Study Design and Approach
A pre-post controlled quasi-experimental study design with a quantitative research approach. The study included consented undergraduate nursing students with steady class attendances. Recruitment of the study participants was done in early February 2018 before baseline data collection. A cluster-randomized educational institution via coin tossing (five hundred Tanzanian coins) was determined by the research assistants to allocate the sampled institutions into either be in an intervention or a control group. The Head of the coin was assigned to an intervention and the second side of the coin (with Buffalo image) to the control group. The researcher and research assistants did the tossing of the coin and identified the sides respectively.
Participants’ social demographic and academic characteristics were used to match them to ensure their similarities at baseline. As it has been used by previous studies of the same methodological approaches (1,4), WinPepi Software program version 11.65 was considered reliable to be used in this study. The ratio of sample size (n = 401) was B:A =1:2 with 134 participants in the intervention and 267 participants in the control group of which a proportionate formula was used to determine participants' distribution at classroom levels. As shown in Table 1, participants in the intervention and those in the control group did the same pre-test and post-test respectively. However, they were treated differently whereas participants in an intervention group learned the conflict resolution content using a problem-based facilitatory pedagogy while those exposed in the control group learned the same content using a lecture-based learning (LBL) method.
Table 1: Summary of a Study Design
Activity
|
Intervention group
|
Control group
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Pre-test (Baseline)
|
√
|
√
|
Intervention (Mid-line)
|
Problem-based Facilitatory Pedagogy
|
Lecture-based Learning Method
|
Post-test (End-line)
|
√
|
√
|
Source: Researcher’s Plan (2018)
Data Collection Process
The researcher and research assistants identified the study participants in the sampled study centers and put them in a separate and quiet room to ensure privacy and confidentiality during the filling process of questionnaires. Brief instructions on how to fill the questionnaires were provided among the study participants before distributing copies of the questionnaires. The researcher and assistants supervised the process and responded to participants’ queries throughout the process before collecting questionnaires. All participants answered the same questions before and after an intervention.
Data Collection Tools
The instrument used for data collection was a structured Questionnaire titled Academic Motivation Scale (AMS-HS 28). A tool was adopted from AMS – College Version 1993 (24) having a Cronbach’s Alpha of 0.84. It has once been validated by Haugan et al., (25) and used by Millanzi et al., (4) in Tanzania. The tool was used for assessing levels of intrinsic motivation (towards knowledge, accomplishments, and stimulation), extrinsic (introjected and identified regulation), and amotivation among undergraduate nursing students. The AMS-HS had 28 items with 140 scores on a 5-point point Likert scale. Scale 1 = does not correspond at all, 2 = correspond a little, 3 = corresponds moderately, 4 = corresponds a lot and 5 = corresponds exactly. Part A of the instrument elicited information about demographic data of the study participants including their age, sex, education level, accommodation status, and marital status. Other important participants’ characteristics included their interest status to join nursing, reasons to join it, their satisfaction status to nursing course, learning benefits, and learning difficulties they encountered during their learning processes. Part B elicited information about levels of motivation to learn adopted by students in their learning processes. This part covered three aspects (Intrinsic motivation, extrinsic motivation, and Amotivation to learn).
Intrinsic motivation was assessed by using a twelve (12) 5-point Likert (≥6 scores were defined as intrinsically motivated) scale items, extrinsic motivation twelve (12) items (≥6 scores were defined as extrinsically motivated), and Amotivation to learn 4 items (≥2 scores were defined as intrinsically motivated). The overall motivation to learn among the study participants was then computed that had a cut-off point set at 70 scores from 140 total scores of the scale items. The study participant, who scored ≥70 of the scale items, was defined as motivated to learn otherwise not.
Development and Prototyping of the Research Conflict Resolution Material in the nature of Problem-based Facilitatory Pedagogy Design
The process of developing and prototyping the PBL materials adopted the conceptualized framework that was developed by Mafumiko (26) but also used by Millanzi et al., (27). As shown in figure 1, the development and prototyping procedures of conflict resolution material in the nature of problem-based facilitatory pedagogy followed four (4) phases including phase 0, I, II, and III. Phase 0 focused on reviewing various documents including online and off-line books, published scholarly nursing profession magazines, and other relevant materials. The reviewed materials made it possible for the development of draft “0” of the conflict resolution material (Prototype “0”). The developed draft was then shared with the experts including tutors/lecturers who had at least > 1-year working experience in teaching leadership and management content and 1 expert in curriculum development for their professional and technical inputs, advice, and comments on the material.
The revised version was exposed to phases “I”, where a first classroom try-out among 20 nursing students, a principal investigator, 1 research assistant participated (Prototype “I”). Comments from experts in the first classroom try-outs were addressed accordingly and resulted in the second version, which was subjected to the second (phase II) classroom try-out (Prototype “II”). The researcher addressed the comments from the second classroom try-out whereas together with the assistant researcher discussed and amended the inputs. The third version (phase III) was refined and subjected to the actual field-testing (Prototype “III”). Summative evaluation of the effectiveness of PBL material on the learning process and the academic motivation was determined through a student’s experiences inventory (SEI) developed by the researcher and the administration of posttest among nursing students.
The Intervention (Problem-Based Facilitatory Teaching Sessions)
The intervention part adopted and modified the intervention flow pattern by Millanzi et al., (1) who implemented research of the same nature among nursing students in Tanzania. The intervention implementation involved aspects such as an introduction and formulation of groups, problem presentation, solving, discussions and sharing, scaffolding and group facilitation, mode of assessments, and summary of the study activities between an intervention and the control group.
