Predictors of Intercultural Sensitivity in U. S. Nursing Students Along the Gulf Coast

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(1)Predictors of Intercultural Sensitivity in U. S. Nursing Students Along the Gulf Coast. by Stephen Council Vaughan. A Thesis Submitted to the Graduate Faculty in Partial Fulfillment of the Requirements for the degree of MASTERS OF BUSINESS ADMINISTRATION Major: International Human Resource Development. Advisor: Dr. C. Rosa Yeh, Ph.D.. National Taiwan Normal University Taipei, Taiwan June, 2013.

(2) ACKNOWLEDGMENTS Thank you Dr. Yeh for your patience, time, and advice. Thank you Dr. Chang for your insight and making me a better researcher. Thank you Dr. Tao for asking the hard questions. Thank you all you lovely nurses on the Gulf Coast for taking my survey. Thank you Colonel Reddy for being an example of hard work and integrity. Thank you New Hope Christian Fellowship for your prayers. Thank you Karen Castellanos-Gossman for keeping me on task. Thank you Rachel Grindall for your gentle support.. Thank you Tab & Steve Vaughan aka “Mom & Dad” for your expertise and doing a damn fine job raising me.. I shall be telling this with a sigh Somewhere ages and ages hence: Two roads diverged in a wood, and I— I took the one less traveled by, And that has made all the difference.. The Road Not Taken, Robert Frost.

(3) ABSTRACT The United States has seen a dramatic increase in its levels of diversity over the last half century. This diversity is apparent in all aspects of the nation including the healthcare system thereby necessitating healthcare education institutions to produce more culturally competent healthcare providers. The primary purpose of this study is to investigate predictors of intercultural communication sensitivity (ICS) in U.S. nursing students in the Gulf Coast area. The study investigates the relationship between predictors of ICS such as student’s background setting in terms of rural vs. urban, gender, prior exposure to cultural experiences, and their intended work settings in terms of rural or urban. A questionnaire composed of an existing ICS scale and researcher developed measures was completed by 121 ADN and BSN nursing students from five nursing schools in the region. The results of the study show that a nursing student’s background setting, prior cultural immersion, as well as intended work setting had varying predictive effects on total ICS scores. This study also tested a literature based measure for assessing prior cultural exposure. This measure contained three dimensions, immersion experiences, narrative experience, and language study which were tested for consistency and validity. The immersion experience dimension performed well for properly assessing this aspect of prior cultural exposure as well as predicting higher ICS scores. This study tested the integrity of an existing ICS scale finding this scale to reduce to three dimensions instead of the published five dimensions. The predictors of this study were also regressed on these new ICS dimensions as a post-study investigation into the relationship between these variables. The results were consistent with the main study hypotheses.. I.

(4) TABLE OF CONTENTS Abstract ...................................................................................................................... I Table of Contents ....................................................................................................... II List of Tables ............................................................................................................. IV List of Figures ............................................................................................................ V. CHAPTER I INTRODUCTION ............................................................ 1 Background of the Study ............................................................................... 2 Problem Statement ......................................................................................... 3 Rationale for the Study .................................................................................. 3 Purpose of the Study ...................................................................................... 4 Research Questions ........................................................................................ 4 Contribution of the Study............................................................................... 5 Definition of Terms........................................................................................ 5. CHAPTER II LITERATURE REVIEW ............................................... 7 Melting Pot vs. Salad Bowl ........................................................................... 7 Diversity in the U.S........................................................................................ 8 Culture............................................................................................................ 9 Competency ................................................................................................... 11 Intercultural Competency............................................................................... 13 ICC and Job Performance .............................................................................. 14 ICC and Healthcare ........................................................................................ 15 Intercultural Sensitivity.................................................................................. 16 Dimensions of Intercultural Sensitivity ......................................................... 18 Contact Theory............................................................................................... 19 Background Setting ........................................................................................ 21 Prior Cultural Exposure ................................................................................. 21 Gender ............................................................................................................ 22 Intended Work Setting ................................................................................... 23. CHAPTER III METHODOLOGY ........................................................ 25 Chapter Overview .......................................................................................... 25 II.

(5) Research Framework ..................................................................................... 25 Research Hypotheses ..................................................................................... 26 Research Method ........................................................................................... 27 Research Procedure ........................................................................................ 27 Sample............................................................................................................ 28 Sample Descriptive Statistics ......................................................................... 28 Research Instrument....................................................................................... 32 Categorical Determination and Selection ...................................................... 36 Validity and Reliability .................................................................................. 37. CHAPTER IV FINDINGS .................................................................... 47 Correlation Analysis ...................................................................................... 47 Hypothesis Testing......................................................................................... 49 Post Hoc Analysis of New ICS dimensions ................................................... 54. CHAPTER V DISCUSSION AND CONCLUSIONS .......................... 59 Discussion ...................................................................................................... 59 Practical Implications..................................................................................... 61 Research Implications .................................................................................... 63 Conclusions .................................................................................................... 63 Limitations of Study ...................................................................................... 64 Future Research Suggestions ......................................................................... 65. REFERENCES........................................................................................ 67 APPENDIX A: Research Instrument ...................................................... 77. III.

(6) LIST OF TABLES Table 2.1. Definitions of Culture ........................................................................ 10. Table 2.2. Definitions of Competency ................................................................ 12. Table 3.1. Sample Description ............................................................................ 29. Table 3.2. ICS Dimension Subscales .................................................................. 33. Table 3.3. ANOVA Results for Background Category Items............................. 37. Table 3.4. KMO and Bartlett’s Test scores for exploratory factor analysis ....... 39. Table 3.5. Factor loadings and communalities based on a principle components analysis with orthogonal rotation for 36 items from ICS and prior exposure scales................................................................................... 39. Table 3.6. Factor loadings and communalities based on a principle components analysis with orthogonal rotation for 24 items from ICS scale ......... 43. Table 3.7. Prior Cultural Exposure dimensions and item factor scores for 11 items ............................................................................. 44. Table 3.8. Reliability Analysis ............................................................................ 45. Table 4.1. Correlation Results............................................................................. 48. Table 4.2. T-test results for independent variables' effects on ICS .................... 51. Table 4.3. Results of hierarchical regression analysis on predictors of ICS ....... 52. Table 4.4. Results of hierarchical regression analysis on prior exposure dimensional level predictors of ICS ................................................... 53. Table 4.5. Results of Hypothesis Testing ........................................................... 54. Table 4.6. T-test results for independent variables' effects on new ICS dimensions .................................................................................. 55. Table 4.7. Results of hierarchical regression analysis of predictors on new ICS dimensions.......................................................................................... 57. IV.

(7) LIST OF FIGURES Figure 2.1. Values of community level diversity ................................................. 8. Figure 2.2. Bennett’s developmental model of intercultural sensitivity .............. 17. Figure 3.1. Research framework .......................................................................... 26. V.

