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TEST ANXIETY LEVEL BASED ON GENDER AMONG SEMESTER V MEDICAL STUDENTS OF
UDAYANA UNIVERSITY BALI INDONESIA.
YOGESWARY PHNNIR SALVAM
MEDICAL EDUCATION STUDY PROGRAM
FACULTY OF MEDICINE
I take this opportunity to express my profound gratitude and deep regard to my
guide dr. I Wayan Westa, Sp.KJ (K) for his exemplary guidance, monitoring and
constant encouragement throughout the course of this research. The blessing, help
and guidance given by him time to time shall carry me a long way in the journey
of life on which I am about to embark. Then I also would like to thank my friends
for motivating me and appreciating my work. I would also like to thank my
parents for helping me and encouraging me to go my own way. I wish to
acknowledge the contribution and the support of the Udayana University and to
the medical students for their participation in this elective study. Last, but not the
least, I would like to thank God, who made all the things possible and made it
ACKNOWLEDGEMENT...i CONTENT...........ii CHAPTER I: INTRODUCTION
1.1 Research Background....................1 1.2. Problem Identifications........3 1.3. Aim of Research.......3 1.4. Research Benefits.........3
CHAPTER II: LITERATURE REVIEW 2.1.Definition......4
2.2. Factors..5 2.2.1 Gender............5 2.2.2 Life style issues..........6 2.2.3 Lack of information...........6 2.2.4 Psychological factor...............6 2.2.5 Biological Factor............................6 2.3. Diagnosis..........................................................................................7 2.3.1. GAD-7......7 2.3.2. HAM-A/HARS.....7 2.3.3. TAQ..........7 2.4. Treatment.........................................................................................8 2.4.1. Medication............8 2.4.2. Cognitive Behavioral Therapy......8 2.4.3. Meditation.........9 2.4.4. Parental Anxiety Management......9 2.4.5. Combined Treatments ..........9 2.4.6. Elimination of Caffeine .......9 2.4.7. Other Treatments......10
CHAPTER III: CONCEPT, OPERATIONAL DEFINITION, HYPOTHESIS 3.1 Concept11 3.2 Operational Definition 3.2.1. Anxiety ........................12 3.3 Hypothesis........................................................................................12
CHAPTER IV: METHOD OF RESEARCH 4.1. Design of Research.13 4.2 Population and Sample of Research 4.2.1. Population of Research....13 4.2.2. Criteria of Sample....13 4.2.3. Sample Size..14 4.2.4. Method of Sampling for Research...14 4.3 Research Variable....14 4.4. Data Collecting Method and Analysis....14 4.5 Place and Time of Research.....15 4.6 Instrument of Research....15 4.7 Limitation of Research.........15
1.1 Research Background
Medical conditions such as depression, insomnia, stress, bipolar disorders and
post-traumatic disorders and moreover anxiety has increased in number of cases
rapidly over the past years especially among students due to pressure they gone
through in their daily life and also to perform well.
As we know today, anxiety is became a common phenomenon of everydays life. It plays an important role in human life because all of us are the victims of
anxiety in different ways and in different situation of our daily life activities.
Generally speaking, anxiety can either be a trait anxiety or a state of anxiety. Trait
anxiety which means, a stable characteristic or else trait of the person who undergoes
anxiety. State anxiety is the one which is aroused by some temporary situation of the
environment such as examination, accident, punishments and others (Mohammad
Nadeem et al, 2012). We all sure would have experienced at least a minor anxiety at
some point in our lives. Actually, it is the feeling of thousand butterflies flying in
your stomach before like a big date with someone, the tense feeling you get when
yourself know that you're in danger (eg: dog chasing you). Globally, approximately
273 million (4.5% of the general population) who had an anxiety disorder. It is more
common in females (5.2%) than males (2.8%).In Asian countries, the lifetime rates of
anxiety disorders are probably between 9% and 16%, and while the yearly rates are
between 4% and 7% (Prof Theo Vos et al, 2010).
Nowadays, test anxiety is a common or maybe main cause of poor academic
performance among students in every part of this world. The work of assessing
students learning is complex. In order to assess to their work objectively, teachers and instructors use various methods and instruments, one of which is examination.
We are aware that nowadays examination has become an inherent part of the society
we live in. Consequently, most of the important decisions are made mainly based on
exam results. So, it is not surprising if test anxiety during examination period has
become a most prominent problem in school and also universities.
