ISBN 978-623-99026-3-6

Conquering Stress in Times of Pandemic: An

Intervention Study to Manage Stress among College
Students

Princess Red Rodriguez1,*, Mary Jane Botabara-Yap2

1,2
Adventist University of the Philippines, Philippines
*Corresponding author: [email protected]

Abstract

The COVID-19 pandemic has brought many challenges throughout the population spectrum.
The sudden shift of classes from face-to-face to that of full online has brought into the spotlight
the mental health issue of various groups, including college students. The aim of this study was to
determine the effect of a stress management program on perceived stress, knowledge, attitude, and
preventive practices among college students in the Adventist University of the Philippines. The
study utilized a pre-test/post-test quasi-experimental design among 40 participants through random
sampling. The intervention program was conducted from March 6 until April 17, 2021, and
consisted of motivational talks, lectures, focused group discussions, testimonials, and support
groups. Descriptive (mean and percentage) and inferential (paired t-test) statistics were used to
analyze the data. Both groups showed moderate stress, very good knowledge (mean-15.1), poor
attitude (mean- 2.4), and good preventive practices pre and post-intervention (mean- 2.8). There
was no significant difference in both groups before the program; however, it showed a significant
difference in the perceived stress scale, which strongly indicates that the stress level of the
participants decreased after the stress management program (mean- 4.3, SD- 5.05, p- .001).
Moreover, the participants’ attitude and practice gain scores were higher, while the gain score for
perceived stress was lower in the experimental group. Further, preventive practices showed
significant differences in the gain score (mean- 4.3, p- ≤.05) as compared to knowledge (mean-
2.12) and attitude (mean- 1.9). Results showed that the stress management program was a success
and is recommended to be done regularly for college students.

Keywords: academic stress, stress management program, pandemic, perceived stress scale

INTRODUCTION
Stress affects all types of people regardless of age, gender, beliefs, or status in life (Mazo,
2015). Students with high academic stress were reported to experience different mental health
problems such as depression, anxiety, irritability, and headaches (Deb, Strodl & Sun, 2015). The
number of suicide cases and students with mental disorders has increased significantly, with at
least one suicide referral every day (Tomacruz, 2018).
Stress and mental health of college students is a vital public health matter because when a
student is healthy, they will also become healthy workers in the future. Going to schools or

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universities could be a positive and encouraging experience for the students, but studies have
shown that college students nowadays are more stressed than before (Portoghese et al., 2019; Pryor
et al., 2010), and stress is being described as the number one interference to academic performance
(American College Health Association, 2010).
A recent study from the United States showed that among the 71% surveyed students regarding
their mental stress, showed increased stress and anxiety were brought about by the recent COVID
pandemic. In a Malaysian study, it was shown that health sciences students, such as medical
laboratory science students, are experiencing moderate to high amounts of stress, which was linked
to academic requirements as the major source of stress (Othman et al., 2013, p. 255).
In the Philippines, according to the Social Weather Stations (SWS) survey conducted in the
fourth quarter of 2019, 27 percent or one of four Filipinos are frequently experiencing stress in
their everyday living (Hallare, 2020). Tee et al. (2020) reported that younger people are more prone
to experience stress, anxiety, and depression due to the psychological impact of the pandemic; and
that students who experience stress in high amounts can lead to reduced school performance with
low grades and an increased number of dropouts which results to decreased graduation rates (Byrd
& McKinney, 2012; Keyes et al., 2012; Salzer, 2012; Storrie et al., 2010).
Thus, this study aimed to determine the effect of a tailored mental health program for a chosen
group of medical and laboratory students who are currently in their clinical division (Junior year)
in a chosen university in Luzon, Philippines.

METHODOLOGY
This study utilized a quantitative research design, specifically a pre-test/post-test design. A
tailored mental health program was presented to a group of students chosen randomly and who
attended a total of eight sessions from a pre-created module. Pre-test and post-test results were
measured against a control group to determine its effect.
The 40 participants, 20 experimental and 20 controlled, respectively, were chosen through a
random sampling technique. Students from the clinical division of the Medical Laboratory Science
(MLS) Department of a chosen university in the Philippines are specifically chosen because it is
at this stage that the students face the most challenging period of their four-year academic journey;
moreover, the main researcher is a faculty of said department.
A structured and self-administered questionnaire was distributed to the participants before and
after the program. The questionnaire is composed of 84 items which mostly are close-ended
questions and are divided into six parts: 1) demographic profile questions which describe the
participants’ age, gender, religion, nationality, family income, and other academic information; 2)
general questions; 3) knowledge questions about stress answerable by true or false which measured
the participants’ knowledge on the myths and facts about stress; 4) perceived academic stress with
answers in the form of Likert scale; 5) practices on stress management for the past four weeks with
the responses ranging from (1) Always, (2) Often, (3) Rarely, (4) Never; and the 5) perceived
stress scale which would measure the intensity of their stress which was adopted from Cohen
(1994) and was considered as the most widely used instrument for measuring the level of stress.
For the data gathering, approval from the university’s Ethics Review Board (ERB) was
obtained; the program protocol was duly presented and was approved. A letter for permission was
secured from the MLS Department Head before the data gathering procedure. A list of students in

