Abstract
BACKGROUND:
Academic stress affects student performance, mental health, and retention, especially in radiography programs where students face demanding coursework and clinical training. These pressures often begin early and intensify with each academic year, yet limited research has examined how stress levels vary by GPA and class level. This gap is more evident in the Middle East and North Africa (MENA) region, where educational systems and student support structures differ across countries. Addressing this gap is necessary to inform targeted interventions and improve student outcomes. This study investigates the influence of GPA and class level on academic stress, well-being, and performance among radiography students in Egypt, the United Arab Emirates (UAE), and Jordan.
MATERIALS AND METHODS:
A cross-sectional survey was conducted among 608 radiography students using a validated online questionnaire titled “Radiography Academic Stress Questionnaire (RASQ).” The RASQ was developed based on previous academic stress literature and underwent expert review for content validity. Participants were recruited through convenience and snowball sampling. The survey assessed demographics, academic stressors, and subject-specific challenges. Statistical analyses, including Chi-square and Fisher’s exact tests, were performed to explore correlations between GPA, class level, and academic stress.
RESULTS:
GPA was included as a key variable because it objectively reflects academic performance and is consistently linked to psychological stress. This relationship is evident in the data: Students with lower GPAs reported significantly higher stress across multiple domains, including financial hardship (P = 0.001), examination-related anxiety (P = 0.001), and difficulty balancing academic and personal life (P < 0.001). Stress from specific subjects—such as radiological anatomy, X-ray, and ultrasound—was more common among low-GPA students (P < 0.005). Class level was also a significant factor: freshmen experienced greater financial stress (P = 0.028), while seniors reported elevated stress due to academic workload and graduation projects (P = 0.001).
CONCLUSION:
Academic stress in radiography students is closely linked to GPA and class level. Lower GPAs and transitional academic stages correspond with heightened stress, particularly in demanding subjects and final-year requirements. Targeted interventions are needed to address financial, examination, and workload-related stressors. Impact on Practice: Institutions should implement academic mentoring, financial aid, and stress management workshops. Faculty training and curriculum adjustments, such as incremental learning modules, may reduce stress in challenging subjects. These measures can enhance student well-being and prepare a resilient healthcare workforce.
Keywords: Academic stress, class level, educational measurement, GPA, health occupations, radiography students
Introduction
Academic stress is a growing concern in higher education, particularly in health-related fields such as radiography.[1,2] Students in these programs must navigate a rigorous combination of theoretical coursework and clinical training, often in high-pressure environments.[2] These demands can significantly impact their well-being, academic performance, and overall preparedness for professional practice.[3] Understanding the causes and consequences of academic stress is crucial for developing targeted interventions that enhance student support systems and foster resilience.[2,3,4]
Radiography students face unique stressors, including heavy workloads, clinical placements, and high-stakes examinations. The nature of their clinical examinations, which require mastering both technical skills and patient interactions, adds to this burden.[5] Additionally, the structure of the curriculum and course delivery methods, such as traditional lectures compared to case-based learning, can significantly influence students’ stress levels. In the field of radiography, students are often subjected to intense academic demands, clinical training pressures, and emotional challenges associated with patient care. These are compounded by the need to balance academic obligations with personal responsibilities. It is essential to recognize that such stressors are not incidental but inherent to the program’s nature. Addressing these factors is therefore essential to fostering a supportive educational setting that not only enhances academic performance but also safeguards students’ mental health and overall well-being.[5,6]
One significant yet often overlooked aspect of academic stress is the role of faculty-student communication. Clear expectations, timely feedback, and accessible support can alleviate stress.[7,8] In contrast, unclear guidelines and inadequate communication can heighten anxiety and confusion. Faculty engagement plays a pivotal role in preventing burnout and fostering a sense of academic confidence among students.[9] Exploring these dynamics can provide valuable insights into how educational institutions can enhance stress management strategies.[7,8,9,10] While academic stress in radiography students is well-documented, research on the relationship between stress and factors such as class level and grade point average (GPA) remains limited.[11] As students progress through their programs, they encounter increasingly complex material and demanding clinical duties, which may contribute to varying stress levels.[12] Moreover, GPA, a measure of academic performance, often correlates with stress as students strive to meet high academic standards. Understanding these relationships can help develop more effective support mechanisms tailored to students’ needs.[11,12,13]
Reducing academic stress is not only vital for student success but also for sustaining a competent and resilient healthcare workforce.[14] By identifying key stressors and their impact, this study aims to contribute to the development of strategies that enhance student well-being, reduce dropout rates, and ensure that radiography professionals are well-prepared to face the challenges of their field.[15,16] A deeper understanding of academic stress will help shape a more supportive educational environment, ultimately benefiting both students and the broader healthcare system.[14,15,16,17] This research aims to provide evidence-based recommendations for academic stress management interventions tailored to the needs of radiography students, enhancing their well-being and readiness for diverse professional settings. This study investigates the influence of GPA and class level on academic stress, well-being, and performance among radiography students in Egypt, the United Arab Emirates (UAE), and Jordan.
