Cultural Competence in Health Care: Implications for Human Resource Development

This paper reviews the need for cultural competence in health care, the barriers faced by health care professionals as they attempt to deliver culturally competent care, and the implications for human resource development initiatives.

Cognitive competence and life course change in multi-problem adolescents

The dissertation reports on two studies. The purpose of Study I was to develop and evaluate a measure of cognitive competence (the Critical Problem Solving Skills Scale – Qualitative Extension) using Relational Data Analysis (RDA) with a multi-ethnic, adolescent sample. My study builds on previous work that has been conducted to provide evidence for the reliability and validity of the RDA framework in evaluating youth development programs (Kurtines et al., 2008). Inter-coder percent agreement among the TOC and TCC coders for each of the category levels was moderate to high, with a range of .76 to .94. The Fleiss' kappa across all category levels was from substantial agreement to almost perfect agreement, with a range of .72 to .91. The correlation between the TOC and the TCC demonstrated medium to high correlation, with a range of r(40)=.68, p<.001 to r(40)=.79, p<.001. Study II reports an investigation of a positive youth development program using an Outcome Mediation Cascade (OMC) evaluation model, an integrated model for evaluating the empirical intersection between intervention and developmental processes. The Changing Lives Program (CLP) is a community supported positive youth development intervention implemented in a practice setting as a selective/indicated program for multi-ethnic, multi-problem at risk youth in urban alternative high schools in the Miami Dade County Public Schools (M-DCPS). The 259 participants for this study were drawn from the CLP's archival data file. The study used a structural equation modeling approach to construct and evaluate the hypothesized model. Findings indicated that the hypothesized model fit the data (χ2 (7) = 5.651, p = .83; RMSEA = .00; CFI = 1.00; WRMR = .319). My study built on previous research using the OMC evaluation model (Eichas, 2010), and the findings are consistent with the hypothesis that in addition to having effects on targeted positive outcomes, PYD interventions are likely to have progressive cascading effects on untargeted problem outcomes that operate through effects on positive outcomes.

Subject -centered and problem -based approaches to teaching clinical competence in physical therapy

Physical therapy students must apply the relevant information learned in their academic and clinical experience to problem solve in treating patients. I compared the clinical cognitive competence in patient care of second-year masters students enrolled in two different curricular programs: modified problem-based (M P-B; n = 27) and subject-centered (S-C; n = 41). Main features of S-C learning include lecture and demonstration as the major teaching strategies and no exposure to patients or problem solving learning until the sciences (knowledge) have been taught. Comparatively, main features of M P-B learning include case study in small student groups as the main teaching strategy, early and frequent exposure to patients, and knowledge and problem solving skills learned together for each specific case. Basic and clinical orthopedic knowledge was measured with a written test with open-ended items. Problem solving skills were measured with a written case study patient problem test yielding three subscores: assessment, problem identification, and treatment planning. ^ Results indicated that among the demographic and educational characteristics analyzed, there was a significant difference between groups on ethnicity, bachelor degree type, admission GPA, and current GPA, but there was no significant difference on gender, age, possession of a physical therapy assistant license, and GRE score. In addition, the M P-B group achieved a significantly higher adjusted mean score on the orthopedic knowledge test after controlling for GRE scores. The S-C group achieved a significantly higher adjusted mean total score and treatment management subscore on the case study test after controlling for orthopedic knowledge test scores. These findings did not support their respective research hypotheses. There was no significant difference between groups on the assessment and problem identification subscores of the case study test. The integrated M P-B approach promoted superior retention of basic and clinical science knowledge. The results on problem solving skills were mixed. The S-C approach facilitated superior treatment planning skills, but equivalent patient assessment and problem identification skills by emphasizing all equally and exposing the students to more patients with a wider variety of orthopedic physical therapy needs than in the M P-B approach. ^

Establishing a baseline of psychometric estimates of measurement of intercultural competence of Ukrainian faculty: Setting the stage for domestic and global intercultural understanding

