Helping students cope with adversity: the influence of a web-based intervention on students' self-efficacy and intentions to use wellness-related resources

Nourish: A pilot program to support self-Efficacy, learning, and wellness during USMLE step 1 preparation

PURPOSE

Medical trainees experience significant exam-related stress, such as preparing for the USA Licensing Medical Examination Step 1, which often negatively affects emotional health. Nourish, a novel Step 1 support program, was designed to foster improved self-efficacy and well-being during the process of studying for and taking the exam. Nourish was piloted at Oregon Health & Science University between December 2018 and February 2019.

METHODS

Program elements were guided by Self-Efficacy Theory and included community building, wellness support, peer tutoring and social persuasion. Program evaluation included pre- and post-program surveys. Participation was optional and included 46 of 154 students (30%) with 40 of the 46 students (87%) completing pre and post evaluations. The pre-survey was given during the Nourish orientation in December prior to the Step 1 study period, and the post-survey was given in early February when most students had taken their exam but none had received their scores.

RESULTS

While summary self-efficacy scores increased between baseline and post program (24.9 vs 27.7, p < 0.001), summary emotional health scores worsened (8.15 vs 8.75, p = 0.03). Summary scores for physical health also dropped but this difference was not statistically significant. Summary perceived stress scores increased from 15.5 at baseline to 23.7 post program (p < 0.001). All students who routinely participated in Nourish passed their USMLE Step 1 exam. One student who participated only in the orientation session did not pass.

CONCLUSION

Nourish appeared to improve self-efficacy, even though students reported being stressed with low emotional health. The program appeared to help students align task demands with their own personal resources and set reasonable expectations and strategies to pass the exam. Medical schools should consider similar peer- and faculty mentor-based wellness and tutoring programs to support medical students while they work to achieve academic success.

Freshmen anxiety and COVID-19: Practical implications from an online intervention for supporting students affected by health inequities

OBJECTIVE

This study explored how college freshmen, particularly those affected by health inequities, are affected by COVID-19 and whether they would use a university-created online wellness intervention for help.

PARTICIPANTS

Nine-hundred and eighty-nine freshmen at a large southeastern university.

METHOD

Students responded to an online survey regarding their anxiety, worry, number of life disruptions, perceived resilience and their use of the online intervention during the pandemic (June to mid-September 2020).

RESULTS

During COVID-19, Latinx, Black, women and non-heterosexual students reported significantly greater worry, daily life disruptions than their non-Latinx, white, male and heterosexual counterparts. Women and non-heterosexual students also reported greater anxiety and less resilience. Additionally, Latinx students reported using the university's online intervention for help during COVID-19 more than others. Overall, freshmen, especially Black and women students, reported the online intervention would help them with struggles.

CONCLUSIONS

Universities should identify unique worries faced by students during a health crisis and provide institutional support. Practical implications are discussed.

Enhancing Student Wellbeing Through Social Prescribing: A Rapid Realist Review

Objectives: A Rapid Realist Review of social prescribing in Higher Education (HE) was undertaken to determine what works, for whom, how, why, and within what circumstances. The review resulted in the development of a Realist Programme Theory articulating the way in which social prescribing can be implemented within the HE environment. Methods: Searches of 12 electronic databases were supplemented by citation chaining and grey literature surfaced by the Project Advisory Group. The RAMESES Quality Standards for Realist Review were followed, and the retrieved articles were systematically screened and iteratively analysed to develop Context-Mechanism-Outcome Configurations (CMOCs) and an overarching Realist Programme Theory. Results: A total of 57 documents were included. The overarching programme theory was developed from the analysis of these documents and comprised of a social prescribing pathway with the following components: (1) An Accessible Gateway, (2) A Skilled Peer, (3) Trusted-Safe-Credible Resources, and (4) A Healthy Setting. Conclusion: A Realist Programme Theory was developed-this model and associated principles will provide a theoretical basis for the implementation of social prescribing pathways within higher education. Whilst the direct project outputs are of particular significance to the UK HE audience, the underpinning principles can support practice within the global arena.

Fear of positive evaluation mediates the relationship between self-efficacy and fear of negative evaluation in nursing students: A cross-sectional study

BACKGROUND

Fear of evaluation (including the negative and positive ones) has been the focus of scholarly attention as one of the core components of social anxiety. However, most existing research has focused on participants with social anxiety. Previous research has suggested that self-efficacy and fear of positive evaluation are associated with fear of negative evaluation. Still, it remains unknown whether there is an association between the three. For undergraduate nursing students in complex social environments, understanding the association between self-efficacy and fear of positive and negative evaluation is essential to facilitate the high-quality development of nursing talent.