(8) CHAPTER I INTRODUCTION For most of the past century, grade school students in the United States have been taught that their country is a “melting pot” of cultures. They are taught that new immigrants bring with them their culture and blend it with American culture (Bisin & Verdier, 2000). This however is not the case. America, rather, is like a salad bowl of cultures. The vegetables in a salad co-exist in the same bowl while still retaining their identity as a tomato or a carrot.. This is apparent to. any observer walking in the China Towns, “Little Italys,” and other immigrant communities throughout the U.S. This diversity is reflected in the health care system. Between 1999-2008 long term care facilities in the U.S. have witnessed a 55% and 54% increase in Hispanic and Asian residents while at the same time seeing a 10% reduction in white residents (Feng, Fennell, Tyler, Clark, & Mor, 2011). Diversity is also rising in other areas of healthcare as because ethnically different people are at a greater risk for disease and major health problems and therefore are more likely to make use of the health care system (Betancourt, Green, Carrillo, & Ananeh-Firempong, 2003). This increasing diversity in the healthcare system is pushing the need for more culturally competent healthcare workers (Institute of Medicine, 2002). Culturally competent healthcare workers are better able to treat patients because they can more efficient communicate with a patient to prevent misdiagnosis and explain treatment and recover procedures. This is because a culturally competent person can establish stronger trust and report with a culturally different person. A culturally competent person is aware of their own and others’ cultural values, is knowledgeable about other cultures, and is able to use their awareness and knowledge to skillfully cultivate cross-cultural relationships (Smith, 1998). Culturally competent care is not just providing to patients a culturally knowledgeable medical staff but providing a staff that can sensitively and effectively interact with patients with respect to patients’ beliefs and traditions (Huff & Kline, 1999). Nurses are the backbone of any hospital, clinic, and nursing home.. Their daily. interactions with patients are often the only contacts between a patient and a health care system. Many health care organizations such as the Pew Health Professions Commission (1995) and the 1.

(9) American Association of Colleges of Nursing (1998) have publicly stated the need for cultural education in health care providers. Indeed, it is hard to sell the idea that nurses can improve their care giving by considering non-medical issues: “The toughest change in nursing will be with nurses who have become so medicalized and focused on diseases, symptoms, and treatment modes that they will neglect to consider the client’s culture” (Leininger, 1995, p. 687).. Background of the Study Researchers investigating intercultural competencies (ICC) in nurse practitioner students found that students planning to work in rural areas after graduation had a higher score in cultural competency behavior scores (Benkert, Tanner, Guthrie, Oakley, &Pohl, 2005). Other predictors supported by the same researchers were a nurse’s level of comfort with diversity and the weight that nurse gave to cultural knowledge (Benkert et al., 2005). The study showed there was in fact a link between a student’s ICC level and their intended area to work. However, it did not investigate if there was a correlation between the students and whether they hailed from a rural or urban background. Furthermore the study only looked at predictors of culturally competent behavior which falls under the ICC subset of intercultural adroitness and not intercultural insensitivity. Another study looking at intercultural sensitivity levels in middle school students however did find a correlation between a student’s community setting and their level of intercultural communication sensitivity (Pederson, 1997).. The students from a suburban area. had higher scores than their urban or rural counterparts (Pederson, 1997). This study will not only verify the validity of using a nursing student’s planned area of study as a predictor of ICS but also investigate the links between a community setting and their level of intercultural sensitivity.. 2.

(10) Problem Statement Increasing globalization and the formation of immigrant pockets in the general population is driving a growing need for culturally competent health care workers in the United States. Administrators of nursing education institutions need more information regarding their enrollees’ learning abilities so they can appropriately tailor intercultural curriculum. There is little research looking into the factors that predict intercultural sensitivity in nursing students.. There is little existing research concerning healthcare students and. intercultural sensitivity. Nursing school administrators need more reliable predictors that can be drawn from simple demographic and background data for determining enrollees’ cultural competency learning capabilities.. Rationale for the Study Many researchers have shown that there is a strong connection between a person’s intercultural competence and their job performance while working in multicultural work environments (Mol, Born, Willemsen, & Molen, 2005; Tucker, Bonial, & Lahti, 2004). Nurses are also subject to this connection. Culturally competent nurses provide better care to culturally different patients. Intercultural competency is a process divided into three subsets: awareness, sensitivity, and adroitness.. Intercultural Sensitivity (ICS) facilitates the transition between. awareness and adroitness (Chen, 1997). ICS is the rope bridge that carries a person from ethnocentrism over to ethnorelativism. The higher the level of one’s ICS, the more quickly they will transition from ethnocentric to enthorelative states of mind (Chen, 1997). By measuring the level of an individual’s sensitivity, intercultural trainers can better adjust their techniques to match their student’s needs. Therefore by investigating predictors of intercultural sensitivity, the transitory subset of ICC linking intercultural awareness and adroitness, healthcare institutions and educations centers can better tune their recruitment efforts and in-house training programs to raise the level of care and performance of their nursing staff. Furthermore, nursing schools like most educational institutions, work on limited budgets and so must make the best use of their resources. Administrators responsible for planning and 3.

(11) allocating resources for various curriculums need accurate indicators regarding the cost and effectiveness of particular teaching methods and how those methods match up with their students’ needs. There are many methods for teaching intercultural competency, including classroom lectures, literature review, scenario training, and immersion (Crandall, George, Marion, & Davis 2003; Halloran, 2009; Lasch, Wilkes, Lee, &Blanchard, 2000; Lipson & Desantis, 2007; Mazor, Hampers, Chande, & Krug, 2002). These strategies vary in effectiveness and expense with immersion notably being the most effective and most expensive strategy for teaching cultural competency. The effectiveness of these training strategies is also greatly affected by the level of intercultural sensitivity of the participants.. Understanding the intercultural communication. sensitivity (ICS) predictors of their students will allow nursing programs to tailor their cultural learning curriculum to meet their pedagogical needs in accordance with their fiscal abilities.. Purpose of the Study This study tested for links between the background of nursing students, and the level of their intercultural sensitivity along the Gulf Coast. The study collected demographic data and administered a self-assessment tool to measure ICS levels.. Research Questions This study intended to answer the following questions: 1. Does a nursing student’s background setting, in terms of coming from a rural area versus an urban area, have an effect on their intercultural sensitivity? 2. How much of a nursing student’s prior exposure to cultural experiences affects their intercultural sensitivity? 3. Is there a significant difference in ICS between male and female subjects? 4. Does a nursing student’s intended work setting, in terms of working in a rural area versus an urban area, have an effect on their intercultural sensitivity? 4.

(12) Contribution of the Study This study adds to the body of knowledge that nursing schools use to design their curriculum with regards to the origins of their students. This study also contributed new knowledge to current research by focusing on links between intercultural sensitivity predictors in nursing students and their demographic and background information. The study also sought to develop and validate new scales in this area of research. In accordance with this author’s information, there are no such studies examining this area of research.. Definition of Terms Culture –the learned and shared point of view of a particular people group’s concerns about life that ranks important ideas, shapes attitudes concerning certain matters, and dictates behavior (Beamer &Varner, 2003). Intercultural Competency (ICC) – a combination of knowledge, awareness, sensitivity, attitudes, and skills which empower an individual to have effective interaction with culturally different persons while maintaining acknowledgement and respect for the clients’ culture and traditions (Onyoni & Ives, 2007). Intercultural Sensitivity (ICS) – the affective subset of ICC; ICS represents the active internal process of an individual accepting and appreciating cultural differences and their motivation to better understand those differences (Chen &Starosta, 1998). Competency – a set of personal characteristics and knowledge which have a significant effect on an individual’s behavior and effectiveness in a given situation. Contact Theory – an idea that suggests that the more interaction an individual experiences with an alien group, then the more comfortable, confident, and competent that individual will be during future experiences with alien groups. Intended Work Setting – the community setting in terms of rural or urban where a nursing student wishes to work after graduation and establishment as a professional nurse. 5.

