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COMMUNICATION APPREHENSION WHEN

SPEAKING L2 (ENGLISH): A CASE STUDY OF

PERSONNEL IN THE BUREAU OF TUBERCULOSIS,

DEPARTMENT OF DISEASE CONTROL,

MINISTRY OF PUBLIC HEALTH

BY

MS. NARUEMON BOONCHERD

A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF

THE REQUIREMENTS FOR THE DEGREE OF

MASTER OF ART IN ENGLISH FOR CAREERS

LANGUAGE INSTITUTE, THAMMASAT UNIVERSITY

ACADEMIC YEAR 2016

COPYRIGHT OF THAMMASAT UNIVERSITY

Ref. code: 25595621030104AHL

COMMUNICATION APPREHENSION WHEN

SPEAKING L2 (ENGLISH): A CASE STUDY OF

PERSONNEL IN THE BUREAU OF TUBERCULOSIS,

DEPARTMENT OF DISEASE CONTROL,

MINISTRY OF PUBLIC HEALTH

BY

MS. NARUEMON BOONCHERD

A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF

THE REQUIREMENTS FOR THE DEGREE OF

MASTER OF ART IN ENGLISH FOR CAREERS

LANGUAGE INSTITUTE, THAMMASAT UNIVERSITY

ACADEMIC YEAR 2016

COPYRIGHT OF THAMMASAT UNIVERSITY

Ref. code: 25595621030104AHL

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Thesis Title COMMUNICATION APPREHENSION WHEN

SPEAKING L2 (ENGLISH): A CASE STUDY

OF PERSONNEL IN THE BUREAU OF

TUBERCULOSIS, DEPARTMENT OF DISEASE

CONTROL, MINISTRY OF PUBLIC HEALTH

Author Miss Naruemon Booncherd

Degree Master’s Degree

Major Field/Faculty/University English for Career

Language Institute

Thammasat University

Thesis Advisor Associate Professor Sucharat Rimkeeratikul, Ph.D.

Academic Years 2016

ABSTRACT

English communication apprehension in a second language has been a focus in many

professional fields. Although English is the primary second language used in Thailand

including in the public health area, there has been less emphasis on researching in the

public health profession in Thailand. This study aimed to investigate the level of

participants’ communication apprehension in L1 (Thai) and L2 (English), how

demographic information affected CA in L2 and the techniques they used when facing

CA in L2. This study was a mixed method utilizing quantitative and qualitative data of

92 personnel of the Bureau of Tuberculosis, Department of Disease Control, Ministry

of Public Health. The quantitative data were collected through a questionnaire. The

Personal Report of Communication Apprehension-24 (PRCA-24) was employed to

measure the level of CA in L1 and L2. The qualitative data were obtained from six

interviewees who were found to have high and low levels of CA in L1 and L2. They

were asked how they coped with an oral communication apprehension. The interview

data were transcribed into verbatim transcriptions and reduced to the main themes. In

addition, the NVivo 10 software program was used for to check the data’s accuracy.

ANOVA analysis revealed that years of working and different positions affected CA in

L2. Although the quantitative results indicated that the levels of CA both in L1 and L2

of BTB staff members were categorized as moderate, the qualitative data revealed that

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they still hesitated to perform in English communication circumstances. They also

struggled to implement solutions to overcome their CA in L2.

Keywords: Communication Apprehension (CA), L1, L2, public health, demographic

characteristics, techniques dealt with CA

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ACKNOWLEDGEMENTS

First of all, I would like to thank my thesis advisor, Associate Professor Sucharat

Rimkeeratikul, Ph.D., of the Language Institute at Thammasat University. Without her

encouragement, this study would not have been completed. She consistently allowed

this paper to be my own work, but also steered me in the right direction whenever she

thought I needed it.

I would also like to acknowledge my ex-colleagues at Thailand MOPH U.S.-CDC

Collaboration and Bureau of Tuberculosis, Department of Disease Control, Ministry of

Public Health, Thailand who were involved in the validation survey for this research

project. Without their participation and input, the validation survey could not have been

successfully conducted.

Also, I would like to thank my thesis committee and lecturers, as well as my classmates

and staff members of the Language Institute at Thammasat University for their support,

both academic and emotional.

Finally, I must express my very profound gratitude to my parents and my family for

providing me with unfailing support and continuous encouragement throughout my

years of study and during the process of researching and writing this thesis. This

accomplishment would not have been possible without them. Thank you.

Miss Naruemon Booncherd

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TABLE OF CONTENTS

Page

ABSTRACT (1)

ACKNOWLEDGEMENTS (3)

LIST OF TABLES (7)

LIST OF FIGURES (8)

CHAPTER 1 INTRODUCTION 1

1.1 Background 1

1.2 Research Questions 2

1.3 Hypothesis 3

1.4 Objectives of the study 3

1.5 Scope of the Study 3

1.6 Significance of the Study 4

1.7 Definition of Terms 4

1.8 Limitations of the Study 5

1.9 Summary of the Introduction 5

CHAPTER 2 REVIEW OF LITERATURE 7

2.1 Conceptualization of Communication Apprehension 7

2.1.1 Communication Apprehension as a trait (Trait-like CA) 7

2.1.2 Communication apprehension in a generalized context

(Context-based CA-dyadic, groups, meetings, public speaking

and interviews) 8

2.1.3 Communication apprehension with a given audience across

situations (Audience-based CA) 8

2.1.4 Situational Anxiety or State Anxiety 9

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2.2 Causes and Effects of Communication Apprehension 9

2.2.1 Causes of Communication Apprehension 9

2.2.2 Effects of Communication Apprehension 11

2.2.3 Cultural differences 12

2.2.4 Relevant studies on causes and effects of communication

apprehension 13

2.3 Communication Apprehension Measurement 17

2.4 Communication Apprehension in Second Language (CA in L2) 19

2.5 How to Cope with CA 21

2.6 Background on Bureau of Tuberculosis 23

2.7 Summary of Review of Literature 24

CHAPTER 3 RESEARCH METHODOLOGY 25

3.1 Participants 25

3.2 Research Instruments 25

3.3 Procedures 26

3.3.1 Research Design 26

3.3.2 Data Collection 27

3.4 Data Analysis 28

3.4.1 Quantitative Analysis 28

3.4.2 Qualitative Analysis 28

3.5 Pilot Study 30

3.6 Summary of the Researh Methodoloty 30

CHAPTER 4 RESULTS 32

Part I Demographic Data 32

Part II CA in L1 and CA in L2 of Participants 35

Part III The Comparison of Demographic Data to CA in L1 and L2 35

Part IV The Results of the Interview Session 44

Summary of the Results 68

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CHAPTER 5 Discussion, Conclusion, and Recommendations 69

