How Can We Remove Psychological Entrepreneurship Barriers on Entrepreneurship Intention for Health Organizations in the Future?

: Entrepreneurial orientation significantly influences business financial performance, particularly in global markets, making it pivotal across economies. Developed nations provide a conducive environment for entrepreneurship, supported by educational systems and skill development programs. Conversely, in developing countries, cultural and social disparities create unique challenges, shaping entrepreneurial intentions. Psychological barriers such as risk aversion, fear of failure, and resistance to change hinder potential entrepreneurs, particularly in health science faculties. A study conducted in Turkey aimed to explore these barriers among health science students. Data collected from 788 students revealed that psychological factors explained 72% of entrepreneurial intentions. Regression analysis confirmed the significance of risk avoidance, fear of failure, attitude towards change, and stress avoidance in shaping intentions. Despite these barriers, heightened entrepreneurial intentions among health students were associated with greater success in overcoming obstacles. The findings emphasize the importance of addressing psychological barriers in fostering innovative and entrepreneurial healthcare professionals. By understanding these dynamics, educational institutions, policymakers, and healthcare practitioners can better support the development of an entrepreneurial healthcare workforce. The intersection of healthcare and entrepreneurship presents opportunities for transformative solutions, potentially enhancing patient outcomes and advancing the healthcare sector. Despite challenges, emerging trends suggest a growing interest in leveraging innovation for positive change in healthcare, highlighting the potential for impactful contributions to the industry’s evolution.