(13) Community Setting – the setting, in terms of rural or urban, where from a respondent hails. Prior Exposure – the degree to which a respondent has encountered or has had experiences with other cultures. Rural Area – any area outside of an urban area (US Census Bureau, 2012). Urban or Suburban Area – city or area consisting of between 2,500 residents and 50,000 (US Census Bureau, 2012). Metropolis or Large City – city or area consisting of an urbanized core of at least 50,000 residents and is surrounded by urban clusters and urbanized areas (US Census Bureau, 2012).. 6.

(14) CHAPTER II LITERATURE REVIEW Melting Pot vs. Salad Bowl The United States has often been referred to as a “melting pot” nation. A melting pot refers to a sociocultural situation in which people cast off parts or all of their ethnic differences and blending their ethnic identities into a single large “macroculture” (Chaney & Martin, 2003). The idea that immigrants from any nation can arrive and share in the blending of cultures has long been a selling point for the country. In the early 20th century the melting pot represented the new “liberal and radical vision of American society” (Hirschman, 1983). Furthermore, this symbol was used to reinforce the belief that America is a land of opportunity where a person’s identity would not hinder their pursuit of happiness (Hirschman, 1983). While studying the three faiths Protestantism, Catholicism, and Judaism, social scientists began to notice the melting pot or assimilation theory beginning to fail as early as the 1950’s (Herberg, 1983). Indeed the notion that an individual can arrive in the U.S. and be adopted into a new identity is simply not the case: The result has not been the melding of various cultures into one cultural group as idealists believed would happen.. Because we have cultures within cultures. (microcultures), communication problems often result. In reality, the United States is a salad bowl of cultures. While some choose assimilation, others choose separation. (Chaney & Martin, 2003, p. 3) Likewise the salad bowl idea acknowledges not only how people groups differ culturally but also and “unequal status of different groups in society” (Airhihenbuwa & Pineiro, 1988, p. 241). The same researchers go on to explain that “if a nation’s people share common customs, origins, history, and languages, then the U.S. could be considered a country of many nations including African Americans, Hispanic Americans, Asian Americans, and Native Americans” (Airhihenbuwa & Pineiro, 1988, p. 241). Immigrants don’t fully blend with their host country but rather exist alongside, and even a little separate from, the contemporary culture (Gordon, 1964). 7.

(15) Diversity in the U.S. The United States has not only remained a diverse country in spite of perceptions of assimilation, but has actually increased in its levels of diversity. While looking at data from over the last thirty years Lee, Iceland, and Sharp found that “virtually all types of communities have become more racially and ethnically diverse since 1980” (2012, p. 1). Furthermore they revealed that since 1980 Caucasian communities have dropped in proportional representation by over 10%, Hispanic communities surpassed Black communities as the second largest minority, and the Asian representation has tripled (Lee, Iceland, & Sharp, 2012). Figure 2.1 shows the changes in these values.. Figure 2.1 Values of community level diversity. Adapted from “Racial and ethnic diversity goes local: Charting change in American communities over three decades” by B.A. Lee, J. Iceland, and G. Sharp 2012, p. 5, New York: Russell Sage Foundation.. This increase has been attributed to two forces. Historically speaking, individuals are more likely to risk immigration during their younger years, but also U.S. immigration policy has encouraged these newcomers to bring their relatives and other family members along with them (Shrestha, 2011). For instance, the years ranging from 1966 to 1980 saw 718,000 refugees entering the U.S. (Wasem, 2005). However, after the Refugee Act of 1980 the U.S. experienced an influx of 1.6 million refugees over the following five years (Wasem, 2005). Furthermore, 8.

(16) racial and ethnic groups “are aging at different rates, depending upon fertility, mortality, and immigration within these groups” (Shrestha, 2011). The United States is a collection of growing cultural pockets inlaid in a contemporary society. From 2009 to 2010, the foreign-born population of the U.S. grew by 1.4 million (Batalova & Terrazas 2010). As globalization increases, more immigrants are arriving in the United States and adding to the size and diversity of the salad bowl.. Culture The literature offers a multiplicity of definitions for culture and they are of varying depth and utility. Firstly Bullock and Stallybrass (1977) specify culture as the ‘Social heritage’ of a community: the total body of material artifacts (tools, weapons, houses; places of work, worship, government, recreation, works of art, etc.); of collective mental and spiritual “artifacts” (systems of symbols, ideas, beliefs, aesthetic perceptions, values, etc.); and of distinctive forms of behavior created by a people (sometimes deliberately, sometimes through unforeseen interconnections) and transmitted from generation to generation. (p 150) Culture is a culmination of all aspects of a community’s history and method of living. In 1966, Hall described culture as a set of deeply significant experiences which sets up the criterion against which all other things are judged (Hall, 1966). However, more recently social scientists have shifted culture from this experiential viewpoint of culture to a more psychologically based description. Hofstede (1980), more simply describes culture as the “collective programming of the mind which distinguishes the members of one group or category from others.” (p. 25) Some researchers view culture as being a state of mind or thinking such as a concept of beliefs, shared pattern of thinking learned from an early age (Cullen & Parbotteah, 2005; Xing, 1995). Other researchers posit that culture is a people group’s collective opinion concerning what is important in life and how a person should behave. Table 2.1 lists the various definitions of culture.. 9.

(17) Table 2.1 Definitions of Culture Definition. Year. Culture is a concept of the pervasive and shared beliefs, norms, and. 2005. values that guide everyday life.. Author Cullen & Parbotteeah. Culture is a shared pattern of being, thinking, and behaving;. 1995. Xing. 1966. Hall. 2003. Beamer &. something learned from childhood through socialization; something deeply rooted in tradition that permeates all aspects of any given society. Culture [is] those deep, common, unstated experiences which members of a given culture share, which they communicate without knowing, and which form the backdrop against which all other events are judged. Culture is the coherent, learned, shared view of a group of people about life’s concerns that ranks what is important, furnishes attitudes. Varner. about what things are appropriate, and dictates behavior. Culture is the collective programming of the mind which. 1980. Hofestede. 1977. Bullock. distinguishes the members of one group or category from others. Culture is the ‘Social heritage’ of a community: the total body of material artifacts (tools, weapons, houses; places of work, worship,. &Stallybrass. government, recreation, works of art, etc.); of collective mental and spiritual “artifacts” (systems of symbols, ideas, beliefs, aesthetic perceptions, values, etc.); and of distinctive forms of behavior created by a people (sometimes deliberately, sometimes through unforeseen interconnections) and transmitted from generation to generation. These definitions help to understand what culture is. Culture, however, is more than a description of identity but also acts as a mechanism for human functioning. The National Association of Social Workers (2001) describes culture as the “integrated pattern of human behavior that includes thoughts, communications, actions, customs, beliefs, values, and 10.

