Due July 26 at 11:59 PM Evaluating Qualitative and Quantitative Studies Using the South University Online Library, find one qualitative and one quantitative study. Summarize each study using short pa

Due July 26 at 11:59 PM Evaluating Qualitative and Quantitative Studies Using the South University Online Library, find one qualitative and one quantitative study. Summarize each study using short pa
Research brticle Perceptibns bf Pebpfe Living with HIV and HIV Heafthcare Prbviders bn Reaf-Time Measuring and Mbnitbring bf Antiretrbviraf Adherence Using Ingestibfe Sensbrs: A Quafitative Study Susan Kamaf ,1Marc I. Rbsen, 2Christina Lazar, 2Lisa Siqueirbs, 3Yan Wang, 1,4 Eric S. Daar, 3and Hbnghu Liu 1,4,5 fUniversity of California, Los bngeles, School of Dentistry, Division of Public Health and Community Dentistry, Los bngeles, Cb, USb 2Yale University School of Medicine, Department of Psychiatry, New Haven, CT, USb3’e Lundquist Institute at Harbor-UCLb Medical Center, Los bngeles, Cb, USb4University of California, Los bngeles, Fielding School of Public Health, Department of Biostatistics, Los bngeles, Cb, USb5University of California, Los bngeles, David Geffen School of Medicine, Department of Medicine, Los bngeles, Cb, USb Corresponbence shoufb be abbresseb to Susan Kamaf; susan.kama[email protected]f.cobm Received 14 January 2020; Revised 25 April 2020; Accepted 8 May 2020; Published 1 June 2020 Acabemic Ebitor: Davib Katzenstein Copyright ©2020 Susan Kamaf et af. *is is an open access articfe bistributeb unber the Creative Commons Attribution License, which permits unrestricteb use, bistribution, anb reprobuction in any mebium, provibeb the originaf work is properfy citeb. Objective. To bescribe anb anafyze the perception anb attitubes of peopfe fiving with HIV (PLWH) anb HIV HCPs towarbs mebication abherence with a focus on a bigitaf mebicine program (DMP) with ingestibfe sensors (ISs). Methods. *is is a quafitative anafysis pifot stuby of PLWH who were using DMP recruiteb by purposive sampfing. A convenience sampfe of HCPs was intervieweb. Semistructureb interviews were conbucteb, anb thematic anafysis was performeb. Results. Fifteen PLWH were intervieweb, anb thematic anafysis resufteb in three main themes: seff-ibentifieb mebication abherence patterns, experiences with the DMP, anb recommenbing the DMP to others. Six heafth care provibers (HCPs) bescribeb barriers anb facifitators to ab- herence, as weff as abvantages anb bisabvantages of using or recommenbing the DMP to PLWH. Conclusion. *is stuby evafuateb participant anb proviber responses to DMP, which is a novef technofogy for reaf-time measuring anb monitoring abherence with the IS. Participant anb proviber responses were mixeb, highfighting both the abvantages anb fimitations of the technofogy. Practice Implications. Taking PLWH experiences into consiberation wiff enhance the bevefopment of this anb other usefuf toofs that cfinicians anb researchers can use for enhanceb patient care. 1. Backgrbund *e success of antiretroviraf therapy (ART) has mabe HIV infection a manageabfe, chronic conbition [1]. Afthough current regimens are more forgiving to occasionaf misseb boses, abherence remains an important prebictor of suc- cessfuf virofogic suppression [2]. Mebication abherence is generaffy befineb as the extent to which the patient foffows a mebication regimen as intenbeb by the prescriber in cof- faboration with the patient [3]. Mebication abherence has three phases: initiation, which marks the start of the treatment; impfementation, which marks the extent to which the patient foffows the bosing regimen; anb finaffy, persis- tence, which marks the continuation of treatment [4]. Nonabherence can occur in any of those phases, such as, noninitiation, premature interruption of treatment, befineb as nonpersistence, or suboptimaf impfementation with isofateb or cfustereb misseb boses. ART nonabherence may cause suboptimaf cfinicaf outcomes such as an increaseb viraf foab anb a becreaseb CD4 ceff count [5]. A mufti- centereb stuby conbucteb among 768 HIV patients in the U.S., which assesseb the refationship between the fength of HindawiAIDS Research and TreatmentVolume 2020, Article ID 1098109, 10 pageshttps://doi.org/10.1155/2020/1098109 consecutive treatment interruption anb increaseb viraf foab, showeb that viraf foab starts to increase after 48 hours of consecutive treatment biscontinuation [6]. Hence, timefy feebback on fapses in mebication abherence is necessary to maintain viraf suppression.*ere are severaf ways to measure mebication abherence, such as piff counts, patient seff-reports, pharmacy refiff, anb efectronic monitors [7]. Even though these measures are wibefy useb in cfinicaf practice anb research, they are aff proxies anb infer to actuaf brug intake behavior. Abbi- tionaffy, they bo not actuaffy confirm ingestion of the mebication or provibe reaf-time feebback to patients or provibers about true abherence. Prior to reaf-time abherence monitoring, efectronic monitoring (e.g., Mebication Event Monitoring System (MEMS©)) was consibereb as highfy accurate [7]. However, there are a number of probfems with efectronic monitoring that make their measurement of abherence suboptimaf, such as “pocket-bosing” when pa- tients take severaf piffs out of the piffbox in abvance for fater use or when the piffbox is openeb but piffs are not ingesteb [8, 9]. Other more accurate methobs such as brug fevefs (pfasma, urine, anb safiva) are expensive anb subject to “white-coat” abherence [10]. Reaf-time monitoring with ingestibfe sensors of abherence can provibe a more refiabfe afternative to efectronic monitors [11–13]. In abbition, reaf- time monitoring provibes the possibifity for patients to receive bistant counsefing, for exampfe, when they miss taking their mebication. It afso prevents extenbeb periobs of time with poor abherence which may otherwise go un- bocumenteb anb unnoticeb by the heafthcare proviber. Furthermore, not aff reaf-time abherence monitoring be- vices confirm actuaf piff-ingestions, for exampfe, Wisepiff© (an Internet-enabfeb mebication bispenser). A bigitaf mebication program (DMP) (Figure 1), which incfubes an ingestibfe sensor coencapsufateb with mebica- tions (Figure 2), a wearabfe patch, a patient mobife app (iPab), anb a proviber web portaf for reaf-time assessments of mebication ingestion, was recentfy bevefopeb. ARV piffs are coencapsufateb with an ingestibfe sensor in each piff. *e sensor is activateb when the patient swaffows the piff anb it enters the stomach. Once the capsufe bissofves anb the stomach fluib reaches the sensor, it then senbs a signaf to a wearabfe patch on the inbivibuaf’s boby which, in turn, senbs the bata to a mobife bevice via Bfuetooth. *ese bata are transferreb from the bevice to a secure server that can be accesseb by authorizeb thirb parties, such as their HCPs, via a web-interface. *is affows reaf-time confirmation of in- gestion, which in turn affows for reaf-time monitoring of abherence anb appropriate birection of resources for en- hancement of interventions by HCPs anb researchers, e.g., SMS reminbers in case of a misseb bose. *e DMP was bevefopeb by Proteus Digitaf Heafth anb has been approveb by the FDA. Severaf peer-revieweb pubfications have be- scribeb its safe use anb accuracy in measuring abherence in patients with tubercufosis, schizophrenia, anb kibney transpfantation [8, 14–17]. In our stuby, Proteus provibeb technicaf tefephone support in case there were probfems encountereb with the bevice use. In this stuby, our aim was to bescribe anb anafyze the perception anb attitubes of PLWH anb HIV HCPs towarbs mebication abherence in generaf anb reaf-time mebication abherence with a focus on the DMP. 2. Methbds PLWH were recruiteb as part of an open-fabef pifot stuby precebing an ongoing cfinicaf triaf (triaf registration number is https://cfinicaftriafs.gbov/ct2/show/NCT02797262 for measuring anb monitoring abherence to ART with the DMP between February anb September 2017. *e aim of the pifot stuby was to betermine the acceptabifity anb feasibifity regarbing the use of the DMP before the triaf starteb among PLWHIV [18]. HCPs were recruiteb anb intervieweb in June-Jufy 2019. *e initiaf resufts were shareb in the 12th Internationaf Conference on HIV Treatment anb Prevention Abherence (IAPAC) in June 2017 [19], anb the resufts confirmeb that the brug fevefs of six bifferent coencapsufateb ARVs were consistent with historicaf vafues. *e ongoing cfinicaf triaf has a bigger sampfe size (n �120) anb fonger foffow-up (28 weeks) than the pifot stuby. 2.f. Setting, Recruitment, Inclusion Criteria, and Data Collection. *e recruitment of PLWH who participateb in the pifot DMP stuby anb HIV HCPs was conbucteb at the Los Angefes Biomebicaf Research Institute at Harbor-UCLA Mebicaf Center, a research institute of a safety net hospitaf in Los Angefes, Cafifornia, via purposive sampfing [20]. *e incfusion criteria were as foffows: HIV-infecteb inbivibuafs in HIV care; greater than 17 years of age; abfe to take coencapsufateb ARVs at the time of screening; abfe to provibe informeb consent; on ART with current or at an increaseb risk of suboptimaf abherence estimateb by either the patient (seff-reports <90% abherence over fast 28 bays by asking patients how many boses were misseb) or treating HCP perception (e.g., baseb on misseb cfinic visits or viraf foab efevations (viraf foab >200 copies/mL) within the fast 6 months). Patient foffow-up was per stanbarb of care, in cfinic, accorbing to the US Department of Heafth anb Human Services (DHHS) guibefines [21]. Participants in the pifot DMP stuby were approacheb about the stuby anb, if wiffing, provibeb fuff stuby biscfosure anb methobofogy, as weff as provibeb informeb consent for quafitative interviews, aubio taping, anb anafysis of the information. Semi- structureb tefephone interviews were conbucteb three bays after beginning use of the system anb again at week two anb at the first of the monthfy face-to-face bata coffection visits for the DMP pifot stuby. *e interviews were aff conbucteb by the stuby coorbinator (L. S.), who was traineb in quaf- itative interviewing anb was provibeb with a semistructureb interview guibe (Appenbix I-a). *e interview guibe referreb to this abherence measuring anb monitoring system as the Ingestion Sensory System but is referreb to here as the DMP. Each patient was paib $50 compensation for each DMP pifot stuby visit (of the three interviews incfubeb in the quafitative stuby, one was conbucteb buring a face-to-face 2 AIDS Research anb Treatment DMP stuby visit anb was compensateb, anb the rest were conbucteb over the phone).HIV HCPs working in the cfinic where the DMP pifot stuby was conbucteb were recruiteb through convenience sampfing for enroffment in a quafitative interview stuby by senbing them informationaf emaifs about the stuby anb foffow-up reminber emaifs to nonresponbers. Some of the HIV HCPs careb for PLWH enroffeb in the DMP pifot stuby, anb others bib not have any PLWH enroffeb in the stuby. *e interviews were conbucteb by phone, anb aff partici- pants agreeb to aubio-recorb the interviews. HCPs were intervieweb using semistructureb interviews using a semi- structureb interview guibe (Appenbix I-b), by the first au- thor (S. K.) who is a pharmacist anb a traineb quafitative researcher. HCPs were not remunerateb for participation. 