Trotter S1, Kent A1, Oliva B1
1University of St. Augustine for Health Sciences, Doctor of Physical Therapy Program, Austin, United States
Background: Educators leading international service-learning experiences are challenged to provide an environment that develops culturally competent clinicians while respecting the needs and values of the partnering community. Limited research exists on effective methods of pre-departure training (PDT) for physical and occupational therapy students and clinicians. Implementing best-practice preparedness training for service in a resource-limited country could enhance sustainability.
Purpose: This study evaluated the effectiveness of PDT and cross-cultural adaptability among inter-professional students and clinicians who volunteered for a one-week service-learning experience to Guatemala.
Methods: A convenience sample of 21 physical and occupational therapy students and clinicians who participated in four 1-hour PDT sessions before traveling to Guatemala were included in this mixed methods study. Training consisted of didactic, reflective and simulation components designed to introduce self-awareness, team-building, cultural knowledge, and to support trip preparations. Four debriefings were recorded using open-ended questions with a thematic approach concerning the concept of preparedness and cultural adaptability. The first briefing occurred before the PDT. The second transpired after the third PDT module, the simulation experience. The final two debriefings happened at the first and then last day of the service-learning experience in Guatemala. A convenience sample from the host-site facilitators working directly with the participants was utilized to gather their perspective on the team's level of preparedness and responsiveness to the needs of the community. Digital recordings of all discussions were transcribed and coded using three-level member checking to strengthen the validity and reliability of the emerging themes. The Cross-Cultural Adaptability Inventory (CCAI) was administered pre-training and post-experience. The CCAI is a series of 50 statements that can identify an individual or group's strengths and weaknesses in four areas that are fundamental to valuable cross-cultural experiences: emotional resilience, flexibility/openness, perceptual acuity, and personal autonomy. Data from the CCAI was analyzed using Wilcoxon Sign Ranked Tests using IBM SPSS 25, established p-value .05. A convergent parallel design was used so that both qualitative and quantitative data were compared and integrated for interpretation and results.
Results: Seven themes emerged from the qualitative data analysis: collaboration, mentorship, empowerment, opportunity, preparedness, self-awareness, and confidence. Quantitative analysis revealed all participants pre and post CCAI scores for perceptual acuity were significant (p=.018). Clinicians pre and post CCAI scores for personal autonomy were significant (p=.042). Students pre and post CCAI scores for perceptual acuity were significant (p=.040).
Conclusion(s): Participants demonstrated improvements in perceptual acuity and personal autonomy as it relates to cross-cultural adaptability following PDT and a one-week service-learning experience to Guatemala. Students and clinicians reported that as a result of the PDT, they were better able to respond to culturally complex situations encountered in this resource-limited country. Ideas for process improvement including implementing mentorship training between the experienced clinicians and students could be a part of future PDT.
Implications: Pre-departure training for enhancement of international service-learning experiences is recommended to better prepare health-care providers in facing ethical and cultural demands of resource-limited countries.
Keywords: Pre-departure training, International service-learning, Cross-cultural adaptability
Funding acknowledgements: The researchers were awarded a USAHS internal grant in the amount of $1027.02 to support this study.
Purpose: This study evaluated the effectiveness of PDT and cross-cultural adaptability among inter-professional students and clinicians who volunteered for a one-week service-learning experience to Guatemala.
Methods: A convenience sample of 21 physical and occupational therapy students and clinicians who participated in four 1-hour PDT sessions before traveling to Guatemala were included in this mixed methods study. Training consisted of didactic, reflective and simulation components designed to introduce self-awareness, team-building, cultural knowledge, and to support trip preparations. Four debriefings were recorded using open-ended questions with a thematic approach concerning the concept of preparedness and cultural adaptability. The first briefing occurred before the PDT. The second transpired after the third PDT module, the simulation experience. The final two debriefings happened at the first and then last day of the service-learning experience in Guatemala. A convenience sample from the host-site facilitators working directly with the participants was utilized to gather their perspective on the team's level of preparedness and responsiveness to the needs of the community. Digital recordings of all discussions were transcribed and coded using three-level member checking to strengthen the validity and reliability of the emerging themes. The Cross-Cultural Adaptability Inventory (CCAI) was administered pre-training and post-experience. The CCAI is a series of 50 statements that can identify an individual or group's strengths and weaknesses in four areas that are fundamental to valuable cross-cultural experiences: emotional resilience, flexibility/openness, perceptual acuity, and personal autonomy. Data from the CCAI was analyzed using Wilcoxon Sign Ranked Tests using IBM SPSS 25, established p-value .05. A convergent parallel design was used so that both qualitative and quantitative data were compared and integrated for interpretation and results.
Results: Seven themes emerged from the qualitative data analysis: collaboration, mentorship, empowerment, opportunity, preparedness, self-awareness, and confidence. Quantitative analysis revealed all participants pre and post CCAI scores for perceptual acuity were significant (p=.018). Clinicians pre and post CCAI scores for personal autonomy were significant (p=.042). Students pre and post CCAI scores for perceptual acuity were significant (p=.040).
Conclusion(s): Participants demonstrated improvements in perceptual acuity and personal autonomy as it relates to cross-cultural adaptability following PDT and a one-week service-learning experience to Guatemala. Students and clinicians reported that as a result of the PDT, they were better able to respond to culturally complex situations encountered in this resource-limited country. Ideas for process improvement including implementing mentorship training between the experienced clinicians and students could be a part of future PDT.
Implications: Pre-departure training for enhancement of international service-learning experiences is recommended to better prepare health-care providers in facing ethical and cultural demands of resource-limited countries.
Keywords: Pre-departure training, International service-learning, Cross-cultural adaptability
Funding acknowledgements: The researchers were awarded a USAHS internal grant in the amount of $1027.02 to support this study.
Topic: Education; Education: methods of teaching & learning; Globalisation: health systems, policies & strategies
Ethics approval required: Yes
Institution: University of St. Augustine for Health Sciences
Ethics committee: Institutional Review Board
Ethics number: UR-0809-228
All authors, affiliations and abstracts have been published as submitted.
