ICON College of Technology and Management
Department of Health and Social Care
BTEC HND in Health and Social Care
Coursework
Research Project
Tutor: Dr. Taghi Doostgharin
Submitted by
ID No: *****
Research title
Need for promoting cultural competence in health care in UK
Abstract
Cultural
competence is very urgent issue for the professionals who provide services to
the diverse populations. Both the professionals and the organization which
provides services to the wide diversified people should be competent in this
regard. The main purpose of the paper is
analyzing the important of cultural competence among the people who provide services
to the people in UK social and health care. In this study, both primary and
secondary data have been used. The study has been conducted based on positivism
research philosophy. Survey questionnaires have been used to gather data. Most
of the people are not satisfied with the current competency of the professional
in managing cultural diversity. It has been found that, the professionals who
provide services to the patient in UK social and health care should be
competent in cultural diversity as a well-diversified people are living in UK. They
must have respect to other cultures. They should have willingness to learn
other cultures.
Table of Contents
Chapter one: Introduction
1.2 Background of the study
Every
study has distinct Objective. Such as this study is to analyze the need for
cultural competence in social and health care and the study has been conducted
in context to UK, where a well-diversified cultural people are living. As the
people living in UK have different cultural background, so it is very much
important for the authorities to be aware about cultural issues when they
provide social and health care. One culture is different from another. A right
approach may be wrong in another culture. That is why, the people who are
related to social and health care should have competency in cultural issues. In
the late 1990s and mid 2000s a heap of social differences strategies rose, that
rolled out improvement in demography of Britain and perceives the need to
address social issues (Holland and Hogg, 2001). In case of mental disease cultural issues are
most vital to make the patients okay. The current study has been conducted to
analyze the significance of cultural competence for the people who are related
to social and health care sector. This study also has tried to find out the
ways to increase cultural competency in the people who are related to this
sector.
1.2 Research aim
To analyze importance of stimulating cultural
competence in UK in the term of health and social care
1.3 Research objective
- To analyze needs for promoting cultural competence in health care in UK
- To analyze current cultural competence level in UK heath care
- To find out the ways to promote cultural competence in heath care in UK
1.4 Research question
- Why promoting cultural competence in health care in UK is so important?
- What is the current cultural competence level in UK heath care?
- What are the ways to promote cultural competence in heath care in UK?
1.6 Key research methods
The
study has been conducted considering positive research philosophy as this
research philosophy is helpful to generate measurable and observable result. A
theoretical control can be established using this research philosophy. Deductive
approach has been used to examine the previous theories related to social and
health care. From a specific sector data has been gathered. Primary and
secondary data needs for making the concept clear and analysis. Using survey
questionnaire data has been gathered. Both qualitative and quantitative data
have been used to generate a very comprehensive result. Mixed method has been
used to gather both qualitative and quantitative data. Data has been analyzed
using SPSS and theoretical models of cultural issues in social and health care.
Data analysis has been presented using bar, pie and column charts.
1.7 Structure of the research
There
are five chapters in this study:
Chapter
one-Introduction: this chapter describes the study background and aim,
objectives and key methods.
Chapter
two- Literature review: It discusses the previous studies on cultural competent
in social and health care.
Chapter
three-Methodology: this chapter discusses research design and methods
Chapter
four- Analysis and findings: this chapter discusses data analysis and findings
Chapter
five- recommendation and conclusion: this chapter discusses conclusion and
recommendations and parts for supplementary study.
Chapter Two: Literature review
2.1 Introduction
Aim of the study is to analyze importance to
promote health and social care at cultural competence in UK. In this study, the
importance of promoting cultural awareness has been explained and then the ways
to increase cultural competence has been explained. That is why the theories related
to cultural issues especially in social and health care are the major concerns
for this part. Previous studies and developed theories have been discussed
first and then the argument against these studies and developed theories has
been provided. From this chapter, benchmarks had been set that have been used
to analyze and take decisions in this study.