(18) institutions of a racial, ethnic, religious, or social group” (p. 61). Of all the literature defining culture, the authors Chaney & Martin (2003) put forth a practical and accurate use of the term as “the structure through which the communication [process] is formulated and interpreted” (p. 268). This idea of culture being the conduit of communication is also supported by foreign language learning researchers: “Language is the most typical, the most representative, and the most central element in any culture. Language and culture are not separable” (Brooks, 1964, p. 85). The researchers Samovar, Porter, and Jain (1981) explained in more detail why the two are so intertwined: Culture and communication are inseparable because culture not only dictates who talks to whom, about what, and how the communication proceeds, it also helps to determine how people encode messages, the meanings they have for messages, and the conditions and circumstances under which various messages may or may not be sent, noticed, or interpreted... Culture...is the foundation of communication. (p. 24) Therefore for the purposes of this study the definition of a foreign culture or a culture different to that of the respondents will refer to any culture whose primary language of communication is not English.. Competency The literature offers many useful descriptions of competency. Competency is generally agreed as pertaining to an individual’s KSAO’s. KSAO’s is a common term in the literature and refers to the knowledge, skills, abilities, and other traits such as personality type and interests (Peters, Greer, & Youngblood, 1997). Furthermore, a competency is the application of those KSAO’s (International Standard, 1999).. A competency can also be a measurable or. immeasurable characteristic that causes a person to be highly effective in a given situation (Spencer &Spencer, 1993). Other researchers describe competency as a set of skilled behaviors or at least measurable behaviors leading to effective handling of unique situations (Bowden & Marton, 1998; Spitzberg, 1994). No matter how a competency is described, the existence of a 11.

(19) competency can always be recognized because it “leads to or causes effective or superior performance” (Boyatzis, 1982). Table 2.2 lists other useful descriptions of competency found in the literature. Table 2.2 Definitions of Competency Definition. Year. Group of measurable bits of workplace behavior and a person’s. Author. 1998. Bowden & Marton. A kind of ability or a set of skilled behaviors.. 1994. Spitzberg. An application of knowledge, skills, and behaviors in. 1999. International. ability to handle unique situations in an effective manner.. performance.. Standard ISO 10015. An underlying characteristic of an individual that is causally. 1993. Spencer &Spencer. related to criterion referenced effective and/or superior performance in a job or situation.. Competency in fact includes both an internal or mental factor as well as an external factor. The external element is the observable behavior while the internal element is the intent, or motivation, of the behavior. (Boyatiz, 1982).. For instance, while speaking with a new. acquaintance, a person might continue the conversation by asking interesting questions for the sake of ingratiating themselves to with the new contact. This would be an example of political or social competency. On the other hand, the same behavior might be observed by a person genuinely interested in what the new acquaintance has to say and would like to get to know them better. This shows the person is applying a competency like emotional self-awareness (Boyatiz, 1982). This theme of competency having internal as well as external elements can be extended into different types of competency such as intercultural competency.. 12.

(20) Intercultural Competency Cross, Benjamin, and Isaacs (1989) described intercultural competency as “a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals and enable that system, agency, or those professionals to work effectively in crosscultural situations” (p. 13). This definition outlines the major outward characteristics and end result of effective ICC. Onyoni and Ives (2007) take the definition further by explaining that the behavior is a combination of “knowledge, awareness, sensitivity, attitudes, skills, and encounters by individuals and programs to acknowledge and respect the cultural traditions of their clients and their communities” (p. 1). The intent, therefore, of intercultural competency behaviors is to show acknowledgement and respect to the individuals with whom one is interacting. The same sentiment of respect is expressed by Alvarez et al. (2008) along with the idea that cultural competency is a process that improves over time. Icebergs have long been used for analogous purposes and illustration of cultural competencies is just one of them. Icebergs are unique in that, at first glance, their cap or “tip” catches the eye and can distract one from investigating what lies below the waterline. In fact, only 10 percent of an iceberg is observable (Briney, 2012). Likewise, the observable aspects of cultural competency are only a fraction of an entirety. Spencer & Spencer explain that in this sense the iceberg has four layers of descending degrees of discernibility. The first layer is knowledge that can be taught and learned in a structured format such as training courses (Spencer & Spencer, 1993). For example, one can easily teach a new employee to bow their head slightly when greeting Asian business associates. The second layer is less specific skills that can’t necessarily be taught in a classroom but are learned from situational experience and can be transferred from one scenario to another (Spencer & Spencer 1993). For instance, gauging the appropriate moment to make a toast at a dinner party is a hard skill to teach objectively and can only be learned through experience. The third layer of the iceberg is the relationship between a person’s values and beliefs and their perception of social and political expectations (Spencer & Spencer, 1993). A person with high cultural competency might be more able to understand the other side of a hot-button political topic and therefore more likely to gracefully respond in accordance with their private beliefs. The final layer of the iceberg consists of personal traits 13.

(21) such as their motivation and self-image (Spencer & Spencer, 1993). This last layer is very difficult to observe and measure. For instance, a boss from a detailed oriented culture double checking numbers and figures might come across as untrusting or doubtful of an employee’s hard work. There is no such thing as a completely culturally competent person: “Cultural competence is never fully realized, achieved, or completed, but rather a lifelong process for social workers who will always encounter diverse clients and new situations in their practice” (NASW, 2001, p. 11). Chang (2007) echoes this sentiment but includes that an individual is not left unchanged by pursing ICC because it is “an integrative and transformative process” (p. 189). On a different note Whaley and Davis (2007) describe ICC as “set of problem solving skills” in an intercultural situation. Taylor (1994) takes this problem solving ability further by stating that intercultural competency is “an adaptive capacity based on an inclusive and integrative world view which allows participants to effectively accommodate the demands of living in a host culture” (p. 1). This idea is ultimately the goal of healthcare practitioners with respect to their intercultural competencies: to effectively and smoothly operate in multicultural scenarios.. ICC and Job Performance Factors affecting workers’ job performance are always of great interest to employers. The link between a person’s ability to communicate effectively in multicultural work environments and their occupational performance is strongly supported across various professional fields. Mol et al., (2005) showed that an employee’s intercultural sensitivity was significantly related to job performance.. While studying corporate employees considering. overseas assignment researchers found that job effectiveness was strongly tied to intercultural adjustment (Tucker et al., 2004). Other correlations between job performance and the different sections of ICC have been shown in multiple studies (Cui &Awa, 1992; Hawes & Kealey, 1981; Ruben,1977; Sizoo, Plank, Iskat, & Serrie, 2005). The effect ICC has on job performance extends beyond individual level. Managers from the U.S. and Russia expressed that transparent communication and cultivating cross-cultural rapport among teammates was essential to team performance (Matveev & Milter, 2004). Researchers exploring the inter-workings of self14.

(22) managed work teams (SMWTs) discovered that the root of team inefficiency was a lack of cultural understanding amongst teammates (Kirkman & Shapiro, 1997).. ICC and Healthcare Racial and ethnic groups in the US suffer disproportionally from health problems. The socio-economic status of these groups contributes to this disparity in ways such as poor living conditions and lack of medical insurance (Betancourt et al., 2003). Many of the health problems for these people groups are due to a lack of consistent, if any, access to healthcare. There are, however, cultural problems contributing to the situation: Racial/ethnic disparities in quality of care for those with access to the health care system are equally concerning. These disparities have been shown to exist in the utilization of cardiac diagnostic and therapeutic procedures, prescription of analgesia for pain control, surgical treatment of lung cancer, referral to renal transplantation, treatment of pneumonia and congestive heart failure, and the utilization of specific services covered by Medicare. (Betancourt et al.,2003, p.294) The authors explain that the root of these problems is likely attributed to patient’s cultural beliefs concerning patient recognition of symptoms, thresholds for seeking care, ability to be understood when describing symptoms, ability to understand treatment plans, and adherence to care (Betancourt et al., 2003). These factors affect a healthcare provider’s ability to interact with their patients during a treatment and recovery thereby increasing the disparities in racial and ethnic group health problems (Betancourt et al., 2003). A nursing supervisor from Pensacola, Florida, while being interviewed for a qualitative study parallel to this research, commented on the barrier created by a nurse’s low intercultural communication skills with cultural different patients: “Every time she walked into the room they asked for someone else—They didn’t want her. So if you’re not able to cross that barrier, even if you’re the best nurse in the world, you can’t provide good care” (Vaughan & Yeh, 2013, p. 626). If medical providers are more attuned. 15.