Post-Soviet Ukraine is in a time of upheaval and transition. Internal relations between pro-Western and pro-Russian supporters have deteriorated in the light of recent political events of Euro Revolution, Russia's occupation of the Crimean peninsula, and the militant confrontations in the southeastern regions of the country. In the light of these developments, intercultural competence is greatly needed to alleviate domestic tensions and enable effective intercultural communication with the representatives of different cultures within the country and beyond its borders.^ This study established a baseline of psychometric estimates of intercultural competence of Ukrainian higher education faculty. A sample of 276 professors of different academic majors from one university in Western Ukraine participated in the research. The Global Perspective Inventory (GPI; Merrill, Braskamp, & Braskamp, 2012) was chosen as a research instrument to measure intercultural competence of the faculty members. The GPI takes into account cognitive, intrapersonal, and interpersonal domains, each of which contains two scales reflective of theories of cultural development and intercultural communication – Cognitive-Knowing, Cognitive-Knowledge, Intrapersonal-Identity, Intrapersonal-Affect, Interpersonal-Social Responsibility, and Interpersonal-Social Interaction. Because the research instrument has neither been previously used as a measure of intercultural competence, nor administered in Ukraine, it was cross-validated using a Table of Specification (Newman, Lim, & Pineda, 2013) and two sets of factor analyses. As a result, a modified version of the GPI was created for use in Ukraine.^ Multiple linear regression analyses were used to test relationships between the participants' GPI scores on intercultural competence, and several independent variables that consisted of academic discipline, intercultural experience, and how long the participants taught at the university. The analyses determined a positive relationship between the scores on three out of six scales of the original version and two out of five scales of the modified version of the GPI and all the independent variables simultaneously. The relationship between the faculty responses on the six scales of both GPI versions and the independent variables controlling for each other produced mixed results. A unique role of intercultural professional development in predicting intercultural competence was discussed.^

A intercompreensão em Línguas Românicas nas aulas de Espanhol: o que querem e o que podem essas línguas?

The official documents that guide the teaching and learning process of a Foreign Language in Brazil, Parâmetros Curriculares Nacionais de Língua Estrangeira, suggest a linguistic and intercultural communication as the main objective of teaching a foreign language inorderto contribute withareflexive formation of the students.Toachieve this goal, a Virtual Interchange was realized connecting distant places like Córdoba, in Argentina, and Natal in Brazil, between High School students through Moodle platform and Facebook. The Interchange is based in the Intercomprehension in Romance Languages(IC) guidelines, inthiscase between Portuguese and Spanish, according to which every student speaks their own language and makes an effort to comprehend the others througha collaborative process thatgo es beyond the limits of mere linguistic objectives and favors the students’ reality acceptance before the diversity. This qualitative study with thno graphic characteristic stries to know whe ther differentiate projects can increase students’ interest to learn the target language. It was also set as an aim of this study to develop the intercultural competence of our students and foster the respect for different cultures. In the case of Argentinian and Brazilian students, wetried to promote reflection about social representation trying to destroy stereotypes between both groups. As methodological resources, we used interviews, questionnaires and intercomprehension activities during the Project, as well as a participant observation of the interactions betweenthe students of both countries.Webe lieve tobe contributing towards the integral formation ofth student asacriticalcitizenthatthinksa bouttheir posture before the world, which is one of the formal education aims according to Parâmetros Curriculares Nacionais. Our theoretical foundation is based on Intercomprehension in Romance Languages (IC) as a plurilingualism didactics, (JAMET AND SPIŢĂ 2010; ARAÚJO AND SÁ et al., 2003; CAPUCHO, 2010; ANDRADE etal.,2003), some the oriesaboutinter culturalisman didentity(Vallespir, 1999;DUARTE&SANCHES,2004; REVUZ,1998;SILVA,2000;CHAUÍ2006; SERRANI-INFANTE 1998), motivation and second language learning (DECI & RYAN, 1985; DÖRNYEI AND OTTÓ, 1998; DÖRNYEI, 2000, 2001; 2011) and Significant Learning Theory (AUSUBEL, 1968). The results show an increase of students’ motivation when in contact with the target language through dynamic activities in an IC context. Moreover, we noticed that a deeper thinking aboutthe Argentinian culture helped to deconstruct previous cultural representation.

An analysis of authorship attribution: Identifying linguistic variables in oral and written discourse

This dissertation goes into the new field from applied linguistics called forensic linguistics, which studies the language as an evidence for criminal cases. There are many subfields within forensic linguistics, however, this study belongs to authorship attribution analysis, where the authorship of a text is attributed to an author through an exhaustive linguistic analysis. Within this field, this study analyzes the morphosyntactic and discursive-pragmatic variables that remain constant in the intra-variation or personal style of a speaker in the oral and written discourse, and at the same time have a high difference rate in the interspeaker variation, or from one speaker to another. The theoretical base of this study is the term used by professor Maria Teresa Turell called “idiolectal style”. This term establishes that the idiosyncratic choices that the speaker makes from the language build a style for each speaker that is constant in the intravariation of the speaker’s discourse. This study comes as a consequence of the problem appeared in authorship attribution analysis, where the absence of some known texts impedes the analysis for the attribution of the authorship of an uknown text. Thus, through a methodology based on qualitative analysis, where the variables are studied exhaustively, and on quantitative analysis, where the findings from qualitative analysis are statistically studied, some conclusions on the evidence of such variables in both oral and written discourses will be drawn. The results of this analysis will lead to further implications on deeper analyses where larger amount of data can be used.