Introduction
Entrepreneurship is the act of creating a business that reflects the entrepreneur's vision.Entrepreneurial orientation is crucial for financial success in global markets [1][2][3] and plays a significant role in both developing and developed economies.Therefore, entrepreneurship has become a topic of great interest for researchers and businesses alike [4].
Developed countries provide a favorable environment for entrepreneurship, with education systems and programs designed to develop entrepreneurial skills.However, potential entrepreneurs in developing countries face different barriers due to cultural, contextual, and social differences, which ultimately shape their entrepreneurial intentions.
The link between sustainability and psychological entrepreneurial barriers lies in their combined impact on entrepreneurial intention in health organizations.Sustainable practices require innovation, adaptation, and acceptance of change to meet evolving healthcare needs while ensuring long-term viability.However, psychological barriers such as risk Sustainability 2024, 16, 3503 2 of 14 aversion and fear of failure can prevent healthcare professionals from taking entrepreneurial risks and implementing innovative solutions.It is essential to address these barriers to foster a culture of innovation and entrepreneurship in healthcare organizations, which is critical to achieving sustainability goals.By providing support, training, and resources to overcome these barriers, health organizations can foster a workforce that is more open to entrepreneurial opportunities and positive change toward sustainability in healthcare.Thus, understanding and addressing both sustainability and psychological entrepreneurial barriers are essential for promoting entrepreneurial intent and implementing sustainable practices within health organizations.
Entrepreneurial intention is influenced by various exogenous and endogenous constructs, which are considered barriers [5].
Exogenous barriers can be commercial, educational, knowledge-based, related to various crisis situations, or related to family and entrepreneurial endeavors [6,7].Such obstacles can make it difficult for individuals to pursue their goal of starting their own business and may hinder the transformation of intentions into actions [8].For example, a woman's confidence in pursuing entrepreneurship may be undermined by pressure from family and gender norms [9].Additionally, administrative costs, financial obstacles, and fiscal constraints can also hinder entrepreneurial goals [10,11].According to the Global Entrepreneurship Monitor 2023/2024 Global Report, there are only five countries (economic level C, like Colombia and China) where the proportion of women starting or managing a new business is the same or higher than the proportion of men, while there are 39 countries (economic level B, like Lithuania) where men are more involved [12].Thus, equality in new entrepreneurship is rare and more likely in low-income economies.In high-income countries (e.g., European countries such as Norway, Germany, Slovenia, Italy, Sweden, and France), the gap between male and female entrepreneurs is between three and four percentage points.These results indicate that women entrepreneurs are supported in countries with high national economies.
Although the Global Entrepreneurship Monitor (GEM) provides important data on the entrepreneurial environment of various countries, it often focuses on macroeconomic variables and aggregate indicators, such as the level of economic development, legal infrastructure, and level of education [12].These aspects may not provide a complete picture of the specific issues encountered in a specific field, such as healthcare entrepreneurship.Therefore, although GEM provides valuable insight into global entrepreneurship, it may not always provide specific answers or solutions to problems encountered in a particular field, such as healthcare entrepreneurship.To address these issues in depth, additional research and specialized analysis is often required, focusing specifically on this area.
Complementing GEM, it is important to highlight a new perspective on the controversial effects of other cultural values, whose effects become apparent when the focus is on the motives behind actions, not directly on activities [13].The results of this study confirm that the adoption of social psychology theories of intention and behavior can contribute to the theoretical development of entrepreneurial cognition research in a cross-cultural context.
Applying these theories can improve understanding of the complex relationship between culture and entrepreneurship by helping to elucidate how cultural values influence the reasoning behind entrepreneurial intention and activity, including identifying cultural values that have a significant impact on entrepreneurship.
A study conducted in China combines the synergy theory of entrepreneurial psychology and innovativeness to support new entrepreneurs in improving their success [14].Using the perspective of cross-cultural adaptation and positive psychology, the research explores the relationship between cross-cultural adaptation, entrepreneurial characteristics, and business intentions.
Another study in the researched field compares the entrepreneurial intentions of US and Slovenian students [15].It identifies an association between maximizing decision styles and individualistic cultural orientation in both countries, suggesting that the link between maximization and individualism transcends national and cultural boundaries.In the Amer-ican sample, individualism was a mediating factor in the relationship between decision styles and entrepreneurial intentions, indicating that in individualistic cultures, individuals who adopt a maximizing decision style and take a more individualistic perspective are more likely to pursue entrepreneurial opportunities.
An example of a complex, multicultural study looks at six different countries (Germany, India, Iran, Poland, Spain, and The Netherlands) and analyzes a sample of 1074 students, assessing entrepreneurial career intentions [16].The results indicate a universal effect of culture on attitudes and perceived behavioral control (self-efficacy), influencing entrepreneurial career intentions, with cultural variations in the effects of subjective norms.
