ArticlePDF Available

Do Only-Children Communicate Better Than Non-Only Children?: A Study of Medical Students in China

Authors:
  • State University of New York Buffalo State University

Abstract and Figures

Since the implementation of the One-Child Police in China in 1979, great concern has been raised about the physical and psychological development of “only-children.” Some researchers believe that only-children may have difficulty with social skills, which include communication ability, because they would lack early sibling interactions. The aim of the present study was to explore the communication ability of only-children compared to children raised with siblings. We administered the self-developed Interpersonal Communication Ability Assessment Scale, which had been previously validated and refined, to 1,376 medical students in China. Results showed that when considering communication ability on its own, there were slight differences found between only-children and non-only-children. However, this difference was no longer significant when other independent variables were included in a hierarchical linear regression. This might be due to the fact that only-children have more highly educated parents, with more high-status careers, and greater family income that might provide greater social and educational opportunities, which might then increase communication abilities.
Content may be subject to copyright.
© Journal of Comparative Family Studies Volume 51 Number 1, 2020
10.3138/jcfs.51.1.005
Abstract: Since the implementation of the One-Child Police in China in 1979, great
concern has been raised about the physical and psychological development of
“only-children.” Some researchers believe that only-children may have diculty
with social skills, which include communication ability, because they would
lack early sibling interactions. The aim of the present study was to explore the
communication ability of only-children compared to children raised with siblings.
We administered the self-developed Interpersonal Communication Ability
Assessment Scale, which had been previously validated and rened, to 1,376
medical students in China. Results showed that when considering communication
ability on its own, there were slight dierences found between only-children and
non-only-children. However, this dierence was no longer signicant when other
independent variables were included in a hierarchical linear regression. This might
be due to the fact that only-children have more highly educated parents, with
more high-status careers, and greater family income that might provide greater
social and educational opportunities, which might then increase communication
abilities.
Keywords: only-children, communication ability, communication skills,
medical students
Résumé : Dupuis la mise en place de la politique de l’enfant unique en Chine en
1979, une grande inquiétude a été exprimée concernant le développement physique
et psychologique des enfants uniques. Certains chercheurs croient que les enfants
uniques peuvent avoir des dicultés avec les compétences sociales, y compris les
compétences en communication, parce qu'ils manqueraient d'interactions précoces
entre frères et sœurs. Le but de cette étude était d'explorer les compétences de
communication des enfants uniques par rapport aux enfants élevés avec des frères
Do Only-Children Communicate
Better Than Non-Only Children?1
A Study of Medical Students in China
Wei Wang*, Jie Zhang, Dwight A. Hennessy and
Wenqiang Yin§
* Weifang Medical University, School of Public Health and Management, 7166 Baotongxi Street, Weifang City,
261053, Shandong Province, China (wang_w2006@126.com).
† Correspondence should be directed to Jie Zhang, Department of Sociology, State University of New York
College at Bualo, 1300 Elmwood Avenue, Bualo, New York 14222, USA (zhangj@bualostate.edu).
‡ State University of New York Bualo State, Department of Psychology, 1300 Elmwood Ave., Bualo NY,
14222, USA (HENNESDA@bualostate.edu).
§ Weifang Medical University, School of Public Health and Management, 7166 Baotongxi Street, Weifang City,
261053, Shandong Province, China (yinwq@wfmc.edu.cn).
51
1
85
Wei Wang et al.
© Journal of Comparative Family Studies Volume 51 Number 1, 2020
10.3138/jcfs.51.1.005
et des sœurs. Nous avons administré l'Echelle d'Evaluation des Compétences
en Communication Interpersonnelle, qui était précédemment validée et anée
à 1 376 étudiants en médecine en Chine. Les résultats ont montré que lorsque
nous avons considéré la capacité de communication de façon isolé, il y avait de
légères diérences entre les enfants uniques et les enfants élevés avec des frères
et des sœurs. Cependant, cette diérence n'était plus signicative lorsque d'autres
variables indépendants étaient incluses dans une régression linéaire hiérarchique.
Cela pourrait être à cause du fait que les parents des enfants uniques ont fait des
études supérieures, avec une carrière plus élevée et un revenu familial plus élevé,
ce qui pourrait orir de plus grandes opportunités sociales et éducatives, ce qui
pourrait alors augmenter leurs capacités de communication.
Mots-clés : enfants uniques, capacité de communication, compétences en
communication, étudiants en médecine
Introduction
In order to control rapid population growth in China, the Chinese government
implemented its “One-Child” Policy (OCP) in 1979 which remained in eect
for more than 35 years. As a result of this birth control policy, the number of
only-child homes grew rapidly. e average family size dwindled from 4.54 people
in 1980 to 3.36 people in 2000 (Festini and de Martino, 2004), and plummeted
to 2.54 by 2016 when the one-child policy was ocially abolished. According to
Wang (2013), the number of only-children homes reached 145 million in 2010
and an estimated 176 million in 2015.
For several decades, there has been great concern over the well-being of these
only-children among parents, educators, sociologists, physicians, psychologists,
economists and policy makers. Primarily, interest in the impact of the OCP has
been in the areas of intellectual/educational outcomes, psychological well-being
(including personality and character development), and physical health/
development.
For instance, a noted advantage to the OCP has been the potential for
increased intellectual growth and educational opportunities (Lin, 2019). Parents
in China have typically put more emphasis on the education of their only-child
to ensure that they are more socially and economically competitive in the future,
and as such, educational institutions have ourished across China by putting for-
ward miscellaneous programs to attract eager parents with the promise of optimal
educational experiences and the greatest chance of future success for their child
(Xue and Li, 2016). e extra attention and exclusive focus of resources has been
suggested to account for the general increased academic success of only-children
(Lin, 2019; Qin, Zhuang, and Yang, 2017; Tan, Gupta, and Wilgus, 2019). is
has also generally led to greater expectations on the only-child as well and, as a
result, recent studies (Lao and Dong, 2019; Liu, Lin, and Chen, 2009) have shown
that only-children were more likely to achieve better academic performance than
non-only children.
It has also been noted that parents of only-children typically have higher lev-
els of education themselves which may account for higher academic achievement
of the child, due to the enriched intellectual environment and focus on higher
86 Do Only-Children Communicate Better Than Non-Only Children?
© Journal of Comparative Family Studies Volume 51 Number 1, 2020
10.3138/jcfs.51.1.005
level learning (Wei, Wu, Lv et al., 2016). However, the academic advantage of
only-children has been found to be true even when controlling for the education
level of the parents (Blake, 1989; Falbo and Polit, 1986). According to Falbo and
Polit (1986) this advantage is largely due to the nature of the parent-child rela-
tionship. In China, this may be facilitated by the fact that the only-child is held
in high regard and given special favor in the home. It is conceivable that this in
turn may potentially foster higher self-esteem, as well as increased bonding and
intimate interactions with parents.
It should be noted though, that there are some limits to this academic
advantage among only-children. For example, Poston and Falbo (1990) examined
1,460 schoolchildren, in addition to their parents and teachers, in the urban and
rural areas of Changchun, China, in 1987. ey found that those without siblings
had higher academic scores than those with siblings, but these advantages were
found only among urban children. In a further study by Falbo and Poston (1993)
who selected a total sample of 4,000 school children from four provinces in China,
they found that the academic advantage for only-children occurred in only 3 of
the 4 provincial samples, and that only-children were stronger only in verbal tests.
Further, Jiao, Ji, and Jing (1996) examined 142 rst-grade and 188 h-grade
children in the Beijing area and determined that only-children showed superior
cognitive abilities compared to those with siblings only at the rst grade level.
However, one caveat may be that the h graders in that sample would have been
born prior to the OCP implementation, and dierences in attitudes and treat-
ment of only-children may not have been the same as the policy progressed over
time. Moreover, when only-children were compared to rstborns, no dierences
were found once appropriate background controls were introduced. In a similar
respect, Chen and Liu (2014) found that there were no dierences in self-reported
grades between only-children and rstborns who have younger siblings. is sug-
gests that a birth order eect may account for the academic advantage, where
rst born children have the benet of exclusive attention and expectations from
parents for a given period of time, again conrming that it might be the nature of
the child-parent relationship that accounts for these dierences.
Other concerns have been raised regarding the potential social, psychological,
and physical well-being of only-children stemming from this OCP in China. One
potential issue is based on what the popular media has termed a “little emperor
generation” (Keating, 2013), where the only-child has become the excessive focus
of the entire family, including parents and grandparents, resulting in extraordinary
and extreme privilege. e concern has been that these only-children will develop
excessive levels of esteem and ultimately undesirable personality traits like self-
ishness, aggressiveness, or arrogance because they do not have to share familial
resources or compete for parental attention (Hall, 1987; Jiao, Ji, and Jing, 1986;
Meredith, Abbott, and Zhu, 1989; Yang, Hou, Wei et al., 2017).
In contrast, though, this exclusive familial focus may actually lead to some
functional outcomes as well. For example, research has found that only-children
were reported to have lower levels of fear, anxiety, and depression compared to
87
Wei Wang et al.
© Journal of Comparative Family Studies Volume 51 Number 1, 2020
10.3138/jcfs.51.1.005
non-only-children as children and adults (Falbo and Hooper, 2015; Liu, Lin, and
Chen, 2010; Wang, Du, Liu et al., 2002; Yang, omas, Dong et al., 1995). In
addition, Lin, Fong, and Wang (2017) argued that, while only-children were more
inclined to adopt a self-oriented learning style, which would place them at risk
of decreased self-condence under periods of lost control during the learning
process in school, the increased perception of help availability from the exclusive
family access also led to increased learning condence. ey also noted that the
nature of the interactions between only-children and their peers changes as they
mature, potentially leading to increased condence, which may account for some
contradictions such as increased cooperativeness with peers in their college sam-
ple despite the appearance of self-centeredness. is may also explain the fact that,
despite the existence of some dierences between only and non-only-children
in certain aspects of life, such as character quality and self-centeredness, there
are simultaneously other areas where no dierences are found, particularly as
they emerge into adulthood, such as anger control, self-ecacy, and cooperation
(Guo, Zhang, and Zhang, 2015; Kadoya, Khan, and Sano, 2018; Rodrigues and
Abhyankar, 2012).