Therefore, test anxiety can also interfaces with learnings in that more anxious students will be more easily distracted by irrelevant aspects of the task at hand and
also having trouble in focusing on significant details or information. In addition, it is
also more common in females than in males. Having an anxiety disorder means
coping with everyday life while feeling anxious and worried, with sweaty palms and
a pounding heart, with a paranoid sense that something bad is going to happen, or
even with the threat of a looming panic attack. This is what millions of females deal
with daily, but why they are more likely than males to experience anxiety is still a
mystery. It clearly shows that gender as associated factors that lead to different test
anxiety level among students.
Therefore, it is concluded that test anxiety level based on gender too (Shireen
et al, 2008). This problem should be overcome immediately as it can cause a variety
of effects such as it can cause the affected student to be unable to concentrate on their
education, it can also cause them to constantly lose focus and not actually perform
well during their examination which then leads them to fall into depression state.
Based on this research background, the topic Of Test Anxiety Level Based on Gender
as Associated Factor among Semester V Medical Students of Udayana University
Bali, Indonesia was chosen.
1.2 Problem Identifications
a. How many of the semester V female and male medical students of Udayana
University are affected with mild test anxiety level?
b. How many of the semester V female and male medical students of Udayana
University are affected with moderate test anxiety level?
c. How many of the semester V female and male medical students of Udayana
University are affected with severe test anxiety level?
d. Does gender as associated factor contribute to test anxiety level among
semester V medical students of Udayana University?
1.3 Aim of Research
Mainly this research is to investigate the test anxiety level based on gender
among semester V English class medical students of Udayana University.
1.4 Research Benefits
a. The result of this study may also provide information and latest updates to
teachers and students about the test anxiety level based on gender among
semester V medical students of Udayana University.
b. It may help teachers to guide and motivate students according to their
requirements and background.
c. Knowing the test anxiety level of semester V medical students of Udayana
University according to their gender who are suffering from test anxiety.
Anxiety has been defined as a diffuse, unpleasant, vague sense of
apprehension, which is often assisting by autonomic symptoms, likewise headache,
perspiration, palpitations, stiffness in the chest, and mild stomach discomfort feeling
(Kaplan, H. and Sadock, 1996). Benjamin (1987) noted that test anxiety can interface
with attention, learning and testing. The idea that test anxiety may interface with a
student's ability to demonstrate completely what they have learned is not new. In
1998 test anxiety also defined by Zeidner, that its a set of phenomenological, physiological, and behavioral responses that accompany concern about possible
consequences or else failure on an exam or similar evaluative situation or condition
(Dr.Sadhan Das Gupta et al,2012). In contrast to fear, anxiety involves a more general
or diffused emotional reaction to beyond simple fear which that is out of proportion
to threats from the environment. Freud called anxiety as emotional pain. Anxiety
interferes with school functioning only when an abnormal level is reached, where as
within normal range, being anxious does not automatically imply worst school
functioning and indeed may to a certain extent be motivating and enhancing to
academic performance and this known as test anxiety. Test anxiety defined as
perceived arousal, reported worry, self-denigrating thoughts, tension, and reports of
somatic symptoms in exams or similar evaluative situations. For individuals with test
anxiety, both preparing for and taking a test cause high level of worry and discomfort.
As a result, affected students do not perform to their potential and their test scores
misrepresent their level of knowledge and understanding. In addition, it was found
that boys regard a examining situation as a challenge for them in their academic life
and therefore as low test anxious has determined while in contrast with girls that tend
to see the testing or evaluative situation as a threat or danger that they have to
undergoes, and therefore they are tend to be more test anxious compared to males. So
that as the consequences of this problem some studies was conducted to investigate
effect of gender on test anxiety level (Zaheri et al, 2012).
The main contributing factors of test anxiety are such gender, age, life style
issues, lack of required information and studying style, psychological factors and
biological factors (Shireen Hashmat et al, 2008).
According to Zeinder (1977), the main interpretation of these revealed gender
difference is that males and females socialized to experience evaluation situations
differently and also respond to test anxiety in different ways. It has been suggested
that males may be more likely to perceive examination situations as a personal
challenge rather than as a threat and exhibit behavior characteristic of highly anxious
individuals like fear, feeling worry, anger, lower self-esteem (Zaheri et al, 2012).
Males and females show a clear difference in the levels of anxiety they experience.
Females greater anxiety appears to place them at a disadvantage (Ellen Rydell Altermatt et al, 2004).
2.2.2 Life style issues
Life styles related issues include inadequate rest, insufficient physical activity,
poor nutrition and lack of time management are found to be the contributing factors
leading to exam anxiety as reported by many authors (J.A. Afolayan et al, 2013).
