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The Effect of Perceived Stress and Digital Literacy on Student Satisfaction with Distance Education

O efeito do estresse percebido e do letramento digital na satisfação do aluno quanto à educação a distância

El efecto del estrés percibido y la alfabetización digital en la satisfacción de los estudiantes en educación a distancia

ABSTRACT

Objective:

To examine the relationship between perceived stress/digital literacy and student satisfaction in health science college students in the distance education process.

Method:

The cross-sectional study was conducted by collecting data from 842 students. The dependent variable was student satisfaction in distance education. For the analyses, t-test, ANOVA (post hoc: Bonferroni), and linear regression methods were used.

Results:

Distance education student satisfaction was 178.21 ± 48.64. Student satisfaction was low among those who think that distance education is not more effective than face-to-face education, live in villages/towns, and have high perceived stress. Student satisfaction was high among those who do not have limited internet access, can access the internet via computer, follow the lessons regularly every week, think distance education is applicable in the health domain, can acquire instant feedback from the instructor, and have increased digital literacy.

Conclusion:

Distance education student satisfaction was found to be moderate. Student satisfaction in distance education increases as perceived stress levels decrease and digital literacy levels increase.

DESCRIPTORS
Computer Literacy; Distance Education; Stress, Physiological; Covid-19; Students; Personal Satisfaction

RESUMO

Objetivo:

Examinar a relação entre estresse percebido e letramento digital com a satisfação de alunos de faculdades de ciências da saúde no processo de educação a distância.

Método:

O estudo transversal foi realizado por meio da coleta de dados de 842 alunos. A variável dependente foi a satisfação dos alunos na educação a distância. Para as análises, foram utilizados os métodos de teste t, ANOVA (post hoc: Bonferroni) e regressão linear.

Resultados:

A satisfação dos alunos de educação a distância foi de 178,21 ± 48,64. A satisfação dos alunos foi baixa entre aqueles que pensam que a educação a distância não é mais eficaz do que a educação presencial, que moram em vilas/cidades e apresentam alto estresse percebido. A satisfação dos alunos foi alta entre aqueles que não têm acesso limitado à internet, podem acessar a internet pelo computador, acompanhar as aulas regularmente toda semana, acham que a educação a distância é aplicável no domínio da saúde, podem adquirir feedback instantâneo do instrutor e têm maior letramento digital.

Conclusão

A satisfação dos alunos de educação a distância foi considerada moderada. A satisfação dos alunos na educação a distância aumenta à medida que os níveis de estresse percebido diminuem e os níveis de letramento digital aumentam.

DESCRITORES
Alfabetização Digital; Educação à Distância; Estresse Fisiológico; Covid-19; Estudantes; Satisfação Pessoal

RESUMEN

Objetivo:

Examinar la relación entre el estrés percibido y la alfabetización digital con la satisfacción de los estudiantes de la facultad de ciencias de la salud en el proceso de educación a distancia.

Método:

El estudio transversal se realizó mediante la recopilación de datos de 842 estudiantes. La variable dependiente fue la satisfacción de los estudiantes en educación a distancia. Para los análisis, se utilizaron métodos de prueba t, ANOVA (post hoc: Bonferroni) y regresión lineal.

Resultados:

La satisfacción de los estudiantes de educación a distancia fue de 178,21 ± 48,64. La satisfacción de los estudiantes fue baja entre aquellos que piensan que la educación a distancia no es más efectiva que la educación presencial, los que viven en aldeas/pueblos y con un alto nivel de estrés percibido. La satisfacción de los estudiantes fue alta entre aquellos que no tienen acceso limitado a Internet, pueden acceder a Internet a través de una computadora, siguen las lecciones con regularidad todas las semanas, piensan que la educación a distancia es aplicable en el ámbito de la salud, pueden obtener retroalimentación instantánea del instructor y tienen un mayor conocimiento de alfabetización digital.

Conclusión:

Se encontró que la satisfacción de los estudiantes de educación a distancia es moderada. La satisfacción de los estudiantes en la educación a distancia aumenta a medida que disminuyen los niveles de estrés percibido y aumentan los niveles de alfabetización digital.

DESCRIPTORES
Alfabetización Digital; Educación a Distancia; Estrés Fisiológico; Covid-19; Estudiantes; Satisfacción Personal

INTRODUCTION

One of the areas most affected by the Covid-19 pandemic is the education and training systems. All over the world, face-to- face education has been discontinued and transition to distance education (DE) at all levels of education was implemented(11. Keskin M, Ozer Kaya D. Evaluation of students’ feedbacks on web-based distance education in the Covid-19 process. Izmir Katip Celeb Univ Fac Heal Sci J. 2020 [cited 2021 Feb 11];5(2):59-67. Available from: https://dergipark.org.tr/en/pub/ikcusbfd/issue/55773/754174
https://dergipark.org.tr/en/pub/ikcusbfd...
). During the DE process, students stayed away from their friends and educational environments. As a result, social and economic life became constrained(22. Kurtuncu M, Kurt A. Problems of nursing students in distance education in the covid-19 pandemia period. Eurasian J Res Soc Econ. 2020 [cited 2021 Feb 11];7(5):66-77. Available from: https://dergipark.org.tr/tr/pub/asead/issue/54658/725503.
https://dergipark.org.tr/tr/pub/asead/is...
).

Digital literacy is the ability to find, understand, analyze, produce, and share information through smartphones, tablets, laptops, and desktop computers(33. Yilmaz A, Kaya M, Akca N, Sonmez S. Determination of digital literacy level of the students at faculty of health. In: Proceedings of the 3rd International 13th National Health and Hospital Administration Congress; 2019; Sakarya. Sakarya, Turkey: Sakarya University; 2019 [cited 2021 Feb 11]. p. 287-97. Available from: https://www.researchgate.net/publication/339209308_saglik_bilimleri_fakultesi_ogrencilerinin_dijital_okuryazarlik_duzeylerinin_incelenmesi
https://www.researchgate.net/publication...
). Students must have high levels of digital literacy to conduct procedures efficiently(44. Hamutoglu NB, Canan Gungoren O, Kaya Uyanik G, Gur Erdogan D. Adapting digital literacy scale into turkish submitted. Ege Egit Derg. 2017;18(1):408-29. doi: https://doi.org/10.12984/egeefd.295306.
https://doi.org/10.12984/egeefd.295306...
).