5.1 Summary of the Finding 69

5.1.1 Research Question 1 69

5.1.2 Research Question 2 70

5.1.3 Research Question 3 70

5.1.4 Results of the interview session 71

5.2 Discussion 71

5.2.1 What is the average level of communication apprehension

in L1 and L2 of BTB personnel? 71

5.2.2 What demographic information is associated with BTB

personnel’s communication apprehension in L1 and L2? 72

5.2.3 Are personnel in BTB impeded with L2 communication

apprehension when communicating with foreigners? 75

5.2.4 Discussion of hypothesis: The personnel of Bureau of

Tuberculosis have lower communication apprehension

in their native language than in the English language. 76

5.2.5 Answers from the interview sessions 77

5.3 Conclusion 79

5.4 Recommendations for further research 81

5.5 Implications of the Study 82

REFERENCES 83

APPENDICES 91

APPENDIX A 92

APPENDIX B 95

APPENDIX C 108

APPENDIX D 109

BIOGRAPHY 137

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LIST OF TABLES

Tables

Table 2.1 Major Characteristics of Individualistic and Collectivistic Cultures

(Tubbs & Moss, 2008, p.319) 13

Table 4.1 Gender of Participants 33

Table 4.2 Frequency Statistics for Age 33

Table 4.3 Frequency Statistics for Education 33

Table 4.4 Frequency Statistics of Positions 34

Table 4.5 Frequency Statistics of Years of Working 34

Table 4.6 Frequency Statistics of Overseas Experience 34

Table 4.7 CA Level in L1 and L2 35

Table 4.8 Total CA in L1 Score with Different Genders 36

Table 4.9 Total CA in L2 Score with Different Genders 36

Table 4.10 Total CA in L1 Score with Different Ages 36

Table 4.11 Total CA in L2 Score with Different Ages 37

Table 4.12 Total CA in L1 Score with Different Education 37

Table 4.13 Total CA in L2 Score with Different Education 38

Table 4.14 Total CA in L1 Score with Different Positions 38

Table 4.15 Total CA in L2 Score with Different Positions 39

Table 4.16 Post-hoc Analysis of Total CA in L2 Score with the Positions 39

Table 4.17 Total CA in L1 Score with Different Years of Working 40

Table 4.18 Total CA in L2 Score with Different Years of Working 40

Table 4.19 Post-hoc Analysis of Total CA in L2 Score with Years of Working 41

Table 4.20 Total CA in L1 Score with Overseas Experience 41

Table 4.21 Total CA in L2 Score with Overseas Experience 42

Table 4.22 Total CA in L2 Score with Period of Overseas Experience 42

Table 4.23 Total CA in L2 Score with the Purpose of Travelling Abroad 42

Table 4.24 Comparison of CA Scores in L1 and L2 43

Table 4.25 Theme of the interviewees 52

Table 4.26 Summary of Techniques used 65

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LIST OF FIGURES

Figures

Figure 1 Analytical Framework 4

Figure 2 Continuum from High-Context to Low-Context Cultures

(Williams et al. 2008, p.39) 13

Figure 3 Data Analysis in Qualitative Research (Creswell, 2014) 29

Figure 4 Mind Map of the Frequency of “English” 55

Figure 5 3D Word Cloud of Word Frequency 56

Figure 6 Word Tree of Frequent Words 57

Figure 7 Mind Map of the Frequency of “Information” 58

Figure 8 Mind Map of the Frequency of “Prepare” 59

Figure 9.1 Word Cluster of Frequent Words 60

Figure 9.2 Word Cluster of Frequent Words 61

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CHAPTER 1

INTRODUCTION

1.1 Background

The collaboration between countries in the same region is significant in

supporting the security and economic growth of each region such as the European

Union (EU), Asia-Pacific Economic Cooperation (APEC) and Group of Seven or G7

(consist of seven countries - the United States of America, United Kingdom, France,

Germany, Italy, Japan and Canada). Ten countries in South East Asia formed the

ASEAN Economic Community (AEC), which launched at the end of 2015. It

established a common market between ten ASEAN countries: Thailand, Myanmar,

Laos, Vietnam, Malaysia, Singapore, Indonesia, Philippines, Cambodia, and Brunei.

All members agree to use English as the working language of AEC1. According to

Seidlhofer (2011), English has become a global language that has spread all over the

world. Moreover, English is a primary foreign language in school syllabuses around the

world. Many countries that conduct various activities across the world use English as

an international language.

The Thai government has set a policy to turn Thailand into a medical hub for

the region to support the arrival of AEC (Yongwikai, 2013), as medical treatment in

Thailand has a good reputation in terms of technology and services such as cardiology

and cancer treatment. Therefore, an increasing number of patients and foreigners from

neighboring countries will come to Thailand for medical services. Moreover, the

varieties of collaboration in medical technology between Thailand and many countries

are increasing. Those facilitators who come from USA, UK, Australia, Japan, India,

China and South Africa will use English as an international language for

communication in conferences, workshops or site visits.

Taylor, Nicolle and Maguire (2013) conducted a study, which showed the

significance of communication in healthcare. Their study recognized the essence of

effective communication to ensure patients safety, correction of rules and regulations,

accurate diagnosis and health promotion. Since Thai medical technicians will

communicate in English with a growing number of service receivers, they will also

have to communicate in English properly with confidence to their patients and visitors.

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(ASEAN Charter)

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Moreover, the medical technicians have to be concerned about differences in culture,

context, race, ethnicity and religion, as these significant factors may lead to attaining

the standard of effective communication. Language barriers and cross-culture are also

problems of communication in healthcare (Taylor et al. 2013).

However, some people may have problems communicating in English and face

factors that obstruct their effective communication in English. It is not simple to

confidently communicate in English properly with foreigners in a medical context.

One of the reasons this may occur is from anxiety, which may lead to a problem when

communicating in English for medical technicians. Booth-Butterfiled, Chory and

Beynon (1997) state that communication apprehension has not received much interest

in relation to healthcare. This issue has to be resolved urgently; if not, it may lead to

negative performances from technicians as they may avoid communicating or engaging

with foreigners. The Bureau of Tuberculosis (BTB) is one of the bureaus of the

Department of Disease Control, Ministry of Public Health that has to deal with many

experts and specialists from around the world. These people from the World Health

Organization (WHO) and other international health organizations will provide the

know-how of new technology to BTB and exchange experience in terms of diagnosis

and treatment methods to BTB. Certainly, English is needed in order to communicate

with these people in all areas.

Richmond and McCroskey (1998, p.37) estimated that 20 percent of people are

afflicted with communication apprehension and these people tend to withdraw from

communication situations. This study will examine whether personnel in the medical

field are apprehensive when speaking English to foreigners. It is an essential to find

out the main factors of oral English communication problems. In addition, the study

will offer some suggestions to improve English speaking skills for personnel at both the

Bureau of Tuberculosis and other public health organizations in Thailand.

1.2 Research Questions

This study aimed to answer the following questions:

1.2.1 What are the average scores and levels of communication apprehension

in L1 and L2 of BTB personnel?

1.2.2 What demographic information is associated with CA in L1 and CA in

L2 of BTB personnel?

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1.2.3 Are personnel in the Bureau of Tuberculosis affected by L2

communication apprehension when communicating with foreigners?

1.3 Hypothesis

This study was designed and conducted in order to test the hypothesis as

follows:

H1. The personnel of the Bureau of Tuberculosis have lower communication

apprehension in their native language (L1) than in English language (L2).

1.4 Objectives of the study

The study has the objectives as follows:

1.4.1 To investigate the scores and compare CA in L1 and L2 of BTB

personnel.

1.4.2 To explore the characteristics that affect communication apprehension in

the personnel of BTB.

1.4.3 To explore the level of communication apprehension in BTB personnel

when performing L2 oral communication.

1.5 Scope of the Study

This study was conducted with personnel of the Bureau of Tuberculosis,

Department of Disease Control, Ministry of Public Health, Thailand. The study focuses

on 129 personnel consisting of medical officers, registered nurses, medical

technologists, medical scientists, medical lab technicians, pharmacists, pharmacy

technicians, radiological technologists, radiographer technicians, public health officers,

social workers and administrative officers. The participants had to deal with foreign

experts and/or public health specialists. This study examined the correlation between

L1 and L2 of CA levels in medical professional personnel including administrative

personnel. In addition, the demographic data was compared with CA levels to

determine whether this affected L2 communication apprehension.

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Figure 1 illustrates the introduction of the analytical framework. As can be seen, the

independent variables are demographic data including gender, age, position,

educational background, year(s) of working and overseas experience. The dependent

variable is levels of CA in L1 and CA in L2.

Independent Variable Dependent Variable

Demographic Data

Educational Background

Working Experience

Overseas Experience

Levels of Communication

Apprehension in L1 and L2

Figure 1: Analytical Framework

1.6 Significance of the Study

The study of communication anxiety of the personnel in BTB is significant in

many aspects as follows:

1.6.1 The outcome of this study will help BTB staff to recognize the causes of

problems in oral English communication that may affect their working performance.

Furthermore, the results will assist them to reduce their problem of L2 communication.

1.6.2 The Personnel Division, Department of Disease Control, Ministry of

Public Health will be able to use the data and results from this study to develop and

implement appropriate English courses for the personnel in the BTB and Ministry of

Public Health to improve their oral English skills.

1.7 Definition of Terms

The definition of the terms of this study are as follows:

“BTB” refers to the Bureau of Tuberculosis, Department of Disease Control,

Ministry of Public Health, Thailand.

“CA in L2” refers to a worried feeling when speaking in English. This feeling

will be reflected in the performance in English communication with foreign

interlocutors.

