The Efficacy of the Spaced Learning Teaching Method on Student Engagement and Learning Anxiety

doi:10.21203/rs.3.rs-4712072/v1

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The Efficacy of the Spaced Learning Teaching Method on Student Engagement and Learning Anxiety

https://doi.org/10.21203/rs.3.rs-4712072/v1

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Background: Spaced learning is a relatively new teaching method to enhance learning and memory retention. This study aims to investigate the effectiveness of spaced learning on student engagement and learning anxiety in the principles and techniques of nursing practical course.

Methods: This quasi-experimental study involved 51 first-semester nursing students selected through convenience sampling and randomly assigned to either the experimental or control group. Data were gathered using three standardized questionnaires: demographic characteristics, Learning anxiety, and the Student Engagement in School Questionnaire (SESQ). During the implementation phase, after obtaining consent and completing the demographic characteristics form, the experimental group was taught using the spaced learning method, while the control group received traditional instruction. After completing the classes, students from both groups filled out the learning anxiety and student engagement questionnaires. Data were analyzed using SPSS (version 26) and descriptive and inferential statistics.

Results: The mean age of participants was 19.46 years, with females comprising the majority (58.9%). The main findings indicated that the experimental group had significantly lower learning anxiety compared to the control group (P<0.05). Additionally, the total SESQ mean score was significantly higher in the experimental group (P<0.05). The spaced learning group students also had higher mean scores in all three SESQ dimensions (Affective, Behavioral, and Cognitive), with statistically significant differences observed only in the cognitive and behavioral dimensions (P<0.05).

Conclusions: Spaced learning is a fun, enjoyable, cost-effective, and flexible teaching method that can improve the learning level of students through the management of learning anxiety. It also enhances student engagement, especially in the two crucial and influential cognitive and behavioral dimensions of academic success.

Teaching

Learning

Nursing Education

Research

Anxiety

Rapid and increasing developments in today's world, along with all the various social, cultural, and economic benefits, have also put new challenges in front of societies (1, 2). One of these challenges is the need for a fundamental change in training efficient human resources based on the developments resulting from emerging new technologies (3, 4). Education, as one of the main pillars of the growth and development of societies, has no choice but to change the educational process, as its central mission is to meet the needs of the developing society (5–7). In the meantime, the procedure change from traditional to modern education in the higher education system is more complicated than primary education (8, 9). Higher education is pivotal in advancing and improving a progressive society (10, 11). As the principal executive arm of higher education, universities serve as the bedrock of knowledge dissemination, innovation, and the development of skilled professionals who contribute significantly to various sectors (12, 13). The quality of education in higher education institutions directly and indirectly affects the process of social progress, social, cultural, and economic growth, social cohesion, and overall quality of life. Therefore, it is essential to continually evaluate and enhance education and teaching methodologies to meet the evolving needs of students and society at large (14–16).

One such innovative approach, which holds immense potential, is spaced learning. It was first introduced in 2005 by Douglas Field and has since garnered attention for its potential to enhance learning outcomes remarkably (17). Spaced learning is an innovative teaching method designed to embed information in memory through spaced repetition (18, 19). A vital feature of this approach is the rapid and comprehensive content coverage within a minimal amount of time (20). Each learning session includes three instructional phases interspersed with two breaks of at least ten minutes each. During these breaks, learners are encouraged to engage in simple activities such as physical exercise or skill-based computer games but no other significant mental activities (21, 22). The first phase consists of a lecture where the teacher presents fundamental and essential information, often utilizing educational aids. The second phase emphasizes recall, where learners use the same or complementary educational aids to reinforce the information presented in the first phase. The final phase focuses on understanding and application, requiring learners to practically apply the newly acquired knowledge or skills (23). This structured repetition, combined with short breaks, effectively embeds information in long-term memory (19). This method contrasts with traditional cramming or massed learning, where students are exposed to large amounts of information in a single, prolonged session (18).

Anxiety is a feeling of fear, excessive worry, and unpleasant feelings that assume that something terrible will happen (24). Learning anxiety is a form of anxiety and a common problem among students that impacts their academic performance (25). Learning anxiety can also be interpreted as worry when an individual experiences an under-pressure situation and an inability to complete something (26). This form of anxiety can manifest as fear of failure, overwhelming stress, self-doubt, and inability to properly concentrate and absorb information effectively. Consequently, students may experience decreased motivation, avoidance behaviors, and lower academic achievement (27, 28). Controlling learning anxiety through supportive strategies and interventions is crucial for fostering a positive learning environment and enhancing students' confidence and success (29).

