Content area
There is limited research surrounding the effectiveness of program implementation, and the research that does exist often considers culture as a minor contributing factor. In this study, culture is re-framed as a major contributing factor of program implementation using an international adaptive sports program as an example. The program was planned and implemented by a team of U.S. facilitators for a group of Thai students and professors in Thailand. The purpose of this study was to understand the cultural processes that influence program implementation in the context of adaptive sport. The research team conducted observations of the program delivery and semi-structured interviews with the U.S. program facilitators. Guided by Hofstede's Cultural Dimensions, the findings consider how culture influenced program implementation. Building from existing program implementation models, this study proposes a modified model of program implementation in which culture is positioned as a factor influencing all aspects of program implementation.
Abstract
There is limited research surrounding the effectiveness of program implementation, and the research that does exist often considers culture as a minor contributing factor. In this study, culture is re-framed as a major contributing factor of program implementation using an international adaptive sports program as an example. The program was planned and implemented by a team of U.S. facilitators for a group of Thai students and professors in Thailand. The purpose of this study was to understand the cultural processes that influence program implementation in the context of adaptive sport. The research team conducted observations of the program delivery and semi-structured interviews with the U.S. program facilitators. Guided by Hofstede's Cultural Dimensions, the findings consider how culture influenced program implementation. Building from existing program implementation models, this study proposes a modified model of program implementation in which culture is positioned as a factor influencing all aspects of program implementation.
Keywords
Cross-cultural adaptive sports programming, culture, Hofstedes Cultural Dimensions, program implementation, therapeutic recreation
Introduction
Central to a holistic approach to therapeutic recreation (TR) is the concern of inclusive recreational opportunities where identifying mechanisms for overcoming constraints to participation among individuals with various disabilities is a key focus for practitioners (Skalko, 2009). Adaptive sport is one inclusive recreation modality used in TR (Zabriskie, Lundberg, & Groff, 2005) and can be described as the altering or modifying of recreational or sport activity so that people with different levels of functioning are able to participate (Lundberg, Taniguchi, McCormick, & Tibbs, 2011). This can include, for example, activities such as wheelchair basketball, wheelchair tennis, wheelchair rugby (i.e., murderball), adapted track and field, five-a-side soccer (for individuals with visual impairments) and seven-a-side soccer (for individuals with neurological impairments such as cerebral palsy). Adaptive sport programs continue to grow in popularity as attitudes about disability shift, equipment improves, media coverage of adaptive sports events (e.g., Paralympics) increase, and more certified therapeutic recreation specialists become qualified providers of these programs (Lastuka & Cottingham, 2016). A developed body of literature focusing on adaptive sports programming exists (c.f., Brittain, 2004; Caddick & Smith, 2014; Kiuppis, 2018; Murphy & Carbonne, 2008), yet this line of inquiry is still growing within the field of TR, especially when it comes to international adaptive sport programming.
Recently, scholars have considered the role of program implementation in recreation and leisure program settings (Gagnon, Franz, Garst, & Bumpus, 2015; Morgan, Sibthorp, & Browne, 2016), but still there remains a lack of research related to program implementation quality (Duerden & Witt, 2012). This paper affirms to bridge this consideration to TR and the provision of adaptive sports programs; that is, this paper seeks to understand the factors that influence how well a program is delivered-the quality of program implementation-because when a program is delivered effectively, the desired outcomes are more likely to be achieved. Many factors contribute to the quality of program implementation such as organizational, facilitator, program, and community characteristics (Gagnon et al., 2015), as well as program fidelity, adaptation, and participant responsiveness (Morgan et al., 2016). Within the context of adaptive sports programs, a number of additional factors need to be considered beyond the nature and severity of the disability. These may include the individual's perception of his/her ability, the individual's efficacy in the sport, and other personal, social, and-the focus of the present study-cultural factors, which is especially relevant for programs that are implemented around the world.
Culture, defined here as the collective beliefs, norms, and values that shape human behavior, may affect both the delivery and reception of adaptive sport programming (Kensinger, Gearig, Boor, Olson, & Gras, 2007; Nishino, Chino, Yoshioka, & Gabriella, 2007). Research has examined the idea of cultural mismatch regarding program implementation (Castro, Barrera, & Martinez, 2004), the issue of community characteristics (Gagnon et al., 2015), and program compatibility with regard to cultural context (Durlak & DuPre, 2008; Kumpfer, Alvarado, Smith, & Bellamy, 2002). In current models of program implementation, culture is typically embedded as a subcategory of community characteristics; however, the authors of the present study posit that culture impacts every aspect of program implementation. Thus, the purpose of this study was to understand the cultural processes that influence program implementation in the context of adaptive sports.
Literature Review
Program Implementation
Program implementation has emerged in the extension and prevention science literature as a critical component to the success of a program (putting planning into action) in that program effectiveness and the overall achievement of intended outcomes is dependent on how well a program is implemented (Durlak & Dupre, 2008). Prior to this focused line of inquiry on implementation, program evaluations emphasized summative evaluations of programs while not considering what happened during the actual delivery of the program that could have directly contributed to failure or success. Centered within this research, then, is a focus on factors that contribute to the achievement of quality program implementation-which simply refers to how well a program is delivered-including the dynamic interactions between the participants, staff, and program activities (Morgan et al., 2016). Thus, drawing from existing program implementation models (Gagnon et al., 2015; Morgan et al., 2016), this paper considers how organizational, program, and facilitator characteristics influence the overall program implementation quality, which in turn influences participant responsiveness and ultimately, outcome achievement (Table 1). To this end, the ability to reach intended outcomes requires a negotiation of both program fidelity and adaptation within the program implementation phase.