Development of a work-based learning MSc course which incorporates the development and demonstration of professional engineering competence standards

UK engineering standards are regulated by the Engineering Council (EC) using a set of generic threshold competence standards which all professionally registered Chartered Engineers in the UK must demonstrate, underpinned by a separate academic qualification at Masters Level. As part of an EC-led national project for the development of work-based learning (WBL) courses leading to Chartered Engineer registration, Aston University has started an MSc Professional Engineering programme, a development of a model originally designed by Kingston University, and build around a set of generic modules which map onto the competence standards. The learning pedagogy of these modules conforms to a widely recognised experiential learning model, with refinements incorporated from a number of other learning models. In particular, the use of workplace mentoring to support the development of critical reflection and to overcome barriers to learning is being incorporated into the learning space. This discussion paper explains the work that was done in collaboration with the EC and a number of Professional Engineering Institutions, to design a course structure and curricular framework that optimises the engineering learning process for engineers already working across a wide range of industries, and to address issues of engineering sustainability. It also explains the thinking behind the work that has been started to provide an international version of the course, built around a set of globalised engineering competences. © 2010 W J Glew, E F Elsworth.

Establishing a Baseline Measurement of Intercultural Competence of Ukrainian Faculty: Setting the Stage for Domestic and Global Intercultural Understanding

Post-Soviet Ukraine is in a time of upheaval and transition. Internal relations between pro-Western and pro-Russian supporters have deteriorated in the light of recent political events of Euro Revolution, Russia’s occupation of the Crimean peninsula, and the militant confrontations in the southeastern regions of the country. In the light of these developments, intercultural competence is greatly needed to alleviate domestic tensions and enable effective intercultural communication with the representatives of different cultures within the country and beyond its borders. This study established a baseline of psychometric estimates of intercultural competence of Ukrainian higher education faculty. A sample of 276 professors of different academic majors from one university in Western Ukraine participated in the research. The Global Perspective Inventory (GPI; Merrill, Braskamp, & Braskamp, 2012) was chosen as a research instrument to measure intercultural competence of the faculty members. The GPI takes into account cognitive, intrapersonal, and interpersonal domains, each of which contains two scales reflective of theories of cultural development and intercultural communication – Cognitive-Knowing, Cognitive-Knowledge, Intrapersonal-Identity, Intrapersonal-Affect, Interpersonal-Social Responsibility, and Interpersonal-Social Interaction. Because the research instrument has neither been previously used as a measure of intercultural competence, nor administered in Ukraine, it was cross-validated using a Table of Specification (Newman, Lim, & Pineda, 2013) and two sets of factor analyses. As a result, a modified version of the GPI was created for use in Ukraine. Multiple linear regression analyses were used to test relationships between the participants’ GPI scores on intercultural competence, and several independent variables that consisted of academic discipline, intercultural experience, and how long the participants taught at the university. The analyses determined a positive relationship between the scores on three out of six scales of the original version and two out of five scales of the modified version of the GPI and all the independent variables simultaneously. The relationship between the faculty responses on the six scales of both GPI versions and the independent variables controlling for each other produced mixed results. A unique role of intercultural professional development in predicting intercultural competence was discussed.