Moreover, student engagement is an influential determinant of academic success (30, 31). Engagement encompasses three primary dimensions: emotional (affective), cognitive, and behavioral. Affective engagement refers to students' feelings about their learning experiences, including interest, boredom, or anxiety. Cognitive engagement involves the investment in learning and the willingness to exert the effort to understand complex concepts and solve problems. Behavioral engagement is demonstrated through academic activities, such as attending classes, completing assignments, and contributing to discussions (32–34). Educational methods that foster high levels of engagement are essential for promoting positive academic outcomes. Engaged students are likelier to exhibit persistence, enthusiasm, and a deep understanding of the subject. (35). Given the critical nature of nursing education, exploring teaching methods that can alleviate anxiety, especially learning anxiety, and promote active learning is crucial. Therefore, the present research aims to examine the effectiveness of the spaced learning method in learning anxiety and engagement among nursing students in a practical course on principles and techniques of nursing.

Study design and sampling

This study is a quasi-experimental investigation aimed at evaluating the impact of the spaced learning teaching method on student engagement and learning anxiety, as reported by students in the practical course of principles and techniques of nursing. The study was conducted over four consecutive semesters, from February 2021 to May 2023. The participants in this study were all first-semester nursing students at Abhar School of Nursing, which is part of Zanjan University of Medical Sciences in Iran. The practical skills room served as the research environment. A census sampling method was employed, and participants were allocated to control and experimental groups through a simple randomization process based on a lottery. Three instructors teach specific topics in the practical nursing principles and techniques course at Abhar School of Nursing. Thus, students are divided into three groups, and each group receives instruction on relevant subjects during seven 2-hour sessions with each instructor. Given that one of the instructors was the researcher of this study, two of the three groups were selected by lot for inclusion, with one group designated as the experimental group and the other as the control group.

For instance, in the first semester, 21 students were divided into three groups of seven. The lottery chose two groups, one serving as the experimental group and the other as the control group. This process was repeated for each subsequent semester. Across four semesters, there were 81 students; 27 were excluded through the lottery, and 54 were assigned to either the experimental or control groups. Based on the inclusion and exclusion criteria, three students were removed from the study, leaving 51 participants: 26 in the experimental group (with groups of 7, 7, 6, and 6 students) and 25 in the control group (with groups of 7, 6, 6, and 6 students). The inclusion criteria required participants to be willing to join the study and to take the practical course of nursing principles and techniques for the first time. Non-participation and withdrawal from attendance were the exclusion criteria (Fig. 1).

Instruments

We used the demographic characteristics form, the Student Engagement in School Questionnaire (SESQ), and the learning anxiety part of the Achievement Emotions Questionnaire (AEQ) for data collection. The demographic form included age, gender, marital status, and interest in nursing. Scholars from over 19 countries designed the SESQ, which consists of three components: cognitive, affective, and behavioral, with 32 items rated on a Likert scale from very high (5) to very low (1). The cognitive component has 11 questions with scores ranging from 11 to 55, the affective component has nine questions ranging from 9 to 45, and the behavioral component has 12 questions ranging from 12 to 60 (36). The validity and reliability of the SESQ questionnaire have been confirmed through previous studies (37). Nekavand et al. (2018) validated this questionnaire in Iran, reporting high internal consistency with a Cronbach's alpha of 0.898 (38). We conducted a pilot study with 20 nursing students for further assurance, resulting in a Cronbach's alpha of 0.864, indicating acceptable reliability. Also, the learning anxiety scale is part of the standard Achievement Emotions Questionnaire (AEQ), developed to assess learning anxiety levels by Pekrun et al. (2005). Answers are scored on a Likert scale (1–5), with the following scores: 5 (Completely agree) to 1 (Completely opposed). A score between 11 and 22 means the person's learning anxiety is low, a score between 22 and 33 means the person's learning anxiety is moderate, and a score higher than 33 means the person's learning anxiety is high (39). Cronbach's alpha coefficient and confirmatory factor analysis were used to assess the reliability and validity of this questionnaire in Kdivar et al.'s research in Iran. The results of their research align with Pekrun's (2011) research results and show that the questionnaire has an acceptable internal consistency. The Cronbach's alpha coefficient in this subscale is 0.802, and the alpha coefficient of Pekrun's research was 0.84 (39, 40). The results of our evaluation in the pilot study also showed that the Cronbach's alpha coefficient of this questionnaire is 0.89.