Gagnon and colleagues (2015) considered cultural features of the community within community characteristics as a factor influencing quality program implementation, particularly as it can influence participant responsiveness. Participant responsiveness considers the levels of reception, engagement, interest, and usefulness of the program for each participant in the community (Gagnon et al., 2015). This is particularly relevant in the context of programs designed and planned in one country (or culture) and delivered in another. To this end, it has been noted that when programs are not compatible with the cultural context, participant engagement diminishes (Kumpfer et al., 2002). Community characteristics also include the idea of cultural mismatch regarding program implementation. Castro and colleagues (2004) categorized areas of mismatch between program facilitators (validation group) and the participants (consumer group) in terms of group characteristics including language, ethnicity, socioeconomic status, urban-rural context, and risk factors (e.g., family stability). In doing so, they posited that differences in the two groups effect program implementation quality, resulting in the need for cultural adaptation.
Further research has also found that if there are differences in language or perceptions of disability between the facilitator and participant, the program may not be received well by the participant (Kensinger et al., 2007; Nishino et al., 2007). Kensinger and colleagues (2007) implemented a TR program with refugees who had migrated to the U.S. and found that refugee notions of time and order were much more fluid and laid back compared to the U.S. program providers; the participants would arrive late, if at all. Additionally, Nishino and colleagues (2007) noted the importance of selecting culturally relevant activities that resonate with the community's values (e.g., tradition) in their efforts to develop Fushuki (welfare) recreation resources for the elderly in Japan. The idea of culturally relevant programming expands well outside the realm of recreation and TR programs. Studies have found that the cultural competence of program facilitators is critical to implementation success of rehabilitative correctional programs for indigenous criminal offenders (Gutierrez, Chadwick, & Wanamaker, 2018), and organizational factors related to leadership and structure led to AIDS prevention programming often being culturally irrelevant to African-American women in the U.S. (Archie-Booker, Cervero, & Langone, 1999).
It is also important to note that the notion of disability is rooted in the cultural context, which is discernable through institutional responses of policies and laws (Meyer, 2010). Within TR and adaptive sport, cultural perceptions of disability and sport have the potential to affect participant responsiveness and their experience with the programming (Brittain, 2004). For example, Brittain looked at societal perceptions of disability that manifest through stereotyping and stigma, which may not only serve as a barrier to participation, but can also negatively affect individuals' self-perception and dependency within a sport program (2004). Given the increasing diversity of local communities, global mobility, and increased opportunity for programming internationally, it is vital that TR specialists understand and adapt to the cultural needs of participants which includes developing culturally relevant understandings of disability (Stumbo & Singleton, 2007).
Culture and Hofstede's Cultural Dimensions
Culture is a complex term used to describe the shared artifacts, beliefs, customs, knowledge, practices, and symbols that shape normative behaviors and ways of living within social structures such as ethnic groups, families, organizations, or nation-states (Hofstede, 2011; McSweeney, 2009; Weaver, 1986). Culture has also been characterized as the dynamic system by which belonging, identity(s), and meaning(s) are produced and reproduced within these social structures (Boyd & Richerson, 2005). To give shape to the multifaceted concept of culture, Weaver (1986) uses the iceberg metaphor. In Weaver's (1986) illustration, visible or tangible elements of culture (e.g., language, art, music, or dance) form the small and superficial tip of the iceberg, while invisible or intangible elements of culture (e.g., attitudes, beliefs, values, or mind-sets) represent the often larger portion of the berg that lies beneath the water's surface.
This study focuses on national culture while acknowledging that diverse subcultures and transnational cultures exist and influence behavior (McSweeney, 2009; Taras, Steel, & Kirkman, 2016). This position recognizes that national culture is neither static, uniform, nor tied to geo-political boundaries, and that in response to globalization, individual, group, and situational factors can impact individual identification with or divergence from the national culture. Data analysis of this study was framed by Hofstede's cultural dimensions framework (Table 2), selected due to its clear operationalization of dimensions: Individualism-collectivism, Uncertainty avoidance, Power-distance Index, Masculinity-Femininity, Long-term and Short-term Orientation, and IndulgenceRestraint (Hofstede, 2011; Hofstede, Hofstede, & Minkov, 2010).
Hofstede's dimensions have been used widely across various disciplines but, to our knowledge, have yet to be applied to an understanding of TR programming. In education, Auyeung and Sands (1996) applied the individualism-collectivism dimension to understand influence of students' background on learning styles, and Niehoff, Turnley, Yen, and Sheu (2001) evaluated differences in expectations in the classroom between U.S. and Taiwanese students. Chang, Tucker, Norton, Gass, and Javorski (2017) considered conceptual applications of the framework in adventure programming, bringing to light the important cultural elements to ideas such as adventure and risk. However, the application of the dimensions should be done so cautiously with an awareness of its limitations. Particularly, it is important to recognize that much of the work done to create the dimensions has been in connection to its early roots focused on organizational culture; sampling of individuals has primarily been in a business context-managers, business elites, and of those who generally may reflect a higher socioeconomic status within a country. Hofstede's dimensions in this study allowed for consideration of Weaver's (1986) intangible elements of culture that reflect the more deeply ingrained aspects of culture (i.e., iceberg below the water line).
Additionally, this study also considered Lewis's (2010) work on cultural diversity and categories for understanding macro- and micro-cultures. In his analyses, he considers, but is not limited to, areas where culture differences appear: communication and language, dress and appearance, food and feeding habits, time and time-consciousness, personal space, etc. In this regard, these categories allow us to consider the tangible aspects of culture (i.e., iceberg above the water line). Lewis presumes that behavioral dimensions transcend from national culture and relgion. Still, more emphasis is placed on Hofstede's dimensions in that it does reflect the deeper foundations of cultural influence while Lewis's categories provide areas where culture manifests.
Methods
Project Background
The purpose of this study was to understand the cultural processes that influenced program implementation in the context of adaptive sport. The study was part of a larger grant-funded research project which utilized a multi-method approach to evaluate the effectiveness of an international adaptive sports program1. This program was designed by a team of U.S. TR faculty and students, who are referred to as the facilitation team, over the course of one year.