Student satisfaction (SS) is the satisfaction in learning activities and services among students; it plays a major role in shaping the quality of education and preserving the aspect of learning(55. Himat AN. Afghan Students’ satisfaction from online learning during Covıd-19 at Kandahar University, Kandahar, Afghanistan. Am Int J Soc Sci Res. 2021;6(1):16-29. doi: https://doi.org/10.46281/aijssr.v6i1.93.
https://doi.org/10.46281/aijssr.v6i1.93...
). Determining learning satisfaction and factors affecting health science students who continue their education with DE programs during the pandemic is important in terms of improving program outcomes and educational quality(66. Hark Soylemez N. The evaluation of some studies on distance learning in context of Covid 19. J Curr Res Soc Sci. 2020;10(3):625-42. doi: https://doi.org/10.26579/jocress.396.
https://doi.org/10.26579/jocress.396...
).

In the literature, there are studies demonstrating that DE satisfaction of university students during the pandemic is at low(11. Keskin M, Ozer Kaya D. Evaluation of students’ feedbacks on web-based distance education in the Covid-19 process. Izmir Katip Celeb Univ Fac Heal Sci J. 2020 [cited 2021 Feb 11];5(2):59-67. Available from: https://dergipark.org.tr/en/pub/ikcusbfd/issue/55773/754174
https://dergipark.org.tr/en/pub/ikcusbfd...
,77. Hamdan KM, Al-Bashaireh AM, Zahran Z, Al-Daghestani A, AL-Habashneh S, Shaheen AM. University students’ interaction, internet self-efficacy, self-regulation and satisfaction with online education during pandemic crises of Covid-19 (SARS-CoV-2). Int J Educ Manag. 2021;35(3):713-25. doi: http://dx.doi.org/10.1108/IJEM-11-2020-0513.
http://dx.doi.org/10.1108/IJEM-11-2020-0...
), medium(88. Sharma K, Deo G, Timalsina S, Joshi A, Shrestha N, Neupane HC. Online learning in the face of covid-19 pandemic: assessment of students’ satisfaction at chitwan medical college of nepal. Kathmandu Univ Med J (KUMJ). 2020;18(70):40-7. doi: http://dx.doi.org/10.3126/kumj.v18i2.32943. PubMed PMID: 33605237.
http://dx.doi.org/10.3126/kumj.v18i2.329...
), and high(99. Prasetya TA, Harjanto CT, Setiyawan A. Analysis of student satisfaction of e-learning using the end-user computing satisfaction method during the Covid-19 pandemic. J Phys Conf Ser. 2020;1700:012012. doi: https://doi.org/10.1088/1742-6596/1700/1/012012.
https://doi.org/10.1088/1742-6596/1700/1...
,1010. Terzi D, Akalin RB, Erdal B. The effect of Covid-19 outbreak on education of health science students: example of Tekirdag. Namık Kemal Tıp Derg. 2020;8(3):279-87. doi: https://doi.org/10.37696/nkmj.751961.
https://doi.org/10.37696/nkmj.751961...
) levels. In DE process, SS appears to be affected by age, marital status(1111. Orcanli K, Bekmezci M. Determining university students’ perceptions about distance education in Covid-19 pandemic and its relationship with some demographic variables. Int J Econ Adm Sci. 2020;6(2):88-108. doi: https://doi.org/10.29131/uiibd.836277.
https://doi.org/10.29131/uiibd.836277...
), gender(88. Sharma K, Deo G, Timalsina S, Joshi A, Shrestha N, Neupane HC. Online learning in the face of covid-19 pandemic: assessment of students’ satisfaction at chitwan medical college of nepal. Kathmandu Univ Med J (KUMJ). 2020;18(70):40-7. doi: http://dx.doi.org/10.3126/kumj.v18i2.32943. PubMed PMID: 33605237.
http://dx.doi.org/10.3126/kumj.v18i2.329...
,1111. Orcanli K, Bekmezci M. Determining university students’ perceptions about distance education in Covid-19 pandemic and its relationship with some demographic variables. Int J Econ Adm Sci. 2020;6(2):88-108. doi: https://doi.org/10.29131/uiibd.836277.
https://doi.org/10.29131/uiibd.836277...
,1212. Buluk B, Es¸itti B. Evaluation of distance learning by tourism undergraduate students in the process of coronavirus (COVID-19). J Aware. 2020;5(3):285-98. doi: http://dx.doi.org/10.26809/joa.5.021.
http://dx.doi.org/10.26809/joa.5.021...
), learning conditions(1212. Buluk B, Es¸itti B. Evaluation of distance learning by tourism undergraduate students in the process of coronavirus (COVID-19). J Aware. 2020;5(3):285-98. doi: http://dx.doi.org/10.26809/joa.5.021.
http://dx.doi.org/10.26809/joa.5.021...
), university entrance field(1010. Terzi D, Akalin RB, Erdal B. The effect of Covid-19 outbreak on education of health science students: example of Tekirdag. Namık Kemal Tıp Derg. 2020;8(3):279-87. doi: https://doi.org/10.37696/nkmj.751961.
https://doi.org/10.37696/nkmj.751961...
,1111. Orcanli K, Bekmezci M. Determining university students’ perceptions about distance education in Covid-19 pandemic and its relationship with some demographic variables. Int J Econ Adm Sci. 2020;6(2):88-108. doi: https://doi.org/10.29131/uiibd.836277.
https://doi.org/10.29131/uiibd.836277...
), computer skills(1313. Kukul V. Student and faculty satisfaction in information technologies-based distance education [dissertation]. 2011. Ankara, Turkey: Ankara University.), problems related to systems(1414. Sahu P. Closure of universities due to coronavirus disease 2019 (Covid-19) : impact on education and mental health of students and academic staff challenges. Cureus. 2020;12(4):e7541. doi: http://dx.doi.org/10.7759/cureus.7541. PubMed PMID: 32377489.
http://dx.doi.org/10.7759/cureus.7541...
,1515. Wang C, Cheng Z, Yue X, McAleer M. Risk management of Covid-19 by universities in China. J Risk Financ Manag. 2020;13(2):36-42. doi: http://dx.doi.org/10.3390/jrfm13020036.
http://dx.doi.org/10.3390/jrfm13020036...
), and internet access via Wi-Fi(88. Sharma K, Deo G, Timalsina S, Joshi A, Shrestha N, Neupane HC. Online learning in the face of covid-19 pandemic: assessment of students’ satisfaction at chitwan medical college of nepal. Kathmandu Univ Med J (KUMJ). 2020;18(70):40-7. doi: http://dx.doi.org/10.3126/kumj.v18i2.32943. PubMed PMID: 33605237.
http://dx.doi.org/10.3126/kumj.v18i2.329...
). Student satisfaction plays an important role in the continuation of learning(1313. Kukul V. Student and faculty satisfaction in information technologies-based distance education [dissertation]. 2011. Ankara, Turkey: Ankara University.). The perceived stress during the pandemic process and the digital literacy skills that students need more intensely than before the pandemic are important for the effective continuation of learning. In this transition period, a comprehensive evaluation could not be made to evaluate students’ adaptation to distance education and the effectiveness of distance education(1010. Terzi D, Akalin RB, Erdal B. The effect of Covid-19 outbreak on education of health science students: example of Tekirdag. Namık Kemal Tıp Derg. 2020;8(3):279-87. doi: https://doi.org/10.37696/nkmj.751961.
https://doi.org/10.37696/nkmj.751961...
). When the literature was reviewed, there were no studies that investigated the association between perceived stress/digital literacy levels and SS in distant education. The object of the research is to examine the relationship between perceived stress/digital literacy and SS in health science faculty students in the DE process.

