{"id":72979,"date":"2025-10-07T08:30:41","date_gmt":"2025-10-07T00:30:41","guid":{"rendered":"https:\/\/medicine.nus.edu.sg\/taps\/?post_type=issues&#038;p=72979"},"modified":"2026-01-06T09:08:29","modified_gmt":"2026-01-06T01:08:29","slug":"analyses-of-self-care-agency-and-mindset-pilot-study-on-malaysian-undergraduate-medical-students","status":"publish","type":"issues","link":"https:\/\/medicine.nus.edu.sg\/taps\/issues\/analyses-of-self-care-agency-and-mindset-pilot-study-on-malaysian-undergraduate-medical-students\/","title":{"rendered":"Analyses of self-care agency and mindset: A pilot study on Malaysian undergraduate medical students"},"content":{"rendered":"<p><span lang=\"EN-US\">Submitted: 28 October 2024<br \/>\r\n<\/span><span lang=\"EN-US\">Accepted: 16 June 2025<br \/>\r\n<\/span><span lang=\"EN-US\">Published online: 7 October, TAPS 2025, <\/span><span lang=\"EN-US\">10(4), 35-43<br \/>\r\n<\/span><span lang=\"EN-US\"><\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.29060\/TAPS.2025-10-4\/OA3559\">https:\/\/doi.org\/10.29060\/TAPS.2025-10-4\/OA3559<\/a><\/span><span lang=\"EN-US\"> <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">Reshma Mohamed Ansari<sup>1,2<\/sup>, Chan Choong Foong<sup>3<\/sup>, Hidayah Mohd Fadzil<sup>4<\/sup> &amp; Mohamad Nabil Mohd Noor<sup>3<\/sup><\/span><sup><span lang=\"EN-US\"><\/span><\/sup><\/p>\r\n<p style=\"text-align: justify;\"><i><sup><span lang=\"EN-US\">1<\/span><\/sup><\/i><i><span lang=\"EN-US\">Institute for Advanced Studies, Universiti Malaya, Malaysia; <sup>2<\/sup>Department of Medical Education, International Medical School, Management and Science University, Malaysia; <sup>3<\/sup>Medical Education and Research Development Unit (MERDU), Faculty of Medicine, Universiti Malaya, Malaysia; <sup>4<\/sup>Department of Mathematics and Science Education, Faculty of Education, Universiti Malaya, Malaysia<\/span><\/i><\/p>\r\n<p style=\"text-align: center;\"><b><span lang=\"EN-GB\">Abstract<\/span><\/b><span lang=\"EN-GB\"><\/span><\/p>\r\n<p style=\"text-align: justify;\"><b><span lang=\"EN-US\">Introduction<\/span><\/b><span lang=\"EN-US\">:\u00a0Self-care agency<\/span><span lang=\"EN-US\">,<\/span><span lang=\"EN-US\"> a core concept that helps alleviate <\/span><span lang=\"EN-US\">the <\/span><span lang=\"EN-US\">stressors of medical training<\/span><span lang=\"EN-US\">,<\/span><span lang=\"EN-US\"> is postulated to be <\/span><span lang=\"EN-US\">practiced<\/span><span lang=\"EN-US\"> by medical students <\/span><span lang=\"EN-US\">who exhibit a<\/span><span lang=\"EN-US\"> growth mindset. Hence, this pilot study was designed to measure, compare, and correlate the self-care agency and <\/span><span lang=\"EN-US\">mindsets<\/span><span lang=\"EN-US\"> of undergraduate medical students to <\/span><span lang=\"EN-MY\">assess the potential for scaling to a national survey.<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: justify;\"><b><span lang=\"EN-US\">Methods<\/span><\/b><span lang=\"EN-US\">:\u00a0This cross-sectional study was conducted at one public and one private medical university using a revised version of the Appraisal of Self-<\/span><span lang=\"EN-US\">Care<\/span><span lang=\"EN-US\"> Agency Scale to measure self-care agency and the Implicit Theories of Intelligence Scale to measure <\/span><span lang=\"EN-US\">participants\u2019<\/span><span lang=\"EN-US\"> mindset<\/span><span lang=\"EN-US\">.<\/span><span lang=\"EN-US\"> Data was <\/span><span lang=\"EN-US\">analysed<\/span><span lang=\"EN-US\"> using IBM SPSS. <\/span><\/p>\r\n<p style=\"text-align: justify;\"><b><span lang=\"EN-US\">Results<\/span><\/b><span lang=\"EN-US\">:\u00a0In total, 329 complete responses were obtained. Among the self-care domains, a higher capacity for self-care and <\/span><span lang=\"EN-US\">a <\/span><span lang=\"EN-US\">developing capacity for self-care<\/span><span lang=\"EN-US\">,<\/span><span lang=\"EN-US\"> with <\/span><span lang=\"EN-US\">a <\/span><span lang=\"EN-US\">lower ability to indulge in self-care<\/span><span lang=\"EN-US\">,<\/span><span lang=\"EN-US\"> were reported. Self-care agency showed a significant difference between pre-clinical and clinical students (<i>p <\/i>= .027; Cohen\u2019s d = .2). Mindset <\/span><span lang=\"EN-US\">measurements<\/span><span lang=\"EN-US\"> revealed a higher growth than a fixed mindset. <\/span><span lang=\"EN-US\">The <\/span><span lang=\"EN-US\">Pearson correlation coefficient showed <\/span><span lang=\"EN-MY\">a weak positive correlation, (r = 0.19) <\/span><span lang=\"EN-US\">between <\/span><span lang=\"EN-US\">the <\/span><span lang=\"EN-US\">means of self-care agency and <\/span><span lang=\"EN-US\">a <\/span><span lang=\"EN-US\">growth mindset. Clinical students showed a higher tendency <\/span><span lang=\"EN-US\">toward<\/span><span lang=\"EN-US\"> self-care <\/span><span lang=\"EN-US\">than<\/span><span lang=\"EN-US\"> their pre-clinical counterparts in an independent-samples t-test, with no <\/span><span lang=\"EN-US\">differences between genders<\/span><span lang=\"EN-US\"> and universities. <\/span><\/p>\r\n<p style=\"text-align: justify;\"><b><span lang=\"EN-US\">Conclusion<\/span><\/b><span lang=\"EN-US\">:\u00a0This pilot study <\/span><span lang=\"EN-US\">found<\/span><span lang=\"EN-US\"> a positive correlation between self-care agency and growth mindset among undergraduate medical students. <\/span><span lang=\"EN-US\">Although<\/span><span lang=\"EN-US\"> limited by two prototype universities and response bias, this study provides a solid foundation <\/span><span lang=\"EN-US\">for future nationwide<\/span><span lang=\"EN-US\"> or cross-country <\/span><span lang=\"EN-US\">studies. <\/span><b><span lang=\"EN-US\"><\/span><\/b><\/p>\r\n<p style=\"text-align: justify;\"><b><span lang=\"EN-US\">Keywords<\/span><\/b><span lang=\"EN-US\">:<\/span><span lang=\"EN-US\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><i><span lang=\"EN-US\">Self-care Agency, Growth Mindset, Fixed Mindset, Medical Education, Undergraduate Medical Students, Pilot Study<\/span><\/i><\/p>\r\n<p align=\"center\" style=\"text-align: center;\"><strong><span lang=\"EN-GB\">Practice Highlights<\/span><\/strong><\/p>\r\n<ul>\r\n\t<li style=\"text-align: justify;\"><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">Undergraduate medical students acknowledge importance of self-care agency and growth mindset.<\/span><span lang=\"EN-GB\"><\/span><\/li>\r\n\t<li style=\"text-align: justify;\"><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">Growth mindset correlates with self-care agency necessitating inculcation of both.<\/span><span lang=\"EN-GB\"><\/span><\/li>\r\n\t<li style=\"text-align: justify;\"><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">Growth mindset combats the stressors of medical training by indulging in proactive self-care.<\/span><span lang=\"EN-GB\"><\/span><\/li>\r\n<\/ul>\r\n<p style=\"text-align: center;\"><span lang=\"EN-GB\"><\/span><strong><span lang=\"EN-GB\">I. INTRODUCTION<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">Orem et al. (1995, p. 19) defined self-care as the \u201cpractice of activities that individuals start and perform for their benefit, for the maintenance of life, health, and well-being\u201d. Self-care agency<\/span><span lang=\"EN-US\">,<\/span><span lang=\"EN-US\"> a component of the self-care deficit nursing theory, is \u201cthe acquired, complex capacity to meet the requirements to take care of oneself, regulating life processes, maintaining or promoting integrity, structure, and functioning, as well as one\u2019s development and promotion of well-being\u201d (Oliveira et al., 2022, p. 20; Orem et al., 1995). Research has <\/span><span lang=\"EN-US\">elucidated<\/span><span lang=\"EN-US\"> that the stressors of medical training, which can cause high rates of burnout, anxiety, depression and poor physical health in students (Ayala et al., 2017; Bostock et al., 2018), could be alleviated through self-care (Ayala et al., 2018). <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">However, during medical training, students find little to no time to engage in self-care<\/span><span lang=\"EN-US\">;<\/span><span lang=\"EN-US\"> factors such as increased pressure, poor time management, and a negative environment often acting as barriers (Ayala et al., 2017; Ayala et al., 2018). <\/span><span lang=\"EN-US\">Guldner et al<\/span><span lang=\"EN-US\">.<\/span><span lang=\"EN-US\"> (2020) suggested that mindset is a predictor of depression and burnout <\/span><span lang=\"EN-US\">among<\/span><span lang=\"EN-US\"> medical residents<\/span><span lang=\"EN-US\">, highlighting the<\/span><span lang=\"EN-US\"> relationship between mindset and poor psychological well-being, alleviated by self-care practices (Carter et al., 2025). <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">Carol Dweck coined the terms \u201cgrowth mindset\u201d and \u201cfixed mindset\u201d as part of the implicit theories of intelligence, in which individuals could view intelligence as fixed (entity theory) or as a dimension that can be improved with effort (incremental theory) (Cook et al., 2018; Dweck, 2013). The mindset theory<\/span><span lang=\"EN-US\">,<\/span><span lang=\"EN-US\"> when applied to the medical education context, suggests that a growth mindset views effort as a means to develop abilities (Theard et al., 2021). In contrast, a fixed mindset <\/span><span lang=\"EN-US\">could lead to<\/span><span lang=\"EN-US\"> poorer outcomes in a high-<\/span><span lang=\"EN-US\">pressure<\/span><span lang=\"EN-US\"> educational environment (Bostock et al., 2018) and resultant poor psychological well-being<\/span><span lang=\"EN-US\"> (<\/span><span lang=\"EN-US\">Root Kustritz, 2017).<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">Studies <\/span><span lang=\"EN-US\">have <\/span><span lang=\"EN-US\">measured participants\u2019 mindsets and correlated them with scales <\/span><span lang=\"EN-GB\">measur<\/span><span lang=\"EN-GB\">ing<\/span><span lang=\"EN-US\"> anxiety or overall well-being (Guldner et al., 2020; Root Kustritz, 2017; Wolcott et al., 2021). One of the reasons for a growth mindset to aid students\u2019 well-being is by allowing them to place greater value on health and fitness and <\/span><span lang=\"EN-US\">exhibit <\/span><span lang=\"EN-US\">health-seeking <\/span><span lang=\"EN-US\">behaviours<\/span><span lang=\"EN-US\"> (Orvidas et al., 2018; Thomas et al., 2019).<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">Adding on, identification of stressors, the burnout caused by them, mental health issues, active self-care<\/span><span lang=\"EN-US\"> seeking<\/span><span lang=\"EN-US\"> behaviours including coping strategies are associated with a growth mindset (Burnette et al., 2020). Nursing students who were exposed to <\/span><span lang=\"EN-MY\">structured activities fostering a growth mindset, reported indulging in student-preferred strategies such as viewing obstacles from a newer perspective, working for competency, and indulging in self-care practices, thus directly relating a growth mindset to better self-care agency <\/span><span lang=\"EN-US\">(Carter et al., 2025).