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Factors contributing to student attrition at a healthcare university: a gap analysis

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Factors contributing to student attrition at a healthcare university: a gap analysis

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Content Running head: STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 1

Factors Contributing to Student Attrition at a Healthcare University: A Gap Analysis

by

Benjamin Tran

A Dissertation Proposal Presented to the
FACULTY OF THE USC ROSSIER SCHOOL OF EDUCATION
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF EDUCATION

December, 2017

Copyright 2017 Benjamin Tran

STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 2

TABLE OF CONTENTS

List of Tables 5

List of Figures 9

Abstract 10

Chapter One: Overview of the Study 11

Introduction of the Problem of Practice 11
Organizational Context and Mission 12
Related Literature 13
Importance of Addressing the Problem 14
Organizational Performance Goal 15
Description of Stakeholder Groups 16
Stakeholder Group for the Study 17
Purpose of the Project and Questions 18
Conceptual and Methodological Framework 18
Organization of the Project 19
Chapter Two: Review of the Literature 20
Student Attrition 20

Factors Influencing Performance in Student Attrition 21
The Role of Student Engagement in Student Attrition 24
Influences on Student Engagement through the 29
Clark and Estes (2008) Gap Analysis Framework
Student Knowledge, Motivation and Organizational Influences 30
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 3

Conceptual Framework: The Interaction of Students’ 47
Knowledge and Motivation and the Organizational Context
Chapter Three: Methods 52
Participating Stakeholders 52
Data Collection and Instrumentation 57
Data Analysis 61
Credibility and Trustworthiness 62

Validity and Reliability 63
Ethics 64

Chapter Four: Results 67

Selection of General Education Courses 67
Quantitative Survey Results 68
Focus Group Interview Results 88

Chapter Five: Recommendations 104
Recommendations for Practice to Address KMO Influences 104
Knowledge Recommendations 104
Motivation Recommendations 110
Organization Recommendations 115
Integrated Implementation and Evaluation Plan 120
Conclusion 135
References 137
Appendix A: Survey Items 147
Appendix B: Interview Protocol 155
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 4

Appendix C: Informed Consent/Information Sheet 157

STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 5

LIST OF TABLES
Table Title Page
1 Knowledge Influences on Students 34
2 Motivational Influences on Students 39
3 Organizational Influences on Students 45
4 Summary of Assumed Influences for Knowledge, Motivation, 46
and Organizational Issues
5 Survey Item 1: What is your gender? 68
6 Survey Item 2: Which is you age? 68
7 Survey Item 3: What is your highest educational level completed? 69
8 Survey Item 4: What is your parents’ highest educational level? 69
9 Survey Item 5: What program are you attending? 70
10 Survey Item 6: How long have you attended this university? 70
11 Survey Item 7: Are you currently working in a paid job or 71
other related activities such as volunteering?
12 Survey Item 8: If you are working, is your job related to 71
healthcare?
13 Survey Item 9: If you are working, is your job on this campus? 71
14 Survey Item 10: How many hours a week are you working? 72
15 Survey Item 11: What is your household income level? 73
16 Survey Item 12: What is your health status? 73
17 Survey Item 13: Since you have been at this school, how many 73
times have you been hospitalized?
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 6

18 Survey Item 14: Since you have been at this school, how many times 74
has your immediate family (spouse, kids, parents, etc.)
been hospitalized?
19 Survey Item 15: Did you take any of these science courses in high school? 74
Select all that apply.
20 Survey Item 16: To what level would you agree that your prior knowledge 75
of the sciences before attending this university prepared you to successfully
take courses in Anatomy, Physiology, Microbiology or Chemistry in college?
21 Survey Item 17: Have you taken any of the following classes at another 75
university or community college?
22 Survey Item 18: On average, how many hours a week are you studying for 76
your courses?
23 Survey Item 19: To what level would you say that your study habits are 76
enough to maintain a 3.0 GPA?
24 Survey Item 20: To what degree would you agree that you know enough 77
study strategies (different ways of studying) to maintain a 3.0 GPA?
25 Survey Item 21: Which of the following study strategies do you commonly 77
use during an exam week?
26 Survey Item 22: What was your initial interest level in attending your 78
program?
27 Survey Item 23: What is your interest level now in attending your program? 78
28 Survey Item 24: Have you worked in healthcare? 79
29 Survey Item 25: To what level has your work in healthcare motivated you 79
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 7

to stay in school to learn more about healthcare?
30 Survey Item 26: Do you have friends who work in healthcare? 80
31 Survey Item 27: To what level have your friends motivated you to stay in 80
school to continue to learn healthcare?
32 Survey Item 28: Do you have family who work in healthcare? 80
33 Survey Item 29: To what level did your family influence your desire to 81
attend a healthcare school?
34 Survey Item 30: Has your current job made you want to stay in school? 81
35 Survey Item 31: To what level did your non-healthcare job influence your 81
desire to attend a healthcare school?
36 Survey Item 32: Please select the activity of greatest personal importance 82
to you:
37 Survey Item 33: What do you think is the most likely cause of you not doing 82
well in a course?
38 Survey Item 34: When you have an important task to complete, you start it: 83
39 Survey Item 35: How would you rank your ability to read and understand 84
the course textbook?
40 Survey Item 36: To what level does the course instructor motivate you to 84
study for a course?
41 Survey Item 37: To what degree has the student culture of this school 85
stimulated your interest in your studies?
42 Survey Item 38: Please select the following activities that have stimulated 85
your interest in your major.
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 8

