Design and study context
The study is part of a larger and longitudinal study of occupational therapy students’ academic performance, in context of their perceptions of the learning environment and approaches to studying. In the current study, cross-sectional data from students enrolled in the first year of the study program were used.
Participants and recruitment
First year occupational therapy students at six higher education institutions in Norway were approached for possible inclusion in the study. A total of 305 students were eligible participants, and of these 187 students (response rate 61.3 %) participated. For each of the institutions, the response rates were 24/76 = 31.6 % in Oslo, 56/77 = 72.7 % in Trondheim, 19/39 = 48.7 % in Gjøvik, 31/47 = 66.0 % in Sandnes, 24/24 = 100.0 % in Tromsø, and 33/45 = 73.3 % in Bergen. Thirteen students had missing values on one or more of the employed variables and were consequently removed, rendering a sample of 174 students for the analysis.
Age (in years) and time spent on independent studying (average hours during a typical week) were registered as continuous variables. Gender (male/female), having prior experience from higher education (yes/no) and having occupational therapy as the highest prioritized line of education at the time of enrolment (yes/no) were registered as categorical variables.
The learning environment
In this study, the Course Experience Questionnaire (CEQ) was used to measure aspects of the learning environment. In its original version, the CEQ consists of 30 items distributed onto five scales: clear goals and standards, emphasis on independence, good teaching, appropriate workload, and appropriate assessment . In addition to the 30 items, one item assesses the students’ general satisfaction with the course. The validated Norwegian translation of the CEQ  was used in the present study. The scales indicate that the respondent perceives the course to have (1) clearly established and disseminated goals; (2) high levels of student autonomy and independence; (3) teaching that engages and involves the students; (4) an appropriate workload; and (5) assessment forms that promote and support learning. In the current study, internal consistency measures were 0.73 (clear goals and standards), 0.63 (emphasis on independence), 0.70 (good teaching), 0.69 (appropriate workload), and 0.45 (appropriate assessment). In view of the preliminary internal consistency results, the ‘appropriate assessment’ scale was removed from the subsequent analyses .
Approaches to studying
Study approaches were measured with the Approaches and Study Skills Inventory for Students , and the students used a previously validated Norwegian translation of the instrument . The ASSIST consists of 52 statements to which the respondent is asked to rate his or her level of agreement (1 = disagree, 2 = disagree somewhat, 3 = unsure, 4 = agree somewhat, 5 = agree). The instrument has a three-factor structure, recently replicated in a cross-cultural study of undergraduate occupational therapy students . The items are organized accordingly into three main scales (the deep, strategic, and surface approaches to studying). Scale scores are calculated by adding the scores on the relevant items. In the present study sample, the internal consistency between scale items were 0.71 (deep approach), 0.84 (strategic approach), and 0.76 (surface approach).
The students’ average exam grade scores were based on the qualitative descriptors related to the students’ exam grades : fail = 1, sufficient = 2, satisfactory = 3, good = 4, very good = 5, and excellent = 6. As the exam grade measure, we used the students’ grade point average (GPA) by the time the data was collected.
The sample was described with means and standard deviations on continuous variables, whereas frequencies and percentages are used on categorical variables. Men and women were compared statistically by Chi-square tests (categorical variables) and independent t-tests (continuous variables), and Cohen’s d was used as effect size . Generally, d ranging 0.20-0.49 are considered small effect sizes, whereas d ranging 0.50-0.79 and 0.80 or above are considered medium and large effect sizes, respectively.
To assess the strength of associations between the independent variables and the students’ GPA, a hierarchical linear regression analysis was performed using GPA as outcome variable. In Block 1, representing the background variables, age, gender, educational priority, prior higher education, and time spent on independent study were included as independent variables. In Block 2, representing the perceived learning environment, clear goals and standards, student autonomy, good teaching, and appropriate workload were included. In Block 3, representing the study approaches, the deep approach scale, strategic approach scale, and surface approach scale were included as independent variables. The strength of associations was assessed with the standardized β coefficient. The regression models were also used to assess the outcome variance proportions accounted for by each of the models and by all variables together. All analyses were performed with SPSS for Windows, version 26 , and results were considered statistically significant if p < 0.05.
The Data Protection Official at the Norwegian Center for Research Data approved the study on October 12, 2017 (project no. 55875). The participants provided informed consent prior to the commencement of the study and were assured that their information would be treated in confidence.