“Communication Apprehension (CA)” is defined as an individual’s level of

fear or anxiety associated with either real on anticipated communication with another

person or persons (McCroskey & Beatty, 1984).

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“Foreigners” refers to foreign visitors, public health specialists and/or experts

who provide and/or receive public health knowledge to/from the medical technicians of

BTB in job training, conferences, meetings or workshops.

“L1” means native language. In this study L1 means Thai language.

“L2” refers to English as an international language, which is used to

communicate among personnel of the BTB and with foreign visitors.

“Personnel” refers to medical officers, registered nurses, medical technologists,

medical scientists, medical lab technicians, pharmacists, pharmacy technicians,

radiological technologists, radiographer technicians, public health officers, social

workers, public relations officers, administrative officers, i.e., personnel officers,

finance/accounting officers, computer technical officers, statisticians, policy and

planning analyst officers and general administrative officers of the Bureau of

Tuberculosis, Department of Disease Control, Ministry of Public Health, Thailand.

“PRCA-24” refers to the Personal Report of Communication Apprehension. It

is a measurement of communication apprehension used to determine the level of CA in

a person that was developed by McCroskey (1978).

1.8 Limitations of the Study

There are two limitations of this study:

1.8.1 This study highlighted only Thai and English oral communication

apprehension in personnel of the BTB. Examinations in writing and listening

communication have not been included; otherwise, the generalization in those skills

may reveal different outcomes.

1.8.2 The researcher focused on the personnel who were working in the public

health area in Bangkok. These people have more chances to communicate with

foreigners than public health personnel working in rural areas. Thus, the results may

show only the problems of the people in urban areas.

1.9 Summary of the Introduction

This chapter has presented the background and the significance of English

communication in the public health area. The researcher sought to investigate the

readiness of personnel in this area when entering the AEC community.

Communication apprehension might limit the proficiency of working performance in

terms of obtaining new methods of diagnosis, treatment, and learning new technologies

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in the public health area, which may in turn act as an impediment to public health

development in Thailand. This chapter has highlighted the purposes, analytical

framework, key terms as well as the limitations of the study.

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CHAPTER 2

REVIEW OF LITERATURE

The key concepts reviewed in this chapter concern the following: (1)

Conceptualization of communication apprehension, (2) Causes and effects of

communication anxiety, (3) Communication apprehension measurement, (4) CA in L2,

(5) How to cope with CA, and (6) Background of the Bureau of Tuberculosis.

2.1 Conceptualization of Communication Apprehension

Communication Apprehension (CA) or Communication Anxiety is defined as

an individual’s level of fear or anxiety associated with either real on anticipated

communication with another person or persons (Beatty, McCroskey & Heisel 1998).

McCroskey (1970) considers that CA is “broadly based anxiety related to oral

communication.” Communication anxiety is clearly an obstacle to communication.

Moreover, people who encounter CA tend to decrease or avoid communication. Fear of

communication is an internal feeling that makes people withdraw from communication

with others (Richmond & McCroskey, 1998). It is important to understand the types of

communication anxiety as defined by Richmond and McCroskey (1998), who divided

communication apprehension into four categories as detailed below:

2.1.1 Communication Apprehension as a trait (Trait-like CA)

Trait-like CA is related to the personality of the speaker. It is the internal

anxiety that an individual brings to a speaking situation. Richmond and McCroskey

(1998, p.43) define this kind of CA as an actual trait, e.g., eye color, height and weight,

which are not able to change. Although we can change our eye colors by using contact

lenses, the real eye color cannot be changed. According to Pongpun (2012, p.9), “Trait

anxiety is explained as a fixed stage of anxiety or a part of a person’s personality”.

Someone with high trait anxiety is presumed to be frightened in communication

situations, while a person with state anxiety is likely to be frightened only in specific

contexts, such as speaking or interpersonal settings.

Booth-Butterfield, Chory and Beynon (1997) state that “people who experience

either higher trait CA or specific health state CA will probably communicate less

effectively with their health care providers about their health problems.” If a medical

technician or patient is uncomfortable to communicate with each other directly, the

patient will receive less effective healthcare service.

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2.1.2 Communication apprehension in a generalized context (Context-

based CA-dyadic, groups, meetings, public speaking and interviews)

This kind of CA is considered as “a relatively enduring, personality-type

orientation toward communication in a given type of context” (Daly & McCroskey

1984, p.16). This type of CA is associated with people who are frightened of

communicating in one type of situation while they are not afraid in other situations. For

example, people may be anxious when speaking in front of a large number of people or

doing public speaking. On the other hand, they feel comfortable to talk with close

friends.

Type of context-based CA consists of:

(1) Dyadic or Interpersonal Communication: communication

between two persons via channels of communication such as a telephone, e-mail, text

message or social website (Adler, Rodman, & du Pré, 2014, p.11).

(2) Small Group Communication: this refers to a group of more than

three people associating in face-to-face communication and working together toward

the same goal. The effective size of small groups for sufficient communication is

between five to eight persons (Hamilton, 2014, p. 262).

(3) Meeting Group Communication: this refers to a group of people

in a profit or non-profit organization engaging in formal communication (Adler et al,

2014, p. 12). Meeting group communication refers to groups of more than seven

(Degner, 2010).

(4) Public Speaking: this means one or more people communicating

to a large number of people who participate as an audience (Adler et al., 2014, p. 13).

2.1.3 Communication apprehension with a given audience across

situations (Audience-based CA)

This type of CA is focused on people’s feedback when communicating

with a given individual or group of individuals across time (Richmond and McCroskey,

1998, p.46). This kind of CA is viewed as “a relatively enduring orientation toward

communication with a given person or group of people” (McCroskey, 1984, p.17).

These particular individuals or groups of individuals may cause communication

anxiety, such as students talking with their teacher or going on a job interview.

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2.1.4 Situational Anxiety or State Anxiety

Situational Anxiety is a temporary emotion arising from specific

situational factors. Some people may become anxious prior to a new communication

situation. For example, a doctor may feel uncomfortable discussing with foreign

patients in English, but with Thai patients they may feel comfortable. They become

nervous, afraid, or excited, and their body’s nervous system prepares them for action

with a big shot of adrenaline, which accelerates the heart rate; sends extra oxygen to the

central nervous system, heart, and muscles; dilates the eyes; raises the blood sugar

level; and causes perspiration (Hamilton, 2014, p.177). High or low levels of state

anxiety may occur depending on the specific situation (Pongpun, 2012, p.9). This kind

of CA can be alleviated by practicing before the occurrence of situation such as English

practice in classroom or daily life. Richmond, Smith, Heisel, and McCroskey (1998)

found that patients’ state CA or fear of physicians (FOP) was higher than trait CA. In

addition, high FOP leads to decreased satisfaction with healthcare.

2.2 Causes and Effects of Communication Apprehension

As English is not the mother tongue or native language of Thai people, it may

not be easy for people who do not use English regularly in daily life. Many Thai people

might feel anxious and uncomfortable to communicate with a foreigner in another

language. Some people may speak another language when they are forced to, which

will increase their anxiety to speak the other language. Therefore, the causes and effects

of communication anxiety is the one of the important issues that needs to be discussed

in this study.

2.2.1 Causes of Communication Apprehension

There are two categories of causes of communication apprehension –

Trait-like Communication Apprehension and Situation Communication. In this study,

the focus is on Trait-like CA.

2.2.1.1 Causes of Trait-like Communication Apprehension

Trait-like communication apprehension is the result of

personality. Trait-like CA stems from family background and environment, which may

predispose people to having high or low CA (Richmond & McCroskey, 1998, p.49).

Apprehensive people may avoid communicating with almost anyone in any

circumstance (DeFleur, Kearney, Plax & DeFleur, 2014, p.269). DeFleur et al. (2014,

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p.270) also mention that trait-like CA is grounded in past experience. Social scientists

do not contend that trait-like CA is based on genetics.

However, in the past twenty years, psychobiologists and

communication apprehension researchers have claimed that trait-like communication

apprehension results from biological functioning and social learning processes (Beatty,

McCroskey, & Heisel, 1998; McCroskey & Beatty, 2000). They argue that it is

genetically linked to personality traits, which they refer to as “communibilogy”. They

also state that genetics are significant to the development of an individual’s

communication behavior.

