Conceptualising user perceptions of value in service-related contexts

Drawing on the theoretical framework of service dominant logic (S-D Logic) a service can be defined as that which applies ‘specialized competences (knowledge and skills) through deeds, processes, and performances for the benefit of another entity or the entity itself’ [27 p2]. In other words, services provide the resources and processes for users to generate value for themselves and by extension to others indirectly [29]. As such, services (and by extension resources) are not imbued with inherent value [26, 27]. For example, the courses of study offered by tertiary institutions are services that provide resources and processes by which students gain professional knowledge, skills, and accreditation to work in their chosen profession [30]. The expected and actual value of these resources and processes comes from the ways in which students interact with them [30–32]. In this sense, students are actively involved in appraising the value of these proffered resources [30, 31] and generating their own perceptions of the value that can arise from engaging with them (i.e., the value-in-use from the resource). These appraisals and perceptions, in turn, can influence users’ levels of satisfaction [33, 34] and repeat usage [35]. It is for all of these reasons that service providers are increasingly eliciting input from users to help them better configure their offerings.

Why understanding and analysing users’ perceptions of value is important

Gathering and analysing user-generated perceptions of resource value enables service providers to gain insights that can be used to better identify, configure, refine, manage, and promote these resources going forward. Indeed, leveraging user-generated perceptions of the value accrued from engaging with a resource enables a provider to optimise the fit between what they offer and what actual and prospective users perceive as being beneficial to meeting their personal needs, challenges, lived experiences, and goals [30, 36, 37]. Interacting with current and prospective users also enables a service provider to identify potential areas where there is insufficient knowledge or understanding among users for them to be able to meaningfully appraise the value of proffered resources [38]. Such knowledge is crucial in ensuring resources are presented and promoted to current and prospective users in ways that they can understand.

In the current study context, we focus on inputs from both CALD students and FWSs in order to derive and map the perceived value of support resources that can be used to facilitate their fieldwork placement experiences and outcomes. The rationale for focusing on inputs from these stakeholders is as follows. As actual or prospective users of fieldwork placement support resources CALD students are well positioned to provide evaluative input on what they perceive to be of value and how such resources could be refined to increase their perceived value going forward. Given FWSs benefit from receiving students who have the requisite skills to effectively engage in a fieldwork placement, they can be conceptualised as indirect users and an important, albeit underutilised, source of input into support resource configuration and optimisation. Specifically, their understanding of the skills needed to effectively engage in fieldwork placements combined with their in-situ observations of CALD students’ challenges whilst on placement make them a rich source of insights in this area. They are also uniquely positioned to provide input into configuration of support resource to address their own supervisory needs and challenges.

Data collection and procedure

Institutional ethics approval and informed consent was obtained prior to data gathering. Data were collected from FWSs recruited as part of a larger project that involved University placement administration staff disseminating an online survey URL link to all fieldwork placement supervisors and placement organisations affiliated with the BOT and MSW academic programs between December 2018 and February 2019. In the current study we report on FWSs qualitative responses to open-ended questions included in the larger project to elicit insights into the types of resources and/or processes they perceived would be of value to CALD students in preparing for a positive fieldwork experience and the types of support resources that they perceived to be of value in facilitating their own supervision of CALD students during a placement.

The same administrative staff disseminated bulk email invitations to CALD students inviting those who had completed at least one fieldwork placement to participate in a semi-structured interview. Purposive sampling from BOT and MSW students was used to ensure equal representation from each course. The students were given an explanatory statement about the research and written consent was gained prior to the interviews. The semi-structured interview schedule (see S1 File) included questions pertaining to a range of topics including the types of resource supports (institutional/non-institutional) they used or sought in preparing for a fieldwork placement as well as their perceptions of the value associated with them. The interview schedule was pilot-tested with BOT and MSW students and was modified subsequently to ensure clarity. To facilitate participation, the CALD students could choose either a face-to-face (on campus) or video conference (via Zoom) interview and could opt to see the interview schedule beforehand. The audio-recorded interviews were 30-45-minutes in length with students receiving a $30 gift voucher at the end as a thank you for their time. The interviews were conducted between June and August, 2019 by authors D.-C.A.L or S.B. who did not have direct teaching or supervisory relationships with the students, nor bias or assumptions in the research topic. Field notes were taken by the interviewers. All interviews were transcribed verbatim prior to being analysed. Interviews were conducted until no new information or saturation of data was obtained.