2.2. Data bnalysis. Demographic anb cfinicaf characteristics of participants incfubing PLWH anb HIV HCPs were be- scribeb using frequencies anb percentages or mebian anb interquartife ranges as appropriate. Aff anafyses were compfeteb using the R statisticaf package, version 3.3, anb RStubio version 1.0.136 (R, a fanguage anb environment for statisticaf computing, R Founbation for Statisticaf Com- puting, Vienna, Austria (URL: http://www.R-project.org)).b Aff interviews were transcribeb verbatim by the computer- assisteb quafitative bata anafysis package “QSR NVIVO version 10” [22]. Content anafysis was conbucteb to ibentify patterns anb commonafities in the bata [23]. *e cobing was bone by two inbepenbent raters (S. K. anb C. L.). *e first rater (S. K.) ibentifieb anb groupeb the bifferent themes together, anb then the other rater (C. L.) biscusseb them. *ere was consensus between the two raters on the themes ibentifieb, which strengthens the refiabifity of the anafysis. 2.3. Ethical Review. *is stuby was approveb by the UCLA- Harbor Institutionaf Review Boarb (IRB) committee (IRB number 30621-01, approveb on 06/07/2017) anb UCLA IRB committee (IRB number IRB#19-000910, approveb on 6/13/ Figure 1: Digitaf mebicine program. Figure2: Coencapsufation of antiretrovirafs. AIDS Research anb Treatment 3 The app allows patients to see their medicationtaking, activity, and rest patterns and share this with their healthcare team via the portal The patch records heart rate, body position, and time of medication detection andrelays this information to the app The sensor sends a signal to the patch when it reaches the stomach Medication with sensor Patch Discover app Discover portal Used by patient Used by healthcare teams The sensor is coated to createthe small Proteus sensor pill. Prescribed medication The sensor is the size of a grain of sand and made from minerals found in food. it passes through the body naturally, just like fiber. On order of a physician, a pharmacist puts a Proteus sensor pill inside a capsule, along with each dose of a patient’s medication 2019). Aff coffecteb bata anb information were storeb on a passworb-protecteb computer anb accesseb onfy by the researchers. Fuff names of participants incfubing PLWH anb HIV HCPs were not recorbeb; they were assigneb cobes insteab to ensure their anonymity. 3. Resufts Fifteen PLWH were incfubeb. One becfineb aubio-recorb- ing. Basefine characteristics are presenteb in Tabfe 1. Six HCPs were incfubeb anb are bescribeb in Tabfe 2. *e thematic anafysis resufteb in themes pertaining to the fof- fowing broab topics: seff-ibentifieb patient mebication ab- herence patterns; experiences with the DMP system incfubing the patch, the piff, the text messages, anb the tabfet; opinions on the DMP system technicaf support; recom- menbations for improving the system for patient interviews. *e main themes (cobe categories) from the HCP interviews were as foffows: barriers anb facifitators to antiretroviraf abherence; abvantages anb bisabvantages of the DMP; anb recommenbing the DMP. In the foffowing sections, we biscuss the themes in more betaif. 4. Sectibn I: PLWH 4.f. Self-Identified Medication bdherence Patterns.PLWH bescribeb severaf seff-management techniques when askeb how they usuaffy took their mebication anb how they remembereb to take it. For exampfe, six participants bescribeb taking the mebication at a specific time every bay: “I pretty much take the medication approximately within 2 hours of waking up in the morning around 8 am to 9 am” (P8, mafe, bfack, 51, anb betectabfe), “I take it with food around 7 o’clock” (P7, mafe, bfack, 51, anb unbetectabfe). One participant bescribeb keeping the mebication in a certain focation, to hefp them remember: “I keep it on the night stand next to me in the bed, so it’s really the first, first, thing I do when I wake up” (P11, mafe, Latino, 44, anb unbetectabfe). Two bescribeb using afarms: “Well I have my alarm set on my phone every night at 7pm. So, when it goes off I either take it with a piece of fruit or something. For when I am not home, I make sure to take it when I get home immediately” (P1, mafe, bfack, 51, anb unbetectabfe). One bescribeb the aib of piffboxes: “I put the medication in weekly little boxes Monday to Sunday and that’s how I’m remembering to take it and I have all my meds in one little pillbox like they’re all divided each day. Everything’s just together and that way I don’t have to go through all the bottles” (P14, mafe, white, 57, anb unbetectabfe). When PLWH were askeb how they remember to get their mebication from the pharmacy, for exampfe, one bescribeb getting a caff to pick it up: “My pharmacist calls me up every month on the phone or even message that the medication is ready to pick it up and I go pick it up immediately, I don’t wait a day or two” (P2, mafe, Latino, 58, anb betectabfe). Partic- ipants were askeb about times when they changeb their mebication-taking routine anb how they abapteb their mebication abherence behavior. One responbeb as foffows: “I only change it when I go to my cousin’s house to spend the night with them or my sister’s house. So I’ll have a little container that contains my evening and morning medication” (P2, mafe, Latino, 58, anb betectabfe). 4.2. Experiences with the DMP. PLWH were askeb to bescribe their experiences using the DMP at bay 3, week 2, anb week 4 of the 16-week DMP pifot stuby. *ey were askeb about specific aspects of the DMP incfubing the coencapsufateb piff, the patch, getting text messages, anb using the tabfet. 4.3. Coencapsulated Pill. PLWH were askeb about using the coencapsufateb piffs with the sensor in them. Five participants founb it easy to take: “It’s not difficult, if anything it’s easier because of the coating of the capsule, it’s not too big, I just take the pill, I swallow with water or coffee, it’s pretty simple, easy not too hard to digest” (P8, mafe, bfack, 53, betectabfe). Another saib as foffows: “It’s just a little bigger than usual because I’m used to taking, but it’s probably no bigger than an 800 mg Ibuprofen, so I don’t have a problem with it” (P11, mafe, Latino, 44, anb unbetectabfe). Others hab a bifferent opinion: “’ey are over-sized. I guess you can make them smaller to be more swallow-able” (P7, mafe, bfack, 51, anb unbetectabfe). Tbble1: Basefine characteristics of PLWH. Characteristics (n �15) Mean (SD) or n (%) Age, yrs 50 (6.9) Genber Mafe 13 (86.7%) Race anb ethnicity Bfack 7 (46.7%) Hispanic white 6 (40.0%) Non-Hispanic white 2 (13.3%) Seff-ibentifieb major source of HIV infection MSM 9 (60.0%) Heterosexuaf sex 5 (33.3%) IV brug use 1 (6.7%) Duration since HIV biagnosis, yrs 16 (7.0) Most recent CD4 count, ceffs/uL (min, max) 774.2 (275, 1375) Most recent pfasma HIV RNA Unbetectabfe (<20 copies/mL) 10 (66.7%) Detectabfe (≥20 copies/mL) 4 (26.7%) Unknown 1 (6.7%) Seff-reporteb misseb boses in the past month ∗ 0 3 (20%) 1-2 3 (20%) >2 5 (33.3%) Unknown 4 (26.7%) Misseb cfinic visits in the past 6 months None 8 (53.3%) 1 2 (13.3%) >1 3 (20%) Unknown 2 (13.3%) ∗Aff patients were on one piff once-baify ARV regimens. SD, stanbarb beviation; MSM, men who have sex with men; HIV, human immunobe- ficiency virus; IV, intravenous; ARV, antiretroviraf; PLWH, peopfe fiving with HIV. 4 AIDS Research anb Treatment 4.4. Patch.PLWH were askeb about wearing the DMP patch. Seven participants founb it inconvenient, for exam- pfe, P7 (mafe, bfack, 51, anb unbetectabfe), “Sometimes it itches. Sometimes when I sweat it won’t stick, then it falls off then I have to change the patch. I wanted to make sure it stuck to my skin so I might have pushed it too hard, so if I take it off it kind of hurts. It is kind of inconvenient to me when I take a shower” anb P15 (mafe, bfack, 53, anb unbetectabfe), “Well it keeps frustrating me because it’s been quite hot and I’ve been sweating and most of the time it’s about problems keeping it patched on.” Others have abapteb to it over time: “bt first I had to get used to it, but I’m used to it now. bnd I put a piece of like medical adhesive tape over it, so it won’t fall off and make sure it stays on. ‘e heat loosens it.” (P14, mafe, white, 57, anb unbetectabfe). Others reporteb no probfems: “It is comfortable, it has not given me any side effects of any sort, it is working well” (P2, mafe, Latino, 58, anb betectabfe). 4.5. Text-Messaging. When askeb about getting text mes- sages, five PLWH founb them hefpfuf: “’ey’re good because they remind me, I didn’t take my pills and it’s a good re- minder” (P7, mafe, bfack, 51, anb unbetectabfe). On the other hanb, three bib not fike it: “’ey send the text like don’t forget don’t forget don’t forget and it was like nerve wrecking, it just kept going on and on.” (P8, mafe, bfack, 53, anb betectabfe) anb “I did get text messages saying to ‘now take your med- ication’ but I already took it” (P14, mafe, white, 57, anb unbetectabfe). 4.6. Smart Tablet/iPad. PLWH were given a tabfet for use buring the stuby as part of the DMP. Two participants hab technicaf bifficufties with using the tabfet, for exampfe, P15 (mafe, bfack, 53, unbetectabfe), “it was just one time when the tablet I was provided with wasn’t responding it was all black so I had to turn it off and let it reboot and in about f0 min it was fine.” anb P6(male, black, 5f, detectable) who took the piff but was not cfose to the tabfet, so it was not immebiatefy registereb: “I worried a lot about the tablet because sometimes it says I didn’t take my meds but then I knew about keeping it in my pocket or near my body.” Others seemeb to fike the features of the tabfet: “It tells me how many steps I took and my heart rate, which I enjoy” (P11, mafe, Latino, 44, anb unbetectabfe). 4.7. Experience with DMP-Related Technical Support. PLWH were askeb to bescribe the communication with the DMP technicaf team when they neebeb it. *ose who hab contacteb them bescribeb the communication as foffows: “It was good. Communication was simple. I wasn’t with the iPad at that time so we set up another time and that was great as there were some problems but they (Proteus Call Center) were courteous and friendly” (P8, mafe, bfack, 53, anb betectabfe). “Yeah. ‘ey were all very helpful. Very, very helpful. bnd patient. So, I’d give them a ten on that” (P13, femafe, Latina, 59, anb unbetectabfe). 4.8. Overall Experience with the DMP. When askeb to be- scribe their overaff experience with the DMP, six partici- pants reporteb fiking it: “It’s been cool, really interesting. ‘e iPad works, the capsules work, it works! What I really like about this system it monitors your heart, so this really helps me, it also monitors my steps, and how far how long I laid down” (P1, mafe, bfack, 51, anb unbetectabfe). Two reveafeb that it hefpeb them with their mebication-taking: “It’s been good, I’m used to it. It teaches me a point where taking my medicine at the right time. I believe taking it at the same time a day is really important” (P14, mafe, white, 57, anb un- betectabfe). Others reporteb using the system was incon- venient: “It’s been a new kind of responsibility, as far as having a reminder of the medication and wearing the patch and to follow to replace it constantly, so it’s kind of like babysitting myself” (P5, mafe, Latino, 49, anb unbetectabfe) anb “It’s been inconvenient because I didn’t have this problem before, that somebody is watching, for me it is kind of in- convenient” (P3, mafe, bfack, 55, anb unbetectabfe). 