Factors Affecting Resilience of Nursing, Optometry, Radiography and Medical Laboratory Science Students
Abstract
:1. Introduction
1.1. Studies into the Resilience of Health-Care Students
1.2. Factors Affecting the Resilience of Health-Care Students
1.3. Hong Kong Context
2. Methods
2.1. Study Design and Subjects
2.2. Instruments
- Demographic data included factors such as age, gender, marital status, discipline of study, year of study, cumulative grade-point average, living situation (alone/with family), religious belief, reasons for studying health care, any responsibility for dependent family members, financial assistance, any scholarship from the government or university and having a paid job.
- The 10-item General Self-Efficacy Scale (GSE) is used to measure an individual’s ability to cope effectively with different stressful situations [36]. This scale employs a four-point Likert scale, with scores ranging from 1 = not at all true to 4 = exactly true. The summation score (10–40) was used for analysis, with a higher score indicating a greater sense of self-efficacy [36]. The internal consistency was found to be high, from α = 0.76 to α = 0.90 [13,36]. The GSE has good validity and has been found to be correlated positively with self-esteem and optimism and negatively with depression, loneliness, anxiety, shyness and pessimism in both men and women [37]. In our study, α = 0.866.
- The 12-item Cognitive and Affective Mindfulness Scale, Revised (CAMS-R) measures a vast conceptualization of mindfulness that represents factors of awareness, internal experience, present moment focus, attention control and acceptance of experience [38]. In this study, the participants were asked to rate their responses on a four-point Likert scale, with scores ranging from 1 = rarely/not at all to 4 = almost always. Items 2, 6 and 7 were reverse-scored. Score summation was used for analysis, with a higher score representing higher levels of mindfulness consciousness. The discriminant validity of CAMS-R is established with the concurrent use of mindfulness, distress, well-being, emotion-regulation and problem-solving approaches [38]. Its internal consistency was found to be acceptable: α = 0.76 [38] and 0.80 [13]. In our study, α = 0.660.
- The 20-item Positive and Negative Affect Scale (PANAS) measures participants’ overall emotional states at a particular time [24], with 10 items each for positive affect (PA) and negative affect (NA). A five-point Likert Scale is used, with scores ranging from 1 = very slightly or not at all to 5 = extremely. In the present study, the time instruction “generally” was used to measure trait-based affectivity for trait positive affect (TPA) and trait negative affect (TNA). The summation of scores (10–50) was used for analysis; for TPA, higher scores represented higher levels of positive affect, while for TNA, higher scores indicated more negative moods. The PANAS has been used frequently in research and clinical settings [24]. It demonstrates an excellent internal consistency ranging from α = 0.86 to α = 0.90 for PA and from α = 0.84 to α = 0.87 for NA [13,24]. In our study, α = 0.897 for PA and α = 0.873 for NA.
- The 28-item Brief Cope Scale (BCS) measures adaptive and maladaptive coping skills using a four-point Likert scale (1 = I have not been doing this at all, and 4 = I have been doing this a great deal) [39]. These items were categorized into 14 scales (with two items each). The internal consistency for the 14 scales was as follows: active coping (α = 0.76, 0.68), planning (α = 0.73, 0.73), positive reframing (α = 0.78, 0.64), acceptance (α = 0.70, 0.57), humor (α = 0.72, 0.73), religion (α = 0.83, 0.82), using emotional support (α = 0.73, 0.71), using instrumental support (α = 0.82, 0.64), self-distraction (α = 0.54, 0.71), denial (α = 0.62, 0.54), venting (α = 0.58, 0.50), substance use (α = 0.89, 0.90), behavioral disengagement (α = 0.71, 0.65) and self-blame (α = 0.72, 0.69) ([13] vs [39] for the alphas). A summation of each subscale was used for analysis in this study. Higher scores in that scale indicated a higher utilization of that specific way of coping. In our study, α ranged from 0.384 to 0.892.