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the clinical division was acquired from the Head of Department and participants and was chosen
randomly and allocated to the respective group (experimental and control). Once chosen, the
consent to participate was delivered and disseminated to the students, and once the consent was
signed, the questionnaire was given via google form, and both groups received a thorough
explanation of what was expected from them. The program took place for a period of eight sessions
through a virtual platform and was attended by all the participants. A post-test questionnaire was
conducted after the program to measure the effect of the program on knowledge, attitude, practice,
and perceived stress of the students.

RESULTS AND DISCUSSION

The majority of the participants have ages ranging from 18-21 years old, 85% are female,
coming from different religious affiliations of which the Seventh-day Adventist has the highest
percentage with 59%, followed by the Roman Catholic with 26%, 10% from Born Again Christian
and 2.5% each for Aglipayan Church and Members of Church of God International. For the family
income, more participants come from a family with an income of more than 30,000php per month.
Table 1: Demographic information of the participants

N %
Age 18-21 yrs old 37 95

>21 yrs old 2 5

Gender Male 6 15

Female 33 85

Religion Seventh Day 23

Adventist 59

Roman Catholic 10 26

Aglipayan 1 2.5
Born again Christian 4 10
Members of Church
1 2.5
of God International
Family Income 10,000-30,000php 13 33

>30,000 26 67

Paired t-test was conducted for both groups before the program to determine the homogeneity
of both experimental and control groups, as shown in Table 2.
Table 2: Paired T-test of the Pre-Program Level of Both Groups

Levene’s Test for

Equality of t-test for Equality of Means
Variances

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Sig. Std. 95% Confidence

Mean Interval of the
(2- Error
F Sig. t df Differen Difference
taile Differe
ce
d) nce Lower Upper
.081 .778 1.456 37 .154 .67895 .46643 -.26613 1.6240
Pre-
2
Knowled
1.455 36.845 .154 .67895 .46658 -.26656 1.6244
ge 6
Pre- .001 .970 .861 37 .395 .07544 .08767 -.10219 .25307
Attitude .858 36.094 .396 .07544 .08791 -.10284 .25372

Pre- 1.028 .317 .922 37 .362 .07961 .08634 -.09533 .25454

Practice .916 33.950 .366 .07961 .08690 -.09701 .25622
1.246 .271 -.874 37 .388 -1.43421 1.64188 -4.76097 1.8925
5
Pre PSS -.875 36.963 .387 -1.43421 1.63825 -4.75373 1.8853
1
*P<0.05 is significant
It is revealed in the result that both groups were homogenous as the scores in knowledge,
attitude, practice, and perceived stress scale were all non-significant. An almost similar result was
noted in the post-test between the two groups. However, Table 3 presents the descriptive pre-test
and post-test results of the experimental group’s knowledge, attitude, and practice. The result
showed that the participants had very good knowledge during pre-test and post-test, and for this,
the module did not cover much on enhancing their knowledge but rather concentrated on
enhancing the participants’ attitude and practice.
Table 3: Descriptive comparison of pre-test and post-test on knowledge, attitude, practice, and perceived
stress of the participants.
Pre-test Verbal Interpretation Posttest Verbal Interpretation

Knowledge Very Good Very Good Knowledge

15.1 14.4
Knowledge

Attitude 2.4 Poor attitude 2.5 Poor attitude

Practice 2.8 Good practice 2.9 Good practice

Perceived 23.3 Moderate Stress 19.0 Moderate Stress

Stress

The overall mean for the attitude during pre-test was 2.4 and was increased to 2.5 in post-test,
considered as poor attitude. The participants believed that they would be successful students (pre-
test/post-test mean-3.0 and 3.3) and are positive that they will pass their courses during the
semester (pre-test/post-test mean-3.0 and 3.3), despite believing that the examinations are difficult
(pre-test/post-test mean-1.5 and 1.3) and not having enough time to relax (pre-test/post-test mean-
2.0 and 2.5).
The overall mean for the practice of preventive measures regarding stress during pre-test was
2.8 and was increased to 2.9 during post-test, both considered as good practice. The highest
preventive practices which the participants do are: to pray (pre-test/post-test mean-3.7 and 3.9),
talk to family members and friends when they are stressed (pre-test/post-test mean-3.5 and 3.8),

