Listening and communication styles of undergraduate occupational therapy students: a cross-sectional study.
Abstract: Background: Listening and communication are two critical aspects of positive relationships. In the context of health care, they have been found to have a positive impact on many aspects of client care, including patient satisfaction, emotional wellbeing, and functional and physiological status. However, little is understood about the specific listening and communication styles exhibited by students enrolled in the health-related disciplines, including occupational therapy. The aim of this study was to investigate the listening and communication styles of undergraduate occupational therapy students.

Method: This was a cross-sectional study of 210 students (response rate of 95.5%) enrolled in a Bachelor of Occupational Therapy (BOT) course, who completed paper-based versions of the Listening Styles Profile (LSP) and the Communicator Style Measure (CSM). Both the LSP and CSM are valid and reliable measures.

Results: Participants reported a strong preference for the People listening style and the Friendly and Attentive communication styles. A moderate preference was also shown for the Content listening style. There were only two minor differences between participants enrolled in the different year levels of the BOT course, and only minor differences between the male and female students.

Conclusion: The participants' reported preferences are well suited for the role of occupational therapy. The findings suggest that occupational therapy students exhibit a disposition towards listening and communication styles that are indicative of an underlying interest in the care and welfare of others and which are traits of the 'helping, people-oriented' professions. The implications of these findings are that it is important to consider the listening and communication styles of occupational therapy students during their professional education and while completing practice placement education.

Keywords:

Listening styles, communication styles, occupational therapy students, education.
Article Type: Report
Subject: Occupational therapy (Usage)
Occupational therapy (Patient outcomes)
Occupational therapy (Social aspects)
College students (Public relations)
Listening (Research)
Listening (Social aspects)
Communication in medicine (Usage)
Authors: Brown, Ted
Boyle, Malcolm
Williams, Brett
Molloy, Andrew
McKenna, Lisa
Palermo, Claire
Molloy, Liz
Pub Date: 08/01/2011
Publication: Name: British Journal of Occupational Therapy Publisher: College of Occupational Therapists Ltd. Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2011 College of Occupational Therapists Ltd. ISSN: 0308-0226
Issue: Date: August, 2011 Source Volume: 74 Source Issue: 8
Topic: Event Code: 290 Public affairs; 310 Science & research Computer Subject: Company public relations
Product: Product Code: E197500 Students, College
Geographic: Geographic Scope: United Kingdom Geographic Code: 4EUUK United Kingdom
Accession Number: 265976938
Full Text: Introduction

Communication and listening are essential components in promoting positive relationships between people. In the medical, nursing and other health-related professions, poor communication has been a concern for some time (Stewart 1995, Van Ess Coeling and Cukr 2000). Consequently, the issue of communication has been studied often, particularly in relation to medicine and nursing. However, little research has been conducted into the communication styles demonstrated by students completing courses in other health-related disciplines (including occupational therapy), where it is no less important an issue. Effective listening, in particular, has been found to improve patient satisfaction, emotional health, functional and physiological status, and pain control (Weaver and Kirtley 1995, Trahan and Rockwell 1999). The benefits of communication have been similarly noted (Kaplan et al 1989, Van Ess Coeling and Cukr 2000, Ambady et al 2002). The importance of listening and communication in achieving the desired outcomes in occupational therapy, therefore, makes it worth ensuring that occupational therapy students are well equipped to listen and communicate effectively with patients and co-workers. The purpose of this study was to investigate the listening and communication styles of undergraduate occupational therapy students.

To explore listening styles, the Listening Styles Profile (LSP) has been used previously (Watson et al 1995). The LSP measures four listening styles: People, Action, Content and Time. It has been found that most people adopt a preference for a particular combination of listening styles. This is important because one's listening style tends to be a function of habit rather than a considered use of the most appropriate style for the situation (Watson et al 1995). Accordingly, the LSP will give an indication of how participants will listen when on the job and in social situations. The People listening style is characterised by an awareness of, and concern for, the feelings of others. The Action listening style is characterised by a desire for precise, error-free presentations, and frustration with disorganised presentations. The Content listening style is adopted by those who like to consider facts and details closely. Finally, the Time listening style is adopted by those who are conscious of the time while listening and often prefer brief and hurried interactions.

