|ORIGINAL RESEARCH PAPER
|Year : 2010 | Volume
| Issue : 3 | Page : 424
Listening Styles of Undergraduate Health Students
T Brown, MJ Boyle, B Williams, A Molloy, L McKenna, C Palermo, B Lewis, L Molloy
Monash University, Melbourne, Victoria, Australia
|Date of Submission||20-Nov-2009|
|Date of Acceptance||10-Aug-2010|
|Date of Web Publication||30-Nov-2010|
Monash University, Melbourne, Victoria
Source of Support: None, Conflict of Interest: None
Background: Concerns about poor communication in the medical and other healthcare professions are common in the empirical literature, with studies showing direct relationships between practitioners' effective listening and patients' satisfaction and less risk of litigation. Furthermore, people do not simply listen or not listen, rather they adopt particular listening styles, making the understanding and investigation of practitioner communication a complex topic. The objective of this study was to identify the listening styles of undergraduate health science students enrolled at one Australian university.
Methods: A cross-sectional study using a paper-based version of the Listening Styles Profile (LSP-16) was administered to a cohort of students enrolled in undergraduate education programs in eight different health disciplines: emergency health (paramedics), nursing, midwifery, occupational therapy, physiotherapy, nursing/emergency health dual degree, health science and nutrition and dietetics. The LSP-16 is a validated and reliable scale that assesses participants' preferences for each of four distinct listening style constructs. There were 1459 health students eligible for inclusion in the study. Ethics approval was granted.
Results: A total of 860 students participated in the study (response rate of 58%), of whom 87.2% (n=750) were female. Across the group, a strong preference was shown for the People Listening Style (LS), which is a listening style characterised by a concern for people's feelings and emotions. Otherwise, an unexpected amount of homogeneity in preferred listening style was found within the group of health science students. Female students reported a slightly stronger preference for the People LS, whereas males reported slightly stronger preferences for the Action LS and Content LS. There were no statistical differences in preference for LS by students' age or year level of undergraduate enrolment.
Conclusion: The health professional student participants of this study reported a preference for a range of listening styles, which is appropriate for many healthcare settings. However, a strong preference for the People LS and a moderate preference for the Content LS were evident. This study should be replicated with practicing professionals to establish if the demands of the workplace affect practitioners' listening style(s).
Keywords: Listening styles, health professional students, education, professional behaviour
|How to cite this article:|
Brown T, Boyle M J, Williams B, Molloy A, McKenna L, Palermo C, Lewis B, Molloy L. Listening Styles of Undergraduate Health Students. Educ Health 2010;23:424
Effective communication is vital in human relations, and in the medical and nursing professions poor communication with patients has long been an issue1. Many deaths have been attributed to poor practitioner-patient communication, and more effective communication is thought to reduce the risk of malpractice suits2-4. One of the important areas of communication needing improvement within medicine and other healthcare professions is that of listening. Many malpractice examples cited by Fiesta2 resulted from a failure to listen. Moreover, effective listening has positive effects, including better patient satisfaction, emotional health, functional and physiological status, and pain control. Furthermore, one’s style of listening correlates with one’s ability to empathise1,5,6, which is also important to patient-practitioner relationships.
Listening is a multidimensional construct. There are different styles of listening and it appears that most people listen as a function of habit rather than taking on the most appropriate listening style for the situation7. This has important implications for the healthcare professions because practitioners’ roles vary considerably across disciplines. For example, when arriving at a scene a paramedic needs to ascertain the situation in a concise and timely manner, whereas an occupational therapist needs to develop a more in-depth understanding of the client’s self-care needs and daily functioning. A nurse needs to be able to communicate with a variety of different audiences including other healthcare staff, physicians, and the patient’s immediate family. These situations require different listening styles.
This study explores the preferred listening styles of students enrolled in eight undergraduate health science disciplines using the Listening Styles Profile (LSP-16)7. Through the LSP-16, this study assesses students’ preference for four listening styles, which are the People, Action, Content, and Time listening styles. Studies using the LSP-16 have found that it is common for people to have preferences for combinations of these four listening styles7,8. Furthermore, studies have noted correlations between the listening styles and personality traits9.
There have been no previous studies completed we are aware of that have assessed the listening styles of undergraduate students enrolled in health-related disciplines. The objective of this study was to identify the listening styles of undergraduate students enrolled in eight different health disciplines at one large Australian university.