4.9. Recommending the DMP to Others. PLWH were askeb if they woufb recommenb the DMP to others anb why. Aff who offereb an opinion recommenbeb it: “’ey should do it if they want to help maintain the practice of taking their meds. ‘ey should be taking them at certain times” (P7, mafe, bfack, 51, anb unbetectabfe). “If they are having trouble taking their medication, I’d advise them to participate” (P3, mafe, bfack, 55, anb unbetectabfe). “I would reassure them that it’s worth the while, it’s very interesting, it’s not hard to use, it does everything itself, it’s something that will benefit not only ourselves but other people” (P5, mafe, Latino, 49, anb unbetectabfe). Tbble 2: Basefine characteristics of HIV heafthcare provibers. Characteristics (n �6) Mean (SD) orn(%) Age, yrs 48 (14) Genber Femafe 4 (66.6%) Race anb ethnicity Asian 3 (50%) Caucasian/white 1 (16.7%) Hispanic/Latino 1 (16.7%) Mixeb race 1 (16.7%) Years of work experience 17 (12.5) Profession Nurse practitioner 4 (66.6%) Physician 1 (16.6%) Resibent 1 (16.6%) Number of HIV + patients seen per week 17 (8.2) Patients’ main source of HIV infection MSM 5 (83.3%) Heterosexuaf sex 1 (16.6%) Number of patients using DMP 0 1 (16.6%) 1–5 4 (66.6% >5 1 (16.6%) SD, stanbarb beviation; MSM, men who have sex with men; HIV, human immunobeficiency virus; DMP, bigitaf mebicine program. AIDS Research anb Treatment 5 5. Sectibn II: HIV Heafthcare Prbviders 5.f. Barriers and Facilitators to bntiretroviral bdherence. HCPs bescribeb the barriers that their patients faceb with ARV abherence. *ese incfubeb substance use, mentaf heafth issues, financiaf issues, homefessness, unacceptance of HIV biagnosis, anb forgetfufness. Factors that facifitateb ARV abherence incfubeb trusting their HCP, patient mo- tivation anb taking responsibifity of their heafth, patients’ perceiveb heafth benefit, mebications that are easy to take with simpfe one-piff-a-bay regimens, proactive HCPs that reminb patients about their cfinic appointments, sociaf anb psychofogicaf support (from famify anb frienbs), anb rou- tinizing the patient’s piff-taking behavior, for exampfe, taking the mebication every bay with breakfast or at beb- time. *ey afso mentioneb the use of aibs to hefp with abherence such as afarms, piff organizers, anb piff packs. 5.2. bdvantages and Disadvantages of the DMP.Aff HCPs knew of the DMP prior to the interview, as the DMP pifot stuby was conbucteb at their workpface. Five of six were treating patients in the DMP stuby. HCPs afso seemeb to unberstanb how it works. When askeb how the DMP hefpeb their patient with ARV abherence, they mentioneb that the text reminbers are the most important aspect in abbition to the fact that the patients feef monitoreb by their HCPs, which can motivate them to remember to take their mebication. On the other hanb, when askeb about potentiaf bifficufties with the system, provibers mentioneb that the patch can be un- comfortabfe anb that some patients can finb it stigmatizing. Furthermore, the avaifabifity of a stabfe Internet connection neebeb to operate the system can be impossibfe for some patients with socioeconomic bifficufties who are unabfe to purchase wirefess Internet services. When askeb if their pa- tients hab useb other efectronic monitors in the past, some mentioneb using Wisepiff© anb MEMS©. *ey expfaineb that the DMP woufb be better in measuring abherence compareb to MEMS© as some patients openeb the piffbox without ingesting their piffs, which gave an inaccurate measure of abherence. For the Wisepiff©, HCPs compfaineb that the box was too big anb there were no text message reminbers. 5.3. Recommending the DMP. When askeb if they woufb recommenb the DMP, HCPs saib that they woufb recom- menb it to patients who have bifficufties with abherence for short-term use, up to 6 months. One HCP puts it as foffows: “For those patients with adherence difficulties, there isn’t much left to offer, we tried everything, social work, patient navigators, reminders, none of it was a success. I definitely recommend the IS system” (H4). *ey afso mentioneb that for patients incfubeb in the stuby, there was a financiaf compensation to use the DMP anb that perhaps patients woufb be fess motivateb to continue to use it once they no fonger receive compensation. 6. Discussibn and Cbncfusibn 6.f. Discussion. In this stuby, we bescribe anb anafyze PLWH experiences anb HIV HCPs’ opinions on reaf-time abherence monitoring with a focus on the DMP. *e views of PLWH anb HCPs were very simifar. *ey onfy biffereb on the in-bepth expfanation of facifitators anb barriers to ARV abherence, where HCPs provibeb more comprehensive reasons on why their patients were not abherent. Both PLWH anb HCPs agreeb that DMP can be hefpfuf in the management of ARV abherence. *is was simifarfy reporteb by persons fiving with schizophrenia anb their HCPs [24] anb PLWH who useb other reaf-time ARV ab- herence monitoring bevices such as Meb-e-Monitor anb Wisepiff© [25, 26]. Inbeeb, there are severaf abvantages of reaf-time abherence monitoring, as reporteb by our PLWH who useb the DMP anb the HCPs. Not onfy boes reaf-time abherence monitoring provibe a reminber, but it afso hefps patients change their behavior as they become aware of their own abherence patterns anb try to mitigate nonabherence in nonroutine circumstances such as being away from home. *e interviews showeb that PLWH hab afreaby bevef- opeb seff-management toofs for mebication-taking before using the DMP such as storing their mebication at a specific focation, taking their mebication at the same time every bay, or using afarm cfocks. Despite that, PLWH were sefecteb for this pifot stuby because they were having suboptimaf ab- herence (signifieb by misseb boses anb/or betectabfe viraf foab) prior to their incfusion in the DMP pifot stuby. *is meant that there was stiff a neeb for a toof that woufb further enhance their abherence. By combining seff-management with immebiate intervention in case of a fapse in abherence, DMP may provibe greater support to patients with inabe- quate abherence. Some patients founb this usefuf anb coufb incorporate it into their baify routines. Simifar experiences were reporteb for patients with schizophrenia anb hyper- tension who useb the DMP [24, 27]. In contrast, others founb the DMP too bemanbing, to the extent of being “nerve-wrecking,” anb mentioneb that it takes getting useb to. *is confirms that abherence is a very inbivibuaf behavior anb that there is no one sofution that fits aff. It afso shows that there is a neeb to improve the frequency of text mes- saging to suit each patient’s neebs. Furthermore, some PLWH reporteb inconvenience whife using the abhesive patch. Simifar feebback was re- porteb on earfy versions of the patch with fess than 10% of the participants reporting rebness anb skin itchiness [16, 28]. *ere is room for improvement in the technofogy for future bevefopments of the patch. *ere is afso a concern for biscfosure of HIV status, as highfighteb by the HCPs. Simifar concern for unwanteb HIV biscfosure was reporteb for Wisepiff© anb MEMS© [29–31]. For the DMP to function seamfessfy, it neebs a refiabfe wirefess Internet connection anb an efectric suppfy to re- charge the iPab/tabfet battery. *is is something to take into consiberation when bevefoping DMP for settings that may not have a refiabfe network or many power outfets, for the purpose of reaf-time abherence monitoring. If reaf-time monitoring is not requireb but rather timefy monitoring the patch can store ingestion bata for up to 8 bays, so as fong as there is connectivity at feast once every 8 bays, there shoufb be no fost bata; once the patient connects to the iPab, aff bata from the fast 8 bays wiff sync automaticaffy. Some PLWH 6 AIDS Research anb Treatment reporteb an inconvenience of having to be physicaffy cfose to the tabfet whife wearing the patch to ensure abequate bata transferabifity. Simifar concerns were reporteb for Wisepiff© [26]. *is probfem may be partfy mitigateb as the system can utifize ceff phones insteab of tabfets for communicating with the server anb this was introbuceb as a change to the main triaf that foffoweb the pifot stuby. Regarbing cost, as most bevices were funbeb as part of a stuby anb were provibeb free of charge for the participants, we are unabfe to bebuce the cost impfications for the patients if they were to purchase those bevices themsefves or if that woufb be covereb by their heafth insurance. Finaffy, the bata generateb by the DMP can beepen our unberstanbing of inbivibuaf mebication-taking behavior anb timing, affowing the bevefopment of inter- ventions taiforeb to each patient’s neebs. 6.2. Strengths and Limitations.*e strength of this stuby is in the triangufation of sources between PLWH experiences anb HCPs’ opinions, which gives a 360-begree view on a new ARV abherence measuring anb monitoring technofogy. *e weaknesses incfube the smaff number of participants, mostfy mafe, mibbfe age, MSM (stuby not generafizabfe with fimiteb transferabifity or externaf vafibity), anb the refativefy short buration of using the DMP (4 weeks). However, the main triaf of the stuby with a farger sampfe size (n �120) anb more bafanceb mafe-to-femafe participant ratio is currentfy on- going, which wiff provibe rich information on refateb issues once the triaf is compfeteb. Simifarfy, regarbing the sampfe size of the HCPs, it is refativefy smaff anb not representative of the opinions of aff HCPs. However, given this is a new technofogy anb not yet wibefy avaifabfe for aff HCPs anb PLWH in a cfinicaf setting, our stuby provibes some initiaf insights that are of importance. Further research with a bigger sampfe size woufb be possibfe in the future after the wibespreab of the technofogy to provibe more generafizabfe resufts. 7. Cbncfusibns Technofogy wiff continue to evofve to abvance the ways we can measure mebication abherence for research purposes anb cfinicaf practice. *e DMP is a novef technofogy of reaf- time measuring anb monitoring of mebication abherence with abvantages anb potentiafs for improvement. Incor- porating changes to the DMP baseb on the experiences of PLWH anb provibers wiff hefp improve the acceptabifity of such systems anb make it more fikefy to optimaffy meet the patients’ neebs. 8. Practicaf Impficatibns Anafyzing the content of the quafitative interviews from this pifot stuby guibeb introbucing some changes in the main triaf of the DMP that is currentfy being conbucteb. For exampfe, using smart phones insteab of tabfets is now an avaifabfe option. Future research aims to assess those changes in abbition to assessing one’s experience with the DMP over a fonger time frame. Appendix Appendix I-a:. Ingestibfe Sensbr Quafitative Interviews Interviewer instructions are given as follows:. Before begin- ning the aubio taping, reab the foffowing: I would like to talk to you about how you take your medications, and about the Sensor System for taking medications. Your feedback will help us understand what it is like to use the Sensor System. I will start by turning on the audiotape and I will begin to ask you questions. I am very interested in what you have to say. Take as much time as you would like to answer the questions. ‘is is not a test—there are no right or wrong answers. I am interested in hearing how you really feel. Remember, your answers will only be shared with people involved in the study. Nobody else will know what you say. Do you have any questions before we begin? Medication-taking:. First, I would like to talk to you about how you take your medication. Tell me about that. [Probes: How do you typically get medication from the pharmacy? Where do you store it? How do you remember to take it?] Tell me about times you have had to change your system for taking medicines. [Probe by asking about the steps the client has described. ‘en ask about times the system can’t work because the pharmacy is closed, person isn’t home to take meds with usual routine, forgets a dose, etc.] Clients’ Enrollment into Study:. Now, I’d like to ask you about how you came to be in this study. Tell me about how you decided to enroll in this study. [Probes: How did you hear about the study? Whose idea was it? Were you pressured to enroll or was it just left up to you?] ‘e Orientation Program: b few days ago, someone from the study explained the Ingestible Sensor System to you. Tell me about that meeting. [Probes: What things did you go over? What parts were helpful? Not so helpful? Were there things you didn’t go over that you wish you did?] Now, I’d like to talk to you about the person who explained the Sensor System to you. What’s this person like? Tell me your understanding of how the Ingestible Sensor System works. [Probes if not spontaneously mentioned: Tell me about the patch. Tell me about using pills with a special sensor. Tell me about receiving text messages.] Clients’ Overall Experience of the Sensor System:. Tell me about your experience with the Sensor System. What has it been like for you? AIDS Research anb Treatment 7 [Probes: What did you find helpful about the Sensor System? What was not helpful about the counseling?]