The state of adaptive sports programming in Thailand at the time of this study was minimal, with few existing TR education opportunities in the country, and physical education students were receiving little to no instruction in adaptive sport programming or disability-related issues. The goals of the program were to increase adaptive sports awareness and competency, improve attitudes toward people with disabilities, and ultimately provide individuals with the knowledge required to develop a sustainable adaptive sports program for people with disabilities in the area. The program was implemented in Chiang Mai, Thailand, in March 2018 to a group of approximately 50 students and faculty at a local university (henceforth referred to as the "partnering university") studying or working in fields related to physical education. In this regard, the program was designed to cater to an audience already training to become instructors or coaches in sport and recreation, adding to their skill set the ability to provide adaptive sport programming.
The facilitation team was comprised of four coaches who were recruited as content and skill experts in one of the five adaptive sports included in the training program (5-a-side soccer, goalball, wheelchair tennis, adaptive aquatics, archery); four undergraduate TR students who served as assistant coaches in each sport; one graduate student who served as the assistant program director to help with program logistics; and one TR faculty member who served as the program director. The four expert coaches included three Paralympic-level athletes and one adaptive aquatics business owner and instructor of 20+ years; two of the coaches had previously been instructors in similar sports diplomacy programs.
In addition, the program director had an administrative counterpart from the partnering university in Chiang Mai who was responsible for logistics, such as hiring interpreters and securing facility space. To this end, there was a working partnership between the program director and the administrative counterpart that began during the planning phase of the program. This arrangement required higher levels of communication and collaboration to solidify plans. However, as it will be noted and discussed in the findings, the relationship was framed by nuanced power dynamics: the U.S. Program Director had final decision-making authority along with access to the grant funds and other financial resources.
The facilitation team implemented a week long "train-the-trainer" program. Within this, there was a four-day training portion (e.g., content mastery and initial skill development) delivered to the participants, followed by a two-day portion that provided them an opportunity to practice the delivery of the skills they had acquired to a group of local individuals with disabilities (e.g., practice and skill refinement). During the initial four-day training, the participants were split into groups and rotated through the sports where they learned the basic skills and rules of the game in both a classroom and practice setting. At each sport, there was a coach, assistant coach, and translator. The coaches designed and provided translated sport-specific manuals that served as the basis for the programming.
Situating the Research Team and Data Collection Procedures
With existing program implementation models (e.g., Gagnon et al., 2015; Morgan, 2016) and intercultural frameworks (e.g., Hofstede, 2011; Lewis, 2010) in mind, research team members traveled to Thailand to observe the program and conduct interviews with the team of facilitators. The research team was comprised of one faculty member, one graduate student, and three undergraduate students, all of whom were not involved in program development or implementation. However, members of both the research team and facilitation team were involved in the writing of subsequent reports and manuscripts that came from the data (including the present study).
The research team conducted observations during programming, utilizing a program-specific observation guide before transitioning to freehand field notes. Each member of the team rotated and observed each sport and facilitator pair (coach and assistant coach) throughout the program, looking for aspects of culture (e.g., perception of time) and cultural dimensions (e.g., power-distance) that may have impacted the features of quality implementation (Gagnon et al., 2015). Observation has been, and continues to be, a primary method to evaluate implementation, particularly the extent to which the program was adapted or delivered as designed (Durlak & Dunlap, 2008; Morgan et al., 2016)
The research team also conducted semi-structured, in-depth interviews with members of the U.S. facilitation team (n=6). These interviews were conducted with the four coaches, the program director, and the assistant director. Three of the interviews were conducted in person, on-site immediately following the conclusion of the program; within the next month, two more were conducted in person, and one was conducted over the phone. Interviews lasted 20-50 minutes, were audio recorded, and transcribed, clean verbatim. The interview guide included questions of what worked, what didn't work, and whether or not changes were made to the program in situ. Additional questions associated with the impact of culture and adaptations made in response to cultural differences were also included.
The research team independently analyzed observations, field notes, and interviews in two rounds: first to familiarize themselves with the data and create initial deductive codes; and second, to explore, review, and develop themes (Braun, Clarke, Hayfield, & Terry, 2019). Patterned after Fereday and Muir-Cochranes' (2006) "hybrid" approach to thematic analysis, round one was guided by an inductive process of open coding, whereas round two was guided by a deductive process and consolidation of themes (see also Creswell & Creswell, 2017). The researchers utilized a codebook in the second round of coding comprised of constructs from existing program implementation models and Hofstede's cultural dimensions. This integration of data-driven and theory-driven coding allowed for new codes to be observed that may not have fit within the existing models (Fereday & Muir-Cochrane, 2006). Moreover, this approach allowed for a more nuanced discussion of cultural influences (e.g., time, communication patterns, etc.) that did not fit "nicely" within Hofstede's dimensions. Following independent coding, the team collectively discussed interpretation of themes.
In addition to triangulating data using multiple data points (e.g., observations & interviews), the research team met with the program director to ensure a rigorous data analysis and interpretation process. Specifically, the director functioned as a "critical friend" (Smith & McGannon, 2018) providing feedback to and challenging the research team regarding their interpretations. This process was less about data verification and more about exploring alternative interpretations of the data. The research team also met regularly prior to and during the program, engaging in a form of reflexive practice by constantly questioning their own cultural stereotypes and assumptions, and by exploring the political and social context in which the study was occurring. Specifically, the team had considered contextual factors such as national-level perceptions of dis- ability (and the religious beliefs underlying those perceptions) and national-level educational practices that may have impacted how the program was received. As a result of this process, the research team acknowledged, for one, that national-level cultural perceptions of disability may have less bearing on the rising Thai generation who have greater access to global perspectives on this and related issues. An important limitation of this research, however, is that the data, and subsequent interpretations, only reflect the U.S. perspectives.
Findings and Discussion
This study set out to understand how culture influences implementation of an adaptive sport program in a cross-cultural context; specifically, Thai and U.S. collaboration. The themes that emerged included a focus on communication within the structure of the organization-from communication styles, language, and translation, to program characteristics such as culturally relevant scheduling, issues of group dynamics, and fundamental treatment of individuals with disabilities, as well as the role of the facilitator to adapt to language barriers and draw on culturally relevant examples within their sports.