Data analysis

All authors contributed to data analysis (F.N. is an Associate Professor in Marketing, D.-C.A. Lee is a Research Fellow in Allied Health and S.B. is a lecturer in Occupational Therapy) and each had at least five years of research experience and training. Data analysis utilised thematic analysis, which is used to identify, examine, characterise, and report recurring themes and patterns emerging from qualitative data [42, 43]. This approach was deemed well suited to our situation where perspectives of CALD students and FWSs were being explored since differences and similarities could be highlighted. After data familiarisation, the authors independently analysed the data to develop initial codes using a coding framework of users’ perceptions of support resource value in facilitating fieldwork placements. The codes were recorded in an Excel spreadsheet along with data extracts from the interviews/open-ended questions. During this review process, the authors met regularly to discuss the codes being generated. The transcripts and open-ended survey responses were repeatedly re-read to ensure that the generated codes and themes fitted the original data. All codes, categorisations of themes, and the connections between themes were arrived at through discussion and consensus of the researchers. Member checking with selected students (n = 3) was performed to ensure validity of the researcher’s interpretation of student interviews. These themes were then transformed into a conceptual map to more clearly illustrate the connections and structural layers in how CALD students and FWSs were appraising the value of the support resources and processes they mentioned.

1. University generalised support resources for students: (Level 1 support)

In this section, perceptions of the value associated with general support resources such as university-run clubs, societies, and conversational English resources are presented. For FWSs, these general level resources were valued for providing a means for CALD students to build a base level of ‘awareness of the environmental/societal context’ (OT, FWS-85) that could be drawn upon later ‘to assist in understanding the population being worked with’ (OT FWS-16). In turn, this awareness building was seen as protecting against CALD students feeling at a disadvantage during their placements in terms of ‘ability to realistically assess the clients’ (OT FWS-34). Some FWSs also saw value in building in processes that would encourage and enable CALD students to reflect on these interactions in order to see how their cross-cultural journey could influence their professional practice. Such reflections were seen as helping students to identify points of strength, think about how their learning style aligns with clinical practice expectations, and to identify areas where cultural differences may mean that they needed additional assistance. This insight emerged from field observations that CALD students who engaged in such reflections tended to adjust better to fieldwork placements. As one FWS commented, ‘What makes the difference is how they view their culture ‘of origin’ and its effect on their learning’ (OT, FWS-6). Communicating the need for, and benefits accrued from, this type of reflection to CALD students was seen as important.

Seen through the lens of CALD students, perceptions of value arising from generalised university supports were more nuanced. Only some CALD students saw value accruing from University general level resources. For example, clubs and societies were seen by a few as a means of increasing understanding of ‘Australia society’ (MSW, Student-6) or as an interesting way to engage in cultural familiarisation: ‘When you talk about culture, experiencing it is definitely better than reading it’ (BOT Student-17). Notably, the potential to leverage these general support resources for social interaction and friendship, especially with local students, was often overlooked: ‘how can we just make friends with local students…. sometimes, you want to communicate with them but have no chance to do that’ (MSW Student-8). Likewise, CALD students’ appraisals of the proffered value of University general language and conversational English resources were typically poor in spite of their concerns that they lacked the skills to understand ‘accents’ (MSW, Student-6) and the use of ‘slangs…and people [that] talk very fast’ (MSW Student-8) during fieldwork placements.

2. University discipline-contextualised support resources for students: (Level 2 support)

For some CALD students, their negative appraisals of generalised supports emanated from not seeing their relevance relative to the more narrowly focused Level 2 discipline contextualised support resources aimed at strengthening particular professional communication skills. Indeed, there was a tendency to want assurance that the time they spent seeking help from support resources would deliver course-specific value. These findings along with the perceived value of supports to understand how healthcare is socially and culturally contextualised are outlined below.

Resources to build and consolidate professional communication skills

In analysing CALD student inputs it became clear that they perceived value in using support resources that have an obvious or clear link to ‘placement settings’ (BOT, Student-16) or to the professional communication skills needed during placements. As one student noted:

‘there’s a specific role about what an OT can do within that setting. So, it’s a very specific kind of thing, and I don’t think a general English communication class can have any influence on our communication skills….It’s not about my course, so I don’t find it useful’ (BOT, Student-12).