2.2.3 Lack of information
Sujit et al have reported that lack of strategic studying likewise ineffective
studying style through inconsistent content coverage and also most of the students
will studying all night before exams which causes them to be inadequate rest,
inefficient studying style too which includes lack of revising and review of course
material studied are major factors leading to differ in test anxiety level (J. A.Afolayan
et al, 2013).
2.2.4 Psychological factors
Psychological factors which contribute significantly to exam anxiety are
negative and irrational thinking about exams, outcomes of exams and feelings of no
control over exam situation (e.g. going blank during exam) are reported by many
authors (shireen Hasmat et al, 2008).
2.2.5 Biological factors
It is basically a series of biochemical changes in human brain and body, such
as increase in adrenaline (causing heart to beat faster) and a decrease in dopamine (a
brain chemical that helps to block pain). These changes result in a state of heightened
attention to the source of the anxiety. A high level of anxiety causes human body to
prepare to fight or run away from the perceived threat which commonly called as
flight-or-fight response (shireen Hasmat et al, 2008).
There are several steps that need to be done to confirm the diagnosis.
Diagnosis of anxiety disorder can be made by taking complete anamnesis and by the
usage of screening tools that is valid to be use among that particular country
population. The anamnesis can be done by using basic four and sacred seven concept.
From the anamnesis, actually we can have a rough idea on what the supposed
diagnosis will be for that case and also by asking specific question and information
that required which will further support our suspected diagnosis to be confirmed.
Screening tool that can be use is as follows:
2.3.1 GAD-7 (Generalized Anxiety Disorder- Seven Item Scale)
The GAD-7 is a 7 item scale, which is useful for screening Generalized
Anxiety Disorders severity level in clinical practice and also in research study. This GAD-7 can also be used to assess the therapeutic interventions, so which help us to
know the progress of that patient (Spitzer RL et al, 2006).
2.3.2 HAM-A/HARS (Hamilton Rating Scale for Anxiety)
Hamilton Anxiety Rating Scale is a 14 item scale, which designed to identify
the level of anxiety symptoms and also to assess the response to therapeutic
interventions that have already done to the patient (Hamilton M. et al, 1959).
2.3.3 TAQ (Test Anxiety Questionnaire)
Nist and Diehl (1990) developed a short questionnaire for determining if a
student experiences a mild or severe case of test anxiety. It indicates how often each
statement describes who fill-up the questionnaire by choosing a number from one to
five as outlined 1- never, 2 - rarely, 3 - sometimes, 4 - often and 5 - always.
Treatment for anxiety is not specified yet and it depends on the severity level.
Medication will not cure anxiety disorders but will keep them under control. Taking
prescription of drugs does not really cure the underlying causes of the anxiety
problems that faced by the person. Drug treatments for anxiety disorders work by
downplaying threat detecting mechanisms in the body (Terry Dixon, 2011).
The first famous known medication is benzodiazepines such as Alprazolam,
Diazepam, and Lorazepam commonly used to treat test anxiety with low dosage
while at higher dosage it can lead to sedative effect. Antidepressant commonly used
for general depression, which can accompany test anxiety. Side effects include, but
are not limited to, the potential to cause agitation and suicidal thoughts. These need to
be taken on a regular basis not when needed before an exam (Terry Dixon, 2011).
2.4.2 Cognitive behavioral therapy
Cognitive Behavioral Therapy (CBT) is very useful in treating anxiety
disorders. CBT helps to change the pattern of thinking that support the fear and help
the sufferer overcome the negative beliefs. CBT often lasts about two weeks and
takes place in small groups. Medication combined with psychotherapy has shown to
be the most effective treatment approach for people suffering from anxiety disorders.
Cognitive interventions have only had limited results when it comes to improving test
performance (Olatunji et al, 2010).
Meditation, is one kind of treatment that use to treat test anxiety (Jon Kabat-
Zinn et al, 1992). Meditation reduces anxiety level mentally. Most commonly other
simple activities likewise jogging, lying down for a moment, walking around or just
listening to the simple, soothing and also mind relaxing music which will help to
decrease the test anxiety level in particular individual.
2.4.4 Parental Anxiety Management
Recent years have seen increasing interest in the role the family plays in the
development and treatment of childhood disorders. (Paula M. Barrett et al, 2001).
Although it is always advisable to seek professional help, especially in more severe
cases, help is not always readily available. Even if parents do decide to seek help in
managing their child's anxiety, they can still play a key role in helping their child.
2.4.5 Combined treatments
Some research also shows that a combination of CBT and Parental Anxiety
Management has been proven to be more effective than administering these
treatments separately (Paula M. Barrett et al, 2001).