Thai citizens are more collectivist, feminine, accepting of enduring power differentials, short-term oriented, restrained, and likely to avoid uncertainty than citizens of the U.S. (Marta & Singhapakdi, 2005; Moran, Harris, & Moran, 2011; Pornpitakpan, 1999); however, an important caveat to discussing these findings is that it is important to acknowledge the difficulties of teasing out culture. This study uses national-level cultural generalizations to consider individual cross-cultural interactions. The line between what is personality and what is cultural influence is fuzzy at best, recognizing that even personality can be largely a product of culture. Nonetheless, the value in the findings below is to capture the idea that cultural processes are always at play and we must plan for them in cross-cultural programs. The findings are followed by a discussion of the implications for professionals working in cross-cultural TR settings.
Organizational Characteristics
Organizational characteristics represent the aspects of program implementation that have to do with logistical planning, technical support, organizational structure, and leadership; past studies have found a direct correlation between the overall quality of program implementation and organizational characteristics (Durlak & DuPre, 2008). This research identified several ways that culture interplayed with organizational characteristics, particularly related to communication (e.g., communication styles, language, and translation) and power structures (e.g., hierarchical, top-down leadership), which created challenges associated with program implementation. For example, regarding communication, translators were an important aspect of successful implementation. To this end, though translators were trained in Thai-English translations, they were not as prepared for the technical sport-specific language required by the program, nor were they familiar with the disability-specific language. Given the centrality of translating knowledge and skills delivered by the facilitators to the participants, effectively transmitting the facilitator's message was important to the overall success of the program. This issue may be seen as a technical component, where in a cross-cultural programming context, translators must be incorporated into the program design and in some cases, receive their own training prior to program implementation. For example, Tom, the coach for soccer, explained how his translator,
"...didn't know soccer at all, so the first day was a learning experience for her because she didn't know the terminology. But she went home and looked up some stuff with my sports manual and then she could do it [on later days]"
Ensuring that the translators read the sport-specific manual was a simple technical step that helped address this issue. However, in some cases, translators appeared to be hesitant to provide assistance when further clarity in the translation may have helped work through the delivery of certain aspects of the program. In other cases, it was noted by the interviewees that the translators simply did not repeat the facilitator's message to students or ask for clarifications. Both instances may reflect a deeper aspect of culture, something that is often referred to as saving face. Derived from various dimensions of Hofstede's model (e.g., uncertainty avoidance, short-term orientation), saving face is seen as a main effect of culture where in some contexts-particularly East Asian cultures-there is a high level of importance placed on controlling the expression of emotion in order to avert public humiliation (Pornpitakpan, 1999; Stein & Ohler, 2018). What results from this cultural norm of non-emotion, is that in cases where embarrassment might be felt or if there is a lack of understanding something, communication breakdowns occur.
A similar example occurred with Ashley, the coach of goalball, who described her frustrations of how the translators' efforts to save face influenced facilitation. She stated, "For the first two days, we didn't have a proper translator who understood the sport...they didn't ask questions so they could properly explain it to the students" During the specific goalball session that Ashley mentioned above, the research team observed and interpreted that the behavior of the translator seemed to reflect confusion and may have resulted in reduced confidence in translating the instructions for the participants. Despite this perceived misunderstanding, the translator didn't ask clarifying questions and Ashley did not clarify. The translator may have been hesitant to ask clarifying questions in order to save face, and once the facilitation began, Ashley stopped it to re-explain because it seemed as if the participants were unclear about the instructions.
Finally, this was also noted within communication of the larger program planning process between the program director, Jordyn, and her counterpart, Ann, who was in charge of logistics in Thailand. From Jordyn's perspective, Ann "...didn't ask for help," potentially to save face. What is important to note here is that these behaviors may reflect part of a larger pattern of behavior that resulted in different communication styles. Americans, based on their cultural communication norms, expect others to ask for help if needed and seek clarification if confused; cultural norms within Thai communication focus on maintaining face. Further instances of cross-cultural communication breakdown were evident. Take for example, the following perspectives from Jordyn, who stated that, "there were lots of communication barriers. I went 6 weeks with no communication from our Thai partners" Similarly, Elise, the assistant program director, made comments about administration difficulties that matched those of Jordyn's. Elise reflected that "...there were a lot of unknowns going into it because Jordyn's counterpart didn't relay a lot of information to us. It wasn't weeks or months in advance, we had to figure things out the day we got there."
These quotes parlay a certain sense of frustration among the U.S. facilitation team; however, perhaps they equally demonstrate the underlying issues of culture at play and how they potentially led to misunderstanding on both sides. The U.S. planning team had certain expectations for how their counterparts should approach the planning, based on their collective experience with program planning in the context of their own cultural norms and the behaviors they have come accustomed to perceive as acceptable. The Thai counterparts did not exhibit these culturally subjective behaviors that the U.S. facilitation team expected. While the research team did not interview the Thai counterparts and thus cannot directly speak to their perspective, based on observations and literature-based knowledge about culture, it is possible that in Thai culture, their subjective acceptable behavior for approaching professional endeavors such as collaboratively planning a program does not match that of the U.S. As Lewis (2010) suggests, work habits and practices, as well as attitudes toward work vary across culture.
In addition to a broader saving-face mentality, one cultural explanation of what is perceived to be a "non-response" in communication efforts could relate to the different cultural approaches toward authority. In considering the difference in power distance, where the U.S. generally has a low power distance and Thailand generally embodies a high-power distance, this can lead to issues in communication flow vertically through an organizational structure. That is, communications and decision-making were often directed from the program director who was perceived to be in an authoritative position, even over the Thai counterpart. For example, Jordyn indicated
Ann was my counterpart so she ruled all over there.... everything had to go to her, and she wouldn't respond. So I would email her assistants directly and say that I needed this done, but then she would respond to me after I emailed her assistants.
