
A Pilot Survey with University Students
Amee P. Shah, Ph.D., CCC-SLP
Professor of Health Science Stockton University
Cross-Cultural Speech, Language, and Acoustics Laboratory
School of Health Sciences 101 Vera King Farris Drive Galloway, NJ 08205.
Yulong Gu, Ph.D.
Associate Professor of Health Science Stockton University
Abstract
Background: Accent-related difficulties and perceptions create communication
barriers that affect patient safety and quality of care. However, healthcare
communication trainings seldom measure how students’ knowledge, attitude, and
skills shift with regard to the actual perception of the cross-cultural
communication, including accent differences. Method: This pilot study assessed
baseline knowledge and stereotypes regarding accents through a 42-item
questionnaire survey, the Cross-Cultural Communication Quotient (CCQ). The
survey was administered across five classes in two universities. Results: 186 (85%
females) respondents were included in the analyses. Results showed the average
score for knowledge is 65%; stereotypes: 67%; and competency: 66%. Higher
scores of accent knowledge are associated with higher levels of competency
(rho=0.18, p=0.015). Higher stereotype scores (lower levels of accent stereotype
beliefs) are associated with higher levels of competency (rho=0.15, p=0.048).
Interestingly, higher knowledge scores are associated with lower stereotype scores
(i.e., higher levels of stereotype beliefs), suggesting that more knowledge does not
prevent stereotype beliefs (rho=-0.34, p<0.001). Conclusions: Findings suggest that
knowledge and stereotypes are both reliable predictors of competency in cross- cultural communication. Many gaps in students’ knowledge of accent-shaping, and
presence of stereotypes related to accents identify the need to build competencies
in this area of cultural competence. Furthermore, higher level of knowledge does
not prevent or reduce stereotype beliefs. We recommend developing healthcare
education curricular programs that focus more intentionally on addressing
stereotypes, in addition to the more traditional knowledge-building elements.
Keywords: cross-cultural communication; intercultural; competency; accent; cultural
competence; healthcare
INTRODUCTION
Cross-cultural and intercultural communication barriers between patients and healthcare
providers o lead to disparities in care, breakdown of patient trust, patient dissatisfaction, poor
adherence to medications, and poorer health outcomes [1, 2]. A frequent barrier to cross- cultural communication is the mismatch between speakers’ and listeners’ accents, leading to
the perception of a “different accent”. While accents are a natural characteristic of
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Advances in Social Sciences Research Journal (ASSRJ) Vol. 10, Issue 3, March-2023
Services for Science and Education – United Kingdom
pronunciation of language, they have been shown to present a barrier to effective cross-cultural
communication in the healthcare settings [3, 4]. Communication barriers involving accents
encompass two underlying issues. First, differences in accents between speakers and listeners
create a breakdown in clarity and comprehension of communication [5]. Secondly, listeners
have stereotypes and judgments about accents, which then affect the decisions they make [6, 7,
8]. In order to navigate such cross-cultural barriers, healthcare students and providers
routinely receive cultural competence trainings [1]. The 2013 National Standards for Culturally
and Linguistically Appropriate Services (CLAS) call for quality healthcare services that are
responsive to diverse cultural beliefs and practices [9]. The CLAS call further provided the
impetus for accreditation standards in Nursing and Pharmacy, for example, to require cultural
competence trainings in their curricula.
Current models of the development of cultural competence (e.g., the IDEA model [10], LEARN
Framework [11], The Purnell Model [12], The Leininger Sunrise Model [13], The Campinha- Bacote Model [14], or the Giger and Davidhizar Transcultural Assessment Model [15] do not
attempt to account for the accent-related competence, specifically the assumptions related to
accents and speech variables in the cross-cultural communication. In order to follow an
evidence-based pedagogical framework for offering cross-cultural communication competence
training, it becomes important to assess objectively students’ knowledge and
stereotypes/biases (as barriers to learning), as well as skills and competencies in
understanding accented speech at baseline and after training. Typically, studies measure the
degree of changes in students’ knowledge, attitude and skills related to cultural competency as
a result of the targeted education [16, 17, 18, 19]. However, none of the studies to date have
attempted to measure how students’ knowledge, attitude, and skills shift with regard to the
actual perception of the cross-cultural communication, including accent differences. It would
be beneficial to identify these perceptions early on, and thereby address them in course of
healthcare students’ educational training. Without the understanding of attitudes and
behaviours related to what listeners hear in crosscultural communication, and to any pre- existing biases they may have based on those communication stereotypes, the ensuing trainings
and curricula may not be sufficiently addressing the gaps in developing cultural competence.
As a first step towards addressing the communication/accent element in diversity curricula in
healthcare education, this exploratory study aims to measure students’ baseline cross-cultural
communication competencies related to accents, and understand the influencing factors. In this
initial iteration, the study explored baseline competencies in both, healthcare students as well
as students in other professional programs where cultural competence trainings are also
provided. Collectively, it would help understand the nature of students’ knowledge and
competency in programs where students would routinely encounter communication diversity,
and where part of their professional skills would be the need for good competencies in
managing cross-cultural communication. The results of such pilot studies are expected to help
in the longterm to develop a good baseline instrument specifically for healthcare students, that
would be informed by the unique needs and gaps experienced by healthcare students.
In the present study, baseline cross-cultural competence is assessed through questions in three
key areas: 1) existing factual knowledge, 2) existing stereotypes, beliefs, and biases, and 3)
existing competencies that encompass preferences and choices they are likely to make, as well