METHOD

Design of Study

The cross-sectional study was conducted between March and May 2021 in Turkey. The study’s population included 1,056 students from the departments of nursing, midwifery, and physical therapy and rehabilitation at Balıkesir University Faculty of Health Sciences (BUFHS).

Population

In a process where education was carried out remotely, it was not possible to meet students face-to-face. The sample size was not calculated in this study; all students who volunteered to participate and met the research entry criteria were contacted. The research sample consists of students from the BUFHS who have access to the online questionnaire, volunteer to participate in the study, and pursue their undergraduate education remotely during the Covid-19 pandemic. The link to the questionnaire form prepared online was delivered to the students via e-mail and social platforms.

The study sample consisted of 842 participants (79.7%) who completed all of the online forms. The study dependent variable was the level of satisfaction among distant education students using information technology. Sociodemographic characteristics, DE features, digital literacy, and perceived stress levels were the independent variables.

Data Collection

Sociodemographic Characteristics Information Form

The form was developed by (our) researchers after a literature(11. Keskin M, Ozer Kaya D. Evaluation of students’ feedbacks on web-based distance education in the Covid-19 process. Izmir Katip Celeb Univ Fac Heal Sci J. 2020 [cited 2021 Feb 11];5(2):59-67. Available from: https://dergipark.org.tr/en/pub/ikcusbfd/issue/55773/754174
https://dergipark.org.tr/en/pub/ikcusbfd...
,1010. Terzi D, Akalin RB, Erdal B. The effect of Covid-19 outbreak on education of health science students: example of Tekirdag. Namık Kemal Tıp Derg. 2020;8(3):279-87. doi: https://doi.org/10.37696/nkmj.751961.
https://doi.org/10.37696/nkmj.751961...
,1111. Orcanli K, Bekmezci M. Determining university students’ perceptions about distance education in Covid-19 pandemic and its relationship with some demographic variables. Int J Econ Adm Sci. 2020;6(2):88-108. doi: https://doi.org/10.29131/uiibd.836277.
https://doi.org/10.29131/uiibd.836277...
) review. In the first part of the form, which consists of two parts, there were 10 questions about sociodemographic characteristics and 13 questions about DE.

Perceived Stress Scale (PSS)

An adaptation of a standardized scale(1616. Cohen S, Kamarck T, Mermelstein R. Perceived stress scale (PSS). J Health Soc Behav. 1983 [cited 2021 Feb 11];24(285):1-2. Available from: https://www.midss.org/content/perceived-stress-scale-pss
https://www.midss.org/content/perceived-...
) was used to measure what situations in an individual’s life are perceived as stress. The PSS was adapted into Turkish by Eskin et al. in 2013 through a study with university students. In the validity study of the 10-item scale, the Cronbach’s 〈 coefficient was calculated as 0.82 for the overall PSS(1717. Eskin M, Harlak H, Demirkiran F, Dereboy C. The adaptation of the perceived stress scale into Turkish: a reliability and validity analysis. New Symp J. 2013 [cited 2021 Feb 11];51(3):132-40. Available from: www.yenisymposium.net
www.yenisymposium.net...
). In this study, the Cronbach’s 〈 coefficient was calculated as 0.79 for the overall PSS. The scale has a total of 14 items and one dimension. Each item is rated on a five point Likert scale, between “0 (never)” and “4 (very often)”. The total score obtained from the scale ranges from 0 to 40, and an increase in the score indicates an increase in stress(1717. Eskin M, Harlak H, Demirkiran F, Dereboy C. The adaptation of the perceived stress scale into Turkish: a reliability and validity analysis. New Symp J. 2013 [cited 2021 Feb 11];51(3):132-40. Available from: www.yenisymposium.net
www.yenisymposium.net...
).

