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Evaluation of sociocultural competency training in enhancing self-efficacy among immigrant and Canadian-born… Wong, Yuk Shuen 2001

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Evaluation of Sociocultural Competency Training in Enhancing Self-Efficacy among Immigrant and Canadian-born Health Sciences Trainees by Y U K SHUEN WONG B.ED., The Chinese University of Hong Kong, 1993 M.ED., The Chinese University of Hong Kong, 1995 A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY IN THE FACULTY OF GRADUATE STUDIES (Department of Educational and Counselling Psychology, and Special Education) We accept this thesis as confirming to the required standard  THE UNIVERSITY OF BRITISH COLUMBIA August 2001 ©YukShuen Wong, 2001  In  presenting  degree freely  this  at the available  copying  of  department  publication of  in  partial  University  of  British Columbia, I agree  for reference  this or  thesis  thesis by  his  for  and study.  or  this thesis for  her  I further  the  representatives.  The University of British Columbia Vancouver, Canada  requirements that the  agree be  It  financial gain shall not  Department  DE-6 (2/88)  of  scholarly purposes may  permission.  Date  fulfilment  is  for  an  Library shall make  that permission for granted  by the  understood  be allowed  advanced  that  it  extensive  head  of  copying  my or  without my written  Abstract T h e study w a s to investigate the effectiveness of Sociocultural C o m p e t e n c y Training ( S C C T ) a s a n intervention in e n h a n c i n g self-efficacy a m o n g trainees in the health c a r e profession. T h e p u r p o s e s o f t h e study w e r e threefold: (a) to evaluate the effectiveness o f t h e training in e n h a n c i n g the trainees' self-efficacy a n d behavioural performance; (b) to e x a m i n e their p e r s o n a l e x p e r i e n c e s in the learning o f t h e sociocultural c o m p e t e n c i e s , a n d (c) to identify the factors that contribute to effective o u t c o m e s . A s a m p l e of 84 participants in the Health S c i e n c e s program at the V a n c o u v e r C o m m u n i t y C o l l e g e w a s recruited. T h e r e w e r e 26 local born C a n a d i a n s a n d 3 2 immigrants in the experimental group, w h e r e a s 11 local born C a n a d i a n s a n d 15 immigrants w e r e in the control group. Experimental group participants took part in a n 18hour training o v e r a 6-week period a s part of their regular H u m a n R e l a t i o n s Skills c o u r s e curriculum. T h e control group a l s o took the s a m e training c o u r s e after posttest d a t a collection. T h i s study u s e d both quantitative a n d qualitative m e t h o d s . Self-efficacy a n d behavioural performance w e r e a s s e s s e d quantitatively by the results from the G e n e r a l S e l f - E f f i c a c y S c a l e ( G S E ) , Situational S o c i a l A v o i d a n c e S c a l e ( S S A ) , S o c i a l S e l f - E f f i c a c y S c a l e ( S S E ) , a n d Interpersonal Skills C h e c k l i s t ( I S C - 3 3 ) . Qualitative data w a s collected through written f e e d b a c k from 2 8  Ill  participants a n d semi-structured interviewing with 24 volunteer interviewees in the experimental group. T h e results of this study supported the h y p o t h e s e s that the S o c i o c u l t u r a l C o m p e t e n c y Training w a s effective in improving the interpersonal skills a n d lowering the s o c i a l a v o i d a n c e t e n d e n c y a m o n g participants in the experimental group w h e n c o m p a r e d to individuals in the control group. T h e h y p o t h e s i s that there w o u l d be more significant c h a n g e in participants' s o c i a l self-efficacy w a s a l s o s u p p o r t e d . T h e Sociocultural C o m p e t e n c y Training offered effective w a y s of helping p e o p l e d e v e l o p positive self-efficacy a n d behavioural c o m p e t e n c i e s . Participants reported the training e n a b l e d t h e m to h a v e the sociocultural c o m p e t e n c i e s to c o n d u c t their professional c a r e e r in a multicultural community. In the future, the training c a n be u s e d with high s c h o o l students, c o l l e g e a n d university students, international students, professionals, b u s i n e s s p e o p l e , a n d expatriates w h o n e e d to learn the sociocultural c o m p e t e n c i e s for c a r e e r success.  iv  Table of Contents Abstract  ii  Table of Contents  iv  List of Tables  vi  List of Figures  ix  Acknowledgments  x  Chapter I:  Introduction  1  Chapter II:  Literature Review  11  Sociocultural Competence in Intercultural Communication  11  Theoretical Bases of Learning Sociocultural Competence  17  Implications in Developing Sociocultural Competence and Self-Efficacy 28  Chapter III:  Sociocultural Competency Training (SCCT)  35  Methodology  42  Research Design  42  Participants  45  Quantitative Method  50  Research Questions  50  Hypotheses  51  General Self-Efficacy Scale  52  Situational Social Avoidance Scale  53  Interpersonal Skills Checklist  53  Social Self-Efficacy Scale  54  Quantitative Data Collection Procedures  55  Quantitative Data Analysis  56  Qualitative Method  57  Qualitative Data Collection Procedures  58  Qualitative Data Analysis  59  Chapter IV:  Chapter V:  Results  61  Quantitative Results  61  Descriptive Statistics of the Four Dependent Variables  62  Equivalence of Experimental and Control Groups  63  Multivariate Repeated Measures MANOVA  67  Statistical Analysis on Subscales  78  Causal-Comparative Analysis  87  Qualitative Results - Interview  101  Presentation of findings  102  Qualitative Results -Written Feedback  126  Presentation of findings  128  Discussion  148  Effectiveness of the SCCT Program  148  Improvement in Interpersonal Skills  148  Reduction of Social Avoidance  149  Enhancement of Social Self-Efficacy  151  Comparison of Social Self-Efficacy and General Self-Efficacy .. 152 Effects of Subject Variables on Program Effectiveness  153  Program Effectiveness in Caucasian and Ethnic Minority Participants .... 155 Personal Changes of Participants  156  Participants' Experiences in Learning Sociocultural Competence  159  Implications  160  References  166  List of Appendices  186  vi  List of Tables T a b e l 1  D e m o g r a p h c i D a t ao ft h eS a m p e l P o p u a lt o in  4 7  T a b e l 2  D e s c r i p t i v eS t a t i s t i c so f t h eD e p e n d e n tV a r i a b l e sF o rE x p e r m i e n t a l  6 2  a n dC o n t r o lG r o u p s T a b e l 3  A N O V Ao fP r e t e s tC o m p a r n ig E x p e r m i e n t a la n dC o n t r o lG r o u p s  6 3  T a b e l 4  A N O V Ao fP r e t e s tC o m p a r n ig m I m g ir a n t s in t h eE x p e r m i e n t a la n d 6 6 C o n t r o lG r o u p s  T a b e l 5  A N O V Ao fP r e t e s tC o m p a r n ig L o c a lB o r nC a n a d a in s in t h e  6 6  E x p e r m i e n t a la n dC o n t r o lG r o u p T a b e l 6  R e p e a t e dM e a s u r e sM A N O V A  T a b e l 7  F v a u le sfromR e p e a t e dM e a s u r e sM A N O V Af o rE x p e r m i e n t a l  6 7 6 8  a n dC o n t r o lG r o u p s T a b e l 8  t t e s tv a u le sf o rP r e t e s ta n dP o s t e s tS c o r e s in E x p e r m i e n t a lG r o u p  6 9  T a b e l 9  t t e s tv a u le sf o rP r e t e s ta n dP o s t e s tS c o r e s in C o n t r o lG r o u p  6 9  T a b e l 1 0  R e p e a t e dM e a s u r e sM A N O V Af o rS SA  T a b e l 1 1  R e p e a t e dM e a s u r e sM A N O V Af o rS IC  7 2  T a b e l 1 2  R e p e a t e dM e a s u r e sM A N O V Af o rS S E  7 4  T a b e l 1 3  R e p e a t e dM e a s u r e sM A N O V Af o rG S E  7 6  T a b e l 1 4  R e p e a t e dM e a s u r e sM A N O V Af o rS S AS u b s c a e ls  7 9  T a b e l 1 5  R e p e a t e dM e a s u r e sM A N O V Af o rS IC S u b s c a e ls  8 2  T a b e l 1 6  R e p e a t e dM e a s u r e sM A N O V Af o rS S ES u b s c a e ls  8 5  T a b e l 1 7  R e p e a t e dM e a s u r e sM A N O V AR e s u t l sU s n ig " E t h n i c i t y "a s  7 0  8 8  B e t w e e nG r o u pF a c t o r T a b e l 1 8  R e p e a t e dM e a s u r e sM A N O V AR e s u t l sU s n ig " L a n g u a g e  9 1  U s e da tH o m e "a sB e t w e e nG r o u pF a c t o r T a b e l 1 9  R e p e a t e dM e a s u r e sM A N O V AR e s u t l sU s n ig " Y e a r s in C a n a d a "  9 3  a sB e t w e e nG r o u pF a c t o r T a b e l 2 0  R e p e a t e dM e a s u r e sM A N O V AR e s u t l sU s n ig " A g e " of.  9 5  P a r t i c i p a n t sa sB e t w e e nG r o u pF a c t o r T a b e l 2 1  R e p e a t e dM e a s u r e sM A N O V AR e s u t l sU s n ig " A g eo f Arrival  9 8  t oC a n a d a "o fP a r t i c i p a n t sa sB e t w e e nG r o u pF a c t o r T a b e l 2 2  H e l p f u l/U s e f u lC o m p e e tn c y Skils  1 0 2  T a b e l 2 3  A c t o in sT a k e nR e l a t i n gt ot h eC o m p e e tn c y Skils a n dF r e q u e n c e is  T a b e l 2 4  M e a n n ig U n i t so fA c t o in sa n dC o n s e n s u so fR a t e r s  1 0 4 1 0 5  vii  List of Tables Table 25 Table 26 Table 27 Table 28 Table 29.1 Table 29.2 Table 29.3 Table 30 Table 30.1 Table 30.2 Table 30.3 Table 31 Table 32 Table 33 Table 34.1 Table 34.2 Table 35 Table 36 Table 37 Table 38 Table 39 Table 40 Table 41 Table 42 Table 43  Summary of Interviewees' Descriptions of Confidence 109 Interviewees' Confidence Change Before and After Training Ill Question Three- Theme two: Presence of Shyness 113 Sources of Efficacy for Interviewees' Confidence 114 Examples of Increase in Confidence due to Mastery Experiences 114 Examples of Increase in Confidence due to Change in 115 Physiological and Affective States Examples of Increase in Confidence due to Verbal Persuasion or 116 Vicarious Experiences Categories of Situations that Interviewees Plan to Use the Skills 117 Social Performance Situations that Interviewees Plan to Use the Skills.... 118 Socializing Situations that Interviewees Plan to Use the Skills 119 Self-Assertion Situations that Interviewees Plan to Use the Skills 120 Summary of Overall Comments About the Program 121 Summary of Comments About the Program Delivery 122 Summary of Comments about the Approach ofthe Program 123 Summary of Comments about the Small Group Format 124 Summary of Comments on Group Participation 124 Summary of Useful Activities 125 Demographic Data ofthe Sample Population 127 List of Positive Self-Perceptions and Respective Frequencies 128 List of Meaning Units of Positive Self-Perceptions Created 129 in the Training List of Meaning Units of Communicating More Effectively 130 After Training List of Meaning Units of Gaining New Information, Knowledge 131 and Skills After Training List of Most Often Used Skills and Their Respective Frequencies 132 Examples of Most Often Used Skills 133 List of Most Effective / Easy to Use Skills and 134 Respective Frequencies  viii  List of Tables Table 44.1  Examples of Most Effective and Easy to Use Skills  135  Listening and Clarifying Messages Table 44.2  Examples of Effective and Easy to Use Skills  136  Making Social Contact and Social Conversation Table 44.3  Examples of Effective and Easy to Use Skills  136  Interrupting to Seek Support Table 45  List of Least Effective/Hardest to Use Skills and Respective  137  Frequencies Table 46.1  Examples of Least Effective/Hardest to Use Skills  138  Expressing Disagreement Table 46.2  Examples of Least Effective/Hardest to Use Skills  138  Refusing a Request Table 46.3  Examples of Least Effective/Hardest to Use Skills  139  Engaging in Social Conversation and Small Talk Table 46.4  Examples of Least Effective and Hard to Use Skills  139  Interrupting to Give a Message Table 46.5  Examples of Least Effective/Hardest to Use Skills  139  Managing Anxiety Table 47  List of Skills That Needed More Coaching and  140  Their Respective Frequencies Table 48  Examples of Feedback on Communication Competence  141  that Needed more Coaching Table 49.1  Examples of Benefits in Thinking and Knowledge Development  143  Table 49.2  Examples of Benefits in Affective Reactions  144  Table 49.3  Examples of Benefits in Behaviour  145  Table 50  List of Suggestions to Improve the Sessions  146  Table 51.1  Examples of Participants' Suggestions to Improve the Program  147  Table 51.2  Examples of Participants' Positive Remarks About the Program  147  ix  List of Figures Figure 1  The effects of different patterns of efficacy beliefs and  24  performance outcome expectancies on behavior and affective states. (From Bandura, 1997,  p.20)  Figure 2  Research Design Model  43  Figure 3  Profile Plots for S S A  71  Figure 4  Profile Plots for ISC  73  Figure 5  Profile Plots for S S E  75  Figure 6  Profile Plots for G S E  77  Figure 7  Profile Plots for the Three S S A Subscales  80  Figure 8  Profile Plots for the Six Subscales of ISC  83  Figure 9  Profile Plots for the Four Subscales of S S E  86  Figure 10 Profile Plots of "Ethnicity" and Four Dependent Variables  89  Figure 11  92  Profile Plots of "Language Used at Home" and Four Dependent  Variables  Figure 12 Profile Plots of "Years in Canada" and Four Dependent Variables  94  Figure 13  Profile Plots of "Age" and Four Dependent Variables  96  Figure 14 Profile Plots of "Age of Arrival in Canada" and Four Dependent  99  Variables Figure 15  Profile Plots of "Gender" and Four Dependent Variables  100  X  Acknowledgments  I w o u l d like to e x p r e s s my appreciation to my dissertation committee m e m b e r s . I thank my supervisor, Dr. Ishu Ishiyama for his support a n d direction during the d e v e l o p m e n t of this thesis; to Dr. Marvin W e s t w o o d for his e n t h u s i a s m a n d e n c o u r a g e m e n t ; a n d to Dr. Anita M a k for her support. I thank Dr. M a r i a T r a c h e for her statistical consultation. A s p e c i a l thanks g o e s to P a t Hartley, Hilary P e a r s o n , D i a n e W e s t w o o d at the V a n c o u v e r C o m m u n i t y C o l l e g e , for their efforts in delivering the training p r o g r a m . I thank the r e s e a r c h participants for sharing their e x p e r i e n c e s a n d very m u c h a p p r e c i a t e their willingness to participate in this r e s e a r c h . I w o u l d a l s o like to thank V a u g h a n Miller, A n g e l a P o s t , P a m C a t a p i a , S a t o m i K o n d o , Nigel T o d d , Dick Williams, A n d r e w C h a n a n d M a r i a W o o for their a s s i s t a n c e in preparing this manuscript. I must gratefully a c k n o w l e d g e my h u s b a n d , K o o n M i n g H o for loving m e unconditionally a n d making this dissertation possible. I thank my mother for t e a c h i n g m e to r e a c h for the stars. I a l s o thank my children, J e s s i c a a n d J o n a t h a n for e n c o u r a g i n g m e to work hard. Finally, I thank G o d for His guiding h a n d s in my life journey.  1  Chapter I Introduction As we enter the 21st century, there is a growing sense of urgency that we need to increase our understanding of people from diverse cultural and ethnic backgrounds. From interpersonal misunderstandings to intercultural conflicts, friction exists within and between cultures. With rapid changes in technology, transportation, immigration policies, and the rise of the international economy, the world is becoming a global community. We find ourselves in increased contact with people who are culturally different, working side by side with us. Different cultural beliefs, values, and communication styles exist from the workplace to the classroom. Westwood and Borgen (1988) emphasized the need for, and importance of, culturally embedded intercultural communication and training for intercultural workers in Canada. Hagrie (1997) said that the "interpersonal professionals" require three types of competence: (a) cognitive skills, (b) technical skills, and (c) social communicative skills. Hagrie observed that only recently the need for "interpersonal professionals" to receive training in social and communication skills has been recognized. According to St. Clair and McKenry (1999), cultural competence is an emerging need for the health care professions due to the ease of immigration and society increasingly becoming multicultural. In health care, health care providers and their clients sometimes have different and even conflicting cultural beliefs, standards, or practices. The health care providers are required to be socioculturally competent practitioners in dealing effectively with culturally diverse clients.  2 The Demand for Sociocultural Competence Acquiring the knowledge and skills of cultural competence is a necessaryfirststep in becoming a global citizen ofthe 21st century. According to the Workforce 2020 Report (Judy & D'Amico, 1997), international trade grew by about 120%from1980 to 1995 on the global level. The global economy, and hence global contact, has become a crucial part of our everyday work lives (Brake, Walker, & Walker, 1995). Effective globalization, in part, depends on professionals being able to deal with a diverse workforce. Adler (1995) has suggested that global leaders in today's world need to work in the followingfiveareas of cultural competencies: (a) understanding the worldwide political, cultural, and business environment from a global perspective; (b) developing multiple cultural perspectives and approaches to conducting business, (c) being skillful at working with peoplefrommany cultures simultaneously, (d) adapting comfortably to living in different cultures, and (e) learning to interact with international colleagues as equals. Learning to understand cultural differences will serve as a major step toward building a more harmonious, multicultural community. Data indicated that ofthe total newcomers to the province of British Columbia in the year 2000, 61.5% are of Asian heritage, and 19% are from Europe, 8%fromAfrica, 3%fromthe United States, 7.5% from Latin and South America, and 1%fromelsewhere. Newcomers make up 20% ofthe general workforce. From 1991 to 1996, the immigrant population increased 15.5%, a rate three times that ofthe Canadian born population. Federal Human Resources Minister Jane Stewart has described the situation as follows: "Seventy percent of the additions to our labour force in the past three years have comefromimmigration" (Frank, 2001).  3 In a global workplace, people bring with them different values, work habits, and cultural practices. Encountering peoplefromother cultures helps us to question our way of thinking and behaving. Getting to know culturally different people helps us to experience a range of unfamiliar experiences and a set of different values. As Hall (1983) concluded, "Human beings are such an incredibly rich and talented species with potential beyond anything it is possible to contemplate that... it would appear that our greatest task, our most important task, and our most strategic task is to learn as much as possible about ourselves ... My point is that as humans learn more about their incredible sensitivity, their boundless talents, and manifold diversity, they should begin to appreciate not only themselves but also others" (p. 185). Sociocultural Competence In everyday social situations, every interaction with another person can have an aspect of competence. Each task requires a behaviour or set of behaviours, and these behaviours can be performed well or poorly. All people require specific knowledge and skills to interact effectively in social situations and problem-solve in the rapidly changing sociocultural environment. In order to be successful, people must develop interactive skills and role-related competence. For example, certain role-related behaviours such as confronting others, speaking up, asking questions or volunteering opinions are more prevalent among Western cultures. It has been suggested that Asians unfamiliar with these conventions are inconvenienced and often at a disadvantage (Sue, Bernier, Durran, Feinberg, Perdensen, Smith, & Vasquez-Nuttall, 1982). Mak, Westwood, and Ishiyama (1994) observed cross-cultural differences between Western and Asian cultures required any  4 intercultural communicator to make adjustments in social interactions. For example, individuals comingfroma high context culture often required considerable practice and encouragement in order to directly express themselves in the low-context Western culture (Hall, 1976). People must acquire understanding and knowledge that will lead them to new behaviours that can be tried and practiced until competence is achieved in the performance of these behaviours. Most people learn through processes of socialization at home, at school and in the community. Sociocultural competency training is a competency-based approach to social interaction, rather than a deficiency-based approach. It is based on the assumption that sociocultural skills are learned and therefore can be taught to people who lack them. The goal is to convert psychological principles to teachable skills and disseminate these skills by means of a systematic method and program. The learning of new roles in an intercultural training sociocultural competency program enables participants to be more effective in different social situations. Sociocultural competency training has three major components of counselling as follows: (a) a process designed to help people cope more effectively with predictable developmental problems, crises, and problems in living that they confront at various stages of their lives; (b) a process for facilitating personal growth, and (c) a learning process in which persons with problems are helped to acquire new knowledge, attitudes, and behaviours that allow them to take action to resolve their problems. The Sociocultural Competency Training developed in 1997 by Westwood, Mak, Barker, & Ishiyama. The training helps people to learn skills for intercultural competence  that will improve their success in their new work or educational setting. The training has been developed to provide a means for helping immigrants and international students to learn critical behaviours for effective social interaction so that they could be more successful in reaching their individual goals. This training does not attempt to devalue or negate their home culture based competence, but rather intends to augment the competence people already possess. The training is designed to protect their original cultural self-identities while at the same time allowing dual cultural identities to develop — one for the new context and one maintained for the self. It helps participants to learn, practice, improve and expand new competencies, and to enhance confidence by mastery experiences. Westwood et al. (1997) believed that having social confidence and competence were vital for meeting the human needs for belonging, love, and esteem as people seek acceptance in a multicultural environment. Once people realize that effectiveness in social interactions is an integral part of the path to social success, they are more likely to be ready for sociocultural competency training. Sociocultural Competency Training developers proposed that social skills taught should be discrete in order to facilitate learning and be applicable to a wide range of social situations (Mak, 2000). The sociocultural competency training demonstrates how to perform specific skills. Participants watch trainers model or demonstrate what intercultural competencies are required for pursuing success in various areas of life. Trainers teach people how to reach their work, social or educational goals by providing direct practice in developing and  6  acquiring specific skills. Modelling, coaching and offering positive feedback are fundamental aspects of the program, and these help people develop skills and confidence. Effectiveness of Sociocultural Competency Training Studies on the effectiveness of sociocultural training have been conducted in Australia, Great Britain and Canada. The results indicated significant increases in interaction skills, reduction of social avoidance tendencies, and increases in intercultural social self-efficacy on completion of the training program. Both local and international students were found to benefit significantly in terms of social confidence and various domains of interaction skills as a result of taking the program. They rated very favourably various aspects of the program, including skills demonstration by the trainers, the process of practice and coaching, group discussion, and homework. Most ofthe qualitative feedback focused on the effective aspects of the program, including the acquisition of cultural knowledge, the cultural mapping process, English language development, role play participation, "discovery" and action-orientated learning, opportunities to deal with personal difficulties, safety in having practice sessions prior to real life implementation, fostering of friendships, and confidence gains (Mak, Barker, Logan, & Millman, 1999; Shergill, 1997). The evaluation results with the mixed student groups in the studies suggested that sociocultural competency training was essentially a social effectiveness training program that was also beneficial for mainstream students. Mak (2000) argued that overseas-born students in a mixed group have opportunities for cross-cultural contact with host students and have shared goals regarding the improvement of sociocultural competencies.  7 Sociocultural Competency Training for Health Sciences Trainees A previous study was conducted at the Vancouver Community College (VCC) in the Practical Nursing program (Shergill, 1997). The study suggested that both Canadian-born and immigrant students who had received sociocultural competency training showed higher levels of competencies in both work-site (i.e., practicum) and classroom situations and reported a higher level of self-efficacy. The results indicated the program's effectiveness in bringing about significant improvement in social skills valued in Canada and in encouraging participants to apply the competencies acquired in the program to real-life situations beyond the period of training. The present study was conducted as part of a training and research partnership between Vancouver Community College and the Department of Educational and Counselling Psychology and Special Education at the University of British Columbia. This research is one of the few empirically based studies to investigate the efficiency of a theorydriven approach in changing self-efficacy through sociocultural training interventions, while investigating the changes in participants' perceived efficacy and skill levels. It evaluated the six-session Sociocultural Competency Training, which was based on the self-efficacy theory (Bandura, 1977, 1986, 1995, 1997), role-based group learning theory (Corey & Corey, 1988; Westwood, Mak, Baker , & Ishiyama, 1997) and behavioural learning theory (Pavlov, 1928; Skinner, 1953, 1972). The sociocultural competency training had been incorporated into the VCC Health Sciences program curriculum. The VCC faculty delivered the training for the health  8  sciences trainees in three different Health Sciences programs: (a) Practical Nursing, (b) Residential Care Attendant, and (c) Hospital Unit Coordinator. The program was originally developed to provide immigrants to Canada with opportunities to learn about the "cultural map" and to build effective sociocultural competencies in a new cultural context to pursue academic and career success. However, both Canadian-born and immigrant trainees may be considered at various stages of adapting to new social, educational, and work cultures in our increasingly diverse society. For this reason, it was believed that both Canadians and immigrants can benefitfromlearning sociocultural competencies that help them to be effective in relevant educational, work and social contexts. The Need for the study The goals of sociocultural competency training involves some form of change in the following three areas: (a) cognition, (b) affect, and (c) behaviour. Cognitively, the training needs to focus on helping trainees to gain knowledge and awareness in understanding how their culture, stereotypes, and attitudes influence their interactions with other members of the culture. Affectively, the training helps trainees effectively manage their emotional reactions such as anxiety and shyness. Behaviourally, the training helps trainees develop the skills they need to interact effectively with members of other cultures. To achieve these goals, successful performance requires a combination of intercultural knowledge and skills, positive efficacy beliefs, positive outcome expectancies, and positive motivation. Specifically, the goals of developing sociocultural competencies are: (a) to transfer intercultural communication knowledge and skill, (b) to enhance general  9 and social self-efficacy, (c) to foster realistic outcome expectation, and (d) to manage social anxiety. Most studies in self-efficacy intervention programs have investigated people's coping behaviours such as pain management, addiction recovery, coping with stress, and coping with chronic disease (Bandura, 1997). Only relatively few of them focused on positive behaviours such as career decision and academic attainment. Very few experimental studies have been conducted to evaluate self-efficacy based interventions, which aim to build skills and enhance self-efficacy, and fewer have studied the combined effects of skill-building and self-efficacy enhancement on competence in a particular activity (Dawes, Horan, & Hackett, 2000). A literature search in the Psych-Info Database found that there were few reports on the evaluation of social skills training programs designed for ethnic minorities in intercultural communication in the previous ten years (Wood & Mallinckrodt, 1990). Few studies had tried to measure change in self-efficacy in regard to intercultural adaptation (Jerusalem & Mittag, 1995). This study is unique in its goal of evaluating the effectiveness of sociocultural competency training, and at the same time investigating the changes in participants perceived efficacy and skill levels. The aim of this study was to investigate the effectiveness of introducing sociocultural competency training to enhance the self-efficacy of Canadian-born and immigrant Health Sciences trainees. The researcher hypothesized that the sociocultural competency training experience would change participants' attitudes regarding their general and social self  10  efficacy, reduce situational avoidance behavior, and enhance interpersonal skills competence. This study integrated quantitative and qualitative measures to examine the effectiveness of sociocultural competency training on general self-efficacy, social selfefficacy, interpersonal skills competence, and social situational avoidance behaviours. The study evaluated the effectiveness of the sociocultural competency training and examined the experiences of Canadian-born and immigrant health sciences trainees before and after the training. For exploratory purposes, the study also tried to identify factors contributing to self-efficacy enhancement, that might lead to possible improvements to the training. The first chapter has introduced the study by explaining its purpose and rationale. Chapter two is a review of relevant literature on the theoretical bases for learning sociocultural competencies, and practical strategies for developing sociocultural competencies. Chapter three is an overview of the research design and a thorough account ofthe methodology. Chapter four presents the quantitative results and the qualitative results collected from the instruments, interviews and written feedback. Finally, chapter five discusses the implications and limitations of the study.  11  Chapter II Literature Review The increasing ethnic and cultural diversity in today's world of work presents new challenges for professionals who spend a large part of their working lives in face-to-face interaction with others. Social and cultural competence have been recognized as increasingly important for both professionals serving their multicultural communities (Hagrie, 1997; St. Clair, & McKenry, 1999; Westwood & Borgen, 1988), and for professional immigrants adjusting to and working in different cultural environments (Mak, Westwood & Ishiyama, 1994; Westwood & Ishiyama, 1991). This review of relevant literature focuses on sociocultural competence in intercultural communication, the theoretical bases for learning sociocultural competencies, and practical strategies for developing sociocultural competencies. Sociocultural Competence in Intercultural Communication The concept of sociocultural competence is still evolving. Westwood, Mak, Barker, and Ishiyama (1997) used the concept in the EXCELL Program Manual aiming at developing social and cultural competencies among immigrants, international students and sojourners. Competence can be defined as the capability to make events occur (Hannigan, 1990), while skills are the specific behaviors performed competently on a given task (Merrell & Gimpel, 1998). Competence refers to the total composition of social and nonsocial skills that makes people successful in their tasks (Hops & Finch, 1985). The term "sociocultural competence" originated from Ruben's (1976) research in interactive competence that used the term "competence" to measure behavioural performance in  12 intercultural communication training outcomes. In the 1990s, Ward used the term "sociocultural adaptation" (p.451) referring to the acquisition of behavioural adaptive outcomes as results of acculturation (Searle & Ward, 1990; Ward, 1996). Sociocultural Competence as a Multidimensional Construct of Social and Cultural Skills, Awareness and Knowledge Skills and competence are often used interchangeably. Social skills are regarded as the actual behaviors associated with a given task (Brislin & Yoshida, 1994b; Merrell & Gimpel, 1998), whereas social competence is an evaluative term that carries the judgment that a person performs a task adequately (Gresham, 1986; McFall, 1982). A focus only on behavioural skills for intercultural communication is too narrow and not adequate for effective intercultural communication. In order for people to have the abilities to know and judge the appropriateness of language behaviour in different intercultural contexts, argued Hymes (1971), language fluency is not enough; people must also have sociolinguistic competence (i.e. understand the social, cultural and historical values of certain behaviours). In a discussion of multicultural competence, Sue et al. (1982) emphasized that competencies not only include skills, but also awareness and knowledge. Brislin and Yoshida (1994a, p.7; 1994b, p.26) emphasized awareness, knowledge, attitude (or emotion), and skills in their intercultural training literature. St. Clair and McKenry (1999) conceptualized cultural competence for health professionals as an endpoint, dependent on achieving self-efficacy in communication skills, cultural assessments, and acquisition of knowledge related to health practices of certain cultures. They said cultural competence is more than the achievement of skills to work with people of diverse ethnic and cultural communities. It incorporates the perspectives of both effectively working within the cultural context of race; gender; and  13 sexual orientation of the individual, family, or community and working within the traditions, beliefs, customs, and values of the particular patient. Redmond and Bunyi (1993) used "intercultural communication competence" to summarize the skills related to intercultural communication. The term refers to a composite of skills for effective intercultural communication. They suggested six core components for intercultural communicative competence: (a) communication skills (specifically social decentering), (b) knowledge ofthe host culture, (c) language competence, (d) adaptation, (e) communication effectiveness, and (f) social integration. Kim (1991, 1995) summarized intercultural communication abilities as consisting of two components: personal communication competence, and (b) social communication competence. Kim used the term "personal communication competence" to include cognitive, affective, and behavioural competence. "Cognitive competence," includes knowledge of the host culture and other information; "affective competence" involves having the emotional capacity to deal with challenges and to empathize with others; and "behavioural competence" denotes choosing appropriate verbal and non-verbal behaviours to achieve harmonious interaction. "Social communication competence" is associated with the participation in social and communication activities. Therefore, Kim (1991, 1995), Redmond and Bunyi (1993), St. Clair and McKenry (1999) have considerably broadened the notion of intercultural communication ability from one that focuses exclusively on language and communication skills to one that encompasses other aspects of social and cultural competence including awareness, attitude, knowledge, and the ability to make good judgments. There seems to be a common consensus that competence and skills are independent multidimensional constructs, that competence is  14 superordinate of the two concepts, and describes the total capability of people to communicate across cultures. Acquisition of Sociocultural Competence in Acculturation Ward and colleagues proposed dividing adaptive outcomes of cultural contact into psychological and sociocultural domains (Searle & Ward, 1990; Ward, 1996; Ward & Searle, 1991). Psychological adjustment, defined in terms of emotional well-being, is broadly affected by personality, life changes, coping styles and social support, while psychological difficulties have been linked to a higher incidence of life change, loneliness, stress, and avoidance coping styles (Berno & Ward, 1998; Searle & Ward, 1990; Stone Feinstein & Ward, 1990). Sociocultural adaptation, defined in terms of behavioural competence, is strongly influenced by factors underpinning culture learning and social skills acquisition. These factors include length of residence in the new culture, cultural knowledge (culture, politics, geography, and lifestyle), amount of interaction and identification with host nationals, cultural distance (how different or similar are their own and the host cultures in various areas), expected difficulty, depression, cultural identity (cultural group membership), language fluency, and acculturation strategies (Searle & Ward, 1990; Ward, 1996). Successful acculturation results in better psychological well-being and sociocultural competence (Searle & Ward, 1990). Sociocultural adaptation predictably follows a learning curve with rapid improvement demonstrated over the first few months of cross-cultural transition and then a gradual "leveling off of newly acquired culture-specific skills (Ward & Kennedy, 1996a, 1996b). Psychological adjustment is more variable over time, with the greatest difficulties typically experienced at the earliest stages of cross-cultural transition  15 (Ward & Kennedy, 1996a, 1996b). When immigrants and sojourners adapt to new cultures, those who have optimal degree of voluntariness of contact, positive acculturation attitudes, and low acculturation stress experience fewer difficulties in acculturation. They acculturate in the modes of integration or assimilation. (Berry, 1990, 1997). However, people such as refugees who have less optimal voluntariness of contact, negative acculturation attitudes, and high acculturation stress experience more difficulties in acculturation (Berry, 1990, 1997). They acculturate in the modes of separation, and marginalization; and have more difficulty attaining sociocultural competence and psychological well-being. Positive and Negative Factors in Sociocultural Competence Development Recent research has suggested that different personality types and adult attachment styles might be mediating factors that affect social competence (Ashby & Kottman, 2000; Corcoran & Mallinckrodt, 2000). Hannigan (1990) enumerated abilities, attitudes, and traits as three important personal factors in developing sociocultural competency. The first factor he identified was a number of positive traits such as patience, tolerance, courtesy, persistence with flexibility, energy, self-confidence, maturity, and self-esteem, saying they can play effective roles in developing sociocultural competencies. Traits that correlate negatively with sociocultural competency include perfectionism, rigidity, dogmatism, ethnocentrism, dependent anxiety, task-oriented behaviour, narrow-mindedness, and selfcentered role behaviours may play less effective roles in developing sociocultural competencies. The second important factor for the individual to possess is their attitude towards the host culture. Positive attitudes include respect for the host culture, showing interest and  16 appreciating the new environment, cultural empathy, a sense of politics, a relativistic orientation to knowledge, and acceptance of others as people. The third factor is intercultural communication competence. It includes listening, dealing with communication misunderstandings and different communication styles, linguistic ability to effectively communicate one's knowledge to others, and the ability to deal with psychological stress. Many researchers cited intercultural communication competence as the fundamental skill to succeed in a culturally different environment. Cultural distance between two cultures, that is the host culture and the countries of entry, has a strong impact on people's development of sociocultural competencies. Cultural distance refers to the degree of psychological adjustment that is needed to bridge the dissimilarities such as language and cultural norms (Hofstede, 1990; Ward, 1996; Ward & Searle, 1991). Cultural distance in intercultural interaction might also create shyness in behaviour. Studies of shyness have found that shy people tend to be less competent on various measures of their perceived effectiveness in social interaction (Prisbell, 1997). Gaw (1995) studied re-entry students to the US and found that those who experienced cultural shock were more likely to exhibit shyness behaviours. Many immigrants who have selfconscious emotions such as shame and embarrassment have reported some degree of shyness in intercultural communication (Chen, 2000, 1995; Miyake & Yamazaki, 1995). Crosscultural studies in Europe and Asia have shown that shyness in some non-American countries is not viewed as negatively as in the North American culture (Breidenstein & Goering, 1989; Kerr, 1995; Weisz, Suwanlert, Chaiyasit, & Weiss, 1988). Some communicative and sociocultural incompetence exhibited by less assertive immigrants could be the result of experiences of cultural shock and shyness rather than their actual ability.  