2.2 Literature review
Cultural competence
“The Macpherson
Inquiry” article portrays an examination based preparing intercession. This
article incorporates the improvement and utilization of a social capability
evaluation device (O’Hagan, 2001). This
articles discusses about the challenges of cultural competence and the succeed
way to be competent in this issue. Lots of studies have been conducted on the
social and health care. Department of
Health and National Health Services have explained what actually refers
patients or staff which is not really easy for establishing. This article discusses these issues in a
brief (Kandola and Fullerton, 1998). This article has also a lack of defining
clients. In the UK health care, literature
and policy document are not clear. Cultural sensitivity and cultural awareness
are used synonymously. To ensure operation of cultural competence and its use
in proper way, it is very important to make clear what cultural competence
actually means. In most cases the
clients are nurses who provide services to the patients. This is additionally
pertinent for the wellbeing and social consideration specialists, suppliers of
administrations and those accused of the advancement of social capability
preparing programs.
Cultural competence is
characterized in different routes regarding the results for the customers and
bunches or as the disposition and the practices of the professionals and the
association or the mix of both. As per Holland and Hogg (2001) cultural
competence implies the capacity to expand affectability and minimize
heartlessness in the administration of culturally assorted groups. Cultural
competence requires learning, qualities and aptitudes. However a large portion
of these are essential learning and abilities which support any competency
preparing in various consideration callings. Success of the professionals
depends on their fruitful application in the work with different individuals
and groups that depend on an extraordinary arrangement upon cultural
mindfulness and states of mind and competency. The workers need not to be
highly knowledgeable in cultural issues rather they should have good approach
to different cultural people, openness and regard and enthusiasm to learn. Here
Self-awareness treats as much essential to be competent in cultural issues.
The importance of cultural competence
As the cultural
diversity has been increasing in the world in large portion, need for promoting
cultural awareness in caring sectors is also being increased (Kandola and
Fullerton, 1998). The social and health care association which gives
administration to mono-social populaces is feeling the skillful in expanded cultures.
The administration orders, health and social care arrangements, enactments,
health change targets, consumerism, contracting assets and monetary defense and
a large group of different activities demand social capability by the
associations and the experts (Gerrish and Papadopoulos, 1999). Absence of
confirm based transcultural nursing and look into information about the social
contrasts makes it troublesome for gave to convey and to customers to
experience quality, financially savvy care. Through there are similitudes among
the general population from distinctive parts of the world, there is disparity among
a large portion of the general population because of assortments society,
religions and family foundation and singular or bunch affecting care experience.
This difference sways the qualities, convictions and practices of the
customers. These distinctions support around the procurement of care and impact
the desires that the customers and specialists have to one another.
Developing cultural competence
Cultural capacity is
the ability to give viable health care thinking seriously about people groups;
social convictions, practices and needs. Social ability is the amalgamation of
a great deal of information and aptitudes that are procured amid individual and
expert live (Acheson, 1998).
Trans-cultural health is the study of cultural diversities and
seminaries in health care.
“The Papadopoulos,
Tilki and Taylor Model for developing cultural awareness” provides a calculated
guide for every stage as a rule no one but and can be adjusted to suit the
sorts and level of understudies (Kandola and Fullerton, 1998).
a. First stage- cultural
awareness: This stage begins with one’s personal value base and belief. One can
understand the nature and construction of his cultural identify. The person can
be more aware about his cultural background to shape his values, beliefs.
b. Second stage-Cultural
knowledge: Cultural knowledge can be picked up in distinctive ways. Powerful
correspondence with the general population of distinctive social foundation can
upgrade information about health convictions and practices and raise
understanding they confront.
c. Third stage: How
professional view people in their care: The professional needs to be careful to
provide service to the people of different cultures.
d. Fourth stage- The
achievement: Cultural fitness requires the combination and utilization of
beforehand picked up mindfulness, information and affectability. Further,
significance is given on handy aptitudes.
Chapter Three: Methodology
3.1 Methodology, Methods and technique
3.1.1 Research philosophy
According to Creswell
and Clark (2007) discuss about philosophy that refers to the perception of the
researcher towards the research issue. He also mentioned that, philosophy is
the knowledge and the ways to develop it. It is found that there have three
types of research philosophy and it is known as positivism, realism and
interpretive. In business and social science studies, positivism research
philosophy is mostly used. Using positivism research philosophy measurable and
observable result can be generated as this philosophy deals with measurable and
observable data. According to Franklin (2012) audiences can be convinced with
measurable data easily. In fact audiences expect to get measurable data.
Moreover, if positivism research philosophy is used, a theoretical framework
can be developed previously. As a result, the researcher can establish control
on the study. In this study, to get the
measurable outcomes positivism research philosophy has been considered.