Richmond, McCroskey and McCroskey (2005, p.72) mention

that some communication behavior such as language in childhood or non-verbal

communication in some cultures can be learned. According to Richmond et al. (2005

p.72) (as cited in Beatty & McCroskey, 2001), “the communibiologists point out that it

seems the inheritance of genetics may be the major factor of a communication trait,

which is the main factor in temperament and personality”.

Richmond et al. (2005, p.71) also point out that the association of

many kinds of traits can be identified as “Super Traits” or “temperament”. Super traits

or temperament may be associated with many characteristics of human behavior and

communication. Rothbart, Ahadi and Evans (2000) argue that temperament is based on

genetics and personality is influenced by temperament. McCroskey, Richmond, Heisel

and Hayhurst (2004) found that temperament may be one of the significant factors

regarding oral communication traits. Paulsel and Mottet (2004) state that

communication apprehension is peoples’ apprehension level linked to communication

and is associated with temperament. Understanding temperament will help people deal

with communication with others in various circumstances.

2.2.1.2 Causes of Situational Communication Apprehension

The causes of situational or state CA differ from one person to the next

and from one situation to others. Richmond and McCroskey (1998, p.50) cited by Buss

(1980) and DeFleur et al. (2014, p.272) list the main causes of anxiety as shown below:

(1) Novel situations: This will often cause an individual some

apprehension because they do not know how to send feedback or interact. It is difficult

to estimate how to act in a new situation.

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(2) Formal situations: Anxiety will increase when people are

expected to communicate properly. People may not be confident in how to behave in

particular formal settings.

(3) Subordinate status: This will occur when people have “higher

status” than another, such as when a prime minister meets with people. In this situation,

people might experience situational shyness. People in higher position may make us

feel nervous and anxious to talk with them.

(4) Feeling conspicuous: This may cause apprehension. In this

situation, people will be very noticeable, or they may feel different from other people.

People will be anxious when they turn to be the center of attention.

(5) Unfamiliarity: People may feel uncomfortable to deal with

different norms and cultures than their own, because they are not familiar with those

factors. Therefore, anxiety may increase in these situations.

(6) Dissimilarity: The more dissimilar we are to others, the harder it

is to communicate with them. Increases in dissimilarity will increase anxiety.

(7) Excessive attention: If people receive too much attention, they

may feel uncomfortable and this will increase anxiety.

(8) Repeated failure: If we have not succeeded in the past, we will

be worried that we will fail again.

2.2.2 Effects of Communication Apprehension

McCroskey (1984, p.33) categorized effect of CA in two categories:

(1) Internal Effects

Communication apprehension is a cognitive response that occurs

internally. McCroskey (1984, p.33) states that “the only effect of CA that is predicted

to be universal across both individuals and types of CA is an internally experienced

feeling of discomfort”. People with low CA will feel comfortable to communicate in

their minds. On the other hand, the internal feelings of people with high CA may

include discomfort, fear and the inability to control their emotions. Richmond and

McCroskey (1998, p.52) assert that the relational effect of internal fear affects peoples’

bodies such as accelerating heart rates, stomach aches, sweating, shakiness and dry

mouths.

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(2) External Effects

Richmond and McCroskey (1998, p.52-53) state that there are

three main reactions to of the fear of communicating:

(a) Avoidance: In case people are afraid of someone or

something, they may opt to avoid communication.

(b) Withdrawal: Sometimes it is impossible to keep avoiding

the communication situation. People with low willingness to communicate (WTC) will

withdraw by keeping quiet or expressing minimal opinions in a conversation.

(c) Disruption: This type of effect will appear in people who

are not fluent in verbal speech. People may express themselves in inappropriate ways

such as stuttering or biting their nails.

(d) Overcommunication: This kind of effect is quite rare in

communication anxiety. People with extremely high CA may cope with their fear by

talking excessively, but this is a rare and abnormal reaction.

2.2.3 Cultural differences

In addition, there are several dimensions of cultural differences that also cause

conflict in communication (Hamilton, 2014, p.74), which consist of (1) Individualistic –

Collectivistic; (2) High-Low Context; and (3) Monochromic-Polychromic.

Eastern culture tends to value their group members achieving group goals,

which we refer to as “collectivistic”. On the other hand, western culture is different in

terms of action and concept. “Individualistic” cultures encourage people to focus on

their own rights rather than the group. Croucher (2013) argues that individualism or

collectivism have a significant effect on communication apprehension. Table 2.1

illustrates the differences of Individualistic and Collectivistic cultures.

Individualistic Collectivistic

Emphasis on individual’s goals

Self-realization

Little difference between in-group and

out-group communication

Independent self-construal

“I” identity

Saying what you are thinking

Emphasis on in-group’s goals

Fitting into the in-group

Large difference between in-group and

out-group communication

Interdependent self-construal

“We” identity

Avoiding confrontations in in-group

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Individualistic Collectivistic

Low-context communication: direct,

precise, and absolute

High-context communication: indirect,

imprecise, and probabilistic

Table 2.1 Major Characteristics of Individualistic and Collectivistic Cultures

(Tubbs & Moss, 2008, p.319)

As mentioned above, the second difference is high-low context cultures. High-

context cultures focus on relationships and may prefer indirect communication. On the

contrary, low-context cultures prefer direct communication and pay attention to the

goal rather than the relationship (Williams, Krizan, Logan and Merrier, 2008, p.39).

High Context Low Context

Figure 2: Continuum from High-Context to Low-Context Cultures (Williams et al.

2008, p.39)

2.2.4 Relevant studies on causes and effects of communication

apprehension

1. Cultural differences

Knutson, Hwang and Vivatananukul (1995) compared the CA in Thai

and American students. The result revealed that Thai students had exhibited higher CA

than American students. They also stated that Thai culture and family background

taught Thai children to try to avoid the confrontation. Thai children would not express

any comments to the senior people or people with a high status if they did not agree.

Pribyl, Keaten, Sakamoto, and Koshikawa (1998) conducted a study

with 283 students in a private university in Tokyo. The outcomes revealed that

Japanese women were more apprehensive than men in a public speaking context, with

both of them experiencing more communication apprehension in public speaking than

Americans. In addition, Japanese culture pays more attention to masculinity than

femininity and women may thus express themselves less in the public settings.

Gibson and Zhong (2005) conducted the study with 136 medical

providers and patients at a non-profit healthcare organization in the western United

American

Scandinavian

German

French Japanese

Chinese

Arab

Greek

Mexican

Spanish

Italian

French English

Canadian

American

English Canadian

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States to examine the intercultural communication competence of healthcare providers

and patients' perceptions towards healthcare providers' ability to communicate with

diverse patients. The study revealed that positive empathy was correlated with

intercultural communication competence in both healthcare providers and patients'

perceptions. Empathy played a significant role in terms of intercultural communication

competence toward patients' perceptions. This study illustrated that the significance of

intercultural communication is one of the factors determining the effectiveness of

healthcare treatment.

Hofstede and Hofstede (2005) mentioned that Thai culture accepted the

people holding a high status and a high-powered in the organization. People of high

power-distance culture have more powerful than junior people. In addition, junior

people or low power-distance people would respect and listen to senior people or

people with a higher position.

Anyadubalu (2010) studied students’ recognition of self-efficacy and

anxiety in obtaining English language in a Thai girls’ secondary school with 318

students between 13-14 years old. The researcher recommended that foreign teachers

teaching English language to Thai students should learn and understand Thai culture, as

this will encourage students to improve their English competency and confidence.

Croucher (2013) examined the association among communication

apprehension (CA), self-perceived communication competence (SPCC), and

willingness to communicate (WTC). The research findings pointed out that religious

identification or immigration status dramatically affected CA, SPCC, and WTC.

French Muslims had higher CA, whereas French Catholics had higher SPCC and WTC,

respectively. Since Catholics in France are the majority, they could express their

thoughts with less apprehension. On the other hand, Muslims are a minority in France,

and as such prefer non-direct communication and are less confident. The researcher

found that individualism and collectivism have a significant effect on CA, SPCC and

WTC. People who had higher scores of collectivism tend to have higher levels of CA.