Considering communication more broadly, the Communicator Style Measure (CSM) has been used to explore the preferred styles of communication used by individuals (Norton 1978). The CSM measures 10 different communication styles, which Norton (1978) described as 'the way one verbally and paraverbally interacts to signal how literal meaning should be taken, interpreted, filtered, or understood' (p99). The 10 styles are described as follows. The Dominant communication style is characterised by a desire to take control of conversations. Dramatic involves exaggerating, understating and otherwise stylising one's conversation. Contentious is characterised by being argumentative. The Animated style involves using many non-verbal physical cues, such as hand gestures or nodding. The Attentive style involves letting one's conversation partner know that he or she is being listened to. Impression Leaving is a memorable style of communication. Relaxed is characterised by a lack of anxiety when communicating. Open is characterised by being affable, unreserved, extraverted and approachable. Friendly ranges from not being hostile through to deep intimacy. Finally, Precise involves a focus on accuracy and detail in conversations.

A person is found to have not one communication style but, rather, preferences for different combinations, to the extent that Norton (1983) suggested that the styles are multicollinear. In developing the CSM, Norton (1978) described six clusters of communication styles that group together statistically and conceptually. These were combinations of communication styles that were likely to be found together. For instance, the Dramatic and Animated styles were found to cluster together. Studies using the CSM have not limited themselves to communication styles outlined by Norton, either. Buller and Buller (1987) grouped the CSM's items into two groups called Affilitative and Dominance when analysing the communication styles of a cohort of physicians. The Affilitative style, characterised by a desire to establish positive patient-physician relationships, was found to have a positive relationship with patient satisfaction. In contrast the Dominance style, which was characterised by the physician maintaining control over the physician-patient relationship, was negatively related to patient satisfaction.

Method

Design

This was a cross-sectional study using paper-based versions of the Listening Styles Profile (LSP) and the Communicator Style Measure (CSM), which were administered to a cohort of undergraduate occupational therapy students.

Participants

All students (n = 220) enrolled in the Bachelor of Occupational Therapy (BOT) course at Monash University were eligible to participate.

Instrumentation

The LSP is an instrument designed to assess four styles of listening: People, Action, Content and Time. It consists of 16 items rated on a five-point rating scale (0 = Never, 1 = Infrequently, 2 = Sometimes, 3 = Frequently, 4 = Always). The higher the reported score, the higher is the participant's preference for that style. The LSP score range is 0 to 20. Examples of the LSP items are located in Table 1. The internal consistency for the LSP's four constructs as measured by Cronbach's alpha, reported by Watson et al (1995), were People ([alpha] = 0.62), Action ([alpha] = 0.64), Content ([alpha] = 0.58) and Time ([alpha] = 0.65). In the original development of the LSP, a test-retest found the scale to be stable over a 2-week period (Watson et al 1995). Evidence of the content validity and construct validity of the LSP have been reported (Watson et al 1995).

The CSM is an instrument designed to assess 10 styles of communication and one's perception of their communication ability (Norton 1978). The instrument consists of 51 items; however, once the filler items and items related to communication image, which are not relevant to this study, are set aside, each communication construct consists of four items. These are rated on a five-point rating scale (YES! = 5, yes = 4, ? = 3, no = 2, NO! = 1). Three items were reversed for analysis. The constructs derived from the CSM have scores ranging from 4 to 20, with higher scores indicating a stronger preference for that communication style. The internal consistency, as measured by Cronbach's alpha for each of the CSM's subscales, was reported by Norton (1978) as follows: Friendly ([alpha] = 0.37), Impression Leaving ([alpha] = 0.69), Relaxed ([alpha] = 0.71), Contentious ([alpha] = 0.65), Attentive ([alpha] = 0.57), Precise ([alpha] = 0.52), Animated ([alpha] = 0.56), Dramatic ([alpha] = 0.68), Open ([alpha] = 0.69) and Dominant ([alpha] = 0.82). Examples of the CSM items are located in Table 1. The CSM also has established content validity and construct validity (Graham 2004).