<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">Medical students in Malaysia, akin to their global counterparts have reported increased levels of stress and psychological distress (<\/span><span lang=\"EN-MY\">Masilamani et al., 2020<\/span><span lang=\"EN-US\">), due to stringent admission <\/span><span lang=\"EN-US\">processes<\/span><span lang=\"EN-US\">, higher cognitive load, and<\/span><span lang=\"EN-US\"> an<\/span><span lang=\"EN-US\"> assessment-based curriculum (Yusoff et al., 2013). Studies across four public medical schools in Malaysia <\/span><span lang=\"EN-GB\">have <\/span><span lang=\"EN-US\">shown that students <\/span><span lang=\"EN-GB\">tend<\/span><span lang=\"EN-US\"> to alleviate stress through religious activities, active coping strategies, positive <\/span><span lang=\"EN-US\">reinterpretation<\/span><span lang=\"EN-US\">, acceptance, and planning (Yusoff et al., 2011), which could be viewed as a subtle expression of a growth mindset. Despite the postulation that a growth mindset accentuates self-care agency, there is a dearth of studies on <\/span><span lang=\"EN-US\">the <\/span><span lang=\"EN-US\">self-care agency of Malaysian medical students and its correlation with mindset.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">Hence<\/span><span lang=\"EN-US\">,<\/span><span lang=\"EN-US\"> this pilot study<\/span><span lang=\"EN-US\"> was conducted<\/span><span lang=\"EN-US\"> with the <\/span><span lang=\"EN-US\">objective of measuring, comparing<\/span><span lang=\"EN-US\">, and <\/span><span lang=\"EN-US\">correlating<\/span><span lang=\"EN-US\"> self-care agency and <\/span><span lang=\"EN-US\">the mindsets<\/span><span lang=\"EN-US\"> of Malaysian undergraduate medical students to gauge the feasibility of a nationwide survey (Lowe, 2019).<\/span><\/p>\r\n<p style=\"text-align: center;\"><strong><span lang=\"EN-GB\">II. METHODS<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">This cross-sectional pilot study was conducted at <\/span><span lang=\"EN-US\">a<\/span><span lang=\"EN-US\"> public and a private medical university in Malaysia. which were accessible to researchers. The selected public university is a prototype of Malaysian public universities characterised by highly qualified students with excellent examination results<\/span><span lang=\"EN-US\"> <\/span><span lang=\"EN-GB\">paying<\/span><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">subsidi<\/span><span lang=\"EN-GB\">sed<\/span><span lang=\"EN-US\"> fees, as the operation of the university is funded by the government (Wan, 2007). The selected private university is representative of <\/span><span lang=\"EN-GB\">Malaysian <\/span><span lang=\"EN-US\">private universities<\/span><span lang=\"EN-US\">,<\/span><span lang=\"EN-US\"> which primarily <\/span><span lang=\"EN-US\">provide<\/span><span lang=\"EN-US\"> an alternate pathway for the high school students who <\/span><span lang=\"EN-US\">are<\/span><span lang=\"EN-US\"> not placed in public universities. Being self-funded, the fees are relatively higher, and <\/span><span lang=\"EN-GB\">the <\/span><span lang=\"EN-US\">students <\/span><span lang=\"EN-US\">are typically<\/span><span lang=\"EN-US\"> of paying capacity (Wan, 2007).<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">Permission to conduct <\/span><span lang=\"EN-US\">this<\/span><span lang=\"EN-US\"> study was obtained from the ethics committees of both the public and private universities (UM.TNC2\/UMREC_2872 and RMC\/SEP\/2023\/EC02<\/span><span lang=\"EN-US\">, respectively).<\/span><span lang=\"EN-US\"> Generally, <\/span><span lang=\"EN-US\">although<\/span><span lang=\"EN-US\"> every medical school in Malaysia is homegrown and has variations in <\/span><span lang=\"EN-US\">its<\/span><span lang=\"EN-US\"> curriculum, both the universities chosen for this study had a similar integrated curriculum spanning over five years for the Bachelor of Medicine<\/span><span lang=\"EN-GB\">,<\/span><span lang=\"EN-US\"> Bachelor of Surgery (MBBS) program, with two years of <\/span><span lang=\"EN-US\">pre-clinical<\/span><span lang=\"EN-US\"> and three years of clinical studies. <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">The study instrument consisted of three sections. Data collection was anonymous, and the first section <\/span><span lang=\"EN-US\">recorded<\/span><span lang=\"EN-US\"> the details of the participants\u2019 age, gender, institution of study, and year of study. Section two included the revised version of the Appraisal of Self-care Agency Scale (ASAS-R), used to measure self-care agency (Oliveira et al., 2022). <\/span><span lang=\"EN-US\">The <\/span><span lang=\"EN-US\">ASAS is a 24-item scale developed by Evers et al. in 1986 (Evers, 1989) and modified by Sousa et al<\/span><span lang=\"EN-US\">.<\/span><span lang=\"EN-US\"> (2010) <\/span><span lang=\"EN-US\">into<\/span><span lang=\"EN-US\"> a 15-item scale that can be applied to adults aged over 18 years<\/span><span lang=\"EN-GB\">.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">The three domains of ASAS-R holistically measure the three types of personal trait components that characterise the concept of self-care agency (Oliveira et al., 2022). The responses were <\/span><span lang=\"EN-GB\">ranked on<\/span><span lang=\"EN-US\"> a <\/span><span lang=\"EN-GB\">5<\/span><span lang=\"EN-US\">-point Likert scale (1 = totally disagree<\/span><span lang=\"EN-GB\">;<\/span><span lang=\"EN-US\"> 5<\/span><span lang=\"EN-US\"> <\/span><span lang=\"EN-US\">= totally agree).<\/span><span lang=\"EN-GB\"> The total<\/span><span lang=\"EN-US\"> scores ranged from 15 to 75, with higher scores indicating greater self-care agency (Oliveira et al., 2022).<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">Sousa et al<\/span><span lang=\"EN-US\">.<\/span><span lang=\"EN-US\"> (2010) divided the items into<\/span><span lang=\"EN-GB\"> the following domains: Domain <\/span><span lang=\"EN-US\">I<\/span><span lang=\"EN-GB\">: having<\/span><span lang=\"EN-US\"> the capacity for self-care (items 1, 2, 3, 5, 6, and 10; maximum domain score<\/span><span lang=\"EN-US\"> <\/span><span lang=\"EN-US\">= 30<\/span><span lang=\"EN-GB\">); Domain <\/span><span lang=\"EN-US\">II<\/span><span lang=\"EN-GB\">: developing<\/span><span lang=\"EN-US\"> the capacity <\/span><span lang=\"EN-GB\">to<\/span><span lang=\"EN-US\"> self-care (items 7, 8, 9, 12<\/span><span lang=\"EN-US\">,<\/span><span lang=\"EN-US\"> and 13; maximum domain score = 25<\/span><span lang=\"EN-GB\">);<\/span><span lang=\"EN-US\"> and <\/span><span lang=\"EN-GB\">Domain <\/span><span lang=\"EN-US\">III<\/span><span lang=\"EN-GB\">: inability<\/span><span lang=\"EN-US\"> to self-care (items 4, 11, 14, and 15; maximum domain score = 20<\/span><span lang=\"EN-GB\">), with<\/span><span lang=\"EN-US\"> acceptable Cronbach\u2019s alpha values of 0.86, 0.83, and 0.79, respectively. The instrument <\/span><span lang=\"EN-US\">has been<\/span><span lang=\"EN-US\"> validated among the general population in countries such as China, Spain, <\/span><span lang=\"EN-US\">and <\/span><span lang=\"EN-US\">Brazil<\/span><span lang=\"EN-US\">,<\/span><span lang=\"EN-US\"> and among medical students in Portugal (Alhambra-Borr\u00e1s et al., <\/span><span lang=\"EN-US\">2017; Guo et al., <\/span><span lang=\"EN-US\">2017; Oliveira et al., 2022<\/span><span lang=\"EN-US\">; Yuan et al., 2021).<\/span><span lang=\"EN-US\"> \u00a0<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">Section three consisted of <\/span><span lang=\"EN-US\">the<\/span><span lang=\"EN-US\"> Implicit Theories of Intelligence Scale (ITIS<\/span><span lang=\"EN-US\">),<\/span><span lang=\"EN-US\"> adopted from the published version of<\/span><span lang=\"EN-US\"> the<\/span><span lang=\"EN-US\"> ITIS by Cook et al. (2017), to measure the mindset of medical students. The ITIS is an eight-item instrument with four items related to incremental beliefs (1, 2, 3<\/span><span lang=\"EN-US\">, and<\/span><span lang=\"EN-US\"> 4) and four items related to entity beliefs (5, 6, 7, <\/span><span lang=\"EN-US\">and<\/span><span lang=\"EN-US\"> 8) <\/span><span lang=\"EN-US\">regarding<\/span><span lang=\"EN-US\"> intelligence and ability<\/span><span lang=\"EN-US\">. Responses<\/span><span lang=\"EN-US\"> were based on a <\/span><span lang=\"EN-GB\">6<\/span><span lang=\"EN-US\">-point Likert scale (1 = strongly disagree<\/span><span lang=\"EN-GB\">;<\/span><span lang=\"EN-US\"> 6 = strongly agree) (Cook et al., 2017). For each domain,<\/span><span lang=\"EN-GB\"> the<\/span><span lang=\"EN-US\"> scores ranged from 4 to 24. <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">A confirmatory factor analysis of the ITIS scores demonstrated an overall acceptable model fit<\/span><span lang=\"EN-US\">;<\/span><span lang=\"EN-US\"> an exploratory factor analysis confirmed a two-factor structure (Cook et al., 2017), with the Cronbach\u2019s alpha \u2265 0.77 for each domain (Cook et al., 2018).<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">The <\/span><span lang=\"EN-US\">sample<\/span><span lang=\"EN-US\"> size of the study was calculated using Raosoft online software <\/span><span lang=\"EN-US\">(<\/span><span lang=\"EN-US\"><a href=\"http:\/\/www.raosoft.com\/samplesize.html\">http:\/\/www.raosoft.com\/samplesize.html<\/a><\/span><span lang=\"EN-US\">).<\/span><span lang=\"EN-US\"> <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">With an approximate total population of <\/span><span lang=\"EN-GB\">1300<\/span><span lang=\"EN-US\"> (public university = approximately 900<\/span><span lang=\"EN-US\">;<\/span><span lang=\"EN-US\"> private <\/span><span lang=\"EN-US\">university <\/span><span lang=\"EN-US\">= approximately 400), based on a confidence level of 95%, a response distribution of 50%, and a margin of error of 5%, the sample size was determined to be 297. A quota sampling technique was applied to ensure adequate sample representation for each university: 204 from the public university and 93 from the private university. <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">The questionnaire items were entered into a Google Form, and the link was distributed to all <\/span><span lang=\"EN-GB\">the <\/span><span lang=\"EN-US\">students of both the universities where they were asked to answer the questionnaire after reading the participant information sheet and providing informed consent. <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">The data<\/span><span lang=\"EN-US\"> were collected over four weeks<\/span><span lang=\"EN-US\">,<\/span><span lang=\"EN-US\"> starting <\/span><span lang=\"EN-US\">on<\/span><span lang=\"EN-US\"> November <\/span><span lang=\"EN-US\">1 &#8211; <\/span><span lang=\"EN-US\">November 30, 2023, which<\/span><span lang=\"EN-US\"> <\/span><span lang=\"EN-US\">was two months from the start of the new semester (September 2023) in both universities which gives ample time for the students to experience the learning environment and respond to the questionnaire. A reminder was <\/span><span lang=\"EN-US\">provided<\/span><span lang=\"EN-US\"> two weeks after the start of data collection<\/span><span lang=\"EN-GB\">, and<\/span><span lang=\"EN-GB\"> <\/span><span lang=\"EN-US\">data collection ended two weeks <\/span><span lang=\"EN-US\">after the reminder.<\/span><span lang=\"EN-US\"> The students were informed of the closure of data collection.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\"> <\/span><span lang=\"EN-GB\">The data<\/span><span lang=\"EN-US\"> were <\/span><span lang=\"EN-US\">analysed<\/span><span lang=\"EN-US\"> using the IBM Statistical Package for Social Sciences (SPSS) v.26 via descriptive and inferential tests. The normality of <\/span><span lang=\"EN-GB\">the <\/span><span lang=\"EN-US\">data distribution was screened. <\/span><span lang=\"EN-US\">Pearson\u2019s<\/span><span lang=\"EN-US\"> product-moment correlation was used <\/span><span lang=\"EN-US\">to analyse<\/span><span lang=\"EN-US\"> the relationship between self-care agency and <\/span><span lang=\"EN-US\">mindset, whereas<\/span><span lang=\"EN-US\"> independent-samples t-tests were used for comparative analyses between gender and years of study.