Cultural Differences In On-Line Learning Motivation: A Cross-Sectional Survey Among Chinese And South Asian Undergraduate Medical Students

Background: During the COVID-19 pandemic the requirement for On-line learning in the modern world of education has become clear.On-line education provides one such avenue by creating new opportunities for students, faculty, regulators of education, and educational institutions. Cultural diversity has become a defining characteristic of the students bodies.The current study aims to analyse differences in motivation on on-line learning and the impact of their culture. Methods: : A cross-sectional survey was conducted from 2021.04.04 to 2021.05.03 among the undergraduate Chinese and South Asian students from 5 classes of Chinese students and 6 classes of South Asian students with major of Clinical Medicine at Dali University, Dali, China. The study used a questionnaire which were identical both in Chinese and English language. Platforms of Wen Juan Xing (WJX) and Ding-talk were used to distribute the questionnaire. Results: : Based on the statistical analysis results, the structural validity of the bilingual questionnaire was confirmed, the reliability was found to be satisfactory. A total of 433 students questionnaire data from class of 2018 and 2019 were collected, including 173 males (40.00%), 260 females (60.00%), 216 Chinese (49.88%), 99 Indians (22.86%), 51 Nepalese (11.78%), 48 Pakistani (11.09%), 19 from Laos and Cambodia (4.39%) respectively. The total score of Chinese students was highest with Pakistani students showing the lowest. It was found that there were significant differences in score for the dimensions of reinforcement, Affects & emotion, interest and self-efficacy in between Chinese and South Asian students. Multiple linear regression analysis showed that nationality as the key factor influencing the on-line learning motivation of the undergraduate medical students from China and South Asian countries. Conclusions: : The results provides with the evidence on the feasibility, as well as information about the potential barriers and the cultural impact to on-line learning in medical education among Chinese and South Asian undergraduate students.


Introduction
The corona-virus disease 2019 (COVID-19) pandemic presents a huge challenge to the education system worldwide, which national education system has never faced before. This COVID-19 pandemic has disturbed the lives of the students in various aspects, depending not only their level and course study, but also on the point they have reached in their program [1]. Moreover, as a result of social distancing, the most effective preventive strategy since the emergence of COVID-19 [2], medical education has been profoundly disturbed as it involves in-person didactic lectures and tutorials, clinical rotation exposures, laboratory experiences, observing and assisting relevant medical and surgical procedures [3]. During this crisis, the requirement for On-line learning in the modern world of education has become clear. Various institutions, along with teachers and students, have found new avenues to repair the damage cause and to continue their learning process in digital format. On-line education provides one such avenue by creating new opportunities for student, faculty, regulators of education, and educational institutions [4]. Since the emergence of the internet, it has become an important medium of communication, as well as a research tool for learning and information [5]. On-line learning refers to the use of internet technologies to deliver a broad array of solutions that enhances knowledge and performance [6]. E-learning is "an approach to teaching and learning, representing all or part of the educational model applied, that is based on the use of electronic media and devices as tools for improving access to training and communication and interaction and that facilitates the adoption of the new ways of understanding and developing learning" [7]. "On-line learning" can be broadly referred to almost any learning environment in which electronic media such as computers are used as a component of an instructional delivery system. The bene ts of on-line learning are that learners have a control and responsibility for the learning, and the content can be taken whenever a learner has access allowing more exibility and large amounts of content are broken down into smaller manageable modules. On-line learning offers a means of self-directed education with improved learning through interactivity The inter-cultural research most focused on motivational to successful learning and related learning [9]. There are a variety of ways individuals from different cultures are motivated to learn, which are supported by various researches. It is being noted that the students from Asian countries those of Confucian heritage culture (CHC) have been outperforming students from western countries both in studies making comparisons across nations as well as where Asian students have studied in Western countries, as migrants or as international students.
The countries of "Confucian-heritage cultures" includes mainly China, Taiwan, Singapore, Hong Kong, Korea and Japan [10]. Cultural diversity has become a de ning characteristics of students' bodies [11].
There are various impacts of culture on learning style preferences. Yu-Chih et al. Conducted a review of literature in order to compile results of earlier research, such as Hofstedes's cultural dimension, which pertains to the impacts of culture on learning style preferences. With advancement in the studies conducted in the led of learning, it has become evident that the teaching quality is positively associated with the characteristic of students, teaching styles, as well as the teaching environment. Also, when a student is transferred from an unsuitable learning environment to a suitable one, there is resulting improvement in academic performance [12].
Studies have shown that teaching methods and style do not threaten the socio-cultural backgrounds of the learners. Indeed, teaching methods can vary signi cantly. There are teachers who want to focus on instructions, while there are also those who make learners signi cantly engage with their peers. Other teachers also encourage learners to look for their own resources however studies also attest that certain cultural barriers prevent effective interaction between teachers and learners [13].
When it comes to learning, motivation is relevant to learning, because learning is an active process which requires conscious and deliberate activity. For students to derive maximum bene ts from school, educators must provide a leaning context in which students are motivated to engage actively and productively in learning activities [14]. Functional de nition of motivation is to understand "its as a natural human process for directing energy to accomplish a goal" [15].
On-line learning offers a means of self-directed education with improved learning through interactivity. The most concentrated cross-cultural research on learning pertains to achievement motivation and related learning.
The current study aims to analyse differences in motivation on on-line learning and the impact of their culture through a survey conducted in a Chinese University with splendid experience in international education.