3.1.2 Research approach
Dewberry (2004)
mentioned that there are two types of research approaches widely used in social
science study and these are; Inductive and deductive. There are some basic
differences between inductive and deductive. Inductive methodology is utilized
to produce new hypotheses. Then again, deductive methodology is utilized to
look at the current hypotheses. There is not hypothetical limit to assemble
information when inductive methodology is utilized. Then again, there is a
hypothetical limit to accumulate information, when deductive approach is
used. In deductive approach assumptions
can be set at the beginning of the study to test the appropriateness of the
existing theories. In this study, data has been gathered from particular
sources and deductive has been considered.
3.1.3 Research methods
There are three types
of research methods; qualitative, quantitative and mixed (Bell, 2010).
Quantitative method is used when quantitative issues are considered to conduct
the study. On the other hand, qualitative method is used when qualitative
issues are considered. On the other hand, if both qualitative and quantitative
issues are considered then mixed or hybrid method should be considered. In
fact, mixed method is the method where we find qualitative and quantitative
method. Here, both quantitative and qualitative
issued has considered and that is why, mixed or hybrid method has been used.
3.1.4 Data type
Data has been classified
into qualitative and quantitative. Quantitative data can be expressed
mathematically while qualitative data cannot be expressed in such way.
According to Creswell (2012) to create a thorough result, both qualitative and
quantitative information ought to be utilized. That is why, in this study, both
qualitative and quantitative data have been used. Another arrangement of data
is primary and secondary. Primary data can be gathered from the respondents as
crude information. Secondary data can be gathered from books, articles,
diaries, magazines and daily papers. To augment acknowledgment of essential
information, optional information ought to be utilized. That is the reason, in
this study, both essential and optional information have been utilized.
3.2 Sampling
All the citizens of
UK are related to the social and health care services. However, it is not
possible to deal with the total population. That is why; a small portion has
been selected by sampling method. In this study, 40 respondents who are
directly related to social and health care have been selected using random
sampling method. Both experts and
patients from different cultures have been considered in this regard.
3.3 Data collection
Both primary and
secondary data have been collected from proper way. We collect Primary data
from 40 respondents using survey questionnaire. Main reason of using survey questionnaire
is to safe time. There are five measure scales in the survey questionnaire;
·
Strongly agree (1)
·
Agree (2)
·
Neutral (3)
·
Disagree (4)
·
Strongly disagree (5)
Secondary data has
been collected from books, magazines, articles, journal s and also from
newspaper. Data has been analyzed using
SPSS and theoretical models of cultural competence in health and social care.
3.4 Ethical consideration
In this study,
ethical and moral issues have been maintained properly. Data has been collected
and stored properly. Privacy of the respondents has been protected by not
disclosing their personal information.
The respondents have been convinced that, the study would be conducted
only for academic purpose. Risk related to animal and environment has been
avoided totally. Directions provided by the supervisors have been followed
properly.
Chapter Four: Data collection and analysis
4.1 Data collection
Sample questionnaire
Demographic
information
Gender
|
|
Frequency
|
Percent
|
Valid Percent
|
Cumulative Percent
|
|
|
Valid
|
male
|
20
|
50.0
|
50.0
|
50.0
|
|
female
|
20
|
50.0
|
50.0
|
100.0
|
|
|
Total
|
40
|
100.0
|
100.0
|
|
|
In this study both
male and female have been considered as the respondents. Data has been
collected from 20 male and 20 female.
Age
|
|
Frequency
|
Percent
|
Valid Percent
|
Cumulative Percent
|
|
|
Valid
|
20-30
|
8
|
20.0
|
20.0
|
20.0
|
|
31-40
|
8
|
20.0
|
20.0
|
40.0
|
|
|
41-50
|
20
|
50.0
|
50.0
|
90.0
|
|
|
above 40
|
4
|
10.0
|
10.0
|
100.0
|
|
|
Total
|
40
|
100.0
|
100.0
|
|
|
Data has been
collected from people of different ages. 20% were from the range 20-30, 20%
from 31-40, 50% were from 41-50 and the remaining was from above 50 years old.
