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2Moreover, the medical technicians have to be concerned about differences in culture,context, race, ethnicity and religion, as these significant factors may lead to attainingthe standard of effective communication. Language barriers and cross-culture are alsoproblems of communication in healthcare (Taylor et al. 2013).However, some people may have problems communicating in English and facefactors that obstruct their effective communication in English. It is not simple toconfidently communicate in English properly with foreigners in a medical context.One of the reasons this may occur is from anxiety, which may lead to a problem whencommunicating in English for medical technicians. Booth-Butterfiled, Chory andBeynon (1997) state that communication apprehension has not received much interestin relation to healthcare. This issue has to be resolved urgently; if not, it may lead tonegative performances from technicians as they may avoid communicating or engagingwith foreigners. The Bureau of Tuberculosis (BTB) is one of the bureaus of theDepartment of Disease Control, Ministry of Public Health that has to deal with manyexperts and specialists from around the world. These people from the World HealthOrganization (WHO) and other international health organizations will provide theknow-how of new technology to BTB and exchange experience in terms of diagnosisand treatment methods to BTB. Certainly, English is needed in order to communicatewith these people in all areas.Richmond and McCroskey (1998, p.37) estimated that 20 percent of people areafflicted with communication apprehension and these people tend to withdraw fromcommunication situations. This study will examine whether personnel in the medicalfield are apprehensive when speaking English to foreigners.It is an essential to findout the main factors of oral English communication problems. In addition, the studywill offer some suggestions to improve English speaking skills for personnel at both theBureau of Tuberculosis and other public health organizations in Thailand.1.2Research QuestionsThis study aimed to answer the following questions:1.2.1What are the average scores and levels of communication apprehensionin L1 and L2 of BTB personnel?1.2.2What demographic information is associated with CA in L1 and CA inL2 of BTB personnel?Ref. code: 25595621030104AHL

31.2.3Are personnel in the Bureau of Tuberculosis affected by L2communication apprehension when communicating with foreigners?1.3HypothesisThis study was designed and conducted in order to test the hypothesis asfollows:H1.The personnel of the Bureau of Tuberculosis have lower communicationapprehension in their native language (L1) than in English language (L2).1.4Objectives of the studyThe study has the objectives as follows:1.4.1To investigate the scores and compare CA in L1 and L2 of BTBpersonnel.1.4.2To explore the characteristics that affect communication apprehension inthe personnel of BTB.1.4.3To explore the level of communication apprehension in BTB personnelwhen performing L2 oral communication.1.5Scope of the StudyThis study was conducted with personnel of the Bureau of Tuberculosis,Department of Disease Control, Ministry of Public Health, Thailand. The study focuseson 129 personnel consisting of medical officers, registered nurses, medicaltechnologists, medical scientists, medical lab technicians, pharmacists, pharmacytechnicians, radiological technologists, radiographer technicians, public health officers,social workers and administrative officers. The participants had to deal with foreignexperts and/or public health specialists. This study examined the correlation betweenL1 and L2 of CA levels in medical professional personnel including administrativepersonnel.In addition, the demographic data was compared with CA levels todetermine whether this affected L2 communication apprehension.Ref. code: 25595621030104AHL

4Figure 1 illustrates the introduction of the analytical framework. As can be seen, theindependent variables are demographic data including gender, age, position,educational background, year(s) of working and overseas experience. The dependentvariable is levels of CA in L1 and CA in L2.Independent VariableDependent Variable Demographic Data Educational Background Working Experience Overseas ExperienceLevels of CommunicationApprehension in L1 and L2Figure 1: Analytical Framework1.6Significance of the StudyThe study of communication anxiety of the personnel in BTB is significant inmany aspects as follows:1.6.1The outcome of this study will help BTB staff to recognize the causes ofproblems in oral English communication that may affect their working performance.Furthermore, the results will assist them to reduce their problem of L2 communication.1.6.2The Personnel Division, Department of Disease Control, Ministry ofPublic Health will be able to use the data and results from this study to develop andimplement appropriate English courses for the personnel in the BTB and Ministry ofPublic Health to improve their oral English skills.1.7Definition of TermsThe definition of the terms of this study are as follows:“BTB” refers to the Bureau of Tuberculosis, Department of Disease Control,Ministry of Public Health, Thailand.“CA in L2” refers to a worried feeling when speaking in English. This feelingwill be reflected in the performance in English communication with foreigninterlocutors.“Communication Apprehension (CA)” is defined as an individual’s level offear or anxiety associated with either real on anticipated communication with anotherperson or persons (McCroskey & Beatty, 1984).Ref. code: 25595621030104AHL

