Research Design

A mixed method approach was used in this research. Mixed method, as the name suggests, uses more than one method for the investigation of a phenomenon of interest so as to minimise the limitations associated to one method and also to enhance confidence in the findings (Creswell, 2009). Creswell (2009) explains that researchers use a mixed method approach to expand the understanding from one method to another and also confirm the findings from different data sources.

Concurrent triangulation strategy is a form of mixed method that has been emphasized by Creswell (2009). The concurrent triangulation strategy uses the quantitative and qualitative approaches to cross validate and corroborate the findings. This strategy is adopted as a means to complement the weakness in one method with the strengths in another method (Creswell, 2009). This study uses the concurrent triangulation strategy using both quantitative and qualitative approaches.

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The quantitative approach is commonly used for the purpose of assessing behaviour, knowledge, opinions and attitudes among a group of subjects, usually using a survey questionnaire (Cooper and Schindler, 2006). There are several reasons why a quantitative questionnaire survey is used in this study. According to Sekaran and Bougie (2013), a questionnaire survey will increase the speed and accuracy of recording and facilitate data processing. It also ensures comparability of data. A questionnaire is a highly structured data collection instrument that is designed to elicit very specific information on the area of inquiry. In the questionnaire, the respondents are given a set of items for which there are several options to choose from (Dornyei, 2010). Many studies in education and language related perceptions have also used this quantitative survey approach. Quantitative method can elicit information from a larger number of subjects in a short period of time and it is cost effective.

The qualitative approach, on the other hand, is used to gather in-depth information on why a certain phenomenon happens in the population. This uses the narrative approach which involves gathering data by collecting information on experiences reported and interpreting the meaning (Creswell, 2009). According to Buckner and Fivush (1998), narratives about self and experiences are increasingly seen as reflections of the self. In this study, semi-structured interviews are used to gain deeper insight on the challenges faced by nurses engaged in Medical Tourism in English communication. Semi- structured interviews enable the researcher to be build a picture of what the respondents think of themselves, their experiences and their opinions (O’Neill, 2011).

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The quantitative method of using a questionnaire is used to identify the English language communicative challenges of the nurses engaged in Medical Tourism in Malaysia as well as the English language communicative needs of the these nurses. A questionnaire is used as it elicit very specific information on the area of inquiry. In this case, the English language communicative needs and challenges of the nurses engaged in Medical Tourism in Malaysia. As mentioned before, questionnaires can elicit more information from a larger number of subjects. The information on the English language communicative need and challenges among nurses is collected through distributing questionnaires to many nurses.

In order to validate the findings from the questionnaire, semi-structure interviews using the qualitative method is used. Semi structured interviews is used in order to get in-depth information on the English language communicative needs and challenges of the nurses. As O’Neill (2011) explains, semi-structure interview enable the researcher to paint a better in-depth picture on the problem at hand. The researcher is able to understand the specific problems in English language communication among nurses.

The concurrent triangulation strategy that uses both the quantitative as well as the qualitative is important in this study. The quantitative aspect gathers information on the English language communicative needs and challenges of the nurses in large number through the use of a questionnaire. The qualitative aspects gathers in-depth information as well as to validate the findings on the English language communicative needs and challenges through the use of semi-structure interviews.

53 3.3 Research Instruments

In the quantitative part of the research, a questionnaire was developed and used while in the qualitative part semi-structured interviews were conducted.

3.3.1 Questionnaire

To identify the problems faced by the nurses engaged in Medical Tourism in Malaysia in English language and their English language needs, a questionnaire was developed (Refer to Appendix A). The questionnaire was developed based on instruments used by Dudley-Evan and St-John (1998), Basturkmen (2010), Wang et al. (2008) and O’ Neil (2011). Further questions were added based on exploratory interviews with nurses and nursing tutors on communication issues faced by the nurses in the Medical Tourism context in Malaysia.

There were three sections in the questionnaire. The first section was on demographic information of the respondent. There were eight questions regarding the respondent’s personal information, mother tongue, spoken languages at home, and the respondent’s rating on his or her overall English language proficiency. The second section of the questionnaire had nine questions regarding the respondent’s language abilities and the learner’s learning preference. The first four of these questions in this section asked the respondent about the usage of English skills, how he or she rates his or her English language skill and what English language skills he or she would want to improve. The remaining five questions in this section probed the learner’s learning preference. The respondents were asked if they were interested in joining an English course, and if yes, they were asked to respond to questions on the time and duration of the course, the respondent’s preferred learning mode and the kind of activities the respondent would like to have in the class. The third section in the questionnaire comprised of 17

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statements. The purpose of these statements was to investigate the problems faced by the nurses and their perceived strengthens and weaknesses in using English at their work place. The 17 statements used a 5 point Likert scale, where a response of 1 indicated Strong Disagreement while a response of 5 indicated Strong Agreement to the statement (Refer to the appendix A).

The questionnaire was pilot tested among 20 nurses. The purpose of this pilot study was to check the suitability of the items in the questionnaire. Based on the pilot test results, a few ambiguous words were replaced with words which could be well understood by the nurses.

3.3.2 Interviews

To further understand and validate the information gathered from the self-administered questionnaire survey, semi-structured interviews were conducted among the human resource managers, matrons, clinical instructors, sisters and nurses (Refer to Appendix B, C, D, E and F). The semi-structured questions were generally on self-evaluation, problems faced by nurses when using English, experiences encountered by nurses when using English and recommendations on the usage of English.