Table 3.

Summary of Accent- and Dialect-Related Intervention Elements and the Intervention Effects in the Included Studies

StudyParticipantsAccent InterventionObjective InstrumentsSubjective Measures
StudyQualityTypenContent/StructureDurationPretestPosttestPretestPosttestEffect Results
Yahes and Dunn, 199648LowINGs30Weekly 2-hour sessions led by SLP and nursing educator. Content: pronunciation, accent remediation, phonetics.12 weeksNoneNoneNoneTrainee feedbackClinical supervisor feedbackAnecdotal comments on increased job satisfaction, fewer communication-related complaints from physicians and staff, improved collegiality among staff, and decreased overall number of incident reports.
Chur-Hansen and Barrett, 199651LowESL medical students44Elective supplementary course on colloquial expressions. Structure: 2 tutorials + assignment to collect colloquial expression examples. Topic: colloquialism.1 semesterNoneNoneNoneStudent course evaluation questionnaireStudents reported they learned informal language.
Chur-Hansen, 199952LowESL medical students87Part of weekly elective supplementary tutorials adjunct to Doctor, Patient and Society course. Accent topics: vocabulary and colloquial language.2 semestersNoneDoctor, Patient and Society course gradesNoneStudent feedbackNo conclusive benefit or harm. Tutorial attendees performed less well than nonattendees in the course, but the author stated, “without the program, the disparity in performance may have been much greater and the fail rates far more substantial.” Students reported the course as useful teaching support.
Symes et al, 200222LowNursing students32Part of a required 3-credit course, Student Success Program, led by an SLP and a nursing teacher; 15-hour accent modification + 2 4-hour periods of nurse shadowing + 4 oral presentations. Topics: medical and general vocabulary.2 semestersNurse Entrance Test reading comprehension testStudent retention ratesAcademic and clinical pass ratesNoneTrainee feedbackFaculty feedbackSome students reported more confidence about talking to patients and staff as a result of the course.
Bosher and Smalkoski, 200239LowESL health students18Part of a required 2-credit course that meets once a week for 2 hours. Course structure: lecture, discussion, reading, journal entry, student presentation, 9-10 role plays per student. Topic: paralinguistic features of communication (eg, tone, volume, and rate of speech).14 weeksCombined English Language Skills Assessment + Comprehensive English Language Test or University of Michigan English placement test or University of Michigan English Language Proficiency test3 instructor-graded role-play scenariosFinal written examStudent questionnaire (needs assessment)Students’ course evaluation surveysAnecdotal comments by instructor and studentsAnecdotal student success stories about improved communication skills. Positive responses on course usefulness, particularly role plays.
Guhde, 200335LowESL nursing student1Weekly 1-hour one-on-one tutoring by a nurse tutor. Topics: listening, speaking and pronunciation, and medical terminology.10 weeksListening and note-taking testListening and note-taking testNoneTrainee feedbackIncreased accuracy in note-taking.
Satter et al, 200555LowTelephone survey interviewersN/ATraining materials + in-person training. Topics: American Indian and Alaska Natives’ cultural and linguistic issues; reservation dialect English, long pauses, slow speaking, “walking on words,” and tribal heritage.1 sessionNoneCalifornia Health Interview Survey response rateNoneTrainee feedbackTrainer observationThe health survey response rate in the target population is high; trainees reported training was helpful; trainer observed that trainees felt sensitive, connected, and responsible to the community and were motivated to do their best.
San Miguel et al, 200645LowESL nursing students154-hour sessions per day for a total of 20 hours led by a language teacher. Topics: small-talk, formulaic expressions, vocabulary, grammar, and colloquial language/switching register.5 weeksNoneStudents’ clinical grades at the end of the next clinical placementStudent focus group on needsFacilitators’ written comments on students’ clinical performanceStudent written feedback surveyStudent focus groupFacilitator focus group and interviewImproved communication skills and increased confidence, resulting in a more positive clinical experience for the majority of students.