OBJECTIVE

We aimed to explore the mediating role of fear of positive evaluation in the relationship between self-efficacy and fear of negative evaluation.

METHODS

A cross-sectional survey was conducted on 824 undergraduate nursing students using the Brief Fear of Negative Evaluation Scale-Straightforward Items, the Fear of Positive Evaluation Scale, and the General Self-Efficacy Scale. Pearson correlation analysis was used to explore the correlation of the variables. t-test or ANOVA was used as a univariate analysis. A bootstrap test was conducted to verify the mediating effect through the SPSS macro plugin PROCESS v3.3, with P < 0.05 indicating a statistically significant difference.

FINDINGS

Self-efficacy, fear of positive evaluation, and fear of negative evaluation were significantly associated. Self-efficacy directly and negatively predicted fear of negative evaluation (B = -3.14, p < 0.001). Fear of positive evaluation partially mediated between self-efficacy and fear of negative evaluation, with a mediating effect size of 38.22 %.

DISCUSSION

Self-efficacy can directly and negatively influence fear of negative evaluation. Meanwhile, it can also indirectly reduce the fear of negative evaluation by reducing the fear of positive evaluation. Nursing educators can improve the fear of negative evaluation by increasing students' self-efficacy and encouraging them to view positive assessments correctly.

Emotion dysregulation, help-seeking attitudes, and posttraumatic stress disorder symptoms: A structural equation model

Objective: Most college students have experienced an adverse event in their lifetime, yet help-seeking rates remain low. This study seeks to understand psychological factors that might contribute to delays in treatment initiation among trauma-affected students. Participants: Our sample consisted of 531 undergraduate students of which 27% scored above the clinical cutoff for PTSD using the PTSD Checklist for DSM-5 (PCL-5). Methods: This cross-sectional study explored relationships among help-seeking attitudes, emotion dysregulation, and PTSD symptoms using structural equation modeling. Results: Findings demonstrated that individuals with more severe emotion dysregulation had more severe PTSD symptoms and held more negative attitudes toward seeking help. Conclusions: Individuals who are the most in need of treatment hold attitudes that may impede help-seeking. We discuss clinical implications and ways college counseling centers can maximize outreach and programming efforts to increase treatment initiation and engagement.

Aligning students and counseling centers on student mental health needs and treatment resources

ObjectiveTo recognize gaps between students' expectations of college counseling centers and centers' current practices and to identify strategies to improve care from both clinicians and students. Participants: As part of an ongoing study on mobile technologies for stress management, we gathered data from counseling center clinicians and students at two large Midwestern universities. Methods: Clinicians completed online questionnaires on their current practices and interest in digital mental health tools. Students and clinicians completed co-design workshops. In subsequent individual interviews, students identified barriers to care. Results: Both students and clinicians recognized a need for stress management and mental health support outside of counseling sessions. Conclusions: Students and clinicians recognize barriers to face-to-face therapy and are eager to collaborate to identify opportunities to address barriers to mental health services. We discuss digital mental health tools as a potential opportunity for support and benefits of including students in discussions of treatment resources.

Differing trajectories of adversity over the life course: Implications for adult health and well-being

BACKGROUND

Adverse childhood experiences (ACE), can give rise to long-term mental and physical health consequences as well as additional stressors later in the life course. This study aims to examine differing profiles of trajectories of adversity over the life course and investigate their association with socioeconomic and health outcomes.

METHODS

We used population representative data from the Washington State 2011 Behavioral Risk Factor Surveillance System BRFSS survey n = 7953. Six ACE items were paired with six Adverse Adulthood Experience AAE items in respondents' adulthood that parallel the ACE e.g. physical abuse in childhood and physical victimization in adulthood. We applied latent class analysis to identify distinct trajectories of adversity; then tested for differences across trajectories in terms of demographic, socioeconomic, and health measures.

RESULTS

Six latent classes were identified: individuals with high AAE: (1. Consistently High, 2. Substance Abuse and Incarceration, 3. Adult Interpersonal Victimization) and individuals with low AAE (4. Repeat Sexual Victimization, 5. High to Low, and 6. Consistently Low). The Consistently High group had the highest prevalence of ACE and AAE and fared poorly across wide ranging outcomes. Other groups displayed specific patterns of ACE and AAE exposures (including salient subgroups such as those with incarceration exposure) as well as differences in demographic characteristics, illustrating disparities.

CONCLUSIONS

Subgroup analyses such as this are complementary to population generalized findings. Understanding differences in life course patterns of adversity can shed light on interventions in earlier life and better target service provision to promote health and well-being.