Data collection and statistical analysis

After securing approval from the Ethics Committee of Zanjan University of Medical Sciences, Zanjan, Iran, the researchers met with the educational managers at Abhar School of Nursing to explain the study's objectives and methods and ensure the confidentiality of information. Students were then divided into experimental and control groups. After obtaining written consent and collecting demographic data, researchers reassured students that participation in the study would not affect their evaluations. The experimental group attended a 30-minute briefing session on spaced learning, where it was explained that the class would be divided into three 25-minute sessions with two 10-minute breaks. Students were encouraged to engage in non-academic activities during breaks, preferably using computer games like Super Mario and Sonic, due to equipment limitations and easy access to mobile phones. The experimental group's sessions involved lectures, demonstrations, and practical skill implementation in the first session, repetition and additional information in the second session, and review and practice in the third session. The control group continued with their usual educational routine. At the end of each semester, both groups completed the SESQ and learning anxiety questionnaires. Data analysis was implemented using SPSS version 26, employing descriptive (mean and standard deviation) and inferential statistics (Chi-square, Independent t-test).

In the first step, the demographic characteristics of the participants were analyzed. The results showed that the mean (SD) age of the students was 19.46 (1.01) years, and female students comprised most of the participants (58.9%). Most were single (90.4%) and highly interested in nursing (55.3%). In the next step, the chi-square statistical test was used to check the independence of the data about demographic characteristics between two experimental and control groups. The results unfolded no statistically significant difference between the two groups (P > 0.05); therefore, the two groups are independent. The demographic characteristics of our students and results of the Chi-square test are listed based on experimental and control groups in Table 1.

Table 1

Frequency of demographic characteristics variables based on experimental and control groups along with the results of Chi-square statistical test
Variable		Experimental	Control	P-value
Gender	Male	12 (46.2%)	11 (44%)	0.321
Gender	Female	14 (53.8%)	14 (56%)	0.321
Marital status	Single	24 (92.3%)	22 (88%)	0.755
Marital status	Married	2 (7.7)	3 (12%)	0.755
Interest in nursing	Low	4 (15.4%)	3 (12%)	0.502
	Moderate	7 (26.9%)	8 (32%)
	High	15 (57.7%)	14 (56%)

In the next step, the Kolmogorov-Smirnov statistical test was employed to ensure appropriate statistical tests. We found that the data collected from the statistical point of view based on experimental and control groups had a normal distribution (P > 0.05). Based on this, parametric statistical tests were used to analyze the data without hindrance. In line with the first goal of this research, the statistical analysis results showed that the experimental group's mean (SD) learning anxiety was 19.12 (2.04), and the control group was 33.85 (1.97). Due to the results of the independent t-test, it can be extracted that the difference between the two groups in the learning anxiety score is statistically significant (P < 0.05). This result means that the experimental group students trained by the spaced learning method experienced less learning anxiety than the control group.

The following findings of the Student Engagement in School Questionnaire (SESQ) were analyzed. The test results ascertained that the mean (SD) score of total SESQ in the experimental group was 127.89 (9.01), while this score in the control group was equal to 96.75 (10.10). The statistical analysis showed that this difference is significant (P < 0.05). This outcome means that the total student engagement in the experimental group was higher than in the control group. Furthermore, the evaluation of the dimensions of this questionnaire showed that in the affective dimension, the mean (SD) score of the experimental group was 36.06 (4.29) and that the control group was 30.23 (3.52); therefore, the statistical results showed that this difference in the mean score of affective dimension in the experimental and control group students is not statistically significant (P > 0.05). So, despite the mean difference between the two groups in the affective (emotional) dimension, this difference is not significant, and there is no difference between the two groups in this dimension. In the dimension of cognitive, one of the essential dimensions of academic engagement, the mean (SD) score of the experimental group was 45.81 (4.09), and the control group was 32.11 (3.90). Based on the obtained P-value, statistically, the mean difference between the two groups was significant (P < 0.05), showing that the experimental group students were more engaged in the cognitive dimension than the control group. Furthermore, in the behavioral dimension, our statistical analysis discovered that the mean score (SD) of the students in the experimental group was 46.02 (5.27) and that the control group was 34.41 (4.68). The statistical analysis findings showed that the mean difference between the scores of the two groups was significant (P < 0.05), which means that the behavioral engagement of students in the experimental group who were educated by the spaced learning method is higher than in the control group. The results of the statistical analysis of the learning anxiety and student engagement scores and their dimensions in the two experimental and control groups are shown in Table 2.