17 Many factors affect people's sociocultural adaptation and the attainment of competence. Mak, Westwood, Ishiyama, and Barker (1999) stated that the psychosocial barriers and personal factors could explain individual differences in cross-cultural adjustment. Potential psychosocial barriers to developing sociocultural competencies include lack of coaching and practice opportunities, a sense of being overwhelmed by the number of adjustments required, heightened needs for self-validation, interpersonal anxiety about how to relate to the host culture, and perceived threats to the newcomers' original cultural identity. Theoretical Bases of Learning Sociocultural Competence Intercultural trainers and educators have demonstrated a number of approaches to designing intercultural training (Brislin, Landis, & Brandt, 1983; Brislin & Yoshida, 1994a, 1994b; Gudykunst, Guzley, & Hammer, 1996; Gudykunst & Hammer, 1983). Cushner and Brislin (1996) summarized five common components in most intercultural programs: (a) cognitive training, (b)behavior modification, (c) experiential learning, (d) cross-cultural awareness, and (e) attribution training. Although most intercultural trainers have chosen some combination of these components to accomplish their training objectives, Gudykunst and Hammer (1983) have been critical ofthe fact that many approaches "do not articulate the theoretical foundations upon which the training is based (p. 121)". Gudykunst, Guzley, and Hammer (1996) again pointed out that "one major problem in the literature of intercultural communication training is the lack of an articulated theory underlying the various designs and techniques in use (p.65)". Mak, Westwood, Ishiyama, and Barker (1999) commented that besides few theoretical discussions about learning intercultural  18 effectiveness, most training approaches had not considered learners' psychosocial barriers. Mak, Westwood, Ishiyama, and Barker (1999) proposed that integrating instructional implications from established models of classical and operant conditioning, and social cognitive learning in a role-based group training program, can both address the potential barriers and provide optimal conditions for learning sociocultural competencies. The following literature review attempts to respond to Gudykunst's call by expanding on Mak, Westwood, Ishiyama, and Barker (1999)'s sociocultural competency training framework. Operant Conditioning Skinner (1953, 1972) suggested that only the observable qualities of behaviour have any scientific relevance to psychology. He maintained that human learning was a functional reaction to reinforcement. Westwood et al. (1997) stated that the following conditions, based on the principles of operant conditioning, are critical for teaching new micro social skills (a) correct responses to specific social cues are repeatedly rewarded by praises and successes, (b) appropriate social behaviors are further reinforced by the reduction of embarrassment and anxiety about unfamiliar social interactions, and (c) provision of coaching and opportunities for practice to facilitate corrective feedback and perfection of new skills. Classical Conditioning The work of Pavlov (1928) in classical conditioning is useful for understanding social anxiety reactions in intercultural interaction. Neutral stimuli (e.g., accent, visibly different facial features, and unfamiliar gestures) may provoke anxiety in a new social situation meeting with strangers. Extensive research has established the effectiveness of counter-conditioning procedures (Masters, Burish, Hollon, & Rimm, 1987; Wolpe, 1958,  19 1973) in helping an individual extinguish conditioned anxiety through repeatedly pairing the anxiety-provoking stimuli with the relaxation response. In this procedure, the individual is exposed to increasing amounts of anxiety-provoking cues, instead of avoiding the exposure. Applied to dealing with anxiety in intercultural interactions, it is important to provide opportunities for interaction between newcomers and hosts in a supportive, safe and relaxed environment with rewarding outcomes. The acquisition of sociocultural competencies through operant conditioning procedures is likely to increase the chances of having a rewarding social interaction. Self-Efficacy Theory The development of sociocultural competence in the present study is conceptualized within the framework of Bandura's self-efficacy theory (1977, 1986, 1995, 1997, 2000). Bandura (1977) distinguished between "efficacy expectation" and "outcome expectancies." He defined perceived self-efficacy as "a judgment of one's ability to organize and execute given types of performance", and outcome expectation as "a judgment of the likely consequence such performance will produce (p.21)." The theory states that given the appropriate skills and adequate incentives, people's perceived self-efficacy is a major factor determining whether they will put an effort into learning new behaviour. Sources of self-efficacy. People's perceived self-efficacy can be influenced by four main forms of information: enactive mastery experience, vicarious experience, verbal persuasion, and physiological and affective states (Bandura, 1977, 1995, 1997). According to Bandura, enactive mastery experience consists of one's previous achievements and the resulting skills. It is the most authentic evidence and the most influential source of selfefficacy beliefs compared with other modes of influences such as vicarious experience and  20 verbal persuasion. Previous successes in tough times and obstacles can build a strong resilient belief in one's efficacy belief. On the other hand, failures weaken it, especially if the failures are experienced before a sense of efficacy is firmly established. The next source of self-efficacy is vicarious experience of the behaviours of others. This is a less powerful source of efficacy belief than enactive mastery experience. It becomes a safe and effective alternate source when one is unsure of his/her ability or has no prior experience (Ozer & Bandura, 1990; Kazdin, 1982). Aspects of vicarious experiences include modelling, and observing another demonstrate a behaviour. The impact of modelling on beliefs of personal efficacy is strongly influenced by an individual's perceived similarity to the models. The greater the assumed similarity, the more persuasive are the model's successes and failures. Effective modelling not only conveys efficacy beliefs, but also transmits knowledge and skills. Verbal persuasion or verbal judgment made by others is another source of selfefficacy, though it is weaker than mastery experience and vicarious experience. Verbal persuasion is often conveyed in evaluation feedback, and positive feedback highlights personal capability and in turn raises self-efficacy (Schunk, 1982; Watt & Martin, 1994). Feedback framed as gain is also likely to support self-efficacy rather than be framed as inadequacy. Verbal persuasion is widely used because it is easy to give, but people do not always believe others' perceptions about their abilities. Verbal persuasion is effective if it is presented sincerely, from a believable source, and within realistic bounds of the receiver's capability. Physiological and affective states include stress, anxiety, fatigue, mood states, and arousal experienced by people. People often read high physiological arousal in a stressful  21 situation as vulnerability to failure, and interpret fatigue and pain as indications of physical inefficacy (Bandura, 1997). Mood also affects people's judgment of their personal efficacy. A negative mood activates thoughts of past failures and a sense of inadequacy and worthlessness through biased affective and cognitive priming (Bandura, 1997). People tend to make positive evaluations about themselves when they are in a good mood but negative evaluations while in a bad mood. Bandura (1995) suggested that by reducing stress and negative emotional tendencies, and by correcting misinterpretation of bodily states, selfefficacy can be enhanced. Efficacy-activated cognitive processes. Bandura (1995, 1997) described four efficacy-activated processes in his self-efficacy theory: cognitive, motivational, affective, and selection processes. He used these four processes to explain how efficacy beliefs produce their effects. He defined self-efficacy as "the product of a complex process of selfpersuasion that relies on cognitive processing of diverse sources of information" (Bandura, 1995, p.ll). In the cognitive process, strong self-efficacy brings successful forethoughts and sets challenging personal goals that pay off in performance accomplishment. People with a strong sense of competence can visualize successful scenarios that provide support and guidance for eventual performance. They can better maintain their problem-solving skills. People of low self-efficacy dwell on self-doubt and failure scenarios. They become more erratic in their analytic thinking (Bandura, 1995, 1997). Self-efficacy level is the key to enhancing or impeding motivation. In the motivational process, there are three different forms of cognitive motivators: causal attribution, outcome expectancies, and cognized goals. Perceived self-efficacy  22 operates through these three motivators in the course of action. Bandura (1995, 1997) cited support from attribution theory such as Weiner's attribution theory of motivation (1985) to conclude that persuasory attribution can serve as a supplementary motivator in addition to enhancing self-efficacy. Bandura argued that the predictive power of outcome expectation on behaviour would be enhanced by including the self-efficacy determinant. He cited works in expectancy-value theory such as Ajzen's (1985) theory of planned behaviour to support his argument. Bandura also cited Locke and Latham's (1990) work to show that explicit and challenging goals can enhance motivation. Bandura added that simply adopting a goal has no lasting impact on motivation but the combined influence of goal setting with knowledge of performance heightens motivation significantly. Highly self-efficacious persons are motivated to invest more effort and persist longer than those who are low in self-efficacy. When setbacks occur, they also recover more quickly and maintain the commitment to their goals. In the affective process, perceived ability to exercise control over anxiety and other forms of negative affect help people perform without impairing their level of functioning. A low sense of self-efficacy is associated with depression, anxiety, and helplessness. People who have inefficacious thinking magnify the severity of possible threats and impair their abilities to manage stress and depression (Bandura, 1995). Such individuals also have low self-esteem and harbour pessimistic thoughts about their accomplishments and personal development. In the selection process, self-efficacy also influences how people select their settings, explore their environments, or create new environments. Strong self-efficacy helps people to involve themselves in activities and environments that develop their own potential.  23 Through the selection process, people's destinies are shaped by their own selection of environments, which in turn cultivates their consequent potentialities and life-styles (Bandura, 1995, 1997). As people's self-efficacy influences how they think, motivate themselves, feel, and choose for themselves, it is important for intercultural competence training programs to enhance participants' efficacy beliefs. Positive qualities of perceived self-efficacy help people to choose, expend, and sustain efforts in new patterns of behaviours despite barriers and adversity. Outcome Expectancy Some theorists have criticized Bandura for overlooking the importance of outcome expectancy, proposing outcome expectancy makes significant contributions to determining behavioural performance (e.g., Eastman & Marzillier, 1984; Kirsch, 1986, 1999; Leary & Atherton, 1986; Maddux, 1999; Maddux & Stanley, 1986). Bandura (1997) has responded by saying that "human behaviour and affective states would be best predicted by the combined influence of efficacy beliefs and types of performance outcomes expected with given social systems, (p.20)" Combined effects of efficacy beliefs and outcome expectancies. Bandura (1997) proposed that four different possible combinations of efficacy beliefs and performance outcome expectancies produce four different behaviours and affective states. These four efficacy-activated mediating processes influence human functioning in complex ways, and in addition, the joint influence of outcome expectation and self-efficacy can provide a good basis for predicting people's behaviour and affects. Bandura proposed that people who have high self-efficacy and high outcome expectancies reward themselves by continual and  24 productive engagement, and this, in turn, fosters aspiration and personal satisfaction. People who have high efficacy beliefs but low outcome expectations might not give up their efforts as readily as those had low efficacy beliefs and low outcome expectancies. The four possible combinations and their likely consequences are illustrated in Figure 1. -  Outcome Expectancies  Protest Grievance +  Efficacy  +  Productive engagement  Social activism  Aspiration  Milieu change  Personal satisfaction  Resignation  Self-devaluation  Apathy  Despondency  Beliefs  Figure 1 The effects of different patterns of efficacy beliefs and performance outcome expectancies on behavior and affective states. The pluses and minuses represent positive and negative qualities of efficacy beliefs and outcome expectancies. (From Bandura, 1997, p.20) Intercultural social interaction is a complex performance that depends not only on one's behaviours but also on prediction and perception of others' responses. It is important to help participants establish positive outcome expectations and enhance their self-efficacy through intercultural competency training. Positive outcome expectations help people continue to be active to accomplish their best controllable outcome or to sustain efforts to  25 change social unresponsiveness, though unrealistically high outcome expectations may result in disappointment. Often it is not actual intercultural communication experiences that discourage people, but the disappointment that resultsfromthe gap between their expectations and their experience (Brislin & Yoshida, 1994b; p.39). Therefore it is necessary in sociocultural competency training to help participants gain outcome expectations that are not just positive but realistic, thereby immunizing them from disappointment, anxiety and other negative affects that could impair their level of performance. Anxiety in Intercultural Communication Several researchers have suggested that low efficacy beliefs and low outcome expectancy predict social anxiety (Bandura, 1997; p.323; Leary & Atherton, 1986; Maddux, Norton, & Leary, 1988). Intercultural interaction can be very anxiety provoking (Cushner & Brislin, 1996; Gudykunst & Hammer, 1988). Gudykunst and Hammer (1988) found that intercultural communicators who are unfamiliar with the host cultural code may experience considerable interpersonal anxiety as they interact with host nationals. Normative speakers in a state of second language anxiety often experience self-doubt and become very anxious and self-conscious (Westwood & Ishiyama, 1991). Intercultural communicators experience a higher possibility of social anxiety when there is larger cultural distance (Hofstede, 1983; Mak, Westwood, Ishiyama, and Barker (1999). Gudykunst (1995; p. 10) used the concept of "stranger" to describe the uncertainty and anxiety people experience in intercultural communication. Gudykunst suggested that there is an optimal level of uncertainty and anxiety so that people feel confident, comfortable, and interested in communication. Crushner and Brislin (1996) studied intercultural interaction using the critical incident  26 method, and found that people experience intense feelings in intercultural interaction. These feelings are mostly anxiety-related such as feelings of ambiguity, feeling doubtful of belongingness, feeling confrontation with prejudice, and having disconfirmed expectations (Crushner & Brislin, 1996). Leary and colleague's self-presentation theory (Leary & Atherton, 1986; Schlenker & Leary, 1982) suggested that social anxiety is aroused when people try to make a particular impression on others. They used the notions of "low self-presentation efficacy expectancy" and "low self-representation outcome expectancy" to describe socially anxious people. Burgoon (1978, 1995) observed that all cultures have their own communication expectancies. These expectancies could be as cast cultural rules (Ekman & Friesen, 1969) or cognitive schemata (Planalp, 1985) for processing social information. However, some people do not have an explicit set of norms to guide their behaviour. (Shuval, 1982). Those who are less socioculturally competent feel stressed, and may choose to minimize contact with members ofthe new culture, leading to social avoidance or isolation (Mak, Westwood, Ishiyama, and Barker (1999). Burgoon (1995) reminded us that these norms and expectations vary substantially across cultures, and that successful intercultural communication depends upon discerning the norms or expectations for a given situation and conforming to those expectations. People coping with social anxiety may minimize their social contact and have social avoidance behaviour (Ishiyama, 1999; Mak, Westwood, Ishiyama, & Barker, 1999) 1999). It is necessary to help people to manage their uncertainty and anxiety in intercultural training and subsequently in real situations. Often intercultural trainers or counsellors need to motivate discouraged people who feel incompetent in their unfamiliar sociocultural  27 environment (Ishiyama & Westwood, 1992). Ishiyama's self-validation model (1989) provides themes and components to validate culturally discouraged people who underestimate their competencies and feel self-doubt in new cultures. Morita therapy can also be introduced to people with social anxiety. The goals of Morita therapy are to reduce people's self-preoccupation and increase their realistic and practical thinking and action. Anxiety is presented as a normal human experience and a reflection of the underlying desire for self-actualization. Individuals undergoing this form of therapy are challenged to take self-enhancing action instead of anxiety-avoiding action (Ishiyama, 1989, 1995). Role-Based Learning in Groups Westwood, Mak, Barker and Ishiyama (2000) emphasized the importance of groupbased sociocultural competency training. They said that the preferred training model is one which utilizes role-based learning in groups and incorporates aspects of group counselling theory and practice. The training facilitators focus on taking participants through four stages: (a) alliance building, (b) cultural mapping, (c) coaching, and (d) practising and contract setting. Group-based learning can offer a safe place for people to learn new skills, helping group members to relax, reduce social anxiety and, take risks. The group format also provides opportunities for mutual validation, feedback and modelling. In their review of the literature involving 39 studies comparing individual and groupbased treatment approaches, Toseland and Siporin (1986) found group treatment to be more effective and efficacious than individual therapy and found the attrition rate to be considerably lower than in individual therapy. Mackenzie (1986) suggested that the group format is also a powerful method for overcoming motivation issues. Corey and Corey (1988) summarized three advantages of using role-plays in developing competence in a  group situation: (a) they serve as a method of diagnosis, (b) they provide opportunities to observe different ways to deal with problems, and (c) they enable participants to gain new insights for cultural and self-understanding and to develop new interpersonal presentation styles. Implications in Developing Sociocultural Competence and Self-Efficacy Effects of cultural contact are usually identified in three areas: changes in people's thinking (cognition), changes in people's affective reactions (feeling) and changes in people's behaviour (Brislin, Landis, & Brandt, 1983; Landis & Bhagat, 1996; Ward, 1996). The goals of any sociocultural competency training involve some form of change in these three areas: cognition, affect, and behaviour. Cognitively, the sociocultural competency training is aimed at helping trainees understand how their culture, stereotypes, and attitudes influence their interactions with other members of the culture. Cognitive goals, therefore, focus on knowledge and awareness. Affectively, the training is aimed at helping trainees effectively manage their emotional reactions such as anxiety and shyness. Behaviourally, the training is designed to help trainees develop the skills they need to interact effectively with other members of other cultures. An intercultural competency training program needs to help participants enhance their self-efficacy and set realistic outcome expectancies. People with low self-efficacy and expectancies often view others as uninterested, critical, and difficult to impress. This cynical view of social interaction needs to be addressed through positive learning experiences. Self-efficacy is the most powerful and effective way to initiate and sustain active effort and performance. Self-efficacy can be enhanced by four sources of efficacy  information previously mentioned (Anderson & Betz, 2001; Bandura, 1977, 1995, 1997). In building self-efficacy, Bandura (1997) described skilled efficacy builders this way: "Skilled efficacy builders do more than simply convey positive appraisals .... They structure activities for them in ways that bring success and avoid placing them prematurely in situations where they are likely to experience repeated failure. ...persuasory mentors must be good diagnosticians of strength and weaknesses and knowledgeable about how to tailor activities to turn potential into actuality. ...skilled efficacy builders encourage people to measure their successes in terms of selfimprovement rather than in terms of triumphs over others (p. 106)." Performance accomplishment is the most dependable determinant of self-efficacy expectancies (Bandura, 1977, 1997). People's thought processes bring past experiences and their associated anxiety back into present intercultural situations (Brislin, Landis, & Brandt, 1983), so people need mastery experiences to build up sociocultural competence. An experiential group-based on social interaction under supportive, non-threatening conditions can reduce anxiety, facilitate learning and heighten perceived efficacy. Relationship Between Self-efficacy and Performance An immense amount of research in various fields has been spawned by the selfefficacy construct. Self-efficacy has been widely researched in the areas of health, athletic performance, organizational functioning, psychology, and various counselling areas (Maddux, 1995; Bandura, 1997). Bandura (1997) observed that "self-efficacy theory is applied to strikingly diverse spheres of human functioning (p. ix)". Lent and Maddux (1997) reviewed and summarized that "self-efficacy has probably received more attention  30 from clinical, counselling, and vocational researchers than any other aspect of social cognitive theory over the past two decades (p.243)." Correlation between self-efficacy and human performance. Correlational research in self-efficacy in general has supported the positive relationship between self-efficacy and positive human performance in various aspects of human activity. Eight meta-analyses in self-efficacy published between 1977 and 2001 were identified in the Psyc-Info database (Forsyth, 2000; Guertin & Courcy, 1999; Holden, Moncher, Schinke, & Barker, 1990; Holden, 1991; Judge & Bono, 2001; Multon, Brown, & Lent, 1991; Sadri & Robertson, 1993; Stajkovic & Luthans, 1998). These eight meta-analysis articles covered such diverse areas as job satisfaction, job performance, HIV prevention, work adaptation and work stress, work performance, health related outcomes, and adolescent behaviour. These meta-analyses reported a moderately strong association between self-efficacy and the performance variable investigated. Multon, Brown, and Lent (1991) studied the relationship between self-efficacy and academic outcome studies. The results of 39 qualified studies revealed a positive and statistically significant relationship between efficacy beliefs and academic performance that persists across a wide variety of subjects using various assessment methods. However, most studies in self-efficacy intervention programs have investigated people's coping behaviours such as pain management, addiction recovery, coping with stress, and coping with chronic disease (Bandura, 1997). Only a few of them focused on positive agentic behaviour such as career decision-making (Lent, Brown, & Hackett, 1994) and academic attainment (Hackett, 1985).  31 Experimental studies in enhancing self-efficacy. Very few experimental studies have been done to evaluate self-efficacy based interventions, which aim to build skills and enhance self-efficacy, and fewer have studied the combined effects of skill-building and selfefficacy enhancement on competence in a particular activity. The few reported experimental studies yielded mixed results, leaving unanswered whether self-efficacy based intervention is better than a control group or other types of interventions (Dawes et al., 2000; Sharma, Petosa, & Heaney, 1999, Shergill, 1997). Sharma et al. (1999) compared a self-efficacy based problem-solving skills program with a knowledge based program and reported that the self-efficacy based intervention was significantly superior than the knowledge-based intervention. In the self-efficacy based program, the posttest results of problem solving selfefficacy were significantly improved compared with pretest results in the experimental group. Dawes et al. (2000) used a self-efficacy based program to enhance participants' aspirations in technical / scientific career decision but no treatment effect was found. Shergill (1997) compared experimental and control groups in a self-efficacy based interpersonal competence training but found no significant treatment effect in enhancing self-efficacy. Effectiveness of intercultural training program. There were a few evaluations reported on intercultural training programs for other special populations such as people with physical disabilities, and people with learning disabilities. These evaluations generally found such training to be effective for enhancing participants' social/interpersonal skills (Glueckauf & Quittner, 1992; Weston & Went, 1999). Previous studies of social /interpersonal skills training and assertiveness training on health care professions have shown that such programs are also effective in helping participants cope with stress and  32 negative emotions at work (Cook, 1998; Freeman, 1993; Mahaffey, 1993; Mink, 1993;). Literature search finds few assertiveness or social/interpersonal training programs designed for ethnic minorities in dealing with problems and barriers in intercultural communication in the recent decade; Wood and Mallinckrodt (1990) had discussed a more culturally appropriate approach in assertiveness training and some strategies for therapists training ethnic minorities. Few studies have attempted to measure change in participants' selfefficacy in assertive or intercultural training. In a longitudinal study Jerusalem and Mittag (1995) found the general self-efficacy ofthe East German immigrants were stable over time in the sociocultural changes in the revolutionary events in Germany in 1989. However general self-efficacy was found to be a significant factor that influenced immigrants' appraisal of their intercultural adaptation. Immigrants with a high sense of efficacy reported less anxiety and better health, and felt more challenged than threatened in intercultural adaptation. Given the importance of high self-efficacy, the present study is unique in its goal of evaluating the effectiveness of sociocultural competency training, while investigating change in participants' perceived self-efficacy and skill levels in a self-efficacy based training program. Developing Skills for Effective Intercultural Communication Intercultural communication can be viewed as a, communication exchange process between persons of different cultures, and has the principal goal of creating shared meanings between individuals of two different cultures in an interactive situation (Collier & Thomas, 1988; Ting-Toomey, 1999; Westwood & Borgen, 1988). The term "cross-cultural" refers to the communication process between cultures that is comparative in nature while "intercultural communication" refers to the communication process face-to-face between  33  members of different cultural communities (Jandt, 2001; Ting-Toomey, 1999). Westwood and Borgen (1988) described intercultural communication as a "people process" rather than merely a language process because individuals involved have very different cultural worlds and perceptual sets regarding their life experiences, and communication actions. The study of intercultural communication started with Hall (1959) who extended the study of culture in anthropology into communication. Hall (1959) stated, "Communication is culture and culture is communication" (p.169). Gudykunst and Ting-Toomey (1996) also argued that communication and culture reciprocally influence each other. The culture in which people are socialized influences their verbal and non-verbal messages, and the way people communicate can change the culture they share. According to Kleinjans's study (as cited in Dean & Popp, 1990), an effective intercultural communicator (a) sees people first, representative of cultures second, (b) knows people are basically good, (c) knows the value of other cultures, and (d) has inner security and is able to feel comfortable being different from other people. Gudykunst, Wiseman and Hammer (1977, p. 145) hypothesized a general "crosscultural attitude" accounting for cross-cultural effectiveness. This attitude includes seven factors: (a) open-mindedness towards new ideas and experiences, (b) ability to empathize with others, (c) accuracy in perceiving differences and similarities between the sojourner's own culture and the host culture, (d) non-judgmental attitudes, (e) ability to be astute noncritical observers of their own and other people's behaviours, (f) ability to establish meaningful relationships with people in a host culture, and (g) minimal ethnocentrism.  34 Hammer, Gudykunst, and Wiseman (1978) identified three important abilities accounting for intercultural communication effectiveness: (a) dealing with psychological stress, (b) communicating effectively, and (c) establishing interpersonal relationships. Abe and Wiseman (1983) reported five abilities in interpersonal communication; (a) adjusting to different cultures, (b) communicating interpersonally, (c) adjusting to different societal systems, (d) establishing interpersonal relationships, and (e) understanding others. Dean and Popp (1990) observed that these researchers had arrived at a high degree of consensus regarding what abilities were related to intercultural communication effectiveness. However, there was no unifying agreement on a concept of intercultural competence among these researchers. In short, sociocultural competence is a multidimensional construct of social and cultural skills, awareness, attitude and knowledge. Giving the appropriate skills and adequate incentives, people's self-efficacy determines whether they will put an effort to learn a new behaviour in a new culture.  35  Sociocultural Competency Training (SCCT) The Sociocultural Competency Training (SCCT) has resulted from collaboration between Dr. Anita Mak at Canberra University and Dr. Michelle Barker at Griffith University in Australia, and Professors Marvin Westwood and Ishu Ishiyama at the University of British Columbia in Canada. The training program operatesfromthe assumption that effective sociocultural training programs must go beyond knowledge and awareness to include skills coaching and training (Ishiyama & Westwood, 1992). The program is based on the assumption that acquisition of cultural information and awareness, and in some cases, language development, are necessary but insufficient components of an effective program for participantsfroma culturally different background (Westwood, Mak, Barker & Ishiyama, 2000). The sociocultural competency training uses an action-oriented approach to teach six main competencies for negotiating strategic common social situations; these are (a) participating in a group, (b) seeking help or information, (c) making social contact and social conversation, (d) refusing a request, (e) expressing disagreement, and (f) giving feedback. The authors have drawn upon the operant conditioning, classical learning, social cognitive learning, and role-based learning paradigms in designing the program. They have developed an 18-hour (six three-hour sessions) skills based, practice-focused training program designed to help participants to manage psychosocial needs for successful cultural adaptation and provide critical cultural information and skills for enhancing employability and career and educational success.  