This study is necessary to guide the development of targeted interventions that reduce academic stress and improve student outcomes in radiography programs.
Materials and Methods
Study design and setting
This study used a cross-sectional design and was conducted online across three countries: Egypt, the United Arab Emirates (UAE), and Jordan. It targeted radiography students currently enrolled in academic programs at recognized universities. The use of a web-based approach enabled broad geographic coverage and flexible participation.
Study participants and sampling
The study included radiography students aged 18 years or older, of any gender, and from any academic year. Inclusion required current enrollment in a radiography program and willingness to provide informed consent. Exclusion criteria were age under 18, enrollment in non-radiography programs, or refusal to consent. A nonprobability sampling approach was used, combining convenience and snowball sampling. Participants were recruited through student unions, official email lists, social media platforms (LinkedIn, Facebook), and personal networks. Snowball sampling allowed participants to share the survey with peers. A total of 608 students completed the questionnaire, providing a diverse and balanced sample across institutions and countries.
Data collection tool and technique
The Radiography Academic Stress Questionnaire (RASQ) was developed based on a review of literature focused on stress among radiography and healthcare students.[1,2,5,18,19,20] The instrument included 27 closed-ended questions covering demographics, academic workload, and perceived stress. It was created using Google Forms and designed in accordance with the CHERRIES checklist to ensure completeness and transparency in web-based surveys.[21] Pretesting was conducted with three radiography students, and their feedback led to refinement to improve clarity and structure. JavaScript validation enforced the completion of all required items. Duplicate submissions were controlled through IP checks, without storing identifiable information. Cross-browser and device compatibility were verified before launch.
Reliability of the RASQ was evaluated using the test-retest method,[22] with five radiography students completing the questionnaire twice at a 2-week interval. The Pearson correlation coefficient was 0.82, indicating strong internal consistency. These respondents were not part of the main study sample. Selection was based on availability and willingness to participate in both rounds. All were enrolled in similar programs to the main participants, ensuring content familiarity. Although the sample size was small and self-selected, the high correlation supports the tool’s reliability in measuring the intended constructs.
Ethical consideration
All participants gave informed consent after receiving a clear explanation of the study’s objectives. Participation was voluntary. No personal data was collected at any stage. Data collection occurred from April 10 to June 20, 2024. Responses were anonymized before storage and saved in an encrypted database. Only the research team had access. Confidentiality and data protection protocols were strictly applied throughout. The study received approval from the Gulf Medical University Ethics Committee (IRB-COHS-STD-119-APR-2024).
Statistical analysis method
Data was analyzed using IBM SPSS version 20.0. Categorical data were summarized using frequencies and percentages. The Chi-square test was used to assess associations between categorical variables. If more than 20% of the cells had expected counts below 5, Fisher’s exact test was applied. Continuous data were described using range, mean, standard deviation, and median. Statistical significance was set at a 5% level (P < 0.05).
Results
Demographic characteristics
The research included 608 participants, predominantly female (70.4%) and a lesser proportion male (29.6%). The majority of participants were aged 20–22 years (48.2%), followed by those aged 18–20 years (44.9%). Fewer participants were aged 22–24 years (5.4%) and 24–26 years (1.5%). The predominant group of participants was from Egypt (70.6%), followed by the UAE (18.1%), Jordan (9.7%), and other countries (1.6%). Sophomores were the predominant segment (44.6%), followed by juniors (26.0%), freshmen (16.1%), and seniors (13.3%). The majority attained a GPA between 3 and 4 (53.5%), (36.2%) obtained a GPA between 2 and 3, (7.9%) scored between 1 and 2, and (2.5%) slipped below 1. A substantial majority of the participants (88.3%) indicated that they attended lessons consistently.
Correlation between GPA and academic stress
The results revealed significant correlations between GPA and various academic stress factors. Financial stress was significantly higher among students with lower GPAs, with 60.0% of the 0–1 GPA group and 43.8% of the 1–2 GPA group reporting financial difficulties, compared to only 25.5% of those in the 3–4 GPA category (P = 0.001). Examination-related stress was also more prevalent among students with lower GPAs, with 86.7% of the 0–1 GPA group and 75.0% of the 1–2 GPA group reporting stress, compared to 58.2% of the 3–4 GPA group (P = 0.001). Similarly, challenges in balancing study and social life were reported by 86.7% of the 0–1 GPA group and 79.2% of the 1–2 GPA group, compared to 53.8% of students in the 3–4 GPA group (P < 0.001). The loss of interest in courses was significantly higher among students in the 1–2 GPA group (58.3%) compared to those in the 3–4 GPA group (34.2%, P = 0.002). Additionally, students with lower GPAs were more likely to report difficulties in handling academic problems, with 58.3% of the 1–2 GPA group and 53.3% of the 0–1 GPA group experiencing this issue, compared to 32.0% of the 3–4 GPA group (P < 0.001) [Table 1].
Table 1.
