SBIR-STTR Award

In the years since World War II, the U.S. has grown increasingly dependent on foreign-born health care providers at all levels of the health care system. Today 1.1 million immigrants account for 13 percent of all health care providers in the U.S.(Paral, 2004). Foreign-born practitioners, whether educated in the U.S. or abroad, face tremendous challenges adjusting to differences in language, culture and healthcare practices in the U.S. (Doutrich, 2001; McMahon, 2004; Yi & Jezewskii, 2000; Xu & Davidhizar, 2004). We propose to develop a multi media educational tool that will integrate instruction in language, culture, and U.S. healthcare practices to improve the overall communicative competence of foreign-born health care providers. The Intercultural Communication Workshop (1C Workshop) will provide strategies for improving intelligibility, vocabulary, communication skills, and knowledge of U.S. culture as it shapes health care. Instruction will be embedded in clinical scenarios and enriched with audio/video simulations of interactions for demonstration and practice. The 1C workshop can be revisited over time as learners' needs change and an integrated assessment of communicative competence will allow users to set learning goals and measure their progress. The Baseline Assessment of Communicative Competence (BACC) will generate user profiles based on native language, years speaking English, level of employment in the health care system, and performance on the four dimensions of instruction which will direct users to targeted instruction in Phase II. The computer-based workshop can be used as an adjunct to formal courses and orientations programs or stand alone as self-paced instruction. The workshop will provide ongoing opportunities for practice and reinforcement when courses have been completed. Foreign-born employees, employers, educators, and professional associations will make up a sizable market for the 1C Workshop. In Phase I we will develop and field test the multimedia BACC and the first module on speech intelligibility. The Phase I assessment and module will target Filipino nurses, one of the largest segments of the foreign-born health care labor force. We will also develop software for creating user profiles from the BACC and for rule-based branching that will direct users to relevant instruction in Phase II. Our Phase I goals are to demonstrate the feasibility of a computer-based assessment of communicative competence and establish preliminary construct validity of the BACC

Currently 17 percent of the total U.S. nursing work force is foreign-born. Many of these highly qualified professionals speak U.S. English as a second language and struggle to communicate effectively with clients and colleagues. The Intercultural Communication Workshop (hereafter, ICW), is a multimedia, internet-based educational tool designed to improve the overall communicative competence of foreign- born nurses. ICW Phase I integrates instruction in speech intelligibility with contextual information about communication, culture, and healthcare in the U.S. In Phase II, the user interface and navigation will be refined based on the findings of the Phase I field trial and the content will be expanded to address the language needs of diverse native speakers. Interactive role-play simulations will provide opportunities to practice new communication strategies. A multi-method, multi-measure two-group randomized controlled trial will be used to evaluate the educational effectiveness of the ICW, using an intent-to- teach approach analogous to the intent-to-treat approach for evaluations of effectiveness of biomedical interventions. Successful completion of ICW and a satisfactory demonstration of educational effectiveness will result in a new, low-cost, efficient resource for foreign-born nurses and their employers, lead to gains in speech intelligibility and communication skills in U.S. English for foreign-born nurses, enhance the intrinsic rewards of their profession for foreign-born nurses, and ultimately improve retention of foreign-born nurses in challenging and rewarding positions in the healthcare workforce. ICW will also yield two online assessment tools that facilitate the work of second-language acquisition and speech & language professionals. The use of computer-based training to improve the speech intelligibility and communication skills of foreign-born nurses addresses NINR's strategic plan for Adopting, adapting and generating new technologies for better health care.

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