Similarly, the value attached to using support resources appeared tied to the credence of the resource endorser (i.e., promoter). For example, messages were less likely to be attended to if they were promoted university wide or there was no clear connection to a student’s discipline area; ‘just ignore it because, you know, they are not sent from [the] school or department’ (MSW, Student-9).

Evidence also emerged of the potential for social norms and cultural values to influence CALD students’ appraisals of some Level 2 support resources especially in terms of understanding culturally appropriate communication with their FWSs. From the perspective of FWSs, CALD students require additional resources to develop their confidence and skills in ‘asking for assistance or seeking clarification from the supervisor’ (OT, FWS-75). Indeed, such resources were seen as a pathway forward to ameliorating a potential source of disadvantage as ‘question asking’ was often used to gauge if students ‘are interested in placement and what they are learning’ (OT, FWS-71). However, there was evident reluctance among some CALD students to pursue such resources. As one student noted: ‘in China maybe, we feel kind of rude if we just ask questions directly or ask them again or again’ (MSW, Student-9). Moreover, the notion of a perceived power imbalance between themselves as students and their FWS meant they were uncertain how to frame their questions and ideas so as not to cause umbrage:

‘….and another thing is more about the appropriateness in using language…..especially when talking to someone who’s more superior. Like a supervisor, what kind of language is considered professional, well mannered?’ (MSW, ID7).

Resources to aid understanding of the culture-professional practice nexus

Both CALD students and FWSs perceived value in discipline contextualised support resources that focused on consolidating CALD students’ understanding of how culture can influence professional practice. For CALD students these types of Level 2 support resources enabled them to ‘catch up’ with their peers as they felt they started from ‘ground zero’ in terms of understanding ‘the system and the society….the difference between hospital and community service’ (MSW, Student-7). Using such support resources to build their understanding of the ways in which healthcare provision is socially contextualised was also seen as a way to become more competitive in the graduate marketplace: ‘if we want to find a job in Australia, because the market here is so competitive, we need to compete with the local students’ (MSW, Student-9). While not explicitly couched in terms of a mechanism to bring CALD students up to the same level of playing field as non-CALD students, FWSs saw such resources as enhancing their placement performance by providing them with the knowledge to identify a:

‘patient’s situation and their occupational roles….to appropriately identify relevant patient goals, initiate appropriate treatment/patient management and then be appropriately involved in discharge planning’ (OT, FWS-12).

3. External support resources for students: (Level 1 & 2 support)

Resources external to the university were also perceived as offering value preparing for fieldwork placements. General (i.e., non-health related) volunteer and paid work within the community, for example, were perceived by FWSs as valuable Level 1 support resources through which CALD students could ‘gain knowledge about the country’ (OT, FWS-36) and culture as well as building their language skills. Indeed, for many FWSs engaging with these resources was seen as an essential step towards placement success, particularly for students whose ‘English is not good enough to have a complex conversation with a patient’ (OT, FWS-21).

Interestingly, in contrast to their somewhat muted perceptions of the value of Level 1 university support resources, CALD students also saw general work and volunteering as effective and valuable support mechanisms to help them understand ‘the culture inside a community…prepare your communication skills’ (BOT, Student-13), and to ‘build your confidence’ (MSW, Student-3). Not surprisingly, these perceptions of value extended to volunteer or paid work in areas connected to their chosen academic discipline, as these opportunities enabled them to gain discipline-contextualised experience.

Community events and sporting activities were also perceived as valuable support resources. As one OT student noted:

‘I played sports with a volleyball club, so I went there and…..talk with the people inside the club after the training, and I think this is building my confidence and also allowing me to know their culture as well’ (BOT, ID13).

However, fear and lack of confidence to step out of their comfort zone was seen to hamper use of these types of support resources resulting in some students developing and maintaining a narrow network of peers from the same home country:

‘I know many international students they are afraid… just have less opportunities to go out and find some friends’ (BOT, ID17).

4. Individualised resources and mechanisms to tailor CALD student placements: (Level 3 support)

Analysis of the FWS data indicated that a tailored rather than ’one size fits all’ approach was needed to meet the needs of CALD students in preparing for, and undertaking, fieldwork placements. Fieldwork supervisors perceived value in having formalised participatory processes to allow co-creation of the fieldwork experience through mechanisms such as dialogue between ‘the supervisor, student, and university …to identify any potential challenges and useful strategies’ (OT, FWS-13) and ‘to understand the context of placement/organisation/expectations’ (SW, FWS-5). Such dialogue was seen as a means of proactively addressing acculturation concerns and needs so that ‘supports can be put in place’ (OT, FWS-7). Examples of co-created tailoring included providing ‘additional modified scenarios or activities to support them in working towards areas of competencies’ (OT, FWS-70) and being able to not ‘overload students…[but rather] gradually increase complexity’ (OT, FWS-65).