It is important to note how the partnership was established when reflecting on the relationship between the U.S.-Thai counterparts. Though the program director partnered with a local institution, the program was funded by a grant that placed the power into the hands of the U.S. program director in terms of final decision-making and financial considerations. How the program director's communication was received could be filtered through perceived power distance resulting in a situation where the program director did not receive questions (and was never questioned). Many of these cross-cultural communication issues have been considered in global management literature where culture becomes central to management practices to avoid miscommunication and ensure efficient productivity (e.g., Moran et al., 2011; Ting-Toomey et al., 2005).
On another occasion, Jordyn described an experience during the planning process by reflecting that she
...shipped the goal balls over there, and... FedEx couldn't find the [local school].. I emailed Ann and was like I really need you to respond to this email today because FedEx was going to ship it back to London. So I got on Facebook and messaged her and told her to check her email and within 12 hours it was figured out.
This may be an example of an apparent cultural difference in perception of professional communication etiquette; there were different expectations in email response times, and in this case, informal communication methods such as Facebook messenger became necessary and seemingly more effective. How we communicate is culturally bound, and goes beyond language to include how we interpret communication (Ting-Toomey et al., 2005). Simply, what we may consider appropriate communication modes (or effective communication) may be perceived differently across cultures. Further, lost in translation is not just an issue of language barrier but also includes the deeper interpretation of communication and meaning of communication (Orasanu, Fischer, & Davison, 1997).
Program Characteristics
Program characteristics include factors such as how appropriate a program was designed for the participants, including length and complexity, as well as structured outcomes and thought-out processing (Gagnon et al., 2015). The implementation structure of the program appeared to have been effective in this study, despite the organizational and administrative challenges. However, the timing of the program had a major impact on implementation quality in that the program coincided with an academic break, which made attendance challenging. Planning should align with the host culture's calendar, rather than the U.S. institution's schedule.
Group composition also had an impact on implementation due to cultural values tied to teacher-student relationships, as well as cultural norms regarding age. The participants in the program included students and faculty from the same Thai university. In many cases, including during one of the soccer facilitations, these faculty took the lead and students deferred, which was reflective of the high power-distance relationships between faculty and students in Thailand. During the interviews, Tom specifically mentioned noticing this, and reported that the facilitators then asked that the faculty step back and let students learn and practice the skills as well.
With regard to program structure, views about time were different between participants and facilitators. Culturally constructed, time may be viewed strictly where being "on time" means promptly at the scheduled time, compared to a more casual approach to being on time (e.g., "on time" meant being in a certain range of the agreed upon time; Moran et al., 2011). In this case, participants showed up late to training sessions, at least in the view of the U.S. facilitators. However, because the program was designed with the U.S. perspective of time in mind the tardiness of participants compromised salient elements of the program design (e.g., fidelity) due to less time for training delivery. On this issue, Jordyn said
...first day, I said be back at 1... it was 1:30 and no one was back from lunch, my interpreter was there and was like this is totally the Thai way, so if I need students to be back at 1 I tell them to be back at 12:30. Yes, I didn't know that there was American standard time and Thai standard time.
Cross-cultural programs must create a schedule that can adapt to deeply ingrained perspectives toward time. Further, there are cultures that also have more standardized breaks in the day where it is typical to leave school or work to go home for a longer lunch and rest time. Programs should consider these cultural daily routines in the planning process.
Likewise, it was observed and reiterated by interviewees that participants seemed to treat individuals with disabilities as fragile and child-like. Ashley highlighted how some of the Thai students treated the participants with disabilities, saying
They were very surprised that there were different levels of blindness. So they led everybody as if they could not see, even if some of those people could see a little bit.. ..and in the U.S. to guide somebody, we use elbows. Here they hold hands.Thhey were doing things for the [people with disabilities] like putting on the blindfold for them instead of handing them the blindfold and telling them to put it on.
The literature is replete with evidence that suggests perceptions toward disability are socially and culturally constructed (c.f., Daruwalla & Darcy, 2005; Esmail, Darry, Walter, & Knupp, 2010), which influences these interactions. While part of the goals of the program are to raise awareness towards disability, preparing the U.S. facilitation team for the cultural differences towards disability would have helped advance the programming.
Facilitator Characteristics
Facilitator characteristics address aspects such as attitude, buy-in, leadership initiative, experience, and skill (Gagnon et al., 2015). This adaptive sports program used coaches and assistant coaches as the direct facilitators of the skills-based training. The coaches were content and skill experts in their specific sport domain, and assistant coaches were TR students that are learning how to work with people with disabilities. A coach and assistant coach were paired together in each sport, but also worked together in advance of the program to plan out the actual delivery. However, many of the interviewees noted that they received little training on Thai culture, sports, learning, perceptions, and laws related to disability, or how to work with a translator to deliver content. Facilitators felt additional cultural training would have prepared them to further the program's intended outcomes.
One of the administrators observed that program implementation may have been better and the Thai participants may have been more receptive if facilitators had more opportunity to get to know the participants and their culture prior to program implementation, connecting across cultural lines. This reflection on planning efforts (i.e., more time to build a relationship) mirrors that Thais tend to desire personal relationships prior to formal, business relationships (Pornpitakan, 1999). The greatest success seemed to come as translators and facilitators built a deeper relationship and had sufficient time to learn how to communicate with one another, in addition to communicating with participants. When discussing the experience of communicating with his translator, Tom talked about how he worked through the language difference to build a relationship by learning some Thai. Specifically, he said
... learning the basics of their language that related to my sport and ...counting 1 to 10 really helped, because I could say that they have 5 minutes left to get what they needed to get through and that kind of thing.