<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-US\">III. RESULTS<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><em>A. Participants\u2019 Characteristics<\/em><\/p>\r\n<p><span lang=\"EN-US\">A total of 329 valid responses were received. The participants\u2019 demographic characteristics are presented in Table 1.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">The distribution of the participants according to their year of study followed the same pattern in both universities, with more female than male respondents and more pre-clinical than clinical students, implying that the sample was representative of the population.<\/span><\/p>\r\n<div align=\"center\">\r\n<table border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\" style=\"width: 100%;\">\r\n<tbody>\r\n<tr>\r\n<td style=\"width: 151.909px; text-align: center;\">\r\n<p align=\"center\"><b><span lang=\"EN-US\">Age<\/span><\/b><\/p>\r\n<\/td>\r\n<td style=\"width: 115.83px; text-align: center;\">\r\n<p align=\"center\"><b><span lang=\"EN-US\">Range (years)<\/span><\/b><\/p>\r\n<\/td>\r\n<td style=\"width: 115.83px; text-align: center;\">\r\n<p align=\"center\"><b><span lang=\"EN-US\">Mean<\/span><\/b><\/p>\r\n<\/td>\r\n<td colspan=\"4\" valign=\"top\" style=\"width: 467.705px;\">\r\n<p><span lang=\"EN-US\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"width: 151.909px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 115.83px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">18\u201328<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 115.83px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">20.8<\/span><\/p>\r\n<\/td>\r\n<td colspan=\"4\" valign=\"top\" style=\"width: 467.705px;\">\r\n<p><span lang=\"EN-US\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td rowspan=\"10\" style=\"width: 151.909px;\">\r\n<p align=\"center\"><b><span lang=\"EN-US\">Year of study<\/span><\/b><\/p>\r\n<\/td>\r\n<td rowspan=\"5\" style=\"width: 115.83px;\">\r\n<p align=\"center\"><b><span lang=\"EN-US\">Private university<\/span><\/b><\/p>\r\n<p align=\"center\"><b><span lang=\"EN-US\">n (%)<\/span><\/b><\/p>\r\n<\/td>\r\n<td rowspan=\"5\" style=\"width: 115.83px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">n=118<\/span><\/p>\r\n<p align=\"center\"><span lang=\"EN-US\">(35%)<\/span><\/p>\r\n<\/td>\r\n<td rowspan=\"2\" style=\"width: 115.83px;\">\r\n<p align=\"center\"><b><span lang=\"EN-US\">Pre-clinical<\/span><\/b><\/p>\r\n<p align=\"center\"><b><span lang=\"EN-US\">n (%)<\/span><\/b><\/p>\r\n<\/td>\r\n<td rowspan=\"2\" style=\"width: 115.83px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">68<\/span><\/p>\r\n<p align=\"center\"><span lang=\"EN-US\">57.63%<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 115.83px;\">\r\n<p align=\"center\"><b><span lang=\"EN-US\">Year 1<\/span><\/b><\/p>\r\n<p align=\"center\"><b><span lang=\"EN-US\">n (%)<\/span><\/b><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 115.852px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">n=31<\/span><\/p>\r\n<p align=\"center\"><span lang=\"EN-US\">45.5%<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 115.83px;\">\r\n<p align=\"center\"><b><span lang=\"EN-US\">Year 2<\/span><\/b><\/p>\r\n<p align=\"center\"><b><span lang=\"EN-US\">n (%)<\/span><\/b><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 115.852px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">n=37<\/span><\/p>\r\n<p align=\"center\"><span lang=\"EN-US\">54.5%<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td rowspan=\"3\" style=\"width: 115.83px;\">\r\n<p align=\"center\"><b><span lang=\"EN-US\">Clinical<\/span><\/b><\/p>\r\n<p align=\"center\"><b><span lang=\"EN-US\">n (%)<\/span><\/b><\/p>\r\n<\/td>\r\n<td rowspan=\"3\" style=\"width: 115.83px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">50<\/span><\/p>\r\n<p align=\"center\"><span lang=\"EN-US\">42.37%<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 115.83px;\">\r\n<p align=\"center\"><b><span lang=\"EN-US\">Year 3<\/span><\/b><\/p>\r\n<p align=\"center\"><b><span lang=\"EN-US\">n (%)<\/span><\/b><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 115.852px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">n=28<\/span><\/p>\r\n<p align=\"center\"><span lang=\"EN-US\">56%<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 115.83px;\">\r\n<p align=\"center\"><b><span lang=\"EN-US\">Year 4<\/span><\/b><\/p>\r\n<p align=\"center\"><b><span lang=\"EN-US\">n (%)<\/span><\/b><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 115.852px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">n=12<\/span><\/p>\r\n<p align=\"center\"><span lang=\"EN-US\">24%<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 115.83px;\">\r\n<p align=\"center\"><b><span lang=\"EN-US\">Year 5<\/span><\/b><\/p>\r\n<p align=\"center\"><b><span lang=\"EN-US\">n (%)<\/span><\/b><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 115.852px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">n=10<\/span><\/p>\r\n<p align=\"center\"><span lang=\"EN-US\">20%<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td rowspan=\"5\" style=\"width: 115.83px;\">\r\n<p align=\"center\"><b><span lang=\"EN-US\">Public university<\/span><\/b><\/p>\r\n<p align=\"center\"><b><span lang=\"EN-US\">n (%)<\/span><\/b><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td rowspan=\"5\" style=\"width: 115.83px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">n=211<\/span><\/p>\r\n<p align=\"center\"><span lang=\"EN-US\">(65%)<\/span><\/p>\r\n<\/td>\r\n<td rowspan=\"2\" style=\"width: 115.83px;\">\r\n<p align=\"center\"><b><span lang=\"EN-US\">Pre-clinical<\/span><\/b><\/p>\r\n<p align=\"center\"><b><span lang=\"EN-US\">n (%)<\/span><\/b><\/p>\r\n<\/td>\r\n<td rowspan=\"2\" style=\"width: 115.83px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">127<\/span><\/p>\r\n<p align=\"center\"><span lang=\"EN-US\">60.2%<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 115.83px;\">\r\n<p align=\"center\"><b><span lang=\"EN-US\">Year 1<\/span><\/b><\/p>\r\n<p align=\"center\"><b><span lang=\"EN-US\">n (%)<\/span><\/b><\/p>\r\n<\/td>\r\n<td style=\"width: 115.852px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">n=78<\/span><\/p>\r\n<p align=\"center\"><span lang=\"EN-US\">61.4%<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 115.83px;\">\r\n<p align=\"center\"><b><span lang=\"EN-US\">Year 2<\/span><\/b><\/p>\r\n<p align=\"center\"><b><span lang=\"EN-US\">n (%)<\/span><\/b><\/p>\r\n<\/td>\r\n<td style=\"width: 115.852px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">n=49<\/span><\/p>\r\n<p align=\"center\"><span lang=\"EN-US\">38.6%<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td rowspan=\"3\" style=\"width: 115.83px;\">\r\n<p align=\"center\"><b><span lang=\"EN-US\">Clinical<\/span><\/b><\/p>\r\n<p align=\"center\"><b><span lang=\"EN-US\">n (%)<\/span><\/b><\/p>\r\n<\/td>\r\n<td rowspan=\"3\" style=\"width: 115.83px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">84<\/span><\/p>\r\n<p align=\"center\"><span lang=\"EN-US\">39.8%<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 115.83px;\">\r\n<p align=\"center\"><b><span lang=\"EN-US\">Year 3<\/span><\/b><\/p>\r\n<p align=\"center\"><b><span lang=\"EN-US\">n (%)<\/span><\/b><\/p>\r\n<\/td>\r\n<td style=\"width: 115.852px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">n=20<\/span><\/p>\r\n<p align=\"center\"><span lang=\"EN-US\">23.8%<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"width: 115.83px;\">\r\n<p align=\"center\"><b><span lang=\"EN-US\">Year 4<\/span><\/b><\/p>\r\n<p align=\"center\"><b><span lang=\"EN-US\">n (%)<\/span><\/b><\/p>\r\n<\/td>\r\n<td style=\"width: 115.852px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">n=8<\/span><\/p>\r\n<p align=\"center\"><span lang=\"EN-US\">9.5%<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"width: 115.83px;\">\r\n<p align=\"center\"><b><span lang=\"EN-US\">Year 5<\/span><\/b><\/p>\r\n<p align=\"center\"><b><span lang=\"EN-US\">n (%)<\/span><\/b><\/p>\r\n<\/td>\r\n<td style=\"width: 115.852px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">n=56<\/span><\/p>\r\n<p align=\"center\"><span lang=\"EN-US\">66.7%<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td rowspan=\"4\" style=\"width: 151.909px;\">\r\n<p align=\"center\"><b><span lang=\"EN-US\">Gender<\/span><\/b><\/p>\r\n<\/td>\r\n<td rowspan=\"2\" style=\"width: 115.83px;\">\r\n<p align=\"center\"><b><span lang=\"EN-US\">Male<\/span><\/b><\/p>\r\n<p align=\"center\"><b><span lang=\"EN-US\">n (%)<\/span><\/b><\/p>\r\n<\/td>\r\n<td rowspan=\"2\" style=\"width: 115.83px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">\u00a0<\/span><\/p>\r\n<p align=\"center\"><span lang=\"EN-US\">n=112<\/span><\/p>\r\n<p align=\"center\"><span lang=\"EN-US\">34.1%<\/span><\/p>\r\n<p><span lang=\"EN-US\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 115.83px;\">\r\n<p align=\"center\"><b><span lang=\"EN-US\">Private university<\/span><\/b><\/p>\r\n<p align=\"center\"><b><span lang=\"EN-US\">n (%)<\/span><\/b><\/p>\r\n<\/td>\r\n<td style=\"width: 115.83px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">n=38<\/span><\/p>\r\n<p align=\"center\"><span lang=\"EN-US\">33.9%<\/span><\/p>\r\n<\/td>\r\n<td colspan=\"2\" rowspan=\"4\" style=\"width: 233.136px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 115.83px;\">\r\n<p align=\"center\"><b><span lang=\"EN-US\">Public university <\/span><\/b><\/p>\r\n<p align=\"center\"><b><span lang=\"EN-US\">n (%)<\/span><\/b><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 115.83px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">n=74<\/span><\/p>\r\n<p align=\"center\"><span lang=\"EN-US\">66.1%<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td rowspan=\"2\" style=\"width: 115.83px;\">\r\n<p align=\"center\"><b><span lang=\"EN-US\">Female<\/span><\/b><\/p>\r\n<p align=\"center\"><b><span lang=\"EN-US\">n (%)<\/span><\/b><\/p>\r\n<p align=\"center\"><b><span lang=\"EN-US\">\u00a0<\/span><\/b><\/p>\r\n<\/td>\r\n<td rowspan=\"2\" style=\"width: 115.83px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">n=217<\/span><\/p>\r\n<p align=\"center\"><span lang=\"EN-US\">65.9%<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 115.83px;\">\r\n<p align=\"center\"><b><span lang=\"EN-US\">Private university <\/span><\/b><\/p>\r\n<p align=\"center\"><b><span lang=\"EN-US\">n (%)<\/span><\/b><\/p>\r\n<\/td>\r\n<td style=\"width: 115.83px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">n=80<\/span><\/p>\r\n<p align=\"center\"><span lang=\"EN-US\">36.9%<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 115.83px;\">\r\n<p align=\"center\"><b><span lang=\"EN-US\">Public university <\/span><\/b><\/p>\r\n<p align=\"center\"><b><span lang=\"EN-US\">n (%)<\/span><\/b><\/p>\r\n<\/td>\r\n<td style=\"width: 115.83px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">n=137<\/span><\/p>\r\n<p align=\"center\"><span lang=\"EN-US\">63.1%<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<p align=\"center\"><span lang=\"EN-US\">Table 1<\/span><span lang=\"EN-US\">. Participants\u2019 demographic characteristics (N = 329)<\/span><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-US\">B. Descriptive Statistics<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">The key descriptive statistics and reliability indices of the ASAS-R are presented in Table 2.<\/span><\/p>\r\n<div align=\"center\">\r\n<table border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\" style=\"width: 100%;\">\r\n<tbody>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 48.8864px;\">\r\n<p align=\"center\"><b><span lang=\"EN-US\">Item No.