2.4.6 Elimination of Caffeine
Stimulants are some type of chemicals that excite your central or peripheral
nervous system in your body system. The term "excite" in this matter, means which
release more chemicals or send more and faster messages through your nervous and
body system to the brain. While each of these excites our mind and body, and also
can create extra energy that is transformed into anxiety or else create nervous or tense
feeling toward the situations. Caffeine known to be the most common stimulant that
often found in coffee (P.Narrow et al, 2003). Especially, one cup of coffee in the
morning is most unlikely to cause extreme anxiety although different people can react
differently towards the stimulant, so it may contribute to more anxiety symptoms (A.
2.4.7 Other treatments
Other treatment methods that could use in treating severe anxiety cases also
include electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS),
psychosurgery, and also breathing training teaches correct breathing habits to people
with anxiety disorders (Nicola Reavley et al, 2010).
CONCEPT, OPERATIONAL DEFINITION AND HYPOTHESIS
Based on the description mentioned above, hence the main concept of this
study is to know the test anxiety level based on gender as associated factor.
Semester V English class medical students of both gender of Udayana University
3.2 Operational Definition
To evaluate test anxiety level, Test Anxiety Questionnaire (TAQ) is used.
Nist and Diehl (1990) developed a short questionnaire for determining if a student
experiences a mild or severe case of test anxiety level. Score ranged from 10 to 50.
a. 10-19: no test anxiety
b. 20-35: moderate test anxiety
c. 35-50: severe anxiety
Since it is a descriptive study, this study does not have a hypothesis. However
a predictable hypothesis would be those female students will have more test anxiety
level than male students.
METHOD OF RESEARCH
4.1 Design of Research
This research which investigates the problem of test anxiety level is known as
descriptive study. Descriptive study is the study that uses the collection of data
without any manipulation of the surrounding environment with true data. This study
is a one-time interaction study which is with the groups of people or else clearly
known as the cross sectional study. As this study was descriptive at first, we shall use
survey technique, questionnaire and checklist by given it to the participants by the
researcher or investigator. Therefore, descriptive studies such as a cross-sectional
study, really helps in generating the hypothesis on which further research may be
4.2 Population and Sample of Research
4.2.1 Population of Research
Target population of this study is the English class students of Udayana
University in Denpasar, Bali. These students will particularly be chosen from English
class students who are currently pursuing their studies in semester V.
4.2.2 Criteria of Sample
Research will take place on campus students and these students selection
randomly done based on the name list of semester V students from the faculty of
medicine of Udayana University. Moreover, in this descriptive study about 100
students in total will be selected which includes 50 males and 50 females. All the
participants will be assured that confidentiality of information provided and moreover
they will be approached and each of them will be provided an informed consent
particularly before each of them participating in this research study. The inclusion
criterias for this study are the participants selected must be aged between 19 to 22 years old, from both genders, stable mental status, and joins the study research
4.2.3 Sample Size
The sample size of this research is that, 100 medical students of semester V of
English class from medical faculty of Udayana University which is composed of 50
males and 50 females.
4.2.4 Method of Sampling for Research
Sampling technique that will be used for this research study is simple random
sampling. The investigator selects 100 medical students of Udayana University from
a name list of semester V English class students. Each name will be put on a separate
small piece of a sheet and then the names will be drawn randomly until all the 100
names have been picked up and it will be recorded accordingly.
4.3 Research Variable
In this descriptive study, to investigate the above stated problem, medical
university students of Udayana University will be approached. They will be given
papers of questionnaires to access their test anxiety level.
4.4 Data Collecting Method and Analysis
The data will be collected from students who are studying in the faculty of
medicine Udayana University specifically those who are in their fifth semester of
English class students. Ethical approval was obtained from the respective relevant
ethics committee within the Udayana University.
4.5 Place and Time of Research
This research will be conducted at University of Udayana Denpasar, Bali. The
time and duration of data collection is from 10 am in the morning until 4pm in the
evening. The questionnaire paper will fill-up own by the English class students
exactly one week before their exam. The questionnaire used for the study was
designed by the researchers and self administered to the students and collected at the
spot after been fully completed by the students.
4.6 Instrument of Research
The instrument that used in this investigation is questionnaire to access test
anxiety level. The questionnaire consisted of two sections. Section A was designed to
collect data on personal variables of gender, age and religion. While the other one
Section B will be focus on the study objective or aim of this research. The
questionnaire had particular items on indicators of variables to require the opinion of
respondents or participants. The questionnaire used in this research Test Anxiety
4.7 Limitations of Research
This descriptive cross sectional study uses questionnaire to analyze, hence it
may not be entirely true since it depends on the person or participants who willingly
join the study on what they would like to fill up in their forms. Sometimes they also
may refuse to provide the accurate answers in the questionnaire given due to some
A.Smith. 2002. Eects of Caeine on Human Behavior. Food and Chemical Toxicology 40 12431255. Available [Online] at: http://www.elsevier.com/locate/foodchemtox.
