Keywords
academic stress - study habits - undergraduate students
Introduction
Stress may be viewed as an individual’s reaction to any change that requires an adjustment
or response, which can be physical, mental, or emotional. Stress and its manifestations
such as anxiety, depression, and burnout syndrome are commonly found in professionals.[1] University curriculum-based academic activities create more stress compared to primary
education.[2] The reason may be that in university education, students are going through a transitional
phase from adolescence to adulthood. Over these academic years, they try hard to adapt
to university life and overcome challenges. In addition to this, they are trying to
become financially and emotionally independent (not dependent on their families).[3]
The existing research studies revealed that perceived stress is higher in medical
students than nonmedical students.[4] Previous research also revealed that stress levels are high among nursing, pharmacy,
and physiotherapy students.[5] The cause may be responsibilities placed on these professions. Health care professions
have very little tolerance for mistakes.[5] Other sources which contribute to academic stress are exam-taking, academic workload,
grade competition, and a large number of skills to be mastered in a small amount of
time. When academic stress is taken negatively, it affects the students’ social and
psychological well-being.[6]
A study conducted in Norway revealed that undergraduate nursing students have more
distress than physiotherapy and occupational therapy students.[7] Another study conducted in Kathmandu University showed that 74% of nursing students
had high academic stress and 78% had low self-esteem.[8] Further, a study conducted in Pakistan by Sabih et al concluded that the prevalence
of stress among physiotherapy undergraduate students was 88%.[9] Besides, a study conducted at the University of Ghana revealed that 93.6% of the
students indicated that pharmacy education was stressful.[6]
Good study habits are essential for college and university students. The study habits
differ in the higher education system in comparison with primary education. The previous
research conducted in this area shows that most undergraduate students are unaware
of good study habits. They follow the traditional way of study, such as mugging up
without understanding practical application.[10] To support this, a study conducted by Kumar revealed that the majority of the students
do not follow effective study habits. This study also shows the majority of the students
(48%) spend less than 10 hours/week on the study and would not revise the topic at
home on the day of the lecture (58%).[11] Another study conducted by Looyeh et al revealed that undergraduate students study
habits are average.[12] Also, a survey conducted by Dehbozorgi and Mooseli found that 43.4% of the unsuccessful
students had no plans for learning.[12]
Many research studies support that academic stress is widespread among undergraduate
health care students, affecting their academic performance and mental health. But
there are very few research studies on the study habits of undergraduate health care
students. Therefore, the present study aims to find the study habits of undergraduate
students and their relation with academic stress, which could be the initial step
to plan the measure to relieve academic stress and improve undergraduate students’
study habits.
Methods
A quantitative research approach with a cross-sectional survey design was adopted
in the study. The study has followed all ethical guidelines such as obtaining institutional
ethics committee (IEC) (reference number: NUINS/CON/NU/IEC/2019-20/1479), taking informed
consent from the study participants. A total of 150 study participants were selected
by stratified random sampling technique (n = 150). For the study, second-year undergraduate nursing, pharmacy and physiotherapy
(from each batch, 50 students) students from Nitte (deemed to be university), Mangaluru,
were taken. The mean age of the study participants is 19.24 years, in the range between
18 and 23 years. The participants who had medical problems and other health issues
were excluded from the study. Participation in the study was purely on a voluntary
basis.
Data Collection Tool
Initially, demographic characteristics such as age, gender, type of family, monthly
family income residence, preuniversity exam marks, percentage of first-year marks,
and selection of course were collected.
Academic stress of the students was assessed by the Student Stress Inventory (SSI),
which was developed by Arip et al to measure the stress among university students.
SSI contains 40 negative items to measure 4 subscales (physical, interpersonal relationship,
academic factors, and environmental factors). Each subscale had 10 items. It is an
ordinal scale and has the option of never, somewhat frequent, frequent, and always.[13] Score less than 40 is considered as no stress, 40 to 80 considered mild stress,
81 to 121 moderate stress, and 122 to 160 is considered as severe stress.[10]
Students study habits were assessed by Palsane and Sharma Study Habit Inventory (PSSHI)
designed by Palsane and Sharma in India (1989). It is a three-option Likert scale
consists of 45 items, which assess the study habits of the students in eight areas,
including time management (5 items), physical conditions (6 items), learning motivation
(6 items), reading ability (8 items), note-taking (3 items), memory (4 items), and
health of study (3 items). Score 2 represents always or mostly, 1 represents sometimes,
and 0 represents rarely or never. The score ranges of the questionnaire are between
0 and 90. Score less than 56 indicates very unsatisfactory study habits, 57 to 58
indicates unsatisfactory, 59 to 64 indicates average, 65 to 67 good, and above 68
is excellent study habits.
The reliability of PSSHI and SSI was assessed by the split-half method. The calculated
Pearson–Brown coefficient was 0.8 for both the tools, which indicates that the tools
were reliable.