36 The program is differentfromexisting programs in that it recognizes potential psychosocial barriers that may impede the development of sociocultural competence in participants. These barriers include limited opportunities for receiving coaching and corrective feedback, feelings of being overwhelmed by the number of adjustments required to live in a foreign country, interpersonal anxiety in relating to host nationals, and threats to participants' original identity (Mak, Westwood, Ishiyama, & Barker, 1999). Westwood et al. (2000) stated, "Effective sociocultural competence training program should be designed to augment the existing competencies of the participants, not to replace them with new ones. The expected orientation ofthe program is social selfenhancement, rather than cultural assimilation, as the latter results in de-valuing the participants' culturally competent selves. Participants are encouraged to approach intercultural interactions like learning about novel social roles, while they can choose to retain customary social skills for interacting with co-ethnics." (p.318). Learning Stages of Sociocultural Competence The sociocultural competency training is based on a five-stage cycle. The first stage is to assess and build an alliance between group members and the trainers. Within a safe and supportive environment, the cultural self is validated. The participants can share difficulties in the personal-social aspects of their lives and identify individual goals in a specific context. The second stage is cultural mapping. A cultural map is a clear and simple description of effective and appropriate ways of behaving in specific situations, and why  37  these behaviours are preferred. These explanations are discussed in respect to the cultural context ofthe participants , looking for similarities and differences. The third stage is demonstration, practice, feedback and coaching. The trainer models a scenario with the participants observing the interaction. The trainer then asks for feedback and reactions to the simulation. The goal is cognitive assimilation of the new learning into the participants' personal behavioural repertoires. The participants are then invited to practice the same exchange, preferably in pairs with a third person as observer. This can be done infrontof the group with the trainer coaching and giving feedback. Feedback is given after the first attempt at practice is completed. The trainer may repeat the practice sessions. The goal is to enable the participants to acquire skills through practice until they feel comfortable saying and doing the appropriate things. The fourth stage is goal setting, action planning and contracting. Repeated trials are followed by a contract to apply the new learning in a real situation. Participants are helped to create realistic action plans. These_plans are then presented to the group for clarification and refinement. The fifth stage is transfer of learning. Participants apply their cultural maps and newly-acquired behavioural competencies to their own social, work or educational setting. They can experience the feelings of success and confidence by doing, and thereby evaluate the effectiveness ofthe training experiences. Unlike other cross-cultural information-giving and sensitivity training programs, the sociocultural competency training focuses on behavioural competence training derived from established learning paradigms. A particular influence is Bandura's (1986) social cognitive  38 learning theory, that emphasizes the development of both behavioural skills and domainspecific self-efficacy through observational learning involving the use of credible and similar role models. According to Bandura (1997), self-efficacy expectancy enables individuals to produce the desired outcome by motivating them to try out the requisite behaviours, setting appropriate goals, and devoting continuous effort until task mastery is finally achieved. The program model is largely based on Bandura's theories of self-efficacy and social cognitive learning (1977, 1995, 1997). With regards to the study of the production of new behaviour, the concepts of social learning through modelling are pivotal. Another contribution of social learning theory is the analysis of the implications of a person's prior learning and of the predispositions a person brings to situations as a result (Bandura & Walters, 1959). The assessment stage of the training model is intended to determine prior learning and predisposition. The assessment process is designed such that each participant ascertains specific skills or behaviours he or she would like to learn. When desired behaviours are modeled, the modelling stimuli have both functional value and distinctiveness. Kagan (1963) addressed the cross-cultural context of client incentive when he stated that a model's behaviour must represent some desirable goals that the participant would like to obtain. "The most salient of these include: (a) power over social environment, (b) competence and instrumental skills, (c) autonomy of action, and (d) the receipt of love, affection, and acceptance from others" (Kagan, 1963, p.82). The sociocultural competency training allows for the learning sequence to develop by encouraging rehearsal both symbolically (at the demonstration stage, as well as through  39 observation of others in the group context) and through motor rehearsal or practice (at the practicing and coaching stages). Feedback is an integral part of the model, as is the encouragement of self-observation. Finally, the motivation processes described by Bandura (1977, 1995, 1997) are incorporated throughout the model with the trainer and other participants providing external reinforcement and the encouraging of self-reinforcement through self-observation. Special Features of the Sociocultural Competency Training The sociocultural competency training aims to provide optimal conditions for participants to acquire the requisite knowledge and skills for successful social interaction with host nationals while maintaining their original cultural identity, and it does this by incorporating various special features. Credible role models. For the participants to reap the maximum benefits from a sociocultural training program, it is most effective to use a co-facilitation model, with a trainer from a minority cultural background providing a credible role model, and a trainer from the dominant cultural background for authentic explanation of the host cultural code. Trainees are encouraged to witness how someone with visibly different features and speaking with a foreign accent can successfully assume a leadership position and demonstrate effective intercultural social skills. Such emphasis on attribute similarity and model competence increases the power of modelling (Bandura, 1997; p. 99). Culture map. The idea of cultural map is fundamental to this sociocultural competency training. A cultural map is a succinct description of effective and appropriate ways of behaving in specific contexts and an explanation of why these behaviours are  40 preferred. Trainees' understanding is enhanced by providing not only instruction on how to behave, but the social, cultural and historical reasons why certain behaviours are valued in the culture. Baxter (1983) referred to this as sociolinguistic competence. A cultural map has the following features:(a) behaviours are precise/specific and are described in sequential steps; (b) each step is described in precise, behavioural terms; (c) behaviours are described as observable units which can be practised by participants; (d) cultural explanations for the behaviours are given and compared with the participants' understanding of the behaviours; and (e) alternative supportive strategies are provided. The trainers facilitate the rehearsal and retention of each competence through the schematic method of using a "cultural map," using a sequence of precise and concrete micro-skills. Experiential learning. A goal of the SCCT is to reduce intercultural social anxiety by increasing social confidence developed through mastery of actual skills, including those useful for assessing the new culture (e.g. introducing oneself, starting conversation, and asking questions). The trainers help the participants to set goals and action plans. Modelling is a central feature of this training approach. Ozer and Bandura (1990) found that modelling creates strong and highly significant gains, not only in skills acquisition and performance, but more importantly, in developing a strong sense of self-efficacy in social situations. The SCCT model is designed specifically for the cross-cultural context, with the goal that participants in this program will achieve significant gains in increased selfefficacy as well as skill acquisition. The concept of role-playing and rehearsal is also used in the model. Role playing is a derivative of psychodrama (Moreno, 1946) that has been used extensively in education and training as well as in therapy. Common elements applied  41 to the model include reenactments, use of the "here and now", a gradual shaping process, and positive feedback. The experience-reflection format is intended to assist the trainer to prevent terminating role playing with too few trials. The reflection component allows the participants to process their experiences. In the assessment phase of the model, the trainer's task is to understand the participant's schema about the world and to learn specifically where and when the participant is experiencing difficulty. The schemata are known as "worldview" in the multicultural literature (Sue, 1978). The trainer and participants mutually explore each participants' worldview and areas of concern. Together they formulate a plan to assist the participants to achieve desired outcomes. Given that the goal is an increased sense of self-efficacy, the emphasis is on valuing the strengths the participant already possesses, and augmentation rather than replacement of the participant's skill-base or experience (Mak et al., 1994). The trainers avoid imposing their own worldview on the participants. Since the process is dialectical and interactive in nature, all parties in the process will experience assimilation or accommodation (Ivey, 1986).  42 C h a p t e r III  Methodology This chapter describes the methodology used in the study, starting with an overview of the research design, the research questions, hypotheses, participants, training session plan, instruments, and procedures. It is followed by a description of the quantitative research methodology and that of the qualitative research methodology, specifying the research measures and methods of data collection and data analysis. Research Design This study used quantitative and qualitative methods to evaluate the effectiveness of the training in enhancing trainees' self-efficacy and behavioural performance; to examine the trainees' experiences in the learning of the sociocultural competencies; and to identify the factors that contribute to effective outcomes. Self-efficacy and behavioural performance were assessed qualitatively through semi-structured interviewing and participants' written feedback. Quantitative data was analyzed by comparing the pre-post scores on the Schwarzer's (1993) General Self-Efficacy Scale, Ishiyama's (1995) Situational Social Avoidance Scale, Ishiyama's (1996) Interpersonal Skills Checklist, and Fan and Mak's (1998) Social Self-Efficacy Scale. A research design model is presented in Figure 2. There are three reasons for using qualitative and quantitative methods together. First, comprehensive evaluation should be concerned with both process and outcome. Qualitative method is effective in describing the context and participants of the study, discovering the extent to which the program has been implemented, and providing feedback.  43  Figure 2 Research Design Model  Validity Rationale  program delivery  Qualitative Data  Situational Social Avoidance Scale  - What aspects of the program do you find useful? -Which skills are the most / least useful or hardest / easiest for you? -What should be improved?  Personal Demographics - age - gender - years in Canada - ethnicity -age of arrival in Canada -language used at home  Operational Level  C on text: InterculturalC om m unication  - 15 items with 3 subscales: social performance socializing self-assertion  Qualitative data e.g. In what situation do you plan to use the skills?  General Self Efficacy Scale: 10 items of self I perceptions.  Social Self Efficacy Scale - 20 items with 4 subscales: absence of social difficulties social confidence sharing interests friendship initiatives  Qualitative Data e.g. -How confident are you in using the skills?  Interpersonal Skills Checklist - 33 items with 6 subscales: processing skills active engagement skills self-enhancement skills approaching skills assertive skills interruptions skills  Qualitative Data e.g. -What kind of actions do you take relating to the skills?  44 Denzin and Lincoln (1994) stated: "qualitative researchers study things in their natural settings, attempting to make sense of, or interpret phenomena in terms of the meanings people bring to them" (p.2). The quantitative method measures more accurately the outcome effect of the program. The discovery or confirming of the process by which the program had the effect that it did, is most effectively achieved through the use of both qualitative and quantitative methods. The second reason is each method type complements the other. Qualitative methods can be defined as techniques of personal understanding, common sense, and introspection whereas quantitative methods could be defined as techniques of counting, scaling, and abstract reasoning. Using of qualitative and quantitative methods together provides a depth of perception. The third reason is to serve as an alternative to validation through triangulation. Triangulation refers to converging data gatheredfromdifferent methods, different informants, different accounts made by the same persons to different audiences, and findingsfromdifferent researchers (Fielding & Fielding, 1986). Triangulation is expected to bring data to a focal point; threats to validity are expected to be cancelled out by the application of different sources. Sociocultural Competency Training Session Plan The sociocultural competency training consisted of training participants in sociocultural competencies necessary for being effective and successful health care providers. The training was constructed of six sessions, each of three hours, held at weekly intervals. In the first session, the program was introduced, objectives were reviewed and the majority of the session was devoted to building trust and confidence both with the  45  group facilitators and the group members. It was crucial to the success ofthe program that people felt safe and included so that they would be willing to try out new behaviours in the following sessions. Group discussions, role-playing, and behavioural rehearsals were used. A session-by-session detailed description showing the design refers to Appendix A - l . A summary of the 6 interactive sessions is presented. Session 1  Introduction  Speaking in small group : Cultural Coat of Arms  Session 2  Active Listening  Attending, Listening, Clarifying  Session 3  Assertion Skills  Expressing Ideas and Opinions, Seeking Information and Support  Session 4  Assertion Skills  Refusing Unreasonable Requests, Expressing Disagreement, Managing Difficult Situations  Session 5  Initiating Social Contact and Conversation in Professional Situations  Session 6  Giving and Receiving Feedback  Participants Eighty-four trainees enrolled in the 3 different health sciences programs participated in this study. The participants had functional fluency in English as determined by the Vancouver Community College's English Language Competence Test. All the trainees in the Health Sciences Program were required to take the sociocultural competency training as a core course. The inclusion of both Canadian-born and immigrant participants was also necessitated by the field nature of this study. It was considered that the mixed group would  46 provide a wide diversity of participant role models. The experimental group participants took part in an 18-hour training program over six weeks as the Human Relation skills course. The control group also took the same 18-hour training as part of their regular course curriculum at a later stage. Normal course scheduling constraints required the experimental group participants to receive training in three groups. The training was delivered by VCC faculty members who had completed the trainer course. Permission for the study was obtained from the University of British Columbia Ethical Review Committee andfromthe Dean and Head of the Vancouver Community College Health Sciences Program. The researcher met with all the participants to introduce the research project and administer the consent form, demographic questionnaire, and research measures. The participants gave written consent voluntarily to participate in the study, and all participants were assured that they couldfreelyenter and exit the study without experiencing negative academic consequences. The informed consent form is in Appendix A-2. The control group participants completed the pretest and posttest packages. The experimental group completed the self-reported instruments at the beginning and at the end ofthe 6-week training. Participantsfromthe experimental group were then interviewed by the researcher to provide qualitative information.  47 Demographic Characteristics of the Sample Population A 12-item demographic questionnaire was administrated to collect personal information of participants in the pretest at the beginning of the program (see Appendix A3). The data of the combined experimental group and a control group are provided in Table 1. The experimental and control group had a similar composition of Canadian-born and immigrant participants, and they had similar mean values on the 6 subject variables: (a) ethnicity, (b) gender, (c) age, (d) age of arrival in Canada, (e) years of residence in Canada, and (f) language used at home. The demographics of Canadian-born and immigrant participants in the experimental group also resembled their counterparts in the control group. However, the control group had more male participants than the experimental group. Table 1 Demographic Data of the Sample Population Experimental Total Canadian n=58 n=26 Ethnicity: (1) Caucasian 20 20 (2) Ethnic minorities 38 6 Language used at home: (1) English only 24 22 (2) Mother tongue only 15 1 (3) English and mother tongue 19 3 Gender: (1) Male 6 2 (2) Female 52 24 Age : Mean 30.69 28.15 Range 18-51 18-43 Years in Canada: Mean 16.21 27.35 Range 1-43 16-43 Age of arrival: Mean 14.50 0.81 Range 0-42 0-9  Group Control Immigrant Total n=32 n=26  Group Canadian Immigrant n=ll n=15  0 32  9 17  9 2  0 15  2 14 16  13 6 7  9 2  4 5 6  4 28 32.75 20-51 7.16 1-23 25.63 1-42  9 17 31.72 19-50 16.15 2-48 14.36 0-46  4 7 30.70 21-48 30.70 21-48 0 0  5 10 33.33 19-50 7.06 2-15 23.93 3-46  48 In this study, the terms "Canadian" and "immigrant" were used to refer to the participants' places of birth and not their citizenship status. Under the "ethnicity" category, participants who had ethnic minority parents were categorized as "ethnic minorities" while "Caucasians" referred to participants who had British, French or U.S. heritage. The experimental group consisted of 58 participants. Twenty-six were categorized as Canadianborn, and the remaining were immigrants born elsewhere. Six Canadian-born participants in the experimental group had ethnic minority parents. All immigrants in this group were ethnic minorities. The participants ranged in age from 18 to 51; only six of the 52 participants were male. The control group consisted of 32 participants. Six participants did not complete all the items in the demographic questionnaire; therefore, there were only 26 participants with complete demographic information. Fifty-eight percent of them were immigrants; 42% were Canadian-born; only two of them had ethnic minority origins. Canadians in the Experimental Group Twenty-six Canadian-born participants had a mean of 27.35 years living in Canada, which was much longer than the immigrants' group mean of 7.16 years. Their mean age of 28.15 was slightly younger than the immigrants' group mean age of 30.69. Twenty-four (92%) were female and 2 were male (8%). Twenty (77%) were Caucasians and 6 (23%) had parents from ethnic minorities backgrounds. Three were South Asians, one was Eastern European, one was South European, and one was Chinese. Four of the Canadian-born participants with ethnic minorities origins still used their mother tongues at home.  49 Immigrants in the Experimental Group Thirty-two participants in the experimental group were born outside Canada. Their mean age of 32.75 was slightly higher than the group mean of 30.69. They had a shorter mean duration of living in Canada compared with the Canadians. Most of them started residing in Canada at a mean age of 25.63. Twenty-eight (88%) were female and 4 (12%) were male. All 32 participants in the immigrant group were self-identified as ethnic minorities. They were 16 (50%) Southeast Asians, 9 (28%) East Indians, 4 (13%) Central or South Americans, 1 (3%) East European, 1 (3%) Chinese and 1 (3%) Korean. Sixteen participants (50%) used their mother tongues and English at home. Fourteen (44%) used only their mother tongues. The remaining 2 (6%) used only English at home. Canadians in the Control Group The demographics were very similar to the Canadians in the experimental group. Nine (82%) had at least one parent who was Canadian or British in origin, 2 (18%) had both ethnic minority parents. They used their mother tongues at home. Immigrants in the Control Group Fifteen immigrants in the control group had a mean age of 33.33, which was slightly higher than the group mean age of 31.72. Their mean duration in Canada was 7.06 years starting at a mean age of 23.93 , similar to those immigrants in the experimental group. They came from diverse cultural backgrounds: 9 (60%)fromSoutheast Asia or the Philippines, 2 (13%)fromIndia or Pakistan, 3 (20%)fromCentral or South America, and 1 (7%)fromChina. All of them had both parents comingfromthe same culture. Eleven (73%) used their mother tongue at home.  50 Quantitative Method Quantitative Research Design A pretest-posttest mixed quasi-experimental design was used, as schematically shown to assess the effectiveness ofthe Sociocultural Competency Training: -RSQ  Ol (pretest)  X(SCCT)  C*2 (posttest)  -R SQ  Ol (pretest)  —  0"2 (posttest)  X(SCCT)  Legend: -R S(\): Experimental Group -R S(2): Control Group X : Intervention (Training)  Research Questions Question 1: How effective is SCCT in enhancing participants' perceived general and social self-efficacy? Question 2: How effective is SCCT in enhancing participants' behavioural performance of the sociocultural competencies? Question 3: What is the nature of the internal changes of the participants? Question 4: What leads to the participants' positive changes in their perceived self-efficacy? Question 5: What are the effective learning components for participants?  51 Hypotheses In the study, it was hypothesized that: 1. The experimental group would report higher general self-efficacy after treatment than the control group. 2. The experimental group would report at the posttest a significantly lower self-reported situational avoidance tendency as measured by the Situational Social Avoidance Scale than would the control group. 3. The experimental group would report a significantly higher level of interpersonal communication competency as measured by the Interpersonal Skills Checklist than would the control group. 4. The experimental group would report higher social self-efficacy by the Social Selfefficacy scale than would the control group. 5. There would be more significant changes in social self efficacy than the general self efficacy. Quantitative Research Measures The following four measures were used in the quantitative research: (a) Schwarzer's (1993) General Self-Efficacy Scale (see Appendix A-4), (b) Ishiyama's (1995) Situational Social Avoidance Scale (see Appendix A-5, A-6), (c) Ishiyama's (1996) Interpersonal Skills Checklist (see Appendix A-7, A-8), (d) Fan and Mak's (1998) Social Self-Efficacy Scale (see Appendix A-9).  52 The measures were administered twice to participants in the experimental and control groups at both pretest and posttest in a time interval of six weeks. All participants were kept anonymous, only identifiable by the last three digits of their student numbers to allow for matching of the pretest and posttest measures. Three of the measures had subscales. Statistical analysis on the subscores of these subscales was conducted to reveal more information about the participants' sociocultural competencies and their learning experiences in the training process. The following section discusses characteristics ofthe four research measures. Schwarzer's (1993) General Self-Efficacy Scale. The general self-efficacy scale aims at measuring personal competence to deal effectively with a variety of stressful situations. The German version of this scale was originally developed by Jerusalem and Schwarzer in 1981,firstas a 20-item version and later as a reduced 10-item version (Schwarzer, BabTer, Kwiatek, & Schroder, 1997). It has been used in numerous research projects, where it typically yielded internal consistencies between alphas = .75 and .90. The scale was found not only parsimonious and reliable, but also valid in terms of convergent and discriminant validity. For example, it correlated positively with self-esteem and optimism, and negatively with anxiety, depression, and physical symptoms. A manual (Schwarzer, 1993), includes the scale in English, German, Spanish, French, Hebrew, Hungarian, Turkish, Czech, and Slovak, and also the results offivestudies conducted to examine the psychometric properties ofthe German version. In addition, norms based on a sample of 1660 German adults are available. The manual describes retest reliability over  53 one-and two-year periods, and different kinds of validity, such as experimental, criterionrelated and predictive validity, had satisfactory coefficients. Ishiyama's (1995) Situational Social Avoidance Scale. The SSA scale is a selfreport measure of situational avoidance tendency that can be regarded as an indirect measure of social anxiety. The scale is normed on 407 university students. It is a 15-item scale consisting of descriptions of different social interactions. Participants rate themselves in terms of how often they tend to avoid the 15 social situations on a 7-point Likert-type scale, where 1 represents "almost never" and 7 represents "almost always." The scale has high internal consistency (oc=.89) and adequate test-retest reliability over a 6.5-week interval. A factor-analysis yielded an interpretable 3-factor solution with three domains of social avoidance: (a) social performance (6 items), (b) socializing (4 items), and (c) self-assertion (3 items). The scale had high positive correlation (from r =.60 to r=0.78) with four frequently used social anxiety scales, and meaningful correlation with depression (r = .36), self-esteem (r = -.49), and self-critical cognition (r = .50). The concurrent and predictive validity of the SSA have also been well established (Ishiyama, 1995). The SSA scale was administrated to all the groups as pre- and post- test measure of situational avoidance tendency. Ishiyama's (1996) Interpersonal Skills Checklist. The Interpersonal Skills Checklist is an unpublished instrument, designed to measure interaction competency in interpersonal situations. It is a 33-item self-reported scale normed on a cross-cultural sample of 215 university students. Six subscales were developed for examining the intercorrelation among them. It yields six subscores on: (a) processing skills (6 items), (b) active engagement skills  54 (6 items), (c) self-enhancement skills (6 items), (d) approaching skills (6 items), (e) assertive skills (5 items), (f) interruption skills (4 items). High internal consistency for each subscale as well as for the total score has been reported. Participants rate their effectiveness using a 7-point Likert-type scale, where 1 represents "not at all effective" and 7 "extremely effective". The item total reliability indices variedfrom.46 to .68 with a Cronbach alpha of .94. Ishiyama (1996) reported adequate concurrent validity for the ISC-33. The Interpersonal Skill Checklist (ISC-33) was administrated as a pre- and a post- indicator of change in participants' self reported verbal interaction competence in social situations. Fan and Mak's (1998) Social Self-Efficacy Scale. The 20-item Social Self-Efficacy Scale normed on a cross-cultural sample of 228 university undergraduate students. The scale consists of four items adoptedfromSherer, Maddux, Mercabdante, Prentice-Dunn, Jacobs, and Rogers's (1982) Social Self-Efficacy Scale, eight items adaptedfromSolberg, O' Brien, Villareal, Kennel, Davis's (1993) College Self-Efficacy Instrument, and eight items developedfroma qualitative method using a focus group interview. The scale has been reported to have satisfactory internal consistency and test-retest reliability. It had four subscales: (a) absence of social difficulties (9 items), (b) social confidence (5 items), (c) sharing interests (3 items), and (d)friendshipinitiatives (3 items). The internal consistent reliability coefficients for these four subscales were estimated to be 0.82, 0.73, 0.74 and 0.52, respectively. The participants indicate their degree of agreement with each item on a 7-point Likert-type scale where 1 represents "strongly disagree" and 7 represents "strongly agree." This instrument is considered useful for measuring the effectiveness of social skills training programs designed to enhance social self-efficacy. The scale was administrated as a pre and post test indicator of change in participants' social self-efficacy.  55 Quantitative Data Collection Procedures There were 58 participants in the experimental group; and 32 participants in the control group. In the actual quantitative data collection , the instruments had been administrated in four groups of students enrolled in three different programs: (a) one group in Practical Nursing, (b) two groups in Hospital Unit Coordinator, (c) one group in Residential Care Attendant. Results from one of the groups in the Hospital Unit Coordinator program were deemed not valid because the posttest was not administrated to the participants. As a result, the 7 pretest measuresfromthese participants were discarded for the present study. Seven other participantsfromthe experimental group, and two participants in the control group failed to offer data at posttest; therefore their pretest data was excludefromthe study. The attrition rate was 10% for the experimental group and 6% for the control group. The following table summarized the schedule of the quantitative data collection. Research study in the Health Sciences Program  Pretest  Posttest  Experimental Group 1: First year PN program (n=29)  12 Jan, 1999  9 Mar, 1999  Experimental Group 2: First year HUC program (n=10)  11 Mar, 1999 7 May, 1999  Experimental Group 3: First year RCA program (n=19)  1 Oct, 1999  25 Nov, 1999  Control Group: First year RCA program (n=32)  8 Apr, 1999  6, Jun, 1999  56  Quantitative Data Analysis The four dependent variables: (a) General Self-efficacy Scale, (b) Situational Social Avoidance Scale, (c) Interpersonal Skills Checklist, and (d) Social Self-efficacy Scale were analyzed using descriptive and multivariate analysis programs. All statistical analyses were conducted on the University Computing Centre's SPSS (Version 10). Treatment effect was analyzed by a repeated measure MANOVA between the experimental and control group. The repeated measure MANOVAs analyzed the four dependent variables as a multivariate, and then as an individual univariate. Repeated measure MANOVAs were also performed to analyze the Interpersonal Skills Checklist subscores, Situational Social Avoidance subscores and the Social Self-efficacy subscores. Means and standard deviations of the pretest and posttest were calculated, and the pretest and posttest means were compared by paired sample t-tests. Causal-comparative analyses were also conducted to examine how selected independent subject variables such as gender, age, ethnicity, and language used at home contributed to differences in treatment effectiveness.  57 Qualitative Method Qualitative Research Design Qualitative data was obtained from two sources: (a) interviews with 24 participants from the experimental group, and (b) written feedback from 28 participants in the Residential Care Attendant Program. A semi-structured interviewing method was used for the following reasons. This method facilitates rapport, allows a greater flexibility in coverage, and produces richer data for analysis. The data was used to complement quantitative data analysis. On the other hand, this form of interviewing reduces the control the researcher has over the situation, takes longer to carry out, and is harder to analyze (Smith, 1995). The interviewees answered the following five questions. Each interview lasted for about 30 minutes. Question 1: Which of the six competence skills did you find helpful and/or useful to you? Question 2: What kind of action did you take relating to the competence skills? Question 3: How confident are you that you will use the competence skill(s)? Question 4: In what situations do you plan to use these competence skills? Please give me a scenario in which you will use these skills. Question 5: What aspects of the program did you find most helpful? Prompts were used to encourage participants to elaborate on their responses. Prompt 1: What were your feelings when that happened? Prompt 2: What went through your mind when that happened? Prompt 3: What did you do when that happened? Prompt 4: What did that mean to you? Prompt 5: How did that affect you?  58 Twenty-eight participants from the experimental group provided written feedback for the following seven questions: Question 1: How have the six interactive practice sessions helped you in your new role as a student resident care attendant? Question 2: Which of the skills have you used most often? Give an example from your clinical experience. Question 3: Which skills are most effective and/or easy to use? Describe one example of what happened when you used this/these skills. Question 4: Which skills are least effective and/or hardest to apply? Describe one example of what happened when you used this/these skills. Question 5: Which communication competencies do you want more coaching and/or practice? Question 6: What are the benefits of this type of learning? Question 7: What suggestions do you have to improve the sessions? What would have helped you more? Qualitative Data Collection Procedures Qualitative interview data were obtainedfrom24 volunteer interviewees in the combined experimental group and additional written feedback datafrom28 participants in the Residential Care Attendant Program. Interviews with the 24 interviewees who agreed to participate took place in the college library or classroom. The semi-structured interviewing lasted for 30 minutes. Privacy and confidentiality were guaranteed. Participants were given ID numbers to protect their identities.  59 Qualitative Data Analysis Following each interview, audio-tapes were reviewed and then transcribed for analysis. Semi-structured interviewing and qualitative analysis method (Smith, 1996) provides the means to identify and extract meaning units. This process included the following steps. The researcher read the interview transcript of each participant. Each transcript was carefully studied in order to get the full meaning of the description. The researcher identified the meaning units with respect to the questions being asked. A series of meaning units were obtained through the process. The meaning units were expressed in the language of the participants. Each meaningful unit was compared with another to determine whether there was any similarity or difference. Series of meaning units such as skills, actions, social situations, descriptions of confidence change, and sources of self-efficacy were obtained. Each series of meaning units were categorized according to the categories in the quantitative research instruments. In short, the analysis of the data involved three parts. First, meaning units were extracted from transcripts and written notes. Second, the meaning units were grouped according to similarities to form categories. Third, the validity of the categories were examined by raters. To ensure the validity and reliability of this study, the research data was presented to four independent raters (three females and one male). The raters were either professional counsellors or graduate students. Included were one Ph.D degree university counsellor, one cross-cultural counselling practitioner with a magistral degree, a doctoral student and a magistral student in counselling psychology. Their ethnic backgrounds were: Caucasian  60 Canadian, Caucasian Canadian, Chinese, and Japanese respectively. Meaning units were categorized by the raters, without collaboration, following instructions that were provided. In order to maintain a high level of consistency and agreement, an individual consultation hour was given to each rater. The categorization by the raters for each question across all participants was compared by the researcher. The agreement rangedfrom82% to 90%. This study used both quantitative and qualitative methods. The purposes ofthe study were threefold: (a) to evaluate the effectiveness of the training in enhancing the trainees' self-efficacy and behavioural performance; (b) to examine their personal experiences in the learning of the sociocultural competence skills; and (c) to identify the factors that contribute to effective outcomes. Self-efficacy and behavioural performance were assessed quantitatively by the resultsfromthe General Self-Efficacy Scale (GSE), Situational Social Avoidance Scale (SSA), Social Self-Efficacy Scale (SSE), and Interpersonal Skills Checklist (ISC-33). Qualitative data was collected through written feedbackfrom28 participants and semi-structured interviewing with 24 volunteer interviewees in the experimental group.  61  Chapter IV Results: Part 1 Quantitative Results A quasi-experimental design was used to evaluate the effectiveness of the Sociocultural Competency Training. It was hypothesized that compared to the control group, the experimental group would report significantly higher general self-efficacy, higher interpersonal skills, higher social self-efficacy and less situational social avoidance due to the participation in the SCCT program. The changes in social self-efficacy were predicted to be greater than the general self-efficacy. For exploratory purposes, effects of the following participants' demographic variables on training outcomes were investigated: ethnicity, gender, age, years in Canada, age of arrival in Canada, and language used at home Causalcomparative analyses were conducted to examine how these subject variables contributed to differences in treatment effectiveness. An experimental group (n = 58) that received SCCT training was compared with a waitlist control group (n = 32). Both groups provided data in a pretest-and-posttest design with a six-week interval using the following four instruments: (a) Generalized Self-Efficacy (GSE),(b) Situational Social Avoidance (SSA), (c) Interpersonal Skills Checklist (ISC), and Social Self-efficacy (SSE).  62 Descriptive Statistics of the Four Dependent Variables Table 1 shows the means of the four dependent variables ofthe control group remained relatively unchanged at posttest. The pretest means of the experimental group were lower than those of the control group. Yet the posttest means ofthe experimental group showed improvement in the predicted direction after the training. Table 2 Descriptive Statistics of the Dependent Variables For Experimental and Control Groups Variable  GSE SSA ISC SSE  Legend:  Experimental Group  Control Group  n=58  n=32  Mean  S.D.  Mean  S.D.  pretest  29.67  3.61  31.03  3.62  posttest  31.71  4.17  31.91  4.19  pretest  56.76  16.59  55.22  14.61  posttest  48.19  14.38  53.19  16.56  pretest  147.98  31.77  165.34  28.20  posttest  168.71  27.67  165.34  30.35  pretest  90.19  17.08  97.66  18.14  posttest  98.88  17.68  97.88  15.79  GSE: Generalized Self-Efficacy (Schwarzer, 1993) SSA: Situational Social Avoidance (Ishiyama, 1995) ISC: Interpersonal Skills Checklist (Ishiyama, 1996) SSE: Social Self-Efficacy Scale (Fan & Mak, 1998)  63 Equivalence of Experimental and Control Groups It was important to investigate the equivalence of the experimental and control groups in this quasi-experimental study so that casual inference could be made. ANOVAs of pretest scores and examination of demographic data were done to test the equivalence of the groups. ANOVAs of pretest scores. One-way ANOVAs examined the equivalence of the experimental and control groups was by comparing the pretest scores of GSE, SSA, ISC, and SSE. The ANOVA results indicated that the experimental group did not differ significantly with the control group in three out of the four pretest scores. Table 3 shows the pretest scores. There was a significant difference between the experimental and control groups in the ISC pretest score, F(l, 88) =6.66, p<0.05. The control group (165.34 ±28) was significantly higher than the experimental group (147.98 ±31). Table 3 ANOVA of Pretest Comparing Experimental and Control Groups  Sum of Squares sum Cibb pretest  sum S S A pretest  sum ISC pretest  sum S S E pretest  df  Mean Square  38.078  1  38.078  Within Groups  1151.745  88  13.088  Total  1189.822  89  48.899  1  48.899  Within Groups  22300.089  88  253.410  Total  22348.989  89  Between (iroups  Between Groups  Between Groups  6215.621  1  6215.621  Within Groups  82174.202  88  933.798  Total  88389.822  89  Between Groups  1149.690  1  1149.690  Within Groups  26840.133  88  305.002  Total  27989.822  89  F  Sig. 2.9l  .0§2  .20  .662  6.66  .012  3.77  .055  64 To further investigate the equivalence of the experimental and control groups, the participants in both groups were categorized by their status as "immigrant" or "Canadian." ANOVAs on the pretest scores were performed between Canadians in the experimental and control groups, and between immigrants in the experimental and control groups respectively. The ANOVA results on immigrants did not show any significant differences between the experimental and control groups on all four pretest scores. The data is shown in Table 4. The ANOVA results on Canadians in experimental and control groups showed a significant difference between the two groups on the ISC pretest score, with F(l,27)=l 1.41 at p_<.05. The ISC score of control group (185.22 ±28) was significantly higher than the experimental group (147.80 ±27). The ANOVA results also showed significant difference between Canadians in the experimental and control groups in SSE pretest score, with F(l,27)=4.23 at p<.05. The SSE score of the control group (106.56±17) was significantly higher than that of the experimental group (92.25 ±17). Table 5 shows the data. There was no significant difference between Canadians in the experimental and control groups in both SSA and SSE pretest scores. The ANOVA results on the pretest scores supported that immigrants in the experimental and control groups were equivalent in their ISC, SSA, SSE and GSE scores. Yet the ANOVA results did not firmly support that Canadians in the experimental and control groups were equivalent in their pretest scores. Since the Canadians in the experimental group had lower ISC and SSE pretest scores than the Canadians in the control group, the above non-equivalence of groups would not threaten the validity to accept our stated null hypotheses.  