<\/span><\/b><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 359.386px;\">\r\n<p align=\"center\"><b><span lang=\"EN-US\">Items<\/span><\/b><sup><span lang=\"EN-US\">a<\/span><\/sup><b><sup><span lang=\"EN-US\"><\/span><\/sup><\/b><\/p>\r\n<\/td>\r\n<td style=\"width: 90.8409px;\">\r\n<p align=\"center\"><b><span lang=\"EN-US\">Minimum<\/span><\/b><\/p>\r\n<\/td>\r\n<td style=\"width: 99.2273px;\">\r\n<p align=\"center\"><b><span lang=\"EN-US\">Maximum<\/span><\/b><\/p>\r\n<\/td>\r\n<td style=\"width: 57.2841px;\">\r\n<p align=\"center\"><b><span lang=\"EN-US\">Mean (SD)<\/span><\/b><\/p>\r\n<\/td>\r\n<td style=\"width: 32.1023px;\">\r\n<p align=\"center\"><b><span lang=\"EN-US\">\u00a0<\/span><\/b><\/p>\r\n<\/td>\r\n<td style=\"width: 107.659px;\">\r\n<p align=\"center\"><b><span lang=\"EN-US\">\u00a0<\/span><\/b><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td colspan=\"6\" style=\"width: 695px;\">\r\n<p><span lang=\"EN-US\">ASAS-R Cronbach\u2019s alpha<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 107.659px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">.841<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td colspan=\"6\" style=\"width: 695px;\">\r\n<p><span lang=\"EN-US\">ASAS-R total score Mean (SD)<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 107.659px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">55.74 (8.10)<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td colspan=\"7\" style=\"width: 804.114px;\">\r\n<p><b><span lang=\"EN-US\">Domain I: Having the capacity for self-care (items 1, 2, 3, 5, 6 &amp; 10 of ASAS-R)<\/span><\/b><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 48.8864px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td colspan=\"2\" valign=\"top\" style=\"width: 451.682px;\">\r\n<p><span lang=\"EN-US\">Domain total score (SD)<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 99.2273px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 57.2841px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 32.1023px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 107.659px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">24.14 (4.17)<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 48.8864px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td colspan=\"2\" valign=\"top\" style=\"width: 451.682px;\">\r\n<p><span lang=\"EN-US\">Domain Cronbach&#8217;s alpha<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 99.2273px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 57.2841px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 32.1023px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 107.659px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">.875<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td colspan=\"7\" style=\"width: 804.114px;\">\r\n<p><b><span lang=\"EN-US\">Domain II: Developing the capacity for self-care (items 7, 8, 9, 12 &amp; 13 of ASAS-R)<\/span><\/b><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 48.8864px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td colspan=\"2\" valign=\"top\" style=\"width: 451.682px;\">\r\n<p><span lang=\"EN-US\">Domain total score (SD)<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 99.2273px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 57.2841px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 32.1023px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 107.659px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">19.69 (3.61)<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 48.8864px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td colspan=\"2\" valign=\"top\" style=\"width: 451.682px;\">\r\n<p><span lang=\"EN-US\">Domain Cronbach&#8217;s alpha<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 99.2273px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 57.2841px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 32.1023px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 107.659px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">.762<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td colspan=\"7\" valign=\"top\" style=\"width: 804.114px;\">\r\n<p><b><span lang=\"EN-US\">Domain III: Inability to self-care (items 4, 11, 14 &amp; 15 of ASAS-R)<\/span><\/b><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"width: 48.8864px; text-align: center;\">\r\n<p><span lang=\"EN-US\">4<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 359.386px;\">\r\n<p><span lang=\"EN-US\">* I often lack energy to care for myself in the way that I know I should.<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 90.8409px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">1.00<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 99.2273px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">5.00<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 57.2841px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">3.09 (1.18)<\/span><\/p>\r\n<\/td>\r\n<td colspan=\"2\" rowspan=\"4\" style=\"width: 141.216px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"width: 48.8864px; text-align: center;\">\r\n<p><span lang=\"EN-US\">11<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 359.386px;\">\r\n<p><span lang=\"EN-US\">* In my daily activities I seldom take time to care for myself.<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 90.8409px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">1.00<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 99.2273px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">5.00<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 57.2841px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">2.82 (1.19)<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"width: 48.8864px; text-align: center;\">\r\n<p><span lang=\"EN-US\">14<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 359.386px;\">\r\n<p><span lang=\"EN-US\">* I seldom have time for myself.<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 90.8409px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">1.00<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 99.2273px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">5.00<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 57.2841px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">2.82 (1.18)<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"width: 48.8864px; text-align: center;\">\r\n<p><span lang=\"EN-US\">15<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 359.386px;\">\r\n<p><span lang=\"EN-US\">* I am not always able to care for myself in a way I would like.<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 90.8409px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">1.00<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 99.2273px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">5.00<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 57.2841px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">3.15 (1.20)<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td colspan=\"6\" valign=\"top\" style=\"width: 695px;\">\r\n<p><span lang=\"EN-US\">Domain total score (SD)<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 107.659px;\">\r\n<p align=\"center\"><span lang=\"EN-US\">11.90 (3.63)<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td colspan=\"6\" valign=\"top\" style=\"width: 695px;\">\r\n<p><span lang=\"EN-US\">Domain Cronbach&#8217;s alpha<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 107.659px;\">\r\n<p align=\"center\" style=\"text-align: center;\"><span lang=\"EN-US\">.761<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<p style=\"text-align: left;\"><i><span lang=\"EN-US\">*Negatively worded items; the answers were reversely scored.<\/span><\/i><\/p>\r\n<p style=\"text-align: left;\"><i><sup><span lang=\"EN-US\">a<\/span><\/sup><\/i><i><span lang=\"EN-US\">5-point Likert scale: 1 (totally disagree) to 5 (totally agree).<\/span><\/i><\/p>\r\n<p style=\"text-align: center;\"><i><span lang=\"EN-US\">\u00a0<\/span><\/i><span lang=\"EN-US\">Table 2<\/span><span lang=\"EN-US\">. ASAS-R and its scores<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">The domain scores for Domains I (<\/span><span lang=\"EN-US\">M<\/span><span lang=\"EN-US\"> = 24.14, <\/span><span lang=\"EN-US\">SD<\/span><span lang=\"EN-US\"> = 4.17) and II (<\/span><span lang=\"EN-US\">M<\/span><span lang=\"EN-US\"> = 19.69, <\/span><span lang=\"EN-US\">SD<\/span><i><span lang=\"EN-US\"> <\/span><\/i><span lang=\"EN-US\">= 3.61; maximum scores = 30 and 25, respectively) were higher than those for Domain III (<\/span><span lang=\"EN-US\">M<\/span><span lang=\"EN-US\"> = 11.90, <\/span><span lang=\"EN-US\">SD<\/span><span lang=\"EN-US\"> = 3.63; maximum score = 20). The items of Domains I and II showed mean scores varying from 3.7 to 4.1, indicating global positive scores for one\u2019s self-perception of having and developing self-care abilities. The mean scores of the items of Domain III varied from 2.8 to 3.15, suggesting that the students acknowledged a lack of means to self-care (all four items were reversely worded) (<\/span><span lang=\"EN-US\">Dam\u00e1sio &amp; Koller, 2013)<\/span><span lang=\"EN-US\">. <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">Table 3 presents the key descriptive statistics and reliability indices of the ITIS questionnaire. The maximum score for each domain was 24. The score for the incremental domain (Min: 1.00 and Max: 6.00; <\/span><span lang=\"EN-US\">M<\/span><span lang=\"EN-US\"> = 18.49, <\/span><span lang=\"EN-US\">SD<\/span><span lang=\"EN-US\"> = 4.13) was higher than that for the entity domain (Min: 1.00 and Max: 6.00; <\/span><span lang=\"EN-US\">M<\/span><span lang=\"EN-US\"> = 12.33, <\/span><span lang=\"EN-US\">SD<\/span><i><span lang=\"EN-US\"> <\/span><\/i><span lang=\"EN-US\">= 5.24), indicating that the students were more aligned toward a growth mindset than a fixed mindset (Sun et al., 2021). The mean of the items indicating a fixed mindset (entity domain) showed a range of 2.8 to 3.3, compared with the mean of the items indicating a growth mindset (incremental domain), which showed a range of 4.5 to 4.7 (Hong et al., 1999).<\/span><\/p>\r\n<div align=\"center\">\r\n<table border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\" style=\"height: 397px; width: 100%;\">\r\n<tbody>\r\n<tr style=\"height: 59px;\">\r\n<td width=\"79%\" valign=\"top\" style=\"height: 59px; text-align: center;\">\r\n<p style=\"text-align: left;\"><b><span lang=\"EN-US\">ITIS Cronbach\u2019 alpha<\/span><\/b><i><sup><span lang=\"EN-US\">a<\/span><\/sup><\/i><\/p>\r\n<\/td>\r\n<td width=\"20%\" valign=\"top\" style=\"height: 59px; text-align: center;\">\r\n<p align=\"center\"><span lang=\"EN-US\">.724<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 58px;\">\r\n<td width=\"100%\" colspan=\"2\" valign=\"top\" style=\"height: 58px; text-align: center;\">\r\n<p style=\"text-align: left;\"><b><span lang=\"EN-US\">Domain: Entity (items 1, 2 3 &amp; 4 of ITIS)<\/span><\/b><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 56px;\">\r\n<td width=\"79%\" valign=\"top\" style=\"height: 56px; text-align: left;\">\r\n<p><span lang=\"EN-US\">Domain total score Mean (SD)<\/span><\/p>\r\n<\/td>\r\n<td width=\"20%\" valign=\"top\" style=\"height: 56px; text-align: center;\">\r\n<p align=\"center\"><span lang=\"EN-US\">12.33 (5.24)<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 56px;\">\r\n<td width=\"79%\" valign=\"top\" style=\"height: 56px; text-align: left;\">\r\n<p><span lang=\"EN-US\">Domain Cronbach&#8217;s alpha<\/span><\/p>\r\n<\/td>\r\n<td width=\"20%\" valign=\"top\" style=\"height: 56px; text-align: center;\">\r\n<p align=\"center\"><span lang=\"EN-US\">.930<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 56px;\">\r\n<td width=\"100%\" colspan=\"2\" valign=\"top\" style=\"height: 56px; text-align: center;\">\r\n<p style=\"text-align: left;\"><b><span lang=\"EN-US\">Domain: Incremental (items 5, 6, 7 &amp; 8 of ITIS)<\/span><\/b><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 56px;\">\r\n<td width=\"79%\" valign=\"top\" style=\"height: 56px; text-align: left;\">\r\n<p><span lang=\"EN-US\">Domain total score Mean (SD)<\/span><\/p>\r\n<\/td>\r\n<td width=\"20%\" valign=\"top\" style=\"height: 56px; text-align: center;\">\r\n<p align=\"center\"><span lang=\"EN-US\">18.49 (4.13)<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 56px;\">\r\n<td width=\"79%\" valign=\"top\" style=\"height: 56px; text-align: left;\">\r\n<p><span lang=\"EN-US\">Domain Cronbach&#8217;s alpha<\/span><\/p>\r\n<\/td>\r\n<td width=\"20%\" valign=\"top\" style=\"height: 56px; text-align: center;\">\r\n<p align=\"center\"><span lang=\"EN-US\">.907<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<p style=\"text-align: left;\"><i><sup><span lang=\"EN-US\">a<\/span><\/sup><\/i><i><span lang=\"EN-US\">6-point Likert scale: 1 (strongly disagree) to 6 (strongly agree).