The Effect of Health-Related Quality of Life on Academic Success in Nursing Students: The Mediating Role of Academic Burnout and Academic Motivation

doi:10.21203/rs.3.rs-3233485/v1

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Research Article

The Effect of Health-Related Quality of Life on Academic Success in Nursing Students: The Mediating Role of Academic Burnout and Academic Motivation

https://doi.org/10.21203/rs.3.rs-3233485/v1

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Background

Identifying the key factors that affect academic success in nursing students, including health-related quality of life, academic burnout, and academic motivation has been to date of utmost importance. In this sense, the present study aimed to investigate the effect of health-related quality of life on academic success, as mediated by academic burnout and academic motivation.

Methods

This cross-sectional study was fulfilled upon recruiting 262 eligible nursing students, selected via convenience sampling. To collect the data regarding health-related quality of life, academic burnout, and academic motivation, the 12-item Short Form Health Survey, the Academic Motivation Scale, and Breso’s Academic Burnout Scale, were respectively administered. Moreover, the nursing program grade point average was considered as the measure of academic success. The data analysis was further performed using the SPSS Statistics (ver. 26) and Mplus (ver. 6.12) software packages at the significance level of 0.05.

Results

The study results showed that although health-related quality of life did not directly affect academic success, it can increase academic success by 0.005 through mediating intrinsic motivation. In addition health-related quality of life can increase academic success through mediating academic burnout and intrinsic motivation by 0.013 (p ≤ 0.05), which means academic burnout and intrinsic motivation significantly mediates the path from the health-related quality of life to academic success.

Conclusions

In accordance with the study results, nursing education planners and instructors are recommended to develop and implement proper measures to enhance academic success in nursing students, and then promote their health-related quality of life and academic motivation, thereby reducing academic burnout.

health-related quality of life

academic success

burnout

motivation

nursing

student

The schools of nursing operating around the world are at the head of educating nurses and graduating competent ones. This can be accomplished by guaranteeing acceptable academic performance (AP) and academic success (AS) [1]. To this point, a range of definitions have been presented for AS. For instance, it implies meeting the minimum standards beyond, i.e., achieving personal satisfaction, reaching some high standards to realize one’s potentials, and making much more efforts In nursing, AS has been further reflected as a student’s nursing course grade, cumulative grade point average (GPA), and overall GPA [2]. Among the indices employed for assessing nursing students’ AS in the National Council Licensure Examination (NCLEX-RN® exam) is nursing program GPA [3].

In this context, AP and AS have been acknowledged as multifaceted phenomena, which can be influenced by a mixture of factors [4]. In view of that, identifying the effective factors and predictors of AS seems to crucial for ensuring high-quality education and its completion [5]. As well, academic motivation (AM) has been introduced as one of the predictors of AS [6]. It has been thus explained as a student’s innate desire to continually uncover useful, novel ideas [1]. Hence, learners with strong AM would rather perfection and strive to expand their AP [7]. Some have correspondingly recounted a significant relationship between AM and some educational outcomes, e.g., student grades, regular attendance and active participation, as well as satisfaction with educational activities. AM has been further linked to academic effort, deep processing, and the use of cognitive and metacognitive strategies within self-regulated learning (Rafii et al., 2019).

In keeping with self-determination theory, there is a continuum with different types of AM. In this respect, three levels of AM can be classified, viz. intrinsic, originating from personal interests and desires; extrinsic, induced by external social or parental pressure; and amotivation, representing loss of interest in learning [8].

In this way, nursing students’ AM is of great significance as effective nursing care services demand motivated students to acquire more knowledge and skills, and continue their studies. There is also the evidence of a significant positive relationship between AM and professional dedication in nursing students. Besides, motivated nursing students are less likely to undergo academic depression, but might experience higher levels of self-esteem [4]. In spite of this, nursing students are typically subjected to numerous challenges, mainly regarding their AM owing to some internal and external factors, including personal, family, social, educational, and professional issues [9]. Such students are thus required to gain professional knowledge, skills, and competencies to provide high-quality care services in their future career. In general, they feel a significant amount of academic stress attributable to course assignments, clinical reports, examinations, lower-than-expected grades, and poor interpersonal relationships with faculty members [10]. As university students, they stand facing much more responsibilities accompanied by increased autonomy, such as coping with moving away from home, handling peer pressure, managing individual finances on their own, and controlling some challenges during personal relationships [11]. As concluded in the review by Labrague et al. [12], nursing students could suffer from moderate-to-severe levels of stress, and the main stressors were patient care, course assignments, and workload, as well as negative interactions with other staff and instructors. In this line, chronic exposure to academic stress might result in academic burnout (AB) in such students [10].