It should be noted, however, that in many studies comparing only and
non-only-children in China, the non-only-children groups are typically dispro-
portionately selected from rural areas and among lower income families with
low social status (Huang, 2009). is is important because such factors might
alternatively account for dierences in these studies due to the excessive levels
of psychological diculties stemming from lower resources and opportuni-
ties, elevated competition and pressure, and decreased levels of social/familial
respect found among rural communities in comparison to urban environments.
Nonetheless, the existing research is clear that the only-child environment does
have the potential to impact social and psychological factors, although the exact
nature is not always clear.
Another area of concern, and one that has not received a great deal of research
attention to this point, is the potential impact of the OPC on the development of
communication. Normally, communication is considered to be a
process in which
people exchange information, ideas, feelings, and facts through the use of verbal
or nonverbal signals across various contexts, cultures, environments and media
so that they can gain consensus or understanding among each other (Jha and
Malik, 2018; Weaver and Hybels, 2007). It has been shown that communication is
essential for success among young adults, particularly as they enter the workforce
(Katz and Kahn, 1966; Phillips, 1998, 1999; Redding, 1972; Sarpparaje, 2016;
Weaver & Hybels, 2007). Netzley (1999), for example, argued that in order for
employees in business to succeed, they not only need technological knowledge,
but also the ability to cooperate and communicate eectively. Similarly, based
on a study by the National Association of Colleges and Employers, good com-
munication ability was considered the top “must have” quality among potential
job candidates (Hull, 2017). So in this respect, if the family emphasis in Chinese
only-children homes is to help the child develop the intellectual and educational
88 Do Only-Children Communicate Better Than Non-Only Children?
© Journal of Comparative Family Studies Volume 51 Number 1, 2020
10.3138/jcfs.51.1.005
background to excel in their future careers, the question is whether this has also
translated to benets in communication ability.
ere have been numerous studies attempting to link communication with
success at obtaining or succeeding in particular occupational roles. ese studies
have ranged from the evaluation of graduate business students’ perceptions of
their communication competencies at the onset of a required managerial com-
munication course in relation to their self-ratings at the conclusion of the course
(Hill, Mehta, and Hynes, 2014), to the eectiveness of a job search and interview
skills workshop for graduate students in audiology and speech-language pathol-
ogy (Ward, Leuty, and Corie, 2016). ey have included varied topics such as the
development and validation of the Science, Technology, Engineering, and Math
Interpersonal Communication Skills Assessment Battery (STEMICSAB) for
women doctoral students in engineering, mathematics, computer sciences, and
the physical sciences (Wilkins, Bernstein, and Bekki, 2015), and the evaluation of
communication skills among medical students and physicians from a variety of
dierent medical specialties (Gude, Finset, Anvik et al., 2017; Han, Joekesc, Elwyn
et al., 2014; Liew, Dutta, Sidhu et al., 2014; Maraccini, Houmanfar, Kemmelmeier
et al., 2018; Modi, Anshu, Gupta et al., 2016; Shafakhah, Zarshenas, Sharif et al.,
2015). However, what seems to be lacking is an attempt to understand how com-
munication ability might dier between only-children and non-only-children.
ere are more than 200 million only-children in China (Yi, 2013) whose ability
to communicate with others is an issue worth addressing.
Furthermore, it should also be noted that previous studies on the impact of
the OCP have focused mainly on elementary and middle school children, with
a few notable exceptions (Kadoya et al., 2018; Lin et al., 2017; Wang, Du, et al.,
2002; Yang et al., 2017) which have examined adult only-children. erefore,
the present study was designed to examine potential dierences between only
and non-only-children as young adults. In particular, the focus was on medical
students due to the fact that China has seen a sharp rise in medical demand in
recent years which has been met by a rapid increase in the number of physicians
(National Health Commission of the People's Republic of China, 2019). Within
the medical system, physicians are required to communicate with a number of
dierent individuals on a variety of levels, including other doctors and nurses
to share health information to impact outcomes and treatment, with patients
to understand symptoms and to pass on relevant medical information at a level
they might understand, with families of patients to pass on support or to share
information during medical procedures at times when patients are unable, and
with the hospital administration to communicate about systematic aspects like
patient payments or employment issues. In this respect, ecient communication
is essential for eective medical practice (Guetterman, Sakakibara, Baireddy et
al., 2019; Zhang, Jiang, Sun et al., 2018), whereas poor communication can lead
to disadvantageous consequences, medical error, physician-patient conict, and
declined doctor-patient satisfaction (Carter, Ward, Wexler et al., 2018; Curry,
Spatz, Cherlin et al., 2011; Kemp, Santana, Southern et al., 2016). In China, lack
89
Wei Wang et al.
© Journal of Comparative Family Studies Volume 51 Number 1, 2020
10.3138/jcfs.51.1.005
of communication with patients is considered to be responsible for the bulk of
conicts between medical providers and the users of the medical system (Huang,
Huang, and Hu, 2011; Yin, 2003; Yu, Wang, and Sun, 2018). Evidence currently
notes that physicians in China do not appear to be considered good at communi-
cating with others (Liu, Rohrer, and Luo, 2015; Wu, Gao, and Fan, 2007). In this
respect, as future physicians, the communication of medical students might have
impact on good physician-patient relations, as well as eective medical treat-
ment/outcomes, as they commence their medical practice and career.
erefore, the aim of the present study was to understand if there are dier-
ences in only-children’s socio-demographic makeup, and if there are dierences in
their communication ability aer controlling for social and demographic factors
among young adult medical students in China. It was hypothesized that: (1) basic
demographic and social factors like gender, birthplace and family atmosphere,
father’s and mother’s education, father’s and mother’s occupation, and family
economics will dier between only and non-only-children and (2)only-children
will show greater communication ability than non-only-children.
Method
Sample and Data Collection Procedures
In order to examine potential dierences between only-children and non-only-
children in communication ability, a cross-sectional survey was conducted in
May, 2012 and December, 2013 among a convenience sample of three medical
universities in Shandong province, China. All participants were undergraduates
who enrolled directly into university from high school. Of the three universities,
one was aliated with the Ministry of Education in China, the other two were
aliated with the Shandong Provincial Department of Education.
Administrative approvals were obtained from all three universities before
survey implementation. All participation was voluntary and all information
was kept private and condential. Written informed consent was obtained
prior to participation. Approximately 5% of all students were randomly chosen
from within each of the ve grade levels. erefore, there were a total of 1,600
respondents who were recruited with 1,460 (91.25%) returning the questionnaire
battery. From these, 84 were excluded due to missing data, leaving 1,376 (86.0%
of the total recruited and 94.25% of the total returned) completed questionnaires
in the nal analyses.
Design and Materials
A cross-sectional design and quantitative method were used. In terms of ma-
terials, this study involved two self-developed questionnaires. e rst was
a self-reported measure of basic socio-demographic information, including
Gender, Birthplace (city/rural area), Year in School (ve year options based on
timing to complete medical undergraduate training), Family Structure (sin-
gle family, nuclear family, extended family), Father’s and Mother’s Education
Degree (Bachelor’s and above, junior college, technician training school, high
90 Do Only-Children Communicate Better Than Non-Only Children?
© Journal of Comparative Family Studies Volume 51 Number 1, 2020
10.3138/jcfs.51.1.005
school and below), Father’s and Mother’s Occupation (head of state organization
or enterprise, technology professional/clerk, military, worker/farmer), Family
Atmosphere (1–5 scale representing extremely hostile to extremely harmoni-
ous), and Family Economic Condition (1–5 scale representing extremely poor
to extremely wealthy).
e second questionnaire (Interpersonal Communication Ability As-
sessment Scale – ICAAS) was a self-reported tool designed to measure
communication abilities, and was developed through pilot work prior to the
implementation of this study by members of the current research study (Wan g
and Yin, 2015). Beginning with a review of communication literature (Baney,
2004; Barker, 2006; Chen and Miao, 2007; Gallagher, Hartung, Gerzina et al.,
2005; Humphris and Kaney, 2001; Liu, 2005; Pearce, 1994; Team FME, 2013;
Wang, 2013; Weaver and Hybels, 2007), the initial development of questionnaire
items followed a grounded theory approach to establish baseline dimensions of
key communication abilities. Specically, key identiers of communication abil-
ities among young adults and ultimately potential survey items were generated
through qualitative surveys and focus groups made up of individuals such as
researchers and professors with expertise in the areas of communication, psy-
chology, and sociology, as well as those with experience in social science method-
ology, health statistics, and communication theory and practice. e initial list of
41 items was then presented to a pilot group of 600 medical students (228males
and 372 females) that were recruited from Weifang Medical University. ese
students were asked to rate how much they agreed that each item applied to
them using a 5-point Likert scales (1 = strongly disagree to 5 = strongly agree).
Of the 557 questionnaires returned, 502 (90.1%) were completed suciently for
further analysis.
In order to improve item and test quality, item analysis was performed to
evaluate the performance of individual items (observed variables) and of the
scale as a whole. Critical Ratio analysis was conducted, through which it was
determined that a score of 129 signied the lower 27% of scores, and 154 identi-
ed the highest 27% of scores (Wu, 2010). Accordingly, the low and high Critical
Ratios were set at 127 and 154 respectively and an Independent samples t-test (p<
0.05) showed that dierences between low score and high score items were sig-
nicant, which meant individual items performed well. Subsequently, Principal
Component Analysis was applied to test the validity of ICAAS. e initial
scale provided a good t to the data (KMO = 0.97, Bartlett's Test of
Sphericity:
Χ2 = 34,205.928, p < 0.001) which indicated that Factor Analysis could be used to
purify the initial assessment scale. erefore, using Factor Analysis, 8 items were
eliminated whose factor loadings were below 0.50 which indicated that those
observed variables had weak associations with latent variables.
e resulting ICAAS revision included 33 items across 5 factors as shown
in Table 1. e 5 dimensions were labeled as follows: Factor 1: Communication
Inclination with Friends (11 items; loadings:0.509 to 0.758), which represents
91
Wei Wang et al.
