Effect of the COVID-19 pandemic on health sciences students’ individual entrepreneurship perception

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Submitted: 3 April 2024
Accepted: 22 July 2024
Published online: 1 October, TAPS 2024, 9(4), 33-39
https://doi.org/10.29060/TAPS.2024-9-4/OA3282

Meltem Saygılı1, Aysun Kandemir Türe1 & Şirin Özkan2

1Department of Health Management, Kırıkkale University, Kırıkkale, Türkiye; 2Department of Medical Services and Techniques, Vocational School of Health Services, Uludag University, Türkiye

Abstract

Introduction: Many societal changes threaten the sustainability of health systems. Entrepreneurs play a significant role in creating sustainable innovations necessary for development and structural change. This study aimed to evaluate how university students studying health sciences perceive individual entrepreneurship during the COVID-19 pandemic and to explore the impact of COVID-19-related hopelessness on their perception of entrepreneurship.

Methods: Six hundred eighty-one undergraduate students from the faculty of health sciences in Türkiye, participated in the study. The Individual Entrepreneurship Perception Scale and Beck Hopelessness Scale were used to collect data.

Results: The results revealed that the students’ perception of individual entrepreneurship was high, while their hopelessness levels were moderate. In addition, a moderate negative relationship was found between the students’ hopelessness levels and their perception of individual entrepreneurship. The regression analysis showed that the students’ hopelessness levels and sub-dimensions (hope, loss of motivation, and future expectation) accounted for 26.3% of the total variance in individual entrepreneurship perception. Increased hopelessness regarding the sub-dimensions of hope, loss of motivation, and expectations for the future decreased their individual entrepreneurship perceptions.

Conclusions: These findings suggest that individual entrepreneurship perception among health sciences students could be negatively impacted during extraordinary periods related to health crises like pandemics. Developing hope, motivation, and expectations for the future is crucial to enhancing individual entrepreneurship perception among health sciences students.

Keywords: Individual Entrepreneurship Perception, Hopelessness, Health Sciences, University Students, COVID-19 Pandemic

Practice Highlights

  • University education plays a critical role in developing students’ perceptions of entrepreneurship.
  • Students’ perceptions of entrepreneurship are affected by changing environmental conditions.
  • The COVID-19 pandemic has led to a significant increase in awareness of Healthcare Entrepreneurship.
  • The COVID-19 pandemic has negatively affected students’ expectations and hopes for the future.
  • Health sciences students experienced the psychological effects of the pandemic more intensely.

I. INTRODUCTION

Entrepreneurs are described as individuals who “implement bold new ideas from the outset, taking on the risks of the business or venture that enables innovation to happen” (Suryavanshi et al., 2020). Entrepreneurship education seeks to provide students with in-depth knowledge, motivation, and skills to increase entrepreneurial intentions’ success in various settings (Sampene et al., 2023). In developing economies such as Türkiye, government efforts to improve unemployment conditions are directed towards developing students’ positive attitudes towards entrepreneurship and increasing their interest in self-employment.

Universities are crucial in developing students’ entrepreneurial intentions (Bagheri, 2018). It is critical to examine and develop the entrepreneurial potential of university students trained to fulfill important roles in the field of health services in the future. This is because students and newly graduated healthcare professionals with entrepreneurial skills are now needed to develop innovative healthcare delivery models that can improve the quality of healthcare services, improve treatment outcomes, and reduce the cost of care (Fashami et al., 2021; Mohamed et al., 2023). It is stated that healthcare is one of the main industrial areas where user entrepreneurship takes place worldwide (Schiavone et al., 2020) and the pandemic environment brings unique opportunities for entrepreneurs, especially in healthcare. However, research shows that fear and worry due to the COVID-19 pandemic are making the future workforce anxious and hopeless about their professional futures (Duplaga & Grysztar, 2021; Tao et al., 2023). In such an environment, it is predicted that university students, especially those who are trained to work in health service delivery, may act in different ways in their decisions about their professional future.