Notably, AB has been illustrated as a global problem in nursing students [13]. It refers to feeling fatigued among students as a result of the requirements and difficulties of studying, loss of interest in performing course assignments, and being laid up with a sense of ineffectiveness [14]. From this perspective, nursing students live through more stress and AB as compared with those enrolled in other health professions, with the prevalence rate of up to 20% [15]. The nursing students’ AB typically comes from high workload and inflexible curricula and then their resulting stress [16]. AB accordingly has an adverse effect on the learning process and AP of nursing students [13]. Furthermore, the students undergoing AB have been reportedly more susceptible to have higher rates of attrition and burnout after being employed (Spivey et al., 2020). Therefore, AB in nursing students can be a subject of interest for further investigation [13] as a big concern in higher education today, although few studies on its mechanism are still available [15].

Such conditions can affect physical, mental, and social health and even quality of life (QoL) among nursing students [9]. In relation to the definition of QoL by the World Health Organization (WHO), it is the subjective assessment of one’s life with regard to a value system, a series of goals, expectations, interests, and the cultural context they live in [17]. QoL is also a broad view of one’s life, health status, or life satisfaction (Grande et al., 2021). In this connection, health-related QoL (HRQoL) is a multidimensional concept that contains physical, mental, emotional, and social functioning. It further rises above the direct measures of public health and lays much more focus on the effect of health status on QoL [15].

Nursing students’ QoL may also affect their learning outcomes, socialization, and AS [9]. As evidence, students with higher perceptions of QoL make the best use of all educational services, and get more involved in the scientific and extracurricular ones [17]. The positive correlation between physical activity habits and high AS has been similarly documented in medical students [18]. Assessing QoL in nursing students has been further highlighted over the past years [9], since it may shape improved learning strategies, socialization, and AS [19], as indicators of education quality by higher education policymakers [9].

Numerous studies have been to date conducted on the relationship between HRQoL, AM, AB and AS. In this vein, Elbsuony shed light on the correlation between AM and HRQoL in nursing students [19]. As well, the relationship between nursing students’ QoL and their AM was investigated by Emamjomeh et al. [20]. Furthermore, Bulfone et al. delineated the mediating role of AB in the relationship between self-efficacy and AS in such students [21]. In one other study, the effect of nursing students’ AB on their psychological well-being and AS was additionally analyzed [22]. Chattu et al. in a study in Brazil established the differences in QoL among the students of different fields of healthcare, and then described the AP predictors [23]. Besides, Douris et al. examined the correlation between AS and sleep, stress, and QoL in the physiotherapy students in the first year [18]. Henning et al. correspondingly considered the relationship between QoL perceptions, learning motivation, and AS among the medical students in New Zealand [24]. In another study, the correlation between AB, QoL, AM, and AS in medical students was explored [25]. Likewise, Colby et al. determined the relationship between AB and QoL of senior medical students of the University of the Free State in South Africa [26].

Although previous research had been conducted on the relationship between QoL, AB, AM, and AS among nursing and medical students, there was no study reflecting on the correlation between the variables of HRQoL, AB, AM, and AS, to the best of the authors’ knowledge. Against this background, this study aimed to investigate the effect of HRQoL on AS, as mediated by AB and AM. In view of that, the research hypotheses were as follows:

H₁: HRQoL has a direct effect on AB and AM.
H₂: AB has a direct effect on AM and AS.
H₃: AM has a direct effect on AS.
H₄: HRQoL has a direct effect on AS.
H₅: HRQoL has an indirect effect on AM, as mediated by AB.
H₆: HRQoL has an indirect effect on AS, as mediated by AM.
H₇: HRQoL has an indirect effect on AS, as mediated by AB.
H₈: HRQoL has an indirect effect of AS, as simultaneously mediated by AB and AM.