© Journal of Comparative Family Studies Volume 51 Number 1, 2020
10.3138/jcfs.51.1.005
Table 1: Rotated component matrix for the ICAAS
Items
Factors
1 2 3 4 5
Communication intent 0.758 0.202 0.247 0.219 0.039
Heart-to-heart talk with friends 0.755 0.148 0.136 0.183 0.184
Enjoy sharing with friends 0.738 0.195 0.260 0.169 0.053
Tell about your own suerings 0.630 0.096 0.053 0.140 0.326
Perceptive towards friend’s emotions 0.619 0.264 0.238 0.160 0.293
Good listener 0.583 0.272 0.457 0.057 −0.041
Getting along with everyone 0.545 0.253 0.317 0.411 −0.122
Attentive to others’ feelings 0.543 0.361 0.422 0.024 0.064
Take the initiative to reconcile with
friends
0.525 0.115 0.187 0.209 .0331
Put yourself in the another person's
shoes
0.518 0.351 0.308 −0.045 0.309
Empathetic in others’ experiences 0.509 0.432 0.297 −0.066 0.321
Decide what other’s need 0.137 0.771 0.127 0.127 0.183
Figure out what’s going on 0.075 0.735 0.173 0.103 0.229
Empathetic to others’ feelings 0.309 0.717 0.253 0.108 −0.024
Judge a person’s character 0.189 0.673 0.300 0.125 0.016
Know how to help others 0.221 0.670 0.103 0.283 0.171
Adopt communication ways according
to a person’s social status
0.254 0.558 0.334 0.273 0.190
Adopt communication ways according
to environment
0.323 0.530 0.271 0.334 0.218
Clear about communication situation 0.258 0.525 0.323 0.264 0.218
Eectively communicate with the help
of environment
0.267 0.518 0.345 0.254 0.204
Using body language 0.233 0.175 0.737 0.217 0.155
Using eye expression 0.200 0.232 0.719 0.181 0.180
Using eye contact 0.180 0.248 0.694 0.152 0.179
Using facial expression 0.342 0.233 0.636 0.160 0.160
Explaining yourself clearly 0.292 0.285 0.585 0.215 0.188
(Continued)
92 Do Only-Children Communicate Better Than Non-Only Children?
© Journal of Comparative Family Studies Volume 51 Number 1, 2020
10.3138/jcfs.51.1.005
Items
Factors
1 2 3 4 5
Clear verbal symbols 0.260 0.301 0.573 0.266 0.115
Participating in social activities 0.129 0.115 0.220 0.683 0.323
Good at organizing activities 0.022 0.210 0.241 0.647 0.282
Good at hosting 0.304 0.262 0.137 0.639 0.100
Getting along with older people 0.337 0.253 0.206 0.526 0.000
Talking to strangers like friends 0.169 0.183 0.110 0.200 0.776
Initiating a talk with strangers 0.175 0.179 0.182 0.166 0.733
Expressing yourself clearly with
strangers
0.219 0.249 0.350 0.166 0.581
Table 1: Continued
a preference for sharing and communicating thoughts/feelings with friends;
Factor2: Perception of the Communication Environment (9 items; loadings:0.518
to 0.771), which identies a persons ability to think about potential communi-
cation situations and develop communication skills or strategy based on specic
situational or contextual elements like culture, language, and communication
location; Factor 3: Communication Skills (6 items; loadings:0.573 to 0.737),
which represents the ability to eectively present and understand communi-
cation verbally and non-verbally; Factor 4: Self-Evaluation (4 items; loadings:
0.526 to 0.683), which includes items that focus on how an individual evaluates
their own communication ability; Factor 5: Communication Inclination with
Strangers (4 items; loadings:0.581 to 0.776), which represents a preference for
sharing and communicating thought/feelings with strangers. Table 2 shows good
internal reliability (ranging from 0.782 to 0.914) which supports its use in the
current study to measure communication ability.
Table 2: Reliability levels of the ICAAS factors
Factors Items Cronbach's Alpha
Communication Inclination with Friends 11 0.914
Perception of the Communication Environment 9 0.901
Communication Skills 6 0.886
Self-Evaluation 4 0.724
Communication Inclination with Strangers 3 0.782
Total 33 0.962
93
Wei Wang et al.
© Journal of Comparative Family Studies Volume 51 Number 1, 2020
10.3138/jcfs.51.1.005
Statistical Analyses
Descriptive statistics, chi-square analysis, and logistic regression were employed
to describe and compare the demographic characteristics. T-tests were used to
compare dierences in communication ability on ve factors between only and
non-only-children. One-way ANOVA was applied to describe and compare
communication mean scores across demographic variables. Finally, a hierarchical
linear regression was conducted in order to explore the impact of onlyvs. non-
only child status on communication ability, aer controlling for demographic
and social factors.
Results
Characteristics of Only-Children Respondents
A total of 1,376 undergraduate medical students were included from rst year
to h year in three medical universities in Shandong Province; only-children
accounted for 40.9% of this sample. e frequencies of each response option
to each of the socio-demographic factors can be found in Table 3. Chi-square
was conducted to examine potential dierences between only-children and
non-only-children in terms of the frequency of social-demographic charac-
teristics, including gender, birthplace, year in school, family structure, parents’
education and occupation, family atmosphere, and family economic condi-
tion. Outcomes showed that all but family structure were statistically signif-
icant (seeTable 3). In this sample, only-children were more likely to be males
(53.6%), live in cities (73.4%), have parents with the highest level of education
(82.0% for father, 86.9% for mother), have parents with occupations as head of
state organizations (72.8% for father, 82.7% for mother), to have higher family
income (72.7%), and less likely to report a somewhat (34.2%) or extremely
(46.6%) harmonious family atmosphere. Further, the average score for the
family atmosphere variable was 4.54 (SD = 0.70) for only children and 4.37
(SD = 0.7565) for non-only-children (where higher scores indicated greater
levels of family harmony rather than hostility) (t =4.565, p < 0.001). e aver-
age rating of family economic standing was 3.38 (SD = 0.74) for only children
and 2.95 (SD = 0.67) for non-only-children (where higher scores indicated
greater wealth) (t = 11.65, p < 0.001). e discrepancy between the number of
only-children and non-only-children in terms of year in school was greater in
the later years.
Logistic Regression was used to explore the demographic makeup among
the only-children group (see Table 4). e only-children group was 4.38 times
more likely to be males than females and 4.65 times more likely to live in urban
rather than rural areas. ey were also 1.32 more likely to have parents with
higher education, as well as 3.03 times more likely to have mothers with head
of state/entrepreneur careers and 1.78 times more likely to have mothers with
technology/clerk careers. Finally, they were 10.26 times more likely to live in
extremely wealthy families.
94 Do Only-Children Communicate Better Than Non-Only Children?
© Journal of Comparative Family Studies Volume 51 Number 1, 2020
10.3138/jcfs.51.1.005
Table 3: Demographic characteristics of only-children and non-only-children
(N = 1,376)
Demographic
characteristics Total Only-child
Non-only-
child Χ2p
n f (%) f (%)
Gender Male 524 281 (53.63) 243 (46.37) 56.55 < 0.001*
Female 852 282 (33.10) 570 (66.90)
Birthplace City 507 372 (73.37) 135 (26.63) 349.84 < 0.001*
Rural area 869 191 (21.98) 678 (78.02)
Year in
school
Freshman 298 130 (43.62) 168 (56.38) 12.54 < 0.001*
Sophomore 263 123 (46.77) 140 (53.23)
Junior 269 117 (43.49) 152 (56.51)
Senior 247 85 (34.41) 162 (65.59)
Graduate 299 108 (36.12) 191 (63.88)
Family
structure
Single parent 56 27 (48.21) 29 (51.79) 6.18 0.103
Nuclear family 1228 508 (41.37) 720 (58.63)
Extended
family
74 21 (28.38) 53 (71.62)
Others 18 7 (38.89) 11 (61.11)
Father's
education
Bachelor's and
above
924 230 (24.89) 694 (75.11) 321.92 < 0.001*
Junior college 73 42 (57.53) 31 (42.47)
Technician
training school
140 95 (67.86) 45 (32.14)
High school
and below
239 196 (82.01) 43 (17.99)
Father's
occupation
Head of state
organization/
enterprise
254 185 (72.83) 69 (27.17) 248.99 < 0.001*
Technology
professional/
clerk
348 192 (55.17) 156 (44.83)
Military and
others
485 101 (20.82) 384 (79.18)
Worker/farmer 289 85 (29.41) 204 (70.59)
(Continued)
95
Wei Wang et al.