2.3. Data Analysis
3. Results
3.1. Demographics of the Students
3.2. Differences among Health Care Students in Five Study Scales
3.3. Predictors of Resilience among Health-Care Students
- Total sample: nine predictors (R2 = 0.648): high self-efficacy (t = 13.44), positive mindfulness (t = 12.89), high positive affect (t = 6.17), low negative affect (t = −6.51), positive denial (t = 16.08), negative behavioral disengagement (t = −6.37), positive reframing (t = 2.50), positive humor (t = 4.12) and high acceptance (t = 2.70).
- Nursing students: nine predictors (R2 = 0.658): high self-efficacy (t = 11.59), positive mindfulness (t = 12.81), high positive affect (t = 5.13), low negative affect (t = −5.19), positive denial (t = 14.81), negative behavioral disengagement (t = −6.17), positive reframing (t = 3.24), positive humor (t = 2.96) and positive acceptance (t = 3.28).
- Medical laboratory students: six predictors (R2 = 0.629): high self-efficacy (t = 5.13), high positive affect (t = 2.86), low negative affect (t = −4.05), positive denial (t = 2.99), positive humor (t = 2.40) and low self-blame (t = −2.24).
- Radiography students: three predictors (R2 = 0.532): high self-efficacy (t = 2.05), positive mindfulness (t = 2.84) and positive denial (t = 2.69).
- Optometry students: four predictors (R2 = 0.755): high self-efficacy (t = 4.97), positive mindfulness (t = 2.03), active coping (t = 2.23) and positive denial (t = 2.44).
4. Discussion
4.1. Differences in Independent Variables in Health-Care Students
4.2. Differences in Resilience in Health-Care Students
4.3. Similarities and Differences in Predictors of Resilience among Health-Care Students
4.4. Implications
4.5. Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Acknowledgments
Conflicts of Interest
References
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Characteristics of Students | Total (N = 1320) n (%) | Nursing (N = 1070) n (%) (A) | Medical Laboratory Science (N = 133) n (%) (B) | Radiography (N = 65) n (%) (C) | Optometry (N = 52) n (%) (D) | Comparison among Different Groups of Students χ2, df, Phi, p | Post-Hoc Test # (A = Nursing; B = Medical Laboratory Science; C = Radiography; D = Optometry) |
---|---|---|---|---|---|---|---|
Age | 109.63, 9, 0.29, p < 0.001 ** | ||||||
≤18 | 68 (5.2) | 49 (4.6) | 18 (13.5) | 1 (1.5) | 0 (0.0) | (A,B) (B,C) | |
19–20 | 457 (34.7) | 314 (29.4) | 68 (51.1) | 39 (60.0) | 36 (69.2) | (A,B) (A,C) (A,D) | |