The research revealed that the surrounding context, e.g. religious, cultural background,

individualism/collectivism, political, and economic, have a significant effect on CA,

SPCC and WTC.

Taylor et al. (2013) conducted a qualitative study with 34 respondents

and six healthcare providers with ages ranging between 25-60 years old. Moreover, 40-

45 minute semi-structured interviews were conducted to obtain in-depth information

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from each interviewee. They investigated healthcare professionals who treated the non-

English native speaker patients and received medical treatment at a healthcare center in

the United Kingdom. The researchers observed that low literacy and language barrier

resulted in a lack of confidence across cultures, including patients with poor or no

English language skills. Low literacy was related to anxiety and a lack of confidence

among patients; however, the improving of knowledge of language barriers and poor

literacy could help the workflow and staff-patient interactions.

Rimkeeratikul (2017) conducted a study of CA in L1 and CA in L2

among Thai monk Ph.D. students. The results revealed that there were no any

differences of four dimensions of communication of monk Ph.D. students, between CA

in L1 and L2. However, ANOVA analysis discovered that the result of CA in L2 was

different based on the number of years in the monkhood. Monk students, who were in

the monkhood for a longer time, had lower CA than the monk students who had fewer

years of experience in monkhood. It is possible that the monk who has more

experience in monkhood may have gained more experiences to deal with the

communication problems in many situations. In addition, they may have obtained high

self-esteem from the people who believe in and respect them. Furthermore, the

seniority system is also important for the monk with longer time in the monkhood to

have more confidence when using L2, since members of Thai society paymore respect

to senior people, especially with a higher status.

2. Demographics

In the article of McCroskey and Beatty (2000), it revealed that genetics

affect various dimensions of human behavior, learning processes and communication.

Moreover, cultural background, political situation, economic status and environmental

surroundings are related to human communication; the results also showed that

neurobiological structure and the communibiological perspective are related to

communication behavior. They argue that the effect of genetics and environment are

significant issues in regard to human behavior.

Neuliep, Chadouir and McCroskey (2003) conducted a study focusing

on the cause of communication apprehension resulting from genetic factors or

communibiology. Even though communication apprehension results from genetics,

culture also leads to high or low communication apprehension. The communibiological

perspective holds that the genetic element is a significant cause of communication

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apprehension; however, differentiation in cultures and norms probably result in

distinctions between cultures and levels of communication apprehension.

Frantz, Marlow and Wathen (2005) examined the communication

apprehension of 699 undergraduate students from Huntington College. This study

investigated the communication apprehension in students of different genders and

college years. The findings of this study reported that females had communication

apprehension at a mean 69.12, which was higher than males at only 62.62. However,

there were no significant differences with respect to year.

Degner (2010) conducted a study on communication apprehension at a

Texas community college by employing the quantitative method in 111 participants

both supervisor levels and support staff. The results from the post hoc test to make a

multiple comparison showed significant differences with respect to position and

communication apprehension, that is, support staff (e.g. clerical staff, support staff,

clerk, administrative staff and secretaries) and middle line staff (division chair,

manager, coordinator, director), support staff and operation (full-time faculty), support

staff and technostructure (non-faculty professional, specialist, technical assistant,

analyst, advisor, counselor). The researchers encouraged the head of the college to

show concern for communication apprehension in the organizational structure.

Kasemkosin (2012) conducted a communication apprehension study in

student officers at the Royal Thai Air Force language center. The outcome showed that

the students had average CA as compared to the mean score that gathered the high level

of CA. The demographic information showed that title and educational background

were associated to the student’s CA level. However, the English comprehension level

and experience in native English countries was not related with their CA level.

Boonsongsup and Rimkeeratikul (2012) conducted a study of the

willingness to communicate (WTC) and communication apprehension (CA). The

results revealed that the demographic information that WTC in L2 and CA in L2 was

working experience. The results showed that high WTC in L2 or willingness to

communicate was found in the participants between 1-5 years of experiences. On the

contrary, low level of WTC in L2 and high level of CA in L2 were found in the people

who had experiences of more than 10 years.

Taylor et al. (2013) also found in their study that females had a better

response to treatment than males, because they keep repeating the method to treat

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themselves. Meanwhile, over-confidence in males keeps them quiet or causes

misinterpretation of the treatment during translation.

Rimkeeratikul (2016) examined the CA in L2 among the first-year and

second-year of a Master Degree students majoring in English in Bangkok. The result

revealed that both groups were with a medium level of CA in L2. They felt relaxed

when they performed oral English communication. However, the mean scores of CA in

L2 of the first-year students in four dimensions of communication were higher than

those of the second-year students. This study may indicate that students of this

Master’s Degree program might have felt that they were better at the English language,

which helped them be more confident when using English.

2.3 Communication Apprehension Measurement

One of the most well-known communication apprehension measurements is

“The Personal Report of Communication Apprehension-24 (PRCA-24)”, which was

developed by McCroskey (1998). It was designed to measure a common trait of

communication apprehension or anxiety on how people interact with others by oral

communication. The score in this test will show the level of communication

apprehension (McCroskey, Richmond & Steward 1986). With this measurement, the

participant will get a view of their own CA and in which situations they will encounter

a problem in oral communication. Charlesworth (2006), Frantz, Marlow and Wathen

(2014) state that the PRCA-24 measurement is a reliable and valid instrument to

generate data, so this instrument was an appropriate tool to employ in this study.

The PRCA-24 categorizes communication apprehension into four dimensions –

small groups, speaking in meetings or classroom situations, interpersonal encounters

and public speaking (McCroskey et al., 1986). This tool uses self-measurement,

employing a 5-point Likert scale to determine the level of apprehension. The reliability

of this form is high (Daly & McCroskey, 1984). The scores of this measurement range

from 24 to 120. Richmond and McCroskey (1998) indicated that scores above 65 will

show the general CA in people; it means that people have more problems in

communication than normal people. Meanwhile, scores above 80 indicate that the

people have a very high level of CA; they are afraid to communicate with others and

this makes them avoid these situations. On the other hand, scores below 50 mean that

people have a low CA; they are ready to communicate. This measurement is not too

complicated to comprehend and it is a well-known communication apprehension

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measurement; therefore, this measurement was chosen for this study. Degner (2010)

cited McCroskey (1984) in claiming that “The Personal Report of Communication

Apprehension-24 is an appropriate scale for measuring the level of communication

apprehension in dyadic, group, meeting, and public-speaking contexts”. In this study,

the Thai version of PRCA-24, which was developed by Rimkeeratikul (2008), was

applied.

Relevant studies on the PRCA-24 measurement

Pribyl, Keaten, Sakamoto and Koshikawa (1998) conducted a study of the

validity of PRCA-24 in a Japanese context. Although, PRCA-24 is a wide trait-like

communication apprehension measurement, it was not well-known in Japan. The

outcomes revealed that some students were confused between the group and meeting

dimension communication because of a lack of experience or cultural differences. The

conclusion of this study suggested that PRCA-24 could be employed in some of CA

dimensions for Japanese people.

Frantz et al. (2005) investigated the CA of 138 undergraduate students of a

small liberal arts Christian college in the midwestern United States. This study aimed to

examine the association between CA and gender as well as the relationship between CA

and one’s year in college. PRCA-24 was employed as the research instrument to

measure the trait-like CA in the participants. They mentioned that the PRCA-24 is a

reliable measurement of trait-like CA that had high validity. The PRCA-24 results

revealed that females had a higher level of CA than males. The study also found no

significant relationship between CA and length of time in college.

Francis and Miller (2008) conducted a study to examine oral communication

apprehension levels of 2,040 first-generation college students of Northwest Arkansas

Community College. The PRCA-24 was chosen as the research instrument to measure

the CA of the participants, since it is widely used, and a reliable and valid measurement

of oral communication apprehension. In addition, this instrument was developed to

measure all four dimensions of communication apprehension in a generalized context

e.g. interpersonal communication, group discussions, meetings, and public speaking.

The outcome from the PRCA-24 indicated that the participants of this study were

categorized as having medium apprehension.

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2.4 Communication Apprehension in Second Language (CA in L2)

English is seen as a significant communication language throughout ASEAN.