Design

Utilizing a cross-sectional descriptive research design, this study was to illuminate the effect of HRQoL on AS based on the mediating role of AB and AM among nursing students in 2022.

Participants and setting

Considering nursing education as a four-year program in Iran, this study was conducted on the nursing students at Shahid Beheshti University of Medical Sciences, Tehran, Iran, selected via convenience sampling. With reference to Mohammadi et al. [14], recruiting the formula for determining the sample size in correlation studies with α = 0.05, β = 0.20, and r = 0.181, the sample size was thus obtained by at least 238 students. Taking account of 10% attrition, 262 eligible participants were finally included in the study. The inclusion criteria were completing at least one year of nursing education and not working in any other fields but nursing.

Measures

Demographic information questionnaire

This questionnaire contained six items about age, gender, marital status, academic semester, interest in the field of study, and nursing program GPA as a measure for AS.

12-item Short Form Health Survey (SF-12)

The 12-item Short-Form Health Survey (SF-12) used for measuring HRQoL. The tool includes 12 questions into two sub-scales: physical and mental health. The physical subscale includes six questions in 4 dimensions: 1) Physical functioning (2 items) with answers given on a 3-point Likert scale ranging from “Yes, limited a lot” (1 score) to “No, not limited at all” (3 scores); 2) Role-physical (2 items) with binary answers “Yes” (1 score) and “No” (2 score); 3) Bodily pain (1 item) with answers given on a 5-point Likert scale ranging from “Extremely painful” (1 score) to “Not at all” (5 scores); 4) General health (1 item) with answers given on a 5-point Likert scale ranging from “Poor” (1 score) to “Excellent” (5 scores). The mental subscale consists of 6 questions in 4 dimensions: 1) Social functioning (1 item) with answers given on a 6-point Likert scale ranging from “All of the time” (1 score) to “None of the time” (6 scores); 2) Role-emotional (2 items) with binary answers “yes” (1 score) and “no” (2 scores); 3) Vitality (1 item) with answers given on a 6-point Likert scale ranging from “None of the time” (1 score) to “All of the time” (6 scores); 4) Mental health (two items) with answers given on a 6-point Likert scale ranging from “All of the time” (1 score) to “None of the time” (6 scores). Depending on the type of question, answers are designed based on a 2 to 6-point Likert scale. Answers to all questions are scored in the direct order, except 1, 8, 10, and 11. This questionnaire’s minimum and maximum scores are 12 and 48, respectively. The psychometric properties of this tool for Persian-speaking patients have been confirmed [27]. Cronbach's alpha of the instrument was 0.88 in an Iranian study [28]. In the present study, Cronbach's alpha of the whole instrument was 0.8 after 20 nursing students who did not enter the study completed it.

Academic Motivation Scale

The Academic Motivation Scale (AMS) was translated from French into English in 1992 by Vallerand et al. to identify AM in students [29]. This 28-item questionnaire comprised of three subscales, namely, intrinsic motivation (12 items), extrinsic motivation (12 items), and amotivation (4 items), scored on a seven-point Likert-type scale from strongly disagree (score 1) to strongly agree (score 7) [14]. The validity and reliability of this tool had been already confirmed in the Middle East by Al Ansari et al. [8], and such criteria had been further established in a study in Iran with the Cronbach’s alpha coefficient of 0.83 [30]. In the present study, Cronbach’s alpha coefficient of this scale was 0.8.

Breso's Academic Burnout Scale

Breso's Academic Burnout Scale measures three aspects of AB: exhaustion, cynicism, and inefficacy. Breso et al. designed this scale to measure the burnout level in students. This scale contains 15 items which evaluate the dimensions of exhaustion (5 items), cynicism (4 items), and inefficacy (6 items) with answers given on a 5-point Likert scale ranging from "Disagree" (1 score) to "Agree" (5 scores) [31]. The minimum and maximum scores were 15 and 75, respectively. The reliability of these three dimensions, including exhaustion, cynicism, and academic efficacy, were 0.70, 0.82, and 0.75, respectively [32]. In the present study, Cronbach's alpha of the whole instrument was 0.91.

