Perception, Attitude, and Practice Toward Community Research Among Medical Students in Hadhramout University, Yemen

Research is an important element in the improvement of the quality health services provided to the public. It is documented that, globally, medical students apply research in their school life. This study aimed to assess perception, attitude, and practice toward community research among medical Students at Hadhramout University. This is a cross-sectional descriptive study was conducted among medical students in Hadhramout University in Al-Mukalla district, Yemen during the academic year 2016-2017. A self-administered pilot-tested questionnaire was used for data collection to assess perception, attitude, and practice toward the community research during the educational year 2016-2017.

also has an impact on health care programs policy and services. (7,8) Moreover, research will broaden students' scienti c training helping them to pursue their careers in academic medicine. (9) During the last decade, there has been a renewed emphasis on the medical student research experience and many programs have been developed in different countries such as those two large United States programs that have sought to engage students during this critical period of training are the National Institutes of Health (NIH) sponsored Medical Student Research Fellowship Programs (MSRFs) (10) and the Doris Duke Clinical Research Fellowship (CRF) Program, (11) other examples are those which developed in Europe (12) and the Netherlands. (13) Many students agreed that there would be no progress of humankind without the progress of science and the basis of medical progress is the use of scienti c methodology and the knowledge of scienti c methodology is essential for obtaining accurate objective data so the research was important in the medical eld. The student who had a high attitude science will tend to be highly involved in research activities.
However, some students do not agree that research will be a part of the future, and most of them not present any research. (2,14,15) Some of them agreed that some participation in research was likely valuable within their medical education so they showed the research should be being mandatory in curriculum and more time in medical school should be set aside to allow participation in research endeavors to improve research skills, attaining research publication and reinforce a teamwork spirit. (2,14−16) One of the most important factors underlying any study is the researchers' beliefs, as it is these that motivate them to undertake a study in the rst place. (17) The attitude to health research stems from the researchers' curiosity and interest in a particular subject or their wish to solve a problem within a community. (18) Students have faced many barriers when conducting the research activities as no enough time, supervisor, guidance, inadequate training in research methodology, hard to publish research during medical school, (19) uncertainty about the ability to complete a study (lack of research self-e cacy), (20) lack of research interest (21) and limited access to data sources (i.e., internet), materials and equipment. (22) Research is an important element in the improvement of the quality health services provided to the public.
It is documented that, globally, medical students apply research in their school life. To our knowledge, there was no previous published research that addressed the issue in Yemen, and given the role of research in health care programs, this study aims to assess perception, attitude, and practice toward community research among medical students in Hadhramout University College of Medicine (HUCOM) during the academic year 2016-2017.

Methods
Study design: Cross-sectional study among the last three years of medical students of Hadramout University in Yemen.
Study subjects: All 418 students were enrolled in the study, 154 students from the fourth year, 134 students from the fth year, and 130 students from the sixth year.
Data collection: The data collected by using a self-administered pre-tested questionnaire which was designed and validated by experts from different universities in the Arab world. The questionnaire was divided into seven sections as the following: section 1. Personal data (Age, Gender, academic level, Name not included), section 2. student's perception toward research, section 3. students' attitude toward research, section 4. students practice toward research, section 5. barriers toward research, section 6. relevance of the undergraduates' research and section 7. Suggestions to improve engagement of students in research.
Knowledge and attitude score: The knowledge score consisted of 6 items. Each correct answer was given a score of 1, while zero for the wrong answer. The total knowledge score ranged from 0 to 6 and then was classi ed as High knowledge score (above or equal to the mean), and low knowledge (if it was below the mean). Attitudes towards research were assessed by 8 questions. The answers were measured by a 5point Likert scale ranging from strongly disagree (score 1) to strongly agree (score 5). So the range of the total attitude score was ranged from 0 to 40, then it was classi ed as Positive attitude (above or equal to the mean), and negative attitude (if it was below the mean).
Data Analysis: The collected data were checked, coded, entered, and analyzed using a statistical package for social science (SPSS v20). Frequencies, mean and standard deviation are the descriptive statistical tools used as appropriate. The outcome variables were students' knowledge and attitude while gender and the academic level were the main independent variables. Statistical tests used for analysis were t-test for continuous variables and one-way analysis of variance (ANOVA) for multiple comparisons. For all purposes, the criteria of signi cance were considered at a P-value of 0.05.

Results
Out of 418 questionnaires distributed, 265 students respond and return lled questionnaires giving the response rate of 66.5%. (104 fourth-year students 86 fth-year students, 75 sixth-year students). The mean age of participants is 23.9 years (±1.5) The majority of students were in the age group 23 -26 years, 134 of students (50.6%) were males and (49.4%) were females. (Table 1)    The present study found that there was a signi cant difference between sex in terms of knowledge score with Female students (2.99±1.24) having greater knowledge than males (2.45±1.16) (P-value 0.000), but there was no signi cant difference between sex regarding attitude sore (P-value .064). (Table 5)    Provide sources for nancial support 75.1 23.0 Other suggestion: 1. Course on how to publish our research in a journal.
2. The research should be done for postgraduate due to curriculum overload 3. Publish the best research in HUCOM journal.