Researchers observed throughout the program that facilitators who adopted more authoritarian teaching styles appeared to be well received by participants. The participants seemed to appreciate the direct, instructor-led approach (reflective of high power distance cultures); this reflects the norms discussed by Gunawan (2016) who examined culture within higher education in Thailand and noted several cultural dimensions that influence teaching and learning in the Thai classroom. Likewise, while fun and laughter were part of the learning process, facilitators also observed an intensity in students that they mirrored by stressing the seriousness and importance of what was being taught. Gunawan also noted that the collectivist nature of Thai individuals results in an avoidance of difficult discussions and sharing of individual opinions. Similarly, the feminine qualities of Thai culture imbue an exaggerated degree of politeness and quietness. In many cases, humor is used to avoid difficult conversations, remain polite, and save face. Tom also reflected that "They [Thai participants] are really into learning something new. I think also as a coach or a teacher, to teach them kind of putting that feel on it that it's serious so they know the sport also really helped them learn."
Program Fidelity and Adaptations
Program fidelity and adaptations, while two separate categories, are interrelated; fidelity is based on how closely the program went as planned, while adaptations are changes made during the program. Fidelity decreases when adaptations increase, regardless of whether those adaptations are positive or negative (Gagnon et al., 2015). Facilitator, program, and organizational characteristics all connect to fidelity and adaptations.
In terms of facilitator characteristics, more experienced coaches who had been involved with prior iterations of the program2 felt that the program was delivered as designed when compared to past programs. Newer facilitators seemed more attuned to implementation challenges and cultural barriers and subsequently made a number of adaptations.
In order to compensate for program characteristics, facilitators made changes to make the program more appropriate for the audience. For example, to overcome language and translation issues, facilitators made the following adjustments: broke down messages into simpler, shorter sentences; learned and used Thai vocabulary; slowed down speech and paused to allow time for translators to process and disseminate the message; utilized manuals, visuals, and demonstrations; communicated with hand signals and body language; or used local sports as relatable examples.
Others made small changes to their program plans to accommodate the shorter training periods due to the perception of time. Overall, during the program, facilitators adapted to overcome certain language and cultural barriers during the program, but felt that they maintained program fidelity to the extent necessary while working towards the desired outcomes of the program.
In terms of organizational characteristics, when it came to addressing the cultural differences toward time-how the U.S. perspective is to be "on time" compared to a more fluid notion of timeliness, the program director had to make new rules toward attendance. On the first day, attendance was not taken both before and after lunch, but to protect program fidelity (and amount of time in program sessions), the program director modified the protocol for each coach/assistant coach to take attendance twice a day for the rest of the program. Further, to address declining attendance rates over the duration of the program, facilitators announced that to receive their certificate of completion at the end of the program, participants had to be on time and stay for the duration of the sessions. This slight adaptation helped maintain fidelity of the program by ensuring participants received as much of the programming as possible by making this policy as a logistical modification.
Participant Responsiveness
Participant responsiveness refers to how engaged the participants are in the program, as well as how relevant the program is for those participants (Gagnon et al., 2015). On the first day of the program, many facilitators were concerned that participants were neither engaging with nor understanding the material. Specifically, facilitators reflected that participants seemed somewhat reserved in the classroom settings and struggled to transfer instruction in the classroom to application in the court, field, or pool setting. Many noted that participants asked few questions, which was interpreted as a sign of disengagement. However, put into the cultural context, this behavior reflects the norms of a learning environment that result from high uncertainty avoidance and power distance. For example, as a result of Thai culture having high power distance, teachers are highly respected and considered the authority of knowledge (Gunawan, 2016). As a result of this, students rarely ask professors questions directly and often remain quiet to show respect, making active learning almost impossible to implement in this context. Facilitators misinterpreted participant responsiveness because they were not considering the cultural context of the behavior; future programming should incorporate into the training what is the culturally appropriate response from participants.
One exception to this observation provides a stark example of the role of culture on participant responsiveness. Male Thai participants who were working on water transfers in the pool were very reluctant to transfer females into the water. The close contact required for this particular maneuver challenged their notions of modesty. These concerns were overcome, somewhat, when facilitators made it clear that water transfers with members of the opposite sex would be a reality in their future as adaptive sport programmers (shifting from the cultural norm associated with short-term orientation toward long-term orientation). Interestingly, participants seemed to respond best to a specific facilitator who had a more authoritative demeanor. They even gave the facilitator a nickname that related to words such as strong and powerful in the U.S. Participants also responded differently when the school administrators came to observe the trainings (e.g., more sober demeanor; indicative of high power distance).
Modified Model of Cross-Cultural Program Implementation
The data support the notion that culture impacts program quality, fidelity, and adaptation as well as participant responsiveness (Figure 1). Specifically, instead of considering culture in an independent dimension of 'community characteristics', this modified model draws out culture to be a more holistic factor that interplays in every aspect of program implementation.
Implications and Limitations
While it is clear that culture influences program implementation, it is less clear how culture may influence adaptive sports and TR interventions. TR practitioners should assess and consider the client's culture during the initial assessment so that the treatment plan is relevant in the context of their cultural background and preferences. It is also important for TR professionals to acknowledge potential cultural differences and be aware of their own cultural autopilot to ensure treatment that fits the client, as leisure and recreation often differ across cultures. While this study focused on cultural differences between Thailand and the U.S., culture differs more than just across nations, including what Kumpfer and colleagues (2002) mention "...critical values and traditions for within race cultural subgroups defined by geographic location (rural, suburbs, urban, reservation), educational achievement, socioeconomic status, language, acculturation level, and the individual's own interpretation and identity with their race, ethnicity, and culture" (p. 242).
Still, as other scholars have noted within prevention sciences, culture-though raised as a concern for programmers-rarely receives the attention and focus it needs (Castro et al., 2004; Gagnon et al., 2015). Importantly, Hofstede's dimensions focus on national-level culture that are reliant on numerical measures and cross-sectional data, and neglect nuanced dimensions that have been captured in other intercultural models (e.g., the work of Lewis, 2010; Taras et al., 2016). Moving forward, as the TR profession works toward expanding a solid evidence base, professionals could contribute to cultural considerations in research studies by using different intercultural models and considering culture in every aspect of the Assessment, Planning, Implementation, Evaluation, and Documentation (APIED) process. For example, including questions about cultural background, religion, and nationality in assessment can help practitioners acquire a better picture of the client's cultural orientation. This, as well as choosing culturally relevant programs and considering cultural nuances throughout treatment, can address and prevent complex cultural mismatches in order to maximize outcomes for that client.