HELPING YOUTH WITH AUTISM SPECTRUM DISORDER DEVELOP SOCIAL COMPETENCE IN COMMUNITY-BASED SETTINGS

The purpose of the current dissertation is to identify the features of effective interventions by exploring the experiences of youth with ASD who participate in such interventions, through two intervention studies (Studies 1 and 2) and one interview study (Study 3). Studies 1 and 2 were designed to support the development of social competence of youth with ASD through Structured Play with LEGO TM (Study 1, 12 youths with ASD, ages 7–12) and Minecraft TM (Study 2, 4 youths with ASD, ages 11–13). Over the course of the sessions, the play of the youth developed from parallel play (children playing alone, without interacting) to co-operative play (playing together with shared objectives). The results of Study 2 showed that rates of initiations and levels of engagement increased from the first session to the final session. In Study 3, 12 youths with ASD (ages 10–14) and at least one of their parents were interviewed to explore what children and their parents want from programs designed to improve social competence, which activities and practices were perceived to promote social competence by the participants, and which factors affected their decisions regarding these programs. The adolescents and parents looked for programs that supported social development and emotional wellbeing, but did not always have access to the programs they would have preferred, with factors such as cost and location reducing their options. Three overarching themes emerged through analysis of the three studies: (a) interests of the youth; (b) structure, both through interactions and instruction; and (c) naturalistic settings. Adolescents generally engage more willingly in interventions that incorporate their interests, such as play with Minecraft TM in Study 2. Additionally, Structured Play and structured instruction were crucial components of providing safe and supportive contexts for the development of social competence. Finally, skills learned in naturalistic settings tend to be applied more successfully in everyday situations. The themes are analysed through the lens of Vygotsky’s (1978) perspectives on learning, play, and development. Implications of the results for practitioners and researchers are discussed.

COGNITIVE AND LINGUISTIC FACTORS OF READING ARABIC: THE ROLE OF MORPHOLOGICAL AWARENESS IN READING

Scientific reading research has produced substantial evidence linking specific reading components to a range of constructs including phonological awareness (PA), morphological awareness, orthographic processing (OP), rapid automatized naming, working memory and vocabulary. There is a paucity of research on Arabic, although 420 million people around the world (Gordon, 2005) speak Arabic. As a Semitic language, Arabic differs in many ways from Indo-European languages. Over the past three decades, literacy research has begun to elucidate the importance of morphological awareness (MA) in reading. Morphology is a salient aspect of Arabic word structure. This study was designed to (a) examine the dimensions underlying MA in Arabic; (b) determine how well MA predicts reading; (c) investigate the role of the standard predictors in different reading outcomes; and (d) investigate the construct of reading in Arabic. This study was undertaken in two phases. In Phase I, 10 MA measures and two reading measures were developed, and tested in a sample of 102 Grade 3 Arabic-speaking children. Factor analysis of the 10 MA tasks yielded one predominant factor supporting the construct validity of MA in Arabic. Hierarchical regression analyses, controlling for age and gender, indicated that the MA factor solution accounted for 41– 43% of the variance in reading. In Phase II, the widely studied predictor measures were developed for PA and OP in addition to one additional measure of MA (root awareness), and three reading measures In Phase II, all measures were administered to another sample of 201 Grade 3 Arabic-speaking children. The construct of reading in Arabic was examined using factor analysis. The joint and unique effects of all standard predictors were examined using different sets of hierarchical regression analyses. Results of Phase II showed that: (a) all five reading measures loaded on one factor; (b) MA consistently accounted for unique variance in reading, particularly in comprehension, above and beyond the standard predictors; and (c) the standard predictors had differential contributions. These findings underscore the contribution of MA to all components of Arabic reading. The need for more emphasis on including morphology in Arabic reading instruction and assessment is discussed.

Mitigating Social Risk in the Extractive Sector: Developing Intercultural Competence as a Tool for Negotiating Western-Indigenous Perspectives within the Undergraduate Mining Engineering Curriculum

Drawing upon critical, communications, and educational theories, this thesis develops a novel framing of the problem of social risk in the extractive sector, as it relates to the building of respectful relationships with indigenous peoples. Building upon Bakhtin’s dialogism, the thesis demonstrates the linkage of this aspect of social risk to professional education, and specifically, to the undergraduate mining engineering curriculum, and develops a framework for the development of skills related to intercultural competence in the education of mining engineers. The knowledge of social risk, as well as the level of intercultural competence, of students in the mining engineering program, is investigated through a mixture of surveys and focus groups – as is the impact of specific learning interventions. One aspect of this investigation is whether development of these attributes alters graduates’ conception of their identity as mining engineers, i.e. the range and scope of responsibilities, and understanding of to whom responsibilities are owed, and their role in building trusting relationships with communities. Survey results demonstrate that student openness to the perspectives of other cultures increases with exposure to the second year curriculum. Students became more knowledgeable about social dimensions of responsible mining, but not about cultural dimensions. Analysis of focus group data shows that students are highly motivated to improve community perspectives and acceptance. It is observed that students want to show respect for diverse peoples and communities where they will work, but they are hampered by their inability to appreciate the viewpoints of people who do not share their values. They embrace benefit sharing and environmental protection as norms, but they mistakenly conclude that opposition to mining is rooted in a lack of education rather than in cultural values. Three, sequential, threshold concepts are identified as impeding development of intercultural competence: Awareness and Acknowledgement of Different Forms of Knowledge; Recognition that Value Systems are a Function of Culture; Respect for varied perceptions of Social Wellbeing and Quality of Life. Future curriculum development in the undergraduate mining engineering program, as well as in other educational programs relevant to the extractive sector, can be effectively targeted by focusing on these threshold concepts.

