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ORIGINAL ARTICLE
3 (
1
); 38-46
doi:
10.21106/ijtmrph.78

Stress Coping Strategies Among Secondary School-Aged Students in Government Schools in Northern West Bank/Palestine

Public Health Department, Faculty of Medical and Health Sciences, An-Najah National University, Nablus, Palestine
Faculty of Nursing, Arab American University, Jenin, Palestine
Corresponding author email: m.altell@najah.edu
Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background or Objectives:

All humans by nature cope with stressors by using productive and non-productive coping strategies. Adolescents and students in particular experience stress mainly due to academic examinations but the strategies adopted by students in the West Bank/Palestine are largely unknown and understudied. This study examines stress-coping strategies adopted by general secondary school-aged students in government schools in Northern West Bank.

Methods:

This is a quantitative designed study of 334 students selected from 39 schools utilizing a stratified random sampling method. A self-reporting questionnaire composed of Brief Coping Orientation of Problems Experienced (COPE) was used to identify stress management methods among the students.

A scale consisting of 14 domains representing 28 coping methods was created with the following 4-likert- scale response choices: 1) “I haven't been doing this at all,” 2) “I've been doing this a little bit,” 3) “I've been doing this a medium amount,” and 4) “I've been doing this a lot.” Respondents reported their views scoring them from 1-4; the mean for each method was calculated and ranged from scores 2-6.

Results:

In all, religion (6.30±1.6,1) and planning (6.11±1.35) methods were the predominant domains of coping methods used by majority of the students. Problem-focused and emotion-focused coping methods were used more than the “less-useful” coping methods more among females than by their male counterparts. The “use of instrumental support,” “denial,” and “behavioral disengagement” were methods used more by students in the humanities than their counterparts in the scientific branches.

Conclusion and Implications for Translation:

Almost all of the students have different levels of stress with different effects. The useful (i.e., “problem-focused” and “emotion-focused”) coping methods were mostly used by students, and the “less useful” coping once were used a “little bit.” Religion and planning were the predominant coping methods used by students. It is recommended that schools should emphasize on the use of useful evidence-base coping methods to deal with their stress.

Keywords

Stress
Coping
Coping methods
Secondary schools
Students

Introduction

Background of the study

Childhood and adolescence is an important transitional period in the development of coping mechanisms for stress. The ability to cope with stress is considered a central feature of human development. Naturally, all humans are confronted with threatening and challenging events in their daily life that need for action and readjustment.1 Adolescents might face problems in coping with stress, and they need new educational programs in schools to learn how to cope with stress.2 Most students face different problems, challenges, obstacles and situations that can produce or increase stress. The different level of stress and or poor management of stress may affect the academic performance and achievements of students. Managing and coping with these stressors are the cornerstones to pass any transitional period. Identifying how students cope with stress in their daily life is a crucial issue as maladaptive and poor management will inversely affect students' future. The results of this study might help to take effective steps to reduce stressors among students through designing related training programs for all staff caring for school-aged children and adolescents.

Coping and coping strategies

Coping is defined as the ability to deal with an attempt to overcome problems and difficulties.3 Carver and Connor-Smith define coping as efforts to prevent or diminish threat, harm, and loss or to reduce associated distress.4 Coping strategies also refer to specific efforts, both behavioral and psychological, that people employ to master, tolerate, reduce, or minimize stressful events.5,6 Three types of coping strategies have been identified by Xiao7 and Chen.8 The first is the passive coping strategies that include withdrawal, imagining, ignoring, waiting, and catharsis. The second is the maintenance coping strategies which include self-adjustment, self-restraint, and replacement. Thirdly, active coping strategies and include problem-solving, seeking support, cognitive reconstruction, and comparison.

According to Carver et al.,9 coping strategies are categorized into three categories. First is the “problem-focused coping” which includes active coping, planning, and suppression of competing activities, restraint coping and seeking of instrumental social support. The second is the “emotion-focused coping” which contains seeking of emotional social support, positive reinterpretation (positive reframing), acceptance, denial, and turning to religion. The third category is the “less useful” one and includes focus on and venting of emotions (venting), behavioral disengagement, mental disengagement (self-distraction), humor, and substance use. Other two forms of coping were developed by Lazarus & Folkman,10 the-problem-focused coping and emotional-focused coping.

