IMPACT OF STRESS REDUCTION AND COPING
STRATEGIES ON ACADEMIC SUCCESS OF PART-TIME
ADULT SCIENCE STUDENTS
Presented by Anwar Chaudhry MD., MPH
Faculty COLS. National University
Fresno CA
Presentation Outline
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Introduction
Research Questions
Literature
Conceptual Model
Methods
Results
Discussion
Conclusion: Implication, Limitations and future
directions
Abstract
•Background: This research article examined the triggers of academic stress, its impact on
the emotional, psychological and physical health of part-time adult science students. It
further evaluated the effectiveness of a stress reduction program on the wellbeing and
learning abilities of the students.
•Methods: A prospective, interventional, single-arm cohort study design was used on a
convenience sample of 16 students (n=16) at a National University. Based on a framework
of social cognitive theory, a 6-week cognitive behavioral intervention program of group
activities was designed and implemented to empower students to identify and cope with the
triggers of stress. Primary data were analyzed using parametric two-sample dependent ttests and the non-parametric Wilcoxon Rank Sum Test at an alpha of 05. The 10-item
Cohen Perceived Stress Scale and a questionnaire designed for the study were utilized to
determine participants’ perceived levels of stress before and after intervention.
•Results: Major factors interfering with the learning process in part-time adult science
student population were found to be personal, family, job responsibilities and situations.
PSS score, pulse and blood pressure difference was calculated by comparing baseline and
week 6 score using paired sample t-test. The intervention group showed significant
reduction in stress. Impact of counseling was assessed using the pre-test post-test analysis.
Fourteen of the 16 participants (87.5%) stated that attending personal counseling had a
positive impact on their academic performance.
•Conclusion: A six weeks follow-up showed that the stress reduction and coping strategic
interventions had positive effects on perceived stress among the students, and further
analysis showed that this was due to participation in self-development groups.
Stress
The tension that emanates from an individual’s interaction
with the environment.
o In this interaction, the individual perceives that the
demands of the environment exceeds his or her personal
resources(Lazarus & Folkman , 1984).
Although stress is not a mental disorder, stress has been
reported as a contributing factor or comorbidity of mental
illnesses.
Stress
Background and Statistics
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According to (CDC) estimation 1 in 2 Americans are annually
diagnosed with a mental disorder ( Center for Disease Control and
Prevention , 2005)
National Center for Health Statistics attributed 46 million
physician office-based visits in 2003 to mental disorders.
(National Center for Health Statistics, 2005)
In a study conducted by the American College Health Association
, 63% of college students felt “hopelessness” at times, and 94%
reported feeling of “overwhelmed”. Forty-eight percent of females
and 39% of males reported that they felt so depressed it was
difficult to function ( American College of Health Association.
Mental and physical Health data,2002).
Introduction
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This study examined the perceived stress among part-time adult
science students which tends to affect not only academic
performance but also physical, emotional, and social health of
students.
It further investigated the relationship of vital signs (blood
pressure and pulse) changes before and after intervention
therapies.
Adult students in non-traditional institutions seeking professional
science education in fast paced format are vulnerable to
tremendous amount of stress. (World Health organization, 2000;
Saipanis, 2003). Major triggers of stress are found to be inability
to cope, helplessness, increased psychological pressure, mental
tension, financial and excessive workload (Galbraith & Brown,
2011).
Introduction (Cont’d)
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Part-time adult students report high level of stress due to lack of
leisure time and minimal opportunity to relax, leading to serious
physical emotional and psychological consequences (Dixon
&Kurpius, 2008).
Other important factors interfering the learning process in this
student population are; family and job responsibilities and
situations (e.g., financial worries, childcare, domestic violence and
transportation issues) (Coffield, Moseley, Hall, &Ecclestone,
2004).
The effects of these stressors can produce many emotional
conditions that include: alcohol and drug abuse, relationship
difficulties, depression, anxiety, and suicide (Levey, 2001).
Introduction (Cont’d)
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Group activities are planned and intended to
ameliorate one’s physical and psychological conditions
( Buckworth & Dishman, 2002)
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Research studies results have revealed that social
networking is one of the factors strongly associated
with high stress tolerance ( Ainslie RC; Shafer A;
Luther SS et al,. 2006).
Purpose of the study
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The objective of this study was two- folds: (a)
Increased knowledge to identify signs and symptoms
of negative stress (b) To design self –support
interventions (opportunity for emotional expression,
peer affiliations, self- support groups) to cope stress.