Because an individual’s perception of current conditions can significantly, positively, or negatively affect the formation of entrepreneurial intentions and the likelihood of starting an enterprise (Krichen & Chaabouni, 2022). Considering the increasing entrepreneurship opportunities in healthcare and the negative effects of the COVID-19 pandemic on healthcare services, it has become important to address the entrepreneurship perceptions of students who will serve in this field in the future and to evaluate the hopelessness experienced. When the literature was examined, no other research addressing entrepreneurship in the context of hopelessness was found. Therefore, we believe that our research findings will make a valuable contribution to filling this gap in the literature.

A. Universities, Health Sciences Education and Entrepreneurship

Recent years have focused on the role of universities in industrial competitiveness and their impact on social change (Hart & Rodgers, 2023), and universities in teaching and initiating entrepreneurship have emerged as leading actors. Recent research examining students’ attitudes toward entrepreneurship reveals that universities have a critical role in developing entrepreneurial spirit and perceptions of entrepreneurship in students (Krichen & Chaabouni, 2022; Liao et al., 2022; Sampene et al., 2023). Moreover, university students now value real experience more and prefer universities that offer entrepreneurship opportunities and experiences (Taneja et al., 2024).

Universities providing education in healthcare have traditionally emphasised vocational training and unfortunately, there are very few university programs with curricula that focus on innovation and entrepreneurship in healthcare (Suryavanshi et al., 2020). Consequently, most newly graduated physicians and other healthcare professionals start their careers without the knowledge, experience, and courage to integrate their medical knowledge with the healthcare business world, and thus are unable to commercialise new healthcare delivery methods (Boore & Porter, 2011).

B. Hopelessness Experienced by Students Due to the COVID-19 Pandemic and Perception of Individual Entrepreneurship

Students are one of the groups that experience the psychological effects of the pandemic most intensely (Marahwa et al., 2022). Studies conducted with students during the pandemic period showed that students experienced higher levels of anxiety and depressive symptoms due to uncertainties about the future and the negative effects of the pandemic on their educational lives (Alnıaçık et al., 2021; Hajinasab et al., 2022; Kaplan Serin & Doğan, 2023; Zhang et al., 2021). Moreover, it was also determined that students’ hopelessness levels were higher in the first wave of the pandemic and during the quarantine period and decreased with normalisation (Tao et al., 2023). In addition, it has been found that students who are educated in the field of health and have clinical experience are more anxious and hopeless than undergraduate students who are educated outside the field of health (Pretorius, 2021). Although entrepreneurship is a future-oriented orientation and is perceived as the ability to turn negative situations into opportunities, it is estimated that the psychological effects of COVID-19 may negatively affect entrepreneurial intention in students. Therefore, this study aims to examine the effect of hopelessness experienced by health sciences faculty students during the COVID-19 pandemic on their perception of individual entrepreneurship.

II. METHODS

A. Sampling and Participants and Data Collection

The study was conducted with university students studying at the Faculty of Health Sciences in Türkiye. The faculty consists of six departments, namely Physiotherapy and Rehabilitation, Health Management, Social Work, Nutrition and Dietetics, Child Development and Nursing, and has 2335 students. The sample size required for the study was calculated using the formula (n=[z²xp(1-p)/d²]/1+[z²xp(1-p)/d²N]) and it was determined that a minimum of 337 participants would be sufficient with a 5% error level and 95% confidence level. Participants were selected using a simple random sampling technique and volunteerism was taken as a basis in obtaining the data. The study was conducted between April and May 2022 and 681 valid questionnaires were returned from the participating students.