There are other limitations to this study that must be noted. This study had a mix of coaches and participants, with varying levels of experience working cross-culturally, or in adaptive sports programs. Aside from cultural interpretations, some coaches had more experience teaching a sport than others, and so this could have impacted how the programming components played out in terms of facilitator characteristics, use of adaptations, and the responsiveness of the participants. Additionally, none of the Thai counterparts or participants were interviewed due to limited time and resources (e.g., reliable translators). As previously mentioned, Thai schools were on break during the program implementation, so participating was already a burden for the Thai counterparts and Thai participants, making the notion of additional in-depth interviews difficult to implement. As a result, the data and interpretations came solely from researchers' observations and interviews with the American facilitators. Thus, misinterpretation of the observed cultural nuances of program implementation may have occurred, a reminder that culture influences the evaluation process as well. Lastly, this study focused on one program in a single cultural context, and the findings should be generalized to other settings with caution.
The value of this study is how it brings to light the importance of culture in designing, planning, and implementing adaptive sports programs. That is, our study found evidence of culture impacting organizational, program, and facilitator characteristics, program adaptations, and participant responsiveness, which indicates the importance of considering culture throughout the development and implementation of international adaptive sport programming. TR professionals should take into consideration the impact that culture could have on how TR programs are run, even if they are not international programs. Culture is complex but influential and must be treated as an important element of any program that is delivered in cross-cultural contexts in order to minimize potential.
Conclusions
Given the increasing diversity of local communities and increased opportunity for programming internationally, it is vital that TR specialists understand and adapt to the cultural needs of participants because the findings of this study suggest that culture influenced all aspects of program implementation quality. For example, program characteristics (e.g., translator competency), facilitator characteristics (e.g, impact of power distance), organizational characteristics (e.g., uncertainty avoidance in relation to communication styles), and community characteristics (e.g, Thai participants' concept of time) were impacted by culture. In light of these findings, the authors propose a modified model for international or cross-cultural program implementation that situates culture more explicitly as a major consideration to any program design, implementation, and evaluation.
1The National Ability Center (NAC) in Park City, Utah received a grant from the U.S. Bureau of Cultural and Educational Affairs in order to implement international adaptive sports programs in five predetermined countries. Each country was considered a separate project, and TR professionals from around the U.S. were eligible to apply to coordinate each one alongside the NAC.
2This adaptive sports program has been occurring since 2006 using the same "train-the-trainer" model. Approximately 12 different programs have been implemented in Thailand, Indonesia, Mexico, El Salvador, South Korea, Myanmar, Vietnam, Laos, and Cambodia.
References
Archie-Booker, D. E., Cervero, R. M., & Langone, C. A. (1999). The politics of planning culturally relevant AIDS prevention education for African-American women. Adult Education Quarterly, 49(4), 163-175.
Auyeung, P., & Sands, J. (1996). A cross cultural study of the learning style of accounting students. Accounting & Finance, 36(2), 261-274. doi: 10.1111/j.1467-629X.1996. tb00310.x
Berkel, C., Mauricio, A. M., Schoenfelder, E., & Sandler, I. N. (2011). Putting the pieces together: An integrated model of program implementation. Prevention Science, 12(1), 23-33. doi: 10.1007/s11121-010-0186-1
Boyd, R., & Richerson, P J. (2005). The origin and evolution of cultures. New York, NY: Oxford University Press.
Braun, V., Clarke, V., Hayfield, N., & Terry, G. (2019). Thematic analysis. In P Liamputtong (Ed.), Handbook of research methods in health social sciences (pp. 843-860). New York, NY: Springer.
Brittain, I. (2004). Perceptions of disability and their impact upon involvement in sport for people with disabilities at all levels. Journal of Sport and Social Issues, 28(4), 429-452. doi: 10.1177/0193723504268729
Caddick, N., & Smith, B. (2014). The impact of sport and physical activity on the wellbeing of combat veterans: A systematic review. Psychology of Sport and Exercise, 15, 9-18. doi: 10.1016/j.psychsport.2013.09.011
Castro, F., Barrera, M., & Martinez, C. (2004). The cultural adaptation of prevention interventions: Resolving tensions between fidelity and fit. Prevention Science, 5(1), 41-45. doi: 10.1023/B:PREV0000013980.12412.cd
Chang, T. H., Tucker, A. R., Norton, C. L., Gass, M. A., & Javorski, S. E. (2017). Cultural issues in adventure programming: Applying Hofstede's five dimensions to assessment and practice. Journal of Adventure Education and Outdoor Learning, 17(4), 307-320. doi: 10.1080/14729679.2016.1259116
Creswell, J. W., & Creswell, J. D. (2017). Research design: Qualitative, quantitative, and mixed-methods approaches. Thousand Oaks, CA: Sage publications.
Daruwalla, P, & Darcy, S. (2005). Personal and societal attitudes to disability. Annals of Tourism Research, 32(3), 549-570.
Durlak, J. A., & DuPre, E. P (2008). Implementation matters: A review of research on the influence of implementation on program outcomes and the factors affecting implementation. American Journal of Community Psychology, 41(3-4), 327. doi: 10.1007/s10464-008-9165-0
Esmail, S., Darry, K., Walter, A., & Knupp, H. (2010). Attitudes and perceptions towards disability and sexuality. Disability and Rehabilitation, 32(14), 1148-1155. doi: 10.3109/09638280903419277
Fereday, J., & Muir-Cochrane, E. (2006). Demonstrating rigor using thematic analysis: A hybrid approach of inductive and deductive coding and theme development. International Journal of Qualitative Methods, 5(1), 80-92. doi: 10.1177/160940690600500107
Gagnon, R. J., Frans, N. K., Garst, B. A., & Bumpus, M. F. (2015). Factors impacting program delivery: The importance of implementation research in extension. Journal of Human Sciences and Extension, 3(2), 68-82.
