In recent decades, both global migration in general and specifically migration to Sweden have increased. This development compels the need for delivering healthcare to the increasingly diverse populations in Sweden. To support health professionals, for instance occupational therapists, in developing their professional knowledge in encounters with foreign-born clients a self-rating instrument measuring cultural competence is developed. This may contribute to the development of suitable services for foreignborn clients and improve person-centered interventions for these clients. The general aim of this thesis was to develop an instrument for health professionals by examining psychometric properties and utility of the Swedish version of the Cultural Competence Assessment Instrument (CCAI-S) among occupational therapists. The specific aim of study I was to evaluate the content validity and utility of the Swedish version of the Cultural Competence Assessment Instrument (CCAI-S) among occupational therapists. The study had a descriptive and explorative design. Nineteen occupational therapists participated, divided into four focus groups. Qualitative content analysis was used to examine the content validity and utility of the CCAI-S. The specific aim of study II was to examine the clinical relevance, construct validity and reliability of the Swedish version of the Cultural Competence Assessment Instrument (CCAI-S) among Swedish occupational therapists. The study had a cross-sectional design. A web-based questionnaire was e-mailed to a randomised sample of 428 occupational therapists to investigate the construct validity, reliability and utility of the CCAI-S. Factor analysis was performed as well as descriptive statistics. The findings from study I revealed high content validity for all 24 items. However, six items needed reformulations and exemplifications. Regarding utility, the results showed strong support for CCAI-S. The category ‘Interactions with clients’ showed that the CCAI-S could be utilised individually for the health professional and create a higher awareness of cultural questions in practice. The category ‘Workplace and its organisational support’ displayed potential for use in different workplaces regarding CCAI-S and indicated the importance of organisational support for health professionals in the development of cultural competence. The findings from study II regarding construct validity generated a three-factor model with the labels ‘Openness and awareness’, ‘Workplace support’ and ‘Interaction skills’. All three factors showed high factor loadings and contained 12 of the 24 original items. The Cronbach’s Alpha showed high support for the three-factor model. Concerning utility, the participants reported that all 24 items had high clinical relevance. In conclusion, the findings from the two studies indicated good measurement properties and high clinical relevance for the CCAI-S. This may sup-port the utilisation of CCAI-S in the Swedish context for health professionals, for instance occupational therapists. The results of the instrument development show that the upcoming published version of the CCAI-S can be a valuable self-assessment tool for health professionals who strive to improve in person-centred communication in encounters with foreign-born clients. CCAI-S can also be of support for the organisation to serve as a guide for what to focus on to develop cultural competence within the staff. Altogether this presumably influence the effectiveness of the healthcare and enhance the evidence of interventions for foreign-born clients. To develop an instrument is an iterative process requiring several evaluations and tests in various settings and populations. Therefore further psychometric testing and utility studies on the CCAI-S is crucial.

There is a large demand for the use of e-learning tools to support student learning, in the form of distance or blended learning. The need for e-learning environment that encourages learners to learn independently or in groups in virtual settings is crucial. Some e-learning environments provide repositories of `resources¿. They neither facilitate a strategy for learning or teaching, nor they guide students through the resources, and tutors in constructing their courses. E-learning environments need to incorporate pedagogical practices which support and allow students to learn by removing any barriers that might inhibit their learning. Therefore, one of the most important aspects in developing e-learning environments is defining appropriate models where technology and pedagogy are integrated. This thesis provides such a framework for developing e-learning applications; it aims to make it easier for tutors to implement their lesson content and engage learners to achieve the course objectives. The proposed model incorporates constructive alignment, assessment and feedback and unlike other e-learning environments guides the tutor to construct lessons and help learners to use effective learning environment. Furthermore, the thesis investigates on how supported learning can help students adapt to the different approaches to learning. The empirical work undertaken investigates the role of constructing a well designed self-assessment and feedback unit within a learning environment.

ESL writing teachers often deal with a heavy workload of giving feedback to students. Training students to self-assess their work can ease teachers' burdens; one self-assessment method is rubric training (RT), where teachers guide students in reading and grading sample essays. This research explores whether RT leads to positive emotional and regulatory gains. Twenty-one students enrolled in a first-year writing class received incremental exposure to RT. The same set of surveys, Self-efficacy Scale (SES) and Self-regulated Learning Perception Scale (SRLPS), was administered three times to measure the changes in their language self-efficacy (LSE) and self-regulated learning (SRL). The results were compared to the 15 students in the control group, where students also completed the same surveys on the same class days. Results showed that RT had a significant impact on students' LSE, but there was no presence of interaction or main effect for SRL. In post-assessment interviews, most students expressed feeling positive about RT because of the model essays; they learned about essay organization and coherence from the sample writing. However, some did not like the rubric because they thought it was difficult to read and the lexical complexity of the rubric was above students' reading level; it might be what made students feel less capable of completing the task. Still, LSE bridges students' self-assessment and language gains; therefore, RT should be used when teachers want to increase students' LSE.