Correlation between GPA and academic stress (n=608)
| Academic Stress | Total (n=608) | GPA |
P | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 0–1 (n=15) | 1–2 (n=48) | 2–3 (n=220) | 3–4 (n=325) | |||||||||
| Do you have a financial problem due to university expenses? | ||||||||||||
| Yes | 191 (31.4%) | 9 (60.0%) | 21 (43.8%) | 78 (35.5%) | 83 (25.5%) | 0.001* | ||||||
| No | 417 (68.6%) | 6 (40.0%) | 27 (56.3%) | 142 (64.5%) | 242 (74.5%) | |||||||
| Do you feel nervous about delivering the class presentation? | ||||||||||||
| Yes | 402 (66.1%) | 12 (80.0%) | 36 (75.0%) | 144 (65.5%) | 210 (64.6%) | 0.341 | ||||||
| No | 206 (33.9%) | 3 (20.0%) | 12 (25.0%) | 76 (34.5%) | 115 (35.4%) | |||||||
| Are you feeling stressed as the submission deadline nears? | ||||||||||||
| Yes | 432 (71.1%) | 11 (73.3%) | 39 (81.3%) | 157 (71.4%) | 225 (69.2%) | 0.392 | ||||||
| No | 176 (28.9%) | 4 (26.7%) | 9 (18.8%) | 63 (28.6%) | 100 (30.8%) | |||||||
| Do you feel stressed about sitting for an examination? | ||||||||||||
| Yes | 395 (65.0%) | 13 (86.7%) | 36 (75.0%) | 157 (71.4%) | 189 (58.2%) | 0.001* | ||||||
| No | 213 (35.0%) | 2 (13.3%) | 12 (25.0%) | 63 (28.6%) | 136 (41.8%) | |||||||
| Do you find it challenging to balance your time between studying and social activities? | ||||||||||||
| Yes | 371 (61.0%) | 13 (86.7%) | 38 (79.2%) | 145 (65.9%) | 175 (53.8%) | <0.001* | ||||||
| No | 237 (39.0%) | 2 (13.3%) | 10 (20.8%) | 75 (34.1%) | 150 (46.2%) | |||||||
| Are you losing interest in the upcoming courses? | ||||||||||||
| Yes | 246 (40.5%) | 6 (40.0%) | 28 (58.3%) | 101 (45.9%) | 111 (34.2%) | 0.002* | ||||||
| No | 362 (59.5%) | 9 (60.0%) | 20 (41.7%) | 119 (54.1%) | 214 (65.8%) | |||||||
| Do you feel burdened by academic workloads? | ||||||||||||
| Yes | 364 (59.9%) | 8 (53.3%) | 32 (66.7%) | 138 (62.7%) | 186 (57.2%) | 0.411 | ||||||
| No | 244 (40.1%) | 7 (46.7%) | 16 (33.3%) | 82 (37.3%) | 139 (42.8%) | |||||||
| Do you feel stressed when dealing with difficult subjects? | ||||||||||||
| Yes | 430 (70.7%) | 12 (80.0%) | 37 (77.1%) | 158 (71.8%) | 223 (68.6%) | 0.496 | ||||||
| No | 178 (29.3%) | 3 (20.0%) | 11 (22.9%) | 62 (28.2%) | 102 (31.4%) | |||||||
| Do you find it challenging to manage your academic issues? | ||||||||||||
| Yes | 244 (40.1%) | 8 (53.3%) | 28 (58.3%) | 104 (47.3%) | 104 (32.0%) | <0.001* | ||||||
| No | 364 (59.9%) | 7 (46.7%) | 20 (41.7%) | 116 (52.7%) | 221 (68.0%) | |||||||
P: P value for the relationship between GPA and academic stress. *Statistically significant at P≤0.05
Correlation between GPA and academic subject stress
Stress related to academic subjects showed notable variation across GPA groups. Radiological anatomy courses were particularly stressful for 68.8% of students in the 1–2 GPA group, compared to 48.9% of those in the 3–4 GPA group (P = 0.004). Similarly, X-ray courses caused significantly higher stress levels in students with GPAs of 0–1 (66.7%) and 1–2 (56.3%), compared to 31.4% in the 3–4 GPA group (P < 0.001). Furthermore, stress from ultrasound and Doppler courses was more common among students with GPAs of 0–1 (66.7%) and 1–2 (58.3%) compared to 37.2% in the 3–4 GPA group (P = 0.002) [Table 2].
Table 2.