Procedure

Ethics approval was obtained from the Monash University Standing Committee on Ethics in Research Involving Humans (SCERH). At the conclusion of a lecture, occupational therapy students were invited to participate in the study. Students were provided with an explanatory statement and were informed that participation was voluntary and anonymous. A non-teaching member of staff facilitated the process and participants completed a questionnaire containing the LSP, CSM and a brief set of demographic questions. It took approximately 10 minutes to complete both questionnaires and participant consent was implied by completion of the questionnaire. The data were analysed on a group basis, therefore no individual participants were identifiable.

Data analysis

The Statistical Package for the Social Sciences (SPSS, Version 17.0) was used for data storage, tabulation, and the generation of descriptive statistics. Medians were used to describe the data, and the non-parametric Mann-Witney U test and Kruskal-Wallis test were used to explore differences in preferences between the genders and the year level in which the student was enrolled (for example, first, second, third or fourth years). The results were considered statistically significant if the p value was < 0.05.

Results

Demographics

A total of 210 students participated in this study (response rate of 95.5%). A large number of participants were enrolled in the first year (n = 85), but there was also a reasonable representation of students from the second year (n = 35), third year (n = 38) and fourth year (n = 52). The vast majority of participants were female (90.0%) and the participants were almost all either under 21 years of age (54.0%) or between 21 and 25 years of age (42.2%). The gender and ages of the sample were consistent with the actual demographic profile of the students enrolled in the BOT course. The sample consisted of 21 male and 189 female students.

Listening styles

As shown in Table 2, participants showed the strongest preference for the People listening style. A moderate preference was shown for the Content listening style and little to no preference was exhibited for the Action and Time listening styles. A Mann-Witney U test found a statistically significant difference in the preference for the People listening style between males (Md = 3.00, n = 21) and females (Md = 3.5, n = 189), U = 1207.5, z = -2.981, p = 0.003, r = 0.21. The same test found no significant differences between the two genders for either the Action (p = 0.532), Content (p = 0.571) or Time (p = 0.764) listening styles.

A Kruskal-Wallis test found a statistically significant difference between students enrolled in the different year levels of the BOT course (first, second, third or fourth year) and their preference for the Time listening style %2 (3, n = 210) = 10.715, p = 0.013. Those participants enrolled in the third year (Md = 1.25, n = 38) had a significantly lower preference for the Time style than those enrolled in the first year (Md = 1.75, n = 95), second year (Md = 1.75, n = 25) or fourth year (Md = 1.63, n = 52) of the BOT course. No statistically significant differences were found between students enrolled in different year levels of the BOT course and their preferences for the People (p = 0.202), Action (p = 0.235) or Content (p = 0.786) listening styles.

Communication styles

Participants showed the strongest preference for the Friendly communication style, followed by the Attentive and Animated styles. Participants reported the least preference for the Relaxed, Contentious and Dominant communication styles. The complete list, including medians, is presented in Table 3. Using a Mann-Witney U test, a statistically significant difference in the preference for the Animated communication style was found between males (Md = 13.0, n = 20) and females (Md = 15.0, n = 188), U = 1105.0, z = -3.065, p = 0.002, r = 0.21. There were no statistically significant differences between the genders for any of the other communication styles.

To analyse differences between the year levels, a Kruskal-Wallis test was conducted, which found a statistically significant difference in the preference for the Precise communication style [chi square] (3, n = 208) = 11.315, p = 0.010. Students enrolled in the third year (Md = 11.0, n = 37) reported a significantly lower preference for this style than students enrolled in the first year (Md = 13.0, n = 95), second year (Md = 13.0, n = 24) or fourth year (Md = 13.0, n = 52) of the BOT course. No statistically significant differences were found between occupational therapy students enrolled in the different year levels of the BOT course for any of the other communication styles.

Discussion

The strongest preference among the undergraduate occupational therapy student group was the People listening style. This style is characterised by an interest in and concern for those one is listening to. A significant difference in the preference for the People listening style was found between the genders, with female students having a slightly stronger preference for this style than male students; however, it should be noted that the effect size was small (r = 0.21). Thus, while a significant difference was found, limited weight should be placed on this finding. The other listening style for which occupational therapy students exhibited a moderate preference was the Content style, which is characterised by a strong interest in the facts and details.