65  Examination of demographic data. Demographic data presented in Chapter Three gave more confidence in the equivalency between the experimental and control groups. Participants in the experimental and control groups had very similar mean values on all the subject variables measured; including age, age of arrival in Canada, and the years of residence in Canada. The two groups also had a similar composition of Canadians and immigrants, and similar percentage of participants using English at home. The Canadians and immigrants in the experimental group also resembled their counterparts in the control group in the means and ranges of their demographics, such as age, number of years in Canada, age starting to reside in Canada.  66  Table 4 ANOVA of Pretest Comparing Immigrants in the Experimental and Control Groups  Sum of Squares sum tibb pretest  sum SSA pretest  sum ISC pretest  sum S S E pretest  between Groups  df  Si .743  Mean Square  Within Groups  753.238  53  Total  784.982  54  27.474  1  Between Groups Within Groups  14510.23  53  Total  14537.70  54  Between Groups  27.47  1  1075.28  55398.64  53  1045.25  Total  56473.92  54  Total  1  699.696  16862.05  53  318.152  17561.74  54  699.696  .14-1  .10  .753  1.03  .315  2.20  .144  273.778  1075.28  Between Groups  Sig. 2.23  14.21  Within Groups  Within Groups  F  \  Table 5 ANOVA of Pretest Comparing Canadians in the Experimental and Control Groups  Sum of Squares sum (ibh pretest  sum SSA pretest  sum ISC pretest  sum S S E pretest  between Groups  4.365  df  Mean Square  \  Within Groups  277.839  27  Total  282.207  28  Between Groups  F  Sig.  4.3S8  .42  .S20  .29  .597  11.41  .002  4.23  .050  10.290  71.752  1  71.752  Within Groups  6780.800  27  251.141  Total  6852.552  28  Between Groups  8692.279  1  8692.279  Within Groups  20576.756  27  762.102  Total  29269.034  28  Between Groups  1270.235  1  1270.235  Within Groups  8113.972  27  300.517  Total  9384.207  28  67 Multivariate Repeated Measures MANOVA The SPSS (Version 10) repeated measures MANOVA program was used to analyze the pretest and posttest data of the experimental and control groups. The probability level of .05 was used as the cutoff level for statistical significance. The multivariate repeated measures MANOVA was used to analyze the four dependent variables: GSE, SSA, ISC and SSE as a combined multivariate. The results of the test showed there was a significant effect of treatment (group X time interaction) with F(4, 85)=3.22 at p<.05 ; see Table 6. The results also showed that there was a significant effect of the time factor, with F(4, 85)=4.82, at g<.05. Yet there was not significant group effect, with F(4,85)=1.09, at p>.05. Complete multivariate MANOVA results are given in Appendix B-l. The multivariate measure could be regarded as consisting of two components: a measure of general self-efficacy and three specific behavioural competency measures, the significant improvement in performance of the experimental group as indicated by the multivariate repeated measures MANOVA strongly supported the hypothesis that treatment was effective to enhance participants' general and specific areas of competency. In the coming sections, the results of statistical analyses conducted to test the hypotheses were reported. Table 6 Repeated Measures MANOVA Source  F-value  hypothesis degree of freedom  error degree of freedom  significance  between subject Groups  1.09  4  85  .369  within subject Time Group X time  4.82 3.22  4 4  85 85  .001 .017  68 Repeated Measures MANOVA and t-tests on Each Dependent Variable The SPSS (Version 10) repeated measures MANOVA also analyzed individually the four dependent variables, (i.e., SSA, ISC, SSE, and GSE scores), between the experimental and control groups. The MANOVA results showed that there were significant differences between the experimental and control groups in three of the four individual dependent variables: (i.e. SSA, ISC, and SSE scores.) Non- significant difference was found only on GSE. The F-values and their levels of significance are shown in Table 7. The results supported the hypotheses two, three and four which stated that the experimental group would report lower situational social avoidance, higher interpersonal communication competency, and higher social self efficacy due to participation in the training. The descriptive statistics are given in Table 2 in the previous section of this chapter. Table 7 F-values from Repeated Measures MANOVA for Experimental and Control Groups Variable F-value significance level GSE 1.66 0.202 SSA 4.14 0.045 ISC 11.88 0.001 SSE 4.84 0.030 Legend: 1. Sample size: Experimental Group n=58, Control group, n=32 2. Variables : GSE: Generalized Self-Efficacy (Schwarzer, 1993) SSA: Situational Social Avoidance (Ishiyama, 1995) ISC: Interpersonal Skills Checklist (Ishiyama, 1996) SSE: Social Self-Efficacy Scale (Fan & Mak, 1998) Paired samples t-tests were performed to examine differences between pretest and posttest paired group means of the experimental and also of the control groups . A probability level of smaller than .05 was used to reject the null hypothesis. The t-test results showed that all posttest scores in all four dependent variables, GSE, SSA, ISC, and SSE of  69 the experimental group were significantly differentfromtheir paired pretest scores. The results are shown in Table 8. For the control group, no significant difference was found between the pretest and posttest dependent variables; see Table 9. The t-test results supported hypothesis one, two, three, and four. The following sections reported results for each individual dependent variable and presented the profile plots. Table 8 t-test values for Pretest and Posttest Scores in Experimental Group Variable GSE SSA ISC SSE Legend:  Experimental Group n=58 pretest posttest pretest posttest pretest posttest pretest posttest  Mean (S.D.)  t-value  29.67 (3.61) 31.71 (4.17) 56.76(16.59) 48.19(14.38) 147.98 (31.77) 168.71 (27.67) 90.19(17.08) 98.88 (17.68)  3.97  significance level .000  4.10  .000  5.91  .000  3.77  .000  GSE: Generalized Self-Efficacy (Schwarzer, 1993) SSA: Situational Social Avoidance (Ishiyama, 1995) ISC: Interpersonal Skills Checklist (Ishiyama, 1996) SSE: Social Self-Efficacy Scale (Fan & Mak, 1998)  Table 9 t-test values for Pretest and Posttest Scores in Control Group Variable GSE SSA ISC SSE Legend:  Experimental Group n=32 pretest posttest pretest posttest pretest posttest pretest posttest GSE: SSA: ISC: SSE:  Mean (S.D.)  t-value  31.03 (3.62) 31.91 (4.19) 55.22(14.61) 53.19(16.56) 165.34 (28.20) 165.34 (30.35) 97.66(18.14) 97.88 (15.79)  1.12  significance level .271  0.98  .336  0.00  1.000  0.07  .944  Generalized Self-Efficacy (Schwarzer, 1993) Situational Social Avoidance (Ishiyama, 1995) Interpersonal Skills Checklist (Ishiyama, 1996) Social Self-Efficacy Scale (Fan & Mak, 1998)  70  Situational Social Avoidance (SSA). The MANOVA results for the dependent variable SSA showed that the experimental group had significantly lower situational avoidance tendency compared with the control group as indicated by a significant group X time interaction F ratio. There was significant treatment effect, with F(l,88)=4.14, at p<.05. The MANOVA results supported the hypothesis two that the SCCT program lowered the situational social avoidance of the participants; see Table 10. The graphical profile plots show that the control group remained unchanged in their situational social avoidance tendency scores between pretest and posttest, whereas the experimental group show a significant decrease in situational social avoidance at the posttest; see Figure 3. Table 10 Repeated Measures MANOVA for SSA Source of Variation Between-Subjects Error Group Within-Subiects Error Time Group X Time !  F  S.S.  df  M.S.  3206.28 123.30  88 1  377.34 123.30  9371.60 1158.60 440.71  88 1 1  106.50 1158.60 10.88 440.71 4.14  .33  Significance of F .569 .001 .045  The paired samples t-test results also supported the hypothesis two. There was a significant difference between SSA pretest and posttest mean scores for the experimental group, with t(57)=4.10, at p<.05; the SSA posttest score (48.19 ±14) was significantly lower than the SSA pretest score (56.76 ±17); see Table 8. No significant difference was found between the SSA pretest and posttest mean scores for the control group; see Table 9.  71  Estimated Marginal Means of SSA  group " experimental  ion  control j-test  post-test  TIME  Figure 3: Profile Plots for SSA  Interpersonal Skills Checklist (ISC). The MANOVA results for the dependent variable ISC showed that the experimental group had significantly higher interpersonal skills compared with the control group as indicated by the significant group X time interaction. There was a significant treatment effect, F(l,88)=l 1.88, p<.05. The MANOVA results supported the hypothesis three that the SCCT increased the interpersonal skills ofthe participants; see Table 11. The graphical profile plots also show that the control group remained unchanged in their interpersonal skills levels between pretest and posttest; whereas the experimental group showed a significant increase in interpersonal skills at the posttest; see Figure 4.  Table 11 Repeated Measures MANOVA for ISC Source of Variation Between-Subjects Error Group Within-Subiects Error Time Group X Time  F  Significance of F  1381.43 2020.36  1.46  .230  372.72 4428.52 4428.52  11.88 11.88  .001 .001  S.S.  df  M.S.  121565.64 2020.36  88 1 88 1 1  32799.79 4428.52 4428.52  The paired samples t-test results also supported hypothesis three. There was a significant difference between ISC pretest and posttest mean scores for the experimental group, _t(57)=5.91, p<.05; the ISC posttest (168.71128) was significantly higher than the ISC pretest (147.98±32) (see Table 8). No significant difference was found between the SSA pretest and posttest mean scores for the control group ; see Table 9.  73  Estimated Marginal Means of ISC  group expenmenta control  post-test  pre-test TIME  Figure 4: Profile Plots for ISC  74 Social Self-Efficacy (SSE). The MANOVA results for the dependent variable of SSE showed that the experimental group had significantly higher social self-efficacy compared with the control group as indicated by the significant group X time interaction. There was a significant treatment effect, with F(l,88)=4.84, at p<.05. The MANOVA results supported hypothesis four that the SCCT increased the social self efficacy of the participants; see Table 12. The graphical profile plots also show that the control group remained unchanged in their social self-efficacy scores between pretest and posttest; whereas the experimental group showed a significantly higher social self efficacy at the posttest; see Figure 5. Table 12 Repeated Measures MANOVA on SSE Source of Variation Between-Subjects Error Group Within-Subjects Error Time Group X Time  S.S.  df  M.S.  F  Sig. of F  38932.846 430.64  88 1  442.42 430.60  .97  .327  13444.94 818.28 739.88  88 1 1  152.78 818.28 739.88  5.36 4.84  .023 .030  The paired samples t-test results also supported hypothesis four. There was a significant difference between SSE pretest and posttest mean scores for the experimental group, t(57)=3.77, p_<.05; the SSE posttest (98.88±18) was significantly higher than the SSE pretest (90.19±17); see Table 8. There was no significant difference found between the SSE pretest and posttest mean scores for the control group; see Table 9.  75  Estimated Marginal Means of SSE  group experimental control post-test 0  pre-test TIME  Figure 5: Profile Plots for SSE  76 General Self-Efficacy (GSE). It was predicted that there would be a significant increase in the control group's GSE score after the training. The MANOVA result did not support this hypothesis with F(l,88)= 1.66, at p>.05; see Table 13. The MANOVA result showed that there was a significant effect of the time factor with F(l,88)= 10.43, at p<.05. As shown in the graphical profile plots, the mean GSE scores of the experimental group increased with time but the increase did not reach statistical significance; see Figure 6. This result did support hypothesis five which stated that there would be more significant changes in the specific measures: (a) social self efficacy (SSE), (b) social avoidance behavior (SSA), and (c) interpersonal communication competency (ISC) than the general self efficacy (GSE). MANOVA results showed that there were significant treatment effects on SSE, ISC and SSA, but there was no significant treatment effect on GSE. Table 13 Repeated Measures MANOVA for GSE Source of Variation Between-Subj ects Error Group Within-Subi ects Error Time Group x Time  S.S.  df  M.S.  F  Significance of F  1951.77 25.03  88 1  22.18 25.03  1.13  .291  736.72 87.28 13.86  88 1 1  8.37 87.28 13.86  10.43 1.66  .002 .202  77  Estimated Marginal Means of GSE 35.0  group experimental ° control pre-test  post-test  TIME Figure 6: Profile Plots for GSE  78 Statistical Analysis on the Situational Social Avoidance (SSA), the Interpersonal Skills Checklist (ISC), and the Social Self-efficacy (SSE) Subscales Three instruments used in this study have their subscales and yielded three subscores. Higher subscores on each of the subscales indicate higher performance in the area. Further analysis on the scores on these subscales revealed more information about the participants' sociocultural competence and their learning experiences in the training process. Repeated measures MANOVAs revealed significant differences between experimental and control groups on these subscales, with a probability level of .05 to reject null hypotheses. Paired samples t-tests were also performed additionally to find any significant difference between pretest and posttest scores for the experimental and control groups. The descriptive statistics for the subscales of these three instruments are reported in the Appendix B-2. Situational Social Avoidance (SSA) subscales. The SSA has three subscales: Social Performance Avoidance (SSA1),: Socializing Avoidance (SSA2), and Self-Assertion Avoidance (SSA3). MANOVAs were conducted on each subscale score separately. MANOVA results indicated that there were significant differences in two subscores, SSA2 and SSA3 as indicated by their significant group X time interactions. There were treatment effects on SSA2, F(l,88)=5.20, p<.05; and on SSA3 subscores, F(l,88)=4.21, p<.05. The SSA2 and SSA3 scores of the experimental group decreased in the posttest, these results suggested that participants had less social avoidance in these two areas after treatment. Only SSA1 showed no significant difference in the MANOVA results (see Table 14). The paired samples t-test results for the SSA subscales showed significant differences between the pretest and posttest in all three SSA subscales of the experimental group including the SSA1 subscale. There was a significant difference between SSA pretest  79 and posttest mean scores for the SSA1 subscore, t(57)=3.99, g<.05; and for the SSA2 subscore, with t(57)=2.61, at p_<.05; and for the SSA3 subscore, with t(57)=4.43, at p_<.05. The SSA1 posttest (20.00±7) was significantly lower than the SSA1 pretest (23.64±8); the SSA2 posttest (12.28±4) was significantly lower than the SSA2 pretest (14.07+5); and the SSA3 posttest (9.55±3) was significantly lower than the SSA3 pretest (11.97+4). There was no significant difference between pretest and posttest scores of the control group. All these t-test results are shown in the Appendix B-3. There were different findings between the MANOVA and t-test results in the social performance avoidance (SSA1) subscore. MANOVAs did not yield a significant difference between experimental and control groups on the SSA1 subscore; but the t-test found a significant difference between the SSA1 pretest and posttest subscores of the experimental group. The profile plot of SSA1 subscore showed that the SSA1 subscores of the control group also decreased in posttest; see Figure 7. This decrease might make the treatment effect for the experimental group not significant in the MANOVA analysis. Table 14 Repeated Measures MANOVA for SSA Subscales  Source  Measure  i IM b  yyM  SSA2 SSA3 TIME X G R O U P S S A 1 SSA2 SSA3 GROUP SSA1 SSA2 SSA3  Legend:  Type III Sum of Squares  285.602 13.326 101.181 41.780 61.860 29.626 1.552 41.200 10.602  df 1 1 1 1 1 1 1 1 1  Mean Square 285.602 13.326 101.181 41.780 61.860 29.626 1.552 41.200 10.602  SSA1: Social Performance Avoidance Subscale SSA2: Socializing Avoidance Subscale SSA3: Self-Assertion Avoidance Subscale  F  Sig.  13.32  .000  1.12 14.38 1.95 5.20 4.21 .02 1.44 .49  .293 .000 .166 .025 .043 .888 .233 .485  80  Estimated Marginal Means of SSA2  Estimated Marginal Means of SSA 1  group  group  experimenta  " experimental  control pre-test  control  post-test  TIME  post-test TIME  Estimated Marginal Means of SSA3  <  C CO O '3 group " experimental control pre-test  post-test  TIME  Figure 7: Profile Plots for the Three SSA Subscales  81 Interpersonal Skills Checklist (ISC) subscales. Interpersonal Skills Checklist (ISC) has six subscales: Processing Skills (ISO), Active Engagement Skills (ISC2), SelfEnhancement Skills (ISC3), Approaching Skills (ISC4), Assertive Skills (ISC5), and Interruption Skills (ISC6). MANOVAs were conducted on each subscale score separately. MANOVA results showed that there were significant differences for all six subscales between the experimental and the control groups, as indicated by their significant group X time interactions ; see Table 15. There were significant treatment effects as follows: ISC1 subscores, F(l,88)=l 1.44, p<.05; ISC2 subscores, F(l,88)=9.01, p<.05; ISC3 subscores, F(l,88)=10.12, p<.05; ISC4 subscores, F(l,88)=4.85, p<.05; ISC5 subscores, F(l,88)=15.98, p<.05; ISC6 subscores, F(l,88)=5.60, p<.05. As shown in Figure 8, all the ISC subscores ofthe experimental group increased at the posttest indicating that participants had increased their interpersonal communication competencies after treatment. The paired samples t-test result for the ISC subscales showed that all six subscales in the experimental group were significantly different in their pretest and posttest scores. There were significant differences between ISC pretest and posttest mean scores: ISC1 subscore, t(57)=6.08, p<.05; ISC2 subscore, t(57)=4.65, p<.05; ISC3 subscore, t(57)=4.17, o<.05; ISC4 subscore, t(57)=4.58, p<.05; ISC5 subscore, t(57)=6.46, p<.05; ISC6 subscore, t(57)=5.90, p<.05. ISC1 posttest score (30.19±6) was significantly higher than pretest score (25.03+7); ISC2 posttest score (33.72±5) was significantly higher than pretest score (30.83+6); ISC3 posttest score (28.60±6) was significantly higher than pretest score (24.95±7);  82 ISC4 posttest score (31.21+6) was significantly higher than pretest score (27.45±7); ISC5 posttest score (24.10±6) was significantly higher than pretest score (20.48±6); ISC6 posttest score (21.17±4) was significantly higher than pretest score (18.14±5). In the control group, all six subscale factors did not have significant difference between posttest and pretest scores. The t-test results supported the hypothesis that the SCCT training would improve interpersonal communication competence in all areas measured by the ISC subscales. All t-test results are attached in the Appendix B-4. Table 15 Repeated Measures MANOVA for ISC Subscales  Source IIMb.  Measure IJSC1 ISC2 ISC3 ISC4 ISC5  Type III Sum of Squares 322.511 65.560 61.208 198.140 121.535  df 1 1 1 1  Mean Square 322.511  F 16.08  65.560 61.208  5.35 2.53  198.140 121.535  9.49 12.99 14.71  .001 .000  11.44  .001  Sig.  .060 .023 .115 .003  ISC6  145.250  1 1  TIME X GROUP ISC1 ISC2  229.489  1  110.360 244.942  1  110.360  9.01  1  244.942  10.12  .004 .002  101.251  1  101.251  4.85  .030  ISC5  149.535  1  149.535  15.98  .000  ISC6  55.295  1  55.295  5.60  ISC1  123.681  1  123.681  2.14  .020 .147  ISC2  61.805  1  61.805  1.18  .280  ISC3  57.163 42.498  1  ISC4  1  57.163 42.498  .88 .64  .350 .427  ISC5 ISC6  368.272 69.484  1  368.272  7.12  .009  1  69.484  2.39  .125  ISC3 ISC4  GROUP  Legend:  145.250 229.489  ISC1: Processing Skills Subscale ISC2: Active Engagement Skills Subscale ISC3: Self-Enhancement Skills Subscale ISC4:- Approaching Skills Subscale ISC5:- Assertive Skills Subscale ISC6:- Interruption Skills Subscale  83 Estimated Marginal Means of ISC2  Estimated Marginal Means of ISC 1  group " experimental ° control pre-test  post-test  TIME  pre-test  post-test  TIME  Figure 8.2: Subscale ISC2  Figure 8.1 : Subscale ISC 1 Estimated Marginal Means of ISC3  Estimated Marginal Means of ISC4  group " experimental control pre-test  post-test  TIME  pre-test  post-test  TIME  Figure 8.4: Subscale ISC4  Figure 8.3: Subscale ISC3  Estimated Marginal Means of ISC6  Estimated Marginal Means of ISC5  group  group  " experimental  " experimental  control  ° control post-test TIME  pre-test TIME  Figure 8.5: Subscale ISC5  Figure 8.6: Subscale ISC6  Figure 8: Profile Plots for the Six Subscales of ISC  post-test  84 Social Self-efficacy (SSE) subscales. The Social Self-efficacy (SSE) Scale has four subscales: Absence of Social Difficulties (SSE1), Social Confidence (SSE2), Sharing Interest (SSE3), and Friendship Initiatives (SSE4). MANOVA results showed that there were significant differences on two subscales, the SSE1 and SSE4 subscores between the experimental and the control groups, as indicated by their significant group X time interactions; see Table 16. There was treatment effect on SSE1, with F(l,88)=9.00, at p<.05; and on SSE4 subscores, with F(l,88)=7.40, at p<.05. As Figure 9 shows, the SSE1 and SSE4 subscores of the experimental group increased at the posttest, indicating that participants had increased social self-efficacy in these two areas after treatment. However, there was no significant difference in SSE2 and SSE3 subscores in the MANOVA results; see Table 16. The paired samples t-test result for the SSE subscales showed that all four subscales in the experimental group were significantly different in their pretest and posttest scores, showing improvement of social self-efficacy made in all four areas. There were significant differences between ISC pretest and posttest mean scores for the following subscales: (a) SSE subscore t(57)=5.28, p<.05, (b) SSE2 subscore, t(57)=2.09, p<.05, (c) SSE3 subscore, t(57)=2.81, p<.05, (d) SSE4 subscore, t(57)=4.18, p_<.05. SSE1 posttest score (45.17 ±10) was significantly higher than pretest score (38.47 ±10); SSE2 posttest score (26.86 ±6) was significantly higher than the pretest score (25.52 ±6); SSE3 posttest score (14.98 ±4) was significantly higher than the pretest score (13.81 ±3); SSE4 posttest score (13.45 ±3) was significantly higher than the pretest score (11.64 ±3).  85 All t-test results for the experimental and control groups are shown in Appendix B-5. Yet the improvement in SSE2 and SSE3 was not significant in the MANOVA test. The MANOVA and t-test results indicated that the training was likely effective to change social self-efficacy in the areas of Social Difficulties (SSE1), and Friendship Initiatives (SSE4); but less likely to change attitude and behaviour in Social Confidence (SSE2), and Sharing Interest (SSE3). Table 16 Repeated Measures MANOVA for SSE Subscales  Source  Measure  Type III Sum of Squares  S S b 1  421.604  SSE2 SSE3 SSE4  46.608 16.530 22.178  TIME X GROUP SSE1 SSE2 SSE3  508.048 3.275 11.997  SSE4  47.845 207.602  IIMh  GROUP  SSE1 SSE2 SSE3 SSE4  Legend:  10.874 1.868 .959  df  F  1 1  421.664  7.46  Sig. .008  46.608  1 1  16.530 22.178  3.83 2.43 3.43  .053 .123 .067  1 1 1 1  508.048 3.275 11.997  9.00 .27 1.76  .004 .605 .188  47.845 207.602  7.40 1.27  .008 .264  10.874  .21  .648  1.868 .959  .10 .050  .753 .826  1 1 1 1  Mean Square  SSE1: Absence of Social Difficulties Subscale SSE2: Social Confidence Subscale SSE3: Sharing Interest Subscale SSE4: Friendship Initiatives Subscale  86  Estimated Marginal Means of SSE2  Estimated Marginal Means of SSE1  group " experimental  <  control  0  pre-test  ^  post-test  TIME  control  pre-test TIME  Figure 9.1: Subscale SSE 1  Figure 9.2: Subscale SSE2  Estimated Marginal Means of SSE4  Estimated Marginal Means of SSE3  group  group  " experimental  expenmenta  ° control  control pre-test  post-test  post-test  TIME  pre-test  post-test  TIME  Figure 9.3: Subscale SSE3  Figure 9.4: Subscale SSE4  Figure 9: Profile Plots for the Four Subscales of SSE  87 Causal-Comparative Analysis on Participants in the Experimental Groups Exploratory analyses were done to examine how participants' demographic variables contributed to the training outcomes. Certain independent subject variables such as age, ethnicity, the use of English language at home, the number of years in Canada, and age starting to reside in Canada, and gender were explored. Causal-comparative analysis of the effect of these subject variables required creation of categories to group participants in the experimental group accordingly. Then statistical analysis was performed to investigate whether there were significant differences among the categorized groups as follows. Ethnicity. The subject variable of "ethnicity" was operationalized into two subgroups: (a) "Caucasians," and (b) "ethnic minorities." The "Caucasians" group consisted of participants who had at least one parent who was Canadian, British or American. The "ethnic minorities" group consisted of participants whose parents were ethnic minorities. There were 20 Caucasians and 38 ethnic minorities identified in the experimental group. Repeated measures MANOVA was used to analyze "ethnicity" as a between-group factor. The MANOVA yielded no statistical significant difference between the two groups. The MANOVA results are presented in Table 17. From the profile plots, the "ethnic minorities" group scored lower in general self-efficacy, interpersonal skills and social self-efficacy, and scored higher in situational social avoidance than the "Caucasians" group for the four dependent variables; see Figure 10. The descriptive statistics of means and standard deviations of the groups are shown in Appendix B-6.  Table 17 Repeated Measures MANOVA Results Using "Ethnicity" as Between Group Factor  Source 1 1Mb  TIMEX ETHNICITY  ETHNICITY  Legend:  Measure GSb SSA  Type III Sum of Squares 130.048  SSA  2146.410 13782.670 2083.835 10.151 62.962  ISC SSE  1327.463 14.077  GSE SSA  37.655 695.072  ISC SSE  ISC SSE GSE  df 1 1 1 1 1 1 1 1 1  Mean Square 130.048  F 17.18  Sig. .000  2146.410 13782.670 2083.835 10.151 62.962  16.77 40.68 13.30 1.34  .000 .000 .001 .252  .49 3.92  .486  1327.463 14.077 37.655 695.072  1225.445  1 1  1225.445  394.048  1  394.048  GSE: Generalized Self-Efficacy (Schwarzer, 1993) SSA: Situational Social Avoidance (Ishiyama, 1995) ISC: Interpersonal Skills Checklist (Ishiyama, 1996) SSE: Social Self-Efficacy Scale (Fan & Mak, 1998)  .09 1.67 1.99 .86 .87  .053 .765 .202 .164 .357 .354  89  ethnicity  ethnicity  Caucasian (n=20)  " Caucasian (n=20)  ethnic minority  ethnic minority (n=38)  (n=38) pre-test  post-test  post-test  TIME  TIME  Figure 10.1: Profile Plots for GSE  Figure 10.2: Profile Plots for SSA  ethnicity  ethnicity " Caucasian (n=20)  " Caucasian (n=20)  ethnic minority  ethnic minority (n=38)  (n=38) pre-test  post-test  post-test  TIME  TIME  Figure 10.3: Profile Plots for ISC  Figure 10.4: Profile Plots for SSE  Figure 10: Profile Plots of "Ethnicity" and Four Dependent Variables  90 Language used at home. The subject variable "language used at home" was defined as language(s) spoken by participants and their family members at home. It was operationalized into three categories. The "English" category consisted of participants who spoke only English at home. Participants who used their own ethnic language were in the "mother tongue" category. Participants in the third category used "both English and mother tongue" at home. There were 24 "English" speakers, 15 "mother tongue" speakers, and 19 "both English and mother tongue" speakers. A repeated Measures MANOVA was used to examine the experimental group using "language used at home" as the between group factor. The ANOVA found no significant difference between these groups. The MANOVA results are presented in Table 18. Profile plots of these groups showed that all three groups reported similar levels of general self-efficacy. The "English" group had higher posttest scores in interpersonal skills and social self-efficacy. As shown in the profile plots Figures 11.1 to 11.4, the "mother tongue" group reported a higher level of situational social avoidance compared with the other two groups in the posttest. These differences were not statistically significant. The descriptive statistics of the means and standard deviations of these groups are shown in Appendix B-7.  Table 18 Repeated Measures MANOVA Results Using "Language Used at Home" as Between Group Factor  Source 11Mb  Measure  Type III Sum of Squares  df  Mean Square  F  1804.020  168.193  14.61 14.19  Sig. .000 .000  SSA  1804.020  168.193  1 1  11159.685  1  11159.685  31.30  .000  TIMEX LANGUAGE  ISC SSE GSE SSA  2021.866 9.222 237.276  1 2 2  2021.866 4.611 118.638  12.71 .60 .93  LANGUAGE  ISC SSE GSE  689.232 36.212 .981  2 2 2  344.616 18.106 .491  .97 .11 .02  .001 .554 .399 .387  SSA ISC SSE  436.047 11.511  2 2 2  218.023 5.756 137.244  .61 .00 .30  Legend:  USE  274.488  GSE: Generalized Self-Efficacy (Schwarzer, 1993) SSA: Situational Social Avoidance (Ishiyama, 1995) ISC: Interpersonal Skills Checklist (Ishiyama, 1996) SSE: Social Self-Efficacy Scale (Fan & Mak, 1998)  .893 .979 .549 .996 .744  92  language at home  language at home  " English (n=24) 0  A  mother tongue (n= 15)  " English (n=24) ^  mother tongue (n=l 5)  0  both English &  both English &  4  mother tongue (n=19) pre-test  post-test  TIME  mother tongue (n=19) pre-test TIME  Figure 11.1: Profile Plots for GSE  Figure 11.2: Profile Plots for SSA  language at home  language at home  " English (n=24)  " English (n=24)  0  mother tongue (n= 15)  0  both English &  post-test  TIME  Figure 11.3: Profile Plots for ISC  mother tongue (n= 15) Both English &  mother tongue (n=19) -test  post-test  Mother Tongue (n=19) pre-test  post-test  TIME  Figure 11.4: Profile Plots for SSE  Figure 11: Profile Plots of "Language Used at Home" and Four Dependent Variables  Number of years in Canada. The subject variable "years in Canada" was operationalized as the number of years participants had stayed in Canada. The ranges of years were defined so that participants were evenly assigned into three groups. There were 16 participants in the categoryfrom"1 to 5 years", 16 participants were in "6 to 19 years" category, and 20 participants were in the "over 20 years" category. A repeated Measures MANOVA was performed on the experimental group using "years in Canada" as the between group factor. As shown in Table 19, there was no significant differences among these groups. The profile plots in Figure 12 showed that participants who had stayed longer in Canada reported higher general self efficacy, lower situational social avoidance, higher self-reported interpersonal skills, and higher social self efficacy. However, these were not statistically significant differences. The descriptive statistics of means and standard deviations of these groups are shown in Appendix B-8. Table 19 Repeated Measures MANOVA Results Using "Years in Canada" as Between Group Factor Source 11Mb  TIME X YEARS IN CANADA  YEARS IN CANADA  Legend:  Measure Ui>h SSA ISC SSE GSE SSA ISC SSE GSE SSA ISC SSE  Type III Sum of Squares S9.9S2 1897.820 10637.355 1972.534 9.804 104.451 762.163 50.024 15.590 671.511 3465.039 1839.804  df  \ 1 1 1 2 2 2 2 2 2 2 2  Mean Square 99.952 1897.820 10637.355 1972.534 4.902 52.226 381.082 25.012 7.795 335.756 1732.519 919.902  GSE: Generalized Self-Efficacy (Schwarzer, 1993) SSA: Situational Social Avoidance (Ishiyama, 1995) ISC: Interpersonal Skills Checklist (Ishiyama, 1996) SSE: Social Self-Efficacy Scale (Fan & Mak, 1998)  F 12.96 14.65 29.94 12.42 .64 .40 1.07 .16 .33 .94 1.23 2.12  Sig. .001 .000 .000 .001 .533 .670 .349 .855 .718 .395 .300 .129  94  years in Canada  years in Canada  " 1 to 5 years (n=16)  pre-test  0  6 to 19 years (n=16)  4  over 20 years (n=20)  post-test  " 1 to 5 years (n=16) ° 6 to 19 years (n=16) * over 20 years (n=20) pre-test  TIME  post-test  TIME  Figure 12.1: Profile Plots for GSE  Figure 12.2: Profile Plots for SSA  years in Canada  years in Canada  " 1 to 5 years (n=16)  " 1 to 5 years (n=16) 0  6 to 19 years (n=16)  ^  0  6 to 19 years (n=16) over 20 years (n=20)  over 20 years (n=20) post-test  post-test TIME  12.3: Profile Plots for ISC  Figure 12.4: Profile Plots for SSE  Figure 12: Profile Plots of "Years in Canada" and Four Dependent Variables  95 Age of participants. The subject variable "age" was defined as the current age when participants took the SCCT training. The range of age was from 18 to 46. The variable was categorized into two age groups: 32 participants were in the group of early adulthood "from 18 to 30," and 26 participants were in the mid-age group of "over 30." A repeated measures MANOVA was performed on the experimental group using "age" as the between group factor. There was no significant difference between the two groups; see Table 20. The profile plots in Figure 13 shows that the two age groups had similar SSA and ISC scores. The "over 30" age group scored higher in general self-efficacy than the "18 to 30" age group at both pretest and posttest, but the "18 to 30" age group had a larger increase in social self-efficacy than the "over 30" group after SCCT training. These differences were not statistically significant. The descriptive statistics are shown in Appendix B-9. Table 20 Repeated Measures MANOVA Results Using "Age" of Participants as Between Group Factor  Source MMb  TIMEXAGE  AGE  Legend:  Measure (jyt SSA ISC SSE GSE SSA ISC SSE GSE SSA ISC SSE  T y p e III S u m of S q u a r e s 119.215 2066.384 12028.568 1978.377 4.244E-02 18.108 165.120 398.549 31.659 .996 67.269 139.253  df 1 1 1 1 1 1 1 1 1 1 1 1  Mean Square 1 19.215 2066.384 12028.568 1978.377 4.244E-02 18.108 165.120 398.549 31.659 .996 67.269 139.253  F  15.355 16.045 33.453 13.210 .005 .141 .459 2.661 1.395 .003 .047 .306  GSE: Generalized Self-Efficacy (Schwarzer, 1993) SSA: Situational Social Avoidance (Ishiyama, 1995) ISC: Interpersonal Skills Checklist (Ishiyama, 1996) SSE: Social Self-Efficacy Scale (Fan & Mak, 1998)  Sig. .000 .000 .000 .001 .941 .709 .501 .108 .243 .958 .830 .583  96  Age  Age  " from 18to30(n=32)  " from 18to30(n=32)  ° over30(n=26) pretest  over 30 (n=26)  posttest  posttest TIME  TIME  Figure 13.1: Profile Plots for GSE  Figure 13.2: Profile Plots for SSA  00 >>  Age  Age  " from 18to30(n=32) over 30 (n=26) posttest  " from 18to30(n=32) o oo  ° over 30 (n=26) posttest TIME  Figure 13.3 : Profile Plots for ISC  Figure 13.4: Profile Plots for SSE  Figure 13: Profile Plots of "Age" and Four Dependent Variables  97  Age of arrival in Canada. The subject variable "age of arrival in Canada" was operationalized as the age participants started to reside here in Canada. The variable was defined into three different groups. Participants in the group "from age 0 to 12" included those who were born here or came to Canada in their early childhood. Participants in the group "from age 13 to 21" included all participants who came here in their teens. The third category was "from age 22 to 46" consisted of all other participants who came here in their adulthood. There were 33 participants in the category "age 0 to 12," 13 participants were "from age 13 to 21," and 12 participants came here in the "agefrom22 to 46." Repeated measures MANOVA was performed on the experimental group using the subject factor as the between group factor. The MANOVA found no significant difference among the groups; see Table 21. The profile plots showed that there was little difference in the level of general selfefficacy reported among the three groups. However, for the other three dependent variables, participants who came to Canada at an age of "from 0 to 12" reported higher level of interpersonal skills, less situational social avoidance, and higher social self efficacy than the other two groups; see Figure 14. However, these differences were not statistically significant. The descriptive statistics are shown in Appendix B-10.  Table 21 Repeated Measures MANOVA Results Using "Age of Arrival in Canada" of Participants as Between Group Factor  Source 11Mb  Measure  ISC SSE GSE SSA  7951.964  1  Mean Square 76.373 1079.414 7951.964  1446.437 9.549 419.383  1 2 2  1446.437 4.775 209.692  ISC SSE GSE  1187.255 367.350 21.830  2 2  593.627  SSA  297.729 4261.652  GbSb SSA  TIMEX A G E OF ARRIVAL  A G E OF ARRIVAL  ISC SSE Legend:  Type III Sum of Squares 76.373 1079.414  2371.387  df  \ 1  F 9.90 8.72  Sig. .663 .005  22.88 9.45 .62 1.69  .000 .003 .542 .193  1.71 1.20 .47 .41  .191 .309 .628  2 2  183.675 10.915 148.864  2  2130.826  1.53  .665 .226  2  1185.693  2.80  .070  GSE: Generalized Self-Efficacy (Schwarzer, 1993) SSA: Situational Social Avoidance (Ishiyama, 1995) ISC: Interpersonal Skills Checklist (Ishiyama, 1996) SSE: Social Self-Efficacy Scale (Fan & Mak, 1998)  99  age o f arrival  age of arrival  " age 0 to 12(n=33) 0  1  pre-test  " age 0 to 12(n=33)  age 13 to 21 (n=13)  pre-test  *  age22to46(n=12)  post-test  TIME  Figure 14.2: Profile Plots for SSA  Figure 14.1 : Profile Plots for GSE  140J  age 13 to 21 (n=13)  age22to46(n=12)  post-test  TIME  o  °  - —  age of arrival  age o f arrival '  age 0 to 12(n=33) age 13 to 21 (n=13)  _  age 22 to 46 (n=12)  Figure 14.3: Profile Plots for ISC  age 0 to 12(n=33)  0  age 13 to 21 (n=13)  *  post-test TIME  •  age22to46(n=12)  post-test TIME  Figure 14.4: Profile Plots for SSE  Figure 14: Profile Plots of "Age of Arrival in Canada" and Four Dependent Variables  100 Gender. The subject variable "gender" was operationalized into male and female categories. There were 52 female and 6 male participants in the experimental group. The small sample size of male participants decreased the power of any statistical test; therefore, no statistical test was performed. The profile plots in Figure 15 showed that the mean scores of the "male group" were higher than the mean scores ofthe "female group" in general and social self-efficacy, and was lower in situational social avoidance than the "female group," both groups had a similar level of interpersonal skills. However these results were not conclusive because ofthe small sample size of male participants. The descriptive statistics are shown in Appendix B-l 1.  