Bunmi O. Olantunji, Josh M.Cisler, Brett J.Deacon. 2010. Efficacy of Cognitive
Behavioral Therapy for Anxiety Disorders: A Review of Meta-Analytic
Findings, Available [Online] at: http://psych.theclinics.com.
Dr. Sadhan Das Gupta, Sreeparna Dutta. 2012. Personality And Behavioural Factors
Associated With Test Anxiety Among Schools Students In Kolkata. Volume 2,
Issue 5 (Sep-Oct), PP 15-20.Available from [Online]: www.iosrjournals.org.
Ellen Rydell Altermatt and Minha Esther Kim. 2004. Can Anxiety Explain Sex
Differences in College Entrance Exam Score?Available at: The Journal of
Farzaneh Zaheri, Roonak Shahoei, Hayeda Zaheri. 2012. Gender Differences In Test
Anxiety Among Students Of Guidance Schools In Sanandaj, Iran. Vol.1 (1),
pp.001-005, September .Available [online] at:
Hamilton M. 1959. The Assessment Of Anxiety States. 32:5055. Available from Healthcare Technology Systems.
J. A. Afolayan, Bitrus Donald, Olayinka Onasoga, Adeyanju Babafemi A., Agama
Juan A. 2013. Relationship Between Anxiety And Academic Performance Of
Nursing Students, Niger Delta University, Bayelsa State, Nigeria. Pelagia
Research Library Advances in Applied Science Research, 4(5):25-33.
Jon Kabat-Zinn, Ann O.Massion, Jean Kristeller, Linda Gay Peterson, Kenneth
E.Fletcher, Lori Pbert, William R.Lenderking, Saki F.Santorelli. 1992.
Effectiveness of a meditation-Based Stress Reduction Program in the
Treatment of Anxiety Disorders. Am J Psychiatry 149:936-943.
Kaplan, H. and Sadock, B. 1996. The Comprehensive Textbook of Clinical
Psychiatry. pg.189. Available [Online] at:
Mohammad Nadeem, Akhtar Ali, Saira Maqbool and Syeda Uzma Zaidi. 2012.
Impact Of Anxiety On The Academic Achievement Of Students Having
Different Mental Abilities At University Level In Bahawalpur (Southern
Punjab) Pakistan. International Online Journal of Educational Sciences, 4 (3),
Nicola Reavley, Nick Allen, Anthony Jorm, Amy Morgan, Rosemary Purcell. 2010.
A Guide to What Works for Anxiety Disorders. Available [Online] at:
Paula M. Barrett, Amanda L. Duff et al. 2001. Cognitive-Behavioral Treatment Of
Anxiety Disorders In Children: Long-Term (6-Year) Follow-Up. Vol. 69, No.
1, 135-141. Journal of Consulting and Clinical Psychology.
P. Nawrot, S. Jordan, J. Eastwood, J. Rotstein, A. Hugenholtz and M. Feeley. 2003,
Eects of Caeine On Human Health. Vol. 20, No. 1, 130. Available [Online] at: http://www.tandf.co.uk/journals.
Prof Theo Vos et al. 2012. A Systematic Analysis For The Global Burden Of Disease
Study 2010 Volume 380, No. 9859, p21632196, 15 December. Shireen Hashmat, Masooma Hashmat, Farhana Amanullah, Sina Aziz. 2008. Factors
Causing Exam Anxiety In Medical Students. (JPMA 58:167).Available from
Spitzer RL, Kroenke K, Williams JBW, Lowe B. 2006. A Brief Measure For
Assessing Generalized Anxiety Disorder. Arch Inern Med.166:1092-1097.
Terry Dixon. 2011. Understanding Anxiety problems.Available ebook [Online] at:
As we know today, anxiety is became a common phenomenon of everydays life. It plays an important role in human life because all of us are the victims of anxiety in different ways and in different situation of our daily life activities. Generally spea...2.3 DiagnosisThere are several steps that need to be done to confirm the diagnosis. Diagnosis of anxiety disorder can be made by taking complete anamnesis and by the usage of screening tools that is valid to be use among that particular country population. The ana...Treatment for anxiety is not specified yet and it depends on the severity level. Medication will not cure anxiety disorders but will keep them under control. Taking prescription of drugs does not really cure the underlying causes of the anxiety proble...