(23) to the cultural lens through which a patient views their health then the provider “can address patient concerns more adroitly, leading to improved clinical outcomes” (Chansky, 2011, p. 88). Striving for a more culturally competent health care system should be a priority among healthcare providers and health educational institutions. Researchers explain that a culturally competent healthcare system “acknowledges and incorporates—at all levels—the importance of culture, assessment of cross-cultural relations, vigilance toward the dynamics that result from cultural differences, expansion of cultural knowledge, and adaptation of services to meet culturally unique needs” (Betancourt et al., 2003, p. 294). This means that healthcare providers should not only increase their cultural knowledge of their patients’ backgrounds but also be actively aware of the interplay of cultures during communication.. To prevent cultural. competence stagnation, providers shouldn’t think of themselves as culturally competent but only as always becoming more culturally competent (Campinha-Bacote, 1998).. Intercultural Sensitivity There is a gap between simply noticing the asynchronies of a culturally different person and appropriately responding to those differences in order to achieve effective interaction. Intercultural Sensitivity bridges that gap. It has been generally described as “sensitivity to the importance of cultural differences and to the points of view of people in other cultures” (Bhawuk & Brislin, 1992, p. 414).. The same authors continue to describe cultural sensitivity, or the. ability to detect cultural differences, as a part of a trio of attributes needed for effective intercultural communication. The other members of the trio, awareness and adroitness, are having an interest in other cultures and the willingness to modify one’s behavior during interactions respectively (Bhawuk & Brislin, 1992). Chen and Starosta further clarified this trio by explaining that all of ICC can be described in one of the following three categories: intercultural awareness, intercultural sensitivity, and intercultural adroitness (1996). Intercultural awareness is the cognitive aspect of ICC which consists of culture knowledge and understanding cultural conventions that drive behavior (Chen &Starosta, 1996). Intercultural sensitivity is the affective ingredient for ICC which is driven by an “active desire to motivate themselves to understand, appreciate, and accept differences among cultures.” (Chen & Starosta, 1998, p. 231). 16.

(24) It has also been defined as “sensitivity to the importance of cultural differences and to the points of view of people in other cultures” (Bhawuk & Brislin, 1992, p. 1). Finally, intercultural adroitness is the behavioral side of ICC which describes a person’s ability to successfully complete tasks and reach communication goals during intercultural interactions. (Chen &. Starosta, 1996). Furthermore Bennett describes intercultural sensitivity as process of developing one’s self in the three ICC aspects by moving through six stages of experiencing cultural differences from a state of ethnocentrism to ethnorelativism (Bennett, 1986). The first stage is denial in which the subject simply rejects the existences of differences. During the second phase, defense, the subject seeks to protect their own world view by countering the differences. The subject then tries to conceal differences to protect their world view during the third stage. In the fourth stage the subject has now crossed into a more ethnorelative perspective and they begin to accept cultural differences.. In the fifth stage the subject now openly recognizes cultural. differences and changes their behavior to become multicultural. When the subject reaches the sixth stage, they view their own culture as one of many cultures—not the best culture—and enjoy cultural interactions (Bennett, 1986). Figure 2.2 illustrates the six stages of Bennett’s Developmental Model of Intercultural Sensitivity.. Figure 2.2 Bennett’s developmental model of intercultural sensitivity. Adapted from “Becoming interculturally competent” by M. J. Bennett, 2004, Toward multiculturalism: A reader in multicultural education, 2, p 63, Newton, MA: Intercultural Resource Corporation. 17.

(25) The greater the level of one’s ICS the more quickly they will transition from ethnocentric to enthorelative states of mind.. Beyond acting as a facilitator for this transition, intercultural. sensitivity also facilitates a person’s movement from the first category of ICC, intercultural awareness or the cognitive aspect, to the behavioral aspect where intercultural competence manifests (Chen, 1997). Therefore by measuring the level of an individual’s sensitivity, intercultural trainers can better adjust their techniques to match their student’s needs.. Dimensions of Intercultural Sensitivity Effective and appropriate cross-cultural communication is important in interpersonal, intercultural encounters. A variety scales and combinations therein have been used to measure individuals’ levels of ICC such as empathy, perspective taking, cultural sensitivity, listening, and non-ethnocentrism (Collier, 1989; Gudykunst, Wiseman, & Hammer, 1977; Hawes & Kealey, 1981; Ruben, 1976, 1977a).. A study concerning intercultural communication competency in. sojourners outlined three general dimensions of ICC: the ability to deal with psychological stress, the ability to effectively communicate, and the ability to establish interpersonal relationships (Hammer et al., 1979). Since then researchers have mapped out more components regarding interculturally effective behaviors, including message skills, interaction management, behavioral flexibility, identity management, and relationship cultivation. (Chen, 1989, 2005; Martin. &Hammer, 1989; Ruben, 1977a; Spitzberg & Changnon, 2009). Chen and Starosta, while testing their Intercultural Sensitivity Scale on studying college students, validated the following five dimensions: interaction engagement, respect for cultural differences, interaction confidence, interaction enjoyment, and interaction attentiveness. (Chen &Starosta, 2000). Interaction. engagement is how involved the respondent feels during an interaction. Respect for cultural differences regards the respondent’s tolerance of cultural differences and opinions. Interaction confidence measures the participant’s confidence during such interactions.. Interaction. enjoyment measures the respondent’s positive and negative feelings that occur during crosscultural interactions. Interaction attentiveness regards the respondent’s level of understanding and awareness during interactions.. 18.

(26) In a related study, German researchers tested Chen and Starosta’s ICS scale for structural validity and consistency (Fritz & Chen, 2000). This study delivered a translated version of the 24 item scale to 400 business students in Germany. The results of their study showed that the scale generally held up under stress.. Two dimensions, interaction attentiveness and interaction. enjoyment had low discriminant validities thus the researchers suggested that these dimensions might be combined in future research (Fritz &Chen, 2000). On the whole, the researchers confirmed “the applicability and usefulness of Chen and Starosta’s instrument in measuring intercultural sensitivity” (Fritz & Chen, 2000, p. 9). Although this study does not investigate the relationships between the independent variables and ICS at the dimensional level, exploratory factor analysis was conducted to test the structure of the dimensions.. Contact Theory The phrase “fear of the unknown” reflects a natural human characteristic. Humans are wary of unfamiliar places, situations, and people. For instance the less experience we have performing a task the more uneasy we feel while performing it. Likewise, the less contact we have with a person or culture, the less confident, relaxed, aware and sensitive we are during cultural interactions. The opposite is also true. The more interaction and exposure an individual experiences with a different people group, the more likely they are to feel comfortable, act confidently, and be more sensitive with that group and other groups. This is the foundation of contact theory. Work on contact theory began after World War II (Watson, 1947; Williams, 1947). Allport (1954) argued that the increasing contact between people groups will decrease their prejudices and conflicts with each other: “whatever makes for…more intimate acquaintance is likely to make for increased tolerance…true acquaintance lessens prejudice” (p. 489). Contact theory developed further during racial integration when racism was “thought derived from irrationally held beliefs and attitudes of individuals” (Emerson, Kimbro, & Yancey, 2002, p. 746). Proponents of contact theory believe that the more contact between individuals of different people groups, the more likely those individuals will be to resolve their misconceptions about the other (Emerson et al., 2002). The effects of contact are not limited to just the contact 19.