Correlation between GPA and Academic subjects stress (n=608)
| Academic subjects stress | Total (n=608) | GPA |
P | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 0–1 (n=15) | 1–2 (n=48) | 2–3 (n=220) | 3–4 (n=325) | |||||||||
| University requirements courses | ||||||||||||
| Yes | 325 (53.5%) | 11 (73.3%) | 31 (64.6%) | 125 (56.8%) | 158 (48.6%) | 0.032 | ||||||
| No | 283 (46.5%) | 4 (26.7%) | 17 (35.4%) | 95 (43.2%) | 167 (51.4%) | |||||||
| Basic science courses | ||||||||||||
| Yes | 314 (51.6%) | 7 (46.7%) | 29 (60.4%) | 116 (52.7%) | 162 (49.8%) | 0.541 | ||||||
| No | 294 (48.4%) | 8 (53.3%) | 19 (39.6%) | 104 (47.3%) | 163 (50.2%) | |||||||
| Elective courses | ||||||||||||
| Yes | 204 (33.6%) | 6 (40.0%) | 21 (43.8%) | 77 (35.0%) | 100 (30.8%) | 0.278 | ||||||
| No | 404 (66.4%) | 9 (60.0%) | 27 (56.3%) | 143 (65.0%) | 225 (69.2%) | |||||||
| Radiological anatomy courses | ||||||||||||
| Yes | 338 (55.6%) | 9 (60.0%) | 33 (68.8%) | 137 (62.3%) | 159 (48.9%) | 0.004* | ||||||
| No | 270 (44.4%) | 6 (40.0%) | 15 (31.3%) | 83 (37.7%) | 166 (51.1%) | |||||||
| Dosimetry and radiation protection courses | ||||||||||||
| Yes | 301 (49.5%) | 8 (53.3%) | 30 (62.5%) | 111 (50.5%) | 152 (46.8%) | 0.223 | ||||||
| No | 307 (50.5%) | 7 (46.7%) | 18 (37.5%) | 109 (49.5%) | 173 (53.2%) | |||||||
| X-Ray Courses | ||||||||||||
| Yes | 231 (38.0%) | 10 (66.7%) | 27 (56.3%) | 92 (41.8%) | 102 (31.4%) | <0.001* | ||||||
| No | 377 (62.0%) | 5 (33.3%) | 21 (43.8%) | 128 (58.2%) | 223 (68.6%) | |||||||
| Ultrasound and Doppler courses | ||||||||||||
| Yes | 264 (43.4%) | 10 (66.7%) | 28 (58.3%) | 105 (47.7%) | 121 (37.2%) | 0.002* | ||||||
| No | 344 (56.6%) | 5 (33.3%) | 20 (41.7%) | 115 (52.3%) | 204 (62.8%) | |||||||
| Computed tomography courses | ||||||||||||
| Yes | 306 (50.3%) | 8 (53.3%) | 28 (58.3%) | 118 (53.6%) | 152 (46.8%) | 0.273 | ||||||
| No | 302 (49.7%) | 7 (46.7%) | 20 (41.7%) | 102 (46.4%) | 173 (53.2%) | |||||||
| Nuclear medicine and radiotherapy courses | ||||||||||||
| Yes | 343 (56.4%) | 9 (60.0%) | 33 (68.8%) | 125 (56.8%) | 176 (54.2%) | 0.291 | ||||||
| No | 265 (43.6%) | 6 (40.0%) | 15 (31.3%) | 95 (43.2%) | 149 (45.8%) | |||||||
| Interventional radiology courses | ||||||||||||
| Yes | 308 (50.7%) | 8 (53.3%) | 29 (60.4%) | 122 (55.5%) | 149 (45.8%) | 0.075 | ||||||
| No | 300 (49.3%) | 7 (46.7%) | 19 (39.6%) | 98 (44.5%) | 176 (54.2%) | |||||||
| Graduation Project | ||||||||||||
| Yes | 389 (64.0%) | 9 (60.0%) | 34 (70.8%) | 135 (61.4%) | 211 (64.9%) | 0.602 | ||||||
| No | 219 (36.0%) | 6 (40.0%) | 14 (29.2%) | 85 (38.6%) | 114 (35.1%) | |||||||
P: P value for the relationship between GPA and academic subjects stress. *Statistically significant at P≤0.05
Correlation between class levels and academic stress
The findings highlight the correlation between class level and academic stress. Financial stress was reported significantly more frequently by freshmen (43.9%) than seniors (25.9%, P = 0.028). Although stress from factors such as deadlines, examinations, and workloads varied across class levels, these differences were not statistically significant. However, seniors reported slightly higher stress levels related to academic workloads (70.4%) compared to freshmen (58.2%) and sophomores (55.7%) [Table 3].
Table 3.