© Journal of Comparative Family Studies Volume 51 Number 1, 2020
10.3138/jcfs.51.1.005
Demographic
characteristics Total Only-child
Non-only-
child Χ2p
Mother's
education
Bachelor's and
above
1038 291 (28.03) 747 (71.97) 302.51 < 0.001*
Junior college 69 49 (71.01) 20 (28.99)
Technician
training school
109 84 (77.06) 25 (22.94)
High school
and below
160 139 (86.88) 21 (13.13)
Mother's
occupation
Head of state
organization/
enterprise
162 134 (82.72) 28 (17.28) 299.41 < 0.001*
Technology
professional/
clerk
347 210 (60.52) 137 (39.48)
Military and
others
502 109 (21.71) 393 (78.29)
Worker/farmer 365 110 (30.14) 255 (69.86)
Family
atmosphere
Extremely
hostile
95 (57.66) 4 (42.34) 29.95 < 0.001*
Somewhat
hostile
13 3 (22.24) 10 (77.76)
Neither hostile
nor harmonious
115 35 (30.52) 80 (69.48)
Somewhat
harmonious
462 158 (34.23) 304 (65.77)
Extremely
harmonious
778 362 (46.55) 416 (53.45)
Family
economic
condition
Extremely
wealthy
21 5 (23.50) 16 (76.50) 34.31 <0.001*
Somewhat
wealthy
176 34 (19.32) 142 (80.68)
Neither poor
nor wealthy
839 304 (36.22) 535 (63.78)
Somewhat poor 287 182 (63.37) 105 (36.63)
Extremely poor 52 38 (72.77) 14 (27.23)
* Signicant at p < 0.05
Table 3: Continued
96 Do Only-Children Communicate Better Than Non-Only Children?
© Journal of Comparative Family Studies Volume 51 Number 1, 2020
10.3138/jcfs.51.1.005
Table 4: Logicstic regression comparison between demographic among
only-children
Dependent
variables Independent variables OR (95% CI) p
Gender Male 4.38 (3.22–5.96) < 0.001*
Female 1
Birthplace City 4.65 (3.26–6.62) < 0.001*
Rural area 1
Father's
education
Bachelor's degree and above 2.55 (1.46–4.54) 0.008*
Junior college 2.48 (1.50–4.10) 0.001*
Technician training school 2.50 (1.37–4.47) 0.003*
High school and below 1
Mother's
education
Bachelor's degree and above 2.24 (1.10–4.55) 0.026*
Junior college 2.15 (1.14–4.05) 0.018*
Technician training school 1.32 (0.67–2.61) 0.420
High school and below 1
Mother’s
occupation
Head of state organization/
enterprise
3.30 (1.75–6.22) < 0.001*
Technology professional/clerk 1.78 (1.17–2.70) 0.007*
Military and others 1.04 (0.72–1.51) 0.829
Worker/farmer 1
Family
economic
condition
Extremely wealthy 10.26 (2.2–48.24) 0.003*
Somewhat wealthy 3.64 (0.91–14.67) 0.069
Neither poor nor wealthy 2.82 (0.72–11.07) 0.137
Somewhat poor 2.50 (0.60–10.39) 0.208
Extremely poor 1
* Signicant at p < 0.05
Evaluation of Only-Children’s Communication Ability
An Independent Sample T-test was conducted to examine potential dierences
in the mean scores on the ve communication ability factors between only and
non-only-children (see Table 5). e results showed that only-children scored
signicantly higher in all ve dimensions individually and on the total score.
A series of one-way ANOVAs were conducted in order to determine if
communication ability diered across the main variables in the study, including
97
Wei Wang et al.
© Journal of Comparative Family Studies Volume 51 Number 1, 2020
10.3138/jcfs.51.1.005
only-child status and socio-demographic factors (see Table 6). Results showed
that communication ability was slightly higher for only-children 3.49 (SD = 0.67)
than for non-only-children 3.29 (SD = 0.67) (F = 15.45, p < 0.001). With the
exception of gender, all socio-demographic variables showed dierences in mean
communication ability scores. Specically, participants from cities, whose father
and mother achieved a bachelor’s degree or above, whose parents were heads of
state-run organizations, who reported a more harmonious family atmosphere,
and those from homes with higher economic levels all reported greater com-
munication skills. While providing useful information on factors that impact
communication ability in young adult medical students, these outcomes also sup-
port treating socio-demographic variables as controls in examining the impact of
only vs. non-only child status on communication ability.
In order to determine if the overall mean of communication ability dif-
fered between only and non-only-children, a hierarchical linear regression was
conducted entering gender (personal variable) on the rst step, birthplace and
family atmosphere (family factors) on the second step, both parents’ education,
occupation and family economics (nancial related items) on the third step, and
only vs non-only-children on the last step (see Table 7). Results revealed that
unlike the results of single factor analyses (t-test and one-way ANOVA), only
father’s education degree was signicantly related to elevated communication
Table 5: Comparison of mean communication ability scores between only and
non-only-children
Independent
variables
Only-
children N Mean SD
Mean
dierence t p
Self-evaluation Yes 563 3.41 0.75 0.17 4.27 P < 0.01*
No 823 3.24 0.73
Perception of the
context
Yes 563 3.56 0.71 0.15 3.68 P < 0.01*
No 813 3.41 0.66
Verbal and
nonverbal symbols
Yes 563 3.56 0.75 0.12 3.12 p < 0.01*
No 813 3.44 0.68
Communication
inclination with
friends
Yes 563 3.77 0.71 0.09 2.22 p < 0.01*
No 813 3.68 0.69
Communication
with strangers
Yes 563 3.32 0.80 0.13 2.99 p < 0.01*
No 813 3.19 0.79
Total mean scores Yes 563 3.52 0.62 0.13 3.94 p < 0.01*
No 813 3.39 0.59
* Signicant at p < 0.05
98 Do Only-Children Communicate Better Than Non-Only Children?
© Journal of Comparative Family Studies Volume 51 Number 1, 2020
10.3138/jcfs.51.1.005
Table 6: One-Way ANOVA model for socio-demographic factors in predicting
mean communication ability scores
Mean ± SD 95% CI F p
Only-child Yes 3.49 ± 0.67 3.19–3.48 15.450 < 0.001*
No 3.29 ± 0.67 3.25–3.52
Gender Male 3.27 ± 0.74 3.18–3.46 0.007 0.934
Female 3.27 ± 0.62 3.26–3.54
Birthplace City 3.37 ± 0.65 3.25–3.53 18.501 < 0.001*
Rural area 3.21 ± 0.68 3.18–3.47
Father's
education
High school and below 3.22 ± 0.67 3.18–3.26 8.927 < 0.001*
Technician training
school
3.19 ± 0.52 3.04–3.35
Junior college 3.29 ± 0.73 3.18–3.41
Bachelor’s degree and
above
3.47 ± 0.66 3.38–3.55
Father’s
occupation
Head of state
organization or
enterprise
3.39 ± 0.72 3.31–3.48 4.497 0.004*
Technology
professional or clerk
3.29 ± 0.67 3.22–3.37
Famers or workers 3.22 ± 0.61 3.17–3.29
Other 3.21 ± 0.71 3.18–3.51
Mother's
education
High school and below 3.22 ± 0.66 3.18–3.26 10.316 < 0.001*
Technician training
school
3.23 ± 0.61 3.08–3.39
Junior college 3.36 ± 0.77 3.23–3.48
Bachelor’s degree and
above
3.53 ± 0.68 3.42–3.63
Mother's
occupation
Head of state
organization or
enterprise
3.41 ± 0.73 3.31–3.52 4.557 0.003*
Technology
professional or clerk
3.32 ± 0.66 3.25–3.39
Famers or workers 3.27 ± 0.62 3.16–3.29
Other 3.21 ± 0.69 3.15–3.29
(Continued)
99
Wei Wang et al.
© Journal of Comparative Family Studies Volume 51 Number 1, 2020
10.3138/jcfs.51.1.005
Mean ± SD 95% CI F p
Family
atmosphere
Extremely hostile 3.04 ± 1.17 2.65–3.43 12.575 < 0.001*
Somewhat hostile 2.96 ± 0.63 2.65–3.28
Neither hostile nor
harmonious
3.39 ± 0.59 3.28–3.50
Somewhat harmonious 3.41 ± 0.55 3.36–3.47
Extremely harmonious 3.60 ± 0.62 3.56–3.65
Family
economic
condition
Extremely poor 3.62 ± 1.12 3.36–3.88 3.485 0.008*
Somewhat poor 3.46 ± 0.54 3.37–3.55
Neither poor nor
wealthy
3.48 ± 0.56 3.43–3.52
Somewhat wealthy 3.61 ± 0.65 3.54–3.69
Extremely wealthy 3.59 ± 0.92 3.42–3.77
* Signicant at p < 0.05
(Continued)
Table 6: Continued
Table 7: Hierarchical regression model in predicting communication ability
Step Predictor
Unstandardized
Coecients
Standardized
Coecients
t p R2
B Std. Error B
1 Gender −.005 .059 −.003 −.080 .936 −.000
Constant 3.342 .037 90.655 0.000
2 Gender .001 .058 .001 .016 .987 .019
Birthplace .151 .061 .103 2.462 .014*
Family atmosphere −.041 .021 −.081 −1.931 .054
Constant 3.277 .061 53.552 0.000
3 Gender −.010 .059 −.007 −.175 .861 .040
Birthplace .122 .067 .083 1.817 .070
Family atmosphere −.039 .021 −.078 −1.876 .061
Father’s education .205 .083 .106 2.486 .013*
Mother’s education .035 .019 .089 1.843 .066
Father’s occupation .061 .065 .044 .947 .344
Mother’s occupation −.007 .028 −.012 −.262 .794
Family economics .029 .027 .046 1.105 .270
Constant 3.165 .079 39.948 .000
100 Do Only-Children Communicate Better Than Non-Only Children?
© Journal of Comparative Family Studies Volume 51 Number 1, 2020
10.3138/jcfs.51.1.005
Step Predictor
Unstandardized
Coecients
Standardized
Coecients
t p R2
B Std. Error B
4 Gender −.020 .060 −.014 −.340 .734 .042
Birthplace .102 .070 .070 1.463 .144
Family atmosphere −.039 .021 −.077 −1.865 .063
Father’s education .209 .083 .108 2.525 .012*
Mother’s education .030 .020 .076 1.530 .126
Father’s occupation .060 .065 .043 .924 .356
Mother’s occupation −.010 .028 −.017 −.350 .727
Family economics .029 .027 .044 1.068 .286
Only/non-only child .071 .069 .049 1.031 .303
Constant 3.150 .081 39.109 .000
* Signicant at p < 0.05
Table 7: Continued
ability. Specically, communication ability was greater among those whose father
achieved a higher-level education degree. But more importantly, contrary tothe
second hypothesis, this analysis showed that overall communication ability did
not dier between only-children and non-only-children aer controlling for
these socio-demographic factors.
Discussion
e present ndings show that there are some distinct dierences in sociodemo-
graphic factors between only-children and non-only-children that is consistent
with the implementation of the OCP in China. Specically, only-children are
more typically males, living in urban settings, with more highly educated parents
who have more upper level careers, and higher family economic levels. Demog-
raphers have indicated that a sex ratio bias, which skews towards a greater male
to female ratio, has existed for many years, especially in Asian countries (Dyson,
2012; Grech, 2015) where Confucius culture and its male preference is popular.