Digital Literacy Scale (DLS)

An adaptation of a standardized scale was used(1818. Ng W. Can we teach digital natives digital literacy? Comput Educ. 2012;59(3):1065-78. doi: http://dx.doi.org/10.1016/j.compedu.2012.04.016.
http://dx.doi.org/10.1016/j.compedu.2012...
). The Digital Literacy Scale was adapted into Turkish by Hamutoğlu et al. in 2017 through a study with university students. In the scale validity study, the Cronbach’s 〈 coefficient was 0.93 for the “whole scale” subscale, 0.88 for the “attitude” subscale, 0.89 for the “technical” subscale, 0.70 for the “cognitive”, and 0.72 for the “social”(44. Hamutoglu NB, Canan Gungoren O, Kaya Uyanik G, Gur Erdogan D. Adapting digital literacy scale into turkish submitted. Ege Egit Derg. 2017;18(1):408-29. doi: https://doi.org/10.12984/egeefd.295306.
https://doi.org/10.12984/egeefd.295306...
). In this study, the Cronbach’s 〈 coefficient was 0.96 for the “whole scale” subscale, 0.89 for the “attitude” subscale, 0.92 for the “technical” subscale, 0.72 for the “cognitive”, and 0.70 for the “social”(44. Hamutoglu NB, Canan Gungoren O, Kaya Uyanik G, Gur Erdogan D. Adapting digital literacy scale into turkish submitted. Ege Egit Derg. 2017;18(1):408-29. doi: https://doi.org/10.12984/egeefd.295306.
https://doi.org/10.12984/egeefd.295306...
). The scale consists of 17 items and four dimensions(44. Hamutoglu NB, Canan Gungoren O, Kaya Uyanik G, Gur Erdogan D. Adapting digital literacy scale into turkish submitted. Ege Egit Derg. 2017;18(1):408-29. doi: https://doi.org/10.12984/egeefd.295306.
https://doi.org/10.12984/egeefd.295306...
). It is evaluated on a five-point Likert scale ranging from “I strongly agree”(55. Himat AN. Afghan Students’ satisfaction from online learning during Covıd-19 at Kandahar University, Kandahar, Afghanistan. Am Int J Soc Sci Res. 2021;6(1):16-29. doi: https://doi.org/10.46281/aijssr.v6i1.93.
https://doi.org/10.46281/aijssr.v6i1.93...
) to “I strongly disagree”(11. Keskin M, Ozer Kaya D. Evaluation of students’ feedbacks on web-based distance education in the Covid-19 process. Izmir Katip Celeb Univ Fac Heal Sci J. 2020 [cited 2021 Feb 11];5(2):59-67. Available from: https://dergipark.org.tr/en/pub/ikcusbfd/issue/55773/754174
https://dergipark.org.tr/en/pub/ikcusbfd...
). The four-factor structure obtained from the scale can be evaluated as four different dimensions, and the total score related to digital literacy can be deduced. The total score obtained from the scale varies between 17 and 85, and an increase in the score indicates an increase in digital literacy(44. Hamutoglu NB, Canan Gungoren O, Kaya Uyanik G, Gur Erdogan D. Adapting digital literacy scale into turkish submitted. Ege Egit Derg. 2017;18(1):408-29. doi: https://doi.org/10.12984/egeefd.295306.
https://doi.org/10.12984/egeefd.295306...
,1818. Ng W. Can we teach digital natives digital literacy? Comput Educ. 2012;59(3):1065-78. doi: http://dx.doi.org/10.1016/j.compedu.2012.04.016.
http://dx.doi.org/10.1016/j.compedu.2012...
).

Information Technologies-Based Distance Education Students Satisfaction Scale

The original form of scale is in Turkish. The scale was developed by Kukul in 2011 through a study with university students. In the scale validity study, the Cronbach’s 〈 coefficient was 0.70 for the “whole scale” subscale, 0.93 for the “structure and operation of the program” subscale, 0.96 for the “Interaction” subscale, and 0.86 for the “Common problem areas” subscale(44. Hamutoglu NB, Canan Gungoren O, Kaya Uyanik G, Gur Erdogan D. Adapting digital literacy scale into turkish submitted. Ege Egit Derg. 2017;18(1):408-29. doi: https://doi.org/10.12984/egeefd.295306.
https://doi.org/10.12984/egeefd.295306...
). In this study, the Cronbach’s 〈 coefficient was 0.98 for the “whole scale” subscale, 0.80 for the “attitude” subscale, 0.94 for the “the technical” subscale, 0.90 for the “cognitive”, and 0.88 for the “social”(44. Hamutoglu NB, Canan Gungoren O, Kaya Uyanik G, Gur Erdogan D. Adapting digital literacy scale into turkish submitted. Ege Egit Derg. 2017;18(1):408-29. doi: https://doi.org/10.12984/egeefd.295306.
https://doi.org/10.12984/egeefd.295306...
). The scale consists of three factors and 42 items. It is evaluated on a five-point Likert scale between “strongly disagree”(11. Keskin M, Ozer Kaya D. Evaluation of students’ feedbacks on web-based distance education in the Covid-19 process. Izmir Katip Celeb Univ Fac Heal Sci J. 2020 [cited 2021 Feb 11];5(2):59-67. Available from: https://dergipark.org.tr/en/pub/ikcusbfd/issue/55773/754174
https://dergipark.org.tr/en/pub/ikcusbfd...
) and “strongly agree”(55. Himat AN. Afghan Students’ satisfaction from online learning during Covıd-19 at Kandahar University, Kandahar, Afghanistan. Am Int J Soc Sci Res. 2021;6(1):16-29. doi: https://doi.org/10.46281/aijssr.v6i1.93.
https://doi.org/10.46281/aijssr.v6i1.93...
). As the scale score increases, the level of satisfaction also increases. In total, the range of 42–92 points is the indicator of “very low” satisfaction; 93–143 points, of “low” satisfaction; 144–194 points, of “moderate” satisfaction; 195–245 points, of “high” satisfaction; and 246–294 points, of “very high” satisfaction(1313. Kukul V. Student and faculty satisfaction in information technologies-based distance education [dissertation]. 2011. Ankara, Turkey: Ankara University.).

Data Analysis

During data analysis, numbers, percentages, arithmetic mean, and standard deviation were used to compare the mean scores in independent groups; Student’s t-test and Bonferroni-corrected one-way variance analysis were also used. Multivariate linear regression analysis was used to investigate the relationship between the independent and dependent variables. All statistical analyses were performed using SPSS software version 26.