21–22 | 515 (39.1) | 447 (41.9) | 37 (27.8) | 21 (32.3) | 10 (19.2) | (A,B) (A,D) | |
≥23 | 277 (21.0) | 257 (24.1) | 10 (7.5) | 4 (6.2) | 6 (11.5) | (A,B) (A,C) | |
Gender | 82.80, 3, 0.26, p < 0.001 ** | ||||||
Male | 380 (29.9) | 261 (25.2) | 47 (37.9) | 47 (73.4) | 25 (51.0) | ||
Female | 891 (70.1) | 773 (74.8) | 77 (62.1) | 17 (26.6) | 24 (49.0) | (A,B) (A,C) (A,D) (B,C) | |
Marital status | 4.15, 3, 0.06, p = 0.25 | ||||||
Single | 1298 (98.6) | 1052 (98.5) | 133 (100.0) | 62 (96.9) | 51 (100.0) | ||
Non-single | 18 (1.4) | 16 (1.5) | 0 (0.0) | 2 (3.1) | 0 (0.0) | ||
Year of study | 269.39, 9, 0.45, p < 0.001 ** | ||||||
Year 1 | 243 (18.4) | 200 (18.7) | 43 (32.3) | 0 (0.0) | 0 (0.0) | (A,B) | |
Year 2 | 208 (15.8) | 173 (16.2) | 35 (26.3) | 0 (0.0) | 0 (0.0) | (A,B) | |
Year 3 | 481 (36.4) | 322 (30.1) | 42 (31.6) | 65 (100) | 52 (100) | ||
Year 4 | 388 (29.4) | 375 (35.0) | 13 (9.8) | 0 (0.0) | 0 (0.0) | (A,B) | |
Cumulative grade Point average | 170.98, 9, 0.36, p < 0.001 ** | ||||||
2–2.5 | 95 (7.3) | 85 (8.1) | 4 (3) | 1 (1.6) | 5 (9.6) | ||
2.6–3 | 550 (42.3) | 496 (47.2) | 24 (18.2) | 14 (21.9) | 16 (30.8) | (A,B)(A,C) | |
3.1–3.5 | 552 42.5) | 429 (40.8) | 65 (49.2) | 40 (62.5) | 18 (34.6) | (A,C)(C,D) | |
≥3.6 | 102 (7.9) | 41 (3.9) | 39 (29.5) | 9 (14.1) | 13 (25.0) | (A,B)(A,C)(A,D) | |
Living | 5.24, 3, 0.06, p = 0.16 | ||||||
With family | 1213 (92.8) | 983 (92.7) | 127 (95.5) | 61 (93.8) | 42 (85.7) | ||
Alone | 94 (7.2) | 77 (7.3) | 6 (4.5) | 4 (6.2) | 7 (14.3) | ||
Religious beliefs | 4.92, 3, 0.06, p = 0.18 | ||||||
No | 956 (72.8) | 761 (71.6) | 101 (75.9) | 53 (81.5) | 41 (78.8) | ||
Yes | 357 (27.2) | 302 (28.4) | 32 (7.2) | 12 (18.5) | 11 (21.2) | ||
Reasons of studying | 25.30, 3, 0.14, p < 0.001 ** | ||||||
One of the reasons a | 339 (25.7) | 270 (25.2) | 26 (19.5) | 33 (50.8) | 10 (19.2) | ||
Multiple reasons b | 981 (74.3) | 800 (74.8) | 107 (80.5) | 32 (49.2) | 42 (80.8) | (A,C)(B,C)(C,D) | |
Family responsibility | 18.98, 3, 0.12, p < 0.001 ** | ||||||
None | 1080 (82.1) | 899 (84.3) | 96 (72.2) | 48 (75.0) | 37 (71.2) | ||
Dependent c | 235 (17.9) | 167 (15.7) | 37 (27.8) | 16 (25.0) | 15 (28.8) | (A,B) | |
Financial assistance | 13.93, 3, 0.10, p = 0.003 ** | ||||||
No | 727 (55.3) | 563 (52.9) | 88 (66.2) | 41 (64.1) | 35 (67.3) | ||
More than one source of assistance | 587 (44.7) | 502 (47.1) | 45 (33.8) | 23 (35.9) | 17 (32.7) | (A,B) | |