The investigator’s goal was to develop a program to
control stress by education and behavioral
modifications to promote health by stress reduction and
improve learning abilities and success in educational
pursuits of adult part-time science students
Conceptual Model
Bandura’s Social Cognitive Theory
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The Bandura’s (SCT) theory accounts for following key points for the influence one’s
environment has on the behavioral choices he or she makes.
The individual must view the results of the change as positive. Students will see the
participation by peers in the stress release activities as being fun and effective for them which
is a positive result. Different group activities give students the opportunity to see others having
fun and relieve stress at the same time. The positive feedback the students give each other
while engaging in these activities serve as a response for the behavior to continue.
Self-expectation of student’s cognitive success and performance, depends upon past
achievements, self-efficacy and overall level of self- control.
Self- efficacy produces confidence in the students to perceive stress as a challenge and
enhances the sense of well -being, performance and persistence resulting in to academic
successes (Bandura 1982).
Students perusing higher education are provided healthy learning environments, enhanced
self-efficacy, and knowledge about stress management techniques to produce positive behavior
change based on the cultural, ethnic, educational, and economic backgrounds.
Coping Strategies: Group Activities
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Peer Affiliations is a group of activities that are
planned and intended to ameliorate one’s
psychological, physical and emotional condition
(Buckworth & Dishman, 2002)
peer tutoring
Emotional ventilation
physical activities
self-regulated learning
effective time management skills
Literature : Peer Affiliations and Stress
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Loehr (1997) proposed that:
Group activities are associated with lower level of
stress
Group activities may change the perception of events
Group activities are connected with improved coping
Literature : Stress Triggers
Non-program
Gender
Lack of background knowledge
Emotional intelligence
o Program
Workload
Student behavior and learning
Challenges and distractors faced by adult learners to
maintain a balance between school/work/family
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Research Questions
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An effort was made to answer the following question. “Can
enhanced knowledge of the effects of stress and greater use of
positive coping skills reduce the stress and improve academic
performance”.
1-What is the perceived level of stress experienced by students
during biology course?
2- What are the major causes of stress?
3-Is excessive stress leading to poor student performance?
4-Can a reduction of stress improves their performance?
5-Can a stress release program make students better aware of the
signs and symptoms of stress within their own lives?
Method : Sample
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A convenience sample of 16 students enrolled in biology course at
National University Fresno campus.
Inclusion criteria was based on Perceived Stress Score of >14
12 females and 4 male participants in the age range of 16 to 35
years of age.
Results from all 16 participants scores were analyzed.
Diverse previous educational experience.
Non-traditional adult learners
Insufficient knowledge about the subject
Time constraints, family, and financial issues
Research Instrument
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Perceived Stress Scale (PSS)
The Cohen Perceived Stress Scale 10 Item (PSS-10) was utilized
to determine each participant’s perceived level of stress
The measurement is scored as a Likert scale and consists of 10
items that are measured on a five-point scale
The higher the score is, the higher the perceived level of stress of
the student
0=never , 1=almost never, 2=sometimes, 3=fairly often, 4=very
often
Various stress relief sessions used in the study
Type of Data Collected
Qualitative data
Gender of the subjects
Sources of stressor
Coping strategies adopted during events of stress
Impact of counseling on training program
Effect of counseling in reducing stress
Retention and personal counseling
Type of Data Collected
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Quantitative data
a. Change in PSS before and after the intervention
b. Pulse
c. Systolic blood pressure
d. Diastolic blood pressure
Data Collection
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Data collection done in three phases:
1.
2.
3.
Baseline
Follow-up
Post follow-up
Statistical Plan
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Both quantitative and qualitative data (pre and post test design)
collected in three phases, were analyzed using parametric twosample dependent t-tests and the non-parametric Wilcoxon Rank
Sum test at an alpha of 0.05 (95% confidence interval).
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The 10-item Cohen Perceived Stress Scale and a questionnaire
designed for the study were utilized to determine participants’
perceived levels of stress before and after intervention.
Results
Research question # 1 and 2
Sources of Stressors
Overall, most participants felt that their stressors impacted their focus
and understanding of the training program
Most frequent sources of stress were:
a. Lack of science background
b. Financial constrain
c. Worrying about the future
d. Vastness of curriculum/syllabus
Other stress causing factors include: family related problems, staying
away from family members.
