Poster

SIGNIFICANCE: The interest in the field of occupational therapy is growing globally. With this growth comes exciting opportunities and also challenges at meeting the demands of future student populations. The growth allows for students, practitioners, and educational professionals to create international connections where communications pertaining to innovative ideas and scientific research can be shared to provide intervention to international populations. This global collaboration is important and significant, as the minority population within the United States is projected to increase by 48% by the year 2050. Additionally, with our profession growing and more schools’ occupational therapy student class sizes growing, meeting the demands of finding fieldwork placements for these students is a current and an ongoing challenge that the profession is encountering. Providing international opportunities with the expected minority growth and the growing occupational therapy student population, as well as studying the effect of international fieldwork experiences and their effect on a student’s cultural and professional growth, is critical. Thus, from a student’s perspective, it is important to measure whether an international fieldwork has an effect on a student’s cultural awareness and cultural competency.

INNOVATION: When reviewing current studies, we found limited evidence to support whether an international fieldwork was more beneficial than domestic fieldwork. Consequently, this lack of knowledge led us to investigate this particular arena in relation to occupational therapy students. Articles have been written on the topic, but there is inadequate quantitative data available. We were unable to locate sufficient quantitative data that would support the prominence of international fieldwork. After reviewing literature and determining the importance of international fieldwork experiences, it was decided that it would be beneficial to examine the importance of student exposure to other cultures along with analyzing the impact that international service learning will have on the students’ cultural awareness and cultural competency skills. In regard to the focus of this study, the Model of Human Occupation (MOHO) is a suitable framework to identify an occupational therapy student’s potential development of cultural awareness and cultural competency. Participation in an international fieldwork provides a new environment that alters the feedback system and challenges a student’s roles, performance skills, and volition clinically and culturally. The context of this theory and how it is applies to a student’s occupational performance and participation helps to support and illustrate a systematic approach of environmental, volitional, and habitual changes that can occur participating in an international fieldwork.

APPROACH: Research questions included the following: Does a student’s perception of cultural awareness increase after participating in an international fieldwork experience? Does a student’s perception of cultural competency increase after participating in an international fieldwork experience? Do students who completed an international fieldwork experience have a greater perception of cultural awareness and cultural competency when compared to students who completed a domestic fieldwork experience?

Fieldwork experience could be considered one of the most important components of an occupational therapy student’s education. It provides students a foundation where they have the opportunity to apply their knowledge and skills, develop communication strategies, and learn to create client-centered relationships. As these relationships develop, it is important to take into consideration the individual’s background, language, and culture when evaluating and treating a client. Culture not only is important to a potential client but also is an important factor in an occupational therapy student’s education and future career.

Cultural awareness and cultural competency are two crucial components for students to develop throughout their education. In a sample of 51 2nd- and 3rd-yr occupational therapy students, 88% felt they had limited knowledge about different cultures, and 55% expressed they should have been provided more cultural experiences during their fieldwork experiences. In addition, 88% of the students also conveyed they had limited awareness to address cultural barriers, and 50% felt they were unaware as to where to access communication interpreter services.

With these factors in mind, a potential way to expose students to an environment where they will work on cultural awareness and will be exposed to diversity is to provide students with opportunities outside the classroom. This can be facilitated through an international fieldwork experience. In this research, we measure occupational therapy students’ cultural awareness. Thus, in the proposed research, we focus on whether an international fieldwork experience will enrich an occupational therapy student’s cultural awareness.

METHOD: A quasi-experimental design was used gathering data with pre- and postsurveys. The Cultural Awareness and Cultural Competence Questionnaire (CACCQ) was used. The survey was a Likert scale broken down into two different sections. The first 10 questions addressed cultural awareness, and the last 5 questions addressed cultural competency. Data were gathered during Gannon University’s Occupational Therapy Intervention: Pediatric and Developmental Disabilities II class in 2013 and 2014. Participation was voluntary. Informed consent was given before distribution of the surveys, and a blank sheet of paper was attached to the surveys so participants could write the last four digits of their social security numbers on them to match pre- and postsurveys. Surveys were distributed a week before and a week after Level I fieldwork. After entering data into SPSS, the sheets of paper with the last four digits of social security numbers were destroyed.