Scholarship from government | 10.57, 3, 0.09, p = 0.01 * | ||||||
No | 1259 (96.4) | 1027 (97.1) | 127 (95.5) | 57 (90.5) | 48 (92.3) | ||
Yes | 47 (3.6) | 31 (2.9) | 6 (4.5) | 6 (9.5) | 4 (7.7) | (A,C) | |
Scholarship from university/hospital | 50.21, 3, 0.20, p < 0.001 ** | ||||||
No | 1195 (91.5) | 994 (94.0) | 103 (77.4) | 56 (88.9) | 42 (80.8) | ||
Yes | 111 (8.5) | 64 (6.0) | 30 (22.6) | 7 (11.1) | 10 (19.2) | (A,B)(A,D) | |
Paid job | 5.24, 3, 0.06, p = 0.16 | ||||||
No | 506 (38.5) | 406 (38.1) | 47 (35.3) | 33 (51.6) | 20 (38.5) | ||
Yes | 808 (61.5) | 659 (61.9) | 86 (64.7) | 31 (48.4) | 32 (61.5) |
Study Scales | Total (N = 1320) Mean, SD | Nursing (N = 1070) Mean, SD (A) | Medical Laboratory Science (N = 133) Mean, SD (B) | Radiography (N = 65) Mean, SD (C) | Optometry (N = 52) Mean, SD (D) | One-Way ANOVA | Post-Hoc Test # (A = Nursing; B = Medical Laboratory Science; C = Radiography; D = Optometry) |
---|---|---|---|---|---|---|---|
CD-RISC | 23.35, 5.43 | 23.29, 5.32 | 24.19, 5.22 | 23.75, 6.45 | 22.10, 6.63 | F(3, 1316) = 2.15, p = 0.09 | |
GSE | 26.98, 3.75 | 26.85, 3.69 | 27.65, 3.86 | 28.43, 3.97 | 26.19, 3.94 | F(3, 1316) = 5.89, p = 0.001 ** | (A,C)(C,D) |
CAMS-R | 31.93, 3.48 | 31.98, 3.45 | 32.37, 3.63 | 31.43, 3.23 | 30.52, 3.72 | F(3, 1316) = 4.10, p = 0.007 ** | (A,D)(B,D) |
PANAS | |||||||
PAS | 27.25, 6.43 | 27.36, 6.37 | 26.94, 6.80 | 26.11, 7.18 | 27.08, 5.80 | F(3, 1316) = 0.90, p = 0.44 | |
NAS | 22.04, 7.60 | 21.94, 7.41 | 21.07, 8.08 | 22.69, 9.04 | 25.75, 7.31 | F(3, 1316) = 5.13, p = 0.002 ** | (A,D)(B,D) |
BCS | |||||||
Self-distraction | 5.53, 1.04 | 5.53, 1.01 | 5.65, 1.10 | 5.43, 1.05 | 5.33, 1.38 | F(3, 1316) = 1.49, p = 0.22 | |
Active coping | 5.61, 0.87 | 5,63, 0.85 | 5.59, 0.90 | 5.52, 0.90 | 5.38, 1.12 | F(3, 1316) = 1.51, p = 0.21 | |
Denial | 4.99, 1.07 | 4.94, 1.04 | 5.23, 1.16 | 5.37, 1.21 | 4.90, 1.12 | F(3, 1316) = 5.76, p < 0.001 ** | (A,B)(A,C) |
Substance use | 2.85, 1.40 | 2.82, 1.38 | 2.70, 1.33 | 3.78, 1.72 | 2.65, 1.06 | F(3, 1316) = 10.90, p < 0.001 ** | (A,C)(B,C)(C,D) |
Use of emotional support | 5.40, 1.19 | 5.44, 1.17 | 5.23, 1.19 | 5.40, 1.16 | 5.08, 1.57 | F(3, 1316) = 2.48, p = 0.06 | |
Useof instrumental support | 5.47, 1.23 | 5.53, 1.18 | 5.22, 1.39 | 5.31, 1.24 | 5.04, 1.53 | F(3, 1316 )= 5.30, p = 0.001 ** | (A,B)(A,D) |
Behavioral disengagement | 4.11, 1.28 | 4.08, 1.26 | 4.18, 1.35 | 4.52, 1.32 | 3.94, 1.14 | F(3, 1316) = 2.87, p = 0.04 * | (A,C) |