pre-test  post-test  pre-test  post-test  TIME  TIME  Figure 15.1: Profile Plots for GSE  Figure 15.2: Profile Plots for SSA  ° female (n=58) post-test  pre-test  post-test  TIME  Figure 15.3: Profile Plots for ISC  Figure 15.4: Profile Plots for SSE  Figure 15: Profile Plots of "Gender" and Four Dependent Variables  101  Chapter IV Results: Part 2 Qualitative Results - Interview After the training, 24 participants from the experimental group were interviewed. In the semi-structured interviews, the interviewees elaborated on their responses to the following five questions. 1. Which of the six competency skills did you find helpful and/or useful to you? 2. What kind of actions did you take in relating to the competency skills? 3. How confident are you that you will use the competency skill(s)? 4. In what situations do you plan to use these competency skills? Please give me a scenario in which you will use these skills. 5. What aspects of the program did you find most helpful? This was done as part of the triangulated research design for integrating quantitative and qualitative methods. The interviews revealed participants' experiences of learning sociocultural competencies and the qualitative data complemented the quantitative results. Demographic Characteristics ofthe Interviewees Twenty-four interviewees consisted of 5 Canadians and 19 immigrants. The resulting interviews contained more experiences of immigrants than those of Canadians' experiences. Among the 19 'ethnic minority' immigrants, 9 werefromSoutheast Asia or Philippines, 7 werefromIndia or Pakistan, 1 wasfromKorea, 1 wasfromChina, 1 was from South America. They had been in Canada for a period of 1 to 10 years.  102 Question One: "Which of the Six Competency Skills Did You Find Helpful or Useful to You?" Twenty-four interviewees reported one or more skills that they found helpful /useful. The number of responses are given in Table 22. Table 22 Helpful / Useful Competency Skills Competency Skills  Number of Interviewees (n = 24)*  Making Social Contact/Conversation  14  (58%)  Seeking Help or Information  10  (42%)  Participating in Groups  6  (25%)  Refusing a Request  6  (25%)  Expressing Disagreement  2  ( 8%)  Giving Feedback  0  ( 0%)  38 Note: "Interviewees provided multiple responses. The total number of interviewees does not amount to 24.  103 Question Two: "What Kind of Actions did You Take Relating to the Sociocultural Competency Skills?" Twenty-four interviewees listed one to seven actions they took using sociocultural competency skills. The researcher extracted 67 meaning units from the interview transcripts. Then a rater and the researcher independently categorized all meaning units using the six subscales of the Interpersonal Skills Checklist (Ishiyama, 1996) in order to better understand the nature of these actions. Three other raters classified the sixty-seven meaning units into categories. Three raters placed 40 items into identical categories (60% of total items). Two raters agreed on the same categorization for the remaining 20 items (30% of total items). The raters reached consensus on 60 items (90% of total items), 7 items were discarded. Table 23 summarizes the frequencies of 60 meaning units of actions, and the number of interviewees who reported actions in each category. Table 24 shows the results of the rating and the categories of the assigned items. The results show that the interviewees used more active engagement, assertive, and approaching skills, whereas they used less processing, self-enhancement, and interruption skills.  104  Table 23 Actions Taken Relating to the Competency Skills and Frequencies Actions Related Skills  Frequency of Meaning Units  No. of Interviewees (n=24)  Active Engagement Skills (ISC2)  20 (33%)  12 (50%)  Assertive Skills (ISC5)  13 (22%)  11 (45%)  Approaching Skills (ISC4)  12 (20%)  9 (37%)  Interruption Skills (ISC6)  7 (12%)  6 (25%)  Self-Enhancement Skills (ISC3)  5 ( 8%)  5 (21%)  Processing Skills (ISC 1)  3 ( 5%)  3 (13%)  60 (100%) Note: *Interviewees provided multiple responses. The total number of interviewees does not amount to 24.  105 Table 24 Meaning Units of Actions and Consensus of Raters Participants' ISCl Actions ID# 1  Giving and receiving feedback in Lx> group participation. Asking friends to do things for me. Approaching people to ask for information about different cultures Starting conversations with other passengers in the skytrain Making social conversation with familiar people Speaking in front of a big group about myself. Expressing my ideas in small group. Discussing with other students in the group Approaching neighbours to have a friendly conversation. Talking to the residents when I am feeding them Listening to residents to show interests in the conversations. Maintaining eye-contact in a friendly conversation. Expressing my understanding of the residents' feelings. Listening with patience Talking about myself Making friendly conversations. Expressing my feelings to others. Expressing disagreement with others. Refusing unreasonable requests. Interrupting to ask questions in a group.  1 1 2 3 4 5 6* 6 7 7 7 8 9 9 9 9 9 9 9  ISC2  ISC3  ISC4  ISC5  ISC6  other  Lx>  Lx> Lx> Lx> Lx>  [x> LE> Lx> Lx> Lx> Lx> Lx> Lx> Ll>  rx>  Lx>  Note: ISCl: Processing Skills, ISC2: Active Engagement Skills, ISC3: Self-Enhancement Skills, ISC4: Approaching Skills, ISC5: Assertive Skills, ISC6: Interruption Skills. Legend: * denotes items that did not have consensus among raters.  [S>  denotes consensus among two and more raters.  (table  continues)  106 Table 24 Meaning Units of Actions and Consensus of Raters Participants' ISCl Actions ID# 10 10 11 11 11 12 12 12 13 13 13 13 14 14* 14 14 14 15 15 15 16 17 17 18 18*  Encouraging others by expressing my appreciation. Asserting my rights. Saying, "excuse me" when I have trouble understanding. Interrupting by asking clarification questions. Sharing positive feelings. Talking to strangers. Expressing my opinions. Talking about myself in an interview Asking for instructors' feedback on my performance. Saying no Asserting my rights. Talking about my cultural background. Approaching new people in different settings. Asking residents for information. Listening to residents' requests. Introducing myself. Asking questions for clarification. Making social conversation. Starting conversation. Introducing myself to new people. Waiting for others to talk. Asking questions to check my understanding. Making social conversation. Expressing disagreement. Refusing a request Asking for help.  ISC2  ISC3  ISC4  ISC5  ISC6  other  Lx> Lx> Lx> Lx>  \E> Lx>  Lx>  \E> Lx>  Lx> Lx> Lx> Ll>  E> Lx> Lx> Lx> Lx> Lx>  Note: ISCl: Processing Skills, ISC2: Active Engagement Skills, ISC3: Self-Enhancement Skills, ISC4: Approaching Skills, ISC5: Assertive Skills, ISC6: Interruption Skills. Legend: * denotes items that did not have consensus among raters.  C*> denotes consensus among two  and more raters.  (table continues)  107 Table 24 Meaning Units of Actions and Consensus of Raters Participants' ISCl Actions ID# 19 19 19* 19* 19 20 20 20 21 21 21 21 21 22 22 22 22 22 23 23* 24 24*  Note:  ISC2  Getting feedback from others. \E> Asking others to repeat when I don't understand what they have just said. Asking questions to get information. Listening for information Introducing oneself in a group Saying no Listening to others in small talk. Lx> Introducing oneself in small talk. Talking to my friends to make E> them feel good. Listening to other students in the E> class. Touching others in a friendly way. H> Approaching the clients in a E> friendly manner. Expressing my understanding of E> the clients' feelings. Making social conversation. \E> Asking for information/direction. Socializing with residents and \E> staff. Asking for clarification Saying "no". Saying "no". Dealing with people from different cultures. Refusing requests. Listening with understanding. Total Number of Meaning Units 3 20 of Actions in each Category Total Number of Persons 3 12 Reported Actions in each Category  ISC3  ISC4  ISC5  ISC6  \E>  Lx> [x> Lx>  Lx>  Lx> Lx> Lx>  [x>  5  12  13  7  0  5  9  11  6  0  ISCl: Processing Skills, ISC2: Active Engagement Skills, ISC3: Self-Enhancement Skills, ISC4: Approaching Skills, ISC5: Assertive Skills, ISC6: Interruption Skills.  Legend: * denotes items that did not have consensus among raters. IE> denotes consensus among two and more raters.  other  108 Question Three: "How confident are you that you will use the competency skills?" Overall, all interviewees said they felt more confident after the training. They expressed the change from a state of lower confidence to increased confidence. Three main themes emerged as follows: (a) trainees felt more confident after the training, (b) presence of shyness before training, (c) sources of self-efficacy. Theme one: Trainees felt more confident after the training. A summary of the descriptions of confidence expressed by the interviewees is given in Table 25.  Table 25 Summary of Interviewees' Descriptions of Confidence Descriptions of Confidence After Training Number of Interviewees (n=24) Very confident  4 (17%)  Much more confident  2 ( 8%)  Confident  13 (54%)  Empowered  1 (4%)  More comfortable  3 (13%)  Not shy  1 (4%) 24 (100%)  There was a sharp contrast in how interviewees described their confidence in social situations before and after training. Before training, interviewees described themselves as not confident, quiet, shy, thinking negatively, not comfortable, and not at ease in social situations. Table 26 summarizes interviewees' descriptions before and after the training.  Table 26 Interviewees' Confidence Change Before and After Training Before Training  Participants'  After Training  ID#  1  not confident  confident  2  not confident  confident  3  shy, quiet, reserved  confident  4  keep quiet  confident  5  shy  confident  6  not quite confident  confident  7  shy, scared  confident  8  not quite confident, uneasy  will become confident  9  confident  confident  10  shy  very confident  11  shy  very confident  12  shy  confident  13  negative thoughts  very confident  14  shy  confident  15  shy, not confident  confident  16  embarrassed  confident  17  shy  comfortable  18  (nothing mentioned)  confident  19  uneasy  comfortable  20  not quite confident  empowered  21  shy  not shy  22  shy  much more confident  23  not comfortable  more comfortable  24  (nothing mentioned)  very confident  110 Theme two: Presence of shyness. Twenty-two interviewees mentioned situations where they felt shy. Eleven interviewees elaborated explicitly that they felt shy or other related feelings such as feeling scared, lacking confidence, and being reluctant to speak up in social situations prior to the training. The context of social situations in which interviewees described feeling shy included: (a) using English as their second language, (b) speaking before strangers, (c) fear of embarrassment, (d) fearful of disappointing people, and (e) not knowing how to communicate interculturally. Many interviewees described the sources of their perceived problems in communication, attributing to feeling culturally different, worrying about their English speaking skills, lacking confidence, or lacking knowledge of appropriate social norms. The researcher and the raters put these twenty-four reasons under the four appropriate categories: (a) psychological factors (8 items), (b) cultural differences (7 items), (c) sociocultural skills (5 items), (d) language issues (4 items). A 91% consensus was accomplished with the raters.  Ill Table 27 Question Three- Theme two: Presence of Shyness Participants' Words Context / Social Situations ID.#  1  used Related to shyness nervous not confident  2  not confident  3  shy quiet reserved  4  keep quiet  5  shyness  6  lack of confidence  7  scared shy  8  9  uneasy  I did not have confidence to speak. I was nervous about people I did not know and their staring eyes. I was not confident in speaking English. I was shy, quiet and reserve. I could not share ideas in the group. I was shy because I did not want to disappoint people.  Reasons  Category of Reasons  Due to differences in my cultural cultural background, I differences did not know how to interact with Canadians. I was worried about my language poor English grammar. Back in the Philippines, -cultural differences I was able to communicate in my own -language language with my own -psychological factor people. I was more confident there than here. I could not express myself Back in my own cultural as my confidence depended country, people were differences on others' acceptance. warm and helpful. Here people were different, they did not share and they worked for themselves. psychological My shyness was not that I was afraid that my deep, I scrapped it a little ideas were not accepted factor bit and the confidence came by others. out. I found it hard to participate My mind put me down. psychological factor as I lacked confidence. I had negative self talk telling me keep quiet in the group. sociocultural I was not used to I used to shy and scared skills though I knew I should not talking. be. I felt uneasy at the I had problem in language beginning of any speaking English conversation and I spoke at because I spoke only a low volume. Punjabi at home. Peoplefromdifferent I experienced cultural cultural cultural background did not shock: how to deal with differences feelfreeto speak with new people, a new English speakers. country, a new culture and new languages. (tabl e continues)  112 Table 27 Question Three- Theme two: Presence of Shyness Participants' Words used Context / Social ID# to refer to Situations shyness 10 shy I used to be too shy to speak up. 11 shy I was shy and I was afraid to speak in front of strangers. 12 shy I was shy to participate in the group. 13  negative  14  shy  15  shy  16  embarrass  17  shy  19  uneasy  20  not quiet  21  shy  22  shy  23  not  thoughts  confident  comfortable  Reasons  Category of Reasons  It was not OK to make mistakes in my work. I had less confidence and I was afraid of people.  psychological factor psychological factor  I did not know the cultural norms and I cared about how people looked at me. I tried very hard to gain I was occupied with respect from residents. negative thoughts. I needed confidence. I I was living in a new was too shy to speak, in country with different English. people. I was shy. My English was not good. I felt embarrassed to give It was not OK to make wrong answers. mistakes. I was shy when I met It was hard for me to strangers. express myself. I was not good in starting conversation or expressing disagreement I forced myself to ask I did not know the questions. people well. I had no power to say no It was very hard to say to my family. no to other persons in real life. I was shy. I thought I was not used to Western culture gave too Western culture. much freedom to everyone. I was shy, I could not I had never learnt social interrupt and I did not skills in high school. want to appear rude. I did not know much I did not know the about cultural differences. appropriate behaviours to deal with people.  psychological factor cultural differences psychological factor cultural differences language psychological factor sociocultural skills  sociocultural skills sociocultural skills cultural differences sociocultural skills sociocultural skills  113 Theme Three: Sources of self-efficacy. Interviewees' increases in confidence were traced back to some significant differences described by interviewees between the pre- and post-training phases. Two raters and the researcher extracted meaning units. Meaning units where a consensus was reached among raters were considered as observed differences; the agreement rate was 90%. Forty-three meaning units were identified as observed differences. The sources of self-efficacy for these differences were categorized by four raters using Bandura's (1997) four sources of self-efficacy: (a) mastery experiences, ( b) vicarious experiences, (c) verbal persuasion, and (d) physiological and affective states. Thirty-three out of the forty-three items (11%) had consensusfromthree to four raters. The majority of sources of self-efficacy werefrommastery experiences of practising, learning and applying skill. Other sources included physiological and affective states such as feeling less anxious and less stressful, and feeling good and confident about themselves. Table 28 Sources of Efficacy for Interviewees' Confidence Sources of Self-efficacy  Frequency of Meaning Units No. of Interviewees (n=24)*  Mastery experiences  16 (49%)  12 (50%)  Physiological and affective states  12 (36%)  11 (46%)  Vicarious experiences  3 ( 9%)  3 (13%)  Verbal persuasion  2 (6%)  2 (8%)  33 (100%) Note.*Interviewees gave multiple responses. Total number does not amount to 24.  Examples of all four sources of self-efficacy are listed in Tables 29.1, 29.2 and 29.3. Appendix C-1 lists the 43 items of meaning units and the results of rating.  114 Table 29.1 Examples of Increase in Confidence due to Mastery Experiences Part. #  5 5 5 6 7 8 8 9 10 10 11 12 13 15 19 22  Observed BEFORE I was uncertain as to how to work with clients from different cultures. I felt uncomfortable with strangers. I was anxious about facing changes in work environment. I told myself to keep quiet in the group.  Differences  AFTER I set my mind and determined to use the skills because I believed I could transfer the skills to real life situations. I made conscious decision to participate in group and practiced the skills I integrated the skills into my own experience system. I used the skills to socialize. I found them useful and good. The training helped me to increase my confidence to talk. I seldom talked in front of I felt more confident. Now I can stand infrontof people. my co-workers to report my work.. I felt uneasy in the beginning to The practice helps me to become confident and do role play. comfortable to speak English which is my second language. I found it difficult to speak to I became better in speaking to residents in the second and third week because I learnt new things residents in my first week. and applied the skills in my workplace. I was not very free to My communication approach and listening skill communicate in English. have been improved. I was confused with the different I understand more about other cultures because I cultural norms. practice the skills in a multicultural atmosphere. I tried to gain respect from The communication skills I learnt are helpful in residents by listening only. working with residents and co-workers. I was afraid of letting people My confidence is built up by active participation down and of being criticized by in the role-play. Now I am not afraid of people others. and I can say anything in a respectful way. I could not say "no" back in my My personality has changed after the training. country. Now I can say "no". I tried to learn different skills in I become more sensitive to others' feelings, verbal dealing with patients from and non-verbal expressions. I can communicate different cultural backgrounds. more confidently with people in different settings. I was shy. I have 70% confidence in using the skills. I forced myself to ask questions. I learn how to ask questions effectively. I was shy and never interrupted I am able to say "no" to unreasonable requests. I others' conversations. am able to interrupt and ask questions when I do not understand.  Legend : Part# -Participants' ID#  115 Table 29.2 Examples of Increase in Confidence due to Change in Physiological and Affective States Part. #  1 3 4  Observed BEFORE I was not confident to speak. I could not participate in the training freely because I lost my line. I used to worry about whether other people accept my ideas. I could not express my disagreement.  Differences AFTER I become less nervous in the small group by getting to know others. I am able to interact with classmates, instructors, clients. I feel so glad and become more confident after the training.  I feel confident after the training when I get rid of feeling rejected by others. 4 I am now less affected by others' responses. I have confidence to go ahead to express myself, to share my ideas, and to get help, no matter whether it is a successful experience or not. I used to be shy and scared of Now I am confident and I say out what is right. It is 7 new people. OK to say my opinions. I feel good about myself after the training, and I feel 10 I was stressed out. relaxed in the communication. I was shy. I knew I could not 12 I become more assertive. I want to be myself and do anything when I was shy. stand up for what I believe to have a bright future. 13 I was occupied with negative I become more confident as I feel good about myself thoughts. by having positive thoughts and avoiding negative thoughts 14 I was worried when things I have more confidence in myself. I am no longer went wrong. worried when something goes wrong. I ask for help and I know I can do it again and again. 17 I was shy when I met I feel comfortable to start the conversation. strangers. 18 I was confident. I am confident to seek help and say "no". 24 I was confident in myself. I am very confident in using the skills. Legend : Part# -Participants' ID#  116 Table 29.3 Examples of Increase in Confidence due to Verbal Persuasion or Vicarious Experiences Part. #  1  5 12 14  16  Observed BEFORE I used to be physically closer with the people in Spain.  Differences  AFTER I learn how to keep boundary and distance with Canadians in Canada. I respect personal space that is different from my Spanish culture. I had no confidence in I develop a belief that I can copy the myself specific behaviours demonstrated. I was not comfortable I think others can do it, I can do it. to meet with strangers. Actually I am able to participate in this research interview. I realized that I My confidence comesfrompeople couldn't do anything if who watch, listen, give feedback and I was shy. My encouragement to me. confidence came from family and friends. I felt embarrassed to My instructors tell me that it is OK say something wrong. to make mistakes.  Legend : Part# -Participants' ID#  Sources of Confidence  Vicarious experiences Vicarious experiences Vicarious experiences Verbal persuasion  Verbal persuasion  117 Question Four: "In What Situations Do You Plan to Use these Skills?" Sixty-one situational items were identified by two raters and the researcher. The agreement percentage was 94%. The meaning units in which the raters reached consensus on were treated as valid situations. Four raters sorted the situations mentioned by the interviewees using Ishiyama's (1996) three categories of social situations from the Situational Social Avoidance Scale: (a) social performance, (b) socializing, and (c) selfassertion. Three raters put 50 meaning units (82% of items) into identical categories. Raters did not have a consensus on three of the 50 items because the interviewees stated those situations in very general terms such as "I use the skills everywhere in everyday life or in workplace every day." The results showed that the interviewees plan to use the skills in social performance situations slightly more than socializing and assertive situations. Interviewees mentioned they would use their competency skills in the workplace (i.e. hospital, residence), school, public areas and home. They would interact with clients, colleagues, classmates, team leaders, friends, strangers, and people of other cultures. Table 30 summarizes the frequencies of all situations. Appendix C-2 presents all meaning units of situations and raters' categorization. Tables 30.1, 30.2, and 30.3 show the different categories of social situations. Table 30 Categories of Situations in which Interviewees Plan to Use the Skills Category of situations  Frequency of Meaning Units  No. of Interviewees(n=24)*  Social performance situation  20 (40%)  13 (54%)  Socializing situation  15 (30%)  14 (58%)  Self-assertion situation  15 (30%)  10 (42%)  50 (100%) * Note: *Interviewees provided multiple responses. The total number of interviewees does not amount to 24.  118 Table 30.1 Social Performance Situations in which Interviewees Plan to Use the Skills p# 1 2 4 5 5 6 7 9 10 10 12 12 12 16 19 19 19 21 24 24  Situations I seek help from my instructors. I practise the socio-cultural competency skills with my classmates. I ask several people to confirm the same right answer I share ideas in a group meeting.  What  seeking help participating in the group seeking information participating in group I transfer role-based learning in group to participating real life situations. in group I give feedback where the environment and giving feedback people are very open I stand infrontof the work team and report participating the work records. in the group I use my intercultural/ interpersonal skills applying all with other international staff. skills I use the skills with residents and coapplying all workers in my workplace. skills I am more open to speak up in a group. participating in a group I participate in the UBC research interview. interviewing I use the skills whenever people are around applying all me anytime, anywhere. skills I participate in the class. participating I practice the skills in the classroom participating I participate actively in the group. participating in group I ask questions when I do not understand my seeking supervisor's instructions. information I get commentsfromother people to receiving improve my work performance. feedback I practise the skills with my classmates in participating the classroom. I ask the nurses to explain what they want seeking help me to do. I seek helpfromthe nurses to attend to the seeking help needs ofthe residents.  Legend : P# - Participants' ID #  When/ Where school social situations school group meeting real life situations anywhere  Who instructors friends classmates colleagues people people  workplace work team members workplace staff workplace  client/staff  group  group members researcher anyone  school anywhere classroom classroom group  classmates classmates group members workplace supervisor workplace other people classroom classmates workplace nurses workplace nurses  119 Table 30.2 Socializing Situations in which Interviewees Plan to Use the Skills Situations 1 3 4 5 6  What  I start conversation with other passengers in starting the skytrain. conversation I make social conversation with people from making other cultures. social conversation I make social contact and start conversation making with strangers. conversation I feel comfortable with friends but not making strangers. social contact I socialize with my friends and feel good. socializing  I talk and listen to depressed clients in the residence room. 10 I am ready to meet people in my new job. 11 I use the skills in all life situations with everyone in everyday life. 12 I ask for information from strangers.  7  13 I communicate with the residents. 13 I deal with people in different settings. 14 I socialize with residents in the community care home. 15 I start conversation by introducing myself to some new people. 17 I make social contact with a lot of residents in the clinical setting. 21 I have small talk with the residents in my workplace. Legend : P# - Participants' ID#  giving feedback socializing applying all skills seeking information socializing socializing socializing making conversation making contact making conversation  When/ Where skytrain station social situations social situations social situations social situations residence room workplace all life situations social situations workplace anywhere care home  Who passengers people from other cultures strangers friends friends depressed clients client/staff everyone strangers residents anyone residents  social new people situations workplace residents workplace residents  120 Table 30.3 Self-Assertion Situations in which Interviewees Plan to Use the Skills p#  Situations  1  I refuse my classmates' requests to borrow my assignment. I tell them to do the work by themselves so that they can learn more. I explain my work procedures to the residents in the workplace. The skills are useful not only for the course but for the entire life to cope with the society. I express my disagreement to others in my daily life. I use my assertive skills to encourage the residents to do their morning care. I use the assertive skill to convince my clients to take their bath. I assert my rights with my family members I refuse to lend money to my friends.  8 9 9 10 12 12 12  12 I say no to the salesperson. 13 I deal with salespersons in a direct and assertive way. 17 I express my disagreement to residents in simple, loud and clear language. 18 I refuse the residents' requests. 20 20 23 23  What  When/ Where school  classmates  asserting rights applying all skills  residence  clients  life  everyone  expressing ideas asserting  daily life  other people  residence  asserting  hospital  client  asserting refusing a request saying no asserting  home  family friends  Refusing requests  expressing workplace disagreement refusing workplace requests I use the assertive skills in my workplace to asserting workplace work with other team members. I refuse my husband's request to follow his refusing home ideas at home. requests I refuse the request to make a donation to refusing the Vancouver fire department. requests I assert my rights to say 'no' to my asserting hospital supervisor in the hospital. rights  Legend: P# - Participants' ID#  Who  salesperson salesperson residents residents team members husband  supervisor  121 Question Five: "What Aspects of the Program did You Find Most Useful?" The researchers categorized the suggestions from all interviewees. Suggestions were classified into four areas: (a) the overall program, (b) delivery and approach of the program, (c) group-based learning, and (d) usefulness of particular activities. Overall comments about the program. There were 9 items described by 8 interviewees in this category. The general theme emerged that the participants were satisfied with the program. Some participants pointed out that the program helped them improve their interpersonal communication (see Table 31). Table 31 Summary of Overall Comments About the Program. Participants' Comments ID# 1 All aspects of the program were useful. 5  The program helped to open up my mind. It was very useful.  7  Everything in the training program was useful.  9  I was happy about the program.  13  The program helped me a lot to deal with people in different settings.  13  The program helped ESL people from other countries to have better communication skills. All aspects of the program were helpful.  18 19 24  All things were useful. I learned how to introduce myself, to talk to people and to ask questions. The whole program was very useful.  122 Delivery of the program. There were 13 items described by 8 interviewees in this category. The supportive, positive, friendly approach was appreciated by the participants. Participants reported that instructors gave individual attention and they perceived them to be friendly and not pushy. Participants commented that the instructors did an excellent job in pacing the program and demonstrating the skills. Items about the delivery of program are listed in Table 32. Table 32 Summary of Comments About the Program Delivery Participants' Comments ID# . 1 The delivery method was useful. 1  The instructors were not pushy.  2  I could befreeto say my ideas.  2  I was not in the spotlight. I did not need to stand up or raise up my hands.  10  The instructors' teaching methods were good.  11  The program was delivered in a good way.  11  The whole schedule ofthe program was manageable. I had time to apply the skills over the weeks. The instructors encouraged us to learn and experience the skills.  11 11 16  Having practice in the classroom and real work experience in the practicum was good. The instructors were friendly.  17  The instructors created afriendlyatmosphere in the classroom.  20  The instructors were nice.  22  The instructors gave enough individual attention to the group members.  123 Positive approach ofthe program. There were 16 items described by 7 interviewees in this category. The positive, and supportive approach ofthe program fostered positive perspectives about themselves: (a) feeling free to express themselves, (b) feeling good about themselves, (c) developing positive thoughts, (d) and improving self-esteem. Items about the program approach are listed in Table 33. Table 33 Summary of Comments about the Approach ofthe Program Participants' Comments ID# 1 The instructors focused on positive things. 2  I learnt the way to say things not [without] hurting others' feelings.  10  I appreciated the multicultural atmosphere.  11  It was wonderful to express feelings freely in the group.  11  I could totally be myself.  11  The program allowed us to share feelings.  13  The program put emphasis on effective communication.  13  We learnt to understand others' feelings.  13  I became more observant.  13  The program made me feel good about myself.  13  I learnt how to avoid negative thoughts.  13  We had a better understanding of ourselves.  13  I developed positive thoughts.  16  The program helped me to build self-esteem.  16  I learned to think before I do.  18  The program emphasized more practical experience than theory.  124 Group-based learning. Comments about group-based learning consisted of two parts: (a) the small group format as summarized in Table 34.1, and (b) the experiences of group participation as summarized in Table 34.2. The results showed that the small group format was strongly favoured by the interviewees. Table 34.1 Summary of Comments about the Small Group Format Participants'ID # Comments 1 Group format was good. 1  19  It helped to build confidence by starting practice the skills with small group and then large group. We got to know each other better in a small group and then did our role play in the large group. I found it was easier and more comfortable for me to talk in a small group. I liked the small group format.  21  I liked to learn in groups.  22  Small groups gave us more time to practice.  2 17  Table 34.2 Summary of Comments on Group Participation Participants'ID # Comments 1 Participating in a group helped me to gain confidence. 1  It was helpful to learn through participation.  2  It was useful to practice in a group.  2  In group interaction, I learnt to respect personal space.  2  I learnt a lot in the group.  9  I felt glad that I did not lose my line when I participated in the group..  10  The participation helped me to gain confidence.  10 11  We laughed when we were embarrassed. It made me feel good about myself. We had a lot of fun laughing at our own mistakes.  21  I built up my confidence by talking in front of the group.  22  We were friends. No one laughed at you.  125 Useful activities in the program. There were 32 items described by 17 interviewees in this category. The data are shown in Table 35. The majority of interviewees raised some particular aspects or activities that they found specifically useful and helpful to them. Role playing and its related modelling and observational learning, and the practice element of the program were among the most frequently mentioned aspects. Table 35 Summary of Useful Activities Activities Role Playing, modelling, demonstration, observation  Frequency (%) 11 (34%)  Practicing the skills  9 (28%)  Giving and receiving feedback, discussion  3 (9%)  Handouts  2 (6%)  Assignments  1 (3%)  Coat of arms  1 (3%)  Contracts for change  1 (3%)  Learning different cultures  1 (3%)  Learning how to keep the physical distance from  1 (3%)  others Transfer to real life situations  1 (3%)  Warm up activities  1 (3%) Total (100%)  126  Chapter IV Results: Part 3 Qualitative Findings of Post-Training Written Feedback Participants' written feedback provided their experiences in the training that further give meaning to the quantitative results. Twenty-eight participants from the experimental group in the Resident Care Attendant program provided written information in response to the following seven questions: Question 1: How have the six interactive practice sessions helped you in your new role as a student resident care attendant? Question 2: Which of the skills have you used most often? Give an example from your clinical experience. Question 3: Which skills are most effective and/or easy to use? Describe one example of what happened when you used this/these skills. Question 4: Which skills are least effective and/or hardest to apply? Describe one example of what happened when you used this/these skills. Question 5: Which communication competence do you want more coaching and/or practice? Question 6: What are the benefits of this types of learning? Question 7: What suggestions do you have to improve the sessions? What would have helped you more? The analysis of the written feedback data resultedfromthe following three phases: (a) meaning units were extractedfromthe written notes, (b) the meaning units were grouped according to similarities to form categories, and (c) the validity ofthe categories was examined by raters.  