This study investigates the interplay between temporal fluency measures, self-assessment, and language proficiency scores in novice- to intermediate- level language learners of Spanish and French. Analyzing data from 163 participants, the research employs both traditional linear regression and advanced XGBoost machine learning models. Findings demonstrate a moderate positive correlation between self-assessment and Oral Proficiency Interview by Computer (OPIc) scores, underscoring the dependable self-awareness of learners. Notably, XGBoost performs as well as linear regression in predicting OPIc scores and has more potential, underlining the efficacy of advanced methodologies. The study identifies Mean Length of Utterance (MLU) as a crucial predictor, highlighting specific temporal fluency measures' significance in determining proficiency. These findings contribute to language assessment practices, advocating for the integration of machine learning for enhanced precision in predicting language proficiency and informing tailored instructional approaches.

The present study explores the relationship between temporal fluency and second language (L2) learners' self-assessed and externally assessed proficiency level across the target languages French, Spanish, and Portuguese. Temporal fluency is operationalized as articulation rate (the speed of speech), the mean length of utterance, and the silent pause frequency. Participants (n = 283) in this study are native English speakers enrolled in upper-division language courses at Brigham Young University (BYU). Each participant completed both a self-assessment (the Language Ability Self-Evaluation Resource or LASER) as well as the Computerized Oral Proficiency Interview (OPIc) to receive an external proficiency assessment. Temporal fluency measures were automatically extracted from audio recordings used for the self-assessment (LASER) using a Praat script developed by De Jong & Wempe (2009). The results from this study find a strong, significant relationship between all temporal fluency measures and both self-assessed and OPIc-assessed proficiency. This relationship remains strong when comparing across L2 groups for all three temporal fluency measures and OPIc proficiency rating. For self-assessed proficiency, only some temporal fluency measures are found to be significantly related to self-assessed proficiency across each target language group, with articulation rate found to be the most consistently significant temporal fluency measure across all three target language groups. Together, these findings suggest that as speakers speak faster, produce longer utterances, and pause less frequently, they also tend to increase in proficiency, both according to their own self-assessment as well as within a formal oral proficiency assessment (OPIc).

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Syftet med studien var att undersöka självupplevd oral hälsa (SPOH) och faktorer som påverkar den, i en vuxen population i Kalmar län, Sverige. Studien är en del av en epidemiologisk studie som genomfördes under 2010-2012. Urvalet för denna studie bestod av 380 slumpvis utvalda personer som deltog i en omfattande klinisk undersökning och svarade på en enkät. Enkäten bestod av 56 frågor angående bl.a. patientens självupplevda orala hälsa och socioekonomiska situation. Den studerade populationen bestod av 189 kvinnor (49,9%) och 190 män (50,1%). Individerna var 20-90 år, med en genomsnittlig ålder av 52 år. Självupplevd oral hälsa definierades statistiskt utifrån en av frågorna i enkäten: självupplevd oral hälsa jämfört med jämnåriga, och benämndes SPOH. De kliniska variabler som analyserades var antal egna tänder, DMFT (Decayed, Missed, Filled Teeth), tandluckor och riskbedömning (summa av tandläkarens bedömning av kariesrisk, parodontal risk, teknisk risk och allmän risk). Bakgrundsvariablerna var ålder, kön, utbildning och etnicitet. Bivariata korrelationer och en regressionsanalys utfördes med SPOH som beroende variabel och med bakgrundsfaktorer och kliniska variabler som oberoende variabler. Signifikanta korrelationer påvisades mellan SPOH och ålder (p<0,01), DMFT (p<0,01), antal egna tänder (p<0,01) och tandläkarens riskbedömning (p<0,01). Högre SPOH korrelerade med ökande ålder, fler egna tänder och lägre DMFT. En överensstämmelse mellan tandläkarens bedömning av patientens orala status och SPOH påvisades i sambandet mellan dessa två variabler, vilket indikerar att högre bedömd risk är förknippat med en lägre SPOH. / The aim of this study was to investigate self-perceived oral health (SPOH) and factors affecting it, among adults in the Swedish county of Kalmar. The study is part of an epidemiologic study conducted in 2010-2012. The sample for this study was comprised of 380 individuals, randomly selected, who participated in a clinical examination with a concomitant questionnaire. The questionnaire consisted of 56 questions concerning e.g. patient perception of oral health and socio-economic situation. The final study population consisted of 189 women (49.9%) and 190 men (50.1%). The individuals were 20-90 years, with a mean age of 52 years. Self-perceived oral health was statistically defined by one question of the questionnaire: self-assessed oral health as compared to contemporaries of the same age, and termed SPOH. The clinical variables analysed were number of own teeth, DMFT (Decayed, Missed, Filled Teeth), gaps between teeth and risk assessment (sum of the dentists assessment of caries risk, periodontal risk, technical risk and general risk). The background variables were age, gender, education and ethnicity. Bivariate correlations and regression analyses were conducted with SPOH as dependent variable, and with background factors and clinical variables as independent variables. Significant correlations were found between SPOH and age (p<0.01), DMFT score (p<0.01), number of own teeth (p<0.01) and the dentists’ risk assessment (p<0.01). Higher SPOH was associated with increased age, increased number of own teeth and decreased DMFT. A consistency between the clinician’s assessment of the patient’s oral status and SPOH was shown in the correlation between these two variables, which implies that a higher risk assessment is associated with a lower SPOH.