Correlation between class levels and academic stress (n=608)
| Academic Stress | Total (n=608) | Current class level |
P | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Freshmen (n=98) | Sophomore (n=271) | Junior (n=158) | Senior (n=81) | |||||||||
| Do you have a financial problem due to the university’s expenses? | ||||||||||||
| Yes | 191 (31.4%) | 43 (43.9%) | 78 (28.8%) | 49 (31.0%) | 21 (25.9%) | 0.028* | ||||||
| No | 417 (68.6%) | 55 (56.1%) | 193 (71.2%) | 109 (69.0%) | 60 (74.1%) | |||||||
| Do you feel nervous delivering the class presentation? | ||||||||||||
| Yes | 402 (66.1%) | 72 (73.5%) | 177 (65.3%) | 96 (60.8%) | 57 (70.4%) | 0.163 | ||||||
| No | 206 (33.9%) | 26 (26.5%) | 94 (34.7%) | 62 (39.2%) | 24 (29.6%) | |||||||
| Are you feeling stressed as the submission deadline nears? | ||||||||||||
| Yes | 432 (71.1%) | 72 (73.5%) | 196 (72.3%) | 109 (69.0%) | 55 (67.9%) | 0.751 | ||||||
| No | 176 (28.9%) | 26 (26.5%) | 75 (27.7%) | 49 (31.0%) | 26 (32.1%) | |||||||
| Do you feel stressed about sitting for an examination? | ||||||||||||
| Yes | 395 (65.0%) | 70 (71.4%) | 180 (66.4%) | 95 (60.1%) | 50 (61.7%) | 0.256 | ||||||
| No | 213 (35.0%) | 28 (28.6%) | 91 (33.6%) | 63 (39.9%) | 31 (38.3%) | |||||||
| Do you find it challenging to balance your time between studying and social activities? | ||||||||||||
| Yes | 371 (61.0%) | 65 (66.3%) | 167 (61.6%) | 91 (57.6%) | 48 (59.3%) | 0.555 | ||||||
| No | 237 (39.0%) | 33 (33.7%) | 104 (38.4%) | 67 (42.4%) | 33 (40.7%) | |||||||
| Are you losing interest in the upcoming courses? | ||||||||||||
| Yes | 246 (40.5%) | 33 (33.7%) | 105 (38.7%) | 72 (45.6%) | 36 (44.4%) | 0.217 | ||||||
| No | 362 (59.5%) | 65 (66.3%) | 166 (61.3%) | 86 (54.4%) | 45 (55.6%) | |||||||
| Do you feel burdened by academic workloads? | ||||||||||||
| Yes | 364 (59.9%) | 57 (58.2%) | 151 (55.7%) | 99 (62.7%) | 57 (70.4%) | 0.098 | ||||||
| No | 244 (40.1%) | 41 (41.8%) | 120 (44.3%) | 59 (37.3%) | 24 (29.6%) | |||||||
| Do you feel stressed when dealing with difficult subjects? | ||||||||||||
| Yes | 430 (70.7%) | 66 (67.3%) | 192 (70.8%) | 112 (70.9%) | 60 (74.1%) | 0.805 | ||||||
| No | 178 (29.3%) | 32 (32.7%) | 79 (29.2%) | 46 (29.1%) | 21 (25.9%) | |||||||
| Do you find it challenging to manage your academic issues? | ||||||||||||
| Yes | 244 (40.1%) | 35 (35.7%) | 107 (39.5%) | 65 (41.1%) | 37 (45.7%) | 0.583 | ||||||
| No | 364 (59.9%) | 63 (64.3%) | 164 (60.5%) | 93 (58.9%) | 44 (54.3%) | |||||||
P: P value for the relationship between the current class level and academic stress. *Statistically significant at P≤0.05
Correlation between class levels and academic subject stress
The findings revealed a significant association between class level and stress caused by specific academic subjects. Radiological anatomy courses were significantly more stressful for sophomores (63.5%) than for freshmen (45.9%, P = 0.004). Ultrasound and Doppler courses were another notable stressor, with seniors reporting higher stress levels (58.0%) compared to sophomores (39.1%, P = 0.023). Additionally, the graduation project emerged as a significant stressor for seniors, with 80.2% reporting stress, compared to 56.1% of freshmen (P = 0.001) [Table 4].
Table 4.
Correlation between class levels and Academic subjects stress (n=608)
| Academic subjects stress | Total (n=608) | Current class level |
P | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Freshmen (n=98) | Sophomore (n=271) | Junior (n=158) | Senior (n=81) | |||||||||
| University requirements courses | ||||||||||||
| Yes | 325 (53.5%) | 54 (55.1%) | 139 (51.3%) | 86 (54.4%) | 46 (56.8%) | 0.792 | ||||||
| No | 283 (46.5%) | 44 (44.9%) | 132 (48.7%) | 72 (45.6%) | 35 (43.2%) | |||||||
| Basic science courses | ||||||||||||
| Yes | 314 (51.6%) | 52 (53.1%) | 139 (51.3%) | 84 (53.2%) | 39 (48.1%) | 0.888 | ||||||
| No | 294 (48.4%) | 46 (46.9%) | 132 (48.7%) | 74 (46.8%) | 42 (51.9%) | |||||||
| Elective courses | ||||||||||||
| Yes | 204 (33.6%) | 39 (39.8%) | 85 (31.4%) | 51 (32.3%) | 29 (35.8%) | 0.459 | ||||||
| No | 404 (66.4%) | 59 (60.2%) | 186 (68.6%) | 107 (67.7%) | 52 (64.2%) | |||||||
| Radiological anatomy courses | ||||||||||||
| Yes | 338 (55.6%) | 45 (45.9%) | 172 (63.5%) | 78 (49.4%) | 43 (53.1%) | 0.004* | ||||||
| No | 270 (44.4%) | 53 (54.1%) | 99 (36.5%) | 80 (50.6%) | 38 (46.9%) | |||||||
| Dosimetry and radiation protection courses | ||||||||||||
| Yes | 301 (49.5%) | 45 (45.9%) | 149 (55.0%) | 68 (43.0%) | 39 (48.1%) | 0.091 | ||||||
| No | 307 (50.5%) | 53 (54.1%) | 122 (45.0%) | 90 (57.0%) | 42 (51.9%) | |||||||
| X-Ray Courses | ||||||||||||
