Health status and academic progress: A cross-sectional study of nursing students in Croatia and Serbia

Ivanović, Sunčica; Kocić, Ilija; Kocić, Biljana; Jovanović, Milena Cvetković; Vidanović, Vojin; Čukljek, Snježana; Ilić, Boris; Babić, Janko; Kovačević, Irena

doi:10.1590/1980-220X-REEUSP-2025-0082en

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ORIGINAL ARTICLE • Rev. esc. enferm. USP 59 • 2025 • https://doi.org/10.1590/1980-220X-REEUSP-2025-0082en linkcopy

Health status and academic progress: A cross-sectional study of nursing students in Croatia and Serbia

Estado de saúde e progresso acadêmico: Um estudo transversal com estudantes de enfermagem na Croácia e na Sérvia

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective: To compare the health status and academic progress of nursing students in Croatia, a European Union member state, and Serbia, a European Union candidate country, and to identify factors influencing their well-being and academic success.

Method: A cross-sectional study was conducted with 424 nursing students from the University of Applied Health Sciences in Zagreb, Croatia, and the Academy of Educational and Medical Vocational Studies in Ćuprija, Serbia. Data were collected through an online questionnaire assessing health behavior, well-being, and academic performance. Statistical analyses included the Chi-square and Mann-Whitney U tests.

Results: Croatian students had lower absenteeism (31.6%) and exhibited more responsible sexual health behaviors, while Serbian students reported higher levels of self-satisfaction (mean rank: 189.16 vs. 148.75; p < 0.01) and academic motivation (mean rank: 137.51 vs. 105.66; p < 0.01). Both groups showed health behaviors within normal ranges, though stress and substance use were prevalent. Statistically significant differences were found in self-satisfaction and academic progress (p < 0.05).

Conclusion: This study highlights differences in health and academic outcomes between nursing students in Croatia and Serbia, influenced by cultural, educational, and familial factors. Interventions addressing stress and promoting healthy behaviors are recommended.

DESCRIPTORS
Students, Nursing; Education, Nursing; Health Status; Academic progress

Academic Institution		Frequency		Percent %
Croatia			212		50
Serbia			212		50
Year of Study			Frequency	Percent %	Valid Percent %
Valid	1st year (undergraduate)		184	43.4	43.7
	2nd year (undergraduate)		97	22.9	23
	3rd year (undergraduate)		140	33	33.3
	Total		421	99.3	100
Missing	System		3	0.7
Gender			Frequency	Percent %	Valid Percent %
Valid	Male		46	10.8	11
	Female		370	87.3	88.5
	Transgender Person		1	0.2	0.2
	Non-Binary person		1	0.2	0.2
	Total		418	98.6	100
Missing	System		6	1.4
Living Situation			Frequency	Percent %	Valid Percent %
Valid	Parents and/or siblings		310	73.1	78.7
	Extended family		11	2.6	2.8
	Relatives		7	1.7	1.8
	Partner or partner and children		14	3.3	3.6
	Single parent with children and/or grandparents		23	5.4	5.8
	Roommate		14	3.3	3.6
	Living alone		15	3.6	3.5
	Total		394	92.9	100
Missing	System		30	7.1
Total			424	100
		Min	Max.	Mean	Std. Deviation
	Age Statistics	18	48	21.62	4.76

	Minimum	Maximum	Mean	Std. Deviation	p Kolmogorov - Smirnov	Cronbach’s Alpha
Perception of general health	3	9	5.58	1.14	0.00	0.73
Sense of security from potential injury	4	9	7.23	0.88	0.00	0.75
Sense of Well-being	0	5	3.51	1.04	0.00	0.72
Healthy Sexual Activity	2	8	5.90	0.92	0.00	0.76
Use of Psychoactive Substances (PAS)	0	7	1.68	1.62	0.00	0.76
Self-Satisfaction	1	6	5	1.12	0.00	0.77
Academic Progress	4	15	10.17	2.42	0.04	0.74

X²= 12.24; df = 1; p = 0.00			Institution
			Croatia	Serbia
Family arguments	No	Count	144	177
Family arguments		% of no arguments	44.9%	55.1%
	Yes	Count	58	30
		% of arguments	65.9%	34.1%
X²= 7.43; df = 1; p = 0.01			Institution
			Croatia	Serbia
No family problems	No	Count	76	52
No family problems		% no family problem	59.4%	40.6%
	Yes	Count	126	155
		% family problem	44.8%	55.2%
X²= 5.32; df = 1; p = 0.02			Institution
			Croatia	Serbia
Problems at university - Missed classes	No	Count	190	181
Problems at university - Missed classes		% of no Problems at university – Missed classes	51.2%	48.8%
	Yes	Count	12	26
		% of Problems at university – Missed classes	31.6%	68.4%
X²= 14.06; df = 1; p = 0.00			Institution
			Croatia	Serbia
Frequency in communication with friends	No	Count	42	78
		% no Conversations with friends	35.0%	65.0%
	Yes	Count	160	129
		% of Conversations with friends	55.4%	44.6%
X²= 10.76; df = 1; p = 0.00			Institution
			Croatia	Serbia
Frequency in communication with parent	No	Count	88	58
		% no Conversations with Parent	60.3%	39.7%
	Yes	Count	114	149
		% Conversations with Parent	43.3%	56.7%

	Institution	Mean Rank	Mann-Whitney U	p
	Croatia	123.64
Sense of Well-being	Serbia	142.06	7495	0.04
	Croatia	72.70
Healthy Sexual activity	Serbia	56.96	1584	0.01
	Croatia	148.75
Self-satisfaction	Serbia	189.16	10951	0.00
	Croatia	105.66
Academic progress	Serbia	137.51	5481	0.00

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Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
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[T1FN1] Legend: * X² – Chi-square; df – degrees of freedom; p – statistical significance.