Having a formalised process in place to allow for proactive dialogue at the start of a fieldwork placement was also seen by FWSs as a means of enhancing the relationship between CALD students and FWSs. Examples of benefits included helping CALD students understand cultural nuances around the meaning of feedback especially that ‘feedback is not negative but enhances learning’ (OT, FWS-28), facilitating alignment of students’ and supervisors’ expectations in terms of the ‘reflective practice models’ (OT, FWS-28) used in allied health, and communicating ‘key areas they need to perform during placement and resources/strategies they are expected to utilise to reach this standard’ (OT, FWS-21).

5. Support resources for fieldwork supervisors: (Level 1 & 2 support)

Support resources for FWSs were also identified as being of value in helping them to better fulfil their role and by extension, enhance the experience of CALD students during a placement. For instance, both CALD students and FWSs perceived value in the provision of Level 1 general supervisory cross-cultural training centred around optimising the student experience. From the perspective of CALD students, such training would help FWSs ‘recognise the need of some international students’ (BOT, Student-17). Going a step further, FWSs felt such training would enable them ‘to understand and build greater relationships with CALD students’ (OT, FWS-40). This nexus between training and tailoring of fieldwork experiences spilled over into other areas including student referrals to support services. For example, FWSs perceived value in training to ‘understand the range of supports offered to CALD students and how placement supervisors can access these supports for students’ (SW, FWS-13). On a more personal level, FWSs perceived value in training to help them manage role ambiguity. As one FWS noted:

‘if you are needing to teach them how to communicate and write documents in English you are starting from a level behind than if the student is non-CALD….Your role as a supervisor turns into one of a translator/ supporting both the student and patient to understand the communication’ (OT, FWS-81).

The provision of support resources to help FWSs better manage poor placement performance among CALD students was also seen as important as these situations were perceived as being stressful especially ‘if the student is on a scholarship and is failing’ (OT, FWS-30).

6. Resources to monitor CALD students’ fieldwork readiness (Nested support between Level 2 and Level 3)

Unique to FWSs was the notion that mechanisms are needed to monitor the readiness of CALD students to undertake a fieldwork placement. Particular value was seen in having mechanisms in place to check students have ‘an adequate skill level in terms of verbal and written communication’ (OT, FWS-73) including ‘a level of English expressive language to enable them to communicate with patients’ (OT, FWS-68). The provision of such monitoring was seen as a way to reduce some of the challenges faced by CALD students and FWSs during a placement.

Study limitations and suggestions for future research

As with all research, this study had limitations. First, because we utilised data from a larger project, the CALD students and fieldwork supervisors were not selected according to theoretical sampling. Second, while the inclusion of input from direct (CALD students) and indirect (FWSs) beneficiaries of fieldwork placement support resources adds to the strength the findings, we acknowledge the inputs were elicited from one multi-site tertiary provider and did not capture all allied health disciplines. It is therefore possible that the emergent support resource ecosystem may not encapsulate perceptions of the value of all types of support resources used by CALD students undertaking an allied health degree or recommended by allied health FWSs. Although these limitations do not undermine the utility of codifying and mapping perceptions of value to elicit actionable insights, future research could calibrate our support resource ecosystem to encompass a broader range of allied health disciplines using data from multiple institutions. Future research could also explore the efficacy of using a support resource ecosystem to help in tracking patterns of support resource referrals and utilisation among CALD students. This data could then be used to trigger reminders or follow-up for students who do not follow through on referrals, thus closing the support-resource loop. It could also be used to evaluate the efficacy of different patterns of resource usage on fieldwork placement outcomes. Equally importantly, future research is also needed to examine whether knowing that this support resource ecosystem is built on perceptions of value from prior uses has a positive flow-on effect in terms of enhancing perceptions of relevance and value in the minds of new resource users (i.e., new CALD students). Support for this contention comes from research suggesting peer endorsements can influence student choices across a range of contexts [66, 67].