The main purpose of this study was to investigate the effects of form-focused instruction (FFI) on prosody with or without self-assessment on the prosodic and global aspects of L2 speech by Japanese EFL learners using a pre-post design. In addition, native English speaking (NS) and non-native English speaking (NNS) raters with high levels of English proficiency were compared to examine the influence of raters’ L1 backgrounds on their comprehensibility ratings. Sixty-one Japanese university students from four intact English presentation classes participated in the study. The comparison group (n = 16) practiced making one-minute speeches in class (45 minutes x 8 times) without explicit instruction on prosody, while the two experimental groups (n = 17 for the FFI-only group; n = 28 for the FFI + SA group) received FFI on word stress, rhythm, and intonation, practiced the target prosodic features in communicative contexts, and received metalinguistic feedback from the instructor. In total, the experimental groups received six-hours of instruction in class, which was comparable to the comparison group. Additionally, the experimental groups completed homework three times; only the FFI + SA group recorded their reading performance and self-assessed it in terms of word stress, rhythm, and intonation. Three oral tasks were employed to elicit the participants’ speech before and after the treatment: reading aloud, one-minute speech, and picture description. The speech samples were rated for comprehensibility by NS and NNS raters and were also analyzed with four prosodic measurements: word stress, rhythm, pitch contour, and pitch range. Instructional effects on prosody were observed clearly. The FFI-only group improved their controlled production of rhythm and pitch contour, while the FFI + SA group significantly improved all of the prosodic features except pitch range. Moreover, the instructional gains for the FFI + SA group were not limited to the controlled task but transferred to the less-controlled tasks. The results showed differential instructional effects on the four prosodic aspects. The FFI in this study did not help the participants widen their pitch range. The FFI on prosody, which was focused on the cross-linguistic differences between Japanese and English, tended to be more effective in terms of improving rhythm and pitch contour, which were categorized as rule-based, than an item-based feature, word stress. The study offered mixed results regarding instructional effects on comprehensibility. The FFI-only group did not significantly improve comprehensibility despite their significant prosodic improvements on the reading aloud task. Their significant comprehensibility growth on the picture description task was not because of the development of prosody, but of other linguistic variables that influence comprehensibility such as speech rate. The FFI + SA group made significant gains for comprehensibility on the three tasks, but the effect sizes were small. This finding indicated that the effects of FFI with self-assessment on comprehensibility were limited due to the multi-faceted nature of comprehensibility. The data elicited from the post-activity questionnaires and students’ interviews revealed that not all the participants in the FFI + SA group reacted positively to the self-assessment practice. Individual differences such as previous learning experience and self-efficacy appeared to influence the learners’ perceptions of the self-assessment practice and possibly their instructional gains. The two groups of raters, L1 English raters (n = 6) and L2 English raters with advanced or native-like English proficiency (n = 6) did not differ in terms of consistency and severity. These findings indicated that NNS raters with high English proficiency could function as reliably as NS raters; however, the qualitative data revealed that the NS raters tended to be more sensitive to pronunciation, especially at the segmental level, across the three tasks compared to the NNS raters. This study provides evidence that FFI, especially when it is reinforced by self-assessment, has pedagogical value; it can improve learners’ production of English prosody in controlled and less-controlled speech, and these gains can in turn contribute to enhanced L2 comprehensibility. / Teaching & Learning