Venting | 5.07, 1.10 | 5.09, 1.08 | 4.98, 1.24 | 5.17, 1.08 | 4.85, 1.09 | F(3, 1316) = 1.24, p = 0.29 | |
Positive reframing | 5.38, 1.02 | 5.40, 1.00 | 5.35, 1.17 | 5.37, 0.98 | 5.15, 1.09 | F(3, 1316) = 1.01, p = 0.39 | |
Planning | 5.32, 0.97 | 5.32, 0.95 | 5.28, 1.08 | 5.46, 0.94 | 5.17, 1.13 | F(3, 1316) = 0.94, p = 0.42 | |
Humor | 4.82, 1.31 | 4.83, 1.30 | 4.73, 1.44 | 5.02, 1.17 | 4.52, 1.38 | F(3, 1316) = 1.62, p = 0.18 | |
Acceptance | 5.71, 0.96 | 5.74, 0.91 | 5.64, 1.09 | 5.71, 1.01 | 5.33, 1.32 | F(3, 1316) = 3.31, p = 0.02 * | (A,D) |
Religion | 4.41, 1.63 | 4.48, 1.63 | 4.14, 1.68 | 4.48, 1.45 | 3.71, 1.50 | F(3, 1316) = 5.06, p = 0.002 ** | (A,D) |
Self-blame | 4.79, 1.26 | 4.79, 1.23 | 4.65, 1.42 | 5.09, 1.17 | 4.77, 1.46 | F(3, 1316) = 1.78, p = 0.15 |
Variables | Total (N = 1320) R2 0.648 | Nursing (N = 1070) R2 0.658 | Medical Laboratory Science (N = 133) R2 0.629 | Radiography (N = 65) R2 0.532 | Optometry (N = 52) R2 0.755 | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
B | 95% CI | p | B | 95% CI | p | B | 95% CI | p | B | 95% CI | p | B | 95% CI | p | |
Age (≥23 as ref.) | |||||||||||||||
≤18 | 0.50 | −0.36, 1.37 | 0.25 | ||||||||||||
19–20 | 0.49 | 0.01, 0.98 | 0.05 | ||||||||||||
21–22 | 0.35 | −0.13, 0.82 | 0.15 | ||||||||||||
≥23 as ref | |||||||||||||||
Gender Male | −0.07 | −0.52, 0.39 | 0.77 | ||||||||||||
Female as ref. | |||||||||||||||
Year of study | |||||||||||||||
Year 1 | −1.60 | −3.69, 0.49 | 0.13 | ||||||||||||
Year 2 | −2.11 | −4.28, 0.05 | 0.06 | ||||||||||||
Year 3 | −1.08 | −3.19, 1.04 | 0.32 | ||||||||||||
Year 4 as ref. | |||||||||||||||
Financial assistance More than one source of assistance as ref. No | 0.24 | −0.14, 0.62 | 0.22 | ||||||||||||
Paid Job Yes as ref. No | −1.09 | −3.38, 1.21 | 0.34 | ||||||||||||
GSE | 0.40 | 0.34, 0.45 | <0.001 ** | 0.38 | 0.32, 0.45 | <0.001 ** | 0.44 | 0.26, 0.61 | <0.001 ** | 0.37 | 0.01, 0.73 | 0.05 a* | 0.84 | 0.50, 1.18 | <0.001 ** |
CAMS-R | 0.41 | 0.34, 0.47 | <0.001 ** | 0.44 | 0.37, 0.51 | <0.001 ** | 0.15 | −0.07, 0.36 | 0.18 | 0.63 | 0.19, 1.07 | 0.006 ** | 0.37 | 0.00, 0.73 | 0.05 b* |
PANAS | |||||||||||||||
PAS | 0.10 | 0.07, 0.13 | <0.001 ** | 0.09 | 0.06, 0.13 | <0.001 ** | 0.13 | 0.04, 0.23 | 0.005 ** | 0.21 | −0.01, 0.44 | 0.06 | |||
NAS | −0.09 | −0.12, −0.06 | <0.001 ** | −0.08 | −0.11, −0.05 | <0.001 ** | −0.17 | −0.25, −0.09 | <0.001 ** | −0.08 | −0.21, 0.06 | 0.25 | −0.13 | −0.28, 0.02 | 0.09 |
