Cultural Competence Knowledge Research Articles

Exploring the content validity of Clinical Cultural Competence Questionnaire in diverse cultures

Cultural competence is one component of effective communication between patients, families and healthcare professionals. Tools to assess physicians’ clinical cultural competencies need validity evidence. This paper describes Lawshe’s method for determining the Content Validity Index (CVI) for the Clinical Cultural Competence Questionnaire (CCCQ) for North America (NA), Pakistan (PK) and an international group (IG) using physician simulation educators (PSEs) for diverse cultures. Five simulation educators pilot-tested the CCCQ, and initial changes were made based on their feedback. A total of 10 PSEs experts from NA, 11 PSEs from PK and 10 PSEs from IG completed two rounds of validation testing using Lawshe’s CVI survey for the CCCQ. The PSEs rated each item of the CCCQ as ‘essential’, useful but not essential’ or ‘not useful’. Lawshe’s CVI was calculated for the initial CCCQ; the CCCQ was then modified for individual items, separately for each group, NA, PK and IG. The IG comprised PSEs from Bahrain, Oman, Qatar, KSA, UAE, Australia, Argentina, India and Israel. The survey response rate was 83.33% for NA and IG and 91.6% for PK, respectively. The CVI of the CCCQ in round 1 was 0.689 for NA, 0.545 for PK and 0.691 for IG. In the second round of the CCCQ, with modified items, the CVI was 0.89 for NA, 0.802 for PK and 0.862 for IG. The major modifications suggested by the PSEs were to remove the unnecessary items, e.g. demographic information and last medical school attended, as they were deemed unnecessary or reword them for better understanding and combine related items to reduce the length of the CCCQ survey. We also evaluated the comments of PSEs from NA, PK and IG to explore the similarities and differences in their opinions regarding the CCCQ tool items. Our research emphasizes the need to thoroughly examine questionnaire content in tools like the CCCQ to accurately capture the cultural competence knowledge, attitudes and skills crucial for healthcare providers in diverse settings.

Translation, Adaptation, and Validation of the Cultural Competence Assessment in Portuguese Nurses.

Background and Purpose: Previous research shows significant benefits resulting from improving culturally competent nursing care. Thus, the purpose of this study was to translate, adapt, and validate the Cultural Competence Assessment (CCA) in a sample of Portuguese nurses. Methods: A psychometric study of the CCA, after translation into European Portuguese, was performed with a snowball sample of 284 nurses. Participants were asked to fill in a sociodemographic questionnaire and the CCA. Results: The four-factor model of the CCA (Portuguese version) exhibited satisfactory indices of fitness without item nine. Cronbach's alpha was 0.85. Correlations between subscales and the total score scale were strong and statistically significant. Conclusions: These data add to the cultural competence knowledge of nurses to promote better practices and culturally competent care.

Teaching and Learning Interventions Designed to Improve Cultural Competence in Health Profession Students: A Systematic Review

Purpose: Developing healthcare profession students’ cultural competency knowledge, skills and attributes is critical to meet the needs of culturally and linguistically diverse healthcare service consumers. The purpose of this systematic review was to identify effective cultural competence interventions for healthcare profession students. Methods: A systematic review of peer reviewed articles published from 2010-2021 using PRISMA guidelines was conducted by searching CINAHL, EMBASE, ERIC, PubMed, and Psych INFO databases. Article quality was assessed using the Evaluation Tool for Quantitative Research and Mixed Method Appraisal Tool. Results: The initial search identified 2,261 potentially relevant studies, 41 studies met the inclusion criteria in which intervention effectiveness was evaluated using a validated outcome measure pre- and post- intervention. Only one study used a non-self-report outcome measure. Out of the 41 studies, only eight studies employed randomisation in the method. Conclusion/Recommendations: This review evaluated effectiveness of cultural competence interventions and evaluation of the intervention using either self-report or non-self-report validated outcome measures at pre- and post-intervention exposure. Combining cultural competence teaching methods such as lectures with simulations, role-playing and community engagement with diverse populations enhanced cultural competence. Further studies are required to compare effective cultural competence teaching models and identify reliable non-self-report outcome measures to assess the effectiveness of interventions post-exposure. Comparing effective cultural competence teaching models that utilise reliable non-self-report outcome measures will be valuable for guiding the design of teaching and learning interventions directed towards cultural competence. Further research is also required to examine the duration of intervention efficacy and how to maintain efficacy post-intervention exposure. Findings from this review are important for designing and structuring of cultural competence curriculum for healthcare profession students and informing future research on cultural competence teaching. This review has identified that most evaluation tools and studies have been designed for the nursing discipline. There is need to design more cultural competence evaluation tools and studies for other healthcare disciplines such as pharmacy and physical therapy.