| Yes | 231 (38.0%) | 41 (41.8%) | 110 (40.6%) | 49 (31.0%) | 31 (38.3%) | 0.198 | ||||||
| No | 377 (62.0%) | 57 (58.2%) | 161 (59.4%) | 109 (69.0%) | 50 (61.7%) | |||||||
| Ultrasound and Doppler courses | ||||||||||||
| Yes | 264 (43.4%) | 45 (45.9%) | 106 (39.1%) | 66 (41.8%) | 47 (58.0%) | 0.023* | ||||||
| No | 344 (56.6%) | 53 (54.1%) | 165 (60.9%) | 92 (58.2%) | 34 (42.0%) | |||||||
| Computed tomography courses | ||||||||||||
| Yes | 306 (50.3%) | 39 (39.8%) | 148 (54.6%) | 79 (50.0%) | 40 (49.4%) | 0.095 | ||||||
| No | 302 (49.7%) | 59 (60.2%) | 123 (45.4%) | 79 (50.0%) | 41 (50.6%) | |||||||
| Nuclear medicine and radiotherapy courses | ||||||||||||
| Yes | 343 (56.4%) | 45 (45.9%) | 155 (57.2%) | 93 (58.9%) | 50 (61.7%) | 0.123 | ||||||
| No | 265 (43.6%) | 53 (54.1%) | 116 (42.8%) | 65 (41.1%) | 31 (38.3%) | |||||||
| Interventional radiology courses | ||||||||||||
| Yes | 308 (50.7%) | 43 (43.9%) | 133 (49.1%) | 85 (53.8%) | 47 (58.0%) | 0.216 | ||||||
| No | 300 (49.3%) | 55 (56.1%) | 138 (50.9%) | 73 (46.2%) | 34 (42.0%) | |||||||
| Graduation Project | ||||||||||||
| Yes | 389 (64.0%) | 55 (56.1%) | 160 (59.0%) | 109 (69.0%) | 65 (80.2%) | 0.001* | ||||||
| No | 219 (36.0%) | 43 (43.9%) | 111 (41.0%) | 49 (31.0%) | 16 (19.8%) | |||||||
P: P value for the relationship between the current class level and academic subjects stress. *Statistically significant at P≤0.05
Discussion
This study illuminates the intricate dynamics between GPA, class standing, and academic stress among radiography students. The findings underscore the multifaceted nature of academic stress and emphasize the critical need for tailored interventions to support student well-being and academic success.
The significant correlations between GPA and various stress factors highlight the impact of academic performance on students’ stress levels. Students with lower GPAs reported higher stress levels across several domains, including financial difficulties, examination pressure, and balancing academic and social responsibilities. These findings align with existing literature, which suggests that lower academic performance often exacerbates stress due to increased pressures to improve grades and meet academic expectations.[19,20,23] Such insights underline the importance of providing targeted academic and financial support to students at risk of poor performance.
Our study revealed a significant relationship between academic stress and class level, with freshmen experiencing the highest levels of financial stress. This observation aligns with the findings by Moore et al.[24], who highlighted that financial responsibilities during the transition to college frequently overwhelm first-year students, adversely impacting their mental health and academic performance. Educators and institutions should consider implementing class-specific support mechanisms, such as mentorship programs for freshmen.
Robotham’s[25] study on stress in higher education students identifies academic workload, deadlines, and demanding tasks such as final projects as major contributors to stress. Seniors, in particular, experience heightened stress due to the cumulative nature of their tasks, which demand advanced academic and practical involvement. These findings are consistent with our results, which show that seniors experience elevated stress levels, largely driven by the pressure to complete graduation projects. This evidence underscores the importance of implementing interventions to manage workload and stress during this critical stage of students’ academic careers.
Our findings are consistent with previous research on academic stress, study-life balance, and student engagement. Higher stress levels negatively affect both academic performance and mental health. Similarly, Barbayannis et al.[5] found a significant correlation between increased academic stress and deteriorated mental well-being in students.
Similarly, challenges in balancing academic and personal responsibilities are strongly associated with burnout and lower academic performance. Drăghici and Cazan[26] found that students with poor study-life balance experienced higher stress levels and reported lower academic achievement.
Additionally, the loss of interest in courses, especially among students with midrange GPAs, aligns with the findings of Abdulrahman, Bin et al.[27] Their study suggests that students in this group often struggle with intrinsic motivation and engagement, resulting in lower academic performance. These insights emphasize the need to address stress, encourage effective time management, and cultivate motivation to enhance academic outcomes and student well-being.