Research question # 3
Coping strategies adopted by the students during events of
stress
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Five most common coping strategies;
a. Positive reframing
b. Planning
c. Acceptance
d. Active coping
e. Self distraction
Other strategies also includes religion and alcohol/drug use
Research question # 4 and 5
Impact of counseling on training program
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14 (87.5%) out of 16 participants stated that attending personal
counseling had a positive impact on their academic performance
Effects of Counseling on Stress
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Fourteen (87.5%) out of sixteen participants stated that they
agreed that utilizing personal counseling reduced stress
This complements the results of the PSS-10 questionnaire that was
used in the quantitative component of this study
Limitations
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In terms of the qualitative component, one limitation is that the
interpretation of the question and expressing their views varied
person to person but all the participants expressed in a positive
way towards impact of counseling on overall and academic stress
Diversity in age
Gender
Educational background
Limitations (cont’d)
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Sample size
Gender
Age
Family
Self-selection
The primary limitation of this data is the small sample size
There were only four male subjects in the study, this may be
a limitation because coping strategies and other
characteristics differs between the different sexes
This research will assume the variable of stress related
specifically to final exams and papers as a confounder.
Discussion : Research questions
Changes in PSS before and after the intervention
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13 subjects (81.2%) found to have PSS score more than 20, which
showed a significant stress had been felt by students
Mean pre-test score was found to be 23.25+4.12
Mean post-test score was found to be 18.89+3.03
Pulse
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A significant difference between pre-post-test pulse
was observed for week 2 (P = 0.007), week 3 (P =
0.001)
However , baseline pre-test and week 6 post test pulse
(P = 0.09) was not statistically significant.
Discussion : Research questions
Changes in PSS before and after the intervention
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There is a significant decrease in the PSS score after the 6 weeks
of the intervention (p<0.001)
Change in pulse after every follow-up
Systolic blood pressure
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Mean SBP score at baseline was 127.75+15.38 and at
the end of the study i.e., 6th week it was 124.50+11.24
Change in Systolic Blood Pressure after every follow-up
Systolic blood pressure (mmHg)
Change in Systolic Blood Pressure after every
follow-up
135
130
*
*
*
*
125
*
120
115
110
105
100
Week 1
Week 2
Week 3
Week 4
Time
Pre-test scores
Week 5
Week 6
Baseline
(pre-test)
vs Week 6
(post-test)
Diastolic Blood pressure
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A significant difference between pre-post-test DBP
was observed for week 2 (p = 0.017), week 4 (p =
0.027), week 5 (p = 0.001) and week 6 (p = 0.035)
A significant reduction in the baseline pre-test and
week 6 post test DBP (p = 0.001) was observed.
Diastolic blood pressure (mmHg)
Change in Diastolic blood pressure after every follow-up
80
78
*
76
74
*
*
*
72
70
68
66
64
Time
Pre-test scores
Post-test
*
Summary of Findings
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Present study identified most prevalent stressors,
coping strategies and impact of stress reducing
program on over all stress, wellbeing and academic
performance.
Baseline interview revealed that ‘lack of science
background’ (knowledge about anatomy and
physiology), ‘financial constrain’, ‘worrying about the
future', and 'vastness of curriculum/syllabus' are the
most frequently occurring sources of stress
Summary of Findings (cont’d)
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Overall, most participants felt that their stressors
impacted their focus and understanding of the training
program
Common coping strategies adopted were 'positive
reframing', 'planning', 'acceptance', 'active coping' and
'self distraction'.
Other strategies also includes religion and alcohol/drug
use.
Summary of Findings (cont’d)
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Fourteen (87.5%) out of sixteen participants stated that
attending personal counseling had a positive impact on
their academic performance.
All the sixteen participants explained their plans to
continue their education with excitement, and it
seemed that they had thought it over prior to being
asked .
Significance of Findings
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Present study also identified various coping strategies
followed by the students in general which includes self
distraction, religion and others
Present study showed that structured counseling
sessions helped the students in improving the stress
condition which was seen quantitatively by a
significant decrease in perceived stress score and
qualitatively by asking the question.
Significance of Findings (cont’d)
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This study helps in understanding the sources of stress,
knowledge of reasons for stress, types of coping
strategies used and impact of stress relieving
counseling programs, which helps in better
achievement of pre-nursing part time students.
Future Directions
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Enrollment of students who completed pre-requisites
for the biology course.
Structured and strategic academic courses /programs
and stress
Relationship between triggers of academic stress and
coping strategies
Relationship between body and mind