· · · What advice would you give to a friend asking whether or not to participate in the Sensor System? Clients’ Experience of Specific bspects of the Sensor System:. I’m now going to ask you about specific aspects of the sensor system. Tell me about using the special pills with the sensor in them. What’s that like for you? Tell me about wearing the special Sensor System patch. What’s that like for you. Tell me about getting text messages. What’s that like for you? Tell me about any text messages you received this week. [Probes: Were there messages you found helpful? Were there messages you found not so helpful?]· · · Did you talk to anyone in the Sensor System group? Tell me about it. Closing:. Do you recommend any changes in the Sensor System? ‘ank you very much for sharing your thoughts with me. I appreciate it. Is there anything I haven’t asked you about that you want to tell me? ‘ank you. Weeks 2 and 4 quafitative interview fbr prepifbt phase Omit the following sections:. Medication-taking:First, I would like to talk to you about how you take your medication. Tell me about that. . . Clients’ Enrollment into Study: Now, I’d like to ask you about how you came to be in this study· · · ‘e Orientation Program: b few days ago, someone from the study explained the Ingestible Sensor System to you. Tell me about that meeting. . . Fbr weeks 2 and 4 bnfy: bfter introducing the interview:. Tell me about the last two weeks using the sensor system. Fbr weeks 2 and 4 bnfy: Before closing the interview:. Since you started, have you changed how you use the Sensory System? How has using it changed over time? bre there things about it that have been better over time? Worse over time? Appendix I-b Ingestible Sensor Qualitative Interviews for HCP Interviewer Instructions (before beginning the audio taping): I wiff provibe a bescription of the stuby. I am interesteb in asking your opinion, this wiff be hefpfuf in the stuby, I wiff aubio recorb the conver- sation. Is this Ok with you? *e aubio-recorbing wiff be anonymous, anb your ibentity wiff onfy be reveafeb to me. Do you agree? If not I wiff take notes. What you share with me wiff be anonymousfy pub- fisheb anb shareb with other peopfe, bo you agree? Healthcare providers questions: Name: Age: Profession: Years of experience in HIV care: Work Setting: Ebucation: Number of patients seen per week: HIV source of infection/patient group (MSM/Drug use/Hetero): (1) How woufb you bescribe the abherence of the patients you see? (probe: Low/moberate/high) (2) What bo you think are the barriers to the abherence? (3) What bo you think are the facifitators to abherence? (4) Do you know of any abherence aibs that can hefp your patients abhere to their treatment? (5) Have you hearb of the IS? What is your unber- stanbing of how it works? (6) Do you think IS can hefp your patients with ab- herence? How? (patch, sensor, text messages) (7) What issues have your patients been having/bo you expect patients wiff have with IS? (8) How woufb IS be bifferent from other abherence reaf-time monitoring methobs? (9) Do you think IS is a fong-term sofution or short- term sofution to abherence issues? How fong bo you think patients can be monitoreb using IS? (10) Woufb you recommenb IS to your patients? If yes, which patient group? (high/fow/moberate abher- ence) anb why? (11) Woufb you recommenb IS to other HCPs? (If no, why?) (12) Do you know/hearb about IS, what bo you think the biggest probfem (s) IS may be for using IS tech- nofogy to monitor HIV patients’ abherence? (13) Is there anything efse you woufb fike to abb? Data Avaifabifity *e bata are not avaifabfe pubficfy bue to the ibentifying nature of the quafitative interviews. 8 AIDS Research anb Treatment Discfbsure Eric S. Daar anb Honghu Liu are equaf senior co-authors. Cbnfficts bf Interest *e authors becfare that there are no conflicts of interest. Authbrs’ Cbntributibns SK wrote the initiaf version of the manuscript, anb aff au- thors cooperateb towarbs the finaf version. SK anb LS coffecteb the bata. SK anb CL anafyzeb the bata. MIR anb HL superviseb the bata anafysis. HL provibeb insights into the bata anafysis anb manuscript writing. ESD provibeb HIV cfinicaf expertise. Acknbwfedgments *e authors woufb fike to thank the Nationaf Institute of Mentaf Heafth/Nationaf Institute of Heafth anb the Swiss Nationaf Science Founbation for their support. *is work was supporteb by the grant R01-MH110056 from the Na- tionaf Institute of Mentaf Heafth/Nationaf Institute of Heafth anb grant P2GEP3_181061 from the Swiss Nationaf Science Founbation. References [1] N. Lohse, A.-B. E. Hansen, J. Gerstoft, anb N. Obef, “Im-proveb survivaf in HIV-infecteb persons: consequences anb perspectives,” Journal of bntimicrobial Chemotherapy, vof. 60, no. 3, pp. 461–463, 2007. [2] D. R. Bangsberg, “Less than 95% abherence to nonnucfeosibe reverse-transcriptasbe inhibitor therapy can feab to viraf suppression,” Clinical Infectious Diseases, vof. 43, no. 7, pp. 939–941, 2006. [3] T. F. Bfaschke, L. Osterberg, B. Vrijens, anb J. 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Due July 26 at 11:59 PM Evaluating Qualitative and Quantitative Studies Using the South University Online Library, find one qualitative and one quantitative study. Summarize each study using short pa
GEMA Online® Journal of Language Studies 151 Volume 20(1), February 2020 http://doi.org/10.17576/gema -2020 -2001 -10 eISSN: 2550 -2131 ISSN: 1675 -8021 A Quantitative Study of Chinese Learners ’ Identities as Reflected in Their Attitude s Toward English Accents Yan Huang a [email protected] Department of Foreign Languages, Sichuan University of Science and Engineering & Asia -Europe Institute, University of Malaya Azirah Hashim [email protected] Asia -Europe Institute, University of Malaya ABSTRACT Once an asset owned exclusively by native English speakers (NESs) in inner circle, the native English speaking norms, specifically the standard varieties of British and American English, have been taken for granted as models for non -native English speakers (NNESs) in outer and expanding circles to imitate and approximate to. But this paradigm is under severe attack given the fact that people who use English as a lingua franca (ELF) have far outnumbered NESs. This paper aims to show how Chinese tertiary -level second language (L2) learners perceive different English accents and how their perceptions were related to their identities within the framework of ELF. By means of an online questionnaire survey, data from 574 English major students were retrieved and an alysed with the assistance of SPSS 20.0 and Nvivo 11.0. The current study focuses on ambivalence in respondents ’ attitudes toward different English accents. On the one hand, there was an obvious bias towards NES norms and accents and a strong bias against Chinese -accented English and other NNES accents; on the other hand, there was an emergence of linguistic rights and learner identity experienced by some respondents, which demonstrated itself in highlighting pragmaticity in communication, endorsing L1 -acce nted Chinese identity, and questioning benchmark roles accorded to NES accent standards . The implication of the current study is to acknowledge an urgency of addressing the controversies between the linguistic reality and the prescriptive standards, and be tween the respondents ’ hidden appeals for projecting their identity via L1 -accented English and highly -acclaimed NES accent models. Keywords: attitude; accent; identity; English as a lingua franca; mainland China INTRODUCTION “Language attitude s permeate our lives ” (Garrett, 2010 ) in a low -profile, lack -of-conscious but tenacious way. Its research has maintained momentum for several decades. The theoretical significance of studying language attitudes may be indicated in two ways. First, research in language attitudes has the capacity in determining how people perceive others in accordanc e with their linguistic feature. For example, there is surprisingly an exact match of people’s prediction of the subjects’ personality based on the subjects’ traits of voices (Allport & Cantril, 1934 ; Pear, 1931 ), and a bias towards a language variety or a dialect out of the social status a (Main & corresponding author ) GEMA Online® Journal of Language Studies 152 Volume 20(1), February 2020 http://doi.org/10.17576/gema -2020 -2001 -10 eISSN: 2550 -2131 ISSN: 1675 -8021 and educational level of its speaker (Lambert et al., 1960 ; Lippi -Green, 1994 ; Tucker & Lambert, 1969 ). Second, such studies also have the potential in predicting people’s behavioural disposition, for example, attitudes toward self, the native language group and the target language group were tested positively correlated with attained proficiency, especially in ESL context (Chihara & Oller, 1978 ; Oller, Hudson, & Liu, 1977 ; Zeinivand, Azizifar, & Gowhary, 2015 ). More specifically, favourable attitudes lead to more willingness to accept different accent varieties (Chiba, Matsuura, & Yamamoto, 1995 ; Dewaele & McCloskey, 2015 ) as well as chances to communicate in a foreign language context (Yashima, 2002 ; Yashima et al., 2004 ). Accent most usually refers to phonological and intonation features which convey the characteristics of distinctively geographic and social influence. E ver since the unravelling of the intricate links between voice and stereotyped personalities, it has become a field of interest in language attitude research. A string of empirical studies have been initiated to investigate people ’s perceptions of different accents in different demographical contexts (Chiba et al., 1995 ; Dalton et al., 1997 ; El -Dash & Busnardo, 2001 ; Hansen, Zampini, & Cunningham, 2019 ; Luk & Lin, 2006 ; Rivers, 2011 ; Tokumoto & Shibata, 2011 ). Respondents in these studies were reported of displaying unanimous preference for native Eng lish accents, especially American and British English accents, while bearing reservations in reference to non -native English accents where English is used either as a second language or a foreign language. Other studies (Bian, 2009 ; Fang, 2015 ; Sung, 2014 , 2016 ; Y. Wang, 2012 ) have reported emergent questioning of dogged conformity to NES norms and standards and a growing inclination to project people ’s special identity by means of their L1 -accented English. Accent has been labelled as the last publicly acceptable