Study Objective
The purpose of this study is to analyse whether there are differences in between Chinese university students and South Asian university students studying in a Chinese University (hereinafter referred to as "South Asian students") in their motivation for their on-line learning, and their cultural in uence on it. The study was designed by keeping in mind to make it completely voluntary for participation and was approved by the Ethics Committee of Medical Research of Dali University (Registration Number-2020 − 171). . The ve dimensions were evaluated on Likert 5-point evaluation scale (1 = strongly disagree 2 = disagree, 3 = neutral, 4 = agree, and 5 = strongly agree) [5]. .

Survey Tool
After a pretest, the questionnaire was distributed which were identical but in two languages including Chinese and English to above mentioned two groups by WJX ( ) and Ding-talk ( ) respectively. The duration for collection of on-line survey was of one month starting from 2021.4.04 to 2021.05.03.

Study Participants
The subjects of this study were undergraduate students who took on-line courses during the covid-19 pandemic for the academic year 2020-2021, which included three semester in our University. Cluster sampling was applied to recruit subjects which include 5 classes of Chinese students and 6 classes for South Asian students.

Statistical Analysis
The performance of the participants were expressed as Mean ± Standard deviation of total scores and each dimension. Con rmatory factor analysis was conducted on the questionnaire to verify its structural validity. Cronbach's Alpha coe cient, Kaise-Meyer-Olkin (KMO) value and Bartlett spherical test were used for reliability and validity evaluation .
One way analysis of variance (ANOVA) was applied to explore the differences among the demographic data of the participants. Multiple linear regression analysis was conducted to investigate the factors in uencing the participants for their on-line learning motivation.All the statistical analysis was done through SPSS 25.0.

Participants demographic data
The study participants include 216 Chinese students (49.88%) and 217 South Asian students (50.11%). Among South Asian students, Indian students accounted for about 45.8%, followed by Nepalese students with 23.60%, and Pakistani students accounted for 22.2% (Figure-1). Among the Chinese students who participated in the survey were 47 male (10.39%) and 169 female (39.03%) whereas total of 217 South Asian students participated in the survey, 126 male (29.10%) and 91 female (21.02%) respectively. Compared with the students with a Major in Clinical Medicine in this University, study participants shows the same gender distribution. Meanwhile there is a signi cant difference for the gender distribution for Chinese and South Asian students (P < 0.001) (Figure-2).
The participants who were included in the survey, were from three grades ( Table-1).

Quality assessment of questionnaire
The reliability and validity for the Chinese and English version of the questionnaire was evaluated separately.
Cronbach's α coe cient, the indicator for internal consistency, was used for reliability evaluation. According to the results of factor analysis, the questionnaire structure was found to be consistent with the theoretical one.