Data collection and data analysis

The data were collected using a single-step procedure at the school of nursing or the clinical settings wherein the nursing students could be found.

Descriptive statistics and correlation analysis of HRQoL, AB, AM, and AS were done using Structural Equation Modeling (SEM) to estimate the direct, indirect, and total effects of the independent variable (HRQoL) on the dependent variable (AS) in the attendance of mediating variables (AB, intrinsic motivation, extrinsic motivation, and un-motivation). Before conducting the SEM model, data were checked for outlier values and normality assumptions. Normality assumption was checked based on the histograms and Kolmogorov–Smirnov test. Outliers were recognized with a Z score cutoff of 3.29 as proposed by Field [33]. Bivariate correlation test were calculated to assess the assumption of multicollinearity and the relationships between all the variables. It is assumed that highly correlated variables (r > 0.90) indicate multicollinearity [34]. The hypotheses of the study were tested utilizing path analysis: (1) evaluating all mediation effects among variables, (2) examining the main pathway of quality of life to achievement. Independent, dependent, and mediators were analyzed as continuous variables and demographic variables were controlled as covariates in the path model. The estimation method of the path model was MLM, and goodness-of-fit statistics were comparative fit index (CFI), root mean square error of approximation (RMSEA), Tucker–Lewis Index (TLI), Standardized Root Mean Square Residual (SRMR), and Weighted Root Mean Square Residual (WRMR). The values of > 0.95 for CFI and TLI, < 0.05 for RMSEA and SRMR, and < 1 for WRMR represent a good fit [35]. SPSS software (version 26) and M-Plus (version 6.12) were applied to analyses.

Participants’ characteristics

Two hundred sixty-one nursing students with a mean age of 22.57 ± 3.32 years old participated in the study. Their average academic semester was 5.87 ± 1.51. Other demographic information is presented in Table 1.

Table 1

Descriptive statistics of demographic variables (N = 261)
Variables	n	(%)
Gender
Male	146	55.9
Female	115	44.1
Marital status
Married	12	4.6
Single	249	95.4
Academic interest
Yes	177	67.8
No	84	32.2

Correlations between study variables

Table 2 also shows the descriptive results of HRQoL, AB, AM, and their dimensions and AS. According to Table 3, the academic semester was significantly associated with HRQoL (r = 0.15, p ≤ 0.05), AB (r= -0.16, p ≤ 0.05), and AS (r = -0.23, p ≤ 0.01). There was also a correlation between interest in the field of study with HRQoL (r = -0.22, p ≤ 0.01), AB (r = 0.47, p ≤ 0.01), intrinsic motivation (r=-0.28, p ≤ 0.01), extrinsic motivation (r = -0.34, p ≤ 0.01), and un-motivation (r = 0.39, p ≤ 0.01).

Table 2

Descriptive statistics of main variables (N = 261)
Scale	Variable	Mean ± SD	Median [min, max]
HRQoL
	General health (GH)	3.47 ± 0.96	3 [1, 5]
	Physical functioning (PF)	5.33 ± 1.0	6 [2, 6]
	Role physical (RP)	3.64 ± 0.73	4 [2, 4]
	Bodily pain (BP)	4.06 ± 0.86	4 [1, 5]
	Physical health (Total score)^a	16.51 ± 2.61	17 [7, 20]
	Social functioning (SF)	4.64 ± 1.14	5 [1, 6]
	Role emotional (RE)	3.15 ± 0.90	3 [2, 4]
	Vitality (VT)	3.97 ± 1.08	4 [1, 6]
	Mental health (MH)	8.14 ± 1.90	8 [2, 12]
	Mental health (Total score)^b	19.90 ± 4.32	21 [6.28]
	Total score	36.41 ± 6.30	38 [14,48]
AB
	Exhaustion	14.93 ± 5.01	15 [5, 25]
	Cynicism	11.95 ± 3.88	12 [4, 20]
	Inefficacy	14.94 ± 4.05	15 [6, 27]
	Total score	41.83 ± 11.45	43 [15,71]
AM
	Intrinsic motivation	52.22 ± 14.32	52 [19.48]
	Extrinsic motivation	53.86 ± 14.76	54 [12,84]
	Amotivation	8.82 ± 5.13	7 [4.28]
AS (GPA)		16.96 ± 1.10	17 [13, 19.5]
Note: ^a Physical health = GH + PF + RP + BP; ^b Mental health = SF + RE + VT + MH HRQoL, health-related quality of life; AB, Academic burnout; AM, Academic motivation; AS, Academic success