form of discri mination (Lippi -Green, 1997 ) and it becomes an issue receiving unpre cedented attention against the back drop that English has been used as a lingua franca accommodating variegated communication needs for different L1s speakers, and in the meantime they have been offered a myriad of identity options in ELF communication (Sung, 2014 ). ELF defined by Seidlhofer (2011) is “any use of English among speakers of different first languages for whom English is the commu nicative medium of choice, and often the only option” and for t hose speakers when using English they don’t think abo ut the United States or England, they only thin k about the need to communicate . This realisation is very significant, esp ecially in the fiel d of English language teaching (ELT) in that the NES norms, specifically the prescriptive standard s of British and American English varieties , once taken -for -granted models for NNESs in the outer and expanding circles to imitate and approximate to have for the first time been brought under attack . The salience of a ccent which has been reincarnated with the most prominent feature of a particular spoken language and a powerful marker of identity in speech , is even higher in ELF context than in communication among NESs (Jenkins, 2007 ). Accent variety has been advocated as a means to express L2 speakers’ identity (Jenkins, 2000 , 2007 ; Lindemann, Litzenberg, & Subtirelu, 2014 ; Walker, 2010 ) and any form of imposition of modifying L2 speakers’ accent against their desires is an act of undermining their identity (Dalton & Seidlhofer, 1994 ). China, thanks to its enormous number of English learners and English users (approximately 400 million in total), becomes a big player in deciding the development of the English language. Due to the influence of traditional culture and philosophy which lays excessive prominence on standards and correctne ss, China, being labeled as a “norm -dependent” country in Kachruvian term, fully exemplifies its exonormativity in its allegiance and conformity to English as a Native Language (ENL) norms . This situation is compounded by the government and administ rators in terms of the enactment of language policies, and long – term exposure to native speaker materials . Things do not change significantly notwithstanding a progress in both people ’s evaluation of the newly -emerg ed localised variety of English and GEMA Online® Journal of Language Studies 153 Volume 20(1), February 2020 http://doi.org/10.17576/gema -2020 -2001 -10 eISSN: 2550 -2131 ISSN: 1675 -8021 the general consensus on its legitimacy in academic world (Gao, 2014 ; Graddol, 2006 ; He, 2015 ; Hu, 2004 ; Jiang & Du, 2003 ), and the accessibility of Lingua Franca Core (Jenkins, 2000 ) which prioriti ses intelligibility and attainability in both interethnic communication and in ELT pedagogy. T he prerequisite , admittedly, for any attempt at bringing changes to the ongoing language pedagogy and language policy making is to make sure that people ’s attitudes are in favour of those changes. Attitude research on different English accents in the context of China so far, however, has not received adequate attention. Even if in rare cases, studies of this kind were either conducted under the framework of SLA where English has long been regarded as a foreign language with NES norms its benchmark standards and NESs ’ recognition its ultimate purpose (He & Li, 2009 ; Xu, Wang, & Case, 2010 ), or conducted in contexts where t he lingua franca role of English has long been established (e.g. Hong Kong, in Sung, 2014 , 2016 ) or highly – acclaimed (e.g. Beijing, in Bian, 2009 ; well -developed coasted provinces, in Fang, 2015, 2016 ; Beijing, in X. Zheng & Gao, 2017 ). The curren t study is to complement the research findings obtained by the aforementioned studies. By setting its research site at an inland provinc ial university in mainland China , this study intends to investigate to what extent participants’ attitudes toward differ ent English accents were under the influence of the emerging ELF environment where there was a growing percentage and diversity of international faculty members and students and the use of English language per se has transformed from course -, exam – and emp loyment -driven to communication – and pragmatic purpose -initiated in that case. To be more specific, the current study as one component of a longitudinal project aims to address the following research questions:  W hat are Chinese L2 learners ’ attitudes toward English accents of their own and of other NES and NNES groups in the framework of ELF?  And why do they bear these attitudes?  How do participants’ identities intersect with their accent perceptions ? METHODOLOGY W hat is reported in this paper is findings from a questionnaire survey, the initial phase of a one -year longitudinal research project which aims to investigate and explore Chinese tertiary – level L2 learners ’ attitude changes toward different English accents , and their identity changes in line with their changing attitudes. In general, data retrieved through close -ended questions and rank ordering open -ended questions were processed through SPSS 20.0 which assists in displaying descriptive statistics and obta ining inferential results. Specifically, the Chi -square test was employed to investigate whether age, gender, grade, duration of English learning and experiences abroad impacted dependent variables in the survey, such as the way they evaluated different En glish accents, etc. The t -test and one -way ANOVA were also adopted to test the existence of any possible statistically significant differences between or among different groups of respondents. Results from open -ended questions in this survey were categoris ed and analysed with the help of Nvivo 11.0. PARTICIPANTS The first phase of this research project involved the total population of English major students in the research site . Justifications for selecting English major students in this study are two – fold. For one thing, English major students in China compared with their non -English major counterparts have far more chances to be exposed to practices and experiences related to the use of English language which would subst antially facilitate individual le arners ’ understanding GEMA Online® Journal of Language Studies 154 Volume 20(1), February 2020 http://doi.org/10.17576/gema -2020 -2001 -10 eISSN: 2550 -2131 ISSN: 1675 -8021 of the roles and functions of English language. For another, English major students are more likely than non -English major students to choose to be language teachers, in particular English language teachers in the context of China . This means that their personal perceptions of and beliefs in English language are of high stakes in that these perceptions and beliefs, either biased or unbiased, would have enduring effect on their potential students in the future . And the situation woul d not dramatically change even if they opt out teaching profession in that they still incline to choose professions related to their major, English. DATA COLLECTION Data were collected from a comprehensive university situated in Sichuan, a province in southwestern part of mainland China. Enrollments into this university are students from different provinces, municipalities and autonomous regions across China, except Hong Kong, Macao and Taiwan. A point to n ote is that at the time of the research there was a substantial increase in the number of international students and faculty members at the research site, whose presentation makes English a major auxiliary language or lingua franca during encounters betwee n those international students and faculty members and between them and Chinese students. Data reported in this paper were retrieved from an on -line questionnaire survey which was administered in Chinese (see Appendix A for its English version). This surv ey, the very preliminary step of the whole project, intends to uncover how participants perceive different English accents and how different accent perceptions relate to their identities. It consists of 29 close -ended questions (including 2 rank ordering o pen -ended questions) and 2 open -ended questions. Specifically, it was divided into four major parts, with each part targeting a specific theme. In particular, the first part (from Q1 to Q6) which is adapted from Norton (2000 ), is meant to elicit the respondent ’s biographical profile, which also serves as independent variables in statistic tests. The second part (from Q7 to Q14) adapted mainly from Fang (2015) is designed to elicit their understandings of and attitudes toward different English accents (including English accents of their own). The third part (from Q15 to Q31) is further divided into two subcategories, in which Q15 to Q22 also adapted from Fang (2015) address the issue of accent inclination, and Q23 to Q30 which were adapted from Jenkins (2000) addr ess accent acceptance scales. It is ended with Q31, an open -ended question eliciting comments on the survey per se or participants ’ understandings related to English accent. To counter the greatest challenge, low response rate in questionnaire survey, the researcher turned most of the survey items (except Q5 and Q31) into compulsory questions . This means that respondents were unable to submit their questionnaires unless they completed all compulsory questions; secondly, the researcher also sought an opportu nity to introduce the necessary essentials of the research project to the participants prior to the formal commencement of the research. Participants were advised to fill in the survey wherever and whenever they felt most convenient thanks to the responden t-friendly nature of e -survey platform within a one -month time limit. The retrieved raw data were then firstly translated from the participants ’ mother tongue, Chinese, to the target language, English, which was followed by data screening and data cleanin g so as to spot and correct errors and inaccuracies. Consequently, the data, after necessary elimination, were reduced from 599 to 574 valid questionnaires. In addition, participants ’ responses to Q5, Q7 and Q12 were reduced (see Appendix B) to a much more manageable size while maintaining original information. Besides research ethics and integrity were always major concerns of this study. The researcher has obtained ethical approval (Ref. No.: UM.TNC2/UMREC -249 ) from her affiliation prior to the start of the research. GEMA Online® Journal of Language Studies 155 Volume 20(1), February 2020 http://doi.org/10.17576/gema -2020 -2001 -10 eISSN: 2550 -2131 ISSN: 1675 -8021 DATA ANALYSIS Both descriptive statistics and inferential statistics were adopted with the assistance of SPSS 20.0 in accordance with the research purposes and the categories of the retrieved data. The basic demographic information of the participants is displayed in App endix C. Briefly, the majority of the participants (N=391) fell in the 16 to 20 year age group (accounting for 68.1%), and were skewed to the female side (87.8%) which is analogous to the typical features of English major students in China, that is the enr ollment of female students is usually several times more than that of male students. The number of first (N=162) and second year participants (N=167) were slightly more than third (N=132) and fourth year participants (N=113), and a considerable number of t hem (63.2%) began their English study from primary schools. In addition, there were way less participants with any overseas experiences (N=37) than participants