Stress related to academic subjects varied significantly across GPA groups, with lower GPA groups experiencing greater stress levels. Radiological anatomy courses were a prominent stressor, especially for students in lower GPA groups, showing a strong association between academic performance and stress. This aligns with findings from similar studies, which report higher stress levels among academically struggling students, particularly in challenging courses such as anatomy.[28]
Recommendations
Future research should explore the impact of academic mentoring programs for low-GPA students to assess how such guidance can improve academic outcomes and reduce stress. It should also examine stress management resources, such as time management workshops and counseling services, to evaluate their effectiveness in alleviating stress. The role of faculty training in providing clear instructions, timely feedback, and emotional support needs to be studied to understand how this influences student stress and performance. Additionally, research should investigate the impact of open-door policies where faculty are accessible to discuss academic concerns. Financial stress, especially among freshmen and low-GPA students, could be alleviated by scholarships and flexible payment plans, which warrants further investigation. Research should also explore the benefits of course design adjustments, such as incremental learning modules for complex subjects like radiological anatomy, to ease academic pressure for underperforming students. Mentorship programs for freshmen and senior project management workshops should be examined to reduce stress related to final-year tasks, such as graduation projects. Peer mentoring and study groups may offer valuable support systems, and their effectiveness in reducing stress should be explored. Finally, periodic stress assessments can help identify and address stress early, improving mental well-being and academic performance.
Limitation
This study has several limitations that may affect the generalizability and depth of the findings. The use of convenience and snowball sampling may introduce selection bias and limit representation of the broader radiography student population. The focus on institutions in Egypt, the UAE, and Jordan restricts the applicability of results to other regions with different academic and cultural settings. Reliance on self-reported data may lead to social desirability bias, which could influence the accuracy of reported stress levels. Although the gender imbalance reflects actual program demographics, it may still affect interpretation. The cross-sectional design provides only a snapshot of stress at a single point in time, preventing analysis of stress progression across academic years. The study also did not account for nonacademic stressors such as family or personal issues, and it lacked qualitative insights into the relationships among various stress factors. To address these limitations, future studies should apply stratified random sampling, include a wider range of geographic and cultural contexts, use longitudinal designs to assess stress trends over time, incorporate nonacademic variables, and adopt mixed-method approaches to explore deeper patterns and interactions.
Conclusions
This study reveals that students with lower GPAs face significantly higher academic stress, driven by financial struggles and examination pressures, while freshmen experience pronounced economic stress and seniors grapple with heavy workloads and graduation project demands. Challenging subjects like radiological anatomy further exacerbate stress for underperforming students. These findings highlight the urgent need for targeted interventions, including academic support programs, stress management workshops, and faculty training at the institutional level, as well as broader policy measures such as mental health initiatives and financial aid systems. By addressing these stressors through both educational and policy reforms, stakeholders can enhance student well-being, academic success, and the long-term resilience of the healthcare workforce.
Conflicts of interest
There are no conflicts of interest.
Acknowledgment
The authors thank Dr. Samar Ali, clinical psychologist, for her guidance and expertise. Her knowledge of academic stress and student mental health informed the design of the survey and the interpretation of the data. Her input helped align the study with its aim to examine the impact of GPA and class level on radiography students’ well-being and performance. Her support strengthened the quality and focus of the research.
Funding Statement
Nil.
References
- 1.Al-Shahrani MM, Alasmri BS, Al-Shahrani RM, Al-Moalwi NM, Al Qahtani AA, Siddiqui AF, editors, editors. Healthcare. MDPI; 2023. The prevalence and associated factors of academic stress among medical students of King Khalid University: An analytical cross-sectional study. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Ali M, El-Sayed M, El Safwany M, Hassan HMA, Khattap M, Bekheet M, et al. Exploring gender-based stress disparities among radiography students: A comparative analysis across Egypt, UAE, and Jordan. Radiography. 2025;31(1):385–96. doi: 10.1016/j.radi.2024.12.008. [DOI] [PubMed] [Google Scholar]
- 3.Jeyandrabalan M, Punch A, Rogers J, Jimenez Y. Insights into Diagnostic Radiography students’ perception of clinical stressors. Radiography. 2022;28(2):499–505. doi: 10.1016/j.radi.2021.12.014. [DOI] [PubMed] [Google Scholar]