Data were collected using the socio-demographic information form, Individual Entrepreneurship Perception Scale, and Beck Hopelessness Scale. The Individual Entrepreneurship Perception Scale is a 5-point Likert scale consisting of 31 items and six sub-dimensions: planning, locus of control, self-confidence, communication, motivation, and self-discipline. This scale was developed by Incik and Uzun in 2017 to assess university students’ perceptions of entrepreneurship. The reliability coefficients (Cronbach’s Alpha) of the sub-dimensions of the Individual Entrepreneurship Perception Scale and the total scale were found to be 0.80, 0.84, 0.75, 0.75, 0.75, 0.72, 0.75, 0.60 and 0.92, respectively (Incik & Uzun, 2017). For this study, it was determined that the Cronbach Alpha values of the Individual Entrepreneurship Perception Scale ranged between 0.69 and 0.93 (Table 2).

The Hopelessness Scale was initially developed by Beck et al. in 1974 and subsequently adapted into Turkish by Durak and Palabıyıkoğlu in 1994. This scale comprises 20 items divided into three sub-dimensions: expectations for the future, loss of motivation, and hope. Each question in the scale requires a ‘yes’ or ‘no’ response, and the maximum achievable score is 20. An increase in the overall score denotes a higher level of hopelessness. The reliability coefficients for the sub-dimensions of the scale were calculated to be 0.78, 0.72, and 0.72, respectively (Durak & Palabıyıkoğlu, 1994). Table 2 presents the Cronbach’s alpha coefficients for the sub-dimensions and the scale, which were found to be 0.75, 0.77, 0.74, and 0.88, respectively.

B. Statistical Analysis

The statistical analyses used were performed in SPSS v23.0. Descriptive analyses such as percentage, mean, standard deviation, reliability analysis (Cronbach’s Alpha), and normality tests were performed to obtain the results. To test the normal distribution, kurtosis, and skewness values were calculated for each scale’s sub-dimensions and total scores. It was determined that the values obtained were in the range of -1.5 to +1.5 and the data showed a normal distribution (Tabachnick & Fidell, 2013). The results of the analysis are presented in Table 2. In addition, multiple linear regression analysis was used to investigate the relationship between hopelessness and students’ perception of individual entrepreneurship.

III. RESULTS

The study involved students with an average age of 21.3 years, ranging from 18 to 44 years old. 86% of the participants were female students, and the majority (52.3%) reported a grade point average of 3 or above (with a scale of 0 to 4). 68.3% of the students lived in the city center with their families. Among the students’ mothers, 37.7% had a primary school graduate degree, and 81.4% were not working. On the other hand, 32.2% of the students’ fathers had a high school graduate degree, and 78.4% were actively working. Most of the students (68.3%) stayed in dormitories. Regarding career plans after graduation, most students expressed their interest in working in a health institution (public or private). At the same time, only 15.6% said they wanted to start their own business. 15% of the students were still undecided about their work plans (Table 1).

Variables

n

%

Variables

n

%

Department

Place of Residence Outside Education

Health Management (HM)

122

17.9

City Centre

465

68.3

Nursing (HEM)

124

18.3

District

171

25.1

Child Development (CDE)

114

16.7

Village

45

6.6

Nutrition and Dietetics (ND)

116

17.0

Education Level of Mother                                               

Physiotherapy and Rehabilitation (FTR)

140

20.6

Illiterate

23

3.4

Social Work (SW)

65

9.5

Primary School

257

37.7

Classroom

Middle School

171

25.1

Grade 1

159

23.4

High School

178

26.2

Grade 2

188

27.6

University

52

7.6

Grade 3

165

24.2

Education Level of Father

Grade 4

169

24.8

Primary School

173

25.4

Gender

Middle School

141

20.7

Woman

585

85.9

High School

219

32.2

Male

96

14.1

University

148

21.7

Age

Employment Status of Mother

18-20 years old

277

40.7

Working

127

18.6

21-22 years old

272

39.9

Not working

554

81.4

23 years and older

132

19.4

Employment Status of Father

Academic Average

Working

534

78.4

2.99 and below

 260

38.2

Not working

147

21.6

3 and above

356

52.3

Income Status

Total

 616

90.5

Scholarship

190

27.9

Not specified

65

9.5

Tuition loan

211

31.0

Career Future Plan After Graduation

Working

51

7.5

I will definitely be working in an organization (public-private)

225

33.0

Only my family supports me

229

33.6

Where Do You Live During Your Education?