Enhancing FDA's Reach to Minorities and Under-Represented Groups through Training: Developing Culturally Competent Health Education Materials.

Health communications may not reach intended populations due to cultural and language barriers. These barriers may prohibit consumers from understanding information needed to make informed health decisions. It is important to ensure everyone—especially racial and ethnic minorities and under-served and under-represented populations—has access to information on medical products. One strategy to address this issue is to develop trainings and resources to better understand how cultural competency affects the ability to communicate effectively with racial/ethnic minorities. The FDA’s Office of Minority Health & Health Equity developed a 3-module training to (1) increase staff knowledge of the role that cultural competency plays in determining health communication messages and channels and (2) provide tools to assist them in creating culturally-competent strategies and action plans. Offered on 4 occasions, the 4.5-h interactive training, grounded in adult learning and project-based learning theories, and used curricula, case studies, and multimedia to guide the discussion and group work. Participants also completed an action plan to guide their current work. Cultural competency knowledge was assessed pre- and post-training and training satisfaction was assessed post-training. Among the 53 individuals who completed the training, average knowledge increased by 13.6%. The training was a success based on anecdotal and evaluation feedback. The majority of participants indicated that they would refer their colleagues to the training and apply what they learned in their work. Participants felt the training was meaningful, applicable to their work, and provided an opportunity to learn and engage with their peers. Becoming culturally competent is a process that should be supported through ongoing training to help build a strong communications and health educator workforce with expertise in developing culturally competent messages to meet their constituents’ needs.

Cultural Competence: Where Are We as Athletic Training Educators?

Context Cultural competence is the ability of health care professionals to investigate and incorporate the cultural needs of patients into care and clinical decisions. Research shows that athletic training students and certified athletic trainers possess moderate to high levels of cultural competence yet struggle exhibiting culturally competent behaviors. Therefore, an exploration of athletic training educator cultural competence and preparedness to teach cultural competence concepts is warranted. Objective The study sought to assess the cultural competence of athletic training educators and how prepared, comfortable, and confident they feel teaching cultural competence and related concepts. Design Cross-sectional survey. Setting Online. Patients or Other Participants Ninety professional-level athletic training educators (60 women, 30 men). Data Collection and Analysis Cultural competence scores were collected using a previously validated survey tool. The remaining survey items collected information about participants' self-reported cultural competence teaching efficacy. All responses were collected through Qualtrics and analyzed using SPSS version 25. Frequency counts and percentages were determined. Measures of central tendencies were calculated for continuous variables. A paired-samples t test was used to determine if cultural competence knowledge and exhibition of culturally competent behaviors differed significantly. Results Athletic training educators identified mostly as white women (n = 59/90, 65.56%) and had high levels of self-reported cultural competence (5.33/7.00 ± 0.66). However, half of respondents (50.56%, n = 45/89) believed they do not possess adequate knowledge of cultural competence concepts, and a majority of respondents were not taught cultural competence concepts during professional education (78.89%, n = 71/90) nor during athletic training-specific continuing education opportunities (54.44%, n = 49/90). Conclusion(s) Further investigation regarding athletic training educator cultural competence education is warranted. Additionally, barriers to recruitment and retention of underrepresented athletic training faculty should be explored to increase diversity within athletic training programs. Finally, an athletic training-specific cultural competence assessment may more accurately measure cultural competence in this population.