Using the problem-focused coping strategy, individuals develop more skills to help them cope with other situations in the future.11 It includes four steps: 1) Define the problem, 2) Generate alternative solutions, 3) Learn new skills to deal with stressors, 4) Reappraise and find new standards of behaviour.”12 Alternatively, using the emotion-focused coping, individuals change their emotional response to the stressor by diminishing the negative emotion such as embarrassment, fear, and frustration that is associated with stress. It includes different responses, such as self-soothing, expression of negative emotion, and attempts to escape stressful situations.4 It involves gaining strategies for regulating stress such as 1) Avoiding (I am not going to school), 2) Distancing (yourself from the stress, ‘it doesn't matter’), 3) Acceptance (I failed that exam, but I have 4 other subjects), 4) Seeking medical support, 5) Turning to alcohol.12

Education system in palestine

Until the year 2019, the education system in Palestine was divided into two phases. The first phase constitutes the basic phase from the first to 10th grade, and the second phase includes the 11th - 12th grade. Thus, the total number of study years in school is 12 years. By the end of 10th grade, regular students can select the study branches based on their grades; these branches are scientific, the humanities, and commercial branches.13 At the end of the academic year, the 12th grade, students sit for the General Secondary Schools Examination (Tawjihi Exam), which is a unified examination according to each study branch.

This examination is crucial for most students as they considered it a gateway to study at university. In this period, many students expend vast efforts to achieve as highly as they can. Based on their total marks, they can gain admission to the college and specialty; the higher the total marks, the better the opportunity to select from among the most prestigious faculty/school. For example, a student who wants to study medicine or pharmacy requires a total mark in his or her Tawjihi exam of not less than 95%. In the Palestinian community, most students suffer from tension and stress due to the culture prevailing in society. Students who achieve high grades can select between the medicine, engineering or pharmacy which are considered the highest specialties and so they earn respect among their families, community and society. In general, it is widely known that students in all academic years are distressed regardless of country or its educational system. In Palestine, no studies have explored the nature of the stressors or the coping methods to overcome them. This study will highlight the most predominant methods used by Palestinian students and provide options on how to potentially help them.

Objectives of the study

This study aimed at identifying the coping strategies used by general secondary students in governmental schools in the North West Bank. For this study, we hypothesized that there are no significant differences in the domains of coping strategies used by students according to gender. We also hypothesized that there would be no significant difference in the domains of coping strategies used by students according to study branch.

Methods

Our dependent variable was coping methods, while our independent varible was gender and study branch. The Brief Coping Orientation of Problem Experienced (COPE) scale developed by Carver15, was used to identify methods used by students in managing stress. COPE includes 14 domains represented by 28 coping methods. Each item composed of statement with four Likert scale choices: “I haven't been doing this at all,” “I've been doing this a little bit,” “I've been doing this a medium amount”, and “I've been doing this a lot” with scoring method 1 to 4 respectively. Each response was given a point from 1-4 respectively, and the total mean was then calculated for each coping method. The independent t-test was used to test the hypothesis utilizing the Statistical Package for Social Sciences Program (SPSS) version 20. To ensure the reliability and validity of the questionnaire tool, back translation from English to Arabic and from Arabic to English was conducted by expert translators, and then the questionnaire was reviewed by a panel of experts in the academic and psychological fields. A pilot study was carried out on 10% of a sample size between 4th and 6th October, 2015. The reliability coefficient Cronbach alpha was (0.801) and for the original (COPE) scale it ranged from (0.50-0.82).14

Ethical approval

A formal consent form was signed by the parents of students; in addition, the study was approved by the Institutional Review Board (IRB) of An-Najah National University and Palestinian Ministry of Education. Due to a limitation in time, efforts, and money the study was confined to only governmental schools and to only two study variables (gender and study branch).

Results

Sociodemographic characteristics

Table 1 shows that 61.4% of participants were female. Of this number, about 69.2% studied in the humanities branch. Table 2 shows that 46.7% of the students reported that they have a little bit of stress, but it did not affect their general functioning, and 4.2% of them reported that they don't feel any stress. It also showed that the prevalence rate of stress among female students was 61.4% and among students who studied in the humanities branch was 69.2%.