Further, the fact that the OCP in China is more strictly enforced in urban than in
rural areas could contribute to this imbalance. Additionally, even in rural areas,
where many couples have been permitted to have a second child when their rst
child is a girl, this male preference has led to selective sex based termination of
pregnancies—particularly for the second child—which would increase the pro-
portion of males in rural areas (Zhu, Lu, and Hesketh, 2009).
With respect to the dierences in education, employment, and economic
standing imbalance, greater education typically facilitates higher ranked
101
Wei Wang et al.
© Journal of Comparative Family Studies Volume 51 Number 1, 2020
10.3138/jcfs.51.1.005
employment with increased salaries. is is reected in the Chinese proverb “the
carp leaped through the dragon’s gate” where gaining an advanced degree is a
means for someone to achieve greater social/economic standing and status in
Chinese culture. However, these types of esteemed careers oen necessitate living
in urban areas with stricter OCP enforcement.
It is also noteworthy that the only-children were more likely than the
non-only-children to report living in harmonious homes. One explanation for
this might be that, for urban and highly-educated parents, it may be easier to
adopt more “western” parenting principles that emphasize warmth and support
rather than the more restrictive traditions of Chinese parenting (Wang and Chang,
2009), especially in the context of the OCP where time, attention, and eort do
not need to be divided between multiple children (Lu and Chang, 2013). is,
along with the fact that there is no opportunity for sibling conict in only-children
homes, may provide a greater sense of belongingness and satisfaction, leading to
greater perceptions of harmony. Alternatively, it is also oen necessary for parents
in rural communities to move to cities without their children as migrant workers
in order to provide nancial support for their family. It has been estimated that
this phenomenon has impacted nearly one in three children in rural China (Lv,
Yan, Duan et al., 2018). As a result, the absence of a parent (particularly long-
term) might lead to elevated feelings of abandonment, tension, stress, and con-
ict, which may ultimately decrease perceptions of family harmony.
With respect to the potential unique impact of only-children environ-
ments, previous research has found somewhat contradictory evidence. Some
have noted disadvantages in terms of personality, cooperation, and depression
(Falbo, Poston, Ji et al., 1989; Jiao et al., 1986; Wan, Fan, Lin et al., 1994), while
others have revealed advantages in personal traits, academic performances, and
social functioning (Wang, 1980; Wang, Wang, Du et al., 2002; Yang et al., 1995).
e main purpose of the present study was to investigate possible dierences
in communication ability between only-children and non-only-children using
a young adult sample. However, given that there were no established tools that
t this particular goal, a self-report instrument was developed specically for
this study (Wang and Yin, 2015). is Interpersonal Communication Ability
Assessment Scale (ICAAS), which identies an individual’s ability to commu-
nicate on ve dierent dimensions, showed high internal reliability and strong
item association. is multidimensional approach is important because eective
communication represents dierent things to each individual (Berlo, 1960), and
every individual will have their own areas of communication strength.
When considering communication ability on its own, dierences
emerged between only and non-only-children. However, when controlling for
socio-demographic factors, communication ability scores no longer diered
between these two groups. is would be consistent with Poston and Falbo
(1990) who argued that rstborns did not show any distinct advantages in
important developmental areas compared to children with siblings when other
contextual factors were considered as controls. is seems particularly relevant
102 Do Only-Children Communicate Better Than Non-Only Children?
© Journal of Comparative Family Studies Volume 51 Number 1, 2020
10.3138/jcfs.51.1.005
as development progresses towards adulthood (Lin et al., 2017). In fact, quality
parental anity could potentially explain any advantages in developmental
outcomes—including personality, intellect, and in the case of the present nd-
ings possibly communication ability—regardless of the number of children in a
home. While Ching (1982) argued that childrens social qualities (which could
extend to communication) are developed through interaction while playing with
other children, which conceptually would be more limited in the earliest years
for only-children, these ndings could be explained by parental involvement
and attention (Wei et al., 2016). Specically, parents of only-children in China
may spend more time speaking to and interacting with their child at a higher
language level. ey may be more focused on any issues that might arise and
show greater motivation to shape appropriate (or even more advanced) commu-
nication outcomes. Plus, considering the fact that they know that this will be
their only child, they may invest themselves to a greater extent in ensuring that
their child interacts with other children in their neighborhoods or schools. e
fact that the majority of only-children are raised in urban areas may also facilitate
interaction with other children. ese factors then may counteract any potential
disadvantages of not having siblings to interact with in the home.
In a related sense, another explanation for the current outcomes might be
the fact that the communication abilities were measured among adults rather
than children. It is conceivable that communication issues are present but only
at early ages. us, exposure to other children in schools and within larger and
more populated urban neighborhoods may provide opportunities to compensate
for any deciencies that existed earlier in life for only-children. Further, the fact
that the parents of only-children are more likely to have higher levels of education
and hence greater economic status, may allow them to provide an enriched envi-
ronment where the only-child receives better education and encounters enriched
social interactions which help compensate for potential communication issues
experienced at a younger age. erefore, just as Lin et al., (2017) noted separate
pathways in the development of self-ecacy among only and non-only-children,
it is possible that these two group progress towards similar levels of communica-
tion ability into adulthood through dierent pathways as well.
Limitations and Future Directions
One possible limitation to the present study was the fact that it utilized a cross
sectional design and only among young adults. As a result, it was not possible to
examine changes in communication over time and particularly at young ages.
Although the outcomes are still relevant, given that the proposed impact of an
only-child environment is present and observable among adults in China, it may
be useful in the future to make comparisons at younger ages and potentially
engage in a longitudinal design to examine possible changes in outcomes.
Another limitation is the fact that the present study used a convenience sample
narrowed within medical undergraduates which might have generated sampling
bias. For example, perhaps only those who were more condent in their commu-
nication abilities or those with actual higher communication abilities volunteered
103
Wei Wang et al.
© Journal of Comparative Family Studies Volume 51 Number 1, 2020
10.3138/jcfs.51.1.005
to participate in this study which could mask potential dierences that exist. us,
future research may benet from recruiting within a broader base of the population.
Finally, while the self-generated ICAAS does show good psychometric properties,
future research is needed to further establish the goodness of this instrument.
Value of the Outcomes
To our knowledge, this is the rst large scale examination of communication abilities
of only-children following the implementation of the OCP in China. By comparing
only-children with non-only-children cross sectionally, the hope was that the out-
comes of the present study might provide educators and policy-makers with a frame
of reference regarding only-child communication tendencies to inuence pedagogy
and shape family-planning policies. Furthermore, the self-designed ICAAS which
had good psychometric properties could be a useful instrument for researchers to
conduct similar studies. For example, since this study was carried out among med-
ical students, further research could analyze the communication ability of medical
students to explore issues related to medical education and to potentially address
the doctor-patient communication problems in China. Similarly, it may allow future
researchers to examine potential dierences in communication between only-chil-
dren and non-only-children in other regions, among those pursuing other types of
careers, within dierent generations in relation to the implementation of the OCP,
or among only-child parents planning their own families.
Conclusion
e present study demonstrated that there are socio-demographic dierences
that exist between only-children and non-only-children in post-OCP China.
However, the main purpose of the study was to determine if there were dier-
ences in communication ability between only-children and non-only children.
Results showed that when considered on its own, only-children showed slight in-
creased communication ability, but that dierence disappeared when controlling
for socio-demographic factors. is suggests that, on average, any advantage or
disadvantage in communication ability among only-children may be balanced by
factors in their environment.
Note
1. e research was supported by Shandong Provincial Department of Education:
2011GG293, China and Overseas-Study-Program of People’s Government of Shandong
Province, China.
References
Baney, J. (2004). Guide to Interpersonal Communication. New York, NY: Prentice-Hall.
Barker, A. (2006). Improve your communication skills. London: Kogan Page.
104 Do Only-Children Communicate Better Than Non-Only Children?
© Journal of Comparative Family Studies Volume 51 Number 1, 2020
10.3138/jcfs.51.1.005
Berlo, D. K. (1960). e process of communication: An introduction to theory and practice.
New York: Holt, Rinehart and Winston.
Blake, J. (1989). Family size and achievement (Vol. 3). Berkeley: University of California
Press.
Carter, J., Ward, C., Wexler, D., et al., (2018). e association between patient experience
factors and likelihood of 30-day readmission: A prospective cohort study. BMJ Quality
and Safety, 27(9), 683–690. https://doi.org/10.1136/bmjqs-2017-007184.
Chen, Z.Y., & Liu, R. X. (2014). Comparing adolescent only children with those who have
siblings on academic related outcomes and psychosocial adjustment. Child Development
Research, 2014 1–10. https://doi.org/10.1155/2014/578289.
Chen, J., & Miao, D. (2007). Introduction to the Myers-Briggs type indicator. US-China
Education Review, 4(3), 44–47. https://doi.org/10.1177/0030222815612285.
Ching, C. C. (1982). e one-child family in China: e need for psychosocial research.
Studies in Family Planning, 13(6/7), 208–212. https://doi.org/10.2307/1965449.
Curry, L. A., Spatz, E., Cherlin, E., et al., (2011). What distinguishes top-performing hos-
pitals in Acute Myocardial Infarction Mortality Rate? Annals of Internal Medicine, 154(6),
384–390. https://doi.org/10.7326/0003-4819-154-6-201103150-00003.
Dyson, T. (2012). Causes and consequences of skewed sex ratios. Annual Review of Sociol-
og y, 38(1), 443–461. https://doi.org/10.1146/annurev-soc-071811-145429.
Falbo, T., & Hooper, S. Y. (2015). China’s only children and psychopathology: A quan-
titative synthesis. American Journal of Orthopsychiatry 85(3), 259–274. https://doi.org/
10.1037/ort0000058.
Falbo, T., & Polit, D. F. (1986). Quantitative review of the only child literature: Research
evidence and theory development. Psychological Bulletin, 100(2), 176–189. https://doi.
org/10.1037/0033-2909.100.2.176.
Falbo, T., & Poston, D. L. (1993). e academic, personality, and physical outcomes
of only children in China. Child Development, 64(1), 18–35. https://doi.org/10.1111/
j.1467-8624.1993.tb02893.x.