Assessment of cross-cultural competency among dental interns: An exploratory study

Aims: The study aims to quantity the variation in dental interns' self perceived levels toward cultural competence. Settings and Design: A cross-sectional study was conducted among 84 dental interns from dental college during December 2019. Subjects and Methods: 84 dental interns were participated from college during the month of December for this study. Data were collected through interview using pretested and prevalidated form, consisting of demographic variables such as age, gender, and community with cross-cultural care survey that concerning about the ability to deliver diverse patient's care. Statistical Analysis Used: The statistical analysis was done using SPSS software, and mean, standard deviation, paired t-test and Analysis of Variance (ANOVA) test were applied for the analysis of the data, and the level of significance was set at P < 0.05. Results: It showed that males had significantly higher mean ± SD knowledge (3.29 ± 0.60), skill (3.55 ± 0.52), and attitude (3.32 ± 0.51) scores, respectively, as compared to females; however, while comparing the various domains on the basis of religion factor, the difference was not found statistically significant. Conclusions: The current study suggests that cultural competence knowledge, skill, and attitude of the study participants were inadequate. Hence, there is a need to conduct training programs for interns to enlighten them on the sensitive issue of cross-cultural competency in oral health services.

The Impact of a Teaching Activity on Cultural Competence Knowledge

Background: To determine if a teaching intervention can increase cultural competence knowledge in senior nursing students preparing to take the NCLEX-RN exam. Methods: A 90-minute lunch and learn teaching intervention was conducted related to providing culturally competent care. A 10-question quiz was administered to a group of 31 senior nursing students before and after a teaching activity. Results: Mean values for knowledge on cultural competency were significantly higher for the pretest compared to the posttest (p < 0.01). There was a decrease in the NCLEX-RN pass-rate. Conclusion: Though there was a decrease in the NCLEX-RN pass-rate, the teaching activity helped increase cultural competence knowledge in the nursing students on providing care to diverse patients. This implies that similar interventions may be used to increase knowledge related to cultural competence.

Measuring cultural competence in emergency management and homeland security higher education programs

ABSTRACT With the evolving demographics of our communities and recent disasters directly impacting socially vulnerable populations, cultural competency has increased in importance. Emergency management and homeland security scholars have outlined various interpersonal and technical knowledge, skills, and abilities for the discipline; yet lacking in this discussion is cultural competency. By increasing cultural competency knowledge, skills, and abilities in emergency management higher education, we increase our graduates to be more credible, empathetic, relatable, and trustworthy, and less inclined to negatively apply biases, stereotypes, and pre-conceived notions. Using results of a national survey to U.S. Emergency Management and Homeland Security Higher Education programs, we apply Cross’ cultural competence continuum to provide a contextual landscape of the inclusion of these knowledge, skills, and abilities in related courses within the curriculum. We conclude with lessons learned and recommendations for program directors who want to move forward on the continuum.

Ontology based intercultural patient practitioner assistive communications from qualitative gap analysis

Purpose – There is an increasing interest in using information and communication technologies to support health services. But the adoption and development of even basic ICT communications services in many health services is limited, leaving enormous gaps in the broad understanding of its role in health care delivery. The purpose of this paper is to address a specific (intercultural) area of healthcare communications consumer disadvantage; and it examines the potential for ICT exploitation through the lens of a conceptual framework. The opportunity to pursue a new solutions pathway has been amplified in recent times through the development of computer-based ontologies and the resultant knowledge from ontologist activity and consequential research publishing. Design/methodology/approach – A specific intercultural area of patient disadvantage arises from variations in meaning and understanding of patient and clinician words, phrases and non-verbal expression. Collection and localization of data concepts, their attributes and individual instances were gathered from an Aboriginal trainee nurse focus group and from a qualitative gap analysis (QGA) of 130 criteria-selected sources of literature. These concepts, their relationships and semantic interpretations populate the computer ontology. The ontology mapping involves two domains, namely, Aboriginal English (AE) and Type II diabetes care guidelines. This is preparatory to development of the Patient Practitioner Assistive Communications (PPAC) system for Aboriginal rural and remote patient primary care. Findings – The combined QGA and focus group output reported has served to illustrate the call for three important drivers of change. First, there is no evidence to contradict the hypothesis that patient-practitioner interview encounters for many Australian Aboriginal patients and wellbeing outcomes are unsatisfactory at best. Second, there is a potent need for cultural competence knowledge and practice uptake on the part of health care providers; and third, the key contributory component to determine success or failures within healthcare for ethnic minorities is communication. Communication, however, can only be of value in health care if in practice it supports shared cognition; and mutual cognition is rarely achievable when biopsychosocial and other cultural worldview differences go unchallenged. Research limitations/implications – There has been no direct engagement with remote Aboriginal communities in this work to date. The authors have initially been able to rely upon a cohort of both Indigenous and non-Indigenous people with relevant cultural expertise and extended family relationships. Among these advisers are health care practitioners, academics, trainers, Aboriginal education researchers and workshop attendees. It must therefore be acknowledged that as is the case with the QGA, the majority of the concept data is from third parties. The authors have also discovered that urban influences and cultural sensitivities tend to reduce the extent of, and opportunity to, witness AE usage, thereby limiting the ability to capture more examples of code-switching. Although the PPAC system concept is qualitatively well developed, pending future work planned for rural and remote community engagement the authors presently regard the work as mostly allied to a hypothesis on ontology-driven communications. The concept data population of the AE home talk/health talk ontology has not yet reached a quantitative critical mass to justify application design model engineering and real-world testing. Originality/value – Computer ontologies avail us of the opportunity to use assistive communications technology applications as a dynamic support system to elevate the pragmatic experience of health care consultations for both patients and practitioners. The human-machine interactive development and use of such applications is required just to keep pace with increasing demand for healthcare and the growing health knowledge transfer environment. In an age when the worldwide web, communications devices and social media avail us of opportunities to confront the barriers described the authors have begun the first construction of a merged schema for two domains that already have a seemingly intractable negative connection. Through the ontology discipline of building syntactically and semantically robust and accessible concepts; explicit conceptual relationships; and annotative context-oriented guidance; the authors are working towards addressing health literacy and wellbeing outcome deficiencies of benefit to the broader communities of disadvantage patients.