A strong preference for the People listening style is consistent with the career choice that this cohort of students has made. The People listening style is characterised by awareness and concern for the feelings and emotions of others (Watson et al 1995, Chesebro 1999). Those people with a dominant People listening style attempt to establish common interests and to empathise with their clients. They are also likely to have sympathetic tendencies (Weaver and Kirtley 1995). Consistent with these findings, the People listening style has been found to have a strong correlation with the Feeling type on the Myers-Briggs Type Indicator (MBTI) (Worthington 2008). Feelers are described as sympathetic, personable and friendly. It should be noted that concern for the emotions of others does not imply that these people are compelled to feel these emotions. They do, however, feel compelled to achieve conversational goals and maintain relationships (Villaume and Bodie 2007).

Pursuing a career in occupational therapy necessarily means that the focus of occupational therapists' role is to take an interest in the welfare and care of their clients in an effort to improve their lives through occupation. A strong preference for the People listening style is consistent with the career choice that this cohort of students had made. That there were no statistically significant differences between the year levels that the students were enrolled in and their preference for the People listening style would suggest that the BOT course has no direct impact on their preference for any specific listening styles. Instead, it appears that individuals who are interested in entering a people-focused, helping-oriented discipline, such as occupational therapy, already have a disposition toward the People listening style. It is likely that the People listening style is refined and developed during the 4 years of the BOT course, with increased exposure to different client groups though practice education opportunities and academic education activities (for example, learning to take a medical, social or developmental history from a client) where astute listening skills are required.

Students demonstrated a low preference for the Time listening style, which is characterised by a continual awareness of the time when listening to someone, and the Action listening style, which is similarly characterised by a desire to listen to brief, concise and accurate presentations. It is a good finding for future occupational therapists to report a low preference for the Time and Action styles. There are times when it is important to hurry someone, or to have a need to act quickly on accurate information, but these situations generally do not lend themselves to being client centred. A significantly lower preference for the Time listening style was found between students enrolled in the third year and those enrolled in the other three year levels.

Turning now to the communication styles, occupational therapy students showed a strong preference for the Friendly style, followed closely by the Attentive style. A strong preference for these styles is consistent with the preference reported earlier for the People listening style. The Friendly style is characterised by an approach that is anything from not showing any hostility through to deep intimacy. The Attentive style involves ensuring that one's conversation partner is aware that he or she is being listened to. This can be as simple as nodding in agreement while someone is speaking. Norton (1978) considered the Friendly and Attentive styles to cluster together, which the results of this study support; that is, someone who has a strong preference for the one style generally has a similarly strong preference for the other style. In the role of occupational therapist, a strong preference for these two styles is significant for the same reason that a preference for the People listening style is important --occupational therapy is a caring profession and, therefore, requires practitioners who have an interest in other people. Again, no difference was found between the year levels and their preference for either of these styles, so it can also be concluded that students with a disposition toward the Friendly and Attentive communication styles are drawn to the occupational therapy field since these traits are often used during practice.

Infante et al (1996) found that an argument was received better if an affirming tone was used, which is characterised by the Attentive, Friendly and Relaxed communication styles. Van Ess Coeling and Cukr (2000) found better perceptions of collaboration between nurses and physicians who adopted a strong preference for the Attentive style. Infante and Gorden (1989) also found superiors to have a greater level of satisfaction with subordinates when an Affirming style was used. Similarly, Baker and Ganster (1985) found that subordinates were more satisfied when their superiors had stronger preferences for the Open, Friendly, Relaxed and Attentive communication styles. In another study, that by Norton and Pettegrew (1979), respondents reported that they were more physically attracted to a person who was perceived to exhibit the Dominant and Open styles. These studies are all consistent in showing that the communication style is important in how one relates to, and is perceived by, others.

Occupational therapy students exhibited little preference for the Relaxed, Contentious and Dominant communication styles. To reiterate, the Relaxed style is characterised by a lack of anxiety when communicating, the Contentious style is characterised by a tendency to be argumentative, and the Dominant style is characterised by a tendency to take the control of the conversation. It is unfortunate that participants showed little preference for the Relaxed style. It would be beneficial for occupational therapy students not necessarily to be relaxed, but to be less anxious than this result indicates. Their lack of preference for the Contentious and Dominant styles is consistent with the findings discussed above, and is appropriate for therapists being members of multidisciplinary health care teams who provide services for the role of occupational therapist.