Ethical Aspects

Permission was obtained from the Health Sciences School Dean’s Office (dated 07d.01m.2021y and numbered E.1027) and Clinical Research Ethics Committee (dated 04d.03m.2021y and numbered E.15.726, in Balıkesir University) before the study was conducted. The study have been performed in accordance with the ethical standards laid down in the Declaration of Helsinki (as revised in Brazil 2013). Informed consent was taken from all participants before starting the study and anonymity is preserved. Voluntary consent information about the study is included in the invitation to participate in the study, which is sent to the participants online. In line with this information, participants who agree to participate in the study are directed to the research page when they select the “I accept” option.

RESULTS

The research group consisted of 842 participants. It was observed that 84.0% were women, 62.6% were nursing students, 62.1% were people whose income was equal to their expenses, and 38.8% were people living in the city center. Among the participants, 42.6% of them stated that they have a computer, 64.4% can easily enter the DE platform, 67.1% follow the lessons regularly every week, 68.3% state that DE is unapplicable in the health education, and 77.4% reported that DE will negatively affect their post-graduation practice skills (Table 1).

Table 1.
Sociodemographic and DE characteristics of the research group (n = 842) – Balikesir Turkey, 2021.

The descriptive features of some continuous variables of the participants are given in Table 2. The average daily computer usage time was 3.56 ± 2.66/hour, average daily online time was 6.33 ± 4.30/hour, mean digital literacy score was 54.45 ± 14.49, mean score of perceived stress was 21.47 ± 5.78, mean score of DE SS was 178.21 ± 48.64 (Table 2).

Table 2.
Descriptive features of some continuous variables in the research group (n = 842) – Balikesir, Turkey, 2021.

The participants’ DE satisfaction scores according to the characteristics of sociodemographic and DE are given in Table 3. The satisfaction score was significantly higher for the midwifery, physiotherapy, and rehabilitation students (p = 0.002); the first and fourth-grade students (p = 0.000); those whose income is more than/equal to their expenses (p = 0.000); those living in city/town (p = 0.000); those with a computer (p = 0.000); those with no limited internet access (uninterrupted internet access/stable/good internet) (p = 0.000); those who have not undergone a Covid-19 test (p = 0.011); and those who do not have a family history of Covid-19 (p = 0.023) (Table 3).

Table 3.
DE satisfaction scores of the research group according to the sociodemographic and DE characteristics (n = 842) – Balikesir, Turkey, 2021.

According to the results of Pearson correlation analysis, the satisfaction score of students in DE, based on information technologies, increases as lifetime computer usage time increases, as the level of digital literacy increases, and as the perceived stress level decreases (p = 0.000) (Table 4).

Table 4.
Pearson correlation analysis of SS score in DE according to some variables (n = 842) – Balikesir, Turkey, 2021.

The evaluation of SS score in DE by linear regression analysis using backward elimination method is given in Table 5. The satisfaction score was low among those living in villages/towns, those who think DE is not more effective than face-to-face education, and those with high perceived stress (p < 0.000). The SS was high for those who do not have limited internet access (p = 0.009); those who can access the internet via computer (p = 0.026); those who regularly follow the lessons every week (p = 0.000); those who think that DE is applicable in the health education (p = 0.013); those who can acquire instant feedback from the instructor (p < 0.000); those who think that theoretical lessons should be conducted with DE after the pandemic (p = 0.002); and those with high digital literacy (p = 0.000) (Table 5).

Table 5.
Evaluation of SS score in DE by linear regression analysis using backward elimination method (n = 842) – Balikesir, Turkey, 2021.

DISCUSSION

Evaluation of SS and influencing factors are important for a qualified DE process. This research is one of the first studies to evaluate sociodemographic variables in health science college students, as well as the relationship between perceived stress/digital literacy levels and SS. In our research, students’ DE satisfaction was moderate. The literature showed that SS was low(11. Keskin M, Ozer Kaya D. Evaluation of students’ feedbacks on web-based distance education in the Covid-19 process. Izmir Katip Celeb Univ Fac Heal Sci J. 2020 [cited 2021 Feb 11];5(2):59-67. Available from: https://dergipark.org.tr/en/pub/ikcusbfd/issue/55773/754174
https://dergipark.org.tr/en/pub/ikcusbfd...
,77. Hamdan KM, Al-Bashaireh AM, Zahran Z, Al-Daghestani A, AL-Habashneh S, Shaheen AM. University students’ interaction, internet self-efficacy, self-regulation and satisfaction with online education during pandemic crises of Covid-19 (SARS-CoV-2). Int J Educ Manag. 2021;35(3):713-25. doi: http://dx.doi.org/10.1108/IJEM-11-2020-0513.
http://dx.doi.org/10.1108/IJEM-11-2020-0...
,1919. Tuzun F, Yoruk Toraman N. A Regression analysis of factors affecting distance education satisfaction of university students during the Covid-19 pandemic. In: Yalcinalp S, editor. The 3rd International Conference on Distance Learning and Innovative Educational Technologies; 2020; Ankara, Turkey. Ankara, Turkey: Baskent University Distance Education Application and Research Center; 2020 [cited 2021 Feb 11]. p. 302-16. Available from: http://dilet.baskent.edu.tr/wp-content/uploads/DILET2020-Proceedings-Book.pdf
http://dilet.baskent.edu.tr/wp-content/u...
), middle(88. Sharma K, Deo G, Timalsina S, Joshi A, Shrestha N, Neupane HC. Online learning in the face of covid-19 pandemic: assessment of students’ satisfaction at chitwan medical college of nepal. Kathmandu Univ Med J (KUMJ). 2020;18(70):40-7. doi: http://dx.doi.org/10.3126/kumj.v18i2.32943. PubMed PMID: 33605237.
http://dx.doi.org/10.3126/kumj.v18i2.329...
), and high(99. Prasetya TA, Harjanto CT, Setiyawan A. Analysis of student satisfaction of e-learning using the end-user computing satisfaction method during the Covid-19 pandemic. J Phys Conf Ser. 2020;1700:012012. doi: https://doi.org/10.1088/1742-6596/1700/1/012012.
https://doi.org/10.1088/1742-6596/1700/1...
,1010. Terzi D, Akalin RB, Erdal B. The effect of Covid-19 outbreak on education of health science students: example of Tekirdag. Namık Kemal Tıp Derg. 2020;8(3):279-87. doi: https://doi.org/10.37696/nkmj.751961.
https://doi.org/10.37696/nkmj.751961...
).