At the same time, the integration of profit with social responsibility emphasizes the importance of socio-emotional factors in organizational dynamics, contributing to social sensitivity, business ethics, effective communication, and overall performance.Managing emotions is also essential for preventing conflicts and reducing tension in organizations.Events such as the 2008 crisis and the COVID-19 pandemic have highlighted the need for organizations to balance economic interests with social functions.The pandemic has revealed the negative consequences of prioritizing short-term gains over socio-emotional impact, with delayed interventions and neglect of psychosocial aspects.In response to the pandemic, businesses have adapted by converting production to medical supplies and adopting remote work and digital services.However, the response has often prioritized economic and medical aspects, neglecting the need for a broader bio-psycho-social model for effective intervention and prevention [17].
Another example of a relevant study explores the gaps in understanding the factors influencing entrepreneurial intentions among Generation Z in a tourism-dependent transition economy, using various tools: Leveraging Crisis Decision Theory, Theory of Planned Behavior, and the Entrepreneurial Event Model.Predictors investigated include perceived crisis severity, entrepreneurial disposition, social support, university affiliation, gender, academic progress, and work experience.
Data were collected from 300 tourism and hospitality students in Croatia and analyzed using Pearson correlation and multiple regression.This research found that entrepreneurial disposition, work experience, and gender have a direct impact on entrepreneurial intentions, while the perceived severity of the crisis did not influence these intentions.The results contribute to the understanding of entrepreneurship during crises and the entrepreneurial intentions of Generation Z, highlighting the importance of entrepreneurial disposition in determining these intentions and confirming the vital role of creativity and self-motivation in their development.The study also suggests that students with longer work experience show a greater tendency towards entrepreneurship, highlighting the diversity of factors that influence entrepreneurial behaviors [18].
Endogenous barriers are often psychological.These barriers include risk avoidance, resistance to change, fear of failure, and stress avoidance.Psychological barriers significantly impact entrepreneurial intention.To promote entrepreneurial conduct and purpose, it is important to remove these obstacles.
To reinforce entrepreneurial purpose and overcome obstacles, entrepreneurs can receive psychological support, such as same-gender group mentorship.
In the literature, a large number of studies have been conducted analyzing students' entrepreneurial intentions using different dimensions, like the theory of planned behavior, entrepreneurship education and programs, personal and psychological traits, and contextual and institutional factors [19].However, there are few studies examining the psychological barriers affecting students' entrepreneurial intentions.In the existing literature review, some studies found that psychological barriers reduce entrepreneurial intention [20,21], while others found that they increase it [22,23].
Entrepreneurship education empowers students with the mindset, skills, and resilience to succeed in a dynamic environment.It is important to shape a generation that can make a positive impact and foster sustainable change by developing innovation and business acumen [12].Within this context, the main research question of the current study is: "What are the psychological barriers to the entrepreneurial intention of health students?" This question highlights the importance of entrepreneurship in the healthcare sector for researchers.The healthcare sector is a great area for entrepreneurial endeavors due to its complexity and rapid advances, and in recent years, the entrepreneurial mindset in healthcare has begun to receive more attention.
The health sector is finding that entrepreneurship is a very attractive way to deal with the changing challenges it faces [24].In addition, the healthcare system is under tremendous pressure to control costs while continuing to provide high-quality care, education, and research; therefore, the need for alternative sources of income is forcing the healthcare system to consider how to encourage entrepreneurial activity [25][26][27].Assessing the entrepreneurial potential of healthcare students is critical because of their future role in the healthcare environment.
The development of innovative patient care services and practice models that can improve the quality and outcomes of healthcare services and reduce costs requires entrepreneurial skills among healthcare students and recent graduates [28,29].
Personality dimensions are among the most important predictors of successful entrepreneurs.Students with entrepreneurial personality dimensions are expected to develop innovative practices or take on a more patient-centered role in the future.
Turkish healthcare students are currently facing a crucial point where opportunities and obstacles intersect as they strive to contribute to healthcare reform.Various studies have examined students' aspirations to become entrepreneurs, taking into account factors such as the theory of planned behavior, individual characteristics, psychology, and the influence of entrepreneurship programs and education [30][31][32][33].
It is important to have consistent and validated procedures for identifying entrepreneurial traits among healthcare students, as this may be essential for the development of future entrepreneurial healthcare professionals.
Furthermore, exploring the impact of psychological and individual characteristics, such as risk perception, self-efficacy, and desire for autonomy, can contribute to a more comprehensive understanding of the factors that influence entrepreneurial tendencies in this particular group.Therefore, the present study aims to measure the psychological barriers to entrepreneurial intention among Turkish healthcare students.