Background: Listening Styles
The People Listening Style (LS) is characterized by awareness and concern for the feelings and emotions of others7,10. People with a preference for the People LS try to find common interests and empathise with those with whom they are conversing. They are also likely to more generally have sympathetic tendencies6. People LS has also been found to have a strong correlation with the Feeling type on the Myers-Briggs Type Indicator (MBTI)9. Feelers are described as sympathetic, personable, and friendly. Those with a preference for the People LS also have a tendency to achieve conversational goals and maintain relationships8.
The Action Listening Style is characterized by a desire for precise, error-free presentations of information. Consequently those with a dominant Action LS are impatient and easily frustrated by disorganised presentations. The Action LS was found to have a negative relationship with factors associated with conversational sensitivity, which is a concept that involves, amongst other things, enjoying social interaction and being aware of implicit messages in conversations10. An association between Action LS and the Thinking type on MBTI has also been found9. The Thinking type is typified by a desire to ascertain the truth behind what is being said. Supporting this finding is the strong correlation found between Action LS and a propensity to evaluate the veracity of what one is being told and to ‘then generate an alternative, potentially more feasible interpretation’11.
The Content Listening Style is adopted by those who like to evaluate facts and details carefully. People with a preference for the Content LS prefer complex and challenging information. Not surprisingly, the Content LS is also associated with the Thinking type9. And, similar to the Action LS, people with an orientation toward Content LS tend to evaluate information carefully in order to develop an accurate interpretation and understanding11. The difference is that those with a strong preference for the Action LS want concise, to-the-point information, whereas those with a preference for the Content LS enjoy complex and detailed information.
The Time Listening Style is characterized by a preference for brief, hurried interactions. Those with a preference for the Time LS would let their conversation partner know how long they have to speak and aim for a concise and to-the-point conversation. No relationship was found between Time LS and conversational sensitivity10. Furthermore, only weak or no associations were found between the Time LS and the Myers-Briggs type indicators9. In another study, however, it was found that the Time LS was associated with unsympathetic responses; however, this was not necessarily associated with a lack of emotion, but rather that these listeners distance themselves from the ‘vulnerability to empathetic responsiveness’ by keeping to-the-point6.
In this cross-sectional study, a paper-based version of the Listening Styles Profile (LSP-16) was administered to a cohort of undergraduate health students. All students enrolled in one of the following undergraduate health-related courses at Monash University were eligible to participate: emergency health (paramedic), nursing, midwifery, occupational therapy, physiotherapy, health science, nursing/emergency health dual degree, and nutrition and dietetics courses. Monash University is a major Australian tertiary education provider offering a range of undergraduate and postgraduate programs in medicine, nursing and other health sciences. There were 1459 students in the eight targeted disciplines and thus eligible for inclusion in the study.
Students were invited to participate in our study at the conclusion of a lecture for each year level. Students were provided with a statement explaining the study and were informed that participation was voluntary and anonymous. A non-teaching member of staff facilitated the process. Participants were administered the approximately 10-minute questionnaire containing the LSP-16 and a brief set of demographic questions. Consent was implied by completion of the questionnaire. Ethics approval was obtained from the Monash University Standing Committee on Ethics in Research Involving Humans (SCERH).
The Listening Styles Profile (LSP-16)7 is an instrument designed to assess four styles of listening: People, Action, Content and Time. It consists of 16 items on which participants respond on a 5-point Likert-style scale (0=Never, 1=Infrequently, 2=Sometimes, 3=Frequently, 4=Always). The LSP-16’s items are presented in Table 1. Within our study cohort, the LSP-16’s four constructs demonstrated acceptable internal consistency as determined by Cronbach’s alphas: People (α=.599), Action (α=.611), Content (α=.507), and Time (α=.674). These alphas are below the commonly accepted level of .80; however, as each construct consists of only four items this is considered a good internal consistency and is similar to that reported in other studies7,12,13. Furthermore, in a test-retest the LSP-16 in another study was found to be stable over a two-week period7.
Table 1: LSP-16* items
The Statistical Package for Social Sciences (SPSS; Version 17.0) was used for data storage, tabulation, and the generation of descriptive statistics. Means, t-tests, one-way analysis of variance (ANOVA) tests, and eta-squared were used to analyze differences in scale scores for participants of various gender, age and year of course groups. Eta-squared (η2) is a measure of effect size for use in ANOVA and is analogous to R2 from multiple linear regression. Eta-squared ranges from between 0 and 1. A rule of thumb for interpreting eta-squared ranges is: .01 ~ small, .06 ~ medium and .14 ~ large. Findings were considered statistically significant if the p value was < .05.