Parkhurst, 200744LowESL pharmacy students253-credit elective course. Structure: role plays, group practice, and presentations. Content: pronunciation, stress and intonation, register, grammar, medical terminology, and listening comprehension.1 semesterMichigan Test of English ProficiencyOral summary examinationClass oral presentationExit examination using a 4-level holistic assessment rubric. Students were graded by 2 pharmacy faculty members.NoneStudents’ course evaluation formImproved oral skills (eg, intelligibility, stress, intonation, and vocabulary) and listening comprehension.
Seibold et al, 200746LowCALD nursing students20Semester 1: fortnightly group meetings; Semester 2: group and individual meetings with academic mentors. Topics: colloquial language and pronunciation.2 semestersNoneNoneCourse entry questionnaire (needs assessment)Trainee focus groupTrainee exit questionnaireTrainee feedback questionnaire (3 months post-program)The course helped develop oral and written communication skills.
Chiang and Crickmore, 200941LowCALD nursing students (postgraduate)N/APart of a full transition course led by language and clinical teachers, including 4-hour English instruction, 4-hour communication workshops, 2-hour clinical lab with simulated patients, and 32-hour clinical placement. Topics: social and colloquial language.1 semesterNoneNoneNoneStudent interviewsTeacher feedbackNo conclusive benefit or harm, but students reported that the course was useful and that it was helpful to learn about communication skills.
Shah, 201037LowESL anesthesiologist1Weekly 1-hour one-on-one accent modification therapy led by an SLP tailored to trainee needs based on diagnostic-based communication numeric scores. Topics: consonants, vowels, prosody, and suprasegmentals.8 weeksComprehensive Assessment of Accentedness and IntelligibilityComprehensive Assessment of Accentedness and IntelligibilityLanguage background questionnaire Intelligibility assessed by SLP and 3 untrained listenersPretherapy and posttherapy audio comparisonsTrainee exit interviewImprovement in intelligibility, intonation, stress, and vowel and consonant production. Improved comfort and confidence with patients and presentation. Program satisfaction.
Boughton et al, 201040LowCALD nursing students (postgraduate)17Part of CALD support program, led by 3 nursing faculty members. Five-hour introductory workshop + 9 1.5-hour sessions. Topic: colloquial language.1 semesterNoneNoneNoneStudent interviewsLearning about effective communication and colloquial language enabled students to better understand various colloquialisms used by patients.
Cross and Smalldridge, 20117LowIMGs173 sessions (2 half-days + 1 full-day) with feedback by clinical and language teachers. Content: adjustments to accents and tone of voice. Structure: presentation, workshops, practice.N/ANoneNoneFormal feedback from supervising consultantsTrainee feedbackTrainer feedbackImproved communication skills.
Kokkinn and Stupans, 201143LowESL pharmacy students82Weekly 2-hour classes led by clinical and language specialists. Content: terminology, colloquialism, and pronunciation.8 weeksNoneFinal pharmacy counseling testNoneTrainee self-evaluation of progressTrainee survey of the programTrainer feedbackHigh counseling test pass rate.
Woodward-Kron et al, 201147LowIMGsN/AWeekly 2-hour sessions with role plays, simulated examinations, video recordings, and written/verbal feedback (eg, pitch-trace diagram for stress/intonation feedback). Content: vocabulary, grammar, sound production, prosody, and discourse.10 weeksNoneLinguist-graded video tapes on progressionAustralian Medical Council Clinical Examination pass rateNoneTrainee focus groupImproved communication skills and high clinical examination pass rate.
Koch et al, 201153LowNursing students52Web-based glossary with hyperlinks to English and Mandarin (written + audio) and quizzes. Content: teaching resources, vocabulary/medical terminology, and pronunciation.N/AEnglish Language Acculturation ScaleNoneNoneTrainee interviewIncreased confidence in communication.
Carr and DeKemel-Ichikawa, 201221LowESL nursing students13Weekly 1-hour sessions led by SLP postgraduate student clinicians. Topics: speech production and prosodic features of general American English, morphosyntax, American figurative and abstract language, and nursing terminology.2 semestersLanguage background questionnaire (the Rainbow Passage)Brief articulation testPsycholinguistic Aspects of Foreign AccentNoneStudent weekly logsStudent questionnaireFaculty feedbackImproved speech sound production and prosody. Trainees reported the program was beneficial.