Literature Review
Two theories of entrepreneurial intention exist in the literature: institutional and psychological [34].A comprehensive lens for understanding the dynamics of entrepreneurial intention is provided by the integration of these two theories.In fact, the article highlights the distinct yet interconnected roles of these theories in shaping entrepreneurial behavior.
Examining psychological barriers in current research involves analyzing how individual beliefs, perceptions, and emotions contribute to or hinder entrepreneurial intention.For example, valuable insights into the intricacies of entrepreneurial intention can be gained by understanding how fear of failure, risk aversion, or self-confidence affect the decision-making process.In current research, psychological barriers to entrepreneurship will be examined and related to entrepreneurial intention under four sub-headings based on the literature.These are risk avoidance, attitude toward change, fear of failure, and stress avoidance.

The Relationship between Attitude toward Change and Entrepreneurial Intention
The change phase can be a challenging time for any organization, often leading to pressure and a lack of motivation.However, by examining the reasons for and against change, it becomes easier to objectively evaluate the results.A positive attitude towards change involves being comfortable with uncertainty and ambiguity, recognizing that change often brings unknowns, and being willing to navigate them with optimism and confidence.This can increase the motivation of the entrepreneurs driving the change and make them more agile [35].Attitude toward change is positively related to entrepreneurial intention [36,37].Studies show that individuals with positive attitudes towards entrepreneurship are more likely to intend to start their own business [38,39].In addition, attitudes toward intrapreneurship, which refers to entrepreneurial behavior within an existing organization, are positively related to the intention to start an enterprise [40].
The Turkish healthcare industry faces a significant challenge in overcoming resistance to change.Established institutions may resist the adoption of innovative solutions, hindering the implementation and scaling of entrepreneurial ventures [41].These findings suggest that individuals with positive attitudes towards entrepreneurship, either as entrepreneurs themselves or as entrepreneurs in an enterprise, are more likely to intend to become entrepreneurs.
Therefore, we hypothesize that there is a significant relationship between attitude toward change and entrepreneurial intention (H1).

The Relationship between Risk Avoidance and Entrepreneurial Intention
Risk-taking is the act of taking an action even when the outcome is unknown and cannot be predicted.In other words, risk-taking is the willingness to take on a challenge or obstacle and prepare to face the consequences.While exciting, taking a risk can also be terrifying.However, to succeed in life, we must take the opportunity to step outside of our comfort zones [22].
Risk avoidance has been found to significantly influence entrepreneurial intention [42,43].Several studies [44,45] have shown that risk aversion is an important trait that influences entrepreneurial intention.The results indicate that risk tolerance influences entrepreneurial intent, with higher-risk attitudes resulting in increased entrepreneurial intent [46].Furthermore, risk-taking is a mediator of the effects of attitude, entrepreneurial capability, and perceived benefits of digital technology on entrepreneurial intention.These findings highlight the importance of taking into account risk avoidance and risk-taking in the understanding and promotion of entrepreneurial intention.
The healthcare sector is inherently risk-averse, and its cautious approach to change can stifle entrepreneurial initiatives.Turkish healthcare students are significantly deterred by risk-taking and its potential consequences for patient care and professional reputation, according to Hablemitoglu and Yildirim [47].
Therefore, we hypothesize that there is a significant relationship between risk avoidance and entrepreneurial intention (H2).

The Relationship between Fear of Failure and Entrepreneurial Intention
The fear of failure is a psychological barrier that potential entrepreneurs often face [48].This fear is considered the most significant reason for not starting a business [49].However, empirical evidence has shown that the fear of failure can elicit both motivating and inhibitory responses in entrepreneurs [21,50].This could lead to innovative and interventional approaches in the healthcare sector, improving the quality and reducing the cost of healthcare.
It is important to encourage and support young people in entrepreneurship during their youth when it is easier to take risks.Interest in comprehending the determinants shaping individuals' intentions to establish their own businesses has been steadily increasing within the realm of entrepreneurship [44,51].Fear of failure is one such factor that has been extensively studied [52,53].Individuals with higher levels of fear of failure are less likely to intend to become entrepreneurs.Research has shown that fear of failure can significantly influence individuals' entrepreneurial intentions [54,55].This fear may create barriers and prevent individuals from taking the necessary risks and actions required for entrepreneurship [49].The studies show that the fear of failure is an important factor in the shaping of entrepreneurial intention.
Therefore, we hypothesize that there is a significant relationship between the fear of failure and entrepreneurial intention (H3).