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and do something they enjoy (pre-test/post-test mean-3.4 and 3.8); the lowest mean to cram doing
school requirements (pre-test/post-test mean-2.0 and 2.1) not exercising (pre-test/post-test mean-
2.2 and 2.5), not getting at least eight hours of sleep at night (pre-test/post-test mean-2.3 and 3.4),
and not eating a balanced diet (pre-test/post-test mean-2.6 and 2.9); however, it is noteworthy that
these practices improved after the program. For the perceived stress scale, from a mean of 23
during the pre-test, it was reduced to 19 in the post-test. The paired T-test was again conducted to
test whether the difference of the mean scores is statistically significant between the two groups,
and the result showed that the perceived stress scale of the participants was significant (p-value =
0.001, SD=1.13), which further denotes that the program for the clinical division students in
conquering stress was successful in reducing their stress level.
Table 4: Paired T-test of the Difference of the Pre- and Post-Program Levels of the Participants
Paired Differences
95% Confidence Sig.
Std. Std.
Interval of the t df (2-
Mean Deviatio Error
Difference tailed)
n Mean
Lower Upper
Pre-
Pair Knowledge -
.55000 1.76143 .39387 -.27437 1.37437 1.396 19 .179
1 Post
Knowledge
Pre-Attitude
Pair -
- Post -.08333 .22980 .05138 -.19088 .02422 19 .121
2 1.622
Attitude
Pre-Practice
Pair -
- Post -.08604 .29256 .06542 -.22296 .05088 19 .204
3 1.315
Practice
Pair Pre PSS -
4.30000 5.05860 1.13114 1.93250 6.66750 3.801 19 .001
4 Post PSS

To determine the gain scores of the two groups in terms of knowledge, attitude, and practice,
the result showed that it was the practice that showed significant difference among the variables
tested (p value=0.045), as presented in Table 5.
Table 5: Paired T-test of the Gain Scores of the Participants and Non-Participants
Std. 95% Confidence
Sig. Mean
Error Interval of the
F Sig. t df (2- Differe
Differe Difference
tailed) nce
nce
Lower Upper
- -
-
2.125 .153 1.05 37 .301 .52390 1.6115 .51152
.55000
Gain Score for 0 2
Knowledge - -
36.5 -
1.05 .299 .52162 1.6073 .50737
31 .55000
4 7
-
1.963 .169 .334 37 .740 .03070 .09189 .21689
Gain Score for .15548
Attitude 31.5 -
.331 .743 .03070 .09278 .21977
94 .15837
Gain Score for -
4.317 .045 .368 37 .715 .04766 .12954 .31013
Practice .21480

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28.8 -
.363 .719 .04766 .13120 .31603
87 .22071
- - -
1.7275 1.4634
1.365 .250 1.17 37 .246 2.0368 5.5371
2 4
9 4 2
Gain PSS
- - -
35.8 1.7331 1.4784
1.17 .248 2.0368 5.5521
99 2 3
5 4 1

The result shows that the participants may have already taken up and applied some skills that
they have learned from the program that would help them in managing their stress as a student. It
was not surprising that the result of the knowledge is also not significant as it is not addressed in
the program.
Due to the alarming cases of increased mental health disorders of the youth during this time of
COVID-19 pandemic, studies have recommended the need for interventions to address the
growing concern of mental health problems, particularly among college students.
There is now a call to the higher educational institutions (HEIs) leaders to start prioritizing the
mental health of the students. This call includes generating preventive methods and including in
the health screening the mental health aspect to be able to identify particularly those with
psychiatric symptoms and be given proper interventions (Inside Higher Ed. 2020b; Son et al.,
2020; Sun et al., 2021). Virtual outreach programs which are done online, such as webinars,
psychoeducation, mental health interventions or services, counseling, and the likes are
recommended for the schools to be able to effectively reach those in need and to continuously
promote mental health and to increase awareness of the connection of mental health to the
academic performance (Inside Higher Ed. 2020b; Linardon et al., 2019, Sun et al., 2021).
A stress management program is one of the most common interventions done by any type of
institution to care for their subjects. Stress management programs have been proven effective in
reducing stress which may also prevent other mental health problems and may therefore be
regularly implemented in schools (Amanvermez et al., 2020). It was even suggested by a body of
students to incorporate stress management programs in the curriculum (Yasmin et al., 2020).
Through stress management programs, students with more serious mental health problems might
also be encouraged to seek more treatment, and these programs can also be a means for the
development of other mental health interventions (Benjet, 2020).

CONCLUSION
This study determined the effect of a stress management program on the selected college
students in a university in Luzon, Philippines, during this time of the pandemic. The results
showed that after the eight-session program, the participants had applied some techniques in stress
management, which made the gain score of the practice significant, and more importantly, the
stress level of the participants was reduced. This study shows that mental health programs are vital
to the wellbeing of the students and is therefore recommended to be done regularly by higher
educational institutions.

Acknowledgement

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This study is an output of the stress management program for the Public Health Field Study.

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