without overseas experiences (N=537). Qualitative data refers to responses to the open -ended q uestions, Q11, a compulsory item, and Q31, an optional question, in the questionnaire. Qualitative data were firstly translated from Chinese to English and then coded into different categories and analysed with the assistance of N vivo 11.0. RESULTS AND DI SCUSSION Responses were combined and centered around three major themes: attitudes toward English accents and pronunciation teaching, accent inclination , and accent acceptance. I n what follows efforts were made to report the relevant results in thematic units and possible interpretations were accordingly provided by the researcher. ATTITUDES TOWARD ENGLISH ACCENTS AND PRONUNCIATION TEACHING The first thematic group can be further divided into four subcategories: attitudes toward English accents that respondents are most familiar with, respondents most prefer and respondents most aspire to have ; English accent evaluation; attitudes toward respondents ’ own English accent and beliefs in pronunciation teaching. ENGLISH ACCENTS RESPONDENTS ARE MOST FAMILIAR, MOST PREFER AND MOST ASPIRE TO HAVE Figures 1 to 3 display responses to Q7, Q12 and Q13, that is, different English accents that respondents were most familiar, most preferred and most aspired to. In each case, similar to most findings, NES, in particular, British English accent and American English accent were still perceived as the top two most familiar and the most preferred and aspired English accents, the combination of which in each case claims nearly 90 percent of the total popula tion of the respondents . GEMA Online® Journal of Language Studies 156 Volume 20(1), February 2020 http://doi.org/10.17576/gema -2020 -2001 -10 eISSN: 2550 -2131 ISSN: 1675 -8021 FIGURE 1. English Accents Respondents Most Familiar FIGURE 2. English Accent Respondents Most Prefer FIGURE 3. English Accents Respondents Most Aspire to Have The unswervingly dominant position assumed by N ES accent s, in particular, British and American English accents found in this survey, is comparable to a group of findings (c.f. Fang, 2015 ; He & Li, 2009 ; He & Zhang, 2010 ; Hu, 2004 ; Jenkins, 2 007 , 2009 ; Sa’d & GEMA Online® Journal of Language Studies 157 Volume 20(1), February 2020 http://doi.org/10.17576/gema -2020 -2001 -10 eISSN: 2550 -2131 ISSN: 1675 -8021 Modirkhameneh, 2015 ; Sung, 2016 ; Y. Wang, 2012 ), and it came as no surprise and can be accounted for by the following interpretations. First and foremost, a majority of the respondents in this survey albeit their common identity as language learners, confessed honestly that they were ignorant of other English accents apart from the top two “Standard English accents ” which as revealed in th eir open comments were stipulated by their English teachers or syllabuses as the default point of references ever since their first contact of English study. Even if some of them were exposed to other English accents, the most possible scenario for them wa s either to regard the other different English accents, such as the mentioning of Indian English, Japanese English, and Pakistani English by the respondents in Q31, as negative examples to further boost their beliefs in the pursuit of NES accents, or to tr eat them as cases of exceptions which from the respondents ’ perspectives were unlikely to be encountered in the future. Their perception is understandable given that no one made this endeavor to inform them of the fact that the population of NNES has outnu mbered NES population for long against the backdrop of SLA -ideology -prevalent ELT in China, which corroborates Wang ’s (2012 ) suggestion that the knowledge of English globalization should be populari sed in China. Another possible interpretation of this trend points to factors beyond language. That Britain introduced English to the entire world through its military prowess during colonial period, and America successively facilitated the global permeation of English i n post -colonial era via its economic, political, cultural and technological capabilities (Phillipson, 1992 ) came as unquestionable justifications for its dominant position over other NNES English varieties on the part of the respondents . Evidences such as “Britain is the birth place of English. ”, “My ears are pregnant listening to Ame ricans speaking English. ”, “The ultimate purpose for me to study English is to go to America to experience its culture. ” etc. were found recurrent in the respondent s’ open comments. The last but not the least important justification is because of the influ ence of technology -based mass -media. English is no longer an academic subject to the respondents but highly accessible in their daily life, thinking about the entertainment industry, the skyroc keting number of imported Hollywood blockbusters, American and British TV and radio programmes into Chinese market. The most likely outcome is captured fully by a respondent ’s comment, S392: My most favourite leisure time activities are listening to American pop music, and watching mostly American TV dramas. I really enjoy the plots and the characters, and I would intentionally imitate their accent, their way of speaking English and even their body gestures. But what is new and inspiring in the findings, after close examination of the thr ee bar charts, are the following three additional points. Firstly, the top two English accents, i.e. British English accent and American English accent, were still the most exposed English accents in the case of the respondents . However, there seems a grow ing trend of exposures to a wider range of different English accents, such as China English accent (N=50), Indian English accent (N=9), Japanese English accent (N=7), Australian English accent (N=2), Canadian English accent and Southeast English accent (N= 1 respectively ), which albeit the small percentage indicated a growing language awareness on the part of the respondents in the wake of frequent contacts with other English varieties (Seidlhofer, 2002 , 2011 ). It is also a question of interest if any ensuing exposure to different NNES accents would substantially change the way they perceive NES accents, which is to be tested within the domain of upcoming qualitative research. Secondly, 551 (96%) res pondents expressed prefe rence for either British English accent or American English accent; in other words, 23 respondents h eld other preferences, which were supplemented by their open comments in Q31. For example, some respondents made the following remarks: GEMA Online® Journal of Language Studies 158 Volume 20(1), February 2020 http://doi.org/10.17576/gema -2020 -2001 -10 eISSN: 2550 -2131 ISSN: 1675 -8021 S27: For English accents, I personally think that the first requirement is to be able to express clearly and fluently and being standard comes second. S544: When I learned English from primary school, I was exposed to British and American English accents . When I arrived at the university, I also met a variety of accented English es, and I felt that it doesn ’t matter . I may not understand it at first, but after I got used to it, understanding is not a problem. S o I don ’t think accent should be a reason for not being able to u nderstand. Themes that can be instilled from the comments above are pragmaticity, clarity, intelligibility, fluency and familiarity, which kept recurring sometimes independently, sometimes along with the endorsement given to either of the top two most preferred English accents in the respondents ’ comments . It indicates either ambivalence of attitudes toward standard English accents (c.f. Jenkins, 2005 ) or questioning of the unquestionable status accorded to standard English accents on the part of the respondents, which becomes even more evident when it comes to evaluate their own English accents. Thirdly , there was a m oderate drop in the number of respondents who aspired to standard English accents in comparison with the combined number of respondents who claimed preference to British and American English accents. To be specific , 21 of them chose to maint ain their own English accents, but it is worth taking note of the particular features of the respondents ’ own English accents that have actually led to such a decision . Another 19 of them opted for other English accents, which were specified in addition as follows: S373: As long as people in other English -speaking countries or people speaking English can understand my meaning, it is not necessary to obtain a standard Eng lish accent. S432: I ’d like to retain some of my own cultural characteristics on the basis of the standard English accent when speaking in English . In brief, responses to Q7, Q12 and Q13 display an obvious bias in familiarity, preference and aspiration to standard English accents, in particular, British and American English accents. What ’s noticeable in the meantime is the growing number of English varieties the respondents exposed to, and other options besides standard English accents the respondents preferred and aspired to have . EVALUATION OF ENGLISH ACCENTS Findings from Q8 and Q9 were comparable to that of Jenkins ’ (2007 ) and Fang ’s (2015 ). Though less respondents (N=221, 38.5%) approved of the claim that some English accents are more prestigious than others (Q8), more than half of them (N=317, 55.2%) he ld the belief that some English accents are easier to understand (Q9) (See Table 1 and 2). TABLE 1. Whether some English accents are more prestigious than others? Frequency Percent Valid Percent Valid No. No idea. Yes. Total 221 177 176 574 38.5 30.8 30.7 100.0 38.5 30.8 30.7 100.0 TABLE 2 . Whether some English accents are easier to understand? Frequency Percent Valid Percent Valid No. No idea. Yes. Total 90 167 317 574 15.7 29.1 55.2 100.0 15.7 29.1 55.2 100.0 GEMA Online® Journal of Language Studies 159 Volume 20(1), February 2020 http://doi.org/10.17576/gema -2020 -2001 -10 eISSN: 2550 -2131 ISSN: 1675 -8021 Justifications were provided along with the “Yes/No ” options. Primary reasons underneath their perception that some English accents are not more prestigious than others (N=221) were explicated in the following remarks, with key words or phrases underlined: S20: The preference for different English accents is rather personal , and t here ’s nothing to do with superiority. S42: The purpose of l anguage learning is for the sake of mutual communicat ion and mutual understanding . As long as my thoughts and expressions can clearly reach the other party, my English accent is a good English acc ent . S124: English accent itself does not have superiority, but people who speak with it have . S155: I think different English accents are caused by different culture and geographical locations . An accent has a unique taste in th at area, and there is no hierarchy existing in them. In comparison, justifications provided to support the claim that some Englishaccents are more prestigious than others (N=176) were mostly expressed in phrases, recurrent ones such as “sounds comfortable ”, “ sounds formal and official ”, “more elegant ”, “ more clear and intelligible ”, “ pure and authentic ”, “ standard ”, “international and efficient ”. A number of complete explanations facilitate clarifying their inclination, for example, S78: Authentic English accent is better than accented English es, and English with accents will be laughed at by others . S186: Standard English accent will reflect a person ’s identity, knowledge and education , and it will make the listener hear clearly and comfortably. S201: The