Table 2. The results of the Independent sample t-test to compare the mean score of the Learning-related Anxiety and Student Engagement and its dimensions in both groups

The present study evaluated the effectiveness of the spaced learning method on learning anxiety and student engagement of first-semester nursing students. The first significant and somewhat predictable result, considering the nature of the spaced learning method, was the reduction of learning anxiety in the students of the experimental group. In this regard, the results of Cole et al.'s study in 2017 showed that the use of the digital spaced learning method can be considered a method to reduce the stress and anxiety of learners in the anatomy course in medical students (41). Similar results were obtained in a similar study aimed at investigating the effects of the spaced learning method in laparoscopic suturing by Boettcher et al. in 2020. They found that the spaced learning method significantly reduces participants' anxiety levels (42). Considering that in the spaced learning method, games are used as a part of the education process, the study of Hosseini et al. in 2023 can be used to evaluate this finding. They found that the use of game-based methods in the education of nursing students can reduce anxiety and increase learners' satisfaction (43). In 2022, Ahmed et al. also reported the effect of using game-based methods on reducing learners' anxiety (44). However, reviewing studies in this field needs more evidence of the impact of spaced learning on students' anxiety in the field of learning. In the interpretation of these findings, it can be said that compared to the effects of the spaced learning method on the level of learning, few studies have been conducted on its effects on participants' anxiety. In general, the existing studies indicate the positive effect of using this method on reducing anxiety. Considering that in the 10-minute intervals between the data, the students should stay away from the classroom mentally and play games, this significant reduction in the level of learning anxiety in the experimental group can be justified to a large extent.

Another result of our study showed that using a spaced learning method can significantly improve students' engagement. In this regard, and among the few available studies to compare with this finding, the study of Mat-jizat et al. in 2020 can be mentioned. They found that using the spaced learning method can increase students' motivation and improve their performance (45). In line with these findings, Hejr et al.'s study showed that using the spaced learning method can positively affect the relationship between teachers and students and enhance the student's motivation for analyzing and solving problems (46). Another study that evaluated spaced repetition on medical students also showed that this method can positively affect the students' engagement. In this context, Kondratjew et al. (2019) stated that the spaced learning method strengthens memory, and the students are more committed to actively participating and engaging in the process (47). In 2021, Vankúš found that there is a positive impact of game-based learning methods on students' motivation, engagement, attitudes, enjoyment, and state of flow (48). Based on this, it can be concluded that the spaced learning method can significantly impact learning by increasing learners' engagement and involvement in the education process.

In examining the dimensions of students' engagement, the results of our investigations indicated that the increase in the scores of the experimental group trained with the spaced learning method is statistically significant in terms of cognitive dimensions. In this regard, we can refer to the Kondratjew et al. (2019) study, which revealed that the spaced learning strategy activates cognitive processes (47). Also, Kohli et al.'s study (2019) showed that the spaced learning methodology was better than the traditional lecture method and the flipped classroom concerning knowledge gains when measured immediately after applying the learning method (49). In one of the most recent articles, Khalafi et al. found in Iran in 2024 that using the spaced learning method improves nurse anesthesia students' knowledge and retention more than the conventional method (20). On the other hand, the results of some studies have shown that the use of games in education cannot necessarily positively affect learning. In this regard, Telner's study in 2010 found that using these methods does not increase the knowledge and learning of the participants, but it can increase satisfaction with the educational environment (50). Another finding of our study was that the behavioral engagement of students in the experimental group who were educated by the spaced learning method was higher than in the control group, which was statistically significant. A similar study revealed that spaced learning can improve skill performance after one year of training (18). Zaini et al., 2020, also found that the design and development of education based on games can improve the practical performance of learners (51). Also, Zahler and Musllam's study in 2021 showed that game-based learning methods improve nursing students' clinical judgment (52). In explaining this finding, the combination of fun and attractiveness of the spaced learning method with its memory enhancement and information retrieval nature through spaced repetition of the lesson material can improve cognitive engagement and intention to learn and understand. Also, the spaced learning method will be as effective as the cognitive field in improving students' behavioral engagement with the course content. However, the need for more detailed research is quite noticeable.