127 Demographic Characteristics ofthe Sample Providing Written Feedback Twenty-eight participants returned their written feedback. There were 5 Canadians and 23 immigrants. The proportion of 'immigrants' in this sample resulted in more immigrants' experiences than those of Canadians. All twenty-three immigrants were ethnic minorities. They represented a diverse multicultural sample as follows: 11 from Southeast Asia or Philippines, 9fromIndia or Pakistan, 1fromKorea, 1fromChina, and 1fromSouth America. Table 36 shows a summary of the demographics. Table 36: Demographic Data ofthe Sample Population  Ethnicity: (1) Caucasian (2) Ethnic minorities Language used at home: (1) English only (2) Mother tongue only (3) English and mother tongue Gender: (1) Male (2) Female Age : Mean Range Years in Canada: Mean Range  Total n=28  Canadian-Born n=5  Immigrant n=23  5 23  5 -  23  6 8 14  5 -  1 8 14  3 25 30.8 19-51 12.0 2-43  1 4 34.6 23-39 24.6 23-43  2 21 30.0 19-51 7.0 2-21  128 Question One: "How Have the Six Interactive Practice Sessions Helped You in Your New Role as a Student Resident Care Attendant?" The benefits experienced by all participants were grouped into three categories: (a) creating positive self perceptions, (b) communicating effectively, and (c) gaining new information, knowledge, and skills. The raters' agreement rate was 90%. Category 1: Creating positive self perceptions. Table 37 presents a list of positive self-perceptions described by 19 participants. Table 38 presents a complete list of meaning units in detail. Category 2: Communicating effectively. Sixteen participants reported that they learned to communicate more effectively with the residents and staff in the health-care facilities. They were more open in expressing themselves and in receiving feedback from others verbally and non-verbally. Table 39 shows the data in this category. Category 3: Gaining new information, knowledge, and skills. Nine participants reported gaining new information, knowledge, and skills in dealing with people in different situations. Table 40 presents the meaning units in this category. Table 37 List of Positive Self-Perceptions and Respective Frequencies Positive Self-Perceptions Confidence Assertive Self-esteem Trust in oneself Comfortable Gentle Happy Calm Patient Relaxed Not feeling guilty  Frequency (%) 10 (31%) 6 (19%) 4 (13%) 3 (9%) 3 (9%) 1 (3%) 1 (3%) 1 (3%) 1 (3%) 1 (3%) 1 (3%) 32 (100%)  129  Table 38 List of Meaning Units of Positive Self-Perceptions Created in the Training SelfPerceptions  Participants'  Confidence  2 6 9 12 18  Assertive  Self-esteem  Others  Meaning Units  ID#  20 21 25 27 28 15 16 21 27 22 28 7 18 21 25 1 11 11 22 24 26 27  My self-confidence increased. I felt more confident and skillful in social situations. I felt more confident in my communication skills. It helped me feel comfortable and self-confidence. It strengthened my confidence. I trust my ability to do things, deal with other people in the right way, boast my self-esteem. I built up my self-confidence to talk effectively with people. It enabled me to talk and to present myself with confidence. It increased my self-esteem. I felt more confident. I felt more confident after practicing the skills. I built up my confidence and became more assertive. I became more assertive. I became more assertive with the residents. I was assertive enough to interrupt others. I became more confident and more assertive. I was assertive with the residents. I became more assertive to refuse unreasonable requests. It helped my self-esteem. It bolstered my self-esteem. I gained my self-esteem slowly My self-esteem increased. I felt more comfortable and happy. I refused requests in a comfortable manner. I was less stressed out with little things. I was calm, patient and gentle towards my residents. I was more relaxed and less stressed. I learned a lot about myself I was not feeling guilty all the time.  130 Table 39 Lists of Meaning Units of Cornmunicating More Effectively After Training Participants' ID# With Whom?  How?  What?  2 7 13 15 16 17 19 23 28 5 5 7 7 8 15 2 11 14 16 16 16 16 17 17 20 21 21 22 22 22 23 28 28  Meaning units I communicated effectively with residents and staff. I communicated with the clients, residents and staff effectively. I used the skills in my role as a student resident care assistant. I communicated with my classmates, instructors, family and friends. I communicated with residents. I became a good communicator with everybody. I used most of the skills in daily interaction. I communicated more effectively in class. I communicated effectively with my clients. My communication skills worked quite well. I showed my care using gentle touch andfriendlyfacial expressions. I communicated well verbally and non-verbally. I was able to be caring and empathetic to all the residents. The communication skills helped greatly. Communication became interesting and more easily understood. I observed residents' comfort level with me I refused unreasonable request in a comfortable manner. I clarified messages and interrupted to seek help. I cared for the residents' suffering. I listened to what they wanted to say. I encouraged the residents. I understood their feelings and non-verbal messages. I got and sent the messages positively. I received feedback effectively. I introduced myself. I talked and presented myself in a group. I used the appropriate way to interrupt. I used paraphrase and open questions to get information. I used my body language to get attention. I listened to the residents. I asked people to clarify. I asked more clarifying questions. I refused unreasonable requests.  131 Table 40 List of Meaning Units of Gaining New Information, Knowledge and Skills After Training Meaning Units  Participants' ID#  3  I solved the smallest to biggest problems in my new career role and personal life.  3  It gave me a lot of information to use in my new role.  4  I was aware what to do in the clinical situations.  4  I realized in advance what would happen when we were at the facility.  7  I gained knowledge on how to handle situations in the facility.  8  I had knowledge on how to deal with people in different social situations.  10  I learned new skills with which to deal with people in all different situations.  13  I got a lot of information.  24  I understood different types of communication styles.  25  I got more knowledge in communication.  26  I knew what to do or say in different situations.  132 Question Two: "Which of the Skills Have You Used Most Often? Give an Example From Your Experience". All participants chose at least one skill they used most often. Table 41 shows the frequency of skills that were used most often. The top four most used skills were listening, clarifying messages, initiating social contact/introducing yourself, and engaging in social conversation/small talk. Only seven participants reported their most often used skill was refusing unreasonable request. Table 42 shows examples given by participantsfromtheir clinical experiences. The raters agreed that 93% of the skills mentioned in the examples were consistent with the list of skills reported by the participants, indicating a high reliability of participants' feedback. Table 41 List of Most Often Used Skills and Their Respective Frequencies Skills  Frequency (%)  Listening  21 (16%)  Clarifying Messages  20 (15%)  Initiating social contact / introducing yourself  19 (14%)  Engaging in social conversation / small talk  17 (13%)  Interrupting to seek support  16 (12%)  Interrupting to give a message  12 (9%)  Managing anxiety and nervousness  10 (8%)  Expressing disagreement  10 ( 8%)  Refusing an unreasonable request  7 (5%) 132 (100%)  133 Table 42 Examples of Most Often Used Skills Participants' ID#  3 4 5 7 8 9  10  12 15  17 18  19  20 27 28  Examples First day in my clinical experience, I introduced myself to residents and staff. With introduction and small talk, I felt more relaxed and less nervous. With my resident, I read his file and got to know part of his past. So my small talk with him went very well the first time I met him. Even though my resident cannot hear, everyday I wrote a note to her to build trust between each other. I enjoyed being in the facility. I enjoyed talking to the residents, I have learned so muchfromthem. Sometimes, some residents thought I was a nurse and they asked me for help. Clarifying with RCA to make sure I was doing a task properly. During the morning report, I listened and interrupted to give a message. I had the chance to introduce myself to my resident and initiated social contact. I was a stranger to her and she rejected me giving her personal care but she finally let me after I did my best to encourage her, took time out, and showed my warmth and sincere care and she finally responded by smiling. On the first day of clinical, we used all the skills. Listening was one ofthe main skills. First thing in the morning, we had to listen to reports and clarify whether we understood or not. Also, when talking with residents it is extremely important to listen to them to find out how they are and what they like and dislike. When the nurse told me that I need somebody every time I transfer my client. I clarified the message to the nurse telling her that I must have a regular RCA in every transfer of an osteoporosis client. I manage my anxiety and nervousness by taking deep breaths. I am confident in clarifying my messages because I ask others to repeat statements back to me. If they don't understand, I will rephrase my statement. I use a "I" message when I disagree with a statement said or with a procedure done. I interrupt and seek supportfromthe nurse to get my resident up for breakfast. I listened to the RN giving information and instructions. I clarified with her when she mentioned that I should assist the resident in vomiting. When I was actually doing it, I tried to manage my anxiety and nervousness. While I was aware of it, I became more confident and acted very professionally. Every morning we had to listen during morning report, I had to communicate with the care-aids and clarify when I didn't understand the procedures. I initiated social contact with residents, staff and whoever was around. I had to interrupt the LPN to ask her to come to help me. I listened to my resident who complained about her stomach pain and I called the nurse for her. My resident's oxygen tubing came off and I interrupted the RN and informed her ofthe situation. I refused to give personal hygiene in the staffs way. I used techniques learned at school. I used paraphrasing a lot to clarify my residents' thoughts.  134 Question Three: "Which Skills are Most Effective and/or Easy to Use? Describe One Example of What Happened When You Used this/these Skills?" The top two skills reported as most effective and/or easy to use skills were listening and clarifying messages. Other skills mentioned were initiating social contact/introducing oneself, and interrupting to seek help. None of the participants specified the following three skills as the most effective and/or easy to use skills: managing anxiety and nervousness, expressing disagreement, refusing an unreasonable request. Table 43 shows the frequency of skills used by the participants; and Tables 44.1 44.2, 44.3 show the examples given by the participants. The raters agreed that 100 % of the skills described in examples were consistent with the lists of skills reported by the participants, indicating a high reliability of participants' feedback. Table 43 List of Most Effective / Easy to Use Skills and Respective Frequencies Skills  Frequency (%)  Listening  20 (45%)  Clarifying Messages  11 (25%)  Initiating social contact /introducing yourself  6 (14%)  Interrupting to seek support  3 (7%)  Interrupting to give a message  2 ( 5%)  Engaging in social conversation / small talk  2 (5%)  Managing anxiety and nervousness  0 (0%)  Expressing disagreement  0 (0%)  Refusing an unreasonable request  0 (0%) 46 (100%)  135 Table 44.1 Examples of Most Effective and Easy to Use Skills: Listening and Clarifying Messages. Participants'  Examples  ID#  3  4.  8  9  12  17 19  22 27  Listening was very effective and easy to use. One day in my clinical experience, one resident was behaving very aggressively and he kept talking. During my bed making, I stayed there and listened to him. The next day, he was very cooperative and he told me what TV programs he liked to watch. I used listening and observed body language. Quite a lot of residents didn't speak English in the facility. However, you could still get your work done while you used the skills. The listening skill was easy to use. I had a lady that spoke Chinese and was speaking very quickly and continuously. I listened very carefully while she was speaking and did get out of it that she came to Canada at the age of one. It was interesting to find out that even when you didn't understand but you spent enough time you could communicate. Listening and clarifying messages were the most effective skills. With my patients , we used body language as our means of communication. She mumbled to me and used facial expressions and I expressed myself too by clarifying with my body language, gestures, signs, and facial expressions. Listening and clarifying messages were very effective once you listened effectively. You would get clear messages from the person you were talking with. When I used these skills, I clarified all my questions and it made my job easy and comfortable. I listened to the report to know what and who the residents were and who needed more care and attention so that I could focus more on them. For me the most effective skill was clarifying messages from the nurses because I did not want to make a big mistake. I used the skill while helping a lady with skin rash. The nurse was explaining what to do, and I clarified her message to make sure I did it right. Clarifying messages was very important because sometimes it was difficult to know exactly what the residents wanted. The listening skill was the most effective to use as it gave me time to organize my thoughts, e.g. Residents woke up confused and I kept listening to him and organized in my mind how I was going to give him personal care in this particular situation.  136 Table 44.2 Examples of Effective and Easy to Use Skills: Making Social Contact and Social Conversation Participants' ID#  2  10  11  15 22  Examples One thing that was most effective with my resident was engaging in small talk. My resident was very quiet. When I talked to him, he responded back. I was so happy when he talked to me even if sometimes he was confused. My heart lightened up when I saw him laughing. Engaging in social conversation and small talk was a fun part for me. As I got to know my residents, we became friends and shared things with each other. My residents trusted me and I felt that I was helping them. Talking also helped take their minds off what was going on around them. A lot of them did not have a lot of visitors, so they enjoyed my small talk. It was easy for me to make social conversation because I used to practice this social skill. I talked to residents on my way to the lunch room, elevator, ward or wherever I met them. Initiating social contact and introducing myself was what I found the easiest. Introducing myself helped the residents be aware of who I was and what I was doing for them.  Table 44.3 Examples of Effective and Easy to Use Skills: Interrupting to Seek Support Participants' ID#  5  15 18  Examples I used interrupting skills to seek support several times in my work. When I intervened in others' conversations or others' work, I needed to say "Excuse me" with a smile, and to not annoy others. I interrupted the nurse to clarify her report of changes of a client. While I was working with the residents, I did not hesitate to approach the RCA by asking her the procedures and the policy involved in waste disposal.  137 Question Four: "Which Skills are Least Effective and/or Hardest to Apply? Describe One Example of What Happened When You Used this/these Skills." The top two least effective and /or hardest to apply skills were (a) refusing a request, and (b) expressing disagreement. Other skills mentioned here were (a) engaging in social conversation or small talk, (b) interrupting to give a message, and (c) managing anxiety. No participant chose the following four skills as the least effective and /or hardest to use skills: (a) listening, (b) clarifying messages, (c) initiating social contact or introducing oneself, (d) interrupting to seek support. The raters agreed that 100 % of the skills described in participants' examples are consistent with the lists of skills reported by them, indicating a high reliability of participants' feedback. Table 45 shows the frequency of each skill and Tables 46.1, 46.2, 46.3, 46.4 and 46.5 show the examples given by the participants Table 45 List of Least Effective / Hardest to Use Skills and Respective Frequencies Skills  Frequency (%)  Expressing disagreement  9 (39%)  Refusing an unreasonable request  9 (39%)  Interrupting to give a message  2 (9%)  Engaging in social conversation / small talk  2 (9%)  Managing anxiety and nervousness  1 (4%)  Listening  0 (o%)  Clarifying Messages  0 (0%)  Initiating social contact /introducing yourself  0 (0%)  Interrupting to seek support  0 (o%) 23 (100%)  138 Table 46.1 Examples of Least Effective and Hard to Use Skills: Expressing Disagreement Participants' Examples ID#  4 10 17 19  22 24  It was hard to express disagreement. I saw some acts done by the RCA that were not appropriate. Since we were students, we did not talk to the RCA directly. While I was giving my resident a bath, the regular RCA left the room. She was not supposed to leave me unsupervised. I did not express my disagreement. But next time I would make sure she was there. I was not effective in expressing my disagreement. Some of the residents did not want to be bothered and did not want anyone to take care of them. One ofthe co-workers was emotionally abused the resident by telling her that no one liked her and asked her to shut up. I could not say anything because I was there to work, to observe, and not to judge anyone. I told my course instructor later. I really wanted to say something to the RCA but I did not. There were things that the co-workers were not supposed to do and I knew that they had more experience so it was difficult for me to express my disagreement with them. You could not sit there and argued with the residents so it was hard to disagree in an appropriate manner.  Table 46.2 Examples of Least Effective and Hard to Use Skills: Refusing a Request Participants' Examples ID#  3 8 9 11 12 15 21  Refusing an unreasonable request was very hard to apply. One day, a resident asked me to take him upstairs in his wheelchair. I refused the request because he was bed ridden. He looked at me with a red face and big eyes. Refusing an unreasonable request and expressing disagreement would be the hardest for me to apply, but I did not have an opportunity to use the skills in my practicum. The resident insisted on not taking a shower. Encouraging her was kind of hard but still I was able to convince her. Refusing a request was hard. I had not used the skill simply because there was no opportunity to do so. I sure would use this skill, especially if the request was beyond my capability to do what was asked. When the regular RCA wanted me to get the clientfromthe room for a bath. I assertively said no to her and explained to her that the client needed a lift to transfer and I was not capable to do it. Refusing an unreasonable request was the hardest skill for me because I naturally was willing to help people out. For me as an RCA, I must be aware of the policies and procedures, to know what is right and wrong. Refusing a request was hard for me as my resident wanted to sleep all day and I had to encourage her to do other activities.  139 Table 46.3 Examples of Least Effective and Hard to Use Skills: Engaging in Social Conversation and Small Talk  Participants'  Examples  ID#  13  I was not effective in small talk. Sometimes I tried to make small talk. My residents did not understand me and I tried to explain again.  16  When the resident refused to do anything, it was hard to dress them and talk to them.  Table 46.4 Examples of Least Effective and Hard to Use Skills: Interrupting to Give a Message Participants'  Examples  ID#  6  Interrupting to give a message was the hardest and least effective for me. When I used this skill, I felt uncomfortable.  25  Sometimes interrupting other RCAs was hard but I could manage to do it.  Table 46.5 Examples of Least Effective and Hard to Use Skills: Managing Anxiety' Participants'  Examples  ID#  26  Managing anxiety and nervousness was hard but I took deep breaths and had self talk such as, "I can do it". I really did well.  140 Question Five: "In Which Communication Competence Do You Want More Coaching and/or Practice?" Participants chose expressing disagreement and refusing an unreasonable request as the skills in which they needed more coaching. It seemed that the participants wanted more coaching on those skills they found harder to learn or used less effectively. Table 47 presents the frequency of each skill in which they needed more coaching. Table 48 shows the examples given by the participants. Table 47 List of Skills That Needed More Coaching and Their Respective Frequencies Skills  Frequency  Expressing disagreement  10 (34%)  Refusing an unreasonable request  6 (21%)  Engaging in social conversation / small talk  4 (14%)  Managing anxiety and nervousness  3 (10%)  Listening  3 (10%)  Clarifying Messages  2 (7%)  Initiating social contact /introducing yourself  1 (3%)  Interrupting to seek support  0 (0%)  Interrupting to give a message  0 (0%) 29 (100%)  Table 48 Examples of Feedback on Communication Competence that Needed more Coaching Examples  Participants' ID#  4  More practice in initiating social contact with caregivers. They seemed very busy, so it was hard to practice the skills with them.  5  I wanted to communicate more effectively with dementia residents.  6  I wanted more coaching and practice in how I should ask questions because I never wanted to ask the residents questions that would make them mad.  8  Expressing disagreement was the hardest thing to do.  10  Refusing a request because I did not like to be seen as not wanting to do anything.  13  I wanted to learn more verbal and non-verbal communication with residents.  17  I wanted more coaching and practice in small talk and managing anxiety.  26  I would like more practice and coaching in managing anxiety.  28  I still wanted to practice anxiety management.  142 Question Six: "What Were the Benefits of this Type of Learning?" All participants reported some kind of benefits from this type of learning. According to Brislin and Yoshida (1994), the benefits of sociocultural training programs can be organized into three categories: (a) positive effects involving participants' thinking and knowledge development, (b) positive effects involving participants' affective reactions, (c) positive effects involving participants' behaviour. Participants' feedback was identified by using their categories: (a) thinking and knowledge development, (b) affective reactions, (c) behaviour. Category one : Thinking and knowledge development. In general, participants mentioned an increase in cognitive knowledge and skills to cope with people and situations. The knowledge could help them to understand people from a different perspective, and to avoid mis-interpretation. Some of them described that they had ways to communicate effectively with people. Table 49.1 lists examples given by the participants. Category 2: Affective reactions. In general, participants reported more confidence, and a decrease of negative feelings such as fear, nervousness, and stress. Some examples are given in Table 49.2. Category 3: Behaviour. Most participants improved in their interpersonal communication behaviours through role playing, group learning, and practising. Some examples are given in Table 49.3.  143 Table 49.1 Examples of Benefits in Thinking and Knowledge Development Examples  Participants' ID#  1  Whatever we studied in our class, we applied the skills in the practicum.  4  I got to know the correct ways of communicating with people.  5  I met some residents with dementia. I could realize that I felt difficulties in sending my messages to them when they refused to receive my messages.  6  Whatever we studied in our classes was very useful and beneficial. In this way we solved other difficult situation such as how to behave with angry residents.  7  I was more knowledgeable about the residents' physical and psychological needs and how to care for them.  8  I learnt the basic knowledge to cope effectively in the work environment.  13  I understood my residents' feelings, attitudes, and behaviours.  17  I knew how to communicate effectively.  18  I tried to avoid mis-interpretation.  19  I learned a lot. I knew that I had better skills.  21  It helped me to get more information about my residents backgrounds.  25  I had knowledge to communicate effectively and was confident about what I said.  144 Table 49.2 Examples of Benefits in Affective Reactions Examples  Participants' ID#  2  It helped to improve the personality of a person such as self-esteem and self-confident. It helped a person to be comfortable participating or engaging talks in large group or small group.  3  With these skills, I was more comfortable with person, less nervous when I was talking with others. Refusing a request kept me out of stress .  4  I gained confidence.  14  It was very beneficial because these skills helped me to become more assertive. I could approach people for the assistance needed without fear.  25  I had higher self-esteem.  26  I was able to be myself. Be calm and patient.  27  My self-esteem improved.  28  I became more confident about my work because I practiced the skills and I was ready to apply these skills.  145 Table 49.3 Examples of Benefits in Behaviour Examples  Participants' ID#  2  It prepared students to be effective communicators.  9  I learned a lot by really speaking out the words.  10  It was good to practice the skills. My communication skills improved a lot and I learned to accommodate others' feelings.  11  I learned to say things in an acceptable and pleasant manner. It promoted friendship that helped me be sure of what I should say.  12  It really helped me in dealing with different kinds of people in the facility.  16  I worked with people more effectively and helped my residents' wellbeing.  20  I was able to talk effectively with people. It helped me to listen to what other people were saying. I learned how to interrupt others and how to give feedback.  22  I could deal with any type of resident. I was able to be assertive while dealing with confused residents.  146 Question Seven: "What Suggestions Do You Have to Improve the Sessions? What Would Have Helped You More?" Almost two-third of the participants suggested they wanted more practicing and roleplaying in the program. The categories of suggestions was shown in Table 50. Participants' suggestions such as having more practice, lengthening the training time, and teaching more skills were listed in Table 51.1. The feedback showed that most participants were satisfied with the training. One-third of them actually made explicit remarks that the program was good, excellent, and helpful. Table 51.2 presents the positive remarks of the participants. Table 50 List of Suggestions to Improve the Sessions. Categories  Frequency (%)  More practicing  13 (50%)  More role-playing  6 (23%)  Longer program training time  3 (11%)  More communication skills / information  2 (8%)  Help shy students  1 ( 4%)  Encourage students to speak aloud  1 ( 4%) 26 (100%)  Overall, all participants experienced benefits from the program. They increased in their cognitive knowledge and skills to cope with people and situations. They reported more confidence, and less social anxiety. Their interpersonal communication behaviours had been improved. Some of them rated the training as excellent.  147 Table 51.1 Examples of Participants' Suggestions to Improve the Program Participants'  Examples  ID#  1 3 4 8 11 13 13 14 20 24 25 27  I need to learn more communication skills. I need more practice in refusing unreasonable request and expressing disagreement because I need more power to refuse something. Have more role-playing. More practice to make it easier when the situation comes up outside the learning atmosphere. Role-playing on how to comfort a resident who is agitated and restless. Practice to make shy students feel more comfortable. Encourage shy students to feel comfortable practising in class. Make the session longer; we'll learn more. Do more practice in the class by talking to each other. More practice for myself to actually do my tasks. Give more time. Many students have problems with speaking aloud: encourage students to speakfromthe corner of the room in role-play.  Table 51.2 Examples of Participants' Positive Remarks About the Program. Participants'  Examples  ID#  1 3 6 10 15 19 20 25 28  The session was excellent. All sessions were very helpful. Everything was excellent and perfect. It was all beneficial I loved it and would recommend it for everyone who wants to improve oneself. Very worthwhile, the instructors did very well. This session was perfect. All ofthe things that we did in class were really good and helpful. No need to change. The program was good.  148 Chapter V  Discussion Effectiveness of the Sociocultural Competency Training The results of this study supported the hypotheses that the SCCT was effective in increasing the social self-efficacy, improving the interpersonal skills and lowering the social avoidance tendency among participants in the experimental group when compared to individuals in the control group. The study also supported the hypothesis that there would be more significant change in participants' social self-efficacy than in their general selfefficacy. Improvement in Interpersonal Skills Participants' improvement in interpersonal skills was evident over a broad range of interpersonal skills. Compared to the control group, participants in the experimental group had significantly higher scores in all six subscales of the Interpersonal Skills Checklist (ISC): (a) processing skills, (b) active engagement skills, (c) self-enhancement skills, (d) approaching skills, (e) assertive skills, and (f) interruption skills. The qualitative results showed participants' improvement in interpersonal skills. During the interviews, participants were able to give more than one valid example of actions using a wide range of relevant interpersonal skills. For example, 12 participants provided 20 examples of active engagement. Participants reported actions using active engagement skills, assertive skills and approaching skills more frequently than selfenhancement skills, interruption skills, and processing skills. Their examples included a wide range of actions such as talking, listening, expressing feelings during social  149 conversations, expressing disagreement, refusing requests, asserting rights, asking for information, introducing oneself, and approaching others for friendly conversations. Participants also agreed that the competencies of making social conversation, seeking help, participating in groups and making request were helpful interpersonal skills to them . They also pointed out that expressing disagreement, and refusing an unreasonable request were difficult interpersonal skills to use. As mentioned earlier, the participants reported they would take actions involving assertive skills such as expressing disagreement and refusing unreasonable requests, which were considered difficult interpersonal skills to learn in their opinion. It was important to find out that the intervention was able to help participants to face new challenges involving interpersonal skills that they considered difficult to master. Reduction of Social Avoidance Both quantitative and qualitative results showed a reduction in participants' social avoidance tendency after the training. Participants in the experimental group were significantly less avoidant or anxious in many social situations, including socializing situations and self-assertion situations as measured by the three Situational Social Avoidance Subscales, when compared to the participants in the control group. The Situational Social Avoidance Scale has high correlations with four social anxiety scales (Ishiyama, 1999). The SSA scale could serve as an indirect measure of social anxiety. It was possible that whoever received the training might have experienced a reduction in the tendency to avoid social situation, which might have been perceived as anxiety-provoking in the past because of the lack of sociocultural competencies.  150 Such a reduction in social avoidance was also found in the qualitative study. Participants reported in the interviews that they planned to use their competencies in certain social situations. These situations were categorized and were found out to represent all three types of social situations as measured by the SSA scale: (a) social performance situations, (b) socializing situations, and (c) self-assertion situations. All three situations were mentioned by similar numbers of participants. Many participants gave at least two situations in which they would plan to use their competencies although they were requested to provide an example. There was no particular social situation that participants would tend to avoid. The quantitative and qualitative results showed that a reduction in social avoidance was a change concurrent with being more socioculturally competent. Successful reduction of avoidant behaviour helps removing one of those psychosocial barriers that might impede mastery of sociocultural competence (Mak, Westwood, Ishiyama, & Barker, 1999). As Bandura (1997, p.20) pointed out, only people who had both high self-efficacy and high outcome expectancies could engage in continual and productive actions in pursuit of their outcomes; others might give up their efforts ending up with grievance and apathy which could translate into avoidant behaviour. The use of culture mapping in SCCT served as an effective way to build up outcome expectancies and self-efficacy; and participants could engage in learning competencies. Many participants came from Asian countries which had a large cultural distance from the Canadian culture, and the large cultural distance affected acquisition of sociocultural competence (Searle & Ward, 1990; Ward, 1996). Some participants felt shy and were not  151 confident in communication with English as their second language or not knowing how to communicate interculturally; the culture mapping could provide them with the concrete micro-skills to say the right things, at the right time, in the right sequence (Baxter, 1983; Mak, Westwood, Ishiyama, & Barker, 1999). One interviewee (#1) said, "I set my mind and determined to use the skills because I believed I could transfer the skills to real-life situations." Another interviewee (#5) said, "I have developed a belief that I can copy the specific behaviours demonstrated." The SCCT provided an explicit set of norms to guide the participants' social behaviour. Participants who felt confident might choose to increase contact with members of the new culture, leading to successful intercultural communication. Enhancement of Social Self Efficacy The results supported the hypothesis that participants in the experimental group would report significantly increased social self-efficacy. This increase in social selfefficacy coupled with a decrease in social avoidance agreed with previous research (Fan & Mak, 1998). When compared to the control group, participants had significant differences in two social self-efficacy subscales. The SCCT was more likely to enhance efficacious beliefs in social factors of having "friendship initiatives" and the "absence of social difficulties" but less likely to enhance efficacy beliefs in social confidence and sharing common interests. In the qualitative data, many interviewees recalled they were lacking confidence before the start of the intervention. They described their lack of confidence as being due to their perceived cultural differences between their home countries and Canada. Yet the majority of them (87.5%) reported an improvement in confidence after the intervention.  152 Comparison of Social Self-efficacy and General Self-efficacy The hypothesis that there would be more significant change in participants' selfefficacy in social self-efficacy than in general self-efficacy was supported. The hypothesis was based on the theoretical ground that the Social Self-Efficacy scale was designed to measure beliefs in social domain or interactions, whereas the General Self-Efficacy scale was designed to measure people's general personality disposition (Fan & Mak, 1998; Schwarzer et al., 1993). Therefore, the Social Self-Efficacy scale was predicted to be more sensitive to change in the participants' sociocultural competency beliefs than the General Self-Efficacy scale. The Social Self-Efficacy scale also showed stronger predictive power than the General Self-Efficacy scale in participants' social avoidance behaviour and interpersonal skills. For example, participants in the experimental group who had stayed longer in Canada were found to have higher social self-efficacy, higher interpersonal skills, and lower situational social avoidance, but there was no difference in their level of general self-efficacy; see Figure 12. As Bandura (1997) pointed out, "An all-purpose test of perceived self-efficacy would be phrased in terms of people's general belief that they can make things happen, without specifying what those things are. Such a measure would most likely be a weak predictor of attainment in a particular scholastic domain, such as mathematics" (p.40). General Self-efficacy The hypothesis that there would be a significant change in participants' general selfefficacy was not supported by the quantitative results. This might not mean that participants' general self-belief had not changed after the intervention. As mentioned in the earlier section, changes in sociocultural self-belief might not be reflected by administering  153 the General Self-Efficacy scale due to its general nature. Many participants reported in their interviews that the intervention had helped to create positive self belief. In the written feedback, 19 participants out of 28 reported that they had more positive feelings about themselves. They said that they had higher self-esteem and became more assertive; they also felt more comfortable and less stressed in social situations. Some participants recalled that their lack of confidence before training was related to negative self-beliefs such as having negative self-talk, having fear of rejection, and having fear of making mistakes. This finding is consistent with studies suggesting that heightened needs for self-validation (Mak, Westwood, Ishiyama, & Barker, 1999) and certain personality traits such as rigidity and self-centered behaviour (Hannigan, 1990) are negative factors in sociocultural competence development. Effects of Subject Variables on Program Effectiveness No statistically significant differences were found between groups of participants having different subject variables (i.e., ethnicity, age, gender, language used at home, years of stay in Canada, and the age of arrival) in the acquisition of sociocultural competencies. However, further studies are needed to explore the following observations. Gender The results showed that female participants had higher social avoidance, lower general and social self-efficacy than male participants, yet both groups had a similar level of interpersonal skills. Many female immigrant participants were from countries where gender inequity was a social norm. For these female participants, development of self-efficacy and self-esteem would be an important goal in the sociocultural training. As one interviewee (#20) revealed, " Back in India, I had no power to say 'no'. The training gave me power to  154 say 'no', and my husband noticed the change. He could not force me to do what I did not want to do." Language Used at Home The "mother tongue" speaking groups had higher social avoidance than other groups even though all the groups had similar interpersonal skills levels, and social and general self-efficacy. In the qualitative results, participants confirmed that worry about their own English language proficiency was one of the reasons for their lack of confidence in interpersonal communication. The present study confirms that non-native speakers under a state of second language anxiety often experience self-doubt and anxiety (Westwood & Ishiyama, 1991). They may choose to minimize social contact and thus experience social avoidance. Baxter (1983) pointed out the importance of learning conventionalized language in the development of communicative competence. The results of the present study supported the objective of the SCCT program being to teach culture mapping in communication in order to reduce second language anxiety and to develop sociocultural competencies. Years of stay in Canada The findings showed that participants who had been in Canada for a longer time reported improvements in interpersonal skills and social self-efficacy and a decrease tendency in their social avoidance. Such results could mean that it would be easier for participants with more relevant experience of successful adjustment and acculturation to improve their sociocultural competencies. In other words, newcomers would have a slower rate of progress in acquisition of new interaction skills due to the less exposure to the new culture.  