Thus, English is the second language of the region for commerce, education, security

and other cooperation both for the private sector and government sector. In some

countries that use English as a second language, the people hesitate to communicate in

English. It is possible that English is not their mother tongue language and people may

find it exhausting to express themselves in English. CA in L2 affects English

communication. There have been a number of studies conducted on communication

apprehension in a second language.

Relevant studies on CA in L2

Jung and McCroskey (2004) found that there was strong relation between native

language and second language in trait-like CA. They also pointed out that CA in L2

could be predicted from the CA in L1. That is, people who held high CA in their first

language were possibly had high CA problems in the second language.

McCroskey, Fayer, and Richmond (1985b) compared the American and Puerto

Rican students. The results revealed that the Puerto Rican students had lower CA when

communicating in their mother tongue. The result also showed that students who

confronted with high CA in their native language tended to be found holding high CA

in the second and the third languages. McCroskey, Gudykunst, and Nishida (1985c)

investigated the level of CA among Japanese students who spoke Japanese (L1) and

English (L2). The result exhibited that Japanese students had an extremely high CA,

both in L1 and L2. This study pointed out that CA in L1 should be focused prior to

reducing CA in L2.

Anyadubalu (2010) looked at students’ recognition of self-efficacy and anxiety

in obtaining English language. The results of this study showed that low self-efficacy

tended to increase their level of anxiety in English language examinations. They also

had low scores in terms of obtaining and competence in learning including efficiency in

English study. The results indicated that self-efficacy was correlated with English

language anxiety; that is, in those the students who exhibit a high level of self-efficacy,

their English anxiety will be low and they will have high efficiency in other

performances. The results from this study revealed that the level of English language

anxiety affected the students’ English communication.

Tom, Johari, Rozaimi and Huzaimah, (2013) investigated the factors related to

communication apprehension in 49 pre-university students from Sarawak, Malaysia.

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Although, English is the second official language in Malaysia, it was found that

students in rural areas of Malaysia view English as a foreign language used in the

classroom. The results revealed that most students feel uncomfortable to participate in

group discussions and were nervous to participate in English speaking activities. The

outcomes showed that they were also afraid to communicate with a new acquaintance

and speak up in a conversation as well as uncomfortable to give a speech to the public.

However, they were not tense or nervous when using their mother tongue language.

Communication apprehension was found to be a problem for pre-university students for

learning English as a second language.

Őztűrk and Gűrbűz (2014) conducted a study to explore the levels, main issues,

factors of foreign language speaking anxiety and students’ viewpoint in a Turkish EFL

context. The results from the EFL questionnaires or quantitative data analyses showed

that the students in this study had a low level of speaking anxiety in the classroom.

Although the data analyses using a quantitative method revealed a lower rate of anxiety

in their classroom, the qualitative data analyses identified different outcomes.

Considering the information from the interviews, the researchers found that there were

many factors arousing anxiety in those students such as oral communication skill,

preparation time before speaking the foreign language, the student’s self-confidence,

being worried about making mistakes in pronunciation or using wrong English

vocabulary and feedback or assessment of other students in class.

Rimkeeratikul (2015) investigated the study of CA in L1 and L2 among the

first-year engineering students in a public university in Bangkok, Thailand. The result

showed that the total CA in L1 and that in L2 of those students were at a moderate

level. However, the results revealed that the CA in the meeting dimension in L1 of the

students was found higher than that in L2. It was discussed that it might be because the

students may not have got any real experience attending the meeting which was

conducted in English. Accordingly, they did not imagine the feeling of the stress to

communicate in English when they attend the meeting.

Rimkeeratikul, Zentz, Yuangsri, Uttamayodhin, Pongpermpruek, and Smith

(2016) conducted a study of CA in L1 and L2 among first-year students of a graduate

program for executives in a public university. The results revealed that there was no

significance difference in the trait-like CA among the students of this program when

using English in their oral communication. It may possible that the participants of this

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study did not emphasize speaking skills, so they did not feel anxious when speaking

English.

2.5 How to Cope with CA

Since the quality of communication is essential in increasing the effectiveness

of job performance, there are a number of techniques or strategies to overcome the

obstacle of communication apprehension. A number of studies have suggested key

techniques for people faced with communication apprehension.

Relevant studies on the strategies to cope with CA

1. Positive strategies

Kondo and Ying-Ling (2004) categorized five strategies to cope with

CA: Preparation, Relaxation, Positive Thinking, Peer Seeking, and Resignation. They

stated that preparation can improve communication as well as reduce apprehension.

They also assert that people will change stressful situations with positive thinking,

which may help decrease their CA.

Francis and Miller (2008) indicated that there are many strategies to

cope with CA. Preparation is also one of effective strategies which the participants

used. Preparation helps improve confidence and decrease oral communication

apprehension. Skill training is a good way to manage using a variety of methods such

as role playing, modeling, coaching, rehearsal, reinforcement and feedback. Modifying

physical responses can assist people to reduce their CA, e.g. relaxing of muscles, heart

rate training, deep breaths, etc. Some students employed visualization techniques to

deal with their CA by imagining themselves in anxiety-producing situations. Humor

can also help students get relief from their CA. The students used more than one

strategy to reduce their CA such as preparation with modified physical response.

Regarding assertiveness, the students tended to take a risk by asking for a first person to

give a talk because they did not want to remain nervous for a long time. Some students

were unable to deal with their CA and did not try to use the above strategies to reduce

their CA.

Scott and Timmerman (2005) conducted a study to explore the

relationship between unique forms of apprehension (via computer, orally, and in

writing). The data collection was conducted at two different points in time (5-year

interval) from 205 employees. The results of this study revealed that even though the

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apprehension levels were stable during the period of time, the frequency of using

technologies during the past five years changed rapidly to help people cope with their

problem in communication. They mentioned that people had more choices to select

technologies to help them overcome their apprehension.

Leeds and Maurer (2009) conducted a quasi-experimental study of

second-year students in an information systems course at a large southeastern state

university. The PRCA-24 was employed to examine the level of CA of the participants.

PRCA-24 pretests and posttests were given to the control group and the treatment

group. The control group gave in-class presentations while the treatment group

delivered their presentations in the form of digital video through the VISTA course

management system. Therefore, the treatment group did not face their classmates or

instructor directly. The results revealed that technology such as digital video could

assist people in decreasing their CA as well as increasing their presentation ability.

Matsuoka and Rahimi (2010) conducted a qualitative study with nine

students majoring in nursing at a college. The results showed that the participants were

able to reduce the level of their CA from their intention. The study recommended

negative and positive strategies to reduce CA in L2. Negative strategies:

Competitiveness, Perfectionism and Other-directedness. Positive strategies: Gaining

opportunities of using English, Understanding the importance of communication,

Gaining confidence of speaking English and Feeling confident and happy.

Dong (2014) lists six principles to reduce CA. The basic principle was

self-motivation. It is a powerful method to enhance communication and it is an

important key to success. Another interesting strategy is adaptability. When people are

in a new environment, they may feel uncomfortable. They resolved this problem

through their ability to adapt themselves and be open minded to new people and

environments.

2. Negative Strategies

Phillips (1984) found that people tend to avoid communication because

they believe that it will be worse when they talk.

Kondo and Ying-Ling (2004) discovered that the student were not

willing to present when they experienced language apprehension, and avoided the

situation because they did not want to lose face in the classroom.

Boonsongsup and Rimkeeratikul (2012) found that people who worked

for many years tried to avoid English communication situations because they were

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uncertain about the results. Thus, they attempted to avoid “losing face” from junior

staff. In addition, age of the respondents affects WTC in L2 but not CA in L2. If the

participants had high WTC in L2, they had low level of CA in L2. Furthermore,

perceived English language competence affects WTC in L2 and CA in L2 levels.

Patil and Karekatti (2012) found that people who have communication

apprehension will withdraw when the situation arises or they may keep quiet. They will

react when it is necessary to do so.

Suwannaset and Rimkeeratikul (2014) conducted a study with ten 5th

year student teachers of English at the Faculty of Education, Burapha University. From

the interviews and data analysis, the researcher found that the participants sought

solutions for reducing their anxiety during teaching practice as follows: 1) avoiding

high-pressure situations and finding a pleasurable place to rest; 2) positive thinking; 3)

being tolerant; 4) talking to someone about the situation; 5) evaluating the issues and

attempting to solve the problem on their own; and 6) stop thinking about the worrying

issues.