The Relationship between Stress Avoidance and Entrepreneurial Intention
The avoidance of stress emerges as another psychological barrier hindering entrepreneurship [56].Launching a new business or application can be daunting, with some individuals perceiving it as a significant source of stress.This perspective may lead Health Department University students to avoid entrepreneurial ventures, negatively affecting their intentions in this regard.To address this issue, the following research model was suggested based on the literature.
Entrepreneurs frequently experience high levels of stress due to the unpredictable nature of their ventures and the multitude of responsibilities they must handle [57].This stress can significantly affect how well they feel and whether they want to continue to engage in entrepreneurial activities [58].
Entrepreneurs may try to avoid or minimize stress to maintain motivation and drive to pursue opportunities.Stress avoidance can also affect decision making.By avoiding stress, entrepreneurs may be able to make clearer and more rational decisions, as stress can impair cognitive function and lead to biased decision making [59].The literature shows that entrepreneurs can enhance their well-being and intention to pursue entrepreneurial activities and make better decisions for the success of their ventures by actively avoiding stress.
Therefore, we hypothesize the following.There is a significant relationship between stress avoidance and entrepreneurial intention (H4).

Theoretical Approach and Research Model Based on the Literature Review and Proposed Hypotheses
In relation to the literature review paragraphs included above and in relation to those expressed as working hypotheses that have to be verified, we propose the following research model (Figure 1).
create barriers and prevent individuals from taking the necessary risks and actions required for entrepreneurship [49].The studies show that the fear of failure is an important factor in the shaping of entrepreneurial intention.
Therefore, we hypothesize that there is a significant relationship between the fear of failure and entrepreneurial intention (H3).

The Relationship between Stress Avoidance and Entrepreneurial Intention
The avoidance of stress emerges as another psychological barrier hindering entrepreneurship [56].Launching a new business or application can be daunting, with some individuals perceiving it as a significant source of stress.This perspective may lead Health Department University students to avoid entrepreneurial ventures, negatively affecting their intentions in this regard.To address this issue, the following research model was suggested based on the literature.
Entrepreneurs frequently experience high levels of stress due to the unpredictable nature of their ventures and the multitude of responsibilities they must handle [57].This stress can significantly affect how well they feel and whether they want to continue to engage in entrepreneurial activities [58].
Entrepreneurs may try to avoid or minimize stress to maintain motivation and drive to pursue opportunities.Stress avoidance can also affect decision making.By avoiding stress, entrepreneurs may be able to make clearer and more rational decisions, as stress can impair cognitive function and lead to biased decision making [59].The literature shows that entrepreneurs can enhance their well-being and intention to pursue entrepreneurial activities and make better decisions for the success of their ventures by actively avoiding stress.
Therefore, we hypothesize the following.There is a significant relationship between stress avoidance and entrepreneurial intention (H4).

Theoretical Approach and Research Model Based on the Literature Review and Proposed Hypotheses
In relation to the literature review paragraphs included above and in relation to those expressed as working hypotheses that have to be verified, we propose the following research model (Figure 1).

Materials and Methods
This study employs a quantitative approach.This research was developed with the participation of a sample of Turkish health students studying at a public entrepreneurship university.The data collection method was a self-administered questionnaire with several groups of questions on psychological barriers and entrepreneurial intention.Validated instruments were employed to measure psychological barriers and entrepreneurship intentions.The sample was carefully selected to represent the diverse landscape of health students, ensuring the generalizability of the findings.Statistical analyses, including correlation and regression, are conducted to discern patterns and relationships within the data.Data analysis was implemented with SPSS 26.0 statistical software.

Data Collection, Measurement, and Sample
A scale-based methodology was used in the current research to obtain data from students studying in health science faculties in public universities located in the west of Turkey at various academic institutions.A random sampling technique was applied to select the participants.The data was collected from 788 students out of a total of 2547 students who are studying in health science faculties in spring term.788 validated responses were analyzed.This rate is nearly 31%, which represents a good sample.Psychological entrepreneurship barriers were measured by the scale developed by Sandhu et al. (2011), including 16 items (5 items measure Stress Avoidance, 3 items for Attitude towards Change, 3 items for Fear of Failure, and 5 items measuring Risk Avoidance [21].The dependent variable (Entrepreneurship Intention) was measured by a scale developed by Schwarz et al. (2009), including 3 items [60].All variables were measured on a five-point Likert scale ranging from 1, "strongly disagree", to 5, "strongly agree".