Shen et al, 201238 or Xu et al, 201058LowCALD nurses51Weekly 2-hour sessions, taught by an SLP to reduce phonologic errors. Content: expanded from the SLP's 8-week accent reduction course regularly taught at a university.10 weeksCompton Phonological Assessment of Foreign Accent administered by SLPCompton Phonological Assessment of Foreign Accent administered by SLPNoneNoneSignificantly less phonetic errors and linguistic errors.
Baker and Robson, 201249LowIMGs1415 sessions of language training led by a language tutor (accent topics: pronunciation, stress, and intonation) + 6 sessions of consultation training led by experienced general practitioners.6 monthsTutor-graded language skillsTutor-graded consultation skillsTutor-graded language skillsTutor-graded consultation skillsNoneClinical supervisor questionnaireTrainee focus groupImproved language and consultation skills. Trainees reported training as helpful.
Blackburn, 201250LowSLP students631-session dialect instruction. Content: phonological and grammatical rules of African American English (AAE), AAE video clips, practice to translate standard American English (SAE) into AAE.1 day30-minute closed-book questionnaire (knowledge and attitude)30-minute closed-book questionnaire (knowledge and attitude)NoneNoneImproved knowledge of the AAE rules (though <50% accuracy posttest); more aware of difficulties children face in school if they don’t speak SAE.
Belay, 201333LowESL nurses14Weekly 1.5- or 2-hour sessions led by an SLP. Content: based on the Compton Pronouncing English as a Second Language program.13 weeksNoneNoneNoneTrainee interview (4-8 months after training)Increased confidence in language abilities; improved communication experiences.
Khurana and Huang, 201336LowIMGs and IMRs82Weekly 90- to 120-minute classes (size: 8-14) led by accent-reduction instructors. Topics: vowels and consonants, fluency, stress, rhythm, intonation and casual speech linking, blending, contractions, and reductions.8 to 12 weeksVideo/audio tape reviewed by 2 external assessorsVideo/audio tape reviewed by 2 external assessorsTrainee self-evaluation of communication skillsTrainee self-evaluation of communication skillsSignificantly improved ability to pronounce words distinctly and stress more accurately; better accuracy, intonation, fluency, speed, and volume. Increased confidence in communication.
Harvey et al, 201342LowCALD nursing students (postgraduate)2406 weeks of weekly 2-hour interactive discussion sessions, + 4 weeks of role plays led by language and clinical facilitators (18 hours total). Topics: listening, speaking, and vocabulary.10 weeksNoneClinical practice pass rateNoneTrainee survey after 6-week discussion sessionsTrainee survey after 10 weeksTrainee survey 1 week after clinical placement completionSimilar to or higher than overall cohort pass rate for clinical practice. Increased confidence and comfort in communication and enhanced comprehension of Australian colloquial language.
Van Schaik et al, 201454LowCALD nursing students and CALD nurses198-hour practice in online course (3 20-minute practices per week). Structure: instructions, exercises, tips, and feedback. Topics: phonological and prosodic rules that govern American English pronunciation and intonation, vowels, consonants, common idioms, and figures of speech relevant in healthcare.3 monthsOnline Test of English Proficiency LevelKnowledge testProficiency in Oral English Communication – ScreenKnowledge testProficiency in Oral English Communication – ScreenNoneTrainee surveyTrainee exit interviewSignificant gains in knowledge and verbal performance; program satisfaction.
Freysteinson et al, 201734LowCALD health students and CALD nurses27Weekly 1-hour sessions taught by an SLP. Topics: role of prosody in acquisition of American English pronunciation, vowel and consonant sounds, and North American English medical terminology.12 weeksSelf-Esteem ScalePersonal Report of Communication Apprehension-24Self-Perceived Communicative CompetenceSelf-Esteem ScalePersonal Report of Communication Apprehension-24Self-Perceived Communicative CompetenceNoneNoneSignificantly higher self-esteem and overall competence related to communication.
  • AAE, African American English; CALD, culturally and linguistically diverse; ESL, English as second language; IMGs, international medical graduates; IMRs, international medical researchers; INGs, international nursing graduates; N/A, not available; SAE, standard American English; SLP, speech language pathology/speech language pathologist.