- 4.Weerakoon BS, Chandrasiri NR. Anxiety, depression, and stress among radiography undergraduates during the COVID-19 pandemic. Journal of Medical Imaging and Radiation Sciences. 2023;54(2):S29–S37. doi: 10.1016/j.jmir.2022.11.014. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Barbayannis G, Bandari M, Zheng X, Baquerizo H, Pecor KW, Ming X. Academic stress and mental well-being in college students: Correlations, affected groups, and COVID-19. Frontiers in psychology. 2022;13:886344. doi: 10.3389/fpsyg.2022.886344. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Emerson DJ, Hair JF, Jr, Smith KJ. Psychological distress, burnout, and business student turnover: The role of resilience as a coping mechanism. Research in higher education. 2023;64(2):228–59. doi: 10.1007/s11162-022-09704-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Kao P-C. Exploring the roles of academic expectation stress, adaptive coping, and academic resilience on perceived English proficiency. BMC psychology. 2024;12(1):158. doi: 10.1186/s40359-024-01630-y. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Reingold L. Evaluation of Stress and a Stress-Reduction Program Among Radiologic Technologists. Radiologic technology. 2015;87(2) [PubMed] [Google Scholar]
- 9.Hoferichter F, Kulakow S, Raufelder D. How teacher and classmate support relate to students’ stress and academic achievement. Frontiers in psychology. 2022;13:992497. doi: 10.3389/fpsyg.2022.992497. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Rawashdeh M, El-Sayed MZ, Kumar P, Rooeintan N, Shibu AA, Ali M. Insights into radiography students’ perspectives on communication skills development in clinical training. Radiography. 2025;31(1):118–30. doi: 10.1016/j.radi.2024.11.003. [DOI] [PubMed] [Google Scholar]
- 11.Trejo L. Eastern Michigan University; 2021. The Impact of Faculty Feedback on Student Perceptions of Faculty-Student Relationships. [Google Scholar]
- 12.Ago J, Anim-Sampong S, Neequaye J, Acquah G, Markwei LM, Tagoe SA, et al. “Watch them do what they do”: Effects of the clinical learning environment on radiography students’ clinical placement experiences. Radiography. 2025;31(1):320–7. doi: 10.1016/j.radi.2024.12.009. [DOI] [PubMed] [Google Scholar]
- 13.Martincová J, Bílá M. Pedagogical aspects of the development of academic stress. Cogent Education. 2023;10(2):2237285. [Google Scholar]
- 14.Mofatteh M. Risk factors associated with stress, anxiety, and depression among university undergraduate students. AIMS public health. 2020;8(1):36. doi: 10.3934/publichealth.2021004. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Ndahepele MR, Daniels ER, Nabasenja C, Damases-Kasi CN. Factors contributing to stress among radiography and nursing students at University of Namibia. South African Radiographer. 2018;56(1):20–5. [Google Scholar]
- 16.Cohen T, Legg J. Emotional Well-being and Stress Among Radiologic Science Students. Radiologic Technology. 2019;90(5) [PubMed] [Google Scholar]
- 17.Kyei K, Antwi W, Bamfo-Quaicoe K, Offei R. Challenges faced by radiography students during clinical training. Primarily Nurs. 2015;1:2. [Google Scholar]
- 18.Ali M, Asim H, Edhi AI, Hashmi MD, Khan MS, Naz F, et al. Does academic assessment system type affect levels of academic stress in medical students? A cross-sectional study from Pakistan. Medical education online. 2015;20(1):27706. doi: 10.3402/meo.v20.27706. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Li TX, Lin TT, Eng TL, Xin TH, Wardhani STK. The influence of academic stress on academic performance among university students. Asian Pacific Journal of Management and Education. 2023;6(3):129–38. [Google Scholar]
- 20.Al-Tameemi RAN, Johnson C, Gitay R, Abdel-Salam A-SG, Al Hazaa K, BenSaid A, et al. Determinants of poor academic performance among undergraduate students—A systematic literature review. International Journal of Educational Research Open. 2023;4:100232. [Google Scholar]
- 21.Eysenbach G. Gunther Eysenbach Centre for Global eHealth Innovation; Toronto, Canada: 2004. Improving the quality of Web surveys: the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) p. e34. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Skirrow C, Cashdollar N, Granger K, Jennings S, Baker E, Barnett J, et al. Test-retest reliability on the Cambridge Neuropsychological Test Automated Battery: comment on Karlsen et al. (2020) Applied Neuropsychology: Adult. 2022;29(5):889–92. doi: 10.1080/23279095.2020.1860987. [DOI] [PubMed] [Google Scholar]
- 23.Kristensen SM, Larsen TMB, Urke HB, Danielsen AG. Academic stress, academic self-efficacy, and psychological distress: A moderated mediation of within-person effects. Journal of youth and adolescence. 2023;52(7):1512–29. doi: 10.1007/s10964-023-01770-1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.Moore A, Nguyen A, Rivas S, Bany-Mohammed A, Majeika J, Martinez L. A qualitative examination of the impacts of financial stress on college students’ well-being: Insights from a large, private institution. SAGE Open Medicine. 2021;9:20503121211018122. doi: 10.1177/20503121211018122. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.Robotham D. Stress among higher education students: Towards a research agenda. Higher education. 2008;56(6):735–46. [Google Scholar]
- 26.Drăghici G-L, Cazan A-M. Burnout and maladjustment among employed students. Frontiers in Psychology. 2022;13:825588. doi: 10.3389/fpsyg.2022.825588. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27.Abdulrahman KAB, Alshehri AS, Alkhalifah KM, Alasiri A, Aldayel MS, Alahmari FS, et al. The relationship between motivation and academic performance among medical students in Riyadh. Cureus. 2023;15(10) doi: 10.7759/cureus.46815. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 28.Ferriby A, Schaefer AF. The relationship between anatomical self-efficacy and feelings of burnout in first-year medical students. Medical Science Educator. 2022;32(2):437–46. doi: 10.1007/s40670-022-01511-2. [DOI] [PMC free article] [PubMed] [Google Scholar]