Reliability Analysis
For every factor created, Cronbach coefficient alpha values were calculated to assess the scale's internal consistency.Cronbach alpha is a reliability coefficient that shows how effectively the items are positively associated with one another, according to Sekaran and Bougie [61].The internal consistency is higher when Cronbach's alpha is nearer 1.As shown in Table 1, all of the variables' Cronbach's alpha values were above the necessary rate of 0.70 in the literature, indicating that the constructs' internal consistency was confirmed.Additionally, the data were distributed normally.In regression, it is assumed that the variables follow a normal distribution.Non-normally distributed variables, such as those that are highly skewed or show kurtosis or those with substantial outliers, can distort relationships and significance tests.Several pieces of information are useful to the researcher for testing this assumption; skewness and kurtosis are two tests that provide inferential statistics on normality [62].According to Hair et al. [63], skewness and kurtosis tests should be used to ensure that the research's normal distribution is being examined.As long as the skewness and kurtosis values stand between +1 and −1, the data has a normal distribution [64].All of the study's variables had skewness and kurtosis values between +1 and −1, according to the data analysis.The data were, therefore, normally distributed (Table 1).These results indicate that the data are normally distributed and that the relationships between the data are statistically reliable.

Results
The empirical findings illuminate the intricate connections between psychological barriers and entrepreneurship intention among Turkish health students.Specific barriers, such as fear of failure or risk aversion, may emerge as significant factors influencing entrepreneurial aspirations.The results contribute valuable insights into the nuanced dynamics at play, guiding future initiatives to support and encourage entrepreneurial thinking.According to Table 1, the mean score of attitude towards change, risk avoidance, fear of failure, and stress were about three on a five-point Likert scale.While risk avoidance had the highest mean (m = 3.39; sd = 1.15), stress avoidance had the lowest mean (m = 3.00; sd = 1.07).
A multivariate regression model was applied to investigate how perceived physiological impediments affect the tendency toward entrepreneurship.The multiple regression model was formulated as follows: The results of the multiple regression are shown in Table 2.According to the model's R-squared, four independent variables-risk avoidance, fear of failure, attitude toward change, and stress avoidance-accounted for 0.72% of the variation in entrepreneurial intent.According to the data, all of the entrepreneurship barrier factors were statistically significant.The four psychological entrepreneurship barriers (Attitude toward Change, Risk Avoidance, Fear of Failure, and Stress Avoidance) were statistically significant in the current research model.The positive coefficient for the research model suggests that participants have a high perception of psychological entrepreneurship barriers that are intended for entrepreneurial activities.
All independent variables were significant and positively related to the intention to start up a new business.The estimated coefficients of Attitude towards Change, Risk Avoidance, Fear of Failure, and Stress Avoidance were 0.139, 0.073, 0.165, and 0.548, respectively (Table 3).These results showed that the four hypotheses were supported by the current research.Correlations among all variables were checked and are presented in Table 4.The variables show a high correlation, with the highest correlation between Attitude towards Change and Risk Avoidance (0.832) and the lowest correlation between Stress Avoidance and Risk Avoidance (0.652) in the research model.If there is a high correlation among variables, it may indicate the presence of multi-collinearity, which can affect the reliability of the regression coefficients [65].Therefore, we checked the variance inflation factor (VIF) to test for multicollinearity among variables.VIF is calculated as: A VIF value between 1 and 5 indicates that the variables are moderately correlated.A VIF value between 5 and 10 is an indication that the variables are highly correlated.A VIF between 5 and 10 is an indication that there is multi-collinearity between the predictors in the regression model, and a VIF greater than 10 is an indication that the regression coefficients are poorly estimated due to the presence of multi-collinearity [65].
After checking the model, it was found that there is a moderate correlation based on the VIF value of the current research model [1/(1 − R 2 ) = 1/(1 -0.726) = 3.649].Multicollinearity was also checked for each dimension in the research model.As shown in Table 3, the VIF values range from 1 to 5, indicating a moderate correlation between the variables.The low values of VIF for the variables indicate that there is no problem of collinearity.The relationship between entrepreneurship barriers, risk avoidance, attitude to change, fear of failure, and stress avoidance is significant, with p < 0.005.Multi-collinearity among the variables was detected using two techniques: correlation coefficients and variance inflation factor.Even though there is a high correlation among the variables, there is no evidence of multi-collinearity among the variables.The variable Stress Avoidance has the highest impact on the perceived Entrepreneurship Barrier.