Table 3

Bivariate correlation coefficients between variables
	1	2	3	4	5	6	7	8	9	10	11
Age (1)	1	-	-	-	-	-	-	-	-	-	-
Gender (2)	-0.18*	1	-	-	-	-	-	-	-	-	-
Marital status (3)	0.34*	-0.05	1	-	-	-	-	-	-	-	-
Academic semester (4)	0.66**	-0.04	0.15*	1	-	-	-	-	-	-	-
Interest in the field of study (5)	-0.13	0.05	-0.07	-0.12	1	-	-	-	-	-	-
HROoL (6)	0.15*	-0.03	-0.01	0.15*	-0.22**	1	-	-	-	-	-
AB (7)	-0.07	-0.12	-0.06	-0.16*	0.47**	-0.52**	1	-	-	-	-
Intrinsic motivation (8)	-0.02	0.13	-0.06	-0.08	-0.28**	0.13*	-0.47**	1	-	-	-
Extrinsic motivation (9)	0.05	0.12	0.05	0.04	-0.34**	0.25**	-0.49**	0.78**	1	-	-
Amotivation (10)	0.00	-0.20*	0.08	-0.06	0.39**	-0.38**	0.58**	-0.35**	-0.42**	1	-
AS (11)	-0.21*	0.11	-0.23**	-0.23**	-0.07	0.01	-0.02	0.27**	0.24**	0.01	1
HRQoL, health-related quality of life; AB, Academic burnout; AM, Academic motivation; AS, Academic success p-value < 0.05; *p-value < 0.01

HRQoL was significantly associated with AB (r = -0.52, p ≤ 0.01), intrinsic motivation (r = 0.13, p ≤ 0.05), extrinsic motivation (r = 0.25, p ≤ 0.01), and un-motivation (r= -0.38, p ≤ 0.01). There was a significant correlation between AB with intrinsic motivation (r= -0.47, p ≤ 0.01), extrinsic motivation (r = -0.49, p ≤ 0.01), and un-motivation (r = 0.58, p ≤ 0.01). Intrinsic motivation was significantly associated with extrinsic motivation (r = 0.78, p ≤ 0.01), un-motivation (r = -0.35, p ≤ 0.01), and AS (r = 0.27, p ≤ 0.01). Finally, extrinsic motivation was significantly correlated with un-motivation (r = -042, p ≤ 0.01) and AS (r = 0.24, p ≤ 0.01).

Path analysis results

Findings from the path model are outlined in Table 4 and Fig. 1. Results showed that the direct paths from the HRQoL to AB (a1, p ≤ 0.001), intrinsic motivation (a3, p ≤ 0.05), and un-motivation (a4, p ≤ 0.05) were significant; that means, increasing one unit of HRQoL increases intrinsic motivation by 0.29 and can decrease AB and un-motivation by 1.02 and 0.014 respectively. In contrast, the direct effect of HRQoL on extrinsic motivation was not significant (a2, B = 0.09, p = 0.56).