Discussion
This study addresses medical students' knowledge, attitude, and practices regarding research in medical colleges of Hadhramout University. Speci cally, this study has embarked upon assessing the knowledge of medical students regarding research concepts and their attitudes toward research. Additionally, it aims to describe the variations in research practices among medical students and to identify their perceived barriers to conducting research. Finally, the study sought out to suggest recommendations for best research practices among medical students at Hadhramout University.
In the present study knowledge about research was explored. The majority of students understood the concept of research, sampling representation, and descriptive statistics. This nding was similar to research done by Louise N. Burgoyne et al. which found that the largest proportion of students in the study understood the term 'research' (20) . However, students in our study couldn't understand the concepts of inferential statistics, informed consent, or the need for sampling in methodology. Majumdar A et al.
found similar results where knowledge in areas related to data entry and analysis software and scales of measurement Performances in study designs and sampling techniques were also not satisfactory. (24) The result of this study revealed that the vast majority of medical students had a positive attitude toward research. However, the majority of them had low knowledge scores. This nding is inconsistent with the ndings of several studies. (2,23,24) Research has been done previously showing that students with a prior degree or research experience have better attitudes towards research (Siemens et al, 2010). (19) On top of that, students who had a high attitude toward science will tend to be highly involved in research activities (Pruskil et al, 2009) (25) , and teaching research methodology improve the student's attitude toward research (Vujaklija et al, 2010). (26) Since conducting research is mandatory in Hadhramout University such ndings are understandable.
In the current study; female students had greater knowledge than males while the attitudes to research did not differ. Similar results were obtained by Amin et al. (2) and Memarpouret a study. (22) However, studies in Pakistan and the USA revealed male medical students showed a better attitude to research than their female peers. (18,27,28,29) The differences may be related to data collection from different populations, variations in sample size (28) , and the increasing of acceptance female students in our medical universities.
When addressing the research practice more than three-quarters of participants reported that they have participated in research activities. This may be due to the mandatory community research course done in the early years of scienti c education, and a similar policy appears to be implemented in many universities. (2,28) Considerations of research in the curriculum vary across countries and universities. (17,30) it was documented that involved of the medical student to research in further reformed curriculum. (25) Vujaklija et al., Khan  The student perceived barriers in conducting research were explored. Time was seen to be the most signi cant barrier to pursuing research. Followed by a lack of training statics, curriculum overload, lack of a competent supervisor, poor access to the internet, and lack of competent supervisor. Similar results have also been reported in other studies. (2,19,22,32) Lack of time came up as an important barrier, and students not interested in conducting research often identi ed time constraints as the reason. (32) The nding revealed that 74.7% of students recommended specifying enough time in the curriculum plan to conduct research.
The student pointed out several recommendations for improvement of undergraduate engagement in research with the allocation of the speci c session for research supervisor meetings having the highest recommendation. Also, they recommended being provided with extra training in advanced statistics and the provision of nancial support. These recommendations were addressed by several studies. The limitation of this study includes the fact that our questionnaire did not target a full assessment of the students' knowledge. Although we exclusively used closed-ended questions. As well as, we only assessed the encountered barriers

Conclusions
This study concludes that the vast majority of medical students had a positive attitude toward research. However, the majority of them had low knowledge scores. Also, some barriers need to be evaluated to improve the involvement of students in research activities. Time was seen to be the most signi cant barrier to pursuing research, student suggested that specifying sessions for supervisor research meetings must be considered, most students suggested to specify enough time in the curriculum plan to conduct research they also suggested extra training in advanced statistics. Additionally, we recommend encouraging faculty to take an active interest in all aspects of student research design, data collection, statistical analysis, and preparation of scienti c manuscripts. Further researches should be done to nd out the motives of research conduction, which would encourage students to take part in clinical research can be of bene t. Studies like ours should be conducted regularly because they provide an assessment tool for all efforts exerted to increase student participation in research. The research proposal was approved by Hadramout University College of Medicine (HUCOM) department of community medicine. The objectives of the study were clari ed for the participant. We ensured that the information of those who agreed to participate in this study was kept in the strictest con dence and used for the bene t of the community. Students give their consent to participate verbally.

Consent for publication
Not Applicable Availability of data and materials All data sets are available and can be shared by requesting it from the corresponding author by email.

Competing interests
Authors declared that there is no con ict of interest.

Funding
Authors did not receive any fund from any agency.