In our research, the satisfaction of students living in the village/town was negatively affected, similar to the literature(1414. Sahu P. Closure of universities due to coronavirus disease 2019 (Covid-19) : impact on education and mental health of students and academic staff challenges. Cureus. 2020;12(4):e7541. doi: http://dx.doi.org/10.7759/cureus.7541. PubMed PMID: 32377489.
http://dx.doi.org/10.7759/cureus.7541...
,1515. Wang C, Cheng Z, Yue X, McAleer M. Risk management of Covid-19 by universities in China. J Risk Financ Manag. 2020;13(2):36-42. doi: http://dx.doi.org/10.3390/jrfm13020036.
http://dx.doi.org/10.3390/jrfm13020036...
). According to our results, parallel to the literature, it can be determined that inequalities regarding having important components of DE, such as computers, mobile phones, and the internet, are obstacles to achieving satisfaction in DE for students in rural areas. Eliminating inequalities in technological opportunities will play a key role in increasing SS.

Our study further determined that students’ thinking that DE is not more effective than face-to-face education negatively affects satisfaction. The literature reported that 49.7% of the students definitely did not prefer distance learning compared to face-to-face learning, and 43.8% were definitely not satisfied with DE(55. Himat AN. Afghan Students’ satisfaction from online learning during Covıd-19 at Kandahar University, Kandahar, Afghanistan. Am Int J Soc Sci Res. 2021;6(1):16-29. doi: https://doi.org/10.46281/aijssr.v6i1.93.
https://doi.org/10.46281/aijssr.v6i1.93...
). Our findings are similar to the literature. Other studies during the pandemic have reported that theoretical lessons can be conducted with DE; however, there are problems with applied lessons(1414. Sahu P. Closure of universities due to coronavirus disease 2019 (Covid-19) : impact on education and mental health of students and academic staff challenges. Cureus. 2020;12(4):e7541. doi: http://dx.doi.org/10.7759/cureus.7541. PubMed PMID: 32377489.
http://dx.doi.org/10.7759/cureus.7541...
,1515. Wang C, Cheng Z, Yue X, McAleer M. Risk management of Covid-19 by universities in China. J Risk Financ Manag. 2020;13(2):36-42. doi: http://dx.doi.org/10.3390/jrfm13020036.
http://dx.doi.org/10.3390/jrfm13020036...
). Alternatively, it is stated that although DE has limitations for applied lessons, it can be effectively maintained, due to the creation of different strategies(66. Hark Soylemez N. The evaluation of some studies on distance learning in context of Covid 19. J Curr Res Soc Sci. 2020;10(3):625-42. doi: https://doi.org/10.26579/jocress.396.
https://doi.org/10.26579/jocress.396...
). In the DE model, we believe that interaction problems encountered by students should be evaluated and educational environments should be organized to meet their learning needs, in addition to support students in this regard.

In our research, it was determined that the students’ perceived stress level score was at a moderate level and had a negative impact on satisfaction. Similar to our research, it was stated in the literature that the pandemic negatively affected the stress levels of university students(2020. Aslan H, Pekince H. Nursing students’ views on the Covid-19 pandemic and their percieved stress levels. Perspect Psychiatr Care. 2021;57(2):695-701. doi: http://dx.doi.org/10.1111/ppc.12597. PubMed PMID: 32808314.
http://dx.doi.org/10.1111/ppc.12597...
,2121. Essadek A, Rabeyron T. Mental health of French students during the Covid-19 pandemic. J Affect Disord. 2020;277:392-3. doi: http://dx.doi.org/10.1016/j.jad.2020.08.042. PubMed PMID: 32861840.
http://dx.doi.org/10.1016/j.jad.2020.08....
). It was reported that the DE system causes students to experience more stress(2222. Favale T, Soro F, Trevisan M, Drago I, Mellia M. Campus traffic and e-Learning during Covid-19 pandemic. Comput Networks J. 2020;176:107290. doi: https://doi.org/10.1016/j.comnet.2020.107290.
https://doi.org/10.1016/j.comnet.2020.10...
). It is also stated that exposure of students to long-term and uncontrollable stressors during the learning phase negatively affects both their professional identity development and health(2323. Karaca A, Yildirim N, Ankarali H, Acikgoz F, Akkus D. Turkish adaptation of perceived stress scale, bio-psycho-social response, and coping behaviours of stress scales for nursing students. J Psychiatr Nurs. 2015;6(1):15-25. doi: http://dx.doi.org/10.5505/phd.2015.40316.
http://dx.doi.org/10.5505/phd.2015.40316...
). Reducing the stress levels of the health science college students, who will replace health workers at the forefront in the fight against the pandemic, is important in terms of both increasing their educational satisfaction, structuring their future in confidence, and fulfilling their duties and responsibilities professionally when they graduate.