Table 4

Path coefficients of direct and indirect effects among variables (N = 261)
Path		B (SE)	β	95% CI (B)		p-value
Path		B (SE)	β	Lower	Upper	p-value
Direct effect	a₁	-1.02 (0.09)	-0.56	-1.17	-0.87	0.000***
	a₂	0.09 (0.15)	0.04	-0.16	0.34	0.56
	a₃	0.29 (0.14)	0.13	0.06	0.52	0.04*
	a₄	-0.14 (0.05)	-0.17	-0.22	-0.05	0.01*
	b₁	-0.01 (0.01)	-0.08	-0.005	0.021	0.32
	b₂	-0.61 (0.07)	-0.47	-0.72	-0.49	0.000***
	b₃	-0.70 (0.07)	-0.56	-0.82	-0.58	0.000***
	b₄	0.24 (0.03)	0.54	0.19	0.29	0.000***
	C₁	0.02 (0.01)	0.24	0.007	0.03	0.01*
	C₂	0.05 (0.01)	0.07	0.006	0.02	0.04*
	C₃	− .002 (0.01)	-0.01	-0.02	0.02	0.88
	D	0.01 (0.01)	0.06	-0.01	0.03	0.43
Indirect effect	a₁b₁	0.01 (0.01)	0.05	-0.005	0.02	0.32
	a₁b₂	0.62 (0.09)	0.27	0.46	0.77	0.000***
	a₁b₃	0.72 (0.10)	0.32	0.54	0.89	0.000***
	a₁b₄	-0.25 (0.04)	-0.30	-0.31	-0.18	0.000***
	a₃c₁	0.005 (0.003)	0.03	-0.01	0.005	0.05*
	a₂c₂	0.005 (0.001)	0.003	-0.001	0.003	0.65
	a₄c₃	0.00003(0.002)	0.002	-0.003	0.003	0.88
	a₁b₃c₁	0.013 (0.005)	0.08	0.005	0.02	0.01*
	a₁b₂c₂	0.003 (0.004)	0.02	-0.004	0.01	0.47
	a₁bc₃	0.00005 (0.003)	0.003	-0.005	0.006	0.88
Total effect		0.015 (0.01)	0.087	-0.005	0.04	0.22
HRQoL, health-related quality of life; AB, Academic burnout; AM, Academic motivation; AS, Academic success Note: B = unstandardized coefficient; β = standardized coefficient; SE = standard error; CI = Confidence Interval for B; Controlled confounders = age, marital status, academic interest, and semester; p ≤ 0.05; **p ≤ 0.001

According to the results, the direct paths from AB to intrinsic motivation (b3, p ≤ 0.001), extrinsic motivation (b2, p ≤ 0.001), and un-motivation (b4, p ≤ 0.001) were significant; that means, increasing one unit of AB can decrease intrinsic motivation and extrinsic motivation by 0.07 and 0.061 respectively, and increases un-motivation by 0.24. In contrast, the direct effect of AB on AS was not significant (b1, B = -0.01, p = 0.32).

The other results revealed that there is a significant direct effect from intrinsic motivation to AS (c1, p ≤ 0.05) and from extrinsic motivation to AS (c2, p ≤ 0.05); that means one unite of intrinsic motivation and extrinsic motivation increases AS by 0.02 and 0.05 respectively. In contrast, the direct path from un-motivation to AS was not significant (c3, B = -0.002, p = 0.88). The direct path from the HRQoL to AS was also not significant (D, B = 0.01, p = 0.43).

The indirect paths from the HRQoL to extrinsic motivation (a1b2, p ≤ 0.001), intrinsic motivation (a1b3, p ≤ 0.001), un-motivation (a1b4, p ≤ 0.001) through the AB were significant; that means HRQoL can increase intrinsic motivation and extrinsic motivation, and also decrease un-motivation by 0.62, 0.72, and 0.25 through mediating AB

HRQoL significantly indirectly affects AS via intrinsic motivation (a3c1, p ≤ 0.05). The indirect path from the HRQoL to AS via AB and intrinsic motivation was significant (a1b3c1, p ≤ 0.05); that means HRQoL can increase AS by 0.005 through mediating intrinsic motivation and HRQoL can increase AS through mediating AB and intrinsic motivation by 0.013. The model fit results showed that all the indicators indicated a good fit of the data (CFI = 0.992, TLI = 0.979, RMSE = 0.039, SRMR = 0.032, WRMR = 0.863).

The study results confirmed H₁-H₃, denoting that HRQoL could reduce AB and amotivation, and elevate intrinsic motivation. Moreover, AB could have a decreasing effect on intrinsic and extrinsic motivation, but an increasing effect on amotivation. Intrinsic motivation could also boost AS.

The study findings further validated H₅, H₆, and H₈, suggesting that HRQoL could amplify intrinsic and extrinsic motivation, and subsequently diminish amotivation by lowering AB. Although HRQoL did not directly influence AS, AB and intrinsic motivation could mediate the path from HRQoL to AS, and significantly enhance it.