Education
|
|
Frequency
|
Percent
|
Valid Percent
|
Cumulative Percent
|
|
|
Valid
|
up to secondary
|
8
|
20.0
|
20.0
|
20.0
|
|
Graduation
|
8
|
20.0
|
20.0
|
40.0
|
|
|
Post-graduation
|
24
|
60.0
|
60.0
|
100.0
|
|
|
Total
|
40
|
100.0
|
100.0
|
|
|
Perception can vary
based on educational background. That is why, in this study, data has been
collected from the people with different level of educational background.
Professional/Patient:
|
|
Frequency
|
Percent
|
Valid Percent
|
Cumulative Percent
|
|
|
Valid
|
Professional
|
12
|
30.0
|
30.0
|
30.0
|
|
Patients
|
28
|
70.0
|
70.0
|
100.0
|
|
|
Total
|
40
|
100.0
|
100.0
|
|
|
Data has been
collected both from the professionals and the patients living in UK. In this
study, 30% respondents are professionals while 70% are patients.
Q-1:
Do you think that cultural diversity is an urgent issue to manage in UK social
and health care?
|
|
||
|
N
|
Valid
|
40
|
|
Missing
|
0
|
|
|
Mean
|
2.0000
|
|
|
Median
|
2.0000
|
|
|
Mode
|
2.00
|
|
|
Std. Deviation
|
.90582
|
|
|
Percentiles
|
1
|
1.0000
|
|
2
|
1.0000
|
|
|
3
|
1.0000
|
|
|
4
|
1.0000
|
|
|
5
|
1.0000
|
|
|
|
Frequency
|
Percent
|
Valid Percent
|
Cumulative Percent
|
|
|
Valid
|
strongly agree
|
12
|
30.0
|
30.0
|
30.0
|
|
agree
|
20
|
50.0
|
50.0
|
80.0
|
|
|
neutral
|
4
|
10.0
|
10.0
|
90.0
|
|
|
disagree
|
4
|
10.0
|
10.0
|
100.0
|
|
|
Total
|
40
|
100.0
|
100.0
|
|
|
From
the above data analysis it has been found that most of the respondents think
that cultural diversity is an urgent issue to manage in UK social and health
care.
Q-2:-
To provide social and health care efficiently the professional must be
competent in cultural diversity. Do you agree with that statement?
|
|
||||||||
|
N
|
Valid
|
40
|
||||||
|
Missing
|
0
|
|||||||
|
Mean
|
2.0000
|
|||||||
|
Median
|
2.0000
|
|||||||
|
Mode
|
2.00
|
|||||||
|
Std. Deviation
|
.90582
|
|||||||
|
Percentiles
|
1
|
1.0000
|
||||||
|
2
|
1.0000
|
|||||||
|
3
|
1.0000
|
|||||||
|
4
|
1.0000
|
|||||||
|
5
|
1.0000
|
|||||||
|
|
Frequency
|
Percent
|
Valid Percent
|
Cumulative Percent
|
||||
|
Valid
|
strongly agree
|
12
|
30.0
|
30.0
|
30.0
|
|||
|
agree
|
20
|
50.0
|
50.0
|
80.0
|
||||
|
neutral
|
4
|
10.0
|
10.0
|
90.0
|
||||
|
disagree
|
4
|
10.0
|
10.0
|
100.0
|
||||
|
Total
|
40
|
100.0
|
100.0
|
|
||||
Here,
80% respondents believe that, to provide social and health care efficiently the
professional must be competent in managing cultural diversity.
Q-3:
Are you satisfied with the current cultural competency in the professionals of
social and health care in UK?
|
N
|
Valid
|
40
|
|
Missing
|
0
|
|
|
Mean
|
3.3000
|
|
|
Median
|
4.0000
|
|
|
Mode
|
4.00
|
|
|
Std. Deviation
|
1.20256
|
|
|
Percentiles
|
1
|
1.0000
|
|
2
|
1.0000
|
|
|
3
|
1.0000
|
|
|
4
|
1.0000
|
|
|
5
|
1.0000
|
|
|
|
Frequency
|
Percent
|
Valid Percent
|
Cumulative Percent
|
|
|
Valid
|
strongly agree
|
4
|
10.0
|
10.0
|
10.0
|
|
agree
|
8
|
20.0
|
20.0
|
30.0
|
|
|
neutral
|
4
|
10.0
|
10.0
|
40.0
|
|
|
disagree
|
20
|
50.0
|
50.0
|
90.0
|
|
|
strongly disagree
|
4
|
10.0
|
10.0
|
100.0
|
|
|
Total
|
40
|
100.0
|
100.0
|
|
|
It
has been found that, 60% respondents are not satisfied with the current
cultural competence of the professionals in UK social and health care. Howver,
30% are satisfied.