Introduction and Formulation of learning groups: this was the first-day segment which was characterized by the introduction about the intervention process including descriptions of the objectives and the expected terminal behavior among students throughout in-out class learning activities. The researcher and assistants randomly assigned a maximum of 8 students in groups. Given a facilitator’s guidance, members of the formed groups had to appoint a chairperson and secretary among themselves and other members were supposed to actively take part in the assigned activities.
Problem Presentation, Solving, Discussions, and Sharing: Objectives of each session had to be reviewed by the researcher and assistants before their commencements. Classroom management and organization was assured through getting members in their group seat in the round to promote eye contact and enhance the easy flow of discussions through sessions. The developed paper-based conflicts-based scenario among nurses at working places was shared with each group. Debriefing of how to address them through learning activities was done by the researcher and assistants before allowing them to start addressing the assigned problems. Given a 30 minute, students were instructed to identify the professional context of the problem, listing what they knew, what they did not know, what they needed to know and establish the issues to learn from the problem.
Nevertheless, facilitators’ roles were to guide students via clarifying, ranking, and assigning learning tasks to each member of the group that would enable them to find appropriate strategies to resolve problems. Within 60 to 120 minutes, nursing students were guided to identify and suggest with reasons, the available resources needed to resolve the assigned scenario. Moreover, a period of one week was given among students to explore possible conflict resolution strategies that would be channeled to the scenario, then be shared and discussed in the entire class during the next scheduled session. As a closure of each session, nursing students were required to communicate to the researcher and or assistants either by mobile texts, orally or in writings through email whenever they need any help or clarifications of what was learned in the past sessions or what was to be learned in the next session. Following sessions after the offered week served as a room for students to present, discuss, and share what did with their colleagues in the entire class.
Scaffolding and Group Facilitations: Facilitators of sessions were required to scaffold the learning areas that students could not manage by themselves and facilitate their learning activities by making the learning environment friendly to their learning activities i.e. Adequate supply of learning resources and material and enough space for them to discuss or move freely and without disturbances each other. Owing to the big class size, sometimes, facilitators of the sessions used group leaders to control and lead group members. However, a leader who was used had to be briefly instructed on how to act as facilitators during monitoring and controlling the learning activities among members in respective groups.
Mode of assessment: both, formative and summative assessments were used to assess nursing students’ learning behaviors and session achievements. Peer assessment served as a formative assessment among students that helped to determine students’ interactions and abilities to evaluate one another. To evaluate the course PBL material implementation, the facilitator administered a student’s experience inventory (developed by a researcher) among randomly selected students after each session. Besides, the written posttest was used as a summative assessment to measure the end-line levels of academic motivation among nursing students.
Summary of the study activities between an intervention and the control group
Table 2 presents a flow plan of intervention with the session’s implementation to the end-line data collection between the intervention and the control group (Tabe 2).
Table 2: Summary of the study activities between an intervention and the control group (n = 401)
Intervention group
|
Control group
|
134 study participants recruited
|
267 study participants recruited
|
Administered the AMS-HS questionnaires as a pre-test to establish baseline information
|
Administered the AMS-HS questionnaires as a pre-test to establish baseline information
|
Participants organized in groups of 5 to 8 members
|
Participants were not organized into groups
|
Each member of the formed group was assigned a role to play by himself or herself e.g. Chairperson, secretary, timekeeper, etc. and they exchanged the roles per each session activities
|
Participants were not assigned in groups and thus had no roles to play alternatively
|
Participants were exposed to two sessions lasting for 90 minutes each per week according to the institutional schedule. 5 minutes were reserved for a break and 10 minutes for a facilitator to summarize the learned topic and respond to students’ queries per each session
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Participants were exposed to two sessions lasting for 90 minutes each per week according to the institutional schedule. 5 minutes were reserved for a break per each session. No summary of the learned topic and respond to students’ queries from the facilitator per each session. “THANK YOU FOR YOUR ATTENTION” was the end sentence from the facilitator per each session
|
Exposed to nursing-based conflict resolution content through problem-based facilitatory pedagogy
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Exposed to nursing-based conflict resolution content through lecture-based learning pedagogy
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Participants in their respective groups were exposed to conflict scenario to study and find appropriate strategies to resolve it
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Participants learned nursing-base conflicts at working place through facilitator-led PowerPoint presentations, question and answers, buzzing
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A representative from each group had to share and defend their work in front of the entire class
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Participants had opportunities to ask and answer questions from the facilitator
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Participants in their respective groups were required to present and defend a homework activity of the previous session in the entire classroom before the commencement of another day’s session
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Participants were required to answer questions from the facilitator about the previous session before the commencement of another day’s session
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Participants were required to note-keep (establish records) of what is learned and performed per each session so that they could develop a summary of session activities by the end of all sessions
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Participants had no opportunity. They just write summaries of what they learned for their read.
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Two to three randomly selected participants had to share their experiences of the session activities, time, content dosage, and their opportunities to learn
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Participants had no such opportunity. They had to disport once the session is over.
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Administered the AMS-HS questionnaires as post-test to establish baseline information
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Administered the AMS-HS questionnaires as post-test to establish baseline information
|
Source: Researcher’s plan (2018)
Data Analysis
The study performed statistical analyses using the Statistical Product for Service Solutions (SPSS) version 23. Descriptive statistics through chi-square and cross-tabulation established participants’ socio-demographic profiles and determined the relationship between categorical variables. Binary and multinomial logistic regression analyses were performed to determine the association between variables. The confidence interval (CI) was set at 95% whereas the probability value of ≤0.05 was considered to be statistically significant. The power of the study was set at 80% of demonstrating the effectiveness of an intervention.