<\/span><\/i><\/p>\r\n<p align=\"center\" style=\"text-align: center;\"><span lang=\"EN-US\">Table 3<\/span><span lang=\"EN-US\">. ITIS and its scores<\/span><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-US\">C. Correlational Analysis<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">For inferential statistics, the total score of self-care agency and the mindset domains were subjected to tests of normality using the applied statistical methods of skewness and kurtosis; z-values were not considered as the sample size was greater than 300 (Kim, 2013). The resultant absolute skew values were less than 2, and the absolute kurtosis values were less than 7. Hence, the data were considered to be normally distributed, and parametric tests were applied (Hair et al., 2006; Kim, 2013). All values were considered significant if the p value was less than 0.05. <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">The relationship between self-care agency (total score) and growth mindset (domain score) was investigated using Pearson\u2019s product-moment correlation coefficient. There was a significant positive correlation between the two variables (r = .19, n = 329, <i>p<\/i> &lt; .01 (two-tailed)), indicating that self-care agency behaviour is associated with a growth mindset. In contrast, the Pearson correlation between self-care agency (total score) and a fixed mindset (domain score) was not significant (r = .060, n = 329, <i>p<\/i> = .278 (two-tailed)). Pearson\u2019s correlation did not show significant correlations between the domains of growth and a fixed mindset with the individual domains of capacity for self-care, developing capacity for self-care, and inability to perform self-care.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-US\">D. Comparative Analysis<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">An independent-samples t-test was performed to compare the self-care agency (total score) between pre-clinical and clinical students. The analysis showed a significant difference in the total scores of pre-clinical (<\/span><span lang=\"EN-US\">M<\/span><i><span lang=\"EN-US\"> <\/span><\/i><span lang=\"EN-US\">= 54.92, <\/span><span lang=\"EN-US\">SD<\/span><i><span lang=\"EN-US\"> <\/span><\/i><span lang=\"EN-US\">= 8.86) and clinical students (<\/span><span lang=\"EN-US\">M<\/span><i><span lang=\"EN-US\"> <\/span><\/i><span lang=\"EN-US\">= 56.93, <\/span><span lang=\"EN-US\">SD<\/span><i><span lang=\"EN-US\"> <\/span><\/i><span lang=\"EN-US\">= 6.71; <i>t <\/i>(329) = -2.22, <i>p <\/i>= .027, two-tailed). Though the magnitude of the differences in the means (mean difference = -2.00, 95% <\/span><span lang=\"EN-US\">CI<\/span><span lang=\"EN-US\">:<\/span><i><span lang=\"EN-US\"> <\/span><\/i><span lang=\"EN-US\">-3.78 to -.23) was small (Cohen\u2019s d = .2), it implicates that the factors that hinder self-care could be further explored and mindset interventions could be targeted for pre-clinical students.<\/span><span lang=\"EN-US\"> However, the independent-samples t-test performed to compare the domain scores of fixed and growth mindsets did not show any significant difference between pre-clinical and clinical students (<i>t <\/i>(329) = -1.668, <i>p <\/i>= .096, two-tailed) and (<i>t <\/i>(329) = .216, <i>p <\/i>= .829, two-tailed), indicating that their mindsets did not differ in this population.<\/span><i><span lang=\"EN-US\">\u00a0<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">An independent-samples t-test performed to compare the means of self-care agency, fixed mindset, and growth mindset among private and public university students exhibited no significant differences (<i>t <\/i>(329) = .772, <i>p <\/i>= .441, two-tailed), (<i>t <\/i>(329) = -.916, <i>p <\/i>= .360, two-tailed), (<i>t <\/i>(329) = -.252, <i>p <\/i>= .801, two-tailed) indicating that similar stressors and barriers to self-care agency existed in both types of institutions. <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">An independent-samples t-test was performed to compare the means of self-care agency, fixed mindset, and growth mindset among genders; no significant differences were found (<i>t <\/i>(329) = -.58, <i>p <\/i>= .954 two-tailed), (<i>t <\/i>(329) = .936, <i>p <\/i>= .350, two-tailed), (<i>t <\/i>(329) = .052, <i>p <\/i>= .959, two-tailed) suggesting that both the genders had similar views on the problems encountered in medical schools which could hinder self-care despite possessing a growth mindset. A one-way ANOVA was performed to compare the means of self-care agency, growth mindset, and fixed mindset with respect to the year of study (Year 1\u2013Year 5). The post-hoc Tukey test also did not reveal any significant differences. <\/span><\/p>\r\n<p style=\"text-align: center;\"><strong><span lang=\"EN-US\">IV. <\/span><span lang=\"EN-GB\"><\/span><span lang=\"EN-GB\">DISCUSSION<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">The total ASAS-R score in this pilot study is comparable to Guo et al.\u2019s (2017) study of older Chinese individuals (55.29 \u00b1 5.22) and <\/span><span lang=\"EN-US\">Sch\u00f6nenberg et al.\u2019s<\/span><span lang=\"EN-US\"> (2022) study of adults with at least one chronic disorder (52.81 \u00b1 8.39<\/span><span lang=\"EN-US\">).<\/span><span lang=\"EN-US\"> A study conducted in Brazil among fibromyalgia patients showed similar baseline total scores of 51.9 \u00b1 9.7 and 53.5 \u00b1 11.0 in two samples (Yuan et al., 2021). Oliveira et al<\/span><span lang=\"EN-US\">.<\/span><span lang=\"EN-US\"> (2022) did not report the total ASAS-R <\/span><span lang=\"EN-US\">score <\/span><span lang=\"EN-US\">among Portuguese medical students, but <\/span><span lang=\"EN-US\">the <\/span><span lang=\"EN-US\">higher means of Domains I and II and<\/span><span lang=\"EN-US\"> the<\/span><span lang=\"EN-US\"> lower mean of Domain III in this pilot study resonated with their findings which could be further explored by qualitative research. Despite that<\/span><span lang=\"EN-MY\">, Portuguese medical students reported higher mean with Domain II rather than Domain I unlike participants of the current pilot study. This indicates that Portuguese students though lack self-care currently, are positive to be able develop self-care abilities in future. On the other hand, Malaysian students are quite satisfied with their current self-care abilities rather than develop the abilities (Oliveira et al., 2022). The factors for this difference of opinion could be that the Portuguese respondents were of higher age (Mean = 22) and possible cultural factors which could be explored by research as well. <\/span><span lang=\"EN-US\">\u00a0<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">Two items in <\/span><span lang=\"EN-MY\">Domain<\/span><span lang=\"EN-US\"> III (items 11 <\/span><span lang=\"EN-US\">and<\/span><span lang=\"EN-US\"> 14) scored the lowest in this pilot study <\/span><span lang=\"EN-US\">and<\/span><span lang=\"EN-US\"> can be likened to the study by Guo et al<\/span><span lang=\"EN-US\">.<\/span><span lang=\"EN-US\"> (2017) who reported that item number 15 in <\/span><span lang=\"EN-MY\">Domain<\/span><span lang=\"EN-US\"> III \u201cI am not always able to care for myself in <\/span><span lang=\"EN-US\">the<\/span><span lang=\"EN-US\"> way I would like\u201d scored the <\/span><span lang=\"EN-US\">lowest (<\/span><span lang=\"EN-US\">2.83 \u00b1 0.93<\/span><span lang=\"EN-US\">).<\/span><span lang=\"EN-US\"> The opinion that our students also <\/span><span lang=\"EN-US\">agree<\/span><span lang=\"EN-US\"> that they lack time and energy for self-care are similar to a study conducted <\/span><span lang=\"EN-US\">at<\/span><span lang=\"EN-US\"> Yale University<\/span><span lang=\"EN-US\">, and in the United States of America (USA), where<\/span><span lang=\"EN-US\"> medical students <\/span><span lang=\"EN-US\">neglected<\/span><span lang=\"EN-US\"> self-care and <\/span><span lang=\"EN-US\">attributed<\/span><span lang=\"EN-US\"> it to lack of time and high stress levels in their academic journey (Ayala et al., 2018; Gold et al., 2015). Similar factors including <\/span><span lang=\"EN-US\">organisation<\/span><span lang=\"EN-US\"> for self-care, attributable to an intense medical curriculum were voiced out by Portuguese and Malaysian medical students alike (Oliveira et al., 2022; Yusoff et al., 2013). A worldwide analogous opinion among medical students should be taken into account by medical educators to act on easing the academic journey through early detection and targeted interventions. <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">In this pilot study, there was no difference in gender in the self-care agency domain, which differs from a study conducted by Ayala et al. (2018), who reported higher stress and self-care activities among female students. <\/span><span lang=\"EN-US\">However<\/span><span lang=\"EN-US\">, nursing students in Turkey reported a <\/span><span lang=\"EN-US\">more<\/span><span lang=\"EN-US\"> optimistic approach <\/span><span lang=\"EN-US\">to<\/span><span lang=\"EN-US\"> stress management by male students, which correlated with self-care agency among them as well (Komser &amp; \u00d6zakg\u00fcl, 2023)<\/span><span lang=\"EN-US\">. The difference in study results pertaining to gender necessitates a multi-institutional future study with a robust sample size to yield comparable outcomes. \u00a0H<\/span><span lang=\"EN-US\">igher self-care agency among clinical students reported in this study is similar to <\/span><span lang=\"EN-US\">another<\/span><span lang=\"EN-US\"> Malaysian study by Aida et al (2014). Clinical students <\/span><span lang=\"EN-US\">initially <\/span><span lang=\"EN-US\">sought predominantly informal ways (peers, friends, and parents) for health seeking rather than formal channels (counselling<\/span><span lang=\"EN-US\"> and psychiatrists<\/span><span lang=\"EN-US\">) (Aida et al., 2014). A<\/span><span lang=\"EN-MY\">ctive coping strategies, reframing (focusing on the process not results, viewing failures as opportunities) and planning as means of self-care was also reported by clinical students (Masilamani et al., 2020). \u00a0Students have reported struggle in self-care behaviours within the first 12 weeks of medical school training regardless of their gender in USA <\/span><span lang=\"EN-US\">as they struggle with poor sleep and physical activity (Boyd et al., 2023). Though it can be hypothesised that older students with more experience and maturity learn self-care behaviours along their student journey, it is still open to research. Since there is no difference in self-care agency