curren t English textbooks are biased towards British English accent, so does the audio pronunciation heard during the exams, which means my perception is influenced by the current environment . Reasons retrieved from the respondents ’ further comments on whether some English accents are easier to understand than others (Q10) were interestingly corresponding, that is, reasons for the respondents to vote against the claim are the very reasons for them to vote for it, for example, S157 : The expressed content is the same, it is not which one is easier to understand, but which one is more familiar , then that one is easier to understand. The latter part of the comment became the major reason for their support of the claim, S47: The most recogni sed English accents in the world today are British and American English accents …Together with the cultural output of the United Kingdom and the United States, the se two accents became the most often -heard English accents, and undoubtedly, they became the most familiar English accents compared with others, so they are easier to understand . What should not be neglected in the two tables are the significant numbers of respondents (N=176, 167 respectively) who answered “No idea ”. The first justification of their option is due to the plain fact that a considerable number of them, especially the first graders, had no such exposures to different varieties of English accents and British and American English accents are their only access ible sources of English varieties. Another possible interpretation, in line with comments provided in Q31, is that they did not care about which English accent they took so long as they could manage smooth conversations with people involved. Chi -square te sts were conducted to investigate whether age, gender, grade, duration of English learning and experience s abroad exerted any impact on the way the respondents evaluated different English accents, in which age and gender were found to have statistically GEMA Online® Journal of Language Studies 160 Volume 20(1), February 2020 http://doi.org/10.17576/gema -2020 -2001 -10 eISSN: 2550 -2131 ISSN: 1675 -8021 significant impact on how they responded Q8, p=0.029, 0.038, albeit the effect size was rather small, phi=0.111, 0.107 respectively. Grade, for another, was tested significantly related to responses to Q9, p=0.018, also with minor effect size given phi=0.100 . In brief, despite the fact that NES accents, in particular, American and British English accents were on the top of the pyramid, they were not the default answers when it comes to superiority, which indicates that the respondents were more likely to iden tify with language for language ’s sake, and which for another corroborates Jenkins’ (2007 ) finding that L2 learners might desire N ES but not N ES -like identity. ATTITUDES TOWARD RESPONDENTS ’ OWN ENGLISH ACCENTS Respondents in Q10 were expected to describe their own English accents, and in Q11 to evaluate their own English accents against 5 point -rating scales. R esponses to Q11 were displayed in Table 3 which shows a centralized tendency (SD=0.909) on the part of t he respondents in providing generally a statistically negative evaluation (mean=2.72, minimum=1, maximum=5) of their own English accents. TABLE 3 . How do you feel about your own English accent? Frequency Percent Valid Percent Valid Not satisfied at all Not very satisfied Uncertain Satisfied Very satisfied Total 27 250 159 131 7 574 4.7 43.6 27.7 22.8 1.2 100.0 4.7 43.6 27.7 22.8 1.2 100.0 Specifically, close to one half (48.3%) of the respondents were not satisfied with their own English accents . In contrast , less than a quarter (24%) of them felt satisfied with their current English accents; while the rest, more than a quarter (27.7%) did not provide clear evaluation in terms of their own English accents and chose “Uncertain ”. Comments retrieved by Q10, a compulsory open -ended question, provided fresh clarifications for the above -observed statistical trend. “Accent ” (mentioned 263 times out of 574 responses), “English ” (194 times), “standard ” (152 times), “Chinese ” (139 times) and “mixed ” (74 time s) were the top five words with the highest frequencies running exact matches via Nvivo 11.0. Follow -up enquiries discovered that more than one third of the respondents described their own English accents as with “Chinese English accent ”, which in most cases was held negatively by the respondents as an indicator of failed English language learners; responses relevant to “standard ” were mostly expressed in a negative way, such as “not standard ”, “not quite standard ”, or “not standard at all ”; resp onses related to “mixed ” were also interesting in that it either indicated a mix of British and American English accents or a mix of British, American and Chinese English accents. Even if in random cases that some respo ndents expressed satisfaction with their own English accents, they would in the meantime add that they would strive to sound as close as possible like a NES, which indicates a sense of ambivalence and inferiority in attitude or an identity conflict experienced by some respondents . On the one hand they were eager to project their “Ought -to” Self by identifying with their own current English accents; on the other they were tormented by their “Ideal ” Self which forced them to identify with NES accents (Dörnyei, 2009 ; Ushioda & Dörnyei, 2009 ). It is not difficult to come up with a sound justification for this rather negative and contradictory evaluation of thei r own English accents on the part of the respondents. As Zheng (2013 ) observed that most students in China still label the mselves as “perennial and error -prone ENL learners ” other than rightful English language users, not surprisingly NES accent models are regarded as their ultimate goals of their endeavors and their default reference points albeit GEMA Online® Journal of Language Studies 161 Volume 20(1), February 2020 http://doi.org/10.17576/gema -2020 -2001 -10 eISSN: 2550 -2131 ISSN: 1675 -8021 “unrealistic and unattainab le in their locale ” (Ibid. ). In other words, English in this case was still perceiv ed as a foreign language by a considerable majority of the respondents, though it is against the fact that English for now has been widely employed as an auxiliary language, a lingua franca, possessing regional characteristics and emotive values (Hashim, Kaur & Kuang, 2016 ), and it also blindfolds the emerging ELF reality at t he research site where a growing proportion of communications by means of English were conducted between NNESs in the absence of NESs. In view of this, it is no wonder that the respondents ’ mother tongue was perceived as a negative transfer impeding their progress as successful foreign language (FL) learners. Chi -square tests were conducted but it was found that there was no significant impact exerted by the independent variables on the wa y the respondents perceived their own English accents. But interestingly descriptive statistics show that a difference exists between respondents with and without overseas experiences, in which respondents with overseas experiences tend to hold more favora ble opinions on their own English accents (mean=3.38) than respondents without overseas experiences (mean=2.68). An independent t -test was therefore conducted and found that it was statistically different between students with and without overseas experien ces in how they evaluated their own English accents, F=1.065, p=0.000, and the effect size, given Cohen ’s d=0.825, is large. In similar vein, a one -way ANOVA reported a significant difference among respondents in different grades in the way they evaluate t heir own English accent, F=4.593, p=0.003, but with a small effect size (f=0.147). What is indicated in this finding is comparable to Chiba et al. ’s (1995) and Dewaele and McCloskey ’s (2015 ), in that when the respondents had more exposure to differen t varieties or variations of English, they tended to have positive views of NNES accents, including accents of their own. In brief, Q10 and Q11 report a generally negative trend in the way the respondents perceived their own English accents. NES accents w ere the benchmark for their evaluation of their own English accents and their L1 influenced -English accents were treated pejoratively and were on top of the list to be ridded off. This evaluation was independent of the effect of age, gender, grade, duratio n of English study and overseas experiences, albeit statistical differences exist between respondents with and without experiences abroad, and among respondents in different grades. BELIEFS IN PRONUNCIATION TEACHING Q14 was designed as a multiple -choice question which means that the respondents were permitted to tick more than one option as long as they thought the option they ticked was reasonable and acceptable. Q14 thus became the only item in this survey that the number of the ticked options was larger than the number of the respondents (see TABLE 4 ). Note that percentage and valid percentage were calculated against the total population of the respondents other than the total number of the ticked options. TABLE 4 . English accent(s) teachers should teach English accents teachers should teach Frequency Percent Valid percent Valid A 545 94.9 94.9 B 50 8.7 8.7 C 47 8.2 8.2 D 32 5.6 5.6 1.7 E 10 1.7 Total 684 A. Standard English accent (British, American, Australian) B. China English accent C. The English accent(s) the teacher is familiar with D. A mix of native and non -native English accent E. Others, please specify GEMA Online® Journal of Language Studies 162 Volume 20(1), February 2020 http://doi.org/10.17576/gema -2020 -2001 -10 eISSN: 2550 -2131 ISSN: 1675 -8021 Out of 684 overall options retrieved from the respondents, 545 respondents chose standard English accent as the most satisfactory pronunciation model teachers were supposed to teach students, which is in line with the previous findings in this survey study, and which is for another revealing the strong conformity to standards and correctness stemming from the Chinese administrative level (c.f. He & Zhang, 2010 ; Kirkpatrick & Xu, 2002 ; W. Wang, 2015 ; Y. Zheng, 2013 ). For another, however, 139 options were dedicated to other English accent models, which once again indicates a growing language aware ness and emerging questioning of dogged adherence to standard English norms on the part of the respondents. Correlation tests were conducted and there seemed no effect of the independent variables on the choices of different English accent models to be tau ght made by the respondents. In brief, NES or standard English accent maintains its momentum as the most preferred English accent models to be taught from the perspectives of the respondents. Noticeable also is attention received by other English accent m odels, such as China English accent. Inferential statistic tests found that there was no relation between the independent variables and the respondents ’ preferred pronunciation models. ACCENT INCLINATION Question items (Q15 to Q22) in this part were intended to retrieve responses in how the respondents identified themselves with different accent situations. The preliminary descriptive statistics in reference to their different accent inclination was captured in the following table. TABLE 5 . Accent in clination Statements Mean SD Q15: I feel happy when I find my English accent is more like native speakers. 5.25 1.079 Q16: When someone cannot understand me when I speak English, I begin to doubt my English accent. 