Discussion and Conclusions
The psychological factors behind entrepreneurship barriers need to be given special attention.Therefore, in order to investigate the relationship between psychological entrepreneurship barriers and entrepreneurship intentions, we tested four hypotheses.We concluded that there is a statistically significant relationship between psychological entrepreneurship barriers and entrepreneurship intent.Several studies supported the hypotheses of current research, such as those conducted by Rasool et al. [22], Kebaili et al. [5], and Akpınar and Küçükgöksel [66], emphasize that the fear of failure is a significant barrier to student entrepreneurship.Additionally, a negative relationship between entrepreneurial intentions and fear of failure was found [20,21,67].This fear often arises from various sources, including societal expectations, personal insecurities, and the potential consequences of entrepreneurial ventures not succeeding.It is important to note a contradiction in the literature.Some researchers present findings that challenge the relationship between entrepreneurial intentions and fear of failure [52,68,69].These studies suggest that there is a relationship between entrepreneurial intentions and fear of failure for some individuals and that fear may act as a motivator rather than a barrier for some, suggesting that a more nuanced understanding is required.
Entrepreneurship is not universally embraced across all cultures and societies due to the fear of failure.Creativity and innovation are not always highly regarded traits, as mentioned in the paper.
In addition, it is also important to take into account the role of risk aversion in conjunction with the fear of failure.Fear of failure is often rooted in psychology, but it can also cover a wider range of issues, including financial worries, uncertainty, and the perceived personal and professional costs of being an entrepreneur.In conclusion, understanding and addressing entrepreneurship barriers, especially psychological ones like fear of failure, requires a nuanced approach.Recognizing inconsistencies in the literature and taking into account additional factors such as risk aversion may improve the understanding of these barriers, paving the way for more effective strategies to promote entrepreneurship and innovation.Younger people are less likely to have family and other responsibilities that require a steady income, have yet to develop careers, and may have less concerns about the potential consequences of failure, as well as perhaps being more familiar with the ways technology and markets are developing.Older people may have more access to resources and more experience, but they may also have more to lose from starting a new business (Global Entrepreneurship Monitor 2023/2024 Global Report).Empirical studies have shown a relationship between risk-taking and entrepreneurship among students [70,71].Entrepreneurs have a generally high-risk propensity and are typically highly motivated individuals with a proactive approach and a willingness to take risks.They aim to create value for both themselves and their customers by exploiting innovations and opportunities and sometimes by establishing new ventures [72].This research shows that risk-taking may positively impact entrepreneurship.Munir et al. (2019) suggest that young people are the main actors in economic development, and their entrepreneurial aspirations should not be undermined [73].Supporting young people with entrepreneurial aspirations is crucial for positive economic and social contributions to society.It is essential to maintain a clear and logical structure, use precise word choice, and avoid biased language when discussing this topic.Encouraging entrepreneurship can transform young people's qualities, such as creativity, innovation, and contribution to employment, into social contributions.It will also develop self-confidence in young people, teach them to take risks, and enhance their ability to make quick decisions, exercise foresight, and conduct analyses.
Turkish healthcare students face significant challenges in their entrepreneurial endeavors, but emerging trends suggest that there is a growing interest in using innovation to bring about positive change in the healthcare sector.It is important to continue to refine strategies that address the unique challenges faced by health students as Turkey takes steps to foster an enabling environment for health entrepreneurship.Various stakeholders are actively addressing barriers such as regulatory complexity, the improvement of entrepreneurship education, and the promotion of a supportive ecosystem.As a result, Turkey is poised to nurture a new generation of healthcare entrepreneurs.The confluence of healthcare and entrepreneurship is promising to deliver transformational solutions that will improve patient outcomes and contribute to the evolution of the healthcare industry.Through fostering a culture of innovation and providing targeted support, Turkey can position itself as an entrepreneurial hub for healthcare, ultimately benefiting both the industry and society.