5“Foreigners” refers to foreign visitors, public health specialists and/or expertswho provide and/or receive public health knowledge to/from the medical technicians ofBTB in job training, conferences, meetings or workshops.“L1” means native language. In this study L1 means Thai language.“L2” refers to English as an international language, which is used tocommunicate among personnel of the BTB and with foreign visitors.“Personnel” refers to medical officers, registered nurses, medical technologists,medical scientists, medical lab technicians, pharmacists, pharmacy technicians,radiological technologists, radiographer technicians, public health officers, socialworkers, public relations officers, administrative officers, i.e., personnel officers,finance/accounting officers, computer technical officers, statisticians, policy andplanninganalyst officers and general administrative officers of the Bureau ofTuberculosis, Department of Disease Control, Ministry of Public Health, Thailand.“PRCA-24” refers to the Personal Report of Communication Apprehension. Itis a measurement of communication apprehension used to determine the level of CA ina person that was developed by McCroskey (1978).1.8Limitations of the StudyThere are two limitations of this study:1.8.1This study highlighted only Thai and English oral communicationapprehension in personnel of the BTB.Examinations in writing and listeningcommunication have not been included; otherwise, the generalization in those skillsmay reveal different outcomes.1.8.2The researcher focused on the personnel who were working in the publichealth area in Bangkok.These people have more chances to communicate withforeigners than public health personnel working in rural areas. Thus, the results mayshow only the problems of the people in urban areas.1.9Summary of the IntroductionThis chapter has presented the background and the significance of Englishcommunication in the public health area. The researcher sought to investigate thereadiness of personnel in this area when entering the AEC community.Communication apprehension might limit the proficiency of working performance interms of obtaining new methods of diagnosis, treatment, and learning new technologiesRef. code: 25595621030104AHL

6in the public health area, which may in turn act as an impediment to public healthdevelopment in Thailand.This chapter has highlighted the purposes, analyticalframework, key terms as well as the limitations of the study.Ref. code: 25595621030104AHL

7CHAPTER 2REVIEW OF LITERATUREThe key concepts reviewed in this chapter concern the following: (1)Conceptualization of communication apprehension, (2) Causes and effects ofcommunication anxiety, (3) Communication apprehension measurement, (4) CA in L2,(5) How to cope with CA, and (6) Background of the Bureau of Tuberculosis.2.1Conceptualization of Communication ApprehensionCommunication Apprehension (CA) or Communication Anxiety is defined asan individual’s level of fear or anxiety associated with either real on anticipatedcommunication with another person or persons (Beatty, McCroskey & Heisel 1998).McCroskey (1970) considers that CA is “broadly based anxiety related to oralcommunication.” Communication anxiety is clearly an obstacle to communication.Moreover, people who encounter CA tend to decrease or avoid communication. Fear ofcommunication is an internal feeling that makes people withdraw from communicationwith others (Richmond & McCroskey, 1998). It is important to understand the types ofcommunication anxiety as defined by Richmond and McCroskey (1998), who dividedcommunication apprehension into four categories as detailed below:2.1.1Communication Apprehension as a trait (Trait-like CA)Trait-like CA is related to the personality of the speaker. It is the internalanxiety that an individual brings to a speaking situation. Richmond and McCroskey(1998, p.43) define this kind of CA as an actual trait, e.g., eye color, height and weight,which are not able to change. Although we can change our eye colors by using contactlenses, the real eye color cannot be changed. According to Pongpun (2012, p.9), “Traitanxiety is explained as a fixed stage of anxiety or a part of a person’s personality”.Someone with high trait anxiety is presumed to be frightened in communicationsituations, while a person with state anxiety is likely to be frightened only in specificcontexts, such as speaking or interpersonal settings.Booth-Butterfield, Chory and Beynon (1997) state that “people who experienceeither higher trait CA or specific health state CA will probably communicate lesseffectively with their health care providers about their health problems.” If a medicaltechnician or patient is uncomfortable to communicate with each other directly, thepatient will receive less effective healthcare service.Ref. code: 25595621030104AHL