(27) between those individuals. The change an individual undergoes during one contact instance is carried over into future contact scenarios. During future contacts with other groups, such an individual is likely to find more similarities between themselves and their counterparts (Emerson et al., 2002). Research supporting contact theory indicates that exposure to culturally diverse groups can have an effect on healthcare providers’ ability to better interact the people around them (Bartunek, 2011). Therefore the more prior exposure and contact a person experiences with different groups the better prepared they will be to interact with culturally different people in the future. Furthermore the setting in which an individual exists can have an effect on their contact related exposure to diversity. Researchers studying diversity in medical schools and the outcomes therein found that in schools with high levels of diversity the white students “rated themselves better prepared to care for diverse populations” (Saha, Guiton, Wimmers, & Wilkerson, 2008, p. 1139).. Predictors of ICS Cultural competence is like other types of competency in that it is a culmination of a person’s characteristics. Because of this, particular characteristics can be isolated and tested for their effect on the person’s competency. Through this process it is possible for researchers to ascertain various predictors for cultural competency. Because intercultural sensitivity makes up a part of intercultural competency it is subject to the same predictors of ICC. Concepts like empathy, perspective taking, listening, and non-ethnocentrism have all been used by researchers as predictors of ICC and cross-cultural communication effectiveness (Collier, 1989; Gudykunstet al., 1977; Hawes & Kealey, 1981; Ruben, 1976, 1977a). Researchers studying predictors between Japanese and American managers were able to draw from prior research and literature to test for predictors of ICC such as knowledge of the other culture, stereotypes, levels of ethnocentrism, and social distance (Wiseman, Hammer, & Nishida, 1989). Brislin (1981) came up with six abilities tied to ICC: knowledge of subject matter; language; communication skills; positive orientations to opportunities; ability to use personal traits such as tolerance, character, sociability, and task orientation; and ability to deliver results. Imahori and Lanigan (1989) provided three dimensions affecting ICC with each dimension including some sub-factors. Those dimensions are knowledge, skill, and attitude. Knowledge includes general and specific 20.

(28) knowledge about a culture, understanding the language, and awareness of the unspoken social rules regarding interaction. Their skill sub-factors are one’s respectfulness during interaction, posture, information orientation, empathy, role flexibility, interaction management, ambiguity tolerance, linguistic skills, speech accommodation, and affinity seeking. Other researchers have determined other variables related to ICC such as communication skills, empathy/social decentering, knowledge of host culture, and language competence (Bennett, 1979; Hammer, Gudykunst, and Wiseman, 1978; Hannigan, 1990; Kim, 1991; Okazaki-Luff, 1991; Ruben, 1976, 1977b; Searle &Ward, 1990; Ward and Searle, 1991; Wiseman et al., 1989).. Background Setting The United States is a canvas of large swaths of rural area pockmarked by densely populated urban/suburban areas. These urban areas are statistically more culturally diverse than rural areas. (U.S. Census Bureau, 2011) As contact theory would predict, a person living in a culturally diverse area will have a greater affinity for ICS effectiveness. This was found to be the case in a study focusing on the faculty of nursing schools which revealed that programs located in largely urbanized states with a high immigrant population density were more culturally competent than their counterparts hailing from rural areas (Kardong-Edgren, 2007). Thus this study proposes the following hypothesis: H1: Students from an urban or metropolitan background have higher levels of ICS than students from rural areas.. Prior Exposure Prior exposure, even in small amounts, to a culture has a positive impact on a person’s intercultural competency. While studying cultural competency in clinical psychologists, researchers showed that a clinician’s prior exposure to different cultural groups, especially during training, was a strong predictor of cultural competency (Allison, Echemendia, Crawford, & Robinson, 1996). Prior exposure to foreign cultures through cultural immersion experiences has shown to be a strong indicator of intercultural communication competency (Larsen & Reif, 2011). Therefore, the first dimension of this variable is immersion experience. This dimension 21.

(29) seeks to measure the level of immersion experiences and simulated immersion experiences such as attending cultural events, cultivating cross-cultural friendships, and dining at culturally different restaurants. Furthermore, exposure to stories and narratives from foreign cultures has also shown to have a noticeable effect on cross cultural competencies (Anderson, 2004). The second dimension for prior cultural exposure is called narrative experience. This dimension seeks to ascertain how much the respondent has experienced another culture’s perspective or “mindset.” Respondents can gain insight of another culture or “see through their eyes” by consuming books and movies set in and told from a culturally different perspective. The third dimension of prior cultural experience seeks to measure linguistic abilities. A study involving doctors and language ability showed that language proficiency was directly related to successful cross cultural interactions (Fernandez et al., 2004). Therefore this study proposes the following hypothesis: H2: Prior cultural exposure has a positive influence on students’ levels of ICS. H2-1: Cultural immersion experience has a positive influence on students’ levels of ICS. H2-2: Cross-narrative experience has a positive influence on students’ levels of ICS. H2-3: Language study has a positive influence on students’ levels of ICS.. Gender Gender can also have an effect on a person’s cultural competency. In a multicultural study involving mental therapists and diverse populations researchers found that females had much more positive outcomes from treatment from culturally different therapists than males (Sue, Fujino, Hu, Takeuchi, &Zane, 1991). Furthermore, in a study exploring ethnic identity and occupational aspirations the researchers Hogg, Abrams, & Patel (1990) found that females were much more likely to reach out and interact with persons of a different culture than their male counterparts. Thus this study proposes the following hypothesis: 22.

(30) H3: Female students have a higher ICS levels than their male counterparts.. Intended Work Setting Humans naturally tend to seek out jobs and occupational settings where they believe they will be the most successful. This may be because they are already familiar with a particular work setting or believe they have some trait that will give them an edge in that setting. However, in a study looking at the cultural competency of nurse practitioner students, researchers found that individuals planning to work in a rural setting had higher levels of ICC than those intending to work in urban areas (Benkert et al., 2005). These results seem to contradict contact theory which proposes that individuals with prior cultural exposure perform better in future interactions. Thus this study proposes the following hypothesis: H4: Students intending to work in urban areas or large cities have higher levels of ICS than students seeking employment in rural areas.. 23.

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(32) CHAPTER III METHODOLOGY This chapter covers the design and mechanisms of the study.. Firstly, the research. framework and hypotheses are explained in terms of their cultivation and design.. The. methodology is then laid out with relation to the participants involved, the instrument used, and the data collection and analysis processes.. Research Framework The framework for this study was designed in accordance with the research purpose and literature review. The purpose of this study is to investigate predictors of ICS in nursing students along the Gulf Coast. These predictors are divided into four X variables: community setting, prior exposure, gender, and intended work setting. These variables are to be tested against the Y variable of ICS which is comprised of five domains: interaction engagement, respect for cultural differences, interaction confidence, interaction enjoyment, and interaction attentiveness. Figure 3.1 illustrates the research framework.. 25.