BCS | |||||||||||||||
Self-distraction | 0.10 | −0.09, 0.29 | 0.31 | 0.06 | −0.15, 0.27 | 0.57 | 0.38 | −0.21, 0.97 | 0.20 | 0.27 | −0.65, 1.20 | 0.55 | |||
Active coping | 0.07 | −0.17, 0.32 | 0.56 | −0.21 | −0.49, 0.07 | 0.14 | 0.48 | −0.27, 1.22 | 0.21 | 1.04 | −0.36, 2.43 | 0.14 | 1.25 | 0.12, 2.38 | 0.03 * |
Denial | 1.51 | 1.33, 1.70 | <0.001 ** | 1.56 | 1.35, 1.77 | <0.001 ** | 0.80 | 0.27, 1.33 | 0.003 ** | 1.46 | 0.37, 2.54 | 0.009 ** | 1.17 | 0.20, 2.14 | 0.02 * |
Substance use | |||||||||||||||
Use of emotional support | −0.13 | −0.35, 0.08 | 0.22 | −0.06 | −0.29, 0.18 | 0.64 | −0.62 | −1.74, 0.51 | 0.28 | ||||||
Use of instrumental support | 0.01 | −0.20, 0.22 | 0.92 | −0.03 | −0.26, 0.21 | 0.83 | −0.27 | −1.44, 0.90 | 0.64 | ||||||
Behavioral disengagement | −0.52 | −0.68, −0.36 | <0.001 ** | −0.57 | −0.75, −0.39 | <0.001 ** | |||||||||
Venting | |||||||||||||||
Positive reframing | 0.29 | 0.06, 0.52 | 0.01 * | 0.42 | 0.16, 0.67 | 0.001 ** | −0.12 | −0.79, 0.56 | 0.74 | ||||||
Planning | 0.08 | −0.15, 0.32 | 0.48 | 0.17 | −0.10, 0.43 | 0.21 | −0.39 | −1.88, 1.11 | 0.60 | ||||||
Humor | 0.33 | 0.17, 0.49 | <0.001 ** | 0.26 | 0.09, 0.45 | 0.003 ** | 0.58 | 0.10, 1.06 | 0.02 * | 0.57 | −0.62, 1.76 | 0.34 | 0.19 | −0.70, 1.08 | 0.68 |
Acceptance | 0.33 | 0.09, 0.57 | 0.007 ** | 0.45 | 0.18, 0.72 | 0.001 ** | 1.00 | −0.42, 2.42 | 0.16 | −0.25 | −1.52, 1.02 | 0.70 | |||
Religion | −0.06 | −0.18, 0.06 | 0.31 | −0.11 | −0.24, 0.02 | 0.10 | 0.11 | −0.25, 0.48 | 0.54 | ||||||
Self-blame | −0.05 | −0.22, 0.12 | 0.54 | 0.06 | −0.13, 0.25 | 0.56 | −0.48 | −0.91, −0.06 | 0.03 * | 0.09 | −0.71, 0.88 | 0.83 |
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Ching, S.S.Y.; Cheung, K. Factors Affecting Resilience of Nursing, Optometry, Radiography and Medical Laboratory Science Students. Int. J. Environ. Res. Public Health 2021, 18, 3867. https://doi.org/10.3390/ijerph18083867
Ching SSY, Cheung K. Factors Affecting Resilience of Nursing, Optometry, Radiography and Medical Laboratory Science Students. International Journal of Environmental Research and Public Health. 2021; 18(8):3867. https://doi.org/10.3390/ijerph18083867
Chicago/Turabian StyleChing, Shirley Siu Yin, and Kin Cheung. 2021. "Factors Affecting Resilience of Nursing, Optometry, Radiography and Medical Laboratory Science Students" International Journal of Environmental Research and Public Health 18, no. 8: 3867. https://doi.org/10.3390/ijerph18083867