Study Design and Approach
The study was a pre-post controlled quasi-experimental with cluster-randomized educational institutions (to either be in an intervention or control group) through a simple random sampling technique by lottery method determined by the research assistants. The first pick of papers from an allocation choice boxwas assigned to an intervention and the second to the control group. The study participants were purposively selected 401 (interventional group = 134 and control group = 267) by the researcher and research assistants.
The participants were undergraduate nursing students from selected government and private-owned higher learning institutions in Tanzania. The quantitative research approach was employed to determine the extent the intervention could improve levels of motivation to learn among nursing students.
The study included undergraduate nursing students, who had a regular attendance of classes, and those who gave a written informed consent (willingness to join the study). Matching of the study participants by their social demographic and academic characteristics was also done to ensure the similarities.
The sample size was determined by using the findings of Shahin et al., (25), who did a study on critical thinking and self-directed learning as an outcome of facilitation in a problem-based environment among nursing students. A WinPepi Software program (sample size calculator) version 11.65 was used to calculate the minimum sample for this study. Effect size (d = 4.5) of demonstrating a statistically significant difference between mean values of the before and after the intervention, was set at a 95% confidence interval. A significance level was set at 5% (p<0.05) with the power of 80%. The ratio of sample size was B: A =1:2 with 134 participants in the intervention and 267 participants in the control group (n = 401)
The study was done between February and June 2018 in the two major Universities within Dodoma administrative region and currently the Capital city, Central zone of Tanzania. The pre-post written test was used to collect and compare data before and after an intervention. The interventional group learned the prepared research content by using FPBE pedagogy whereas their counterpart (control group) learned by using the conventional-based instructional method.
Data Collection Process
,The researcher and research assistants distributed copies of questionnaires among the study participants. All participants answered the same questions before and after an intervention.
Data Collection Tools
The instrument used for data collection was a structured Questionnaire titled Academic Motivation Scale (AMS-HS 28): adapted from AMS – College Version 1993 and validated by Haugan et al., (26). The tool was used for assessing levels of intrinsic motivation (towards knowledge, accomplishments, and stimulation), extrinsic (introjected and identified regulation), and amotivation among undergraduate nursing students. It had 28 items with 140 scores on a 5-point point Likert scale. Scale 1 = does not correspond at all, 2 = correspond a little, 3 = corresponds moderately, 4 = corresponds a lot and 5 = corresponds exactly. Part A of the instrument elicited information about demographic data (e.g. age, sex, education level of the student, accommodation status, etc.). Part B elicited information about levels of motivation to learn adopted by students in their learning processes. This part covered three aspects (Intrinsic motivation, extrinsic motivation, and Amotivation to learn).
Intrinsic motivation was assessed by using a twelve (12) 5-point Likert (≥6 scores were defined as intrinsically motivated) scale items, extrinsic motivation twelve (12) items (≥6 scores were defined as extrinsically motivated), and Amotivation to learn 4 items (≥2 scores were defined as intrinsically motivated). The overall motivation to learn among the study participants was then computed that had a cut-off point in this study was set at 70 scores from 140 total scores of the scale items. The study participant, who scored ≥70 of the scale items, was defined as motivated to learn otherwise not.
Development and Classroom Tryouts of the Research Teaching Material
As shown in figure 1, the designed material was prototyped into phase 0, I, II, and III. Phase 0 was the development phase while phases 1 and 2 were for classroom tryouts. The third version was subjected to the field-testing. Classroom tryouts for phases 1 and 2 were done in one sampled health training institution, which was different from health training institutions where the study was conducted. All classroom tryouts involved 10 nurse students, a principal researcher, 2 research assistants, 1 curriculum development expert, 1 over five years experienced nurse tutor in teaching leadership and management content. Experts and student’s opinions of one classroom tryout led to the development and refinement of the next version.The evaluation process of the developed research teaching material was done formative and summative basing on the experts' and students’ opinions. All observations from experts and students were only used to assure the acceptability, feasibility, and practicality of the research teaching and learning material before actual field implementation.
Facilitation in a Problem-Based Environment Sessions (Intervention)
This part served as an actual implementation phase, which involved the followings;
Introduction and Group Formulation: this part was covered on the first day of the study. The researcher introduced the FPBE process and shared the expected terminal behavior throughout the FPBE classes. Students were then randomly assigned to the learning groups (8 students) per each whereby they were asked to appoint a leader and record keeper between himself and herself. This part took approximately 30 minutes.
Problem Presentation, Solving, and Discussions: the researcher and research assistant reviewed the objective of each session. Each group was asked to seat in the round so that they could maintain eye contact and facilitate the easy flow of discussions. Thereafter, each group was given the developed scenario on Conflict Resolution at the working place and allows the students to start addressing it. Participants were guided and facilitated by the researcher and research assistants to solve the problem, listing what they knew, what they did not know, what they needed to know and establish the issues to learn.
Students were guided to clarify, rank, and assign learning tasks to each member of the group. They were then guided to identify and suggest the reasoned available resources needed to solve the presented problem and continue solving it. This part took approximately 60 to 120 minutes based on the institution schedules. Then, students were given one week to address the problem until the next scheduled time because there would always-learning issues to be explored about the problem. As part of the closure, the researcher and research assistants required either students to communicate by mobile texts, orally, or writings through email whenever they need any help or clarifications. In the next meeting, presentations of the solved problems were done per each followed by discussions and sharing of real-world scenarios, which reflected their experiences in real life. Misconceptions and other myths got a chance to be cleared. Group Facilitations: this study used two forms of facilitating the groups including researcher and research assistant facilitation and group leaders’ facilitation. Group leaders were sometimes used to facilitate groups because the classes were so large. They were briefly instructed to act as facilitators on how to monitor and control the learning process in their groups.
Assessments: after completing the intervention classroom sessions, the researcher, assistant researchers and students, evaluated the lesson objectives by providing inputs, students learning behaviors, advantages and disadvantages of group interactions, and the benefits of learning through FPBE. Peer assessment was the main method used to assess the learning process among participants. The posttest to assess end line levels of motivation to learn was then administered to the participated students to ascertain the effect of the intervention.
Descriptive and Inferential statistical analyses were performed in this study. All the statistical analysis was performed using the Statistical Product for Service Solutions (SPSS) version 23. Descriptive statistics by the means of chi-square and cross-tabulation statistical tests were performed to determine the relationship between categorical variables and findings were presented in frequencies, percentages, mean scores, and standard deviation (SD). Paired-sample and independent samples t-tests were performed to compare the differences of the mean scores among the study participants within and between groups whereby the mean (M), standard deviation (SD), and p-value were used to present the findings in tables. Inferential statistical analyses were performed through regression analysis to determine the association between variables. The findings were presented by odds ratio (OR), adjusted odds ratio (AOR) and p-value that was set at ≤0.05 to be statistically significant .