Advancing Cultural Assessments in Palliative Care Using Web-Based Education

Research supports the premise that cultural competence in health care improves care delivery and patient outcomes. Despite efforts to promote patient-centered care and respect for choices across the illness trajectories, cultural considerations of palliative care remain poorly understood. The purpose of the study was to determine if, after completing cultural competence education, registered nurses working in a combined palliative care and hospice unit increased their cultural awareness, sensitivity, and cultural assessment documentation. The study used a quasi-experimental design and took place in a 1070-bed Midwestern hospital. Fifteen registered nurses participated. The intervention consisted of 3 Web-based cultural competence education modules. A preintervention and postintervention electronic chart audit identified 80 charts meeting inclusion criteria. The charts’ cultural assessment data, which had been completed by nurses upon patient admission, were extracted and analyzed. The nurses also completed the Cultural Competence Assessment tool preintervention and postintervention. Analysis of the postintervention data showed the nurses had increased their cultural awareness, sensitivity, and cultural assessment documentation. These findings support the use of Web-based education and show how this format can translate cultural competency knowledge into nursing practice. Providing this education is an important component in creating an environment that provides culturally congruent palliative care.

Development of a Framework that Describes how Gardens Become Integrated and Sustained in Elementary and Middle Schools

in the United States. Description: A list of cultural competency topics from the cultural foods course learning objectives were used to develop questions to elicit knowledge and application of these topics to two case study assignments in MNT-II. Evaluation: A cultural competency rubric was developed and tested for reliability to assess question responses. Two sets of questions were included in two consecutive case studies. The first case study did not include the term ‘‘culture,’’ used in the second. Conclusions and Implications: Students who completed the cultural foods course on average scored higher in the first case study using the cultural competency rubric, 2.01/10 versus those who did not, 0.96/10 (P#0.037). Results also identified cultural competency topics for improvement, such as preferences or avoidances related to religion. We can conclude that students who completed the cultural foods course were more likely to apply cultural competency knowledge and skills without explicit elicitation compared to those who had not completed the course; indicating learning transference. Funding: Future Academic Scholars in Teaching Fellowship, Center for the Integration of Research, Teaching, and Learning, The Graduate School-Michigan State University.