Table 1: Distribution of percentage of students regarding their socio-demographic data
Variables Categories Nablus Jenin Tulkarm Qalqilya Total
Gender Male 64 19.2 17 5.1 25 7.5 23 6.9 129 38.6
Female 102 30.5 32 9.6 41 12.3 30 9 205 61.4
Total 166 49.7 49 14.7 66 19.8 53 15.9 334 100
Study Branch Scientific 46 13.8 18 5.4 26 7.8 13 3.9 103 30.8
Humanities 120 35.9 31 9.3 40 12 40 12 231 69.2
Total 166 49.7 49 14.7 66 19.8 53 15.9 334 100
Table 2: Distribution of percentage of prevalence of stress among students
Categories Gender Study Branch
Male Female Total Scientific Humanities Total
No. % No. % No. % No. % No. % No. %
I do not feel any stress 7 2.1 7 2.1 14 4.2 7 2.1 7 2.1 14 4.2
I have a little bit of stress, but it doesn't affect my general functioning 69 20.7 87 26.0 156 46.7 51 15.3 105 31.4 156 46.7
I have stress that affects my general functioning 41 12.3 98 29.3 139 41.6 36 10.8 103 30.8 139 41.6
I have too much stress 12 3.6 13 3.9 25 7.5 9 2.7 16 4.8 25 7.5
Total 129 38.6 205 61.4 334 100 103 30.8 231 69.2 334 100

Table 3 represents the distribution of the percentage of students regarding the coping strategies that were used. It was found that religion and planning strategies were the domains of coping strategies that were used a lot by students with a mean score of 6.30±1.61, and 6.11±1.35, respectively. Students who used the least coping strategies were using “denial,” “behavioral disengagement” and “substance use” as coping strategies with mean scores of 3.79± 1.51, 3.52±1.36, and 2.90±1.77, respectively.

Table 3: Distribution of students according to coping strategies utilized
Domain Mean±Std. Interpretation Rank
Self-distraction 5.35±1.47 Doing this a medium amount 7
Active Coping 5.799±1.42 Doing this a medium amount 4
Denial 3.79±1.51 Doing this little bit 12
Substance use 2.90±1.77 Doing this little bit 14
Use of emotional support 5.34±1.53 Doing this a medium amount 8
Use of instrumental support 5.63±1.74 Doing this a medium amount 6
Behavioral disengagement 3.52±1.36 Doing this little bit 13
Venting 5.16±1.44 Doing this a medium amount 10
Positive reframing 5.90±1.43 Doing this a medium amount 3
Planning 6.11±1.35 Doing this a lot 2
Humor 4.70±1.93 Doing this a medium amount 11
Acceptance 5.793±1.45 Doing this a medium amount 5
Religion 6.30±1.61 Doing this a lot 1
Self-blame 5.18±1.83 Doing this a medium amount 9

Covariates

Table 4 illustrated the differences among students in using coping strategies in relation to gender by using two-independent t-test. It showed that the mean scores of religion, 6.64±1.43; positive reframing, 6.05± 1.44; use of instrumental support, 5.80± 1.80; self-distraction, 5.55±1.44; and venting, 5.38± 1.42 strategies were higher among females than male students, with statistically significant differences (p<0.05). It also showed that humor, 5.03±2.01; substance use, 3.79±2.27; and behavioral disengagement, 3.72± 1.43 were strategies adopted more by male students than female students. The differences between the two groups were statistically significant (p<0.05).

Table 4: Distribution of coping strategies among students according to gender
Domains Variables No. Mean±Std. t P-value
Self-distraction Male 129 5.0543±1.47007 -3.038- 0.003
Female 205 5.5512±1.44628
Active coping Male 129 5.6279±1.49515 -1.754- 0.080
Female 205 5.9073±1.36705
Denial Male 129 3.8915±1.45903 0.970 0.333
Female 205 3.7268±1.54143
Substance use Male 129 3.7984±2.27204 7.950 0.000
Female 205 2.3415±1.04341
Use of emotional support Male 129 5.1938±1.51594 -1.457- 0.146
Female 205 5.4439±1.53490
Use of instrumental support Male 129 5.3643±1.61989 -2.231- 0.026
Female 205 5.8000±1.80793
Behavioral disengagement Male 129 3.7209±1.43601 2.101 0.036
Female 205 3.4000±1.30834
Venting Male 129 4.8140±1.40183 -3.584- 0.000
Female 205 5.3854±1.42897
Positive reframing Male 129 5.6512±1.39559 -2.539- 0.012
Female 205 6.0585±1.44727
Planning Male 129 6.0465±1.29820 -0.717- 0.474
Female 205 6.1561±1.39854
Humor Male 129 5.0310±2.01532 2.454 0.015
Female 205 4.5024±1.85140
Acceptance Male 129 5.7907±1.41793 -0.027- 0.978
Female 205 5.7951±1.47428
Religion Male 129 5.7519±1.72767 -5.126- 0.000
Female 205 6.6488±1.43949
Self-blame Male 129 5.0930±1.90165 -0.753- 0.452
Female 205 5.2488±1.80184

In addition, our results indicate that the mean scores of planning as a coping strategy was 6.15±1.39; active coping was 5.90±1.36; acceptance was 5.79±1.47; use of emotional support was 5.44± 1.53; and self-blame was 5.24± 1.80. These strategies were higher among female students than male students but were not statistically significantly different. The use of denial as a coping strategy was 3.89±1.45, and was utilized more by male students than female students, although the differences were not statistically significant (p>0.05) (Table 4).