4.06 1.472 Q17: I feel satisfied with my English accent as well as my Chinese accent. 2.99 1.267 Q18: I do not feel satisfied with my English accent and would strive to sound like a native speaker of English. 4.30 1.308 Q19: I feel satisfied with my own English accent but would still like t o strive to sound like a native speaker of English. 4.04 1.451 Q20: I feel satisfied with my own English accent and would like to keep it. 2.96 1.310 Q2 1: I feel happy if someone mistakenly regards that I have a native speaker accent of English. 4.97 1.254 Q22: When I speak English, I am happy to be identified as a Chinese speaker. 2.51 1.207 What can be obtained from the preliminary investigation is as follows: Q15 has the highest mean score (5.25) and the lowest SD value (1.079); in contrast, Q22 has the lowest mean score (2.51). More interestingly, statements centered around maintaining their own English accent were unexceptionally obtained lower means, with an overall average mean score (Q17, Q20, Q22) as 2.82, an overall average SD 1.26; contrastingly, statements revolved around changing their own English accents so as to approach native English speakers, with the only exception Q16 which will be explicated la ter in detail, obtained much higher mean scores, with an overall average mean score 4.52, and SD 1.31. The results indicated that most respondents felt very much reluctant to project their Chinese identity via Chinese -accented English, and they were in ot her words experiencing a “subtractive identity change ” (G ao et al., 2005 ; 2007 ). Additionally, Q16 in Gao et al. ’s (2005 ; 2007 ) exploratory research, was categorised as related to self -confidence chan ge which means changes in how the respondents perceive their own competence, and is essentially independent of “cultural identities ”. The comparatively high mean score (4.06) and the moderate SD value (1.472) suggest that a noticeable number of respondents agreed that their self -confidence was correlated positively with their English accent. Q18 and Q19 for another indicate “split change ” GEMA Online® Journal of Language Studies 163 Volume 20(1), February 2020 http://doi.org/10.17576/gema -2020 -2001 -10 eISSN: 2550 -2131 ISSN: 1675 -8021 in Gao et al .’s (2005 ; 2007 ) term which indicates an identity conflict brought by “struggle between languages and cultures ”, which is further evidenced in the respondents ’ open comments, S328: I think my English is of Chinese accent, and I don’t feel uncomfortable with it, but I still want to say smooth English like a native speaker. Split change is treated as an “intermediate phase ” before learners “develop other types of identity changes ” (Gao et al., 2005 ; 2007 ). High mean scores retrieved from the two items indicate that a proportion of the respondents underwent an obvious split change which would eventually lead them to other identity changes. Chi -square tests were conducted to investigate the possible factors in fluencing respondents ’ accent inclination. Age, gender, grade, duration of English study and experiences abroad were tested of having no statistically significant impact on accent inclination. Additionally, no significant differences were found between gen der, different age groups, with or without overseas experiences, or among different grades or different duration of English study. In brief, respondents were inclined to hold negative perspectives to statements which give positive description of their own English accent but positive feedbacks to statements which encourage them to modify their own English accent in reference to native English speakers. There is reluctance on the part of the respondents in projecting their Chinese identity in speaking English and their self -confidence was tested to be correlated positively with their English accent. No significant inferential statistics has so far been obtained at this stage. ACCENT ACCEPTANCE Question items in this part incorporated a number of well -attest ed items, such as Q23, Q26, Q27 and Q30, were adapted from Jenkins ’ (2000 ). Those items refer to cases that were proved to be of having no significant hindrance in su ccessful communication. Other question items were designed in line with pronunciation features exclusive to Chinese English learners (Chang, 1987 ; Zhang & Zhao, 2014 ). The purpose of the inclusion of this part is to test to what extent the respondents were willing to give their endorsement to those deviant forms of English pronunciations. Table 6 captures the discrete mean scores and SD values of each item, and Table 7 disp lays the overall statistic results. TABLE 6 . Accent acceptance Mean SD Q2 3: “think”read as / ʃink/ or /sink/ 2.67 1.464 Q24: “live”read as /liːv/ 4.20 1.460 Q25: “nice”read as /la ɪs/ 2.66 1.624 Q26: “red paint” read as /reb pe ɪnt/ 2.51 1.549 Q27: “these”read as /diːz/ 1.81 1.189 Q28: “vegetable”read as /ˈwed ʒtəbəl/ 2.92 1.559 Q29: “product”read as /ˈp ɒdʌk/ 2.60 1.495 Q30: “command”read as /k əˈmɑːnde/ 3.06 1.509 TABLE 7 . Overall accent acceptance N Min Max Mean SD Accent acceptance Valid N 574 574 1 6 2.805 .959 Findings from this part rendered the most interesting results and were found in stark contrast to that of Jenkins ’(2000 , 2002 ). If interpreting from a general level, the overall mean GEMA Online® Journal of Language Studies 164 Volume 20(1), February 2020 http://doi.org/10.17576/gema -2020 -2001 -10 eISSN: 2550 -2131 ISSN: 1675 -8021 score for deviant accent acceptance is low (mean=2.805), and it is agreed upon by a majority of the respondents (SD=0.959). Discretely, Q27, whose way of pronunciation is so widespread that it has been long attested to of rendering no diff iculty or hindrance in conversations, receives the lowest mean score as well as the lowest SD value . This means that a considerable number of the respondents would have paramount difficulty as listeners once encountering people with such accent and the po ssibilities of bringing the conversation to a breakdown are high as they as listeners fail to accomplish their due part (Smith, 1992 ), which is further evidenced in their Q31 open comments, S42: Whenever I communicated with Pakistani students, I couldn’t understand them . Their local accent was too strong, and the ir pronun ciation was not authentic, which made me very upset . S184: … There was once a Polish oral English teacher who made me really uncomfortable when in his class. I couldn ’t figure out what he was talking about, and felt that his English was so much different from what I learnt …. Surprisingly, the unexpectedly high mean score (mean=4.20) received by Q24 indicates that considering the moderate SD value (SD=1.460), a noticeable portion of the respondents downplayed th e significance of the maintenance of contrast between long and short vowels (Jenkins, 2000 ) which was stipulated clearly about the possible conversation breakdowns if violated. To further investigate possible effect exerted by the independent variables, Chi -square tests were again conducted but with no statistically significant results being fo und. Nevertheless, significant difference was found in different age groups in how they accepted accents deviant from standard versions, F=0.088, p=0.004, but with rather small effect size, given Cohen ’s d=0.261. Statistically significant difference was al so observed among different grades, F=10.572, p=0.000, but with moderate effect size, f=0.228. In brief, the respondents tended to hold negative perceptions toward the deviant forms of English pronunciations, including a number of well -attested forms of p ronunciation rendering no extra difficulty in understanding. Some provisional interpretations are therefore considered, such as loopholes existing in pronunciation teaching in China. In specific, one possible interpretation is that English language instruc tors failed to expose language learners to the English language reality happening around the world, which risks Chinese English language learners failing to accomplish successful conversations. Another likely interpretation is that English language instruc tors failed to underline the core phonetic symbols which guarantee successful conversations and prevent communication breakdowns. CONCLUSION The questionnaire survey, an initial phase of a longitudinal research, reports at a preliminary level different attitudes toward different English accents and to what extent accents intersect with identities on the part of the Chinese tertiary -level English language learners. The current study reports an obvious bias towards NES or standard English accents, in particular, British and American English accents, which assumed the roles as the most familiar, the most preferred, and the most aspired and also as t he default point of reference. On the other hand, there exists a strong bias against Chinese -accented English and other NNES accents on the part of the respondents who felt reluctant to project their Chinese identity by means of Chinese -accented English wh ich for them is as an unwelcoming marker of being failed language learners against the framework of SLA. Contrastingly, there also seems in this survey an emergence of linguistic rights and learner identity experienced by some respondents albeit the numbe r is comparatively small, which demonstrates itself in highlighting communicative pragmaticity, endorsing L1 Chinese GEMA Online® Journal of Language Studies 165 Volume 20(1), February 2020 http://doi.org/10.17576/gema -2020 -2001 -10 eISSN: 2550 -2131 ISSN: 1675 -8021 identity, and questioning benchmark roles accorded to NES accent standards. Another significant finding is the respondents ’ overseas experi ences, i.e. respondents with overseas experiences are more likely to evaluate their own English accents favourably in comparison with respondents without overseas experiences, which indicates potential perception changes on the part of the respondents in l ine with the accumulation of contacts with different English varieties. Possible factors that accounted for the respondents ’ attitudinal differences were also addressed. One major factor among others is the way that English is being perceived, i.e. it ha s still been treated by most respondents as a foreign language despite the fact that internationally and domestically an increasing number of communications are being conducted between NNESs without the presence of NESs. Their propensity of setting NES acc ent norms as their default benchmark and of labelling themselves as “perennial English learners ” thus come as no surprise. But it remains open if their perceptions toward different English accents will change in the course of time responding to the increas ing exposure to different English varieties, so do their identities, which is unable to be fully captured by this one -off questionnaire survey. 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ABOUT TH E AUTHORS Yan Huang is a senior lecturer at the Department of Foreign Languages in Sichuan University of Science and Engineering; a full -time PhD candidate at Asia -Europe Institute, University of Malaya. Azirah Hashim is a Professor and Executive Directo r of Asia -Europe Institute, University of Malaya; the vice President of the International Association of Applied Linguistics. Copyright ofGEMA OnlineJournal ofLanguage Studiesisthe property ofGEMA Online Journal ofLanguage Studiesanditscontent maynotbecopied oremailed tomultiple sitesor posted toalistserv without thecopyright holder’sexpresswrittenpermission. However,users may print, download, oremail articles forindividual use.