Q-4:
Do you think that the professional obviously need to be competent in this issue
to ensure better service?
|
N
|
Valid
|
40
|
||||||
|
Missing
|
0
|
|||||||
|
Mean
|
2.0000
|
|||||||
|
Median
|
2.0000
|
|||||||
|
Mode
|
2.00
|
|||||||
|
Std. Deviation
|
.90582
|
|||||||
|
Percentiles
|
1
|
1.0000
|
||||||
|
2
|
1.0000
|
|||||||
|
3
|
1.0000
|
|||||||
|
4
|
1.0000
|
|||||||
|
5
|
1.0000
|
|||||||
|
|
Frequency
|
Percent
|
Valid Percent
|
Cumulative Percent
|
||||
|
Valid
|
strongly agree
|
12
|
30.0
|
30.0
|
30.0
|
|||
|
agree
|
20
|
50.0
|
50.0
|
80.0
|
||||
|
neutral
|
4
|
10.0
|
10.0
|
90.0
|
||||
|
disagree
|
4
|
10.0
|
10.0
|
100.0
|
||||
|
Total
|
40
|
100.0
|
100.0
|
|
||||
Most
of the respondents think that, the professionals must be competent in managing
cultural diversity to ensure better service.
Q-5:
How the professional can be competent in cultural diversity to provide best
services to the well diversified people?
The
respondents mentioned that willingness is very much essential to be competent
in cultural diversity. The professional should have interest to learn. They
should have respect to other cultures. They must avoid racism and the issue
like that. To be competent they can participate in training and development
programs. However, practical knowledge is most helpful to be competent in
managing cultural diversity.
4.2 Data analysis and discussion
In this study it has
been found that, managing cultural diversity is an urgent and challenging
job. In UK a well-diversified people are
living. They have different types of cultural background. A right approach can be thought as wrong in
another culture. That is the difficulty.
In case of mental patients this issues works more seriously. Most of the
respondents think that the in UK health and social care, managing cultural
diversity is a very urgent job. It has
also been found that, the professionals must be competent in managing cultural
diversity to provide service efficiently. If the professionals are competent in
this regard, they can provide service at minimum cost. It has been found that, most of the
respondents are not satisfied with the cultural competence of the professionals
who are currently providing service in social and health care. The respondents
think that the professionals must be competent to provide social and health
care efficiently. They should have that willingness is very much essential to
be competent in cultural diversity. The professional should have interest to
learn. They should have respect to other cultures. They must avoid racism and
the issue like that. To be competent they can participate in training and
development programs. However, practical knowledge is most helpful to be
competent in managing cultural diversity.
Chapter Five: Conclusion and recommendation
5.1 Conclusion
Cultural
diversity is currently a concerning issue to handle in UK social and health
care. The professionals should be competent in managing cultural diversity. One
culture is different from another. A right job might be wrong in another
culture and that is the problem. The organization which provides service to
mono-cultural people is in challenge to handle the people from different
cultures. In most of the cases they cannot provide service efficiently. They
cannot understand the patients from different cultures. Most of the people
think that, most of the professionals are not skilled in this regard in UK
social and health care. They should be competent in managing cultural diversity
to provide service efficiently in social and health care.
5.2 Recommendations
To
be competent the professional should;
a. the professional must have
willingness to learn other cultures
b. they should have respect to
other cultures
c. they should attain in
culture competence training
d. whole organization should
be competent in cultural diversity
5.3 Areas for further study
In future the study
can be conducted on how to increase cultural competent and the sample size can
be larger.
Reference
- Acheson D. (chair) (1998) Independent inquiry into inequalities in health. The Stationery Office, London.
2.
Bell, J., 2010. Doing your research project. 5th edition. ISBN
0335235824
3.
Best, J, W. and Kahn, J, V., 2005. Research in education. 10th
edition. ISBN 0205458408
4. Creswell, J. W. and Clark,
V. L., 2007. Designing and conducting
mixed methods research. Thousand Oaks, CA: Sage.