155  Age of Participants and Age of Arrival in Canada Participants' current age did not seem to be an influencing factor in the learning of sociocultural competencies. Participants who had come here earlier in their childhood showed higher levels of self-reported interpersonal skills, higher self-efficacy, and less social avoidance than those participants who had come here in their teens and adulthood. This might be due to the fact that the former had more opportunities to learn sociocultural competencies during their formative elementary and high school years as an influential period of socialization. In short, people who are non-native speakers, arriving in Canada in their adulthood or who have been here for a shorter time would benefit most from the sociocultural competency training. Program Effectiveness in Caucasian and Ethnic Minority Participants When the Caucasian and ethnic minority participants in the same experimental group were compared, there was no statistically significant difference between the two groups. Both the Caucasians and ethnic minorities in the experimental group responded to the intervention in similar ways; they both reported decreased situational social avoidance tendency, increased interpersonal competency, and increased social self-efficacy beliefs. Observed Differences Between Caucasians and Ethnic Minorities Caucasians and ethnic minorities showed differences in certain behaviours. The profile plots and descriptive statistics showed that the ethnic minorities had higher social avoidance, lower social self-efficacy compared to the Caucasians before and after the training. Ethnic minorities also made less improvement in acquiring interpersonal skills. The qualitative results indicated four areas which might indicate ethnic minorities' difficulties in acquiring sociocultural competence: (a) psychological factors, (b) cultural  156 differences, (c) sociocultural skills, (d) language issues. This finding is consistent with other studies (Hannigan, 1990; Mak, Westwood, Ishiyama, & Barker, 1999; Searle & Ward, 1990; Ward, 1996; Westwood & Ishiyama, 1991). Personal Changes of Participants Participants described positive multi-dimensional changes. In the interviews, both reducing social avoidance and overcoming shyness emerged as two major themes in which the program had helped the interviewees to develop a strong positive sense of themselves. This strong positive self-image was also reported in the written feedback. Participants reported three themes of personal changes: (a) creating positive self perceptions, (b) communicating effectively, and (c) gaining new information, knowledge, and skills. The themes were consistent with Brislin and Yoshida's (1994b) idea of effective intercultural training. The report of positive self perceptions supported Westwood et al.'s suggestions (2000) that effective intercultural training programs should be self-enhancement rather than cultural assimilation. The results reflected that the training could help the participants to become bi-culturally competent in their original and new cultures. Overcoming Shyness, Social Avoidance and Social Anxiety Reduction in shyness, social avoidance or social anxiety was one ofthe most important achievements for participants in the training as reflected in the qualitative data. To have a certain degree of shyness and social avoidance seems to be common among participants. In the qualitative study, most interviewees mentioned that they were shy. For ethnic minorities or immigrants, they related their shyness to their perception of their own cultural differences, their worry about language use and their lack of sociocultural skills and  157 understanding of the Canadian cultural norms. Such shyness in intercultural or sociocultural training has been found to be related to cultural shock (Gaw, 1995). Some immigrant participants reported the presence of negative self-talk and thoughts about themselves, and negative attributions about others. These type of experiences might be considered to resultfromtheir social norms that required them to be more sensitive to peers and significant others' acceptance (Chen X., 1995, 2000). For example, one interviewee (#4) said, "I could not express myself as my confidence depended on others' acceptance." Another interviewee (#16) said, "it is not OK to make mistakes." Theorists described how this type of social anxiety could inhibit people's interpersonal communication if they believed they could not make desirable impressions of themselves upon others. Theorists also extended and explained this self-presentation model of social anxiety using Bandura's concept of outcome expectancies in his social cognitive theory (Leary 1983, 1995; Leary & Atherton, 1986; Maddux, Norton, & Leary, 1988). Mak, Westwood, Ishiyama, and Barker (1999) described it as heightened needs for selfvalidation. The present study has confirmed the relationship between social anxiety and interpersonal communication, and the need of reducing social anxiety and shyness through self-efficacy based intervention. It was important to include a training component to reduce self-conscious inhibition and to increase self-efficacy beliefs. Often it is difficult to encourage shy or socially anxious people to participate and to learn social skill because their social anxiety causes them to avoid social interaction (Mak, Westwood, Ishiyama, & Barker, 1999). Anxiety always exists in interpersonal or intercultural communication (Crushner & Brislin, 1996; Gudykunst & Hammer, 1988). The findings showed that it was helpful to normalize participants' social anxiety and use the  158 positive reinterpretation technique of Morita therapy for managing anxiety in the communication process (Ishiyama, 1986). Feedbackfromthe participants informed us that the positive, supportive approach of the program, the group-based learning method, and the learning activities were very helpful to alleviate their shyness. They suggested the need for more role playing, modelling and practicing components. It was also suggested that shy and socially anxious participants would benefitfromsuch concrete and pragmatic skills training which in turn increased their social self-efficacy and reduce social anxiety. Mastery Experiences and Changes in Psychological States as Main Sources of Self-efficacy The study confirms and expands on Bandura's theory of self-efficacy (1997) which said mastery experience is the most authentic evidence and influential source of selfefficacy beliefs compared with other modes of influences such as vicarious experience and verbal persuasion. In the interviews, mastery experiences of the competence skills became the most often reported source of change in confidence. Relatively few participants reported change in confidence due to verbal persuasion or vicarious experiences. The nature ofthe SCCT focusing on mastery experiences of sociocultural skills can build up the participants' efficacy beliefs. Furthermore, verbal persuasion and vicarious experiences are not ends in themselves. They are secondary sources of information that eventually need mastery experiences to support in enhancing self-efficacy (Bandura, 1997). It is interesting to find change in physiological and affective states as another important source of confidence for the participants. It is not surprising because anxiety and shyness in intercultural communication were reported in the qualitative data. Participants reported experiences of feeling less shy, less anxious, less stressful, and feeling good about  159 themselves helped them to gain confidence. The ability to do a job without much anxiety conveys strong efficacious beliefs. It may be regarded that participants in this study increased sociocultural competence through mastery experiences, and the efficacious experiences could help them to overcome other negative psychological factors that hindered their social functioning (Mak, Westwood, Ishiyama, & Barker, 1999). Participants' Experiences in Learning Sociocultural Competencies Feedback from participants revealed that the positive, supportive approach of the program, the group-based learning method, and the learning activities especially role modelling and the practicing to gain mastery experiences are components that were very helpful. Many shy and socially anxious participants were able to become socially competent and confident. As one interviewee (#5) said, "My shyness was not that deep; I scraped it a little bit and the confidence came out." It is interesting to know that participants found those more often used skills were also easier than those less often used to learn and apply, whereas skills that were less often used were the hardest ones to learn and apply. In the written feedback and interviews, participants overwhelmingly reported that "making social contact and conversation" (e.g., listening, clarifying messages, introducing yourself, initiating social contact, engaging in social conversation) and "seeking help or information" (e.g., interrupting to give a message, interrupting to seek support) as the two most often used skills. From their feedback, it was evident that participants considered these two skills as the most effective or easiest to be used in real life situation. Most participants did not expect extra coaching in these competence skills except the specific skill of "engaging in social conversation."  160 The participants selected "refusing unreasonable requests" and "expressing disagreement" as the least often used and the hardest to use skills. It is also interesting to note that nine participants' written feedback indicated, "refusing a request" as the least effective or hardest skill, yet four of them provided successful examples of how they had applied the skills and got satisfactory outcomes (participants #1, #3, #12, #21). The participants had tried to overcome barriers in the learning process to acquire the skills that they were once not competent. It was important for skills training program to focus on difficult to use skills such as "refusing unreasonable requests" and "expressing disagreement". Most participants expressed their needs for more coaching to expand on their existing competencies. Implications The present study contributes to our knowledge on the role of developing effective sociocultural competency training among culturally diverse people. Participants suggested effective ways of developing competencies and self-efficacy in the qualitative part of the study. The study has provided evidence that SCCT is effective in providing a group-based social learning environment under supportive, non-threatening conditions that could reduce anxiety, facilitate learning, and enhance perceived social self-efficacy. The sociocultural competency training offered more effective ways of helping people develop positive selfefficacy, self-confidence and behavioural competencies in comparison to other intercultural training programs that have primarily emphasized knowledge and awareness. The study confirmed and expanded on Bandura's theory of self-efficacy which described mastery experience as the most authentic and influential source of self-efficacy beliefs. The study is more than an evaluation of the effectiveness of the sociocultural  161  competency training. It has validated the practical outcome of social learning theory via competency training. The study has also confirmed the relationship between social avoidance and interpersonal communication. The recommendation is that trainers aim at reducing social avoidance behaviour and increasing their social efficacy beliefs which can be reinforced by the mastery of basic interaction skills. Furthermore, trainers need to be aware that reducing stress and negative emotional tendencies is important to many participants as evidenced by the interview data. The group-based learning approach used in this study also facilitated positive personal changes. Many participants reported their positive experiences in group participation reflected in the following phrases: "learn a lot," "build [up] confidence," "feel good about myself," and "having a lot of fun to laugh at our own mistakes". The SCCT group format seemed not only to facilitate the acquisition of competencies but also to reduce anxiety in the learning process. The group setting may be considered to be a community that provides support and cohesion which in terms would help the participants to develop sociocultural competencies. Methodological Implications The sociocultural competency training was provided to the delayed control group after the post-test based on ethical considerations. The provision of sociocultural competency training to the control group after the posttest stage assured the motivational level of the participants with respect to being involved in the research. The research data were provided by college students with sufficient English proficiency. Collecting data on  162  different populations with varying level of English proficiency as a foreign language would provide additional insight into learning of sociocultural competencies among more diverse populations. Moreover, the male sample in this study was not large enough to allow us to make gender-based comparisons. Therefore, we need to exercise caution in generalizing the results of the present study. There are other aspects of this study that require further refinement and improvement in future research. For example, there was no random assignment of participants. Non-randomization may result in a systematic bias of the results caused by known or unknown extraneous variables. A larger sample with random assignment is recommended. Another limitation of this study is the fact that all the data were self-reported. Data were limited to what the participants could remember during the interviews and the paperand-pencil tests. This may not give an accurate behavioural assessment of program effectiveness. In future research, additional data collection methods such as actual observation and interviews of course instructors and practicum supervisors may be used to obtain different perspectives on the participants' behavioural changes. The present study combined both qualitative and quantitative methods. The quasiexperimental design needed enough time between arranging participants to be trained and collected posttest data, in order for the intervention to run its course. Similarly, the researcher consumed a lot of time to conduct the qualitative study using semi-structured interviewing, and to synthesize the qualitative data into a final report. It was a timeconsuming study. However, the qualitative data offered complementary value and helped to better understand the nature of participants' changes. Using qualitative and quantitative  163 data together has provided depth and richness and it is a recommended approach in future study. The amount of data collected was highly informative for designing future study. It is believed that the factors identified are logical and relevant and the training is considered an effective one. The study has provided a wide range of information that could be interpreted in different ways. Some meaning units could be placed in two different and competing categories. This problem was addressed by objective raters reaching valid levels of agreement rate and triangulation through converging operations. Triangulation is expected to bring data to a focal point; threats to validity are expected to be cancelled out by the using of different sources of data. The fact that the statistical difference in the social confidence subscale was not significant may be due to the limited scope of the subscale items which need further investigation. The items may need to be modified. The changes in positive self perceptions could be measured by administering self-esteem measures in addition to the present General Self-Efficacy scale which was designed to measure general personality disposition (Schwarzer et al, 1993). Counselling Implications Based on the findings of this study, it is suggested that counsellors and educators consider the following ways of working with clients in counselling and educational settings: (a) coaching clients in learning sociocultural competencies, (b) encouraging clients to participate in skill-based group training, (c) using cultural mapping to provide clients with micro-skills for effective and culturally appropriate social interaction, (d) using the theme categories to obtain knowledge and skills helping clients deal with intercultural interaction,  164 (e) using credible role-models in training who resemble the clients, such emphasis on attribute similarity and model competence increases the power of modelling, and (f) addressing clients' social avoidance and anxiety prior to and during training sessions. The study has shown that the SCCT can enhance interpersonal skills and selfefficacy among health-care professionals, both of which are vital for them to carry out their professional duties successfully. The training may be extended for use with high school and university students, international students, professionals, business people, and expatriates who need to learn the sociocultural competencies for career success. Further research, as well as the development of innovative applications ofthe program, is recommended. This study supports the notion that sociocultural competency training can improve and further expand participants' existing sociocultural experiences. Additional recommendations for future sociocultural training includes using the mixed ethnic group setting where Caucasians and ethnic minorities are present in the training group. It is important for both Caucasians and ethnic minorities to learn sociocultural competencies who work in a multicultural workplace. The mixed ethnic group format simulates the multicultural workplace and community environment backgrounds, and can stimulate cultural learning and understanding, thereby further increasing participants' sociocultural competencies. The present study also revealed that ethnic minorities with English as a foreign language coming from a different culture, and with limited Canadian experiences are the ones who are in need of sociocultural competencies most. They could benefit from the training but they also reported various barriers of achieving competence. The ethnic  165 minority participants reported in the interviews that their lack of understanding of the Canadian cultural norms and their feeling of being culturally different from Caucasians affected their confidence in using sociocultural competencies. As cultural norms are learned through communication (Hall, 1959), sociocultural competency trainers need to offer real and simulated experiences to participants, and to offer participants the opportunities to acquire host cultural knowledge. Also, it is beneficial for trainers to pay attention to less socially efficacious ethnic minorities who tend to avoid social interaction, and might also face unique difficulties in the learning and acquisition of sociocultural competencies. The sociocultural competency training used in the present study addressed immigrants' challenging task of adapting to a new country's modes of social interaction while preserving their original cultural identity. Such a training needs to aim at increasing the participants' range of sociocultural competencies and emphasizes greater behavioural flexibility, as opposed to behavioural substitution. 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Professional psychology: Research and Practice, 21, 5-11.  186  Appendice A Appendix A-1 Appendix A-2 Appendix A-3 Appendix A-4 Appendix A-5 Appendix A-6 Appendix A-7 Appendix A-8 Appendix A-9  List o f Appendices Research Documentation SCCT Session Plan Informed Consent Form Personal Demographics Form Generalized Self-Efficacy Scale Situational Social Avoidance Scale Situational Social Avoidance Subscale Items Interpersonal Skills Checklist Interpersonal Skills Checklist Subscale Items The Social Self-Efficacy Scale  Appendices B Appendix B-l  Supplementary Statistical Data Multivariate Repeated Measures MANOVA for the Experimental and Control Groups Appendix B-2 Descriptive Statistics For the SSA, ISC, and SSE Subscales Appendix B-3 t-test for SSA Subscales of the Experimental and Control Groups Appendix B-4 t-test for ISC Subscales of the Experimental and Control Groups Appendix B-5 t-test for SSE Subscales ofthe Experimental and Control Groups Appendix B-6 Descriptive Statistics of Dependent Variables For Experimental Groups Using "Ethnicity" as Group Factor Appendix B-7 Descriptive Statistics of Dependent Variables For Experimental Group Using "Language Used at Home" as Group Factor Appendix B-8 Descriptive Statistics of Dependent Variables For Experimental Group Using "Years in Canada" as Group Factor Appendix B-9 Descriptive Statistics of Dependent Variables For Experimental Group Using "Age" as Group Factor Appendix B-10 Descriptive Statistics of Dependent Variables For Experimental Group Using "Age of Arrival in Canada" as Group Factor Appendix B-l 1 Descriptive Statistics of Dependent Variables For Experimental Group Using "Gender" as Group Factor Appendices C Supplementary Qualitative Data Appendix C-1 Observed Change in Confidence and Sources of Self-efficacy Appendix C-2 Situations Plan to Use Competence Skills  187 196 198 199 200 201 202 204 206  208 209 210 211 212 213 214 215 216 217 218  219 222  187  Appendix A-l SCCT Session Plan Human Relations Skills ~ Socio-Cultural Competencies S E S S I O N #1 Pat Diane  1215-1230  Introductions Check-in. Description of mood - animal  Pat  1230-1250  Review of Goals and Objectives Self Reflection Task  Moreah  1250*-1255  Review of Class Norms  Diane  1255 - 1315  Describe UBC Research and VCC Project Consents, Pre-Tests  Diane  1315-1345  Cultural Coat of Arms - each person completes their own  1345-1355  Break  1355-1415  Cultural Coat of Arms (contd.) - 2 groups of 5 and share with the members of your group. Role of Facilitator - Ask each member to describe what they wrote/drew Facilitator clarifies, do not allow group members to clarify At end of small group, ask if anyone wants to clarify or add to what has been said.  1415-1440  Large group - De-briefing Coat of Arms - Questions for Reflection  Pat  1440 - 1 4 5 0  Homework Complete Coat of Anns reflection questions Read for next week: Textbook Chapter 3  Moreah  1450 - 1 4 5 5  Check-out. One word.  188  Hospital Unit Coordinator Program Human Relations Skills - Socio-Cultural Competencies S E S S I O N #2 Moreah  1215-1220  Check in. Energy Level 1-10  Hilary  1220-1230  Review of Reflective Questions on Cultural Coat of Arms Draw out listening/hearing  Pat  1230 - 1 2 4 5  Why is listening so important for the Hospital Unit Coordinator? Get students to generate this. Write on flip chart, then summarize on the overhead.  Hilary  1245-1255  Demo of poor listening and better listening  Moreah  1255 - 1 3 0 5  Feedback about what was effective and what should be avoided.  Pat  1305-1315  Review overhead on "Components of Active Listening" including what should be avoided  Pat  1315-1330  Review grid  Hilary  1330 - 1 3 5 0  Form groups (two triads, one quad). Explain activity and the 3 roles. A l l students rotate in each role for both rounds: Round 1= focus on attending behaviour,  1350 - 1 4 0 0  BREAK  1400 - 1 4 2 0  Round 2 = focus on verbal responses  1420 - 1 4 3 0  Reflection on Listening and Attending  189  Pat  1430 - 1445  Listening Exercise "A Thousand Words for One Picture" De-brief on the exercise - what would have ensured accuracy or been helpful?  Moreah  1445 - 1500  Why is clarifying information important to the Hospital Unit Coordinator?  Hilary  1500  Check out. Energy level 1-10  190  Hospital Unit Coordinator Program Human Relations Skills « Socio-Cultural Competencies  SESSION #3  Diane  1215-1220  Check in. Color.  Pat  1220-1230  Homework Check in. What chances have you had to use and practice the skills since the last session? What happened in these sessions? What aspects did you find the hardest? the easiest? Are there things we need to repractice before moving on?  Pat  1230 - 1 2 4 5  Exercise: "A Thousand Words for One Picture" De-brief on the exercise: What would have ensured accuracy or been helpful?  Dianne  1245 - 1 2 5 5  Why is clarifying information important to the Hospital Unit Coordinator? Group discussion. Write ideas on white board (Pat)  Moreah/Pat 1255-1300  Demonstration: Pat as nurse, flying by and saying to HUC Moreah "Can you change Mr. Brown's diet From a full fluid to a soft?" Moreah gets clarification: "Pat, that's Mr. John Brown, in Room 325, diet from full fluids to a soft diet effective today?"  Dianne  1300-1320  Observations and what was effective. Review of the map.  All  1320-1340  Practice. Break into 3 groups.  1340-1355  BREAK  1355-1405  De-brief re Practice. What did you find easy to do? What was difficult?  Pat  Dianne/Moreah  Pat  1415  1415 - 1 4 2 5  Demonstration: Diane on phone callingfromthe lab with some blood results requiested stat by the physician. First time: Moreah does not write down or repeat the information given. Second time, Moreah writes the information and repeats it to ensure that it is correct. Observations. What happened in the first scenario? Why was the HUC not successful? What was effective in the second scenario?  191  AH  1425 - 1445  Practice. Break into 3 groups.  Diane  1445 - 1455  De-brief. What went well? What was easy to do? What was difficult?  Pat  1455-1500  Homework. Contract  Moreah  1500  Checkout. Colour.  IF T I M E P E R M I T S  Introduction of Oneself  Pat/Moreah  Demonstration: Moreah is student HUC arriving at assigned unit for first Observation Day. Pat is the HUC working on that unit. Moreah: "Hi, my name is Moreah Hamend. I'm the student that was assigned to this unit for an Observation Day. I believe you're expecting me?" Pat: extending her hand in a handshake "Yes, I was told you would be coming today. Welcome. What are the expectations for you today? Do you have an assignment to do?  Diane  De-briefing. What did you observe in this demonstration that was effective? Discuss use of the handshake. Review of Cultural Map.  AU  Practice. Break into 3 groups. Review of practice. What felt good? What was effective? What felt awkward? Contract to practice.  192  Hospital Unit Coordinator Program Human Relations Skills - Socio-Cultural Competencies  SESSION #4 Hilary  1215-1220  Check in. Flower.  Pat  1220-1230  Homework Check in. What chances have you had to practice the skill of clarifying? What aspects did you find the easiest? the hardest? Are there aspects we need to repractice?  Pat  1230-1245  Introduction of the new skill: Introduction of self to the Unit Coordinator on Observation Day. What is involved? Why is it important?  Moreah/Pat 1245 -1250  Demonstration  Hilary  1250-1300  What did you observe from the demonstration? What worked well? Discussion of the handshake: when should it be done? How do you initiate, or do you initiate it? What it feels like  Pat  1300 - 1315 Review of cultural map.  All  1315 - 1335 Practice. 3 groups.  Pat  1335-1345  De-brief re Practice. What did you find easy to do? What was difficult?  Moreah/Pat  1345 -1350  Demonstrate second scenario.  Hilary  1350 -1400  Observation and feedback on the scenario? What did you Observe? What worked well?  All Pat  1400-1415 Practice the skill. 1415-1430  BREAK  1430-1440  De-brief re Practice. What did you find easy to do? What was difficult?  Hilary  1440 - 1455  Discussion on Managing Nervousness and Anxiety  Hilary  1455-1500  Guided imagery.  Hilary  1500  Check out.  193  Hospital Unit Coordinator Program Human Relations Skills - Socio-Cultural Competencies  SESSION #5 Pat  1215 - 1 2 2 0  Check in. Readiness to participate on a scale of 1 - 10.  Moreah  1220-1230  Homework check in. Review of introducing self. What went well? Any problems/concerns? Is more practice needed?  Pat  1230-1315  Introduction to new skill - Assertiveness • Define and explain • Differentiate between passive, aggressive and assertive • Line-up Exercise - Students are asked to place themselves on an imaginary line in the room with assertive at one end and passive at the other end. Where are you now in terms of Observation Days? Where do you want to be at the end of the program? • Description of Assertive behaviour • Learning Activity: Defining Assertiveness • Learning Activity: Non-verbal Aspects of Assertiveness • Learning Activity: Assertive, Aggressive, & Passive Responses  Moreah  1315 - 1325  Why is Assertiveness important in the work place?  Moreah/  1325-1335  Demonstration: Interrupting a Physician/Charge Nurse, etc Pat (Physician) is talking to a group of physicians in the Hall. Moreah (HUC) has a received a phone call for Dr. Pat. She interrupts his conversation to give him the message that he is needed on the telephone. Alternate: Interrupting a Team Leader because of an urgent matter.  Pat  1335 - 1 3 4 0  What was effective?  All  1340-1400  Divide into 2 groups. Practice the skill.  1400-1415  BREAK  Pat  1415-1425  Review of Practice. What was easy? What was difficult?  Moreah  1425-1430  Introduction to new skill: Interrupting and Unidentified Person in the Nursing Station.  Pat  194  Moreah/ Pat  1430 -1435  Demonstration: Pat is looking at patient chart. Moreah seeks clarification of her status. Moreah: "Hi, my name is Moreah, and I am the unit Coordinator on this unit. I don't think we have met before?" Pat: "My name is Dr. Wilson and I am here to see Mrs. Brown. She is a patient of Dr. Lee's" Moreah: "May I help you find Mrs. Brown's chart?"  All  1435 -1450  Break into two groups. Practice.  Pat  1450 -1500  Reflect on Practice. What worked well? What was -difficult?  Moreah  1500  Check out. Energy level 1-10.  195 Hospital Unit Coordinator Program Human Relations Skills - Socio-Cultural Competencies  SESSION #6 Moreah  1215 - 1 2 2 0  Check in. Give a name of an animal you feel like.  Pat  1220 - 1 2 3 0  Review homework. What chances have you had to practice assertive skills since the last session? What happened in these situations? What was the easiest thing to do? The hardest? Is clarification required?  Moreah  1230 - 1 2 4 5  Discussion of situations where HUCs must be assertive What have you noticed from your Observatior»Pays? What specific situations have you notices where the HUC has used their assertive skills?  Moreah/  1245 - 1 2 5 5  Demonstration: Confronting a Family Member who is looking at the Patient Chart. ( extension of skill learned last Session)  All  1255 - 1 3 1 5  Divide into two groups. Practice skill.  Pat  1315 - 1 3 2 5  Review of skill. What was easy? Difficult?  Moreah/  1325- - 1 3 3 0  Demonstration: Physician Asks HUC to Take a Verbal Order.  Pat  1330- - 1 3 4 0  Reflect on the demonstration. What did you notice about when the HUC became assertive? How did the HUC manage this situation? What did she sat and do?  All  1355- - 1 4 1 5  Divide into two groups. Practice skill.  Moreah  1415- - 1 4 2 5  Reflect of the practice. What worked well? What was difficult?  Moreah/  1425- -1430  Demonstration: Too Many Visitors in a Patient's Room  All  1430  Divide into two groups. Practice skill.  Pat  1450- -1500  Pat  Pat  Pat  Moreah  1500  -1450  Reflect on the skill. What was easiest? What did you find difficult? Contract for Homework Check out. Give a name of an animal you feel like.  196 Appendix A-2  Informed Consent Form Social-Cultural Communication Competency Training Principal Investigator  Dr. Ishu Ishiyama, Associate Professor Dept. of Counselling Psychology Phone: 822-5329/822-2790 Research Co-investigators  Dr. Marvin Westwood, and Ms. Yuk Shuen Wong Dept. of Counselling Psychology Phone: 822-6457 Purpose:  The purpose of this study is to investigate the effectiveness of introducing social-cultural competency training as intervention of enhancing selfefficacy among Health Sciences trainees.  Method of Recruitment:  The training program is incorporated into Vancouver Community College program curricula. The curriculum will be delivered in three Health Sciences Programs: Practical Nursing, Resident Care Attendant, and Hospital Unit Coordinator. The participants for this study will be recruited from the college students who enrolled in the above three Health Sciences Programs. The investigators will ask the students' consent to participate in the study and all available subjects will be used. Study Procedures:  Participants will take part in a 20 hour social-cultural competency training program as part of their regular course curriculum in the Health Sciences Programs at the Vancouver Community College. The program will consist of training participants in social-cultural competency skills necessary for being an effective and successful health care provider. The training program will utilize group discussions, simulated role-plays and rehearsals to teach these competency skills. Participants will also be asked to complete generalized selfefficacy scale, situational social avoidance scale, behavioural skills checklists, interpersonal skills checklists, social self-efficacy scale and background information sheet as part of the training program. page 1 of2  197  Confidentiality:  Any information resulting from this research study will be kept strictly confidential. Only the research team will have access to the research data. Participants will not be identified by name in reports or materials relating to the study. All documents will be identified by code number and kept in a locked cabinet. Contact:  If I have any question or desire further information with respect to the study, I may contact Dr. Ishu Ishiyama or one of the co-investigators at 822-5329 or 822-3985. If I have any concerns about my treatment or rights as a research subject, I may contact Dr. Richard Spratley, Director of Research Services at the University of British Columbia at 822-8598. Consent:  I understand that my participation in this study is entirely voluntary and that I may refuse to participate or withdrawfromthe study at any time without jeopardy. I have received a copy of this consent form for my own record. I consent to participate in this study.  Participant's Name (Please Print) Participant's Signature Date  page 2 of2  198  Appendix A-3 Personal Demographics 1. Your sex (Please circle the number of your answer)  1 Male  2 Female  2. Which university or institution are you enrolled in ?  3. What course are you enrolled in ?  4. Which year are you enrolled in ? (e.g. first, second, third, fourth year)  5. What is your country of birth ?  6. How long have you been in this country ?  7. What language(s) do you speak at home ?  8. What is your father's country of birth?  9. What is your mother's country of birth?  10. What is your residential status? (Please circle the number of your answer) 1 Citizen/permanent resident of this country 2 Overseas student 11. Please write down the last 3 digits of your student ID number here: 12. What is your age?  Appendix A-4  Generalized Self-efficacy Please indicate your degree of agreement to the following statements by circling one ofthe numbers.  1) I can always manage to solve difficult problems if I try hard enough.  Not at all Barely Moderately Exactly True True True True  2) If someone opposes me. I can find means and ways to get what I want. 3) It is easy for me to stick to my aims and accomplish my goals. 4) 1 am confident that I could deal efficiently with unexpected events. 5) Thanks to my resourcefulness, I know how to handle unforeseen situations. 6) 1 can solve most problems if I invest the necessary effort. 7) 1 can remain calm when facing difficulties because I can rely on my coping abilities. 8) When I am confronted with a problem, I can usually find several solutions. 9) If I am in a bind, I can usually think of something to do. 10) No matter what comes my way, I'm usually able to handle it.  Schwarzer et al. (1993)  200 Appendix A-5  Situational Social Avoidance Scale How often do you tend to avoid the following situations? Please indicate your avoidance tendency on the scale of 1 (almost never) to 7 (almost always).  1 almost never  2  3 4-—-—5 sometimes often  6  7 almost always  1-2-3-4-5-6-7  1. Eating and drinking with other people.  1-2-3-4-5-6-7  2. Being the focus of attention.  1-2-3-4-5-6-7  3. Talking to people in authority.  1-2-3-4-5-6-7  4. Being criticized or confronted by others.  1-2-3-4-5-6-7  5. Speaking or acting before an audience.  1-2-3-4-5-6-7  6. Mixing with strangers in social situations.  1-2-3-4-5-6-7  7. Asserting rights and saying "No" to others.  1-2-3-4-5-6-7  8. Confronting or disagreeing with others.  1-2-3-4-5-6-7  9. Being a group leader.  1-2-3-4-5-6-7  10. Expressing ideas and feelings in class or in a relatively large group.  1-2-3-4-5-6-7 1-2-3-4-5-6-7 1-2-3-4-5-6-7 1-2-3-4-5-6-7 1-2-3-4-5-6-7 Ishiyama (1995)  ("relatively large group" means over 20 people) 11. Dealing with verbally aggressive people. 12. Initiating conversation with a person I feel attracted to. 13. Asking questions and asking for clarification in a relatively large group. 14. Being uncertain and possibly making a mistake or saying a wrong thing in front of others. 15. Being praised and getting compliments from others in a relatively large group.  201 Appendix A-6 Situational Social Avoidance Subscale Items The situational social avoidance scale identifies three subscales: (a) social performance, (b) socializing, and (c) self-assertion. Item# Subscale 1: Social performance 4.  Being criticized or confronted by others.  5.  Speaking or acting before an audience.  10.  Expressing ideas and feelings in class or to a large group (over 20 people).  12.  Initiating conversation with an attractive person.  13.  Asking questions and asking for clarification in a large group (over 20 people).  14.  Being uncertain and possibly making a mistake or saying a wrong thing in front of others. Subscale 2: Socializing  1.  Eating and drinking with other people.  2.  Being the focus of attention.  3.  Talking to people in authority.  6.  Mixing with strangers in social situations. Subscale 3: Self-assertion  7.  Assertingrightsand saying "no" to others.  8.  Confronting or disagreeing with others.  11.  Dealing with verbally aggressive people.  Item #s refer to item number in the 15-item SSA Scale  (Ishiyama, 1995)  202 Appendix A-7 Interpersonal Skills Checklist (ISC-33)  Please rate yourself on the following social interaction skills. Circle one of the numbers for each item, to indicate how effective your skills are in the present social and cultural environment. Note: "Others" in this checklist refers to people, such as classmates, acquaintance, co-workers, teachers, supervisors, and strangers, other than the very familiar people to you like your family, relative, and close friends. 