82.1.2Communication apprehension in a generalized context (Context-based CA-dyadic, groups, meetings, public speaking and interviews)This kind of CA is considered as “a relatively enduring, personality-typeorientation toward communication in a given type of context” (Daly & McCroskey1984, p.16). This type of CA is associated with people who are frightened ofcommunicating in one type of situation while they are not afraid in other situations. Forexample, people may be anxious when speaking in front of a large number of people ordoing public speaking. On the other hand, they feel comfortable to talk with closefriends.Type of context-based CA consists tionbetween two persons via channels of communication such as a telephone, e-mail, textmessage or social website (Adler, Rodman, & du Pré, 2014, p.11).(2)Small Group Communication: this refers to a group of more thanthree people associating in face-to-face communication and working together towardthe same goal. The effective size of small groups for sufficient communication isbetween five to eight persons (Hamilton, 2014, p. 262).(3)Meeting Group Communication: this refers to a group of peoplein a profit or non-profit organization engaging in formal communication (Adler et al,2014, p. 12). Meeting group communication refers to groups of more than seven(Degner, 2010).(4)Public Speaking: this means one or more people communicatingto a large number of people who participate as an audience (Adler et al., 2014, p. 13).2.1.3Communication apprehension with a given audience acrosssituations (Audience-based CA)This type of CA is focused on people’s feedback when communicatingwith a given individual or group of individuals across time (Richmond and McCroskey,1998, p.46). This kind of CA is viewed as “a relatively enduring orientation towardcommunication with a given person or group of people” (McCroskey, 1984, p.17).These particular individuals or groups of individuals may cause communicationanxiety, such as students talking with their teacher or going on a job interview.Ref. code: 25595621030104AHL

92.1.4Situational Anxiety or State AnxietySituational Anxiety is a temporary emotion arising from specificsituational factors. Some people may become anxious prior to a new communicationsituation. For example, a doctor may feel uncomfortable discussing with foreignpatients in English, but with Thai patients they may feel comfortable. They becomenervous, afraid, or excited, and their body’s nervous system prepares them for actionwith a big shot of adrenaline, which accelerates the heart rate; sends extra oxygen to thecentral nervous system, heart, and muscles; dilates the eyes; raises the blood sugarlevel; and causes perspiration (Hamilton, 2014, p.177). High or low levels of stateanxiety may occur depending on the specific situation (Pongpun, 2012, p.9). This kindof CA can be alleviated by practicing before the occurrence of situation such as Englishpractice in classroom or daily life. Richmond, Smith, Heisel, and McCroskey (1998)found that patients’ state CA or fear of physicians (FOP) was higher than trait CA. Inaddition, high FOP leads to decreased satisfaction with healthcare.2.2Causes and Effects of Communication ApprehensionAs English is not the mother tongue or native language of Thai people, it maynot be easy for people who do not use English regularly in daily life. Many Thai peoplemight feel anxious and uncomfortable to communicate with a foreigner in anotherlanguage. Some people may speak another language when they are forced to, whichwill increase their anxiety to speak the other language. Therefore, the causes and effectsof communication anxiety is the one of the important issues that needs to be discussedin this study.2.2.1Causes of Communication ApprehensionThere are two categories of causes of communication apprehension –Trait-like Communication Apprehension and Situation Communication. In this study,the focus is on Trait-like CA.2.2.1.1 Causes of Trait-like Communication ApprehensionTrait-like communication apprehensionistheresultofpersonality. Trait-like CA stems from family background and environment, which maypredispose people to having high or low CA (Richmond & McCroskey, 1998, p.49).Apprehensive people may avoid communicating with almost anyone in anycircumstance (DeFleur, Kearney, Plax & DeFleur, 2014, p.269). DeFleur et al. (2014,Ref. code: 25595621030104AHL