5. Creswell, J. W., 2012. Qualitative
inquiry and research design: Choosing among five traditions (3rd edition).
Thousand Oaks, CA: Sage
6. Dewberry, C., 2004. Statistical Methods for Organizational
Research: Theory and Practice. Routledge
7. Franklin, M., 2012. Understanding Research: Coping with the
Quantitative - Qualitative Divide. Routledge
- Gerrish K. & Papadopoulos I. (1999) Transcultural competence: The challenge for nurse education. British Journal of Nursing 8 (21), 1453-1457.
- Holland K. & Hogg C. (2001) Cultural awareness in nursing and health care. Arnold, London.
- Kandola R. & Fullerton J. (1998) Diversity in action: Managing the mosaic. Institute of Personnel Development, London.
- O’ Hagan K. (2001) Cultural Competence in the caring professions. Jessica Kingsley, London.
Appendices 1
Sample questionnaire
Demographic
information
|
Q-1:
Do you think that cultural diversity is an urgent issue to manage in UK social
and health care?
|
Strongly agree
|
Agree
|
Neutral
|
Disagree
|
Strongly disagree
|
|
|
|
|
|
|
Q-2:-
To provide social and health care efficiently the professional must be
competent in cultural diversity. Do you agree with that statement?
|
Strongly agree
|
Agree
|
Neutral
|
Disagree
|
Strongly disagree
|
|
|
|
|
|
|
Q-3:
Are you satisfied with the current cultural competency in the professionals of
social and health care in UK?
|
Strongly agree
|
Agree
|
Neutral
|
Disagree
|
Strongly disagree
|
|
|
|
|
|
|
Q-4:
Do you think that the professional obviously need to be competent in this issue
to ensure better service?
|
Strongly agree
|
Agree
|
Neutral
|
Disagree
|
Strongly disagree
|
|
|
|
|
|
|
Q-5:
How the professional can be competent in cultural diversity to provide best
services to the well diversified people?
|
|
Appendices 2
Data summary
|
Respondents
|
Q-1
|
Q-2
|
Q-3
|
Q-4
|
|
1
|
1
|
1
|
1
|
1
|
|
2
|
1
|
1
|
1
|
1
|
|
3
|
1
|
1
|
1
|
1
|
|
4
|
1
|
1
|
1
|
1
|
|
5
|
1
|
1
|
2
|
1
|
|
6
|
1
|
1
|
2
|
1
|
|
7
|
1
|
1
|
2
|
1
|
|
8
|
1
|
1
|
2
|
1
|
|
9
|
1
|
1
|
2
|
1
|
|
10
|
1
|
1
|
2
|
1
|
|
11
|
1
|
1
|
2
|
1
|
|
12
|
1
|
1
|
2
|
1
|
|
13
|
2
|
2
|
3
|
2
|
|
14
|
2
|
2
|
3
|
2
|
|
15
|
2
|
2
|
3
|
2
|
|
16
|
2
|
2
|
3
|
2
|
|
17
|
2
|
2
|
4
|
2
|
|
18
|
2
|
2
|
4
|
2
|
|
19
|
2
|
2
|
4
|
2
|
|
20
|
2
|
2
|
4
|
2
|
|
21
|
2
|
2
|
4
|
2
|
|
22
|
2
|
2
|
4
|
2
|
|
23
|
2
|
2
|
4
|
2
|
|
24
|
2
|
2
|
4
|
2
|
|
25
|
2
|
2
|
4
|
2
|
|
26
|
2
|
2
|
4
|
2
|
|
27
|
2
|
2
|
4
|
2
|
|
28
|
2
|
2
|
4
|
2
|
|
29
|
2
|
2
|
4
|
2
|
|
30
|
2
|
2
|
4
|
2
|
|
31
|
2
|
2
|
4
|
2
|
|
32
|
2
|
2
|
4
|
2
|
|
33
|
3
|
3
|
4
|
3
|
|
34
|
3
|
3
|
4
|
3
|
|
35
|
3
|
3
|
4
|
3
|
|
36
|
3
|
3
|
4
|
3
|
|
37
|
4
|
4
|
5
|
4
|
|
38
|
4
|
4
|
5
|
4
|
|
39
|
4
|
4
|
5
|
4
|
|
40
|
4
|
4
|
5
|
4
|