7-point Scale: from "1: not at all" effective to "7: extremely" effective 1: not at all effective (i.e., "I'm not good at all at doing this.") 2: slightly effective 3: somewhat effective 4: moderately effective 5: quite effective 6: very effective 7: extremely effective (i.e., "I'm extremely good at doing this.")  1-2-3-4-5-6-7  1. Letting others know when I have trouble understanding them.  1-2-3-4-5-6-7  2. Asking others to explain to me what they are trying to say to me.  1-2-3-4-5-6-7  3. Expressing my own personal ideas and opinions.  1-2-3-4-5-6-7  4. Approaching strangers to ask for information.  1-2-3-4-5-6-7  5. Verbally showing interest in others' speech.  1-2-3-4-5-6-7  6. Talking about my personal interest and background.  1-2-3-4-5-6-7  7. Asking others to do things for me.  1-2-3-4-5-6-7  8. Approaching others to have a friendly conversation.  1-2-3-4-5-6-7  9. Asking questions to check if others are understanding me accurately.  1-2-3-4-5-6-7  10. Correcting others' misunderstanding about me.  1-2-3-4-5-6-7  11. Asking others to repeat when I don't understand what they have just said.  1-2-3-4-5-6-7  12. Giving my feedback on others' presentations and performances.  1-2-3-4-5-6-7  13. Asking for others' feedback on my presentations and performances.  1-2-3-4-5-6-7  14. Talking about my positive personal qualities and skills. Ishiyama (1995)  203 ISC Scale 1-2-3-4-5-6-7  15. Talking about my achievements and success stories.  1-2-3-4-5-6-7  16. Using humour in conversation.  1-2-3-4-5-6-7  17. Telephoning and making appointments with strangers.  1-2-3-4-5-6-7 1-2-3-4-5-6-7  18. Approaching new people to expand my career and information network. 19. Repeating my request for information or assistance and not giving up when my first request has been denied or ignored.  1-2-3-4-5-6-7  20. Discussing with others how I can improve myself to be more effective and successful.  1 -2-3-4-5-6-7  21. Verbally expressing my dissatisfaction when I am mistreated.  1-2-3-4-5-6-7  22. Finding another way of expressing myself when there is a breakdown in communication.  1-2-3-4-5-6-7  23. Chit chatting, such as making casual and friendly exchange of words with others.  1-2-3-4-5-6-7  24. Expressing my positive feelings directly to the person involved.  1-2-3-4-5-6-7  25. Expressing my negative feelings directly to the person involved.  1-2-3-4-5-6-7  26. Approaching the same person again to establish a line of communication even when the first attempt has failed.  1-2-3-4-5-6-7  27. Verbally expressing my understanding of the other person's feelings during a conversation.  1-2-3-4-5-6-7  28. Expressing my appreciation directly to the person.  1-2-3-4-5-6-7  29. Talking about my personal and cultural background as a conversation topic.  1-2-3-4-5-6-7  30. Discussing my personal and cultural background in order to avoid or correct misunderstanding.  1 -2-3-4-5-6-7  31. Greeting others in a friendly way.  1-2-3-4-5-6-7  32. Asserting my rights.  1-2-3-4-5-6-7  33. Expressing disagreement with others. Ishiyama (1995)  204  Appendix A-8 Interpersonal Skills Checklist Subscale Items Subscale  1: P r o c e s s i n g  Skills  10. C o r r e c t i n g o t h e r s ' misunderstanding about me. 12. G i v i n g ray feedback on o t h e r s ' p r e s e n t a t i o n s and performances. 13. Asking f o r o t h e r s ' feedback on my p r e s e n t a t i o n s and performances. 20. D i s c u s s i n g with others how I can improve myself t o be more e f f e c t i v e and s u c c e s s f u l . 22. F i n d i n g another way of e x p r e s s i n g myself when there i s a breakdown i n communication. 26^. Approaching t h e same person a g a i n t o e s t a b l i s h a l i n e o f *• communication even when the f i r s t attempt has f a i l e d . Subscale  2 : A c t i v e Engagement S k i l l s  16. Using humour i n c o n v e r s a t i o n . 23. C h i t c h a t t i n g , such as making a c a s u a l and f r i e n d l y exchange of words with o t h e r s . 24. E x p r e s s i n g my p o s i t i v e f e e l i n g s d i r e c t l y to the person involved. 27. V e r b a l l y e x p r e s s i n g my u n d e r s t a n d i n g of the other person's feelings during a conversation. 28. E x p r e s s i n g my a p p r e c i a t i o n d i r e c t l y t o the person. 31. G r e e t i n g o t h e r s i n a f r i e n d l y way. Subscale  3 : Self-enhancement S k i l l s  6. 7. 14. 15. 29.  T a l k i n g about my p e r s o n a l i n t e r e s t and background. Asking others t o do t h i n g s f o r me. T a l k i n g about my p o s i t i v e p e r s o n a l q u a l i t i e s and s k i l l s . T a l k i n g about my achievements and success s t o r i e s . T a l k i n g about my p e r s o n a l and c u l t u r a l background as a conversation t o p i c . 30. D i s c u s s i n g my p e r s o n a l and c u l t u r a l background i n o r d e r t o avoid or c o r r e c t misunderstanding. Subscale .4. 5. 8. 17. 18.  4:  Approaching  Skills  Approaching s t r a n g e r s t o ask f o r i n f o r m a t i o n . V e r b a l l y showing i n t e r e s t i n o t h e r s ' speech. Approaching o t h e r s t o have a f r i e n d l y c o n v e r s a t i o n . Telephoning and making appointments with s t r a n g e r s . Approaching new people t o expand my career and i n f o r m a t i o n network. 19. Repeating my request f o r i n f o r m a t i o n or a s s i s t a n c e and not g i v i n g up when my f i r s t r e q u e s t has been denied o r i g n o r e d .  205 Appendix A-8 substrate Sr"AsSertiVe Skills 3. E x p r e s s i n g my own p e r s o n a l i d e a s and o p i n i o n s . 21. V e r b a l l y e x p r e s s i n g my d i s s a t i s f a c t i o n when I am m i s t r e a t e d . 25. E x p r e s s i n g my negative f e e l i n g s d i r e c t l y t o t h e person involved. 32. A s s e r t i n g my r i g h t s . 33. E x p r e s s i n g disagreement w i t h o t h e r s . Subscale  6: I n t e r r u p t i o n S k i l l s  1. L e t t i n g others know when I have t r o u b l e understanding them. 2. A s k i n g o t h e r s t o e x p l a i n t o ftte what they a r e t r y i n g t o say t o me. 9. A s k i n g questions t o check i f o t h e r s are u n d e r s t a n d i n g me accurately. 11. A s k i n g o t h e r s t o repeat when I don't understand what they have j u s t s a i d . D i s c a r d e d Items ( o r i g i n a l i t e m #s i n the 40-item v e r s i o n ) ( o l d #) 8. Saying "No" t o o t h e r s . 13. Remaining i n a c o n v e r s a t i o n w i t h someone from another c u l t u r e who has d i f f i c u l t y communicating i n our common language (e.g., E n g l i s h ) . 19. T a l k i n g about money and money-related i s s u e s w i t h o t h e r s . 23. O f f e r i n g t o do t h i n g s f o r o t h e r s . 24. L e t t i n g others know t h a t I am l o o k i n g f o r work o r workr e l a t e d information. 33. I n t e r r u p t i n g a c o n v e r s a t i o n t o say something important. 40. Ending a c o n v e r s a t i o n when I want t o go somewhere e l s e .  206 Appendix A-9  The Social Self-Efficacy Scale C. Fan, Department of Psychology, Victoria University of Technology, Melbourne, Australia & A. Mak, Centre for Applied Psychology, University of Canberra, Canberra, Australia  This is an anonymous and voluntary survey of students' attitudes to and experiences with social interactions. There is no right or wrong answer. Part A In relation to your interaction with people in this country (and, in the case of overseas students, interaction back in your own country), please indicate your degree of agreement to the following statements by circling an appropriate number. "1" means you strongly disagree with the statement and "7" means you strongly agree with the statement. Circle "4" if you are uncertain. With People in This Country Strongly Disagree  Strongly Agree  1 2 3 4 5 6 7  Back in Your Own Country (for Overseas Students) Strongly Strongly Disagree Agree  1 2 3 4 5 6 7  1 2  3  4  5  6  7  1 2 3 4 5 6 7  2. When I'm trying to become friends with someone who seems uninterested at first, I don't give up easily.  1 2  3  4  5  6  7  1 2 3 4 5 6 7  3. It is difficult for me to make new  1 2  3  4  5  6  7  1 2 3 4 5 6 7  1 2 3 4 5 6 7  1 2 3 4 5 6 7  1 2  3  4  5  6  7  1 2 3 4 5 6 7  1 2  3  4  5  6  7  1 2 3 4 5 6 7  1 2 3 4 5 6 7  1 2 3 4 5 6 7  1 2 3 4 5 6 7  1 2 3 4 5 6 7  1. If I see someone I would like to meet I go to that person instead of waiting for him or her to come to me.  friends. 4.1 do not handle myself well in social gatherings. 5.1 have difficulties participating in class discussions. 6.1 feel confident in asking questions in class. 7.1 have difficulties getting a date when I want one. 8.1 feel confident talking to my teachers.  Fan & Mak (1998)  207  SSE Scale W i t h People i n This Country Strongly Disagree 1 2 3 9. I have difficulties talking to  Strongly Agree 5 6 7  4  B a c k i n Y o u r O w n Country (for Overseas Students) Strongly Strongly Disagree Agree 1  2  3  4  5  6  7  1  2  3  4  5  6  7  1  2  3  4  5  6  7  1  2  3  4  5  6  7  1  2  3  4  5  6  7  1  2  3  4  5  6  7  1  2  3  4  5  6  7  1  2  3  4  5  6  7  1  2  3  4  5  6  7  1  2  3  4  5  6  7  1  2  3  4  5  6  7  1  2  3  4  5  6  7  1  2  3  4  5  6  7  1  2  3  4  5  6  7  1  2  3  4  5  6  7  1  2  3  4  5  6  7  1  2  3  4  5  6  7  17.1 have common interests with people.  1  2  3  4  5  6  7  1  2  3  4  5  6  7  18.1 enjoy activities that most people enjoy.  1  2  3  4  5  6  7  1  2  3  4  5  6  7  19. It is difficult for me to express a different opinion.  1  2  3  4  5  6  7  1  2  3  4  5  6  7  2 0 . 1 feel comfortable requesting information.  1  2  3  4  5  6  7  1  2  3  4  5  6  7  staff at university or school. 10.1 feel confident asking a teacher a question. 11.1 have difficulties making new friends at u n i v e r s i t y or s c h o o l . 1 2 . 1 feel confident i n joining a student organization. 13.1 find it difficult to hold a conversation with most people. 14.1 am confident o f m y language skills. 15.1 am usually quiet and passive i n social situations. 16. I have common topics for conversation with people.  Fan & Mak (1998)  208 Appendix B-l Multivariate Repeated Measures MANOVA for the Experimental and Control Groups  Effect between Subjects  intercept  Miliars i race Wilks' Lambda Hotelling's Trace Roy's Largest Root  GROUP  Pillai's Trace Wilks' Lambda Hotelling's Trace Roy's Largest Root  Within Subjects  TIME  Pillai's Trace Wilks' Lambda Hotelling's Trace Roy's Largest Root  TIME X GROUP Pillai's Trace Wilks' Lambda Hotelling's Trace Roy's Largest Root  a  Value !59T  Error df  Sig.  4.000 4.000 4.000 4.000 4.000 4.000 4.000 4.000 4.000 4.000 4.000 4.000 4.000 4.000  85.000 85.000 85.000 85.000 85.000 85.000 85.000 85.000 85.000 85.000 85.000 85.000 85.000 85.000  .000 .000 .000 .369 .369 .369 .369 .001 .001 .001 .001 .017 .017 .017  4.000  85.000  .017  Hypothesis df  .005 191.882 191.882 .049 .951 .051 .051 .185 .815 .227 .227 .131 .869 .151  4077.501 4077.501 4077.501 4077.501 1.085 1.085 1.085 1.085 4.821 4.821 4.821 4.821 3.216 3.216 3.216  .151  3.216  y  3  3  3  a  3  a  a  3  a  a  3  a  a  a  3  T o W  SBUOlT UoTT  - Exact statistic  Note: Legend:  Multivariate consisted of four dependent variables: GSE, SSA, ISC and SSE. G S E - Generalized Self-Efficacy (Schwarzer, 1993) SSA- Situational Social Avoidance (Ishiyama, 1995) ISC- Interpersonal Skills Checklist (Ishiyama, 1996) SSE- Social Self-Efficacy Scale (Fan & Mak, 1998)  209 Appendix B-2 Descriptive Statistics For the SSA, ISC, and SSE Subscales Appendix B-2.1: Descriptive Statistics For the SSA Subscales Control Group, n=32 Experimental Group, n=58 SSA Subscal Means S.D. Item Average Mean S.D. Item es Average SSA1 pretest 23.64 7.65 3.94 22.44 6.50 3.74 (6 items) posttest 20.00 6.75 3.30 20.81 6.83 3.47 SSA2 pretest 14.07 4.75 3.50 13.84 4.28 3.46 (4 items) posttest 12.28 4.24 3.07 14.50 4.69 3.63 SSA3 pretest 11.97 4.01 3.99 11.62 3.75 3.87 (3 items) posttest 9.55 3.22 3.18 10.90 4.29 3.63 Appendix B-2.2: Descriptive Statistics For the ISC Subscales Control Group, n=32 Experimental Group, n=58 ISC Subscale Means SD Item Average Mean SD Item s Average ISCl pretest 25.03 7.16 4.17 29.13 5.64 4.86 (6 items) posttest 30.19 5.80 5.03 29.56 5.77 4.93 ISC2 pretest 30.83 6.01 5.14 33.69 5.36 5.62 (6 items) posttest 33.72 5.31 5.62 33.31 6.01 5.55 ISC3 pretest 24.95 7.17 4.16 28.56 6.93 4.76 (6 items) posttest 28.60 5.77 4.77 27.34 6.99 4.56 ISC4 pretest 27.45 7.09 4.58 28.00 6.49 4.67 (6 items) posttest 31.21 5.94 5.20 28.63 7.05 4.77 ISC5 pretest 20.48 5.79 4.10 25.38 4.92 5.07 (5 items) posttest 24.10 5.63 4.82 25.19 5.40 5.04 ISC6 pretest 18.14 4.89 4.54 20.59 4.34 5.15 (4 items) posttest 21.17 4.00 5.29 21.31 4.27 5.33 Appendix B-2.3: Descriptive Statistics For the SSE Subscales Control Group, n=32 Experimental Group, n=58 SSE Subscales Means SD Item Average Mean SD Item Average SSE1 pretest 38.47 10.86 4.27 44.22 9.76 4.91 (9 items) posttest 45.17 9.76 5.02 43.91 11.02 4.88 SSE2 pretest 25.52 5.89 5.10 26.31 5.56 5.26 (5 items) posttest 26.86 5.53 5.37 27.09 5.58 5.42 SSE3 pretest 13.81 3.27 4.60 14.56 3.84 4.85 (3 items) posttest 14.98 3.74 5.00 14.66 3.53 4.88 SSE4 pretest 11.64 3.46 3.88 12.56 4.34 4.18 (3 items) posttest 13.45 3.28 4.48 12.22 3.71 4.07  210  Appendix B-3 t-test for SSA Subscales ofthe Experimental Group and Control Groups Appendix B-3.1 : Experimental Group  Paired Differences  Mean  Std. Deviation  Std. Error Mean  95% Confidence Interval ofthe Difference Lower  Upper  t  df  Sig. (2-tailed)  Pair 1  SSA1 (pretest) SSA1 (posttest)  3.64  6.95  .91  1.81  5.47  3.99  57  .000  Pair 2  SSA2 (pretest) SSA2 (posttest)  1.79  5.24  .69  .42  3.17  2.61  57  .012  Pair 3  SSA3 (pretest) SSA3 (posttest)  2.41  4.15  .55  1.32  3.51  4.43  57  .000  remark:: all pairs have pretest minus posttest to calculate the paired differences  Appendix B-3.2: Control Group  Paired Differences 95% Confidence Interval of the Difference  Mean  Std. Deviation  Std. Error Mean  Lower  Upper  t  df  Sig. (2-tailed)  Pair 1  SSAI (pretest) SSA1 (posttest)  1.63  5.73  1.01  -.44  3.69  1.60  31  .119  Pair 2  SSA2 (pretest) SSA2 (posttest)  -.66  4.13  .73  -2.15  .83  -.90  31  .376  Pair 3  SSA3 (pretest) SSA3 (posttest)  .72  2.88  .51  -.32  1.76  1.41  31  .167  remark:: all pairs have pretest minus posttest to calculate the paired differences  211 Appendix B-4 t-test for ISC Subscales of the Experimental and Control Groups Appendix B-4.1 : Experimental Group  Paired Differences  Mean  Std. Deviation  Std. Error Mean  95% Confidence Interval of the Difference Lower  Upper  t  Sig. (2-tailed)  df  Pair 1  (pretest) ISC1 (posttest)  -5.16  6.46  .85  -6.85  -3.46  -6.08  57  .000  Pair 2  ISC2 (pretest) ISC2 (posttest)  -2.90  4.75  .62  -4.15  -1.65  -4.65  57  .000  Pair 3  ISC3 (pretest) ISC3 (posttest)  -3.66  6.68  .88  -5.41  -1.90  -4.17  57  .000  Pair 4  ISC4 (pretest) ISC4 (posttest)  -3.76  6.25  .82  -5.40  -2.12  -4.58  57  .000  Pair 5  ISC5 (pretest) ISC5 (posttest)  -3.62  4.27  .56  -4.74  -2.50  -6.46  57  .000  Pair 6  ISC6 (pretest) ISC6 (posttest)  -3.03  3.92  .51  -4.06  -2.00  -5.90  57  .000  remark: all pairs have pretest minus posttest to calculate the paired differences  Appendix B-4.2: Control Group  Paired Differences  Mean  Std. Deviation  Std. Error Mean  95% Confidence Interval of the Difference Lower  Upper  t  df  Sig. (2-tailed)  Pair 1  (pretest) ISC1 (posttest)  -.44  6.09  1.08  -2.63  1.76  -.41  31  .687  Pair 2  ISC2 (pretest) ISC2 (posttest)  .38  5.30  .94  -1.54  2.29  .40  31  .692  Pair 3  ISC3 (pretest) ISC3 (posttest)  1.22  7.45  1.32  -1.47  3.90  .93  31  .362  Pair 4  ISC4 (pretest) ISC4 (posttest)  -.63  6.83  1.21  -3.09  1.84  -.52  31  .609  Pair 5  ISC5 (pretest) ISC5 (posttest)  .19  4.42  .78  -1.41  1.78  .24  31  .812  Pair 6  ISC6 (pretest) ISC6 (posttest)  -.72  5.28  .93  -2.62  1.19  -.77  31  .447  remark: all pairs have pretest minus posttest to calculate the paired differences  212 Appendix B-5 t-test for SSE Subscales of the Experimental and Control Groups Appendix B-5.1: Experimental Group  Paired Differences  Mean  Std. Deviation  Std. Error Mean  95% Confidence Interval of the Difference Lower  Upper  t  df  Sig. (2-tailed)  Pair 1  S S b l (pretest) SSE1 (posttest)  -6.71  9.68  1.27  -9.25  -4.16  -5.28  57  .000  Pair 2  SSE2 (pretest) SSE2 (posttest)  -1.34  4.90  .64  -2.63  -6.E-02  -2.09  57  .041  Pair 3  SSE3 (pretest) SSE3 (posttest)  -1.17  3.17  .42  -2.01  -.34  -2.81  57  .007  Pair 4  SSE4 (pretest) SSE4 (posttest)  -1.81  3.30  .43  -2.68  -.94  -4.18  57  .000  remark: all pairs have pretest minus posttest to calculate the paired differences  Appendix B-5.2: Control Group  Paired Differences  Mean  Std. Deviation  Std. Error Mean  95% Confidence Interval of the Difference Lower  Upper  t  df  Sig. (2-tailed)  Pair 1  SSL1 (pretest) SSE1 (posttest)  .31  12.19  2.15  -4.08  4.71  .15  31  .886  Pair 2  SSE2 (pretest) SSE2 (posttest)  -.78  4.99  .88  -2.58  1.02  -.89  31  .382  Pair 3  SSE3 (pretest) SSE3 (posttest)  -9.38E-02  4.49  .79  -1.71  1.52  -.12  31  .907  Pair 4  SSE4 (pretest) SSE4 (posttest)  .34  4.09  .72  -1.13  1.82  .48  31  .638  remark: all pairs have pretest minus posttest to calculate the paired differences  Appendix B-6 Descriptive Statistics of Dependent Variables For Experimental Groups Using "Ethnicity" as Group Factor  Descriptive Statistics  sum (jiib pre-test  sum G S E post-test  sum S S A pre-test  sum S S A post-test  sum ISC pre-test  sum ISC post-test  sum S S E pretest (this country)  sum S S E posttest (this country)  Mean 30.050  Std. Deviation 3.086  ethnic minority  29.474  3.889  Total  29.672  3.615  58  Caucasian  32.900  3.865  20  ethnicity category Caucasian  N 20 38  ethnic minority  31.079  4.239  38  Total  31.707  4.172  58  Caucasian  54.400  15.629  20  ethnic minority  58.000  17.139  38  Total  56.759  16.585  58  Caucasian  43.800  15.686  20  ethnic minority  50.500  13.272  38  Total  48.190  14.376  58  Caucasian  147.800  27.113  20  ethnic minority  148.079  34.310  38  Total  147.983  31.768  58  Caucasian  177.850  24.230  20  ethnic minority  163.895  28.445  38  Total  168.707  27.671  58  Caucasian  92.250  17.134  20  ethnic minority  89.105  17.189  38  Total  90.190  17.085  58  101.900  17.023  20  ethnic minority  97.289  18.028  38  Total  98.879  17.677  58  Caucasian  Appendix B-7 Descriptive Statistics of Dependent Variables For Experimental Group Using "Language Used at Home" as Group Factor Descriptive Statistics  sum u s b pretest  sum G S E posttest  sum SSA pretest  sum SSA posttest  language speaking at home tngnsn Mother tongue  Mean 24J.45a 29.733  4.847  15  Both English and Mother Tongue  29.895  3.089  19  Total  29.672  3.615  58  English  32.125  4.111  24  Mother tongue  31.600  3.979  15  Both English and Mother Tongue  31.263  4.556  19  Total  31.707  4.172  58  sum ISC posttest  sum S S E pretest  sum S S E posttest  N J>4  English  55.625  14.652  24  Mother tongue  56.000  20.993  15  Both English and Mother Tongue  58.789  15.729  19  Total  56.759  16.585  58  English  44.708  14.813  24  Mother tongue  52.133  13.700  15  Both English and Mother Tongue  49.474  14.045  19  Total sum ISC pretest  Std. Deviation  48.190  14.376  58  English  145.292  26.146  24  Mother tongue  149.933  37.120  15  Both English and Mother Tongue  149.842  35.129  19  Total  147.983  31.768  58  English  171.792  26.324  24  Mother tongue  167.267  25.359  15  Both English and Mother Tongue  165.947  31.884  19  Total  168.707  27.671  58  English  91.708  15.895  24  Mother tongue  89.600  15.221  15  Both English and Mother Tongue  88.737  20.390  19  Total  90.190  17.085  58  English  101.000  16.116  24  Mother tongue  96.400  18.298  15  Both English and Mother Tongue  98.158  19.633  19  Total  98.879  17.677  58  Appendix B-8 Descriptive Statistics of Dependent Variables For Experimental Group Using "Years in Canada" as Group Factor Descriptive Statistics  sum b b b pre-test  sum G S E post-test  sum S S A pre-test  sum S S A post-test  Years in Canada i to o years 6 to 19 years  sum ISC post-test  sum S S E pretest (this country)  sum S S E posttest (this country)  Std. Deviation  N  29.687  4.254  16  over 20 years  29.769  3.445  26  Total  29.672  3.615  58  1 to 5 years  31.250  3.821  16  6 to 19 years  31.000  4.274  16  over 20 years  32.423  4.356  26  Total  31.707  4.172  58  1 to 5 years 6 to 19 years  58.250  13.636  58.375  17.281  16 16  over 20 years  54.846  18.152  26  Total  56.759  16.585  58  1 to 5 years  52.750  11.204  16  6 to 19 years  48.813  12.613  16  over 20 years  45.000  16.623  26  Total sum ISC pre-test  Mean  48.190  14.376  58  1 to 5 years  139.937  22.451  16  6 to 19 years  153.000  40.728  16  over 20 years  149.846  30.693  26  Total  147.983  31.768  58  1 to 5 years  159.500  25.724  16  6 to 19 years  166.563  28.121  16  over 20 years  175.692  27.682  26  Total  168.707  27.671  58  1 to 5 years  88.625  16.552  16  6 to 19 years  85.563  17.127  16  over 20 years  94.000  17.170  26  Total  90.190  17.085  58  1 to 5 years  95.250  16.035  16  6 to 19 years  94.563  18.917  16  over 20 years  103.769  17.268  26  98.879  17.677  58  Total  216  Appendix B-9 Descriptive Statistics of Dependent Variables For Experimental Group Using "Age" as Group Factor  Descriptive Statistics  sum ut>b pre-test  Mean 29.22" 30.23 29.67  Std. Deviation  31.22 32.31 31.71  16.92 16.49  Total  57.03 56.42 56.76  16.59  32 26 58  from 18 to 30 over 30  47.75 48.73  14.57 14.41  32 26  Total  48.19  14.38  58  147.59 148.46 147.98 170.47  32.44 31.56 31.77  32 26  27.79  32  166.54  27.92  26 58  Age from 18to3U over 30 Total  sum G S E post-test  from 18 to 30 over 30 Total  sum S S A pretest  sum S S A posttest  sum ISC pretest  from 18 to 30 over 30  from 18 to 30 over 30 Total  sum ISC posttest  from 18 to 30 over 30 Total  sum S S E pretest  sum S S E posttest  a  - G P = experiment  N  3.66  32 26  3.61  58  4.13 4.22 4.17  32 26 58  3.57  58  168.71  27.67  from 18 to 30 over 30  87.53  19.28  93.46  13.59  32 26  Total  90.19  17.09  58  from 18 to 30 over 30  99.56  19.91  32  98.04  14.81  26  Total  98.88  17.68  58  Appendix B-10 Descriptive Statistics of Dependent Variables For Experimental Group Using "Age of Arrival in Canada" as Group Factor  Descriptive Statistics sum <Jt>b pre-test  sum G S E post-test  sum SSA pre-test  sum SSA post-test  sum ISC pre-test  sum ISC post-test  sum S S E pretest (this country)  sum S S E posttest (this country)  3 categories, age trom age i to TZ from age 13-21 from age 22 to 46 Total from age 1 to 12 from age 13-21 from age 22 to 46 Total from age 1 to 12 from age 13-21 from age 22 to 46 Total from age 1 to 12 from age 13-21 from age 22 to 46 Total from age 1 to 12 from age 13-21 from age 22 to 46 Total from age 1 to 12 from age 13-21 from age 22 to 46 Total from age 1 to 12 from age 13-21 from age 22 to 46 Total from age 1 to 12 from age 13-21 from age 22 to 46 Total  Mean J29.b/B 29.385 30.250 29.672 32.061 30.462 32.083 31.707 57.061 55.769 57.000 56.759 45.182 51.615 52.750 48.190 149.030 156.077 136.333 147.983 174.364 165.462 156.667 168.707 92.879 80.846 92.917 90.190 102.909 92.462 94.750 98.879  Std. Deviation 3.1tJ3 4.093 4.454 3.615 4.387 4.034 3.753 4.172 17.578 13.737 17.863 16.585 15.361 10.603 14.079 14.376 30.150 35.645 31.146 31.768 28.256 23.330 28.011 27.671 17.526 18.105 11.333 17.085 17.393 18.760 15.463 17.677  N 13 12 58 33 13 12 58 33 13 12 58 33 13 12 58 33 13 12 58 33 13 12 58 33 13 12 58 33 13 12 58  Appendix B - l l Descriptive Statistics of Dependent Variables For Experimental Group Using 'Gender' as Group Factor  Descriptive Statistics  sum U b b pre-test  sum GSE post-test  sum SSA pre-test  sum SSA post-test  sum ISC pre-test  sum ISC post-test  sum SSE pretest (this country) sum SSE posttest (this country)  gender Male Female  Mean  Std. Deviation  N  30.333  3.670  6  29.596  3.637  52  Total  29.672  3.615  58  Male  33.000  4.147  6  Female  31.558  4.189  52  Total  31.707  4.172  58  Male  53.833  12.007  6  Female  57.096  17.093  52  Total  56.759  16.585  58  Male  43.333  14.306  6  Female  48.750  14.417  52  Total  48.190  14.376  58  Male  146.000  24.133  6  Female  148.212  32.715  52  Total  147.983  31.768  58  Male  170.667  8.981  6  Female  168.481  29.109  52  Total  168.707  27.671  58  Male  96.500  11.520  6  Female  89.462  17.550  52  Total  90.190  17.085  58  Male  105.333  10.967  6  Female  98.135  18.220  52  Total  98.879  17.677  58  219 Appendix C-1 Observed Change in Confidence and Sources of Self-efficacy Part#  Observed BEFORE  Sources of SelfEfficacy  Differences AFTER  1  I was not confident to speak.  I become less nervous in the small group by getting to know others. I am able to interact with classmates, instructors, clients.  Physiological and affective states  1  I used to be physically closer with the people in Spain.  I learn how to keep boundaries and distance with Canadians in Canada. I respect personal space that is different from my Spanish culture.  Vicarious experiences  2  I did not know how to interact with Canadians.  I learn different cultures and the Canadian norms of behaviour. I feel confident because I know how to interact with other people.  *  3  It was not easy for me to participate in the training. I could not do it freely because I lost my lines.  I feel so glad and have become more confident after the training.  Physiological and affective states  4  I used to worry about whether other people accept my ideas.  I feel confident after the training when I get rid of feeling rejected by others.  Physiological and affective states  4  I could not express my disagreement.  I am now less affected by others' responses. I have confidence to go ahead to express myself, to share my ideas, and to get help, no matter whether it is a successful experience or not.  Physiological and affective states  5  I was shy.  The training opens up my mind. I realize that my shyness is not too deep. I scrape my shyness away and my confidence comes out.  *  5  I was uncertain how to work with clients from different cultures  I set my mind and determine to use the skills because I believe I can transfer the skills to real life situations.  Mastery experiences  5  I had no confidence in myself  I develop a belief that I can copy the specific behaviours demonstrated.  Vicarious experiences  5  I felt uncomfortable with strangers.  I make a conscious decision to participate in groups and practice the skills.  Mastery experiences  5  I was anxious to face changes in work environment.  I integrate the skills into my own (experience) system.  Mastery experiences  5  I was afraid that my ideas were not accepted by others.  I am more used to this way of sharing ideas openly. I am not bothered much by others' responses.  *  6  I told myself to keep quiet in the group.  I use the skills to socialize. I find them useful and good. The training helps me to increase my confidence to talk.  Mastery experiences  7  I used to be shy and scare of new people.  Now I am confident and I say out what is right. It is O K to say my opinions.  Physiological & affective states  (table continues)  220 Appendix C-1 Observed Change in Confidence and Sources of Self-efficacy Part.  Observed  Sources of Confidence  Differences  # BEFORE  AFTER  7  I seldom talked in front of people.  I feel more confident. Now I can stand in front Mastery experiences of my co-workers to report my work..  8  I felt uneasy in the beginning to do role play.  The practice helps me to become confident and comfortable to speak English, which is my second language.  Mastery experiences  8  I found it difficult to speak to residents on my first week.  I become better in speaking to residents in the second and third week because I learn new things and apply the skills in my workplace.  Mastery experiences  9  I was not very free to communicate in English.  M y communication approach and listening skill have been improved..  Mastery experiences  10  I used to be shy and not to speak up.  I am more open and assertive.  *  10  I felt guilty and bad by saying no and expressing disagreement.  The training helps me to practice the assertive skills that I observe from group members and I get support from them.  *  10  I was not confused with the different cultural norms.  I understand more about other cultures because I practice the skills in a multicultural atmosphere.  Mastery experiences  10  I tried to gain respects from residents by listening only.  The communication skills I learned are helpful in working with residents and co-workers.  Mastery experiences  10  I was stressed out.  I feel good about myself after the training, and I feel relaxed in the communication.  Physiological & affective states  11  I was afraid to let people down and being criticized by others.  M y confidence is built up by active participation in the role-play. Now I am not afraid of people and I can say anything in a respectful way.  Mastery experiences  11  I was too shy to speak up for myself  M y confidence has increased. I think everyone has the right to say their opinions. I feel very wonderful because I can express my feelings and totally be myself.  *  12  I was shy. I knew I could not do anything when I was shy.  I become more assertive. I want to be myself and stand up for what I believe to have a bright future.  Physiological & affective states  12  I was not comfortable to meet with strangers.  I think others can do it; I can do it. Actually I am able to participate in this research interview.  Vicarious experiences  12  I could not say no back in my country..  M y personality has changed after the training. Now I can say no.  Mastery experiences  13  I was occupied with negative thoughts.  I become more confident as I feel good about myself by having positive thoughts and avoiding negative thoughts  Physiological & affective states  (table continues)  221  Appendix C-1 Observed Change in Confidence and Sources of Self-efficacy Part.  Observed  Differences  Sources of Confidence  # BEFORE  AFTER I become more sensitive to others' feelings, verbal and non-verbal expressions. I can communicate more confidently with people in different settings. M y confidence comes from people who watch, listen and give feedback and encouragement to me.  Mastery experiences  I was too shy to speak in English.  I start conversation in a good manner with confidence. I talk as much as possible in English.  *  14  I was worried when things went wrong.  I have more confidence in myself. I am no longer worried when something goes wrong. I ask for help and I know I can do it again and again. I have more supports.  Physiological & affective states  15  I was shy.  I have 70% confidence in using the skills.  Mastery experiences  16  I felt embarrassed to say something wrong.  Verbal persuasion  17  I was shy when I met strangers.  My instructors tell me that it is O K to make mistakes. I feel comfortable to start the conversation,  18  I was confident.  I am confident to seek help and say no.  Physiological & affective states  19  I forced myself to ask questions.  I learn how to ask questions effectively.  Mastery experiences  20  I could not refuse others' requests..  The training gives me power to say no and I don't feel sorry now.  *  21  I was a compromiser.  I understand others cannot force me to do things I don't want to do  *  22  I was shy and never interrupted others' conversations.  I am able to say no to unreasonable requests. I am able to interrupt and ask questions when I do not understand.  Mastery experiences  23  I felt guilty for saying no.  I assert my rights.  *  24  I was confident in myself.  I am very confident in using the skills.  Physiological & affective states  13  I tried to learn different skills in dealing with patients from different cultural backgrounds.  14  I realized that I couldn't do anything if I was shy. M y confidence came from family and friends.  14  Legend : Part# -Participants' ID# * = items did not have consensus in categorizing among raters  Verbal persuasion  Physiological & affective states  222 Appendix C-2 Situations Plan to Use Competence Skills. Participants' Situation What ID# 1  1 1 2 2 3 3 4 4 4 4 5 5 5  I refuse my classmates' requests to borrow my assignment. I tell them to do the work by themselves so that they can learn more. I start conversation with other passengers in the skytrain. I seek helpfrommy instructors. I practise the socio-cultural competency skills with my classmates. I talk to the team leader about my ideas. I contact my clients and tell them my ideas. I make social conversation with peoplefromother cultures. I make social contact and start conversation with strangers. I ask my instructors questions about the study materials. I ask my instructors to clarify the assignment topics. I ask several people to confirm the same right answer I share ideas in a group meeting. I feel comfortable with friends but not strangers  refusing requests  When/ Where school  Who  Category  classmates  3  starting conversation  skytrain station  passengers  2  seeking help  school  instructors  1  participating in the group  social situations  friends  1  giving feedback expressing ideas making social conversation making conversation  hospital  team leader clients  *  people from other cultures strangers  2  seeking information  school  instructors  *  seeking information  school  instructors  *  seeking information  school  classmates  1  participating in group making social contact participating in group  group meeting social situations  colleagues  1  friends  2  hospital social situations social situations  *  2  I transfer role-based real life people 1 learning in group to real life situations situations. Category 1= social performance situation, 2= socializing situation, 3 = self-assertion situation Legend: * = items did not have consensus in categorizing among raters (table continues)  223 Appendix C-2 Situations Plan to Use Competence Skills. Participants' Situation What ID# 6  When/ Where social situations anywhere  Who  Category  I socialize with my friends socializing friends 2 and feel good 6 I give feedback where the giving people 1 environment and people are feedback very open * I say what isrightto my 7 expressing workplace staff colleagues in my workplace. ideas 7 I talk and listen to depressed giving residence depressed 2 clients in the residence room. feedback room clients I stand in front of the work 7 participating workplace work team 1 team and report the work in the group members records. I explain my work 8 asserting residence clients 3 procedures to the residents in rights the workplace. The skills are useful not only applying all life 9 everyone 3 for the course but for the skills entire life to cope with society. 9 I use my intercultural/ applying all staff 1 interpersonal skills with other skills international staff. 9 I express my disagreement to expressing daily life other 3 people others in my daily life. ideas 10 I use the skills with residents applying all client/staff 1 and co-workers in my skills workplace. 10 I use my assertive skills to asserting residence 3 encourage the residents to do their morning care. I'm ready to meet people in my socializing 10 workplace client/staff 2 new job. 10 I am more open to speak up participating group group 1 members in a group. in a group 11 I use the skills in all life applying all all life everyone 2 situations with everyone in situations skills everyday life. * I use the skills in a 11 applying all professional manner. skills Category 1= social performance situation, 2= socializing situation, 3 = self-assertion situation Legend: * = items did not have consensus in categorizing among raters (table continues)  224 Appendix C-2 Situations Plan to Use Competence Skills. Participants' Situation What ID# 12 12 12 12 12 12 12 12 13 13 13 14 15 16 17 17 18  I participate in the UBC research interview. I use the assertive skills to convince my clients to take their bath. I assert my rights with my family members I use the skills whenever people are around me anytime, anywhere. I refuse to lend money to my friends. I say no to the salesperson. I ask for information from strangers. I participate in the class. I deal with salespersons in a direct and assertive way. I communicate with the residents. I deal with people in different settings. I socialize with residents in the community care home. I start conversation by introducing myself to some new people. I practice the skills in the classroom I make social contact with a lot of residents in the clinical setting. I express my disagreement to residents in simple, loud and clear language. I refuse the residents' requests.  researcher  1  asserting  When/ Where research interview hospital  client  3  asserting  home  family  3  applying all skills  anywhere  anyone  1  friends  3  salesperso n strangers  3  1 3 2  socializing  refusing a request saying no seeking information participating classroom asserting  Who  Category  2  socializing  workplace  classmates salesperso n residents  socializing  anywhere  anyone  2  socializing  care home  residents  2  making conversation  new people  2  participating classroom  classmates  1  making contact  workplace  residents  2  expressing workplace disagreement  residents  3  refusing requests  residents  3  workplace  Category 1= social performance situation, 2= socializing situation, 3 = self-assertion situation Legend: * = items did not have consensus in categorizing among raters (table continues)  225 Situations Participants' ID#  18 19 19 19 20 20 20 21 21 21 22 23 23 24 24  Appendix C-2 Situation I ask the nurses for help to lift up my residents. I participate actively in the group. I ask questions when I do not understand my supervisor's instructions. I get comments from other people to improve my work performance. I use the assertive skills in my workplace to work with other team members. I refuse my husband's request to follow his ideas at home. I use the skills everywhere in everyday life. I have small talk with the residents in my workplace. I practise the skills with my classmates in the classroom. I can apply the skills in every situations. I practise the skills in the workplace everyday with the residents and the staff. I refuse the request to make a donation to the Vancouver fire department. I assert myrightsto say no to my supervisor in the hospital. I ask the nurses to explain what they want me to do. I seek helpfromthe nurses to attend to the needs of the residents.  What  When/ Where seeking help workplace participating group in group seeking workplace information  Who nurses  Category  *  1 supervisor  1  receiving feedback  workplace  other people  1  asserting  workplace  team members  3  refusing requests  home  husband  3  applying all everywhere everyone skills making workplace residents conversation participating classroom classmates applying all skills applying all skills  every situations workplace  2 1  everyone  *  residents staff  *  refusing requests asserting rights  *  3 hospital  supervisor  3  seeking help workplace  nurses  1  seeking help workplace  nurses  1  Category 1= social performance situation, 2= socializing situation, 3 = self-assertion situation Legend: * = items did not have consensus in categorizing among raters  

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