between public and private universities similar to other studies<\/span><span lang=\"EN-US\">,<\/span><span lang=\"EN-US\"> (Ayala et al. 2018<\/span><span lang=\"EN-US\">), we can deduce that the factors for poor self-care are alike across different institutions. <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">In this pilot study, <\/span><span lang=\"EN-US\">more <\/span><span lang=\"EN-US\">medical students were found to exhibit <\/span><span lang=\"EN-US\">a <\/span><span lang=\"EN-US\">growth mindset <\/span><span lang=\"EN-US\">rather <\/span><span lang=\"EN-US\">than<\/span><span lang=\"EN-US\"> a<\/span><span lang=\"EN-US\"> fixed mindset with comparable means with a study among international students in USA, where the growth mindset score was 19.51 \u00b1 1.362, and the fixed mindset score was 14.34 \u00b1 1.557 (Winfrey, 2020) comparable to clinical veterinary students (Guldner et al., 2020<\/span><span lang=\"EN-US\">;<\/span><span lang=\"EN-US\"> Whittington et al., 2017). <\/span><span lang=\"EN-US\">There<\/span><span lang=\"EN-US\"> was no difference between fixed <\/span><span lang=\"EN-US\">and<\/span><span lang=\"EN-US\"> growth <\/span><span lang=\"EN-US\">mindsets between<\/span><span lang=\"EN-US\"> genders in this pilot study<\/span><span lang=\"EN-US\">. However,<\/span><span lang=\"EN-US\"> Bostock et al. (2018) reported that <\/span><span lang=\"EN-US\">more <\/span><span lang=\"EN-US\">females <\/span><span lang=\"EN-US\">had<\/span><span lang=\"EN-US\"> a fixed mindset and poorer mental health<\/span><span lang=\"EN-US\"> than their male counterparts<\/span><span lang=\"EN-US\">. There was no difference in mindset among the students of different years of study in this pilot study<\/span><span lang=\"EN-US\">. This finding differs<\/span><span lang=\"EN-US\"> from <\/span><span lang=\"EN-US\">the results of <\/span><span lang=\"EN-US\">Root Kustritz (2017<\/span><span lang=\"EN-US\">),<\/span><span lang=\"EN-US\"> who reported <\/span><span lang=\"EN-US\">that <\/span><span lang=\"EN-US\">year<\/span><span lang=\"EN-US\">&#8211;<\/span><span lang=\"EN-US\">two veterinary students <\/span><span lang=\"EN-US\">showed a<\/span><span lang=\"EN-US\"> more growth<\/span><span lang=\"EN-US\">-oriented<\/span><span lang=\"EN-US\"> mindset, while Bostock et al. (2018) reported <\/span><span lang=\"EN-US\">that <\/span><span lang=\"EN-US\">year<\/span><span lang=\"EN-US\">&#8211;<\/span><span lang=\"EN-US\">four students <\/span><span lang=\"EN-US\">had<\/span><span lang=\"EN-US\"> a higher growth<\/span><span lang=\"EN-US\">-oriented<\/span><span lang=\"EN-US\"> mindset. <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">Studies that establish a link between psychological distress and mindset predict overall psychological well-being and better mental health in people with a growth mindset due to <\/span><span lang=\"EN-US\">their <\/span><span lang=\"EN-US\">adjustment skills (Whittington et al., 2017). Although there have been limited studies directly correlating growth <\/span><span lang=\"EN-US\">mindsets<\/span><span lang=\"EN-US\"> and self-care, Orvidas et al<\/span><span lang=\"EN-US\">.<\/span><span lang=\"EN-US\"> (2018) <\/span><span lang=\"EN-US\">reported<\/span><span lang=\"EN-US\"> that mindsets lead to self-regulatory actions to help <\/span><span lang=\"EN-US\">people <\/span><span lang=\"EN-US\">engage in exercise and healthy eating habits<\/span><span lang=\"EN-US\">,<\/span><span lang=\"EN-US\"> which are attributed to two of the ten domains of self-care by Ayala et al<\/span><span lang=\"EN-US\">. (<\/span><span lang=\"EN-US\">2017<\/span><span lang=\"EN-US\">).<\/span><span lang=\"EN-US\"> This is due to the fact that growth mindsets are important for increasing the capacity to engage in activities even when challenges arise, as it enables understanding of the value and self-relevance of such activities (Ayala et al., 2017).<\/span><span lang=\"EN-US\">\u00a0<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">Individuals with a growth mindset have intrinsic motivation and show resilience<\/span><span lang=\"EN-US\">,<\/span><span lang=\"EN-US\"> which translates <\/span><span lang=\"EN-US\">in<\/span><span lang=\"EN-US\">to self-care <\/span><span lang=\"EN-US\">abilities<\/span><span lang=\"EN-US\"> during periods of <\/span><span lang=\"EN-US\">distress (<\/span><span lang=\"EN-US\">Alatorre et al., 2020<\/span><span lang=\"EN-US\">; Root Kustritz, 2017).<\/span><span lang=\"EN-US\"> Additionally<\/span><span lang=\"EN-US\">, growth-mindset individuals value<\/span><span lang=\"EN-US\"> personal growth, autonomy, purpose in life, and self-acceptance<\/span><span lang=\"EN-US\">,<\/span><span lang=\"EN-US\"> which could explain their self-care abilities and psychological well-being (Whittington et al., 2017). <\/span><span lang=\"EN-US\">Individuals with a fixed<\/span><span lang=\"EN-US\"> mindset <\/span><span lang=\"EN-US\">are<\/span><span lang=\"EN-US\"> more prone to stress and unhealthy perfectionism<\/span><span lang=\"EN-US\">, which are linked<\/span><span lang=\"EN-US\"> to suicidal <\/span><span lang=\"EN-US\">behaviours<\/span><span lang=\"EN-US\"> (Dweck, 2013). <\/span><span lang=\"EN-US\">A fixed<\/span><span lang=\"EN-US\"> mindset does not believe in change, and self-care to bring about positive change <\/span><span lang=\"EN-US\">may<\/span><span lang=\"EN-US\"> not be appreciated (Root Kustritz, 2017). A meta-analysis conducted by Burnette et al. (2020) concluded that there is a negative relationship between growth mindset and psychological distress, but a positive correlation <\/span><span lang=\"EN-US\">with<\/span><span lang=\"EN-US\"> active coping and treatment values<\/span><span lang=\"EN-US\">,<\/span><span lang=\"EN-US\"> indicating that a growth mindset places value on self-care (Burnette et al., 2020).<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">Selection, complexity, reliability and generalisability biases could occur with quota sampling employed in this study. Selection bias was mitigated by calculating the sample size based on the population in the respective medical schools and complexity was avoided by including two protype schools only. The alpha values for the data ensured reliability. Since this was a pilot study the findings were not generalised but were intended to gauge the logistic and statistical feasibility of a nationwide study. <\/span><span lang=\"EN-US\">Although<\/span><span lang=\"EN-US\"> respondents were informed of their anonymity prior to answering the questionnaire to <\/span><span lang=\"EN-US\">minimise<\/span><span lang=\"EN-US\"> bias, some respondents might have wanted to demonstrate their positive side and<\/span><span lang=\"EN-US\">,<\/span><span lang=\"EN-US\"> therefore<\/span><span lang=\"EN-US\">, present<\/span><span lang=\"EN-US\"> themselves as having self-care abilities and <\/span><span lang=\"EN-US\">a <\/span><span lang=\"EN-US\">growth mindset<\/span><span lang=\"EN-US\">,<\/span><span lang=\"EN-US\"> giving rise to response bias.<\/span><\/p>\r\n<p style=\"text-align: center;\"><strong><span lang=\"EN-GB\">V. CONCLUSION<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">The findings of this pilot study indicate that although students are in favour of self-care capacity and its development, they lack of self-care ability in practice, factors of which could be explored qualitatively in future research. The positive correlation between a growth mindset and self-care ability could be utilised in medical curricula by integrating <\/span><span lang=\"EN-MY\">mindset training to enhance self-care capacity among the students. <\/span><span lang=\"EN-US\">This pilot study also provides justification for a nationwide, <\/span><span lang=\"EN-MY\">multi-institutional<\/span><span lang=\"EN-MY\"> <\/span><span lang=\"EN-US\">global research. <\/span><\/p>\r\n<p style=\"text-align: center;\"><span lang=\"EN-US\"> <strong><span lang=\"EN-GB\">Notes on Contributors<\/span><\/strong><\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">RMA was involved in literature search, data <\/span><span lang=\"EN-US\">acquisition<\/span><span lang=\"EN-US\"> and analysis<\/span><span lang=\"EN-US\">,<\/span><span lang=\"EN-US\"> manuscript preparation and revision. <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">FCC was involved in <\/span><span lang=\"EN-US\">the <\/span><span lang=\"EN-US\">study conception and design, data analysis, manuscript editing<\/span><span lang=\"EN-US\">,<\/span><span lang=\"EN-US\"> and review. <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">HMF was involved in the study conception and design and manuscript review. <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">MNMN was involved <\/span><span lang=\"EN-US\">in data<\/span><span lang=\"EN-US\"> acquisition and manuscript revision. <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">All the authors approved the final version of the manuscript and its revised versions.<\/span><\/p>\r\n<p align=\"center\" style=\"text-align: center;\"><strong><span lang=\"EN-GB\">Ethical Approval<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">Ethical<\/span><span lang=\"EN-US\"> approval was obtained from the research ethics <\/span><span lang=\"EN-US\">committees<\/span><span lang=\"EN-US\"> of both the public and private universities, (UM.TNC2\/UMREC_2872 and RMC\/SEP\/2023\/EC02<\/span><span lang=\"EN-US\">, respectively<\/span><span lang=\"EN-US\">) in accordance with the Declaration of Helsinki.<\/span><\/p>\r\n<p align=\"center\" style=\"text-align: center;\"><strong><span lang=\"EN-GB\">Data Availability<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">As per the <\/span><span lang=\"EN-US\">requirements<\/span><span lang=\"EN-US\"> of the local ethics committees, data will be <\/span><span lang=\"EN-US\">stored<\/span><span lang=\"EN-US\"> in an enclosed and dedicated facility in the faculty building. <\/span><span lang=\"EN-US\">The datasets used and\/or analysed in the current study are available from the corresponding author upon reasonable request.<\/span><span lang=\"EN-US\">\u00a0<\/span><\/p>\r\n<p align=\"center\" style=\"text-align: center;\"><strong><span lang=\"EN-GB\">Acknowledgement<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">The authors express their sincere gratitude to all the students who participated in this study. <\/span><span lang=\"EN-US\">\u00a0<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Funding<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">The authors declare no sources of funding. <\/span><\/p>\r\n<p align=\"center\" style=\"text-align: center;\"><strong><span lang=\"EN-GB\">Declaration of Interest<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">The authors declare that they have no competing interests.<\/span><\/p>\r\n<p align=\"center\" style=\"text-align: center;\"><strong><span lang=\"EN-GB\">References<\/span><\/strong><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Aida, J., Hizlinda, T., Siti Fatimah, S., Mohd Muhaimin, A., Chai, S. Y., Sahrina, W., &amp; Teo, B. H. (2014). Psychological disorders and help seeking behaviour among Malaysian medical students in their clinical years. <i>Medicine &amp; Health<\/i>,\u00a0<i>9<\/i>(2), 114\u201323. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/www.researchgate.net\/publication\/272093951\">https:\/\/www.researchgate.net\/publication\/272093951<\/a><\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Alatorre, A. I., DePaola, R. V., &amp; Haeffel, G. J. (2020). Academic achievement and depressive symptoms: Are fixed mindsets distinct from negative attributional style? <i>Learning and Individual Differences<\/i>, <i>77<\/i>, 101811. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1016\/j.lindif.2019.101811\">https:\/\/doi.org\/10.1016\/j.lindif.2019.101811<\/a><\/span><span lang=\"EN-US\"> <\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Alhambra-Borr\u00e1s, T., Dur\u00e1-Ferrandis, E., Garc\u00e9s-Ferrer, J., &amp; S\u00e1nchez-Garc\u00eda, J. (2017). The Appraisal of Self-Care Agency Scale &#8211; Revised (ASA-R): Adaptation and validation in a sample of Spanish older adults.\u00a0<i>The Spanish Journal of Psychology<\/i>, <i>20<\/i>, E48. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1017\/sjp.2017.52\">https:\/\/doi.org\/10.1017\/sjp.2017.52<\/a><\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Ayala, E. E., Omorodion, A. M., Nmecha, D., Winseman, J. S., &amp; Mason, H. R. C. (2017). What do medical students do for self-care? A student-centered approach to well-being. <i>Teaching and <\/i><i>Learning in Medicine<\/i>, <i>29<\/i>(3), 237\u2013246. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1080\/10401334.2016.1271334\">https:\/\/doi.org\/10.1080\/10401334.2016.1271334<\/a><\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">\u00a0<\/span><span lang=\"EN-US\">Ayala, E. E., Winseman, J. S., Johnsen, R. D., &amp; Mason, H. R. C. (2018). U.S. medical students who engage in self-care report less stress and higher quality of life. <i>BMC<\/i><i> Medical Education<\/i>, <i>18<\/i>(1), 189. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1186\/s12909-018-1296-x\">https:\/\/doi.org\/10.1186\/s12909-018-1296-x<\/a><\/span><span lang=\"EN-US\"> <\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Bostock, R., Kinnison, T., &amp; May, S. A. (2018). Mindset and its relationship to anxiety in clinical veterinary students. <i>Veterinary Record<\/i>, <i>183<\/i>(20), 623\u2013623. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1136\/vr.104621\">https:\/\/doi.org\/10.1136\/vr.104621<\/a><\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Boyd, A., Mealand, K., Briggs Early, K., &amp; Oestreich, E. (2023). Perceived stress, grit, and self-care behaviours in first-year medical students. <i>American Journal of Lifestyle Medicine<\/i>,\u00a0<i>17<\/i>(6), 803-812. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1177\/15598276221124576\">https:\/\/doi.org\/<span lang=\"EN-MY\">10.1177\/15598276221124576<\/span><\/a><\/span><span lang=\"EN-MY\"> <\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Burnette, J. L., Knouse, L. E., Vavra, D. T., O\u2019Boyle, E., &amp; Brooks, M. A. (2020). Growth mindsets and psychological distress: A meta-analysis. <i>Clinical Psychology Review<\/i>, <i>77<\/i>, 101816. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1016\/j.cpr.2020.101816\">https:\/\/doi.org\/10.1016\/j.cpr.2020.101816<\/a><\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Carter, A. N., Evans, J., Seibert, S. A., &amp; Weir, S. (2025). Growth mindset enhancement for new nursing students.\u00a0<i>Teaching and Learning in Nursing<\/i>,\u00a0<i>20<\/i>(1), e258-e262. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1016\/j.teln.2024.10.023\"><span lang=\"EN-MY\">https:\/\/doi.org\/10.1016\/j.teln.2024.10.023<\/span><\/a><\/span><span lang=\"EN-MY\"> <\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Cook, D. A., Castillo, R. M., Gas, B., &amp; Artino Jr., A. R. (2017). Measuring achievement goal motivation, mindsets and cognitive load: Validation of three instruments\u2019 scores. <i>Medical <\/i><i>Education<\/i>, <i>51<\/i>(10), 1061\u20131074. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1111\/medu.13405\">https:\/\/doi.org\/10.1111\/medu.13405<\/a><\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Cook, D. A., Gas, B. L., &amp; Artino, Jr., A. R. (2018). Measuring mindsets and achievement goal motivation: A validation study of three instruments. <i>Academic Medicine<\/i>, <i>93<\/i>(9), 1391\u20131399. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1097\/ACM.0000000000002290\">https:\/\/doi.org\/10.1097\/ACM.0000000000002290<\/a><\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Dam\u00e1sio, B. F., &amp; Koller, S. H. (2013). The Appraisal of Self-Care Agency Scale &#8211; Revised (ASAS-R): Adaptation and construct validity in the Brazilian context. <i>Cadernos de Sa\u00fade P\u00fablica<\/i>, <i>29<\/i>(10), 2071\u20132082. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1590\/0102-311x00165312\">https:\/\/doi.org\/10.1590\/0102-311X00165312<\/a><\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Dweck, C. S. (2013). <i>Self-theories: Their role in motivation, personality, and development<\/i>. Psychology Press.<\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Evers, G. C. (1989). Appraisal of Self-Care Agency ASA-scale: Reliability and validity testing of the Dutch version of the ASA-scale measuring Orem&#8217;s concept&#8217; Self-Care Agency&#8217;. [Doctoral thesis, Maastricht University]. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.26481\/dis.19890629ge\">https:\/\/doi.org\/10.26481\/dis.19890629ge<\/a><\/span><span lang=\"EN-US\"> <\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Gold, J. A., Johnson, B., Leydon, G., Rohrbaugh, R. M., &amp; Wilkins, K. M. (2015). Mental health self-care in medical students: A comprehensive look at help-seeking. <i>Academic Psychiatry<\/i>, <i>39<\/i>(1), 37\u201346. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1007\/s40596-014-0202-z\">https:\/\/doi.org\/10.1007\/s40596-014-0202-z<\/a><\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Guldner, G., Siegel, J., Ellis, B., &amp; Brafford, A. (2020, February 27\u201329). <i>The role of mindset, impostorism, and irrational beliefs in resident wellness: Results from the HCA Nationwide Longitudinal Resident Wellness Study<\/i> [Poster presentation]. ACGME 2020 Annual Educational Conference, San Diego, CA. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/scholarlycommons.hcahealthcare.com\/teaching-learning\/5\/\">https:\/\/scholarlycommons.hcahealthcare.com\/teaching-learning\/5\/<\/a><\/span><span lang=\"EN-US\"><\/span><span lang=\"EN-US\">\u00a0<\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Guo, L., Zauszniewski, J. A., Ding, X., Zhang, L., Gao, H., Guo, Q., &amp; Liu, K. (2017). The Appraisal of Self-Care Agency Scale &#8211; Revised (ASAS-R): Reliability and validity among older Chinese people. <i>Western Journal of Nursing Research<\/i>, <i>39<\/i>(11), 1459\u20131476. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1177\/0193945916672821\">https:\/\/doi.org\/10.1177\/0193945916672821<\/a><\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Hair, J. F., Black, W. C., Babin, B. J., Anderson, R. E., &amp; Tatham, R. L. (2006). <i>Multivariate data analysis <\/i>(6<sup>th<\/sup> ed.). Pearson Prentice Hall.<\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Hong, Y. Y., Chiu, C. Y., Dweck, C. S., Lin, D. M. S., &amp; Wan, W. (1999). Implicit theories, attributions, and coping: A meaning system approach. <i>Journal of Personality and Social <\/i><i>Psychology<\/i>, <i>77<\/i>(3), 588\u2013599. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1037\/0022-3514.77.3.588\">https:\/\/doi.org\/10.1037\/0022-3514.77.3.588<\/a><\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Kim, H. Y. (2013). Statistical notes for clinical researchers: Assessing normal distribution (2) using skewness and kurtosis. <i>Restorative Dentistry &amp; Endodontics<\/i>, <i>38<\/i>(1), 52\u201354. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.5395\/rde.2013.38.1.52\">https:\/\/doi.org\/10.5395\/rde.2013.38.1.52<\/a><\/span><span lang=\"EN-US\"><\/span><span lang=\"EN-US\">\u00a0<\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Komser, N., &amp; \u00d6zakg\u00fcl, A. (2023). Attitudes of coping with stress and self-care agency levels of nursing students. <i>Journal of Education <\/i><i>and Research in Nursing<\/i>, <i>20<\/i>(1), 28\u201334. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.5152\/jern.2023.21004\">https:\/\/doi.org\/10.5152\/jern.2023.21004<\/a><\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Lowe, N. K. (2019). What is a pilot study? <i>Journal of Obstetric, Gynecologic &amp; Neonatal Nursing<\/i>, <i>48<\/i>(2), 117\u2013118. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1016\/j.jogn.2019.01.005\">https:\/\/doi.org\/10.1016\/j.jogn.2019.01.005<\/a><\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Masilamani, R., Jabbar, M. A., Liang, C. S., You, H. L. S., Jonathan, L. J. K., Pei-Suen, W., Yuan, Y.X. &amp; Ling, Y. M. (2020). Stress, stressors, and coping strategies between pre-clinical and clinical medical students at Universiti Tunku Abdul Rahman.\u00a0<i>Malaysian Journal of Public Health Medicine<\/i>,\u00a0<i>20<\/i>(1), 175-183. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.37268\/mjphm\/vol.20\/no.1\/art.503\">https:\/\/doi.org\/10.37268\/mjphm\/vol.20\/no.1\/art.503<\/a> <\/span><span lang=\"EN-MY\"><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Oliveira, L., Teixeira, A., &amp; Duarte, I. (2022). The Appraisal of Self-Care Agency Scale &#8211; Revised (ASAS-R): Reliability and validity among Portuguese medical students. <i>International Journal of Environmental Research and Public Health<\/i>, <i>19<\/i>(17), 10848. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.3390\/ijerph191710848\">https:\/\/doi.org\/10.3390\/ijerph191710848<\/a><\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Orem, D. E., Taylor, S. G., &amp; Renpenning, K. M. (1995). <i>Nursing: Concepts of practice.<\/i> Mosby.<\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Orvidas, K., Burnette, J. L., &amp; Russell, V. M. (2018). Mindsets applied to fitness: Growth beliefs predict exercise efficacy, value and frequency. <i>Psychology of Sport and Exercise<\/i>, <i>36<\/i>, 156\u2013161. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1016\/j.psychsport.2018.02.006\">https:\/\/doi.org\/10.1016\/j.psychsport.2018.02.006<\/a><\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Root Kustritz, M. V. (2017). Pilot study of veterinary student mindset and association with academic performance and perceived stress. <i>Journal of <\/i><i>Veterinary Medical Education<\/i>, <i>44<\/i>(1), 141\u2013146. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.3138\/jvme.1115-181R1\">https:\/\/doi.org\/10.3138\/jvme.1115-181R1<\/a><\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Sch\u00f6nenberg, A., Teschner, U., Prell, T., &amp; M\u00fchlhammer, H. M. (2022). Validation and psychometric analysis of the German translation of the appraisal of self-care agency scale-revised. <i>Healthcare<\/i><i>, 10<\/i>(9), 1785. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.3390\/healthcare10091785\">https:\/\/doi.org\/10.3390\/healthcare10091785<\/a><\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Sousa, V. D., Zauszniewski, J. A., Bergquist-Beringer, S., Musil, C. M., Neese, J. B., &amp; Jaber, A. F. (2010). Reliability, validity and factor structure of the Appraisal of Self\u2010Care Agency Scale &#8211; Revised (ASAS\u2010R). <i>Journal of <\/i><i>Evaluation in Clinical Practice<\/i>, <i>16<\/i>(6), 1031\u20131040. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1111\/j.1365-2753.2009.01242.x\">https:\/\/doi.org\/10.1111\/j.1365-2753.2009.01242.x<\/a><\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Sun, X., Nancekivell, S., Gelman, S. A., &amp; Shah, P. (2021). Growth mindset and academic outcomes: A comparison of US and Chinese students.<i> NPJ Science of Learning<\/i>, <i>6<\/i>(1), 21. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1038\/s41539-021-00100-z\">https:\/\/doi.org\/10.1038\/s41539-021-00100-z<\/a><\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Theard, M. A., Marr, M. C., &amp; Harrison, R. (2021). The growth mindset for changing medical education culture. <i>eClinicalMedicine<\/i>, <i>37<\/i>, 100972. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1016\/j.eclinm.2021.100972\">https:\/\/doi.org\/10.1016\/j.eclinm.2021.100972<\/a><\/span><span lang=\"EN-US\"><\/span><span lang=\"EN-US\">\u00a0<\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Thomas, F. N., Burnette, J. L., &amp; Hoyt, C. L. (2019). Mindsets of health and healthy eating intentions. <i>Journal of <\/i><i>Applied Social Psychology<\/i>, <i>49<\/i>(6), 372\u2013380. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1111\/jasp.12589\">https:\/\/doi.org\/10.1111\/jasp.12589<\/a><\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Wan, C. D. (2007). Public and private higher education institutions in Malaysia: Competing, complementary or crossbreed as education providers. <i>Kajian Malaysia<\/i>, <i>25<\/i>(1), 1\u201314. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/www.researchgate.net\/publication\/49583836\">https:\/\/www.researchgate.net\/publication\/49583836<\/a><\/span><span lang=\"EN-US\"> <\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">\u00a0<\/span><span lang=\"EN-US\">Whittington, R. E., Rhind, S., Loads, D., &amp; Handel, I. (2017). Exploring the link between mindset and psychological well-being among veterinary students. <i>Journal of <\/i><i>Veterinary Medical Education<\/i>, <i>44<\/i>(1), 134\u2013140. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.3138\/jvme.1215-192R\">https:\/\/doi.org\/10.3138\/jvme.1215-192R<\/a><\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Winfrey, S. E. (2020). Validating the mindset scale for use with international students attending college in the United States\u00a0[Doctoral dissertation, North Dakota State University]. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/hdl.handle.net\/10365\/32293\">https:\/\/hdl.handle.net\/10365\/32293<\/a><\/span><span lang=\"EN-US\"> \u00a0<\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Wolcott, M. D., McLaughlin, J. E., Hann, A., Miklavec, A., Beck Dallaghan, G. L., Rhoney, D. H., &amp; Zomorodi, M. (2021). A review to characterise and map the growth mindset theory in health professions education. <i>Medical Education<\/i>, <i>55<\/i>(4), 430\u2013440. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1111\/medu.14381\">https:\/\/doi.org\/10.1111\/medu.14381<\/a><\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Yuan, S. L. K., Couto, L. A., &amp; Marques, A. P. (2021). Effects of a six-week mobile app versus paper book intervention on quality of life, symptoms, and self-care in patients with fibromyalgia: A randomized parallel trial. <i>Brazilian <\/i><i>Journal of Physical Therapy<\/i>, <i>25<\/i>(4), 428\u2013436. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1016\/j.bjpt.2020.10.003\">https:\/\/doi.org\/10.1016\/j.bjpt.2020.10.003<\/a><\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Yusoff, M. S. B., Abdul Rahim, A. F., Baba, A. A., Ismail, S. B., Mat Pa, M. N., &amp; Esa, A. R. (2013). The impact of medical education on psychological health of students: A cohort study. <i>Psychology, Health &amp; Medicine<\/i>, <i>18<\/i>(4), 420\u2013430. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1080\/13548506.2012.740162\">https:\/\/doi.org\/10.1080\/13548506.2012.740162<\/a><\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Yusoff, M. S. B., Yee, L. Y., Wei, L. H., Meng, L. H., Bin, L. X., Siong, T. C., &amp; Rahim, A. F. A. (2011). A study on stress, stressors and coping strategies among Malaysian medical students. <i>International Journal of <\/i><i>Students\u2019 Research<\/i>, <i>1<\/i>(2), 45\u201350. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/www.researchgate.net\/publication\/50944546_A_study_on_stress_stressors_and_coping_strategies_among_Malaysian_medical_students\">https:\/\/www.researchgate.net\/publication\/50944546_A_study_on_stress_stressors_and_coping_strategies_among_Malaysian_medical_students<\/a><\/span><\/p>\r\n<p style=\"text-align: left;\">*Foong Chan Choong <br \/>\r\nMedical Education and Research Development Unit, <br \/>\r\nFaculty of Medicine, Universiti Malaya, Malaysia<br \/>\r\n+0060 12-419 1248<br \/>\r\nEmail: foongchanchoong@um.edu.my<\/p>\r\n<\/div>\r\n<\/div>\r\n<\/div>","protected":false},"featured_media":0,"parent":0,"menu_order":4,"template":"","issues_category":[12],"archive_category":[],"issue_type":[25],"volume_category":[61897],"class_list":["post-72979","issues","type-issues","status-publish","hentry","issues_category-original-articles","issue_type-past-issue","volume_category-volume-10-number-4-october-2025-2"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Analyses of self-care agency and mindset: A pilot study on Malaysian undergraduate medical students - The Asia Pacific Scholar<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/analyses-of-self-care-agency-and-mindset-pilot-study-on-malaysian-undergraduate-medical-students\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Analyses of self-care agency and mindset: A pilot study on Malaysian undergraduate medical students - The Asia Pacific Scholar\" \/>\n<meta property=\"og:description\" content=\"Submitted: 28 October 2024 Accepted: 16 June 2025 Published online: 7 October, TAPS 2025, 10(4), 35-43 https:\/\/doi.org\/10.29060\/TAPS.2025-10-4\/OA3559 Reshma Mohamed Ansari1,2, Chan Choong Foong3, Hidayah Mohd Fadzil4 &amp; Mohamad Nabil Mohd Noor3 1Institute for Advanced Studies, Universiti Malaya, Malaysia; 2Department of Medical Education, International Medical School, Management and Science University, Malaysia; 3Medical Education and Research Development [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/analyses-of-self-care-agency-and-mindset-pilot-study-on-malaysian-undergraduate-medical-students\/\" \/>\n<meta property=\"og:site_name\" content=\"The Asia Pacific Scholar\" \/>\n<meta property=\"article:modified_time\" content=\"2026-01-06T01:08:29+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"27 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/analyses-of-self-care-agency-and-mindset-pilot-study-on-malaysian-undergraduate-medical-students\/\",\"url\":\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/analyses-of-self-care-agency-and-mindset-pilot-study-on-malaysian-undergraduate-medical-students\/\",\"name\":\"Analyses of self-care agency and mindset: A pilot study on Malaysian undergraduate medical students - The Asia Pacific Scholar\",\"isPartOf\":{\"@id\":\"https:\/\/medicine.nus.edu.sg\/taps\/#website\"},\"datePublished\":\"2025-10-07T00:30:41+00:00\",\"dateModified\":\"2026-01-06T01:08:29+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/analyses-of-self-care-agency-and-mindset-pilot-study-on-malaysian-undergraduate-medical-students\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/analyses-of-self-care-agency-and-mindset-pilot-study-on-malaysian-undergraduate-medical-students\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/analyses-of-self-care-agency-and-mindset-pilot-study-on-malaysian-undergraduate-medical-students\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/medicine.nus.edu.sg\/taps\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Analyses of self-care agency and mindset: A pilot study on Malaysian undergraduate medical students\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/medicine.nus.edu.sg\/taps\/#website\",\"url\":\"https:\/\/medicine.nus.edu.sg\/taps\/\",\"name\":\"The Asia Pacific Scholar\",\"description\":\"\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/medicine.nus.edu.sg\/taps\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Analyses of self-care agency and mindset: A pilot study on Malaysian undergraduate medical students - The Asia Pacific Scholar","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/medicine.nus.edu.sg\/taps\/issues\/analyses-of-self-care-agency-and-mindset-pilot-study-on-malaysian-undergraduate-medical-students\/","og_locale":"en_US","og_type":"article","og_title":"Analyses of self-care agency and mindset: A pilot study on Malaysian undergraduate medical students - The Asia Pacific Scholar","og_description":"Submitted: 28 October 2024 Accepted: 16 June 2025 Published online: 7 October, TAPS 2025, 10(4), 35-43 https:\/\/doi.org\/10.29060\/TAPS.2025-10-4\/OA3559 Reshma Mohamed Ansari1,2, Chan Choong Foong3, Hidayah Mohd Fadzil4 &amp; Mohamad Nabil Mohd Noor3 1Institute for Advanced Studies, Universiti Malaya, Malaysia; 2Department of Medical Education, International Medical School, Management and Science University, Malaysia; 3Medical Education and Research Development [&hellip;]","og_url":"https:\/\/medicine.nus.edu.sg\/taps\/issues\/analyses-of-self-care-agency-and-mindset-pilot-study-on-malaysian-undergraduate-medical-students\/","og_site_name":"The Asia Pacific Scholar","article_modified_time":"2026-01-06T01:08:29+00:00","twitter_card":"summary_large_image","twitter_misc":{"Est. reading time":"27 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/medicine.nus.edu.sg\/taps\/issues\/analyses-of-self-care-agency-and-mindset-pilot-study-on-malaysian-undergraduate-medical-students\/","url":"https:\/\/medicine.nus.edu.sg\/taps\/issues\/analyses-of-self-care-agency-and-mindset-pilot-study-on-malaysian-undergraduate-medical-students\/","name":"Analyses of self-care agency and mindset: A pilot study on Malaysian undergraduate medical students - The Asia Pacific Scholar","isPartOf":{"@id":"https:\/\/medicine.nus.edu.sg\/taps\/#website"},"datePublished":"2025-10-07T00:30:41+00:00","dateModified":"2026-01-06T01:08:29+00:00","breadcrumb":{"@id":"https:\/\/medicine.nus.edu.sg\/taps\/issues\/analyses-of-self-care-agency-and-mindset-pilot-study-on-malaysian-undergraduate-medical-students\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/medicine.nus.edu.sg\/taps\/issues\/analyses-of-self-care-agency-and-mindset-pilot-study-on-malaysian-undergraduate-medical-students\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/medicine.nus.edu.sg\/taps\/issues\/analyses-of-self-care-agency-and-mindset-pilot-study-on-malaysian-undergraduate-medical-students\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/medicine.nus.edu.sg\/taps\/"},{"@type":"ListItem","position":2,"name":"Analyses of self-care agency and mindset: A pilot study on Malaysian undergraduate medical students"}]},{"@type":"WebSite","@id":"https:\/\/medicine.nus.edu.sg\/taps\/#website","url":"https:\/\/medicine.nus.edu.sg\/taps\/","name":"The Asia Pacific Scholar","description":"","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/medicine.nus.edu.sg\/taps\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"}]}},"_links":{"self":[{"href":"https:\/\/medicine.nus.edu.sg\/taps\/wp-json\/wp\/v2\/issues\/72979","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medicine.nus.edu.sg\/taps\/wp-json\/wp\/v2\/issues"}],"about":[{"href":"https:\/\/medicine.nus.edu.sg\/taps\/wp-json\/wp\/v2\/types\/issues"}],"wp:attachment":[{"href":"https:\/\/medicine.nus.edu.sg\/taps\/wp-json\/wp\/v2\/media?parent=72979"}],"wp:term":[{"taxonomy":"issues_category","embeddable":true,"href":"https:\/\/medicine.nus.edu.sg\/taps\/wp-json\/wp\/v2\/issues_category?post=72979"},{"taxonomy":"archive_category","embeddable":true,"href":"https:\/\/medicine.nus.edu.sg\/taps\/wp-json\/wp\/v2\/archive_category?post=72979"},{"taxonomy":"issue_type","embeddable":true,"href":"https:\/\/medicine.nus.edu.sg\/taps\/wp-json\/wp\/v2\/issue_type?post=72979"},{"taxonomy":"volume_category","embeddable":true,"href":"https:\/\/medicine.nus.edu.sg\/taps\/wp-json\/wp\/v2\/volume_category?post=72979"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}