Statistical Analysis
The statistical analysis was done by using the Statistical Package for the Social
Sciences (SPSS-version 20, IBM Corp., Armonk, NY) and Jeffreys’s Amazing Statistics
Program (JASP Team (2020). JASP (Version 0.14.1)[Computer software]). Descriptive statistics were used to describe the demographic characteristic, study
habits, and academic stress. Welch test and analysis of variance (ANOVA) were used
to find the difference in the study habits and academic stress of university health
science undergraduate students. The relationship between academic stress and study
habits were found by using the Spearman correlation coefficient. Association between
academic stress and study habits with demographic variables were assessed by chi-square
test and likelihood ratio. For the present study, p-value less than 0.05 is considered as significant.
Results
Demographic Characteristics
[Table 1] represents the demographic characteristics of the study participants. Out of 150
study participants, most (74%) were women and their age group ranged between 18 and19
years. Most of them were staying in hostels (70%) and belonged to nuclear families
(88%). Also, majority of them had joined the course by their own interest (79.3%).
Table 1
Demographic characteristics of undergraduate students
|
Demographic characteristic (n = 150)
|
Frequency (f)
|
Percentage (%)
|
|
Age in years
|
18–19
|
107
|
71.3
|
|
20–21
|
41
|
27.33
|
|
22–23
|
2
|
1.3
|
|
Gender
|
Male
|
39
|
26
|
|
Female
|
111
|
74
|
|
Types of family
|
Nuclear
|
133
|
88.6
|
|
Joint
|
15
|
10
|
|
Extended
|
4
|
2.6
|
|
Monthly family income (Rs)
|
>100,000
|
11
|
7.3
|
|
50,000–100,000
|
27
|
18
|
|
30,000–50,000
|
57
|
38
|
|
<20,000
|
55
|
36.6
|
|
Residence
|
Hostel
|
105
|
70
|
|
Home
|
39
|
26
|
|
Paying guest
|
2
|
1.3
|
|
Rent
|
4
|
2.6
|
|
Preuniversity college percentage
|
>95%
|
6
|
4
|
|
85–94.9%
|
26
|
17.3
|
|
75–84.9%
|
54
|
36
|
|
70–74.9%
|
45
|
30
|
|
<70%
|
19
|
12.6
|
|
First-year marks in percentage
|
>90%
|
4
|
2.6
|
|
80–89.9%
|
29
|
19.3
|
|
70–79.9%
|
32
|
21.3
|
|
60–69.9%
|
74
|
49.3
|
|
<50%
|
11
|
7.3
|
|
Selection of course
|
By self
|
119
|
79.3
|
|
Parent’s force
|
12
|
8
|
|
Relative’s force
|
5
|
3.3
|
|
Any other
|
14
|
9.3
|
Study Habits of Undergraduate Students
[Fig. 1] depicts the level of study habits among 150 undergraduate students. It shows the
majority (62%) had very unsatisfactory study habits, 10% had unsatisfactory study
habits, 19.3% had an average study habit, 5.3% had good, and only 3.3% had excellent
study habits. The mean study habits score of undergraduate students were 52.7 ± 9.152
Fig. 1 Study habits of undergraduate students.
In [Table 2], the Welch test shows the significant difference in the study habits of nursing,
pharmacy, and physiotherapy undergraduate students, that is, H2 = 7.081, p = 0.029 ([Table 2]). Further, the post hoc test using Games–Howell correction showed that the nursing
students had a higher level of study habits than physiotherapy students (mean difference
= 5.280, p = 0.008). There was no significant difference found between study habits of nursing
and pharmacy (p = 0.366), and pharmacy and physiotherapy undergraduate students (p = 0.282).
Table 2
Difference between study habits of nursing, pharmacy, and physiotherapy undergraduate
students (n = 150)
|
Variable
|
Course type
|
N
|
Mean
|
Standard deviation
|
Welch (H)
|
p-Value
|
|
Note: The mean difference is significant at the 0.05 level.
|
|
Study habits
|
Nursing
|
50
|
55.24
|
1.030
|
4.706
|
0.011
|
|
Physiotherapy
|
50
|
49.96
|
1.379
|
|
Pharmacy
|
50
|
52.92
|
1.358
|
Academic Stress of Undergraduate Students
[Table 3] shows that among 150 students, the majority (64%) had mild academic stress, and
36% had a moderate level of stress. However, no students were there in the category
of no stress and severe level of stress. The mean stress score of undergraduate students
is 75.353 ± 16.463.
Table 3
Levels of academic stress among health science university students (n = 150)
|
Academic stress
|
Frequency
|
Percent
|
|
No stress
|
0
|
0
|
|
Mild stress
|
96
|
64.000
|
|
Moderate stress
|
54
|
36.000
|
Comparison of Academic Stress in Nursing, Pharmacy, and Physiotherapy Undergraduate
Students
As shown in [Table 4], the independent one-way ANOVA showed a significant difference between stress score
of nursing, pharmacy, and physiotherapy students, that is, F (2, 147) = 4.477, p = 0.013 (4). Further, the post hoc test using Tukey’s correction revealed that physiotherapy
students had a higher level of stress than pharmacy students (mean difference = 9.260,
p = 0.013). In contrast, there was no significant difference found in the stress level
between pharmacy and nursing (p = 0.083), and nursing and physiotherapy (p = 0.74) students.