Table 5 shows the differences among students in using coping strategies in relation to study branch using two-independent t-test. The use of instrumental support, denial, and behavioral disengagement were used more by students in the humanities branch than those in the scientific, with mean scores of 5.77±1.70, 3.92± 1.54, and 3.63±1.43, respectively.

Table 5: Distribution of coping strategies among students according to study branches
Domains Variables No. Mean±Std t P value
Self-distraction Scientific 103 5.2136±1.53169 -1.208- 0.228
Humanities 231 5.4242±1.44527
Active coping Scientific 103 5.7379±1.31329 -0.527- 0.598
Humanities 231 5.8268±1.47010
Denial Scientific 103 3.4854±1.39230 -2.484- 0.013
Humanities 231 3.9264±1.54322
Substance use Scientific 103 2.6602±1.43864 -1.681- 0.094
Humanities 231 3.0130±1.90076
Use of emotional support Scientific 103 5.2524±1.64923 -0.756- 0.450
Humanities 231 5.3896±1.47580
Use of instrumental support Scientific 103 5.3010±1.79779 -2.324- 0.021
Humanities 231 5.7792±1.70898
Behavioral disengagement Scientific 103 3.2816±1.16667 -2.178- 0.030
Humanities 231 3.6320±1.43515
Venting Scientific 103 5.2621±1.46167 0.824 0.411
Humanities 231 5.1212±1.43649
Positive reframing Scientific 103 5.7670±1.35186 -1.139- 0.256
Humanities 231 5.9610±1.47538
Planning Scientific 103 6.0874±1.39401 -0.237- 0.813
Humanities 231 6.1255±1.34707
Humor Scientific 103 4.5825±1.95300 -0.784- 0.434
Humanities 231 4.7619±1.92230
Acceptance Scientific 103 5.5922±1.35355 -1.697- 0.091
Humanities 231 5.8831±1.48594
Religion Scientific 103 6.2524±1.62528 -0.377- 0.706
Humanities 231 6.3247±1.61333
Self-blame Scientific 103 5.2816±1.89642 0.616 0.538
Humanities 231 5.1472±1.81659

These differences were statistically significant (p<0.05). Results indicated that the mean scores of religion, planning, positive reframing, acceptance, active coping, self-distraction, use of emotional support, humor, and substances use strategies were higher among the humanities branch students than the scientific branch students. The mean scores were 6.32±1.61 for religion; 6.12±1.34 for planning; 5.96± 1.47 for positive reframing; 5.88± 1.48 for acceptance; 5.82±1.47 for active coping; 5.42±1.44 for self-destruction; 5.38±1.47 for use of emotional support; 4.76± 1.92 for humor; and 3.01 ±1.90 for substance use, although the differences were not statistically significant (p>0.05). We also found that venting and self-blame as coping strategies used more by the scientific branch students compared to the humanities branch students, with mean scores 5.26± 1.46, and 5.28± 1.89, respectively but not statistically significantly different (p>0.05).

Discussion

Discussion

According to the Palestinian Ministry of Education, females students who constitute 58.1% of those who studied in 12th and 65.5% were in the humanities branch for the academic year 2015/2016.16 Most of the students (88.3%) have different levels of stress with different effects, and less than tenth 7.5% of them have excessive stress. Other studies found some differences in the prevalence of stress among secondary school students. In Melaka, Malaysia, the prevalence of distress among students was 47.6%,17 while it was 32.8% among students in Kota Bharu.18 In Iran, stress among male adolescents from selected government schools was 17.99% (SD=6.02).19 Moreover, the World Health Organization (WHO) reported that 20% of the world's adolescents have mental disorders or problems.20 This rate of stress in our study may be related to the education system in Palestine, and in most Arab countries, that require students to give complete attention for the last year in the secondary level, which is the key to their future.

