Determinants of intention to study abroad among nursing and midwifery students: an application of the theory of planned behaviour

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Kelleher, Seán J.
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University College Cork
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Background Future health care professionals need to be broadly-educated, adaptable citizens who have significant experience in the world beyond the classroom. Study abroad, and the experiential learning it affords, has been identified as an ideal structure for health care students to develop the skills, competencies and attitudes necessary to prepare them, as health professionals, to work in a globalised health care environment. Despite the perceived benefits associated with study abroad, the rate of participation in study abroad programmes among nursing and midwifery students remains low. The reasons for this are unclear, indicating an urgent need for more studies to explore the factors that influence students’ decisions to study abroad. Aim The purpose of this research project was twofold: 1) to explain the determinants of students’ intention to study abroad; and 2) to determine the efficacy of the theory of planned behaviour as a model to predict nursing and midwifery students’ intentions to study abroad. Understanding more about how various influences can affect students’ general attitude (GA); subjective norm (SN); and perceived behavioural control (PBC) regarding study abroad will be of value to policy makers, academics and administrators when designing and marketing study abroad programmes to nursing and midwifery students. Method A mixed method, exploratory, sequential design was adopted for this study using Ajzen’s (1985) TPB as a theoretical framework. The study was conducted in three phases: Phase one consisted of a qualitative elicitation study to elicit participants’ modal salient beliefs regarding study abroad. Phase two involved the development of the TPB questionnaire, including instrument validation measures and the subsequent pilot testing. Phase three involved conducting the online TPB survey and data analysis. Manifest content analysis was used for the qualitative data, while the quantitative data were analysed using descriptive statistics and Structural Equation Modelling techniques. Data Collection In phase one, qualitative data were collected by means of an open ended questionnaire to elicit participants (n=25) salient beliefs regarding study abroad. In phase three, data for the cross sectional, descriptive, correlational survey were collected using an online software programme (n=245). Results Findings indicated that students’ socio-demographic factors accounted for between 18-21% of the variation in intention to study abroad, with significant associations identified with gender, age, speaking a second language, relationship status and level of parental education. Students’ behavioural beliefs regarding study abroad were generally positive and correlated strongly with GA, with the primary determinants of a positive attitude related to ‘experiencing how nurses/midwives are educated abroad’ (factor score .512, p<0.001) and ‘observing clinical practice in different social and cultural environments’ (factor score .506, p<0.001). Students’ normative beliefs indicated that students believed that studying abroad would be looked upon favourably by other social groups, and their opinions were important. A significantly positive association was found between students’ normative beliefs and SN, with the strongest correlations related to parent’s (factor score .754, p<0.001) and siblings (factor score .629, p<0.001). All control beliefs were identified as important, with ‘having adequate personal finance’ (mean 13.79, SD 7.94) and ‘the availability of financial aid’ (mean 12.73, SD 7.58) identified as the most important factors. No correlation was established between control beliefs and PBC. All three TPB constructs (GA, SN, and PBC) were identified as significant predictors of intention to study abroad, with General Attitude identified as the strongest predictor (standardised coefficient 0.44). PBC was the weakest predictor (standardised coefficient 0.24). When combined all three TPB constructs explained 75% of the variance in intention to study abroad. Conclusion Improving students’ attitudes toward study abroad should be the primary focus for study abroad professionals, administrators, and policy makers who wish to reduce the gap between intention and participation in study abroad. Effective advertising can foster interest and participation by addressing the perceived barriers and focusing on the potential educational and clinical benefits, and the increased employment opportunities associated with study abroad.
Study abroad , Theory of planned behaviour , Midwifery students , Nursing students
Kelleher, S. J. 2016. Determinants of intention to study abroad among nursing and midwifery students: an application of the theory of planned behaviour. PhD Thesis, University College Cork.