(33) Figure 3.1 Research Framework. Research Hypotheses Based on the purpose of the study and the research questions, the following hypotheses seek to explain the relationship between the variables gender, community setting, prior exposure, and intended work setting with the intercultural sensitivity levels of nursing students. H1: Students from an urban or metropolitan background have higher levels of ICS than students from rural areas. H2: Prior cultural exposure has a positive influence on students’ levels of ICS. 26.

(34) H2-1: Cultural immersion experience has a positive influence on students’ levels of ICS. H2-2: Cross-narrative experience has a positive influence on students’ levels of ICS. H2-3: Language study has a positive influence on students’ levels of ICS. H3: Female students have a higher ICS levels than their male counterparts. H4: Students intending to work in urban areas or large cities have higher levels of ICS than students seeking employment in rural areas.. Research Method Based on material in the literature, advice from subject matter experts, and consultations from professors this study was designed to use a quantitative approach for testing the hypotheses. Appropriate participants were selected in accordance with the research purpose. A survey instrument was designed based on the literature and can be found in Appendix A.. Research Procedure This study follows a ten step guide for conducting the research. The steps are as follows: 1. Read literature for gaps or anomalies in a particular field to identify a research problem. 2. Define research objectives to serve as the basis of the study. 3. Review relevant literature to gain greater expertise on the topic. 4. Build research framework. 5. Through using the literature, obtaining advice, and adapting available instruments, create a questionnaire for use in the present study. 27.

(35) 6. Run a pilot study to analyze the reliability of the instrument and adjust as needed. 7. Run the main study. 8. Analyze data and test hypotheses. 9. Discuss findings. 10. Specify implications of study and provide further research recommendations.. Sample The participants of this study were nursing students in the Gulf Coast region of the United States. There were five schools in this study offering either an Associate’s Degree in Nursing (ADN) or a Bachelor’s of Science in Nursing (BSN). The students were attending schools that will prepare them for the licensing exams to become Registered Nurses. These two types of nursing degrees were chosen for this study because they make up about 90% of nurses employed in northwest Florida which is the majority of the research area. (Florida Center for Nursing, 2012) This study looked at nursing schools offering these degrees along the Gulf Coast Region consisting of 121 participants.. Sample Descriptive Statistics In this study, the instrument was distributed to five nursing programs along the Gulf Coast region resulting in 121 completed surveys.. Firstly, the deans or the equivalent. administrative personnel of each institution were contacted to solicit participation.. After. obtaining permission to conduct the study, the researcher then fulfilled the research participation requirements for each institution such as providing letters of intent, samples of the instrument, and assurances of data collection privacy and security. The instrument was then uploaded to a professional survey distribution website, and a secure URL was sent to each institution’s lead point of contact (POC) for the project. The POC in turn distributed the link to the student bodies via their internal and/or private email lists. This was done to protect the security of the student’s online contact information. 28.

(36) Each nursing program averaged 40 to 50 enrolled students, putting the number of participants in the sample at approximately 250 students. This brought the response rate of the sample to 48%. The instrument collected ICS scores, background data, prior cultural exposure, and demographic data which queried age, gender, and highest level of education. Among the respondents, 77% were female, the majority of whom are in their mid to late twenties. Of the respondents 48% acknowledged holding a two year associate’s degree, 36% holding a high school diploma, 14% holding a four year bachelor’s degree, and 1% holding a Ph.D. Among the 121 respondents, there were 31% who identified themselves as coming from a rural hometown, 59% coming from an urban community, and 10% coming from a large city. Table 3.1 displays the descriptive data for the sample. Table 3.1. Sample Description Frequenc Dimension – Characteristic – Item. Scale. Age. Education. Background Setting. y. Percentage. < 20 yoa. 6. 5. 20-29 yoa. 60. 49.6. 30-39 yoa. 32. 26.4. 40-49 yoa. 15. 12.4. > 50 yoa. 8. 6.6. High School. 44. 36.4. Assoc / 2 yr. 59. 48.8. BA / 4 yr. 17. 14. Masters. 0. 0. Ph. D.. 1. 0.8. Rural. 38. 31.4. Non-Rural. 83. 68.6 (continued). 29.

(37) Table 3.1 (continued) Dimension – Characteristic – Item. Scale. Prior Cultural Exposure - Immersion Experience Cultural Courses to Date. Prior Cultural Exposure - Immersion Experience Highest Language Ability. Prior Cultural Exposure - Immersion Experience Cross Cultural Friendships. Prior Cultural Exposure - Immersion Experience Foreign Restaurants per week. Prior Cultural Exposure - Immersion Experience Cultural Events per month. Frequency. Percentage. None. 61. 50.4. 1. 30. 24.8. 2. 23. 19.0. 3. 4. 3.3. >4. 3. 2.5. None. 28. 23.1. Beginner. 62. 51.2. Intermediate. 26. 21.5. Advanced. 1. .8. Fluent. 4. 3.3. 0. 22. 18.2. 1. 14. 11.6. 2. 16. 13.2. 3. 6. 5.0. >4. 63. 52.1. 0. 26. 21.5. 1. 49. 40.5. 2. 33. 27.3. 3. 10. 8.3. >4. 3. 2.5. 0. 35. 28.9. 1. 37. 30.6. 2. 28. 23.1. 3. 8. 6.6. >4. 13. 10.7 (continued). 30.

(38) Table 3.1 (continued) Dimension – Characteristic – Item. Prior Cultural Exposure -Immersion Experience Time Lived Abroad. Prior Cultural Exposure - Narrative Experience - Foreign Authored Books per month. Prior Cultural Exposure - Narrative Experience Foreign Perspective Books per month. Prior Cultural Exposure - Language Study High School Courses. Prior Cultural Exposure - Language Study College Courses. Scale. Frequency. Percentage. None. 74. 61.2. < 3 months. 15. 12.4. 3 - 6 months. 1. .8. 6 - 12 months. 5. 4.1. > 1 year. 26. 21.5. 0. 100. 82.6. 1. 16. 13.2. 2. 4. 3.3. 3. 0. 0.0. >4. 1. .8. 0. 78. 64.5. 1. 25. 20.7. 2. 10. 8.3. 3. 3. 2.5. >4. 5. 4.1. 0. 21. 17.4. 1. 50. 41.3. 2. 34. 28.1. 3. 13. 10.7. >4. 3. 2.5. 0. 71. 58.7. 1. 29. 24.0. 2. 16. 13.2. 3. 4. 3.3. >4. 1. .8 (continued). 31.

(39) Table 3.1 (continued) Dimension – Characteristic – Item. Scale. Prior Cultural Exposure - Language Study -. Frequency. Percentage. 0. 17. 14.0. 1. 76. 62.8. 2. 24. 19.8. 3. 2. 1.7. >4. 1. .8. Male. 28. 23.1. Female. 93. 76.9. Rural. 16. 13.2. Non-Rural. 105. 86.8. #. of Languages Studied. Gender. Intended Work Setting. Research Instrument A 44-item instrument was designed based on the literature. The survey was delivered and the results recorded electronically via an online survey system. The questionnaire consists of four sections. Section 1 contains 24 items measuring intercultural sensitivity using a 5-point Likert scale. Section 1 covers five dimensions of ICS as drawn from work by Chen and Starosta (2000). The first dimension, “interaction engagement” has to do with the feeling of involvement during an intercultural exchange. The next dimension is respect for cultural differences which are concerned with how tolerant the participant is towards cultural differences and opinions during cross cultural interactions. during interactions.. The third dimension measures the respondent’s confidence levels. Interaction enjoyment, the fourth dimension, assesses the respondent’s. reactions during interaction as being positive or negative.. Finally interaction attentiveness. measures how much the respondents try to continually understand and assess what is occurring during cross cultural interactions.. Table 3.2 lists the five dimensions of ICS and their. corresponding items as they appear in the instrument.. 32.