While HRQoL did not have a direct effect on AS according to the study results, it influenced AS through the mediation of intrinsic motivation alone and the simultaneous mediation of AB and intrinsic motivation. In their study, Chattu et al. had similarly demonstrated that QoL was positively correlated with academic GPA as the measure for the AP of medical students and other health care professions [23]. Besides, Douris et al. had concluded that the changes in sleep patterns and QoL could account for about 60% of the variations in GPA [18]. As evidenced in another survey, the medical students’ perceptions of QoL and AM were related to AS [24]. The results of a study on medical students had correspondingly indicated that AM and AS had dropped due to lower QoL and higher AB in medical students [25].

In line with previous research, the study results additionally showed that HRQoL could affect other variables, such as AB, intrinsic motivation, and amotivation. As well, Elbsuony established a positive correlation between intrinsic motivation, extrinsic motivation, and HRQoL in nursing students [19]. Somewhere else, a relationship was observed between AM and the QoL dimensions among nursing students, specifically the mental ones [20]. Colby et al. had also designated a relationship between AB and QoL in fourth-year medical students [26].

As a final point, the study results revealed that AB had a significant effect on intrinsic motivation, extrinsic motivation, and amotivation, and AS was a mediator in the path from HRQoL to AM. Corresponding to these results, Bulfone et al. [21] had found that AB could have a mediating role in the relationship between self-efficacy and AS in nursing students. In a review, nursing students’ AB had been further reported to affect their psychological well-being and AS [22].

Considering the study results, nursing education planners and instructors are suggested to develop and implement proper measures to promote HRQoL, reduce AB, and increase intrinsic and extrinsic motivation, thereby improving AS. Such measures can be focused on education aimed at enriching nutrition and physical activity, relieving stress, augmenting interpersonal communication, and having good-quality sleep. Furthermore, explaining the importance of the nursing profession in promoting individual and public health, strengthening concentration, building self-confidence and self-esteem, managing time and planning, doing extracurricular and leisure activities, paying respect to individual differences and talents, using collaborative learning methods, devoting attention to students’ interests, wishes, and needs in assignments and educational programs, creating friendly environments based on the principles of effective instructor-student communication, and providing continuous academic and performance-based counseling in order to identify weak students, can be among the strategies to increase AM and decrease AB in nursing students.

Among the limitations of this study was the use of self-report data. Another limitation was the cross-sectional research design adopted to determine the effect of HRQoL on AS, as simultaneously mediated by AB and AM. It was thus suggested to investigate the effect of HRQoL-centered empowerment programs on AB, AM, and AS in nursing students and others enrolled in medical fields in future studies. Although the present study was conducted on nursing students, its results could be fortunately generalized to the students of other medical sciences.

QoL

quality of life

HRQoL

health-related quality of life

academic success

academic burnout

academic motivation

Ethical Approval

All the procedures performed in this study were approved by the Ethics Committee of with SBMU, Tehran, Iran (IR.SBMU.PHNM.1400.843), in accordance with the ethical standards of the 1964 Declaration of Helsinki and its later amendments or comparable standards. Informed consent was also obtained from all the study participants.

Availability of data and materials

Data supporting the findings of this study are available from the corresponding author (Parvaneh Vasli) on request at [email protected]

Funding Source

Not applicable.

Conflict of Interest

The authors have no conflict of interest to declare.

Consent for Publication

Not applicable.

Acknowledgments

The authors hereby extend their gratitude to all students for their participation in the study.

Author’s contribution

FT contributed to the conceptualization, data collection. PV contributed to project administration, data analysis and interpretation, writing and final approval of the manuscript.

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The Effect of Health-Related Quality of Life on Academic Success in Nursing Students: The Mediating Role of Academic Burnout and Academic Motivation

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Abstract

Background

Methods

Results

Conclusions

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Introduction

Literature review

Methods

Design

Participants and setting

Measures

Demographic information questionnaire

12-item Short Form Health Survey (SF-12)

Academic Motivation Scale

Breso's Academic Burnout Scale

Data collection and data analysis

Results

Participants’ characteristics

Correlations between study variables

Path analysis results

Discussion

Conclusions

List Of Abbreviations

Declarations

References

Additional Declarations

Status:

Version 1