2.6 Background on Bureau of Tuberculosis

Tuberculosis or TB was a harmful disease after the end of World War II in

Thailand. The death rate from TB was very high at 217:100,000 people in 1949. This

rate did not include people in rural areas. The Bureau of Tuberculosis was established

by the Tuberculosis Control Division to provide treatment and contribute knowledge

regarding preventing and protecting Thai people from TB.

In 1951, the World Health Organization (WHO) and The United Nations

Children's Fund (UNICEF) provided medicine, medical supplies, and scholarships to

the Ministry of Public Health of Thailand in order to eliminate TB in Thailand.

TB is still a public health problem in Thailand. The WHO has ranked Thailand

number 22 among the countries with highest number of tuberculosis cases in the world.

That is, in the Thai population of 67 million, 93,000 new TB patients are found each

year and the overall estimated TB prevalence is 130,000 cases. The WHO and other

healthcare stakeholders such as international funding – Global Fund (GF) for AIDs, TB

and Malaria and Thailand MOPH-U.S. CDC Collaboration (TUC), have provided new

technical assistance, funding and knowledge to strengthen the BTB and Ministry of

Public Health in order to reduce new TB cases in Thailand (WHO, 2015).

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As mentioned earlier, the BTB has obtained international support from various

organizations. The TUC is one of the international organizations supporting the

activities to stop TB in Thailand and the researcher used to work with this organization.

The TUC has collaborated on many aspects with the BTB to provide funding, know-

how and new medical technologies. Sometime, oral English communication between

TUC staff and BTB staff created a problem; consequently, this study looked at the

problem of English oral communication in BTB personnel.

2.7 Summary of Review of Literature

The above concepts and literature identify communication apprehension as one

of the major factors that impact the effectiveness of communication. The findings of

this communication apprehension study will contribute clearer answers regarding the

causes and effects of communication anxiety, which could be advantageous to the

public.

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CHAPTER 3

RESEARCH METHODOLOGY

This chapter describes the research methodology employed in the study. This

chapter consists of four sections: (1) the participants, (2) the research instruments, (3)

the procedures, and (4) the data analysis.

3.1 Participants

A total of 129 staff of the Bureau of Tuberculosis of the Department of Disease

Control, Ministry of Public Health was the sample of this study. The sampling

procedure in this study was one of the non-probability sampling strategies –

convenience or opportunity sampling. It is the most popular procedure in L2 research

(Dörnyei, 2011 p.98). In addition, the population and sample of this study were the

same. The personnel in BTB held a variety of positions such as medical officers,

registered nurses, medical technologists, medical scientists, medical lab technicians,

pharmacists, pharmacy technicians, radiological technologists, radiographer

technicians, public health officers, social workers, public relations officers,

administrative officers including personnel officers, finance/accounting officers,

computer technical officers, statisticians, policy and planning analyst officers and

general administrative officers. Most medical professional staff members tended to use

English in their working life. Additionally, supervisors in the administrative field had a

chance to attend meetings or presentations conducted in English. The respondents

completed questionnaires to provide their demographic data including PRCA-24 to

measure the four dimensions of CA levels.

3.2 Research Instruments

There were two research instruments employed to answer the research

questions. The first research instrument of this study was a questionnaire. The second

tool was interviews with six personnel in the BTB to obtain in-depth information

regarding the effective techniques to solve their CA.

3.2.1 The questionnaire was divided into two parts:

Part I: Demographic Data

The respondents were required to answer questions such as gender, age, marital

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status, education background, years of working, current position and overseas

experience.

Part II: Personal Report of Communication Measurement

In this part the research instrument was the Personal Report of Communication

Measurement or PRCA-24, which was adopted from McCrosky (1978). The PRCA-24

is a research tool based on the four contexts of communication that is capable of

measuring apprehension in four dimensions: dyads (interpersonal), meetings, groups,

and public speaking when communicating in Thai and in English (McCroskey, Beatty,

Kearney & Plax, 1985). However, the Thai version of the PRCA-24 was used in this

research to avoid misunderstanding. Klopf and Cambra (1983) maintain that the

PRCA-24 is an efficient research instrument for English native speakers.

The PRCA-24 uses a 5-point Likert scale with rating scores from 1 – 5 to

measure participants’ comprehension apprehension. The points are as follows:

1 = Strongly agree

2 = Agree

3 = Neutral/Undecided (I neither agree nor disagree.)

4 = Disagree

5 = Strongly disagree

The questionnaire contained close-ended questions and respondents had to

complete both two parts, i.e. demographic data and PRCA-24 questionnaire.

3.2.2 The interview had two main questions as follows:

(1) How do you feel when speaking with foreigners?

(2) A. If you are confident, what makes you feel this way?; or

B. If you are not confident, how do you cope with that feeling?

3.3 Procedures

The procedures used in data collection and analysis are as follows:

3.3.1 Research Design

This research was a mixed method study aimed to obtain qualitative and

quantitative data on the level of communication apprehension of non-English native

speaker in the Bureau of Tuberculosis, Department of Disease Control, Ministry of

Public Health when communicating in English as part of their duties. The PRCA-24

was employed to measure the CA in the BTB personnel. Furthermore, the study

investigated the association between demographic data and CA in the respondents. The

questionnaire pilot session was conducted with 16% of BTB staff or 20 persons to test

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the reliability of the data analysis. Dörnyei (2011, p.44-46) describes a mixed method

study as a combination between quantitative and qualitative methods in a single study.

This method will increase the strengths and reduce the weaknesses in a study, providing

for greater understanding and validity.

3.3.2 Data Collection

Data collection was divided into two parts. The first part sought

demographic data and the second part used the PRCA-24 to investigate communication

apprehension in four dimensions.

(1) In the first stage, data was obtained from the questionnaires and

the second stage was personal interviews. The questionnaire was piloted with 20

respondents. After the pilot session was completed, the questionnaires were distributed

to all respondents. A total of 100 copies of the questionnaire were distributed to the

BTB through project staff employed by the BTB. A total of 92 questionnaires were

returned.

The PRCA-24 allows for the computation of one total score and

four sub-scores (Richmond & McCroskey 1998, p. 133-134). The sub-scores are linked

to communication apprehension in each of the four dimensions; that is, group

discussions, meetings, interpersonal conversations (dyad), and public speaking. The

calculation of sub-scores is as below (Richmond & McCroskey 1998):

Sub-scores Scoring Formula

Group discussions 18 + (scores from item 2, 4, and 6) – (scores from item 1, 3, and 5)

Meetings 18 + (scores from item 1, 3, and 5) – (scores from item 7, 10, and 11)

Interpersonal

conversations (dyad)

18 + (scores from item 14, 16, and 17) – (scores from item 13, 15, and 18)

Public speaking 18 + (scores from item 19, 21, and 23) – (scores from item 20,22, and 24)

The total score comes from adding up the sub-scores. Richmond

and McCroskey (1998, p.44) indicate that scores range from 24 to 120. Scores below 50

represent people who have very low CA level; it means they are happy to speak in L2.

Scores ranging between 51-64 show the score of an average person. On the other hand,

scores higher than 65 mean that the respondent has general anxiety or is afraid to talk.

Meanwhile, scores above 80 represent people who have high levels of trait

communication apprehension or fear. The survey was undertaken from May-August

2015.

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(2) The second stage of data collection was personal interview

sessions consisting of three questions posed to six personnel of the BTB. The interview

sessions were conducted in the Thai language (L1) to collect in-depth information on

communication apprehension, which aimed to determine the cause of problems in L2

communication apprehension and also the strategies used in their daily lives. The

respondents were selected based on the scores of their CA. These people were also

willing to give more information through interviews as they gave their contact details to

the researcher. The interview sessions were recorded with an MP3 recorder and

transcribed. Also, the responses were translated from Thai into English by the

researcher.

3.4 Data Analysis

3.4.1 Quantitative Analysis

The findings of this study were analyzed using the Statistical Package

for the Social Sciences program (SPSS) version 17. Descriptive statistics of mean and

standard deviation were used to analyze the frequency and percentage of respondents’

demographic data, i.e., gender, age, education, position and years of working with the

BTB.