Falbo, T., Poston, D. L., Ji, G., et al., (1989). Physical achievement and personality char-
acteristics of Chinese children. Journal of Biosocial Science, 21(4), 483–496. https://doi.
org/10.1017/S0021932000018228.
Festini, F., & de Martino, M. (2004). Twenty ve years of the one child family policy in
China. Journal of Epidemiology and Community Health (1979-), 58(5), 358–360. https://
doi.org/10.1136/jech.2003.017335.
Gallagher, T. J., Hartung, P. J., Gerzina, H., et al., (2005). Further analysis of a doctor–
patient nonverbal communication instrument. Patient Education and Counseling, 57(3),
262–271. https://doi.org/10.1016/j.pec.2004.06.008.
105
Wei Wang et al.
© Journal of Comparative Family Studies Volume 51 Number 1, 2020
10.3138/jcfs.51.1.005
Grech, V. (2015). Atomic bomb testing and its eects on global male to female ratios
at birth. International Journal of Risk & Safety in Medicine 27(1), 35–44. https://doi.
org/10.3233/JRS-150641.
Gude, T., Finset, A., Anvik, T., et al., (2017). Do medical students and young physicians
assess reliably their self-ecacy regarding communication skills? A prospective study
from end of medical school until end of internship. BMC Medical Education, 17(1), 107.
https://doi.org/10.1186/s12909-017-0943-y.
Guetterman, T. C., Sakakibara, R., Baireddy, S., et al., (2019). Medical students' experi-
ences and outcomes using a virtual human simulation to improve communication skills:
Mixed methods study. Journal of Medical Internet Research, 21(11), 1–9. https://doi.
org/10.2196/15459.
Guo, Y., Zhang, J., & Zhang, N. (2015). Character strengths and their inuencing factors
among nursing students in Changsha, China: the only-child versus non-only-child. [ Research
Support, Non-U.S. Gov't]. Archives Psychiatric Nursing, 29(6), 365–371. https://doi.org/
10.1016/j.apnu.2015.06.008.
Hall, E. (1987). China's only child. Psychology Today, 1987(7), 44–47. https://doi.
org/10.1037/e400842009-003.
Han, P., Joekesc, K., Elwyn, G., et al., (2014). Development and evaluation of a risk com-
munication curriculum for medical students. [Research Support, Non-U.S. Gov't]. Patient
Education and Counseling, 94(1), 43–49. https://doi.org/10.1016/j.pec.2013.09.009.
Hill, K., Mehta, G., & Hynes, G. E. (2014). Do they think they can communicate? Graduate
students' perceptions of their communication competencies. Journal of Organizational
Culture, Communications and Conict, 18(1), 275.
Huang, R. (2009). Only-children in China: Quantity, structure and risks. Journal of
Nanjing College for Population Programme Management, 25(1), 5–10. https://doi.org/
10.14132/j.2095-7963.2009.01.009
Huang, C., Huang, Y., & Hu, Z. (2011). Exploration on the eective factors on doctor-
patient trust (in Chinese). Medicine & Philosophy (Humanistic & Social Medicine Edition),
32(4), 20–22. CNKI:SUN:YXZX.0.2011-04-009
Hull, R. (2017). Good communication skills key to success personally and professional-
ly[online]. e Wichita Eagle. Available from:https://www.kansas.com/news/business/biz-
columns-blogs/business-perspectives/article158644129.html.[Accessed on 14th December,
2018]. https://doi.org/10.1017/S0021932013000540.
Humphris, G. M., & Kaney, S. (2001). e Liverpool Brief Assessment System for com-
munication skills in the making of doctors. Advances in Health Sciences Education, 6(1),
69–80. https://doi.org/10.1023/A:1009879220949.
Jha, S. K., & Malik, M. (2018). Communication skills. Retrieved from http://www.
agrimoon.com/communication-skills-pdf-book-free-download/.
106 Do Only-Children Communicate Better Than Non-Only Children?
© Journal of Comparative Family Studies Volume 51 Number 1, 2020
10.3138/jcfs.51.1.005
Jiao, S., Ji, C., & Jing, Q. (1986). Comparative study of behavioral qualities of only children
and sibling children. Child Development, 57(2), 357–361. https://doi.org/10.2307/1130591.
Jiao, S., Ji, G., & Jing, Q. (1996). Cognitive development of Chinese urban only chil-
dren and children with siblings. Child Development, 67(2), 387–395. https://doi.
org/10.1111/j.1467-8624.1996.tb01740.x.
Kadoya, Y., Khan, M. S. R., & Sano, Y. (2018). Eects of China's one-child policy on group
cooperation: survey evidence. Journal of the Asia Pacic Economy, 23(3), 327–339. https://
doi.org/10.1080/13547860.2017.1409861.
Katz, D., & Kahn, R. L. (1966). e social psychology of organizations. New York, NY: Wiley.
Keating, J. E. (2013). Empire of the sons (and daughters). Foreign Policy, 200, 27.
Kemp, K. A., Santana, M. J., Southern, D. A., et al., (2016). Association of inpatient hospi-
tal experience with patient safety indicators: A cross-sectional, Canadian study. BMJ Open
6(7), e011242. https://doi.org/10.1136/bmjopen-2016-011242.
Lao, Y., & Dong, Z., (2019). e only child, birth order and educational outcomes. Eco-
nomics: e Open-Access, Open-Assessment E-Journal, 13(2019–28): 1–24. http://dx.doi.
org/10.5018/economics-ejournal.ja.2019-28.
Liew, S.-C., Dutta, S., Sidhu, J. K., et al., (2014). Assessors for communication skills: SPs
or healthcare professionals? Medical Teacher, 36(7), 626–631. https://doi.org/10.3109/
0142159X.2014.899689.
Lin, X. (2019). “Purchasing hope”: e consumption of childrens education in urban
China. [journal article]. e Journal of Chinese Sociology, 6(1), 8. https://doi.org/10.1186/
s40711-019-0099-8.
Lin, S., Fong, C. J., & Wang, Y. (2017). Chinese undergraduates’ sources of self-ecacy dif-
fer by sibling status, achievement, and fear of failure along two pathways. Social Psychology
of Education 20(2), 361–386. https://doi.org/10.1007/s11218-017-9367-0.
Liu, M. (2005). e development of interpersonal communication competence inventory
(First ed.). Taiwan:: National Yunlin University of Science and Technology.
Liu, R. X., Lin, W., & Chen, Z.-y. (2009). School performance, peer association, psycho-
logical and behavioral adjustments: a comparison between Chinese adolescents with
and without siblings. Journal of Adolescence, 33(3), 411–417. https://doi.org/10.1016/
j.adolescence.2009.07.007.
Liu, X., Rohrer, W., & Luo, A. (2015). Doctor-patient communication skills training in
mainland China: a systematic review of the literature. Patient Education and Counseling,
98(1), 3–14. https://doi.org/10.1016/j.pec.2014.09.012.
Lu, H., & Chang, L. (2013). Parenting and socialization of only children in urban China:
An example of authoritative parenting. e Journal of Genetic Psychology, 174(3), 335–343.
https://doi.org/10.1080/00221325.2012.681325.
107
Wei Wang et al.
© Journal of Comparative Family Studies Volume 51 Number 1, 2020
10.3138/jcfs.51.1.005
Lv, L., Yan, F., Duan, C., et al. (2018). Changing patterns and development challenge of
child population in China (in Chinese). Population Research, 42(3), 65–78.
Maraccini, A. M., Houmanfar, R. A., Kemmelmeier, M., et al., (2018). An inter-professional
approach to train and evaluate communication accuracy and completeness during the
delivery of nurse-physician student handos. Journal of Interprofessional Education &
Practice, 12(September), 65–72. https://doi.org/10.1016/j.xjep.2018.06.003.
Meredith, W. H., Abbott, D. A., & Zhu, L. T. (1989). A comparative study of only children
and sibling children in the people's republic of China. School Psychology International,
10(4), 251–256. https://doi.org/10.1177/0143034389104002.
Modi, J. N., Anshu, J. C., Gupta, P., et al., (2016). Teaching and assessing communication
skills in medical undergraduate training. Medical Education, 53(6), 497–504. https://doi.
org/10.1007/s13312-016-0879-z.
National Health Commission of the People's Republic of China. (2019). National
Health Service and Quality Safety Report in 2018, from http://www.nhc.gov.cn/xcs/
s7847/201910/03dd66a63a8c4539879991f0221a07fa.shtml.
Netzley, M. A. (1999). Introduction: Are we requiring what our students most need? Busi-
ness Communication Quarterly, 62(1), 7–9. https://doi.org/10.1177/108056999906200101.
Pearce, W. B. (1994). Interpersonal communication: Making social worlds. New York, NY:
Harper Collins CollegePublishers.
Phillips, A. W. (1998). Eective communications skills are career essentials. Healthcare
Financial Management: Journal of the Healthcare Financial Management Association,
52(2), 90.
Phillips, A. W. (1999). Interpersonal skills are key in oce of the future. TMA Journal,
19(4), 53.
Poston, D. L., & Falbo, T. (1990). Academic-performance and personality-traits of Chinese
children-onlies versus others. American Journal of Sociology, 96(2), 433–451. https://doi.
org/10.1086/229535.
Qin, X., Zhuang, C. C., & Yang, R. (2017). Does the one-child policy improve children's
human capital in urban China? A regression discontinuity design. Journal of Comparative
Economics, 45(2), 287–303. https://doi.org/10.1016/j.jce.2016.09.001.
Redding, W. C. (1972). Communication within the organization (First ed.). New York, NY:
Industrial Communication and Purdue University.
Rodrigues, N., & Abhyankar, S. C. (2012). Emotional Intelligence and Anger in only Chil-
dren and Children with Siblings. Journal of Psychosocial Research, 7(2), 227–234.
Sarpparaje, M. (2016). Importance of enhancing communication skills among young
graduates and how to make them career-ready & life-ready? Language In India, 16(4), 93
https://www.researchgate.net/publication/324495577.