I tend to be an

employee in an organization (public-private)

240

35.2

Dormitory

 

465

 

68.3

Undecided

102

15.1

Apart

171

25.1

I tend to start my own business. I have my own business

114

16.7

Home+ Staying with my family

45

6.6

Total

681

100

Total

681

100

Table 1. Sociodemographic characteristics of the students

Variables

Cronbach’s Alpha

Mean

SD

Skewness

Kurtosis

Planning

0.770

21.72

3.82

-0.271

0.233

Focus of Control

0.810

30.96

4.73

1.141

1.157

Self Confidence

0.792

23.42

3.86

-0.231

0.772

Communication

0.694

15.54

2.57

0.880

0.424

Motivation

0.709

15.18

2.78

-0.559

0.596

Self-Discipline

0.726

11.14

2.31

-0.306

-0.031

Individual Entrepreneurship Perception Scale Total Score

0.937

117.95

16.85

-0.406

0.899

Hope

0.739

3.01

2.09

0.292

-0.991

Loss of Motivation

0.766

3.76

2.33

0.295

-0.971

Future Expectations

0.750

2.28

1.71

0.157

-1.273

Beck Hopelessness Scale Total Score

0.885

9.06

5.36

0.232

-0.981

Table 2. Average scores of the participants from the Individual Entrepreneurship Perception Scale and Beck Hopelessness Scale

The data above show the mean scores of the participants obtained from the Individual Perception of Entrepreneurship Scale and Beck Hopelessness Scale used for the research. Despite the difficulties brought on by the pandemic and other negative experiences, students within the health sciences field scored high in individual entrepreneurship perception (Mean: 117.95±16.84 Min:44-Max:155). The study also found that the student’s level of hopelessness was moderate (Mean: 9.06±5.36 Min:0-Max:20) (Table 2).

Variables

B

SE

β

t

p

VIF

(Constant)

131.996

1.113

 

118.644

<.001

 

1. Hope

-19.278

2.611

-.342

-7.383

<.001

1.974

2. Loss of Motivation

-6.568

2.659

-.114

-2.470

.014

1.949

3. Future Expectations

-5.830

2.589

-.119

-2.252

.025

2.547

R =0.513        R² =0.263   F =80.449    p<0.001    Durbin Watson=1.895

 

Table 3. Multiple Linear Regression Analysis results on hopelessness levels and its effect on individual entrepreneurship perception

*Criterion: Perception of Individual Entrepreneurship

In Table 3, the regression model proved significant and reliable (F=80.449; p<0.001), with the hopelessness levels and sub-dimensions of the participants accounting for 26.3% of the total variance in individual entrepreneurship perception. The study found that the participants’ hopelessness perceptions about the sub-dimensions of hope (t=-7.383; p<0.001), loss of motivation (t=-2.470; p=0.014), and expectations for the future (t=-2.252; p=0.025) had a statistically significant impact on their individual entrepreneurship perceptions. As participants’ levels of hopelessness increased, their individual entrepreneurship perceptions decreased. Based on the standardised regression coefficient (β), the predictor variables’ relative order of importance on individual entrepreneurship perception is hope (β=-0.342), expectations about the future (β=-0.119), and loss of motivation (β=-0.114) shown in Table 3. 

IV. DISCUSSION

The results obtained from this study; health sciences students have a positive outlook on individual entrepreneurship despite the challenges created by the adverse conditions due to the pandemic. Studies conducted among health sciences students in Türkiye before the pandemic revealed that students’ perceptions of individual entrepreneurship were at a moderate level (Baltacı & Baydin, 2023; Göktekin et al., 2022). According to these results, it can be said that the pandemic process increased the awareness of individual entrepreneurship in students studying in the field of health sciences. This is a phenomenon that should be considered in discussions about current market trends and potential business opportunities. 