The Assessment of Athletic Training Students' Knowledge and Behavior to Provide Culturally Competent Care

ContextCulturally competent knowledge and skills are critical for all healthcare professionals to possess in order to provide the most appropriate health care for their patients and clients.ObjectiveTo investigate athletic training students' knowledge of culture and cultural differences, to assess the practice of culturally competent care, and to determine efficacy of cultural competency instruction.DesignA mixed methods research design with a case study approach was utilized for this study.SettingThis study was conducted in an athletic training course over a 2-week time period.Patients or Other ParticipantsTen athletic training students enrolled in a professional athletic training program at the master's level participated in this project. Sampling of participants was purposeful and based on convenience.Data Collection and AnalysisThe Cultural Competence Assessment (CCA) instrument was administered and analyzed to determine athletic training students' cultural awareness, sensitivity, and behavior. An assessment questionnaire and focus group were used to determine the athletic training students' experiences in diversity and cultural competency education, to evaluate the efficacy of classroom activities, and to solicit athletic training students' feedback for recommendation regarding the delivery of cultural competency knowledge and skills in the athletic training curriculum.ResultsThe study revealed that athletic training students demonstrated good cultural awareness and sensitivity. However, it was also discovered that athletic training students were less likely to practice culturally competent care.Conclusion(s)Both didactic and clinical experiences increased athletic training students' cultural competency; however, athletic training students wanted to spend more time on cultural competency within the curriculum. Athletic training students also believed it was important to use various tools to teach about cultural competency.

Building Cultural Competence in the Child Welfare Workforce: A Mixed-Methods Analysis

Cultural competence training has been suggested as one way to help address the over-representation of children of color in the child welfare system. This article describes findings from a mixed-methods study of specialized training in cultural competence knowledge, attitudes, and skills for experienced caseworkers in public child welfare. Results indicate training participants had statistically significant increases in knowledge across all topic areas related to cultural competence. Of particular note is the increase in participant knowledge of the Indian Child Welfare Act (ICWA) and related changes in working with families and individuals.

Cultural Competence Knowledge and Confidence After Classroom Activities

To determine change in cultural competency knowledge and perceived confidence of second-year pharmacy students to deliver culturally competent care after completing a required cultural competency curriculum. Cultural competence material was covered in the second-year PharmD curriculum through lectures, laboratories, and an experiential/out-of-class assignment. Eighty-five second-year (P2) pharmacy students completed a survey which assessed influence of classroom activities related to cultural competence. Mean values for knowledge and perceived confidence were significantly higher for posttest compared to pretest (p < 0.01), after cultural competency activities. Focus groups were used to solicit students' opinions on instructional effectiveness, relevance of activities, and areas for enhancement. The cultural competency curriculum increased pharmacy students' awareness of and confidence in addressing cultural diversity issues that affect pharmaceutical care delivery.

Narrative Reflection in the Family Medicine Clerkship - Cultural Competence in the Third-Year Required Clerkships

OPEN ACCESSMay 25, 2010Narrative Reflection in the Family Medicine Clerkship - Cultural Competence in the Third-Year Required Clerkships Donna Elliott, MD, EdD, Pamela Schaff, MD, Theresa Woehrle, MD, Anne Walsh, PA-C, MMSc, Janet Trial, EdD, CNM Donna Elliott, MD, EdD Keck School of Medicine of the University of Southern California Google Scholar More articles by this author , Pamela Schaff, MD University of Southern California Google Scholar More articles by this author , Theresa Woehrle, MD University of Southern California Google Scholar More articles by this author , Anne Walsh, PA-C, MMSc University of Southern California Google Scholar More articles by this author , Janet Trial, EdD, CNM Keck School of Medicine of the University of So California Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.1153 SectionsAboutAbstract ToolsDownload Citations ShareFacebookTwitterEmail AbstractAbstractThis resource cultivates effective cross-cultural communication skills, which requires an understanding of culture that includes both the physician's and the patient's perspectives. Building on a foundation of cultural awareness, knowledge, and skills students have acquired during the preclinical curriculum, this exercise provides an opportunity for students to continue to refine their narrative reflection skills as they interact with patients in the clinical setting. During the family medicine clerkship, students participate in learning activities that provide the opportunity to explore the rich opportunities of thoughtful reflection and narrative practice. Students also participate in a formative narrative reflection exercise during the clerkship orientation. Each subsequent week of the rotation, the students complete an electronic journal entry based on their clinical encounters that is focuses on the patient/physician interaction. At the end of the clerkship, students demonstrate their ability to reflect on patient care through a final project that is shared with faculty and fellow classmates in a faculty-led wrap-up discussion.A diverse patient population is helpful but not necessary to the success of this experience. Integrating cultural competence into the clinical clerkships allows students to apply cultural competence knowledge gained in the first 2 years of medical education, as well develop clinical skills in caring for patients with a variety of backgrounds. This learning experience has allowed faculty the opportunity to regularly address patient-care experiences that everyone acknowledged were fundamental to patient well-being, but had no particular place in the curriculum. A majority of students find positive educational value in their self-reflections and many comment that the family medicine clerkship has provided the one of the only opportunities they've had during their training for this therapeutic activity. Educational Objectives By the end of this module, learners will be able to: Provide health care to a diverse, multicultural patient population.Recognize the impact of the patient's story on the physician and patient relationship, and management of disease.Think and write reflectively about a patient-clinician interaction, and the feelings and attitudes they experienced as part of that interaction.Demonstrate awareness of personal limits, strengths, weaknesses, vulnerabilities, and ethical choices through the use of self-reflection, self-assessment, and narrative. Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Instructor's Guide.docx Family Medicine Clerkship Handout.doc To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. Related Interpretation at the OB/GYN Bedside - Cultural Competence in the Third-Year Clerkships Stereotypes and Bias at the Psychiatric Bedside - Cultural Competence in the Third-Year Required Clerkships Narrative Reflection in the Family Medicine Clerkship - Cultural Competence in the Third-Year Required Clerkships Copyright & Permissions© 2010 Elliott et al. This is an open-access publication distributed under the terms of the Creative Commons Attribution-NonCommercial-Share Alike license.KeywordsHealth Equity ResearchTruth DisclosureClerkshipEthical RelativismTACCT Domain Disclosures None to report. Funding/Support None to report. Prior Presentations Oral presentation at: Western Group on Educational Affairs; 2008. Poster presented at: USC Innovations in Medical Education; 2008. Loading ...