108 Do Only-Children Communicate Better Than Non-Only Children?
© Journal of Comparative Family Studies Volume 51 Number 1, 2020
10.3138/jcfs.51.1.005
Shafakhah, M., Zarshenas, L., Sharif, F., et al., (2015). Evaluation of nursing students' com-
munication abilities in clinical courses in hospitals. Global Journal of Health Sciences, 7(4),
323–328. https://doi.org/10.5539/gjhs.v7n4p323.
Tan, G., Gupta, A., & Wilgus, G. (2019). Investment in early childhood education in a glo-
balized world. New York, NY: Palgrave Macmillan.
Team FME. (2013). Eective communications: Communication skills. Retrieved from
www.free-management-ebooks.com.
Wan, C., Fan, C., Lin, G., et al., (1994). Comparison of personality-traits of only and
sibling school-children in Beijing. Journal of Genetic Psychology, 155(4), 377–388. https://
doi.org/10.1080/00221325.1994.9914788.
Wang, S. (1980). Must only children be spoiled? People's Daily, (October 10). https://doi.
org/10.1186/s12888-018-1621-2.
Wang, G. (2013). “Only-child-death” family and its developing trends under the current
family planning policy (in Chinese). Chinese Journal of Population Science, (1), 57–65.
Wang, P. (2013). Management communication (in Chinese). Shanghai: East China Univer-
sity of Science and Technology Press.
Wang, Q., & Chang, L. (2009). Parenting and child socialization in contemporary China.
In M. H. Bond (Ed.), e Oxford handbook of Chinese psychology (2nd ed., pp. 53–68).
London: Oxford University Press.
Wang, W., Du, W., Liu, P., et al., (2002). Five-factor personality measures in Chinese uni-
versity students: Eects of one-child policy? Psychiatry Research, 109(1), 37–44. https://
doi.org/10.1016/S0165-1781(01)00361-4.
Wang, W., & Yin, W. (2015). Development of Interpersonal Communication Ability
Scale for medical students. Chinese General Practice 18(22), 2709–2712. https://doi.org/
10.3969/j.issn.1007-9572.2015.22.02.
Ward, K. W., Leuty, M., & Corie, J. (2016). Eectiveness of a job search and interview
skills workshop for graduate students in communication sciences and disorders. Contem-
porary Issues in Communication Science and Disorders, 43(Spring), 174–181. https://doi.
org/10.1044/cicsd_43_S_174.
Weaver, R. L., & Hybels, S. (2007). Communication eectively (Vol. 8th). New York, NY:
McGraw-Hill Education.
Wei, W., Wu, Y., Lv, B., et al., (2016). e relationship between parental involvement and
elementary students’ academic achievement in China: One-only children vs. children
with siblings Journal of Comparative Family Studies, 47(4), 483. https://doi.org/10.3138/
jcfs.47.4.483.
Wilkins, K. G., Bernstein, B. L., & Bekki, J. M. (2015). Measuring communication skills:
e STEM Interpersonal Communication Skills Assessment Nattery. Journal of Engineer-
ing Education, 104(4), 433–453. https://doi.org/10.1002/jee.20100.
109
Wei Wang et al.
© Journal of Comparative Family Studies Volume 51 Number 1, 2020
10.3138/jcfs.51.1.005
Wu, M. (2010). Practical questionnaire statistical analysis (in Chinese). Chongqing:
Chongqing university press.
Wu, Y., Gao, J., & Fan, W. (2007). How to raise the clinical students ability to communicate
with the patients? (in Chinese). Medicine & Philosophy:Humanistic & Social Medicine Edi-
tion (3), 43–44. CNKI:SUN:YXZX.0.2007-03-020
Xue, v., & Li, J. (2016). Family capital, shadow education and social reproduction (in Chi-
nese). China Economics of Education Review, 1(4), 60–81. CNKI:SUN:JYJP.0.2016-04-005
Yang, J., Hou, X., Wei, D., et al., (2017). Only-child and non-only-child exhibit dierences in
creativity and agreeableness: Evidence from behavioral and anatomical structural studies.
Brain Imaging and Behavior, 11(2), 493–502. https://doi.org/10.1007/s11682-016-9530-9.
Yang, B., omas, O., Dong, Q., et al., (1995). Only children and children with siblings in
the People's Republic of China: Levels of fear, anxiety, and depression. Child Development,
66(5), 1301–1311. https://doi.org/10.1111/j.1467-8624.1995.tb00936.x.
Yi, F. (2013). Big country with an empty nest. Beijing: China Development Press.
Yin, S. (2003). Tension and its causes of relationship between the medical and the pa-
tient (in Chinese). Health Economics Research, (2), 14–16. https://doi.org/10.14055/j.cnki.
33-1056/f.2003.02.005.
Yu, X., Wang, S., & Sun, D. (2018). Analysis of the causes of medical disputes and sug-
gestions for prevention (in Chinese). China Medicine and Pharmacy, 8(8), 253–256.
CNKI:SUN:GYKX.0.2018-08-079
Zhang, Y., Jiang, G., Sun, Y., et al., (2018). Cross-cultural adaptation and psychometric
properties of the Chinese version of the Communication Skills Attitude Scale among
medical students in Liaoning province, China: A crosssectional study. BMJ open, 8(9),
e020931. https://doi.org/10.1136/bmjopen-2017-020931.
Zhu, W. X., Lu, L. D., & Hesketh, T. (2009). China’s excess males, sex selective abortion,
and one child policy: analysis of data from 2005 national intercensus survey. British Med-
ical Journal, 338, b1211–b1211. https://doi.org/10.1136/bmj.b1211.
CopyrightofJournalofComparativeFamilyStudiesisthepropertyofUniversityofToronto
Pressanditscontentmaynotbecopiedoremailedtomultiplesitesorpostedtoalistserv
withoutthecopyrightholder'sexpresswrittenpermission.However,usersmayprint,
download,oremailarticlesforindividualuse.
... The causes of slow speech development in children of the typical population are not fully known. However, several factors could play a significant role [28][29][30]. ...
... However, most preschool children are not able to read independently, and reading aloud to children of this age significantly affects the formation of their speech and language [44]. In addition, the closure of educational institutions leads to social and emotional problems of children such as significantly fewer hours of sleep, poorer nutrition, more time spent on electronic devices, less physical activity, development of higher levels of stress, and all this can significantly contribute to physical and mental health of children [29]. These results are confirmed by data stating that the COVID-19 virus pandemic has put children at risk for the development of fear of illness, social isolation, prolonged confinement indoors and increased stress levels of parents or guardians of children [40]. ...
Article
Full-text available
Speech is a way of communication formed by rhythmic units of syllables , words and sentences, and as such is inherent in man, the only being whose organs and psyche are trained for this process. Delayed speech is defined as a phenomenon in which a child does not start speaking on time, or there are errors in the speech pattern that are not appropriate in relation to a given age. It is known that significant risk factors for the development of delayed speech in preschool children are physical, and most often social and emotional in nature. For the normal development of speech, it is necessary that the child is in a human environment, and therefore the circle of people with whom children come into contact should always be expanded. The aim of this study is to review the existing literature on studies examining the impact of social isolation during the COVID-19 pandemic on preschool children, as well as the speech and language development in preschool children. The recent pandemic of corona virus infection (COVID-19) has led to a state of emergency, quarantine, closure of public institutions, and pre-schools, kindergartens and schools in 172 countries. These epidemiological measures have led to social isolation and the need for children to learn from home, which has manifested itself in the emergence of difficulties in the development of speech and language. Research has shown that during the pandemic, children spent significantly more time watching television and computer screens than before pandemic , and less in play and physical activity.
... The causes of slow speech development in children of the typical population are not fully known. However, several factors could play a significant role [28][29][30]. ...
... However, most preschool children are not able to read independently, and reading aloud to children of this age significantly affects the formation of their speech and language [44]. In addition, the closure of educational institutions leads to social and emotional problems of children such as significantly fewer hours of sleep, poorer nutrition, more time spent on electronic devices, less physical activity, development of higher levels of stress, and all this can significantly contribute to physical and mental health of children [29]. These results are confirmed by data stating that the COVID-19 virus pandemic has put children at risk for the development of fear of illness, social isolation, prolonged confinement indoors and increased stress levels of parents or guardians of children [40]. ...
... The causes of slow speech development in children of the typical population are not fully known. However, several factors could play a significant role [28][29][30]. ...
... However, most preschool children are not able to read independently, and reading aloud to children of this age significantly affects the formation of their speech and language [44]. In addition, the closure of educational institutions leads to social and emotional problems of children such as significantly fewer hours of sleep, poorer nutrition, more time spent on electronic devices, less physical activity, development of higher levels of stress, and all this can significantly contribute to physical and mental health of children [29]. These results are confirmed by data stating that the COVID-19 virus pandemic has put children at risk for the development of fear of illness, social isolation, prolonged confinement indoors and increased stress levels of parents or guardians of children [40]. ...
... Concerning academic outcomes, Chinese children without siblings appear to have higher academic achievements and cognitive abilities than children with siblings (Poston and Falbo, 1990;Falbo and Poston, 1993;Jiao et al., 1996). With regard to psychological outcomes and character features, some studies observed no significant differences between Chinese only children and non-only children (Poston and Falbo, 1990;Guo et al., 2015;Wang et al., 2020), and others reported better outcomes of only children (Liu et al., 2010;Falbo and Hooper, 2015;Guo et al., 2018). In terms of the traditional virtues, research demonstrated that although Chinese only children did not differ from their non-only counterparts in the sense of family obligation or filial piety (Fuligni and Zhang, 2004;Deutsch, 2006), they are more motivated to have higher achievements in order to assume the responsibility supporting their aging parents (Fong, 2002(Fong, , 2004. ...
... After more than three decades of implementation, the one-child policy created a large number of families with just one child and this family size became the social norm in Chinese society (Falbo and Hooper, 2015;Falbo, 2018). A growing body of research has documented the developmental outcomes of being an only child (Liu et al., 2010;Falbo, 2012;Falbo and Hooper, 2015;Guo et al., 2015Guo et al., , 2018Wang et al., 2020). However, few studies examined whether only children have different parentchild emotional relationships compared with non-only children. ...
