Evaluation of Language and Instructional Method for On-the-Job Training of Foreign Nursing Assistants: An Example of an Oral Hygiene Training Program Author: Jing-Wei Shih (Department of Adult and Continuing Education, National Taiwan Normal University Taichung Nobel Ophthalmology Dermatology Clinic), Chun-Yu Kuo (Department of Adult and Continuing Education, National Taiwan Normal University), Nai-Huan Hsiung (Department of Nursing, Asia Univeristy)

Vol.&No.：Vol. 67, No. 1
Date：March 2022
Pages：63-93
DOI：https://doi.org/10.6209/JORIES.202203_67(1).0003

Abstract：
Background and Purpose
The long-term care of the elderly population in Taiwan relies on foreign nursing assistants. However, their on-the-job training is inadequate because of the high workload, unfamiliar language, and limitations of traditional teaching methods. This study designed a set of training programs suitable for foreign nursing assistants to address the problem of resource constraints and improve their oral care skills.
Method
Volunteers were recruited from long-term care institutions in Taipei, New Taipei, and Keelung. The volunteers committed to a 2-week oral hygiene training program with a pretest and posttest. The participants were assigned to four groups, each of which received training with a different combination of language of teaching method: (1) interactive multimedia teaching in a familiar language (Indonesian or Vietnamese), (2) interactive multimedia teaching method in an unfamiliar language (Chinese), (3) traditional teaching in a familiar language (Indonesian or Vietnamese), or (4) traditional teaching in an unfamiliar language (Chinese).
All participants had normal or corrected-to-normal vision, and no significant differences were detected among the four groups in terms of age (p = .59), sex (p = .99), countries of citizenship (p = .57), level of education (p = .07), or work experience (p = .89). The pretest and posttest both took approximately 40 minutes and consisted of questions relating to the cognitive domain, affective domain, and skill domains of oral care. In addition, the participants’ satisfaction with the training program was evaluated after the posttest.
Results
The normalized scores on the three domains were compared in a 2 (language: Chinese or Indonesian/Vietnamese) × 2 (teaching method: interactive multimedia teaching or traditional teaching) between-subjects design with analysis of variance. The learning outcomes of the four training programs were as follows: 
1. Cognitive domain. Both language (F(1, 321) = 69.83, p = .001,  = .18) and learning method (F(1, 321) = 4.40, p = .037,  = .014) were significant. In addition, a significant interaction between language and learning method was identified (F(1, 321) = 21.73, p = .001,  = .063). The results demonstrated that interactive multimedia teaching methods used with a familiar language improved cognitive performance more than the other combinations of teaching method and language. The results corroborate the findings of Hemmati, Omrani, and Hemmati (2013). 
2. Affective domain. Both language (F(1, 321) = 408.89, p = .001,  = .56) and learning method (F(1, 321) = 4.42, p = .036,  = .014) were significant. In addition, a significant interaction between language and learning method was detected (F(1, 321) = 126.19, p = .001,  = .282). Interactive multimedia teaching methods used with a familiar language improved performance in the affective domain. The self-perceived importance of the care work was enhanced after the training program. These results are not consistent with those of the study by Jeffries, Woolf, and Linde (2003), who did not observe improvements in the affective domain when interactive multimedia methods were used. The different findings of the two studies may be caused by the influence of language. The benefit of interactive multimedia teaching methods in the affective domain was greater when a familiar, rather than unfamiliar, language was used.
3. Skill domain (self-reported). Language (F(1, 321) = 140.38, p = .001,  = .30) and teaching method (F(1, 321) = 30.99, p = .001,  = .088) were significant. No significant interaction between language and teaching method was identified (F(1, 321) = 0.22, p = .633,  = .001). Our findings echo those of other studies demonstrating that multimedia teaching methods enhance the development of care skills (Cardoso et al., 2011; Jiang et al., 2013). Multimedia teaching methods enabled the demonstration of care skills through various formats, and the learners could replay videos and practice the skills until they had become proficient. Thus, multimedia teaching methods were most suggested to enhance the care skills.
4. Skill domain (expert-evaluated). Language (F(1, 321) = 25.33, p = .001,  = .073) and learning method (F(1, 321) = 4.44, p = .036,  = .014) were significant. No significant interaction between language and learning method was detected (F(1, 321) = 0.02, p = .888,  = .001). The results were similar to the self-reported results.
5. Satisfaction. The participants’ satisfaction after the training program was evaluated. The differences between four groups were significant (F(3, 321) = 200.91, p = .001,  = .653), demonstrating that the participants preferred learning in a familiar language. when learning in an unfamiliar language, the satisfaction was higher when used the traditional teaching method than the interactive multimedia teaching method. The major reason for the findings is the fact that when learning in an unfamiliar language, the traditional teaching method enables learners to directly interact with the lecturer, and the lecturer can paraphrase when the learners were confused during the learning phase. 
Conclusions and Discussion
In conclusion, this study reveals that oral hygiene training programs for foreign nursing assistants should be designed to be taught in a language familiar to the participants. The use of a familiar language can improve learning outcomes in several domains. In addition, the use of appropriate media can remove practical restrictions to on-the-job training. Interactive multimedia learning combines diversity with sensory stimulation, and, in this study, its efficacy with respect to all the domains evaluated was higher than that of traditional classroom learning. The first limitation concerns the convenience sampling method used in the current study, convenience sample doesn’t provide a representative result. The second limitation is rooted in the course only focused on the care work of oral hygiene. Thus, the generalization of the results to other populations with different regions and courses for different care works may be limited. Although the results of the present study are not conclusive and future research is obviously required, but this is an exciting first step.

Keywords：oral care, instructional materials of interactive multimedia, foreign nursing assistant, learning outcome

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