Gunawan, J. (2016). Understanding culture in higher education in Thailand. Education for Health, 29(2), 160. doi: 10.4103/1357-6283.188783
Gutierrez, L., Chadwick, N., & Wanamaker, K. A. (2018). Culturally relevant programming versus the status quo: A meta-analytic review of the effectiveness of treatment of indigenous offenders. Canadian Journal of Criminology and Criminal Justice, 60(3), 321-353.
Hofstede, G. (1980). Culture's consequences: International differences in work-related values. Beverly Hills, CA: Sage.
Hofstede, G. (2011). Dimensionalizing cultures: The Hofstede model in context. Online Readings in Psychology and Culture, 2(1), 8. doi: 10.9707/2307-0919.1014
Hofstede, G., Hofstede G. J., & Minkov, M. (2010). Cultures and organizations: Software of the mind (3rd ed.). New York, NY: McGraw-Hill.
Kensinger, K., Gearig, J., Boor, J., Olson, N., & Gras, T. (2007). A therapeutic recreation program for international refugees in a Midwest community. Therapeutic Recreation Journal, 41(2), 148-157.
Kiuppis, F. (2018). Inclusion in sport: Disability and participation. Sport in Society, 21(1), 4-21. doi: 10.1080/17430437.2016.1225882
Kumpfer, K. L., Alvarado, R., Smith, P., & Bellamy, N. (2002). Cultural sensitivity and adaptation in family-based prevention interventions. Prevention Science, 3(3), 241-246. doi: 10.1023/A:1019902902119
Lastuka, A. & Cottingham, M. (2016). The effect of adaptive sports on employment among people with disabilities. Disability and Rehabilitation, 38(8), 742-748. doi: 10.3109/09638288.2015.1059497
Lewis, R. (2010). When cultures collide: Leading across cultures (3rd ed.). Boston, MA: Nicholas Brealey International.
Lundberg, N. R., Taniguchi, S., McCormick, B. P, & Tibbs, C. (2011). Identity negotiating: Redefining stigmatized identities through adaptive sports and recreation participation among individuals with a disability. Journal of Leisure Research, 43(2), 205-225. doi: P10.1080/00222216.2011.11950233
Marta, J. K., & Singhapakdi, A. (2005). Comparing Thai and U.S. businesspeople: Perceived intensity of unethical marketing practices, corporate ethical values, and perceived importance of ethics. International Marketing Review, 22(5), 562-577. doi: 10.1108/02651330510624390
McSweeney, B. (2009). Dynamic diversity: Variety and variation within countries. Organization Studies, 30(9), 933-957. doi: 10.1177/0170840609338983
Meyer, H. D. (2010). Framing disability: Comparing individualist and collectivist societies. Comparative Sociology, 9(2), 165-181.
Moran, R. T., Harris, P R., & Moran, S. (2011). Managing cultural differences (9th ed.). New York, NY: Routledge.
Morgan, C., Sibthorp, J., & Browne, L. P (2016). Moving beyond outcomes: An applied example of implementation evaluation in a youth recreation program. Journal of Park and Recreation Administration, 34(4), 66-81. doi: 10.18666/JPRA-2016V34-I4-7290
Murphy, N. A., & Carbonne, P S. (2008). Promoting the participation of children with disabilities in sports, recreation, and physical activities. Pediatrics, 121(5), 10571061. doi: 10.1542/peds.2008-0566
Niehoff, B. P., Turnley, W. H., Yen, H. J. R., & Sheu, C. (2001). Exploring cultural differences in classroom expectations of students from the United States and Taiwan. Journal of Education for Business, 76(5), 289-293. doi: 10.1080/08832320109599651
Nishino, H. J., Chino, H., Yoshioka, N., & Gabriella, J. (2007). Therapeutic recreation in modern Japan: Era of challenge and opportunity. Therapeutic Recreation Journal, 41(2), 119-131.
Orasanu, J., Fischer, U., & Davison, J. (1997). Cross-cultural barriers to effective communication in aviation. In S. Oskamp & C. Granrose (Eds.), Cross-cultural work groups: The Claremont Symposium on Applied Social Psychology (pp. 134160). Thousand Oaks, CA: Sage Publications.
Pornpitakpan, C. (1999). The effects of cultural adaptation on business relationships: Americans selling to Japanese and Thais. Journal of International Business Studies, 30 (2), 317-338. doi: 10.1057/palgrave.jibs.8490072
Skalko, T. K. (2009). Revisiting the philosophical foundations of recreational therapy: An imperative for survival. American Journal of Recreation Therapy, 8(1), 7-14.
Smith, B., & McGannon, K. R. (2018). Developing rigor in qualitative research: Problems and opportunities within sport and exercise psychology. International Review of Sport and Exercise Psychology, 11(1), 101-121. doi: 10.1080/1750984X.2017.1317357
Stein, J. P, & Ohler, P (2018). Saving face in front of the computer? Culture and attributions of human likeness influences users' experience of automatic facial emotion recognition. Frontiers in Digital Humanities, 5, 18. doi: 10.3389/ fdigh.2018.00018
Taras, V., Steel, P, & Kirkman, B. L. (2016). Does country equate with culture? Beyond geography in the search for cultural boundaries. Management International Review, 56(4), 455-487. doi: 10.1007/s11575-016-0283-x
Ting-Toomey, S., & Chung, L. C. (2005). Understanding intercultural communication. New York, NY: Oxford University Press.
Weaver, G. R. (1986). Understanding and coping with cross-cultural adjustment stress. Education for the Intercultural Experience, 2, 137-167.
Zabriskie, R. B., Lundberg, N. R., & Groff, D. G. (2005). Quality of life and identity: The benefits of a community-based therapeutic recreation and adaptive sports program. Therapeutic Recreation Journal, 39(3), 176-191.
Copyright Sagamore Publishing LLC Third Quarter 2019