According to our research, educational satisfaction of students who have unlimited internet access (uninterrupted/high- speed internet access) and can easily access the internet via computer is positively affected. The transition to DE was made without a comprehensive assessment of students’ DE opportunities at the beginning of the pandemic(1111. Orcanli K, Bekmezci M. Determining university students’ perceptions about distance education in Covid-19 pandemic and its relationship with some demographic variables. Int J Econ Adm Sci. 2020;6(2):88-108. doi: https://doi.org/10.29131/uiibd.836277.
https://doi.org/10.29131/uiibd.836277...
). Disruptions due to insufficient infrastructure or internet access and hardware (computer, tablet, etc.) deficiencies are among the disadvantages of DE(1919. Tuzun F, Yoruk Toraman N. A Regression analysis of factors affecting distance education satisfaction of university students during the Covid-19 pandemic. In: Yalcinalp S, editor. The 3rd International Conference on Distance Learning and Innovative Educational Technologies; 2020; Ankara, Turkey. Ankara, Turkey: Baskent University Distance Education Application and Research Center; 2020 [cited 2021 Feb 11]. p. 302-16. Available from: http://dilet.baskent.edu.tr/wp-content/uploads/DILET2020-Proceedings-Book.pdf
http://dilet.baskent.edu.tr/wp-content/u...
). In the literature, it can be deduced that more than 60% of students are not ready for online classes due to poor network infrastructure and limited daily network data(2424. Naik GL, Deshpande M, Shivananda DC, Ajey CP, Patel GCM. Online teaching and learning of higher education in india during Covid-19 Emergency Lockdown. Pedagog Res. 2021 [cited 2021 Feb 11];6(1):em0090. Available from: https://eric.ed.gov/?id=EJ1287167
https://eric.ed.gov/?id=EJ1287167...
). Another study reported that 65.8% of students experienced issues with their internet connection and the extra financial burden for internet quota caused further problems in DE(2525. Amir LR, Tanti I, Maharani DA, Wimardhani YS, Julia V, Sulijaya B, et al. Student perspective of classroom and distance learning during Covid-19 pandemic in the undergraduate dental study program Universitas Indonesia. BMC Med Educ. 2020;20(1):392. doi: http://dx.doi.org/10.1186/s12909-020-02312-0. PubMed PMID: 33121488.
http://dx.doi.org/10.1186/s12909-020-023...
). A study conducted by Buluk and Esitti (2020) determined that 21.96% of students had problems in following classes due to lack of computers and/or other equipment, and 27.57% faced problems due to frequent disconnections(1212. Buluk B, Es¸itti B. Evaluation of distance learning by tourism undergraduate students in the process of coronavirus (COVID-19). J Aware. 2020;5(3):285-98. doi: http://dx.doi.org/10.26809/joa.5.021.
http://dx.doi.org/10.26809/joa.5.021...
). The preparations proposed by UNESCO (2020) for DE during the Covid-19 pandemic are pedagogical preparation, content preparation, technological preparation, and monitoring and evaluation preparation(2626. United Nations Educational, Scientific and Cultural Organization. Distance learning strategies, What do we know about effectiveness? [Internet]. Paris: UNESCO; 2020 [cited 2021 Feb 11]. Available from: http://www.unesco.org/covid19EDwebinar
http://www.unesco.org/covid19EDwebinar...
). The review of the adequacy of the internet and computer supports provided may be recommended to make necessary enhancements.

In our research, we determined that the satisfaction of students who follow regular lessons every week and believe that they can acquire feedback from the instructor at any moment is positively affected. In the literature, it was reported that, during the pandemic, 33.64% of students were able to follow the lessons completely, 37.85% were generally able to follow the lessons, and 42.53% could not follow the lessons due to poor communication activities with instructors(1212. Buluk B, Es¸itti B. Evaluation of distance learning by tourism undergraduate students in the process of coronavirus (COVID-19). J Aware. 2020;5(3):285-98. doi: http://dx.doi.org/10.26809/joa.5.021.
http://dx.doi.org/10.26809/joa.5.021...
). Another study stated that 21% of the students followed all lessons(2727. Vatier C, Carrié A, Renaud MC, Simon-Tillaux N, Hertig A, Jéru I. Lessons from the impact of Covid-19 on medical educational continuity and practices. Adv Physiol Educ. 2021;45(2):390-8. doi: http://dx.doi.org/10.1152/advan.00243.2020. PubMed PMID: 33961515.
http://dx.doi.org/10.1152/advan.00243.20...
). Another study found that 50.9% of the students could not follow the lessons as they could not access a computer, and 32.6% of them could not reach the instructor for their questions(55. Himat AN. Afghan Students’ satisfaction from online learning during Covıd-19 at Kandahar University, Kandahar, Afghanistan. Am Int J Soc Sci Res. 2021;6(1):16-29. doi: https://doi.org/10.46281/aijssr.v6i1.93.
https://doi.org/10.46281/aijssr.v6i1.93...
). We believe that strategies established in universities to increase the rate of course follow-up and opportunities for interaction with faculty members should increase SS.

In our research, it was determined that the satisfaction of students who think that DE is applicable for the health education and that theoretical lessons should be conducted with DE after the pandemic is positively affected. In the literature, it was stated that students believe that theoretical lessons in DE are efficient, while being inefficient for applied lessons, and they are not satisfied due to lack of question–answer opportunities and problems they face while entering the system(2828. Altun Ekiz M. The Views of physical education and sports school students about distance education in the quarantıne period (A Qualitative Research). J Sport Recreat Res. 2020 [cited 2021 Feb 11];2(1):1-13. Available from: https://dergipark.org.tr/tr/download/article-file/1129313
https://dergipark.org.tr/tr/download/art...
). Another study reported that, during the Covid-19, nursing students thought that DE would not be sufficient for both theoretical and applied lessons(22. Kurtuncu M, Kurt A. Problems of nursing students in distance education in the covid-19 pandemia period. Eurasian J Res Soc Econ. 2020 [cited 2021 Feb 11];7(5):66-77. Available from: https://dergipark.org.tr/tr/pub/asead/issue/54658/725503.
https://dergipark.org.tr/tr/pub/asead/is...
). Integrating simulations used in health services into the DE process can increase satisfaction in applied lessons.