In addition, this research revealed that students had moderate levels of hopelessness during the pandemic period. Although this result is slightly higher than the findings of a previous study conducted with associate degree students in Türkiye during the pandemic (Okur & Şentürk, 2022); similar results were obtained in studies conducted with undergraduate students of the faculty of health sciences in the international literature (Pretorius, 2021). 

Finally, regression analysis findings showed that participants’ hopelessness levels and their sub-dimensions collectively explained 26.3% of the total variance in their individual entrepreneurship perceptions. This result suggests that hopelessness significantly affects students’ perceptions of entrepreneurship. Similarly, a study conducted with Chinese university students supports these findings by showing that the COVID-19 pandemic had a significant and negative impact on students’ entrepreneurial intentions and behaviors (Wang et al., 2023). However, this regression analysis result also implies that hopelessness caused by negative emotions during the pandemic cannot alone determine students’ perceptions of individual entrepreneurship. Other factors that may affect the individual entrepreneurship perceptions of students studying in the field of health sciences in similar health crises such as the COVID-19 pandemic should also be investigated.

Although it is stated that the pandemic period is full of opportunities for health entrepreneurship, it should be taken into consideration that entrepreneurial intention/perception is affected by many environmental factors. The related literature points out that ‘hope’ is a critical source of motivation for individuals who want to become entrepreneurs (Gódány et al., 2021). However, studies conducted during the pandemic period revealed that students perceived a high level of individual entrepreneurship risk (Krichen & Chaabouni, 2022). On the other hand, studies show that fear and anxiety caused by the COVID-19 pandemic negatively affect students’ perceptions of entrepreneurship (Loan et al., 2021). In particular, health sciences students are reported to experience higher levels of anxiety compared to other students studying in non-health fields, which leads to hopelessness and changes in career plans (Alnıaçık et al., 2021). Therefore, the results of this study are supported by the findings of previous studies. 

V. CONCLUSION

Our research has shown that students who are trained to provide health services during periods of extraordinary health crises such as pandemics may experience hopelessness about their professional future and that students’ perceptions of individual entrepreneurship are negatively affected by this situation. The content and purpose of the university education received play a critical role in the development of students’ individual entrepreneurship perceptions.  

Therefore, entrepreneurship courses should be carefully integrated into the curricula of all students studying in the field of health sciences, students should be motivated to take the course and encouraged to become entrepreneurs. In addition, interviews, company visits, and project studies with successful health entrepreneurs during similar crisis periods can increase students’ interest in health entrepreneurship and reduce their level of hopelessness. For a more comprehensive understanding of the relationships examined in the study, the inclusion of qualitative research methods in future studies may increase the depth of the analysis.

Notes on Contributors

MS, reviewed the literature, designed the research, analyzed data, co-wrote the manuscript, critically reviewed and edited the manuscript, and then read it through before final approval.

AKT, co-wrote the manuscript, and critically reviewed and edited the manuscript.

ŞÖ, prepared the manuscript for publication, critically reviewed, and edited the manuscript. 

Ethical Approval

This study was conducted according to the ethical standards of the 1964 Declaration of Helsinki. Approval was obtained from Kırıkkale University Faculty of Health Sciences (Date: 30.03.2022; Number: E.88159) and Kırıkkale University Non-Interventional Research Ethics Committee (Date: 07.04.2022, Decision No: 2022.04.13).  

Data Availability

The data that support the findings of this study are available from the corresponding author upon reasonable request. 

Acknowledgment

All authors would like to thank all participants. 

Funding

No financial support was received from any institution or organisation in the conduct and publication of this research. 

Declaration of Interest

There is no conflict of interest between the authors. 

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*Meltem Saygılı
Department of Health Management,
Prof. Dr. Fuat Sezgin Health Campus
Faculty of Health Sciences
Kırıkkale University
71450 Merkez/Kırıkkale, Türkiye
+90 318 3423738/7732
Email: meltemsaygili@kku.edu.tr

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