At its core, the promotion of entrepreneurship among young people is not just about the development of the individual; it extends to the creation of a broader impact on society.When young entrepreneurs thrive, they become catalysts for growing the economy and driving positive social change.By acknowledging the potential advantages of nurturing the entrepreneurial ambitions of younger individuals, it is crucial to approach this discussion with a fair and impartial viewpoint.
Personality traits such as motivation, courage and willpower, self-efficacy, confidence, and fear have been studied by many authors, both from a financial perspective and from a risk aversion perspective, and have been found to act as drivers or barriers to entrepreneurial intentions.For example, psychological barriers such as lack of motivation, lack of courage, lack of self-efficacy, or confidence can act as constraints in one's pursuit of entrepreneurship.However, the most important thing is that the person is aware of these psychological obstacles and takes precautions.In other words, individuals who are aware of their psychological obstacles can realize their entrepreneurial intentions.On the other hand, the entrepreneurial intentions of people who experience a lack of economic support and exhibit severe fear and risk aversion may be negatively affected [74].
In conclusion, the lens of psychological entrepreneurship barriers fits well with the current research endeavor, which focuses on the impact of psychological barriers in the domain of entrepreneurial intentions.By unraveling the complex interplay between internal psychological factors and external institutional influences in shaping entrepreneurial intentions, this approach has the potential to make a significant contribution to the literature.
This paper also draws attention to recent developments in Turkey's healthcare entrepreneurship environment.Comprehending these trends is essential for anticipating forthcoming challenges and opportunities.This understanding will assist both scholars and policymakers in their endeavors to foster a conducive environment for health entrepreneurship.Current research also outlines practical implications for stakeholders, translating research findings into actionable strategies.Educational institutions can foster a culture of resilience and innovation by adapting their curricula to address psychological barriers.Policymakers can put in place supportive frameworks, while health professionals can be part of mentorship programs for budding entrepreneurs.
The study was limited to students studying health at the university.It produced specific conclusions and recommendations.However, these may not be widely generalizable.
The study provides guidance for further research on the correlation between cultural and psychological factors in entrepreneurship.
In addition, since the research was conducted with Turkish health students studying at state universities in western Turkey, it may not be generalizable to all students.According to the Global Entrepreneurship Monitor 2023/2024 Global Report, the economy of the country is an important factor affecting entrepreneurial intention [12].Therefore, it may be recommended that future researchers conduct the study with different student groups in countries with different economic levels.
It is also worth noting that this study used quantitative and parametric methods to analyze the data.These methods provide valuable insights.However, future researchers may wish to explore the relationships between variables using qualitative or mixed methods.Qualitative methods, such as interviews or focus groups, might provide a deeper understanding of students' experiences and perceptions of entrepreneurial intent.A more holistic perspective and a richer exploration of the complexities surrounding entrepreneurial thinking could be achieved by combining qualitative and quantitative methods in a mixed model approach.Conflicting results between studies may also be due to methodological, cultural, or contextual differences.Future research should explore these aspects in greater depth, unraveling the complexity of the relationship between fear of failure and entrepreneurial intent.

Table 1 .
Reliability analysis and descriptive statistics.

Table 2 .
The results of the regression analysis.
a Predictors: (Constant), Stress Avoidance, Risk Avoidance, Fear of Failure, Attitude towards Change.

Table 3 .
The results of the coefficients.
a Dependent Variable: Entrepreneurship Intention.

Table 4 .
The results of the correlations.