The analyses by year level found third-year students to have a significantly lower preference for the Precise communication style, such that it is on a par with the other least preferred communication styles. No explanation can be provided for why third-year students have a statistically significant difference in their preference for this style. It is unlikely to be a result of their education, as fourth-year students are consistent with first-year and second-year. The other difference found in the participants' communication styles was the greater preference for the Animated communication style among females in comparison to males. A higher preference for the Animated style among females is found elsewhere (Montgomery and Norton 1981). For the most part, however, gender differences in this study, and in other studies with regard to their self-reported communication styles, have been minimal (Staley and Cohen 1988).

Studies using the CSM have also found that gender and ethnicity are very weak factors in explaining differences in participants' perceptions of their communication styles (Montgomery and Norton 1981, Gudykunst and Lim 1985, Staley and Cohen 1988). These similarities are likely to be a function of the CSM asking for participants' perceptions rather than measuring actual communication styles. For instance, a study that analysed the taped interactions between patients and physicians in a number of clinical settings found significant differences between how male and female physicians communicated, with female physicians talking longer and engaging in more positive talk than male physicians (Roter et al 1991).

Limitations of the study and recommendations for future research

A limitation of this study is the use of self-report measures. There are differences between people's perceptions of themselves and how they actually behave. In analysing gender differences, Staley and Cohen (1988) found little difference in how the two genders perceive their communication styles, but reported earlier results showing considerable actual differences in communication styles between men and women. Accordingly, caution is required in the interpretation of the findings of this study because they are self-reported. Nevertheless, these data provide a valuable insight into the listening and communication styles of undergraduate occupational therapy students. Another limitation is that participants were recruited from university, hence the results can only be generalised to groups with similar characteristics.

This study included only occupational therapy students and not working professionals. Kiewitz et al (1997) suggested that the pressures of the workforce may affect the preferences people have for either listening or communication styles. Thus, while the results of this study reliably present the preferences of this cohort of undergraduate students, they can only be used as a guide as to how the students will listen and communicate when in the workforce. It would be interesting to follow this up with a longitudinal study to see whether the transition from student to working professional does, in fact, have such a considerable impact on people.

Recommendations for future research include replicating this study with a larger group of occupational therapy students from other university programmes, and comparing the listening and communication styles of occupational therapists who work in different areas of practice (for example, paediatrics, mental health and physical disabilities) and in different practice settings (for example, acute care hospitals, rehabilitation centres, community health centres, schools, private industry/practice and early intervention centres). Another suggestion would be to compare the listening and communication styles of occupational therapists in cross-cultural contexts (for example, to compare the listening and communication styles of therapists working in different countries).

Conclusion

Overall, participants showed a preference for a combination of listening and communication styles, which is well suited for the profession of occupational therapy. A strong preference for the People listening style and the Friendly and Attentive communication styles augurs well for their engagement with clients when they begin practising as occupational therapists. It should also be kept in mind that the results of this study show how participants perceive themselves, and not necessarily how they actually behave. Further research into how their perception and behaviour correlate, or how their perception changes when they make the transition from student to professional, would yield valuable insights for use in guiding course curriculum and continuing professional development needs.

Key findings

* Undergraduate occupational therapy students exhibited a strong preference for the People listening style and the Friendly and Attentive communication styles.

* Occupational therapy students demonstrated a preference for a combination of listening and communication styles, which is well suited for interacting with clients, their families and other professionals.

* Listening and communication skills of occupational therapy students should be monitored during their academic education and when they are completing practice education placements.

What the study has added

This study has increased our knowledge about the listening and communication styles of occupational therapy students. The study has also demonstrated a method for obtaining information about students' self-perceptions in relation to the professional skills they will need once they start to work with clients.

Conflict of interest: None declared.