Article
Full-text available
After more than three decades of implementation, China’s one-child policy has generated a large number of only children. Although extensive research has documented the developmental outcomes of being an only child, research on the parent–child relational quality of the only child is somewhat limited. Using China Education Panel Survey (2014), this study examined whether the only child status was associated with parent–child relationships among Chinese junior high school students. It further explored whether children’s gender moderated the association between the only child status and parent–child relationships. Two-level ordered logit models suggested that only children were more likely to report a close relationship with their mothers and fathers compared to children from multiple-child families (including two-child families). Taking birth order into consideration, we found that, only children were more likely to have close parent–child relationships than firstborns, whereas no significant differences were found between only children and lastborns. Interaction analyses further suggested that the only child advantages were gender-specific: the positive effects of the only child status were stronger for daughters than for sons, that is, daughters benefited more from being only children. Our findings highlight the importance of considering children’s gender and birth order in exploring the only child effects in the Chinese context. Additional analyses about sibling-gender composition indicated female children were more likely to be disadvantaged with the presence of younger brothers, whereas male children benefited more from having older sisters. This reveals that the son preference culture is still deep-rooted in the Chinese multiple-child families.
... Behavioral differences between OC and non-OC. The y-axis shows each behavioral phenotype, and the x-axis shows -log 10 Consistent causal pathways identi ed by both CMA and SEM. The graphs show consistent causal pathways identi ed by both SEM and CMA. ...
Preprint
Full-text available
With the worldwide increase of only-child families, it is crucial to understand the influence of growth without siblings (GWS) on human health, but there is limited knowledge regarding the effects of GWS on human brain. Besides, existing studies have reported paradoxical associations between GWS and mental health, most likely due to mismatched confounders and overlooked growth environments. Here, using 2,305 pairs of individuals with and without siblings well matched in confounders, we comprehensively examined the impact of GWS on changes in adult brain structure, function, and behaviors, as well as pathways from GWS, growth environments to brain and behaviors. Our findings uncovered novel associations, including GWS being linked to higher language-fiber integrity, lower motor-fiber integrity, larger regional cerebellum volume, and lower frontotemporal spontaneous brain activity. Contrary to stereotypical associations between GWS and problem behaviors, we found positive correlations of GWS with neurocognition and mental health. Despite direct effects, GWS affects most adult brain and behavioral outcomes through modifiable environments, such as socioeconomic status, maternal care, and family support, suggesting targets for interventions to enhance children’s healthy growth.
... Thirdly, Wang et al. (2020) have noted that interpersonal communication skills were slightly higher for only children when not controlling for socio-demographic factors (e.g., gender, family economic income, parental education); however, after controlling for socio-demographic factors, the differences in interpersonal communication between only children and non-only children were not significant. Another related study reported no significant differences in the adaptive and social skills among only and non-only children (Falbo & Polit, 1986). ...
Article
Full-text available
According to the Social Cognitive Theory and the perspectives of parental differential treatment, the current research proposed and verified a moderated mediation model to explore the mediating role of teacher support and the moderating role of only-child (OC) /non-only-child (NOC) status in the relationship between hardiness and college student learning adaptation. A questionnaire survey of 1138 Chinese college students was conducted using the hardiness scale, the learning adaptation scale, and the student perception of teacher supportive behavior questionnaire. The results revealed a significant positive effect of hardiness on college student learning adaptation. The mediation model analysis showed that teacher support had a complementary partial mediating role in the relationship between hardiness and college students’ learning adaptation. Furthermore, the moderated mediation model analysis suggested that OC/NOC status moderated the second half of this mediating relationship and indicated that teacher support had a stronger effect on the learning adaptation of college students with OC status than NOC status. The research results not only enrich our understanding of the internal influence mechanism of the relationship between hardiness and college students’ learning adaptation, but also broaden the research on the identity difference between OC/NOC status. Practical discussions and suggestions are proposed based on the results.
Article
Full-text available
Background: Attending to the wide range of communication behaviors that convey empathy is an important but often underemphasized concept to reduce errors in care, improve patient satisfaction, and improve cancer patient outcomes. A virtual human (VH)-based simulation, MPathic-VR, was developed to train health care providers in empathic communication with patients and in interprofessional settings and evaluated through a randomized controlled trial. Objective: This mixed methods study aimed to investigate the differential effects of a VH-based simulation developed to train health care providers in empathic patient-provider and interprofessional communication. Methods: We employed a mixed methods intervention design, involving a comparison of 2 quantitative measures-MPathic-VR-calculated scores and the objective structured clinical exam (OSCE) scores-with qualitative reflections by medical students about their experiences. This paper is a secondary, focused analysis of intervention arm data from the larger trial. Students at 3 medical schools in the United States (n=206) received simulation to improve empathic communication skills. We conducted analysis of variance, thematic text analysis, and merging mixed methods analysis. Results: OSCE scores were significantly improved for learners in the intervention group (mean 0.806, SD 0.201) compared with the control group (mean 0.752, SD 0.198; F1,414=6.09; P=.01). Qualitative analysis revealed 3 major positive themes for the MPathic-VR group learners: gaining useful communication skills, learning awareness of nonverbal skills in addition to verbal skills, and feeling motivated to learn more about communication. Finally, the results of the mixed methods analysis indicated that most of the variation between high, middle, and lower performers was noted about nonverbal behaviors. Medium and high OSCE scorers most often commented on the importance of nonverbal communication. Themes of motivation to learn about communication were only present in middle and high scorers. Conclusions: VHs are a promising strategy for improving empathic communication in health care. Higher performers seemed most engaged to learn, particularly nonverbal skills.
Article
Full-text available
Abstract Children’s education has become an important part of urban family consumption, and the rapid expansion of private tutoring schools and supplemental lessons has constituted a big part of the children’s education market. Taking the perspective of family studies and using China Education Panel Survey (2013–2014) data, this paper explores the relationship between family structure, parenthood, and the consumption of children’s education. This research shows that family investment in children’s education exhibits dual characteristics of instrumental rationality and emotional expression; children from one-child families, living with both parents and receiving more attention and affection from their parents, have more educational opportunities outside of school; girls receive more advantage over boys. Meanwhile, social class differences in the consumption of children’s education are significant. Middle-class families have greater education expectation and will invest more in children’s education, displaying a significantly stratified preference in supplemental lessons. These findings illustrate the need to take a new look at family studies and consumption research regarding the issue of child education consumption in the future.
Article
Full-text available
Objectives The aims of this study were to develop the Chinese version of the Communication Skills Attitude Scale (CSAS-Ch) in order to test the psychometric properties of the modified instrument. Design A cross-sectional study was conducted in September 2016 to evaluate the attitudes of Chinese medical students towards communication skills learning using CSAS at China Medical University. Participants The study recruited 510 fifth-year medical students by cluster sampling. Methods Cronbach’s α coefficients were calculated for the entire questionnaire and for the subscales to evaluate the internal consistency of the CSAS-Ch. In order to determine the structure underlying the CSAS, the scale was factor analysed using maximum likelihood extraction and the oblique rotation method. Results Of the 510 medical students, 492 (96.5%) completed the questionnaire. Cronbach’s α coefficient for the CSAS scale was 0.897. Exploratory factor analysis showed that the four-factor structure accounted for 59.8% of the variance and produced an acceptable fit to the data. Conclusions The modified CSAS-Ch can be used to evaluate attitudes towards communication skills. Further Future research for improving the teaching methods for communication skills should explore the relationship between medical students’ attitudes and the demographic characteristics.
Book
This book is a comparative study of how early childhood educational policies and initiatives in three countries—China, India, and the United States—have been utilized as both direct and indirect strategies for responding to fierce global economic competition. Human capital theory and cultural ecology theory serve as the conceptual framework for discussing how this has played out in each of the three countries. In addition, this book presents a discussion and analysis of how the beliefs, parents’ perspectives, and practices with regard to childrearing and the education of young children have both changed and remained the same in response to forces of globalization.
Article
One-only children have long been a research concern and previous studies have consistently found that one-only children posed academic advantages. However, we know very little about why one-only children scored higher in school examinations than their peers with siblings. Parental involvement might be the reason underlies this difference. This study compares the relationship between parental involvement and students’ academic achievement in families with only one child and families with more than one child in China. The results indicate that parents with only one child are more involved in their children’s learning compared with their counterparts with more than one child. The findings also suggest that parent-child communication and parent-child activities can positively predict one-only children’s academic performance, whereas parent-school contact negatively predicts non-only children’s academic performance. These findings highlight the complexity and importance of parental involvement in academic achievement and presents implications for future practice.
Article
Importance The I-PASS training bundle has been shown to improve communication errors during medical student and resident handoffs but has not been explored in the context of interprofessional care. Objective We examined the impact of an interprofessional I-PASS training on communication accuracy and completeness during the delivery of nurse-physician student handoffs. Design, participants, and setting A pre-post comparative design was used to evaluate the differential impact of training on sixty-three first year nursing students and sixty-nine first year medical students, as part of an interprofessional curricular intervention, at an integrated university campus. Intervention The interprofessional I-PASS training was adapted from the existing I-PASS: Medical Student Workshop by a team of interprofessional faculty and presented to nursing and medical students. Main measures Simulated patient handoffs were used to assess communication performance prior to and following training. Evaluation involved the transcription and scoring of all verbal units delivered during the nurse-physician student handoffs based on four levels of information accuracy: correct, missing, erred, and omitted. Proportional changes in verbal units produced during pre and post-training encounters were compared at the combine total and individual domain levels based on training, student type, gender, previous handoff experience, and their interactions. Results Significant improvements in the proportions of correct, erred, and omitted verbal units at the combined total levels were observed across students, all p < .001. Accounting for the greatest proportion of this change, was the variation in correct, erred, and omitted verbal units produced within the Patient Summary domain, all p < .001. Several training interactions were also observed involving gender, student type, and previous handoff experience. Discussion I-PASS training can improve communication accuracy and completeness during nurse-physician student handoffs. An event-based tool and coding procedure allowed for the identification of differential training impact based on individual handoff domains and provider demographics.