Our results also showed that the difference in the mean score of affective dimension in the experimental and control group students is not statistically significant. In contrast, Vankúš conducted notable research on the effectiveness of game-based learning methods on the affective domain of learning and found that most (84%) studies reported a positive impact (48). From this result, it can be concluded that nursing students in the first semester usually have much affective engagement in studying and show a lot of interest and attention to the teaching content, so the reason for this lack of difference in the two groups can be explained. In other words, the affective engagement of students in the early stages of their studies cannot be affected by the teaching method.

Limitations

Like many others, this study also had limitations that can be mentioned from the authors' perspective. The first and most important limitation of this research was that even though this method was carried out in 4 academic semesters and one of the most critical study units for nursing students, its generalizability is questioned because it was only implemented in the practical part of one study unit. Therefore, it is recommended that the effectiveness of this learning method be evaluated in more study units (both practical and theoretical) in future studies. On the other hand, the content taught using this learning method requires more time and energy than other methods. For example, in the traditional method, the teacher can divide his teaching content during the class. However, in the spaced learning method, the teacher must present the material in a compact form in the first step and repeat it in the following steps. This problem can increase the teaching speed and sometimes decrease the teaching accuracy. Finally, the last limitation was the fatigue of the students due to the large amount of content in a short time, which sometimes made the students devote the time intervals they should play to resting.

Using diverse and attractive teaching methods is essential in today's education process. Among the different methods and according to the emergence of various computer games on mobile phones, these games can be used to improve the quality of education in the form of spaced learning. In fact, in this method, the teacher will kill two birds with one stone, which means that first, with the help of available games, he reduces mental pressure and learning fatigue in the students and prepares them to continue the teaching process. On the other hand, it prevents the sometimes anxious and stressful classroom atmosphere, which can harm the quality of learning. It seems that using mobile phones and playing games during breaks had a decisive role in reducing learning anxiety in the students participating in this research.

Furthermore, the creation of high engagement in two critical and compelling dimensions of academic success (cognitive and behavioral) shows that the fun atmosphere of the class and repeating the educational content at regular intervals has increased the student's motivation to learn the educational content. Although this study was conducted on nursing students in a practical course and four academic semesters, the content of the materials did not specifically affect the study results. In other words, it can be predicted that the spaced learning method has the potential to be easily used in any academic field and unit. Finally, the spaced learning method is an easy, low-cost, practical, fun and valuable teaching method that can quickly become a suitable alternative to traditional teaching methods to control students' anxiety and increase their engagement in learning because it seems that the traditional method can no longer meet their needs.

Acknowledgment

We express our sincere gratitude to all the nursing students participating in this study and to the managers and staff working in the Abhar School of Nursing who have contributed to the implementation of this research. Also, this study was retrieved from the research project approved by Zanjan University of Medical Sciences, Zanjan, Iran. Therefore, the authors appreciate the support of Zanjan University of Medical Sciences for this research project.

Author contributions

Mk did the design, implementation, data collection, and final revision. MS, HP, IP, and KP were responsible for data analysis and interpretation (results). IJ, along with NE and OD, helped conduct the discussion part of the study. SM also helped edit the language and write the final text. All the authors also helped write the manuscript and read and approved the final version.

Funding

Zanjan University of Medical Sciences, Iran.

Data availability

Data is provided within the manuscript.

Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

Our study received approval from the Research Ethics Committee of Zanjan University of Medical Sciences (IR.ZUMS.REC.1399.309). Ethical considerations included maintaining confidentiality, obtaining informed consent, explaining research goals, ensuring voluntary participation, allowing participants to withdraw at any time, and adhering to academic integrity in using literature.

Consent for publication

Not applicable.

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09 Jul, 2024

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The Efficacy of the Spaced Learning Teaching Method on Student Engagement and Learning Anxiety

Status:

Version 1

Abstract

Figures

Introduction

Materials and Methods

Study design and sampling

Instruments

Data collection and statistical analysis

Results

Discussion

Limitations

Conclusion

Declarations

References

Additional Declarations

Status:

Version 1