T-test analysis was implemented to compare CA in L1 and L2 in each

dimension of communication. The statistical significance level of t-test analysis was set

at 0.05 or less (p≤0.05) to determine if the test was significant.

One-way Analysis of Variance (ANOVA) was used to compare CA

levels in L1 and L2 in terms of the demographic data, i.e., age, education, job

differences and working experience. ANOVA was computed for two variables – the

independent variables and dependent variable. In this study, the independent variables

were the demographic characteristics as described above and the dependent variable

was the CA scores in both L1 and L2.

A 5-point Likert scale was used to measure the communication

apprehension of respondents. The rating scores ranged from 1 (strongly agree) to 5

(strongly disagree).

3.4.2 Qualitative Analysis

The interview part was conducted with six respondents who were

willing to provide in-depth information to the researcher. The results of their CA

revealed that some people had high CA in L2, but it was lower in L1. However, some

of the people had high CA in L1, but the CA was low in L2. In addition, some of them

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had high CA in both L1 and L2. Six interviewees represented both the medical

professional field and administrative field. Those six positions consisted of medical

doctor, nurse, medical technician and administrative staff. The researcher conducted

face-to-face interviews with the participants. The interview sessions were recorded

digitally by an MP3 recorder. The interview data were manually transcribed into

verbatim transcriptions (Vågan, 2009). The verbatim transcriptions adhered to the data

management protocol of many studies conducted in relation to mixed-method

investigations (Halcomb & Davidson, 2006). The transcriptions of the interviews were

done in Thai and then translated into English by the researcher. The English

translations were reviewed by an experienced translator. The qualitative data analysis

was adapted from the model of Creswell (2014). In addition, the transcriptions were

done in a verbatim approach and then reduced to the main themes (Yoosawat, 2013).

To validate the accuracy of the data from the qualitative analysis,

computer-aided qualitative data analysis (CAQDAS) was used to support data

management in the qualitative method (Dörnyei, 2011, p.263). Therefore, the NVivo10

software program was employed to transform the most frequently occurring words in

the interview sessions from the six participants into pictures. This program assisted the

Themes Description

Coding the Data

(hand or computer)

Validating the

Accuracy of the

Information

Interpreting the Meaning of

Themes/Descriptions

Reading through All Data

Organizing and Preparing Data for

Analysis

Raw Data (transcripts,

fieldnotes, images, etc.)

Figure 3: Data Analysis in Qualitative Research (Creswell, 2014)

Interrelating Themes/Description (e.g. grounded theory, case study)

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researcher to obtain the necessary details for qualitative data analysis as opposed to

hand coding (Creswell, 2014).

3.5 Pilot Study

A pilot study was conducted to test the understanding of the participants toward

the research instruments in both parts of the questionnaire – Part I: Demographic Data

and Part II: PRCA-24. The questionnaire was distributed to 20 participants, or 16% of

the 129 participants. A total of 20 copies of the questionnaire were distributed to

medical doctors, nurses, medical technicians and administrative staff and all 20 copies

were returned. There were two issues learned from the feedback of participants:

(i) The chief of the medical scientists recommended that the researcher add

a medical technician position under Part I: General Information. This was not only

because there was a medical scientist in the BTB, but the chief also felt that the medical

technician should be mentioned. The medical technician position is also a professional

position in the public health field.

(ii) Part II: The PRCA-24 questionnaire - the researcher should indicate in

the title which one was for the Thai or English context, because the questions are the

same. However, the chief of the medical scientists thought that the questionnaire was

different situation. Indicating whether it is a Thai or English context would help the

participants imagine themselves in the situation.

The pilot study was conducted in March 2015. The feedback from the

participants was used to amend the questionnaire in terms of making it clearer and more

consistent.

3.6 Summary of the Research Methodology

This chapter described the methodology, the procedures and statistical tools

used in this research study. The aim of this study was to investigate the CA in L1 and

L2 of the BTB personnel, which one was the most significant causes of their oral

communication apprehension. In addition, it explored the communication apprehension

among BTB personnel when performing L2 oral communication. This study also

explored whether demographic factors cause communication apprehension in the

personnel of BTB. The dependent variable was communication apprehension and the

independent variables in this study were gender, age, educational background, job

differences, working experience, overseas experience and length of overseas

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experience. The participants in this study were 92 staff members working in the Bureau

of Tuberculosis, Department of Disease Control, Ministry of Public Health.

Descriptive statistics, t-test and ANOVA analysis were employed to analyse the data

according to objectives of the study.

In addition, personal interviews were conducted with selected informants.

Verbatim transcriptions were opted for to deal with the interview data. The NVivo10

software program was used to check the accuracy of the qualitative data analysis over

verbatim transcriptions.

The next chapter will show the results of the data analysis of the study.

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CHAPTER 4

RESULTS

The previous chapter described the respondents of the study, research

instruments, procedures and data analysis. This chapter reports the results of the study

which is divided into four parts based on the questionnaire and the research questions.

In addition, the results are presented based on the objectives and research questions of

the study.

The results from 109 questionnaires answered by 92 BTB personnel or 84% of

the participants were explored in order to investigate the level of oral communication

apprehension in Thai and English of respondents with different demographic data e.g.

gender, age, education, position and years of working, as indicated in the objective of

this study. Moreover, the results revealed what characteristics are associated with

English communication apprehension in BTB personnel. The interview transcriptions

revealed the techniques which the interviewees used to cope when communicating in

English with a foreigner. The chapter begins with descriptive statistics of mean and

standard deviation used to analyze the frequency and percentages of the respondents’

demographic data. T-test analysis was implemented to compare CA in L1 and CA in

L2 in each dimension of communications. ANOVA analysis revealed whether

demographic factors have any influences on CA of the BTB personnel. SPSS version

17 was utilized to process all data collection and the results are reported in five parts as

follows:

Part I: The demographic data of respondents

Part II: CA in L1 and CA in L2 of respondents

Part III: The comparison of demographic data to CA in L1 and L2

Part IV: The results of the interview sessions

Part I Demographic Data

The first part of the questionnaire investigated the demographic data including

the experience of studying or working abroad. The data was retrieved from the 92

respondents who answered the questionnaires. The information is shown in the form of

frequency and percentages as follows:

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Table 4.1 shows the frequency analysis of gender. The female percentage was

72.80 and males were only 27.20 from the total of 92 participants.

Table 4.1 Gender of Participants

Gender Frequency Percent

Male 25 27.20

Female 67 72.80

Total 92 100.00

Table 4.2 presents the frequency analysis the respondents’ age. Most BTB

personnel’s age was between 25-34 years old or 37% of the total of participants. There

were only 2.2% of the participants who were aged lower than 25 years old.

Table 4.2 Frequency Statistics for Age

Age (Years) Frequency Percent

Below 25 2 2.20

25-34 34 37.00

35-44 30 32.60

Over 44 26 28.30

Total 92 100.00

Table 4.3 shows the frequency of the respondents’ education background. Most

respondents (67.4%) graduated with a bachelor’s degree. Only 10.9% did not have

education as high as a bachelor’s degree.

Table 4.3 Frequency Statistics for Education

Education Frequency Percent

Below Bachelor’s Degree 10 10.9

Bachelor’s Degree 62 67.4

Graduate Degree 20 21.7

Total 92 100.0

Table 4.4 illustrates the positions that the participants hold. The majority of

respondents in BTB were people who worked in administrative support e.g. personnel

officers, public relations officers, accountants, finance officers, and planning and policy

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officers (at 33.70%). The second group is the medical technicians (at 22.80%). There

are only 2.20% who are doctors.

Table 4.4 Frequency Statistics of Positions

Position Frequency Percent

Doctor 2 2.20

Nurse 20 21.70

Medical Technician 21 22.80

Public Health Officer 18 19.60

Administrative Officer 31 33.70

Total 92 100.00

Table 4.5 exhibits the information of the working years with BTB. Most people

worked with BTB for more than ten years (at 54.30%). The result shows that 10.90%

of people worked with BTB for less than 1 year.

Table 4.5 Fr