A total of 860 students participated in this study, providing a response rate of 59%. The number of participants from each discipline is presented in Table 2. Most of the education programs included in this study are three years in length, with the exceptions being occupational therapy, physiotherapy, and nutrition and dietetics, which are four years each. The participation of students by year of training is roughly proportional to the composition of the students within the included disciplines. Half (n=431, 50.1%) of the participants are 21 years of age or younger and a third (n=281, 32.7%) are between 21 and 25 years of age. The majority of participants are female (n=748, 87.2%), as are most students enrolled in these disciplines, which are more popular among female students.
Table 2: Participant Demographics
Listening styles overview
Descriptive statistics for the four listening styles are presented in Table 3. With LSP-16 response options ranging from 0 to 4, the closer the mean response across a group is to 4, the greater the preference is for that listening style among participants. The People LS was the dominant listening style (mean, 3.28); moderate preference was given for the Content LS (mean, 2.28); and little preference was given for the Action LS (mean, 1.67) and the Time LS (mean, 1.44).
Statistically significant gender differences were reported for the People LS (p<.0001), the Action LS (p=.004) and the Content LS (p<.0001). Females reported a slightly stronger preference for the People LS, while males reported slightly stronger preferences for the Action LS and Content LS. The eta-squared for these three differences were small (People=.016, Action=.01, Content=.02). No statistically significant differences in listening styles were found between participants of different age groups and year levels of enrolment (i.e., first year, second year, third year and fourth year).
Dominant listening styles
According to the original development of the LSP-16 instrument, participants with a score in the upper third of the scale’s score range was evidence of a preference for that style7, which we refer to here as individuals’ dominant listening style. Not all individuals will have a dominant listening style, and some will have two or more dominant listening styles. Table 4 presents the proportions of our participants whose high responses on the various scales showed them to have a dominant style. Responses from 42.3% of the students showed them to have the People LS as their dominant listening style. Very few participants had any of the other three listening styles as a dominant style, and few participants had two or more dominant listening styles.
Table 3: LSP-16* mean scores and gender differences
Table 4: Dominant listening styles: number of participants with scores in the top third of each scale’s range
Differences among professions
The preference for the People LS is consistent across the eight disciplines. Statistically significant differences were found among the disciplines in the proportion of students demonstrating a preference (dominance) for the Action LS (p<.0001), the Content LS (p<.0001) and the Time LS (p<.0001) (see Table 5); however, the magnitude of the difference, as measured by eta-squared, was small (Action=.030, Content=.037, and Time=.038).
A post-hoc analysis identified the specific disciplines exhibiting differences in dominant listening styles. Participants enrolled in physiotherapy had a significantly greater preference for the Action LS than participants enrolled in emergency health (p<.01), midwifery (p<.01), and nutrition and dietetics (p<.01), and to a lesser extent nursing (p<.05). Those enrolled in physiotherapy also had a significantly stronger preference for the Content LS than those enrolled in nutrition and dietetics (p<.01) and to a lesser extent occupational therapy (p<.05). And finally, those enrolled in nutrition and dietetics had a significantly lower preference for the Time LS than those enrolled in occupational therapy (p<.01) and to a lesser extent physiotherapy (p<.05).
Table 5: Listening style preferences across students enrolled in the eight health disciplines
Considerable similarity was found between the participants enrolled in the eight health-related disciplines, and where differences were noted the effect size was small. Overall a strong preference for the People LS was found. The People LS is characterized by an awareness and concern for the feelings and emotions of others. The Content LS also received moderate preference amongst the participants and is characterized by a desire to evaluate facts and details carefully. While no listening style is better or more effective than another and all have their appropriate uses, the results of this study may be promising for these future healthcare practitioners in that the participants showed a preference for a range of styles which may be appropriate for the variety of healthcare settings where they will work.
It is of note that only one listening style had a substantial number of participants reporting it as a dominant listening style. Over 40% of participants had scores indicating the People LS was a dominant listening style. In the original development of the LSP-16 it was found that a quarter (24.8%) of participants had two dominant listening styles and sizeable proportions had three or four dominant styles7. This differs from the findings of this study where scarcely any participants had a score indicating one of the other three styles was dominant, let alone produced scores indicating two or more styles as dominant. Thus these results indicate significant homogeneity amongst this study’s cohort compared to the cohort in the LSP-16’s original study. The sample of participants from the LSP-16’s original cohort were composed of a large sample of female and male undergraduate students enrolled in an introductory professional communication at a large state university located in the Southeastern United States7. Indeed, greater differences were found between the listening styles of young adults from different cultures, which further supports the notion that participants from the eight disciplines are more similar than not14. This finding suggests that those people drawn to the eight health-related disciplines included in this study share similarities in their listening style preferences.