References

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Ted Brown, (1) Malcolm Boyle, (2) Brett Williams, (3) Andrew Molloy, (4) Lisa McKenna, (5) Claire Palermo (6) and Liz Molloy (7)

(1) Associate Professor and Postgraduate Coordinator, Department of Occupational Therapy, Monash University-Peninsula Campus, Frankston, Victoria, Australia.

(2) Senior Lecturer, Department of Community Emergency Health and Paramedic Practice, Monash University-Peninsula Campus, Frankston, Victoria, Australia.

(3) Senior Lecturer, Department of Community Emergency Health and Paramedic Practice, Monash University-Peninsula Campus, Frankston, Victoria, Australia.

(4) Research Assistant Department of Occupational Therapy, Monash University-Peninsula Campus, Frankston, Victoria, Australia.

(5) Associate Professor, School of Nursing and Midwifery, Monash University--Clayton Campus, Clayton, Victoria, Australia.

(6) Lecturer, Department of Nutrition and Dietetics, Monash University, Frankston, Victoria, Australia.

(7) Associate Professor, Director of Clinical Education and Professional Development Unit, Monash University, Clayton, Victoria, Australia.

Corresponding author: Dr Ted Brown, Associate Professor and Postgraduate Coordinator, Department of Occupational Therapy, School of Primary Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University-Peninsula Campus, Building G, 4th Floor, McMahons Road, PO Box 527, Frankston, Victoria 3199, Australia. Email: ted.brown@monash.edu

DOI: 10.4276/03080221 1X13125646370933
Table 1. Examples of Listening Styles Profile and Communicator
Style Measure items

Listening        Example item 1              Example item 2
style

People           I lose my attention on      I nod my head and/or use
                 the other person's          eye contact to show
                 feelings when listening     interest in what others
                 to them.                    are saying.

Action           I am frustrated when        I jump ahead and/or
                 others don't present        finish thoughts of
                 their ideas in an           speakers.
                 orderly, efficient way.

Content          I prefer to listen to       I like the challenge of
                 technical information.      listening to complex
                                             information.

Time             I begin a discussion by     I interrupt others when
                 telling others how long     I feel time pressure.
                 I have to meet.

Communicator     Example item 1              Example item 2
style

Friendly         I readily express           To be friendly, I
                 admiration for others.      habitually acknowledge
                                             verbally other's
                                             contributions.

Attentive        I can always repeat back    I really like to listen
                 to a person exactly what    very carefully to
                 was meant.                  people.

Animated         My eyes reflect exactly     I tend to constantly
                 what I am feeling when I    gesture when I
                 communicate.                communicate.

Impression       What I say usually          I leave a definite
Leaving          leaves an impression on     impression on people.
                 people.

Precise          I am a very precise         In arguments I insist
                 communicator.               upon very precise
                                             definitions.

Open             I am an extremely open      I readily reveal
                 communicator.               personal things about
                                             myself.

Dramatic         I dramatise a lot.          Regularly I tell jokes,
                                             anecdotes and stories
                                             when I communicate.

Relaxed          I am a very relaxed         Under pressure I come
                 communicator.               across as a relaxed
                                             speaker.

Dominant         In most social              I am dominant in social
                 situations I generally      situations.
                 speak very frequently.

Contentious/     When I disagree with        I am very argumentative.
Argumentative    somebody I am very quick
                 to challenge them.

Table 2. Listening style preferences (n = 210)

Listening     Mean LSP *              Median
style            score       SD     LSP score

People           3.33        0.5       3.5
Content          1.69       0.55       2.25
Action           2.24       0.52       1.75
Time             1.57       0.72       1.63

* LSP = Listening Styles Profile.

Table 3. Communication style preferences (n = 210)

Communication style          Mean CSM *      SD     Median CSM
                                score                  score

Friendly                        15.89       1.92        16
Attentive                       14.7        1.9         15
Animated                        14.27       2.16        14
Impression Leaving              13.09       2.43        13
Precise                         13.39       2.37        13
Dramatic                        11.91       2.87        12
Open                            12.21       3.09        12
Relaxed                         11.28       2.65        11
Contentious/Argumentative       11.27       3.22        11
Dominant                        11.56       2.97        11

* CSM = Communicator Style Measure
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