3.3.1 Research Instruments and List of Variables
The research instruments were a KAP questionnaire, a written test and a checklist used in the OSCE. The variables are described under each instrument, and consisted of questionnaire items and test or OSCE marks. The types of data and mode of collection are summarised in Table 2.
a) Questionnaire – see Appendix 2
The KAP questionnaire included questions related to personal information about the students,
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language competencies and the specific objectives of the study. The questionnaire used a standard KAP format (Katzenellenbogen, Joubert and Abdool Karrim, 2007) and was
designed specifically to explore the attitude and practice of students in the cohort on specific items related to the T&L of isiZulu clinical communication.
For the purposes of the study, attitude was explored in an attempt to understand students’
behaviour with respect to the T&L of isiZulu in the programme. The everyday use of attitude refers to a feeling or way of thinking that affects a person’s behaviour. “Attitude” as defined by Allport (1935) as a mental state of readiness, resulting from experience, which
influences the individual’s response to related objects and situations. Attempts at analysing
“attitude” typically relate to efforts to explain behaviour. In fact, attitudes are a complex combination of factors related to personality, beliefs, motivations and perceptions (Allport, 1935). Thus the study attempted to explore attitude in terms of awareness and feelings of students about the subject of learning isiZulu as medical students. Individual items are useful to gain insight into specific issues such as awareness of policy. The survey further explored behaviour in terms of practice or use of isiZulu in the clinical situation with patients or staff.
In designing the questionnaire, the following steps were followed:
1) The specific objectives were defined by deciding on the items to be included to gain an understanding of students’ attitude and practice.
2) The survey was developed (see Appendix 2) and the translation component of the proficiency test was appended to it to be a tool to measure written proficiency in isiZulu.
3) The survey questionnaire was designed and piloted as described.
4) Corrections as described were made to the questionnaire following the pilot study.
The questionnaire consisted of 28 items, in 4 sections, described below:
1. Questions 1 – 8 provided demographic and language details.
2. Question 9 explored language competency in English, Afrikaans, isiZulu and other languages.
3. Questions 10 - 26 were scored using a 5-level Likert item for each variable under study and provided quantitative data.
34 The levels 1-5 were described as follows:
1 = Strongly disagree/ not at all 2 = Disagree/ very little
3 = Neither agree nor disagree/ neutral option 4 = Agree/ somewhat
5 = Strongly agree/ a lot
a) To measure attitude, Questions 10-16 and 20-24 measured awareness, beliefs, perceptions and desire as components thereof.
b) To measure practice, Questions 17-19 and 25-26 measured the use of the language and wish to further use the language as components thereof.
Individual Likert items were recorded and, thereafter, separate Likert scales for attitude and practice were created. These Likert scales were the mean of responses of several Likert items related to attitude and practice respectively. Such a mean score (referred to as a Likert scale) is considered more reliable than individual items (Gliem and Gliem, 2003).
4. Questions 27 and 28 comprised the open enquiry section of the questionnaire and collected qualitative data on students’ experiences and recommendations on the teaching and learning of isiZulu. This information was analysed thematically.
b) Written test – see Appendix 2
Students were asked to write a 60-mark written test at the time of completion of the questionnaire. This served to assess their knowledge of isiZulu in the form of written linguistic competence. The task was the clinical translation component from the isiZulu proficiency test written by the study group in 2010. It consisted of 30 general statements and questions, mostly of a clinical nature, and required students to translate 15 statements from English into isiZulu and 15 statements from isiZulu into English. Each statement was worth 2 marks. The marks scored were further analysed by section and also compared with the mark scored in 2010.
c) OSCE station
The students’ OSCE mark in the October 2012 examination was recorded and used as an indicator of knowledge in the form of communicative (oral) competence in isiZulu. The
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OSCE included a short station requiring each student to take a history from a standardised simulated patient in isiZulu (see definitions). The topic was related to the themes studied in the semester and students were given study material and voluntary supplementary tutorials before the OSCE.
Marks were scored for:
1. Initiating the session correctly: greeting and introduction, permission, establishing the presenting complaint;
2. Gathering information related to the specific presenting complaint; and 3. Closing the session appropriately.
The marks of the group of students in the study sample were compared with the class average. This gave an indication of how the students in the study fared in terms of their knowledge and communicative skills when compared with students in the same year of study who were exempted from the isiZulu module by virtue of having been deemed proficient in isiZulu (by virtue of passing the proficiency test in first year, or as mother tongue isiZulu language speakers).
Strengths and limitations of the study
The strength of the KAP survey was that a large amount of data could be collected from participating students to contribute to a snapshot view of their attitudes and practice. This involved the use of a customized questionnaire with questions to explore relevant aspects of isiZulu clinical communication. There are, however, limitations in that the items are only indicative of attitude and practice, and there may be various factors which influence students’
responses, as in the item on desire to work in a rural area. The survey has, however, contributed to our understanding of this subject for medical students.
The measurement of knowledge involved two items, the mark from the test for written proficiency, and the mark from the OSCE for oral or communicative competence. These two sets of data did not test the student in an authentic clinical setting, and only provided an indication of learning of isiZulu in this group. Similarly, students were asked to rate their own ability in isiZulu as an indicator of knowledge.
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3.4 MEASURES TO ENSURE VALIDITY OF DATA