An Accent Modification Intervention for Nursing and Allied Health Students

Purpose: The Texas Medical Center (TMC) in the United States (US), the largest medical center in the world, has a healthcare workforce of individuals from over 150 countries. There are students enrolled in a health sciences university in the TMC who have language patterns, and in particular foreign or regional accents that may be barriers to language that is intelligible to listeners in this given language community. These communication problems may lead to speakers needing to repeat themselves in order to be understood, speakers avoiding social interactions, and frustration for both the speaker and the listener. These students may need additional support for safe clinical practice and academic success (Belay, 2013; Boughton, Halliday & Brown, 2010; Crawford & Candlin, 2013; Jeong et al., 2011). The purpose of this presentation is to share the results of a pilot project to evaluate the feasibility of an accent modification program to improve communication for nursing and other allied healthcare students in a university setting.

Background: Extensive research from the Institute for Healthcare Communication (2011) indicated a strong relationship between a healthcare member’s communication skills and their patients’ compliance with health care recommendations, chronic care management, and preventive health behaviors. The Joint Commission (2015) noted that communication errors are a key factor in sentinel events. US federally-regulated health care organizations invest billions of dollars in translation services, computerized charting, and stream-lined processes to enhance communication. However, the Migration Policy Institute (2012) suggested the verbal communication skills of 45% of foreign-born nurses and 27% of all foreign-born healthcare workers were not proficient. Studies have indicated that foreign-born student nurses have difficulty communicating with patients, families, and other health care workers (Boughton, et al, 2010; Jeong et al, 2011). In 2013, researchers called these healthcare communication difficulties “uncharted territories” (Khurana & Huang, p.2).

Methods: A multi-disciplinary team of faculty and staff developed a tailored accent modification program. The intervention was 12 (non-credit) one-hour classes taught by a licensed speech pathologist. We hypothesized that participants who have participated in an accent modification program would have: decreased communication apprehension, improved communication competence, enhanced self-esteem, and improved spoken language skills. Data collection included pre and post participant audio-tapes and appropriate psychometric tools. In addition, post program focus groups addressed the qualitative question: What are the experiences of students who participate in an accent modification program?

Results: Nineteen graduate and undergraduate students completed the program over two semesters. A high attrition rate was noted primarily due to failure in other classes. Significant positive findings in perceived self-esteem, interpersonal communication, ability to communicate in meetings, groups, and overall communication were noted as measured before and after the program. Judging of pre and post audio-tapes showed no significant difference. Focus group results were positive. An interesting finding was that some participants indicated they understood what others were saying better.

Conclusion: An accent modification program for nursing and other allied health students is feasible and may yield positive outcomes. In order to sustain this program for students, faculty, and staff at no cost, the university has begun to offer the program to healthcare providers in the TMC. The research team is in the planning stages of taking the program to a large hospital center in order to include patient safety and satisfaction indicators.