Empowering Students With Cultural Competence Knowledge: Randomized Controlled Trial of a Cultural Competence Curriculum for Third-Year Medical Students

Formal training in cultural competence for health care providers has become vital as the US population continues to become increasingly culturally diverse. However, a low percentage of medical schools offer formal training in this area, and there is a lack of curriculum evaluation reported in the literature. To determine the impact of formal cultural competence teaching on third-year medical students' knowledge of cultural competence. Data from 109 third-year medical students during the period of November 2001 to February 2004 were analyzed in the study. The intervention was a comprehensive cultural competence curriculum, and the primary outcome measure was the change score in cultural competence knowledge demonstrated by the medical students after completing a precourse and postcourse 40-item multiple-choice questionnaire. Forty-seven medical students in the control group and 62 medical students in the intervention group completed both the pretest and posttest. The overall knowledge scores in the intervention group increased by 19%, compared to a 4% increase in the controls (p < .01). Third-year medical students in the intervention group were significantly empowered with cultural competence knowledge when compared to the control group.

Empowering Students With Cultural Competence Knowledge: Randomized Controlled Trial of a Cultural Competence Curriculum for Third-Year Medical Students

Empowering Students With Cultural Competence Knowledge: Randomized Controlled Trial of a Cultural Competence Curriculum for Third-Year Medical Students

Teaching diversity by using instructional technology

PurposeThis study examines the use of an instructional technology of utilizing the online forum as a tool for improving self‐efficacy related to cultural competency among social work graduate students. As a supplement to face‐to‐face classes, students (n=103) were encouraged to participate in an Online Diversity Forum (ODF).Design/methodology/approachForum participants assessed their perceived level of self‐efficacy related to cultural competency knowledge, attitudes, and values by an end of semester survey.FindingsOverall, students rated their improvements in self‐efficacy as high for most criteria studied; the largest perceived improvement was on items measuring interaction with fellow students. Two class sections (n=34) had online postings reflecting a climate of disrespect for other students and for the instructor, while the other four sections (n=69) had positive climates that had no disrespectful or inappropriate postings. Participants in the positive forums increased self‐efficacy significantly more than those in the negative climate forums.Practical implicationsOur findings suggest that ODF can be a useful adjunct to multicultural education when a positive climate for dialogue is created. Future research should explore ways to design and manage online forums to enhance positive learning climates while reducing negative uses that may serve as a barrier to constructive dialogue and learning.Originality/valueThis paper illustrates an innovative educational strategy of using ODF and evaluation research.