Our study found that a high level of digital literacy had a positive effect on educational satisfaction. Universities have adapted to the transition to DE programs during the pandemic. However, a comprehensive assessment and planning could not be conducted in terms of differences in students’ digital literacy levels(1111. Orcanli K, Bekmezci M. Determining university students’ perceptions about distance education in Covid-19 pandemic and its relationship with some demographic variables. Int J Econ Adm Sci. 2020;6(2):88-108. doi: https://doi.org/10.29131/uiibd.836277.
https://doi.org/10.29131/uiibd.836277...
). In literature, it was stated that approximately two-thirds of students do not prefer DE using digital tools(2929. Langegård U, Kiani K, Nielsen SJ, Svensson P. Nursing students ’ experiences of a pedagogical transition from campus learning to distance learning using digital tools. BMC Nurs. 2021;20(1):23. doi: http://dx.doi.org/10.1186/s12912-021-00542-1. PubMed PMID: 33468132.
http://dx.doi.org/10.1186/s12912-021-005...
), students’ digital literacy level is moderate(33. Yilmaz A, Kaya M, Akca N, Sonmez S. Determination of digital literacy level of the students at faculty of health. In: Proceedings of the 3rd International 13th National Health and Hospital Administration Congress; 2019; Sakarya. Sakarya, Turkey: Sakarya University; 2019 [cited 2021 Feb 11]. p. 287-97. Available from: https://www.researchgate.net/publication/339209308_saglik_bilimleri_fakultesi_ogrencilerinin_dijital_okuryazarlik_duzeylerinin_incelenmesi
https://www.researchgate.net/publication...
), and the lack of digital literacy in students is a major barrier for efficient digital learning(3030. Almazova N, Krylova E, Rubtsova A, Odinokaya M. Education sciences challenges and opportunities for russian higher education amid Covid-19: Teachers ’ Perspective. Educ Sci. 2020;10(12):368-78. doi: http://dx.doi.org/10.3390/educsci10120368.
http://dx.doi.org/10.3390/educsci1012036...
). We believe that after the pandemic, adding planned training to the university curricula for improving digital literacy levels will be beneficial. This, in turn, will increase students’ satisfaction with the educational model that is planned to be implemented after the pandemic and during the possible new pandemic processes.

We also found that the following did not affect educational satisfaction: students’ age, department, class, income status; having a Covid-19 test; family history of Covid-19; having a suitable environment for DE; tools of accessing DE; having difficulty in doing homework/presentation in the digital environment; demand to continue the applied lessons with DE after the pandemic; thinking that the pandemic limited access to the university library; thinking that DE would negatively affect the practice skills; and lifelong computer use,. Some studies determined that the sex variable did not affect SS(55. Himat AN. Afghan Students’ satisfaction from online learning during Covıd-19 at Kandahar University, Kandahar, Afghanistan. Am Int J Soc Sci Res. 2021;6(1):16-29. doi: https://doi.org/10.46281/aijssr.v6i1.93.
https://doi.org/10.46281/aijssr.v6i1.93...
,77. Hamdan KM, Al-Bashaireh AM, Zahran Z, Al-Daghestani A, AL-Habashneh S, Shaheen AM. University students’ interaction, internet self-efficacy, self-regulation and satisfaction with online education during pandemic crises of Covid-19 (SARS-CoV-2). Int J Educ Manag. 2021;35(3):713-25. doi: http://dx.doi.org/10.1108/IJEM-11-2020-0513.
http://dx.doi.org/10.1108/IJEM-11-2020-0...
), and that the variables sex and having mobile internet have no effect on digital literacy skills(33. Yilmaz A, Kaya M, Akca N, Sonmez S. Determination of digital literacy level of the students at faculty of health. In: Proceedings of the 3rd International 13th National Health and Hospital Administration Congress; 2019; Sakarya. Sakarya, Turkey: Sakarya University; 2019 [cited 2021 Feb 11]. p. 287-97. Available from: https://www.researchgate.net/publication/339209308_saglik_bilimleri_fakultesi_ogrencilerinin_dijital_okuryazarlik_duzeylerinin_incelenmesi
https://www.researchgate.net/publication...
). Another study stated that male students have higher satisfaction with DE lessons compared to female students(1212. Buluk B, Es¸itti B. Evaluation of distance learning by tourism undergraduate students in the process of coronavirus (COVID-19). J Aware. 2020;5(3):285-98. doi: http://dx.doi.org/10.26809/joa.5.021.
http://dx.doi.org/10.26809/joa.5.021...
); another one found that students’ age, computer usage frequency, department, total number of years they spend using a computer, and computer usage skills affect digital literacy skills(33. Yilmaz A, Kaya M, Akca N, Sonmez S. Determination of digital literacy level of the students at faculty of health. In: Proceedings of the 3rd International 13th National Health and Hospital Administration Congress; 2019; Sakarya. Sakarya, Turkey: Sakarya University; 2019 [cited 2021 Feb 11]. p. 287-97. Available from: https://www.researchgate.net/publication/339209308_saglik_bilimleri_fakultesi_ogrencilerinin_dijital_okuryazarlik_duzeylerinin_incelenmesi
https://www.researchgate.net/publication...
); and another one found that there is a significant relationship between the Covid-19 pandemic perception of students and the variables of age, their study fields, and sex; however, no significant relationship with the variable grade(1111. Orcanli K, Bekmezci M. Determining university students’ perceptions about distance education in Covid-19 pandemic and its relationship with some demographic variables. Int J Econ Adm Sci. 2020;6(2):88-108. doi: https://doi.org/10.29131/uiibd.836277.
https://doi.org/10.29131/uiibd.836277...
) was observed. We believe that our study’s results can be used as a valuable input in planning of DE practices and formal education process during the pandemic.

CONCLUSION

We conclude that students’ satisfaction with DE is moderate. In distance education, student satisfaction is reduced by variables such as living in the countryside; high perceived stress; low digital literacy; limited infrastructure opportunities, such as internet and computer access; and instructors’ not giving feedback. In this respect, improvements should be made to increase satisfaction with DE by focusing on factors that affect it. Steps need to be undertaken to completely resolve internet access problems for students living in areas with lack of technological infrastructure. Projects can be developed to provide computer support to students. Lessons on stress management and digital literacy can be added to the curriculum to reduce students’ stress and increase their digital literacy. Psychological support programs for university students to cope with stress and anxiety can be designed and sustained as part of the fight against the pandemic. To increase student’s satisfaction with distance education, platforms can be developed to increase the rate of students following courses on a regular basis and ensure effective interaction with instructors. This study can help guide future planning to improve the effectiveness of DE in universities and SS with DE.

Strength and Limitation of Study

This study is one of the first to evaluate the effect of perceived stress and digital literacy on SS. However, the fact that the study was conducted in a single center limits its generalizability.

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Edited by

ASSOCIATE EDITOR

Vilanice Alves de Araújo Püschel

Publication Dates

  • Publication in this collection
    02 Sept 2022
  • Date of issue
    2022

History

  • Received
    02 Nov 2021
  • Accepted
    19 July 2022
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
E-mail: reeusp@usp.br