The Causes and Effects of Consumer Competence Perceptions

Consumers are constantly making consumption decisions and engaging in marketplace activities that require some level of competence. In other words, consumers possess and require some knowledge, skills, and abilities to engage in the marketplace and obtain what they want. But what causes consumers to infer they are or are not competent? And, what are the consequences of these competence inferences on consumer behaviour? This dissertation examines the role consumption plays in consumers’ inferences of their own competence to enhance our understanding of these issues. By integrating the literature on competence and attributions of blame, this dissertation develops a theory for when and how consumption influences self-perceptions of competence and how these self-perceptions of competence impact future consumer behaviours. Evidence from five studies suggests that consumers infer their own competence from their consumption outcomes, despite who is actually responsible for causing these outcomes. This means consumers potentially see themselves as incompetent for negative outcomes that are entirely firm-caused. This dissertation argues that people infer their own competence from firm-caused outcomes because they conflate their decisions made prior to an outcome with the cause of that outcome. This dissertation also examines how these variations in self-perceptions of competence can influence future consumer behaviours.

Self-efficacy in depression: Bridging the gap between competence and real-world functioning

Background: Depression is the largest contributing factor to years lost to disability, and symptom remission does not always result in functional improvement. Comprehensive analysis of functioning requires investigation both of the competence to perform behaviours, as well as actual performance in the real world. Further, two independent domains of functioning have been proposed: adaptive (behaviours conducive to daily living skills and independent functioning) and interpersonal (behaviours conducive to the successful initiation and maintenance of social relationships). To date, very little is known about the relationship between these constructs in depression, and the factors that may play a key role in the disparity between competence and real-world performance in adaptive and interpersonal functioning. Purpose: This study used a multidimensional (adaptive and interpersonal functioning), multi-level (competence and performance) approach to explore the potential discrepancy between competence and real-world performance in depression, specifically investigating whether self-efficacy (one’s beliefs of their capability to perform particular actions) predicts depressed individuals’ underperformance in the real world relative to their ability. A comparison sample of healthy participants was included to investigate the level of depressed individuals’ impairment, across variables, relative to healthy individuals. Method: Forty-two participants with depression and twenty healthy participants without history of, or current, psychiatric illness were recruited in the Kingston, Ontario community. Competence, self-efficacy, and real-world functioning all in both adaptive and interpersonal domains, and symptoms were assessed during a single-visit assessment. Results: Relative to healthy individuals, depressed individuals showed significantly poorer adaptive and interpersonal competence, adaptive and interpersonal functioning, and significantly lower self-efficacy for adaptive and interpersonal behaviours. Self-efficacy significantly predicted functional disability both in the domain of adaptive and interpersonal functioning. Interpersonal self-efficacy accounted for significant variance in the discrepancy between interpersonal competence and functioning. Conclusions: The current study provides the first data regarding relationships among competence, functioning, and self-efficacy in depression. Self-efficacy may play an important role in the deployment of functional skills in everyday life. This has implications for therapeutic interventions aimed at enhancing depressed individuals’ engagement in functional activities. There may be additional intrinsic or extrinsic factors that influence the relationships among competence and functioning in depression.

'I am not an Honourable Lady': gender and language in the National Assembly for Wales

Women have been historically underrepresented in political institutions and it has been claimed that it is difficult for women to succeed in the masculinist cultures that exist in political contexts. The ‘new’ devolved institutions of the UK offer opportunities to investigate gender inequality in political contexts which have a greater proportion of women members; that have included women from their inception; and that have been designed with egalitarian issues to the fore. Here, ethnographic and discourse analytic data is used to assess a senior woman’s performance in the National Assembly for Wales; to explore politicians’ appraisal of this performance; and to analyse the breakdown of the debate floor in terms of ‘rule-breaking’ activities such as barracking. In this Community of Practice the individual’s performance draws upon communicative styles that are both stereotypically masculine (adversarial) and feminine (consensual), which can be viewed as an indication of the speaker’s competence. However, this is undermined by the speaker’s failure to adopt the correct linguistic practices for this CoP which leads to the breakdown of the formal debate discourse. Assembly Members appraise this failure negatively while also drawing upon stereotypical notions of gendered communicative norms and wider discourses of gender differentiation.