In our study, the most used coping strategies were religion, 6.30±1.61, and planning, 6.11±1.35, while the lowest used coping strategies were denial, 3.79±1.51; behavioral disengagement, 3.52±1.36; and substance use, 2.90±1.77. In comparison, the main domain of coping strategies that were used the most by Malaysian secondary school students was religion, 6.29±1.54; while other strategies, including humor were 3.88± 1.56; behavioral disengagement, 3.58±1.50; denial, 3.45±1.40; and substance use, 2.10±0.62 were the lowest used coping strategies.16 This was similar in Iran where religion, active coping, positive reinterpretation, planning, and use of instrumental support were the main coping strategies used by high school students.21 In addition, planning with 13.00±2.59 was the most used strategy among Iranian adolescents in secondary school, while behavioral disengagement, 7.12±2.24 was the least once used.22 These study results indicate that the students tended to use the useful problem- focused and emotion-focused coping strategies in dealing with stressors more than the less useful coping strategies with some differences that might be related to differences in cultures, lifestyles, and other environmental factors.

The results of the study indicated that there were significant differences between gender and use of coping strategies. Religion, positive reframing, instrumental support, self-distraction, or venting were used more among female students than among males, while strategies such as humor, substance use, or behavioral disengagement, were used more by the male students than female students. While in Iran there were significant differences between gender (the mean score was higher among female than male) in using coping strategies, like seeking emotional support 11.8 > 10.46, denial, 8.25 > 7.37 or emotional discharge (venting), 9.4 > 8.3, respectively.22

In Spain, female students had higher mean scores than male students in the use of emotional (13.19±6.25>11.55±5.69) and avoidance (10.09±3.11>9.02±3.19) coping styles, with statistically significant differences.23 Male students had higher mean scores than female students in the use of rational (25.06±6.14>23.15±6.21) and detachment (11.61±4.86>10.61±4.64) coping styles, with statistically significant differences.23 The female students in Hawai'i tended to use adaptive coping strategies more than male students (3.17±0.85>2.91±0.86) (p<0.001),while male students tended to use maladaptive (1.60±0.71>1.52±0.57) and avoidance (2.39±1.10>2.27±1.06) coping strategies more than female student (p<0.05).24

These differences might be related to differences in cultures, and the tools used to measure different types of coping strategies, or it might be due to the fact that Palestinians have been under occupation for a long period of time which has led to political, social and economic problems that affect peoples' lives, especially youth and students. Regarding the differences between the study branches, the findings illustrated that the use of instrumental support 3.92±1.54>3.48±1.39, denial, 5.77±1.70>5.30±1.79, and behavioral disengagement 3.63±1.43>3.28±1.166 coping strategies were higher among the humanities branch students than the scientific branch students with significant differences (p<0.05).

A study in India revealed a significant difference between sciences and arts students in using problem- focused and avoidance coping strategies. In that study, problem-focused coping strategy was used more among sciences students (60.45±6.54>56.54±8.53), while the use of avoidance coping strategy was higher among arts students (28.99±6.08 >26.34±5.53) with a statistically significant difference. But in that study, there was no significant difference between arts and sciences students in using emotion-focused coping strategies.25

Limitations

Due to a limitation in time, efforts, money and difficulty movements in all Palestinian districts, the study was confined to only governmental schools in the four cities in Northern West Bank and in the examination of only two study variables, namely gender and study branch. The inclusion of more variables would have provided more information from the study.

Conclusion and Implications for Translation

The prevalence rate of stress among the students in the study was high. The majority (88.3%) of students have different levels of stress with different effects, and less than one-tenth (7.5%) of them have too much stress. Stress was higher among females than males (61.4% vs 38.6%), and among the humanities branch students than the scientific branch students (69.2% vs 30.8%) with no statistically significant differences. Problem-focused and emotion-focused coping methods were mostly used by students. Female students and humanities branch students tended to use useful coping strategies more, while male and scientific branch students tended to use venting and self-blame strategies. Moreover, cultural influences play a role in the use of different coping methods as religion was the most one used in this study population. Identifying how students cope with stress in their daily lives is a crucial issue as maladaptive and poor management which will inversely affect students' future. So the results of this study might help to take effective steps to reduce stressors among students through the design of related training programs for all staff caring of students.

Compliance with Ethical Standards

Conflicts of interest:

The authors declare that they have no conflict of interest.

Financial Disclosure:

The authors are employees of the Ministry of Education and Higher Education.

Ethics Approval:

The study was approved by both the IRB from An Najah National University and the Ministry of Education, in addition to the agreement of school's headmasters and parents of the students.

Acknowledgments:

The authors thank the Ministry of Education and school headmasters for their support of this study, and all students for their participation.

Funding/Support:

There was no funding support for the study.

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