Reliability evaluation:
The overall Cronbach's α of Chinese questionnaire was 0.953, and along with the Cronbach's α of each dimension was all greater than 0.8, suggesting that the Chinese questionnaire was reliable. The value for Cronbach's α of the English questionnaire is 0.924, with Cronbach's α of each dimension greater than 0.7, indicating that of the English questionnaire is acceptable (Table 2). The overall KMO value of Chinese questionnaire was found to be 0.950, and the value of each dimension was greater than 0.7. The P values of Bartlett test of the whole questionnaire along with each dimension were all less than 0.001 (Table 2), which suggest that the structure of questionnaire perhaps meet the design of study and therefore con rmatory factor analysis was applied to elucidate its structure ( Table 3).
The overall KMO value of English questionnaire was 0.924, and the value of each dimension is greater than 0.7.
The P values of Bartlett test of the whole questionnaire along with each dimension is less than 0.001 (Table.2) which indicate that the structure of questionnaire meets the design and therefore con rmatory factor analysis was applied ( Table 3).
The results of con rmatory factor analysis on the 33 questions of the Likert 5-point evaluation scale for all the 433 questionnaire veri ed the design, based on the ve factors extracted from the questionnaire and corresponding factor loadings of each questions to factor (Table-3). In addition, Question 16 because of language expression issue faced by the Chinese participants it has an overlap between dimension of interest and self-e cacy.  By analysing the scores of ve dimensions in different South Asian countries, it was found that the differences of total scores and the following 4 dimensions Reinforcement, Affects & Emotion, Interest, Self-e cacy among the South Asian countries were statistically signi cant (Figure-4). Based on the post-hoc test results, the difference between India and Pakistan was statistically signi cant, and the difference between Nepal and Pakistan were also proved statistically signi cant.

Comparison of different dimensions of on-line learning motivation among different genders :
According to t-test results for different dimensions of on-line learning motivation among different genders irrespective of the nationalities there was no statistical signi cance found among the ve dimensions. For participants from different countries, there were no notable differences between male and female.

The factors in uencing on-line learning motivations among all the participants:
Multiple linear regression analysis was performed to explore potential factors in uencing on-line learning motivation for Chinese and South Asian students with a major in Clinical Medicine. Nationality as a dummy variable, Gender, any exam failure and Grades were treated as independent variables for model tting. However, the nal model showed only nationality as statistically related to participants on-line learning motivation (Table-5). The combination of self-e cacy and learning motivation theory [20], motivation is not the ultimate goal, which can effectively maintain learners' learning motivation and allow learners to experience learning satisfaction and thus promote learners learning migration. The level of motivation of learners is an important factor in selflearning.
The ve dimensions included in the questionnaire well explained and represented the theoretical framework of the self-e cacy and learning motivation. Combined analysis of open question and Likert 5-point questions, its was found that Chinese undergraduate medical students demonstrated more attention towards on-line courses, because it can be easily and more directly recognized by teachers and fellow classmates help, which provides better experience for Chinese students when compared to South-Asian students with certain language barriers for communicating with teachers and fellow peers. Further more, the function of playback videos provided by on-line teaching methods can prove supportive in improving learning e ciency.
The psychological effect which is brought about by on-line learning have a greater impact on South Asian students, who feel depressed and irritable because they perceive the instability of internet connections, and the time differences between China and their home country, which make them feel di cult and less motivated to study on-line courses. This also describe itself as indicator for the dimension of Barrier to on-line learning.
In terms for dimension of interest, Chinese students with CHC tend to express their attitude with more positivity, towards different teaching methods, and learning patterns, while South Asian students express their negative feedback towards on-line courses more directly thorough open-ended question.
Dimension of self-e cacy, proved for the students from Pakistan, among the other South Asian countries and Chinese students with the least score, which indicate that the students from Pakistan show least involvement in on-line learning when compared to rest of the countries.

Strength And Limitation Of The Study
This study and its design has several strengths and limitations. The major strength of this cross-sectional study was its relevance with the current pandemic situation, its sizeable sample and its representativeness of medical students from different countries, timely information collection, all of these allowed prompt feedback for the making necessary changes in continues on-line teaching and learning.
However, there were some limitation. Firstly, in our questionnaire, all dimensions had their own questions but there was one question in Chinese version of questionnaire which tted itself in two dimensions of Interest and Self-e cacy because of students perception of the question.Secondly, the ndings in our study calls for further validation with more studies like case control study and/or intervention study to explore the fundamental cultural impact on medical education for undergraduate medical students.

Conclusions
In this study, the bilingual questionnaire on on-line learning motivation was designed based on self-e cacy and