(40) Table 3.2 ICS Dimension Subscales ICS Dimension Item Sub-scale 1. I enjoy interacting with people from different cultures. 11. I tend to wait before forming an impression of culturally-distinct Interaction Engagement. counterparts. 13. I am open-minded to people from different cultures. 21. I often give positive responses to my culturally different counterpart during our interaction. 22. I avoid those situations where I will have to deal with culturally-distinct persons.* 23. I often show my culturally-distinct counterpart my understanding through verbal or nonverbal cues. 24. I have a feeling of enjoyment towards differences between my culturally-distinct counterpart and me. 2. I think people from other cultures are narrow-minded.* 7. I don't like to be with people from different cultures.*. Respect for. 8. I respect the values of people from different cultures.. Cultural Differences. 16. I respect the ways people from different cultures behave. 18. I would not accept the opinions of people from different cultures.* 20. I think my culture is better than other cultures.*. *Items reversed coded before summing values.. (continued) 33.

(41) Table 3.2 (continued) ICS Dimension. Item. Sub-scale 3. I am pretty sure of myself in interacting with people from different cultures. 4. I find it very hard to talk in front of people from different cultures.* Interaction. 5. I always know what to say when interacting with people from different. Confidence. cultures. 6. I can be as sociable as I want to be when interacting with people from different cultures. 10. I feel confident when interacting with people from different cultures. 9. I get upset easily when interacting with people from different cultures.*. Interaction. 12. I often get discouraged when I am with people from different cultures.*. Enjoyment 15. I often feel useless when interacting with people from different cultures.* 14. I am very observant when interacting with people from different cultures. Interaction Attentiveness. 17. I try to obtain as much information as I can when interacting with people from different cultures. 19. I am sensitive to my culturally-distinct counterpart's subtle meanings during our interaction.. *Items reversed coded before summing values.. 34.

(42) Section 2 of the instrument investigates a person’s prior exposure to cultural diversity. Section is divided into three categories: Language study, immersion experience, and narrative experience. Firstly, Language study is assessed through the following items: “25. I took ____ foreign language courses during high school: 0/NA, 1, 2, 3, 4, or more; 26. I took ____ foreign language courses during college: 0/NA, 1, 2, 3, 4, or more; 27. I have studied ______ foreign languages: 0/NA, 1, 2, 3, 4, or more; 28. I consider my highest foreign language ability level to be: Non-Existent, Beginner, Intermediate, Advanced, and Fluent. Immersion experience is divided into three aspects: physical immersion, academic immersion, and extracurricular immersion. Item 29 for instance measures time spent abroad as one aspect of physical immersion: “I have lived abroad in a foreign culture for _________. 0/NA, Less than 3 months,. 3-6 months,. 6-12 months, Over. 1. year.”. Academic. immersion is assessed by item 29: “Between High School and College I’ve taken ______ cultural classes such as courses titled: “Cultures of the World” or “Intro to World Culture”: 0/NA, 1, 2, 3, 4 or more.” Extracurricular immersion is measured by looking at the respondent’s cross cultural relationships, time spent at foreign restaurants, and attendance at cultural events using the following items: “30. I have _____ friends that are foreign nationals: 0/NA, 1, 2, 3, 4 or more; 31. I eat at restaurants offering foreign cuisine _________ times a week: 0/NA, 1, 2, 3, 4 or more; 35. Every year I attend ________ cultural events such as food, music, art festivals representing a culture different from my own: 0/NA, 1, 2, 3, 4 or more.” The narrative experience category gauges a person’s experience with understanding a foreign culture with items using the following items: “32. I watch ________ foreign films (nonEnglish speaking) every month: 0/NA, 1, 2, 3, 4 or more; 33. I read ________ foreign authored books each month: 0/NA, 1, 2, 3, 4 or more; 34. I read ________ stories set in foreign culture each month:. 0/NA, 1, 2, 3, 4 or more.”. Section three records the values for the intended work setting, be it an urban or a rural setting for the respondents. Because this measure requires a categorical response there is only a 35.

(43) single item used: “Within 5 years of completing my nursing education, I hope to work in community classified as:__________. 1. Rural 2. Urban/Suburban 3.Metropolitan/ Large City.” The third section of the instrument also poses demographic questions to determine the dimensions of the expected predictor variables gender and background setting. One item asks respondents to mark their gender. Four items ask participants to specify whether they come from a rural community or an urban community. Age and highest level of education were also queried in this section to act as control variables for the expected demographic predictors. Age was added to control for the likelihood of older individuals already having prior cultural exposure. Furthermore, by controlling for a participant’s highest degree of education the instrument will take into account the effects of possessing multiple academic degrees might have had on a person’s level of ICS, prior cultural exposure, as well as general knowledge on cross-cultural communication.. Categorical Determination and Selection One of this study’s independent variables, Background Setting, used four items with response options for one of three categories: Rural, Urban, Metropolitan. Two of the items, 38 and 39, measured travel distance from the participant’s home and the closest neighbor and convenience store. These items were removed due to inconsistency amongst themselves and with the other items responses. The inconsistency may be attributed to the layout of some small rural communities which have tightly packed towns surrounded by swaths of farmland. The second two items, 37 and 40, measured the respondent’s background by asking them what kind of town they are from or high school they attended. Because there were three nominal answers for these items the means for each category were compared using one-way ANOVA to determine which background item is most acceptable for establishing a respondent’s category. Back_Town_37 had a significance of .03 compared with item Back_School_40 with a significance of .075.. This means that item Back_Town_37 best establishes a respondent’s. background setting category because they are statistically different from one another. Table 3.3 shows the one-way ANOVA results for these items.. 36.

(44) Table 3.3 ANOVA Results for Background Category Items Item. 37. 40. Sum of. Item Description. Squares. Asks respondent to which category their home town belongs. Asks respondent to which category their high school belongs.. df. Means Square. F. Sig. 2.407. 2. 1.203. 3.604 .030. 1.799. 2. .899. 2.652 .075. Furthermore item Back_School_40, referring to a respondent’s high school setting, was not reliable at establishing the participant’s category because some respondents might have moved to a different community category for their high school years thus distorting the accuracy of the measurement. For these reasons the item querying a respondent’s home town was used for establishing a respondent’s category. For the purposes of this research responses were recoded into a dummy variable with rural answers valued as 0 and urban and metropolitan, or non-rural, responses coded as 1.. Validity and Reliability After the data was collected, the resulting values were analyzed using the Statistical Package for the Social Sciences (SPSS) PC Version 20 software package. The sections of the instrument measuring ICS and prior cultural exposure used scaled responses and thus could undergo factor analysis to determine dimension reduction and check for cross loaded items. This means that EFA was conducted three times in this study. In the first instance ICS and prior cultural exposure items were combined and underwent exploratory factor analysis together to test for items loading on both the dependent and independent variables. The second and third instances of EFA the ICS and prior exposure scales underwent independent EFA to check for factor loading and component placement for determining dimensions. Although this research does not use the ICS scale at the dimensional level, EFA was still conducted to compare the results against the author’s original testing of the scale. 37.