Table 4
Difference in academic stress of nursing, pharmacy, and physiotherapy students (n
= 150)
|
Variable
|
Course Type
|
n
|
Mean
|
Standard deviation
|
F
|
p-Value
|
|
Note: The mean difference is significant at the 0.05 level.
|
|
Academic stress
|
Nursing
|
50
|
76.88
|
1.849
|
4.477
|
0.013
|
|
Physiotherapy
|
50
|
79.22
|
2.444
|
|
Pharmacy
|
50
|
69.96
|
2.479
|
Correlation between Academic Stress and Study Habits
[Table 5] shows a weak negative correlation between academic stress and study habits (r = -0.048). However, it was not statistically significant (p = 0.557).
Table 5
Pearson’s correlations between study habits and academic stress (n = 150)
|
Study habit–academic stress
|
Pearson’s r
|
p-Value
|
|
Note: The mean difference is significant at the 0.05 level.
|
|
−0.048
|
0.557
|
Association between Academic Stress and Study Habits with Demographical Variables
The likelihood ratio was computed and it was found that there was no significant association
between study habits and demographic variables except for gender (p = 0.021). Furthermore, there was a significant association found between stress level
and demographic variables such as course type, PUC percentage, and first-year percentage
(p-value 0.044, 0.04, and 0.044, respectively).
Discussion
Present study findings are consistent with the study conducted by Mendezabal, which
revealed that 239 Filipino students’ study habits were also ineffective and insufficient.[14] Also, a study conducted by Kumar on undergraduate students shown similar results.[11] In contrast, the study conducted by Jafari et al showed a mean score of study habits
among medical science students were 45.7 ± 11.36 out of 90, where 10% of them were
at a desirable level, 81.3% on a moderate level, and 8.7% were on an undesirable level
of study habits. Also, nursing and pharmacy students’ mean study habit score was 48.66
and 43.33, respectively.[15] One more study by Looyeh et al showed that the mean score of study habits of medical
science students, 48.35 ± 10.37, was considered as average level of study habits.[12] The dissimilarity in the findings may be due to the difference in the classification
of study habit scores and the study’s geographical area. Also, a self-reported tool
used in the study might have caused respondent bias.
In the present study, the prevalence of academic stress among undergraduate students
was 100% and no one in the category of no stress and severe stress. The stress level
ranged from mild to moderate, with a mean score of 75.353 ± 16.463. Also, physiotherapy
students had higher mean stress (79.220 ± 17.284) compared to nursing (76.880 ± 13.072)
and pharmacy (69.960 ± 17.528) students. Furthermore, there was a statistically significant
difference in mean stress scores found between physiotherapy and pharmacy students
(p = 0.013). The study results were consistent with the study conducted by Gupta et
al revealed that the prevalence of the stress among medical students was 91%.[16] A study conducted by Opoku-Acheampong et al also showed that 93.3% of pharmacy students
revealed that pharmacy education was stressful.[6] Furthermore, this study result was consistent with the study conducted by Admi et
al also showed that nursing students overall mean stress was mild to moderate.[17] Also, a study conducted by Sabih et al also showed that 88% of the physiotherapy
students showed mild to severe level of stress, which is consistent with our result.[9] In contrast, a study conducted by Nerdrum et al showed that nursing students had
more distresses compared to physiotherapy and occupational therapy students.[7] Besides, a study conducted by Sharifirad et al showed pharmacy students prevalence
of stress was higher (70.6%) in comparison with medicine (66.1%) and dentistry (62.5%)
students.[18]
In the present study, there was no significant relationship found between study habits
and academic performance. In addition, there was a significant association found between
gender and study habits. This result is consistent with the studies conducted by Looyeh
et al and Khan which showed gender has a significant impact on the study habits.[12]
[19]
There are many limitations to the study. Large sample size could have given a different
result. Also, the present study was limited to only undergraduate second-year nursing,
pharmacy, and physiotherapy students. Future research can be conducted by including
all the branches of medical and paramedical courses. Also, further study can be done
to explore the cause of stress among undergraduate students.
Conclusion
In general, the present study result showed study habits of the health science university
students are not satisfactory. Besides, they had a mild to moderate level of stress.
So, it is essential to identify the means and measures to improve study habits and
alleviate the stress of undergraduate students. Poor study habits and academic stress
may harm the academic success of the students. In this regard, teachers need to take
the necessary steps to correct the study habits of the students, as these skills are
learnable. As students of health professionals have a compact curriculum which may
be the reason, they may not get adequate time for relaxation. So it is very important
to bring changes in their academic routine. Including yoga and meditation in their
curriculum may help them relax, and life skill training programs may help them to
balance their academic and personal life.