We used t tests to compare the two groups involved in the study over the years 2013 and 2014. One group completed a Level I fieldwork internationally in Quito, Ecuador, and another group completed fieldwork domestically.

The CACCQ was distributed during class time in 2013 and 2014. One group of students from each class completed an international fieldwork, and one group completed a domestic fieldwork. Participation in this study was voluntary, and participants were from the occupational therapy program at Gannon University in Erie, Pennsylvania. In 2013, 9 students who completed an international fieldwork participated, along with 27 students who completed a domestic fieldwork. In 2014, 14 students who completed an international fieldwork participated, along with 22 students who completed a domestic fieldwork.

The instrument chosen for this study is a preexisting survey, the CACCQ. The CACCQ was previously used in seven countries including the United States, Australia, and the United Kingdom. Due to its previous use, the survey is used as a reliable resource in this research investigation as previously discussed in the literature review. The random use and developing results of this survey over the past 6 to 10 yr exhibit reliability and validity from its previous use. Permission was obtained from Dr. Shah, an author of the survey, to use the CACCQ.

The survey focuses on measuring occupational therapy students’ perception of their own cultural awareness and cultural competency. Thus, it was a useful tool to measure these components on the basis of an international fieldwork opportunity. The questionnaire is broken up into two sections. Questions 1 through 10 focus on students’ perception of their own cultural awareness, and Questions 11 through 15 target students’ perception of their own levels of cultural competency. A Likert scale—in which participants chose either strongly agree, agree, don’t know, disagree, or strongly disagree—was used to rate Questions 1 through 10. Questions 11 through 15 are rated from culturally competent to culturally unaware.

SPSS was used to analyze data. We ran t tests to determine whether significance was found. Independent t tests were utilized to compare students who completed Level I fieldwork internationally versus students who completed Level I fieldwork domestically.

RESULTS: In regard to cultural awareness, significance was noted in the pre–post difference between the international and domestic groups. Equal variances were assumed. The t value was 4.0, and the (two-tailed) p value was 0.00, which notes significance. The averages of the difference between pre- and postscores were determined. It was calculated that the international group went up 3.05 points in cultural awareness, whereas the domestic group increased 0.05 points in cultural awareness once both groups completed fieldwork.

In regard to cultural competency, results from the postsurvey showed a significant difference in cultural competency between the two groups. Equal variances were assumed. The t value was 2.68, and the (two-tailed) p value was .01, which notes significance.

The mean of each group was calculated, with the international group equaling 14.57 and the domestic group equaling 12.14. When comparing the two mean scores, a higher cultural competency was noted in the international group. Therefore, because the answers to the first two research questions are yes, the answer to the third research question is also yes: Students who completed an international fieldwork experience have a greater perception of cultural awareness and cultural competency when compared to students who completed a domestic fieldwork experience.

CONCLUSION: Exposure to a different culture could be the reason that cultural awareness and cultural competency are greater in those who completed an international fieldwork verses those who completed a domestic fieldwork. Students who completed an international fieldwork were immersed in another cultural for a full week. They completed fieldwork at an orphanage for children with disabilities, a hospital, and a preschool. Students who completed a domestic fieldwork may have experienced other cultures in their fieldwork but would still go home to their daily life.

Limitations included that students may have already been exposed to other cultures before their Level I fieldwork. This could have had an effect on the student’s responses when completing the CACCQ, as it did not examine past international experiences. This could affect the level of awareness that a student perceives him- or herself as having when answering the questions measuring his or her cultural awareness and cultural competency. Additionally, the CACCQ did not allow the researchers to determine the amount of interaction with other cultures that domestic students experienced while on fieldwork. A final limitation to note is that the CACCQ had not been used to compare two populations who completed international versus domestic fieldwork. In previous studies, the survey was used to examine students’ cultural awareness through their educational careers.