Females in this study had a slightly stronger preference for the People LS, whereas males had a slightly stronger preference for the Action LS and Content LS. This difference in listening style preferences between the genders was also found in a study by Weaver III et al.15 involving 1631 students enrolled in an introductory-level professional communication course at a large university in the Southeastern United States who completed the Eysenck Personality Questionnaire and the LSP-16. Weaver III et al.’s found that distinctly different patterns of listening styles were associated with each of three personality dimensions measured by the Eysenck Personality Questionnaire (EPQ). The EPQ Psychoticism personality type was linked with a socially callous listening style, the EPQ Extraversion personality type was associated with a friendly and supportive ‘people’ oriented listening style while the EPQ Neuroticism personality type, on the other hand, was correlated with listening styles that minimized the time spent interacting with others15.
This is also consistent with the results of Villaume and Bodie8 who found that high masculinity and femininity scores, as measured by Bem’s Sex Role Inventory, correlated with a stronger preference for the People LS; and a higher masculinity score was associated with stronger preferences for the Time LS, Action LS, and Content LS. Villaume and Bodie reasoned that both high masculinity and femininity scores correlate with the People LS because this listening style incorporates an attention to people’s emotions (considered to be a feminine trait) and a motivation to act on what they hear (viewed as a masculine trait). But the magnitude of male-female difference in preferred listening style was small, which raises questions about its significance. This gender-difference was questioned by Imhof16 who suggested that they arise due to the wording of the LSP-16’s items which prompts males and females to consider different scenarios when responding. If this is the case, then the gender difference noted in our and previous studies may stem from differences in comprehension between the genders rather than gender differences in listening styles.
It is important to again note that this study’s cohort consists of undergraduate students enrolled in health-related education programs. Generalizing these results to qualified professionals working in the healthcare field must be done with caution. As Kiewitz et al.14 suggested, the pressures of the workforce may have an impact on people’s preferences for listening styles. These pressures would need to be strong enough to overcome these students’ structured and habitual response when listening7. The time and emotional demands common in acute care hospital environments and other clinical settings are potentially capable of altering one’s listening style. Further study exploring the listening styles of working health care professionals and comparing their preferences with students is warranted. We hypothesize that some change in listening preferences occurs when individuals are exposed to such pressures as well as the socializing influences of certain employment environments. The strong preference for the People LS found in this study’s students group is inconsistent with the concerns about healthcare practitioners’ poor communication with patients raised in the literature17. A preference for the People LS would suggest that one would make an effort to communicate well with others.
This study has predominately considered participants’ listening styles in the context of their future roles in clinical and professional practice settings. Not explored in this study is the importance of listening styles for health science students in their present teaching-learning activities18. Further research could apply the LSP-16 and a learning style scale to assess relationships between listening and learning styles. Worthington13 explored the relationship between the ‘Need for Cognition’ – defined as an individual’s tendency to engage in and enjoy thinking – and listening styles, finding a positive relationship between the Content LS and the ‘Need for Cognition’ construct. This, along with the correlations the LSP-16 constructs have with personality constructs, suggests that listening styles not only have importance in clinical/health care settings, but also for how students learn9.
This study’s sample was drawn from one educational institution thus limiting our ability to make generalizations to the wider body of health professionals. Students from this university may differ in important ways from those enrolled at other universities and colleges. Furthermore, those who self-selected to participate in the study may more often be of a particular listening type and this study’s findings may not be fully representative of all students’ enrolled in the eight health-related disciplines in our university. The basic demographic data we collected suggests that the sample is at least roughly representative of those enrolled in the eight healthcare disciplines; however, this supposition is based on the authors’ familiarity with the general student demographics at our university, as age and gender data for the target population is not available.
Our hypothesis that the homogeneity found in listening styles across our cohort’s eight health-related disciplines is due to the eight health science education programs attracting students with similar listening style preferences, assumes that there is a broader range of listening styles in young people in Australia. To date, no studies have established Australian norms for listening style preferences, and Kiewitz et al.14 have demonstrated that there are significant differences between cultures in listening styles. To date, the majority of studies using the LSP-16 have been undertaken in the United States.
This study provides insight into the listening styles of undergraduate health science students from a range of disciplines enrolled in one Australian university. We observed a strong preference for the People Listening Style and a moderate preference for the Content Listening Style. There was an unexpected considerable homogeneity among students enrolled in the eight undergraduate health science disciplines. These findings are promising in that the listening style preferences expressed by participants are potentially appropriate to many healthcare settings. Further study is needed to assess whether students retain their listening style preferences when they begin working in healthcare and other clinical settings.
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