10p.270) also mention that trait-like CA is grounded in past experience. Social scientistsdo not contend that trait-like CA is based on genetics.However, in the past twenty years, psychobiologists andcommunication apprehension researchers have claimed that trait-like communicationapprehension results from biological functioning and social learning processes (Beatty,McCroskey, & Heisel, 1998; McCroskey & Beatty, 2000). They argue that it isgenetically linked to personality traits, which they refer to as “communibilogy”. Theyalso state that genetics are significant to the development of an individual’scommunication behavior.Richmond, McCroskey and McCroskey (2005, p.72) mentionthat some communication behavior such as language in childhood or non-verbalcommunication in some cultures can be learned. According to Richmond et al. (2005p.72) (as cited in Beatty & McCroskey, 2001), “the communibiologists point out that itseems the inheritance of genetics may be the major factor of a communication trait,which is the main factor in temperament and personality”.Richmond et al. (2005, p.71) also point out that the association ofmany kinds of traits can be identified as “Super Traits” or “temperament”. Super traitsor temperament may be associated with many characteristics of human behavior andcommunication. Rothbart, Ahadi and Evans (2000) argue that temperament is based ongenetics and personality is influenced by temperament. McCroskey, Richmond, Heiseland Hayhurst (2004) found that temperament may be one of the significant factorsregarding oral communication traits. Paulsel and Mottet (2004) state thatcommunication apprehension is peoples’ apprehension level linked to communicationand is associated with temperament. Understanding temperament will help people dealwith communication with others in various circumstances.2.2.1.2 Causes of Situational Communication ApprehensionThe causes of situational or state CA differ from one person to the nextand from one situation to others. Richmond and McCroskey (1998, p.50) cited by Buss(1980) and DeFleur et al. (2014, p.272) list the main causes of anxiety as shown below:(1)Novel situations: This will often cause an individual someapprehension because they do not know how to send feedback or interact. It is difficultto estimate how to act in a new situation.Ref. code: 25595621030104AHL

11(2)Formal situations: Anxiety will increase when people areexpected to communicate properly. People may not be confident in how to behave inparticular formal settings.(3)Subordinate status: This will occur when people have “higherstatus” than another, such as when a prime minister meets with people. In this situation,people might experience situational shyness. People in higher position may make usfeel nervous and anxious to talk with them.(4)Feeling conspicuous: This may cause apprehension. In thissituation, people will be very noticeable, or they may feel different from other people.People will be anxious when they turn to be the center of attention.(5)Unfamiliarity: People may feel uncomfortable to deal withdifferent norms and cultures than their own, because they are not familiar with thosefactors. Therefore, anxiety may increase in these situations.(6)Dissimilarity: The more dissimilar we are to others, the harder itis to communicate with them. Increases in dissimilarity will increase anxiety.(7)Excessive attention: If people receive too much attention, theymay feel uncomfortable and this will increase anxiety.(8)Repeated failure: If we have not succeeded in the past, we willbe worried that we will fail again.2.2.2Effects of Communication ApprehensionMcCroskey (1984, p

Personal Report of Communication Apprehension -24 (PRCA -24) was employed to . meetings, public speaking and interviews) 8 2.1.3 Communication apprehension with a given audience across situations (Audience -based CA) 8 2.1.4 Situational Anxiety or State Anxiety 9 . Ref. code: 25595621