43 Survey Item 39: To what degree do you trust your classmates to help you 86
learn the course materials?
44 Survey Item 40: To what degree has the professionalism of faculty at this 86
school stimulated your interest in your major?
45 Survey Item 41: To what degree do you trust your professors to help you 87
learn the course materials?
46 Survey Item 42: To what degree has student services at this university 87
stimulated your interest in your major?
47 Survey Item 43: To what degree would you trust student services to help 87
you to learn the course materials?
48 Summary of Knowledge Influences and Recommendations 105
49 Summary of Motivation Influences and Recommendations 111
50 Summary of Organization Influences and Recommendations 116
51 Outcomes, Metrics, and Methods for External and Internal Outcomes 122
52 Critical Behaviors, Metrics, Methods, and Timing for Students 123
53 Required Drivers to Support Students’ Critical Behaviors 124
54 Components of Learning for the Program 129
55 Components to Measure Reactions to the Program 131
56 Evaluation tools used immediately after the training 132

STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 9

LIST OF FIGURES
Figure Title Page
1 Conceptual framework to contributing and mitigating influences to student 48
attrition
2 Mock dashboard which a representative example of the analytics from this 134
plan

STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 10

ABSTRACT

This study evaluated the phenomena of students prematurely withdrawing from college
or university, termed student attrition, at a Health Sciences University (HSU) in the Western
United States. This study evaluated the knowledge and motivation influences of HSU students,
as well as the organizational (university) influences in achievement of the students’ and
university goals. These influences are collectively termed the KMO. Through use of the
conceptual and methodological framework by Clark and Estes’ (2008), the performance gap of
the HSU students was analyzed. The methods of this study were a mixed methods, convergent
parallel approach using surveys and interviews. Analysis of the data indicated that the students of
HSU lacked knowledge and motivation to achieve their goals. Moreover, the data also revealed
that HSU has organizational inefficiencies that negatively influence achievement of students’
goals. The significance of these results indicates that HSU, and organizations like HSU, may
have to restructure their practices to effectively address the gaps in performance by their students
due to students’ lack of required knowledge, motivation and inefficient organizational support.
This study concludes with context-specific training recommendations for HSU. These
recommendations were intended to improve the university’s performance and to close the gap in
KMO, based on the educational psychology literature and framed by the New World Kirkpatrick
Model (Kirkpatrick & Kirkpatrick, 2016) of training evaluation. This model integrates
implementation of training and evaluation of such training in its effectiveness of closing the gap.

STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 11

CHAPTER ONE:

OVERVIEW OF THE STUDY

Introduction of the Problem of Practice
Attainment of a college education has been linked to important benefits for individuals as
well as society. At the individual level, college graduates benefit from higher social and
psychological development (Bergman, Gross, Berry, & Shuck, 2014). Moreover, young adults
with a bachelor’s degree earned 29% more than those with Associate’s degree (NCES, 2014).
From the societal standpoint, one of the most important goals of a college degree is to prepare
workers for their careers including democratic engagement (Ishitani, 2006) and higher levels of
employment (NCES, 2014). College graduates who earned a bachelor’s degree or higher were
more likely to be employed than those with some college, 88.1% vs. 75.0% (NCES, 2014). With
the globalization of the world economy, future employment prospects will increasingly require
applicants to complete a college degree (Hu and McCormick, 2012). However, within the
United States, college degree completion rates for Bachelor’s and higher degrees are markedly
low, averaging 50% in public institutions (NCES, 2014). With the current rate of college
graduation, it is possible to forecast an economic slump for the workers and the nation due to the
high attrition rate.
The problems stemming from low rates of college degree completion for individuals and
society are compelling. Student attrition is costly to students and institutions in financial terms,
time spent, and other resources (Bass & Ballard, 2012). Students who withdraw prior to
completion can lose their tuition money, time, self-confidence, and future earnings. Similarly,
institutions with high student attrition stand to lose student tuition, state and federal financial or
legislative support (Shaw & Mattern, 2013), and lose effective use of resources (faculty
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 12

positions, supplies, limited enrollment) by allocating these resources to students who do not
graduate (Sadler, 2003). Therefore, high college attrition is a national concern because it
effectively creates barriers to upward social and economic citizenry and decreases the
competitiveness of the national workforce in the global economy (Hu and McCormick, 2012;
Martinez, Sher, Krull & Wood, 2009).
Organizational Context and Mission
Health Sciences University (HSU) is a private, for-profit university in a large
Metropolitan area of the Western United States. The institution offers year-round, personalized,
post-secondary education in healthcare related careers, including nursing and dental hygiene.
The student population is diverse and includes the subgroups traditional, non-traditional, and
minority students. The mission of HSU is to deliver transformational education, where students
develop the competencies, and confidence required in a complex economy. The institution
operates on a student-oriented, learning partnership between the students, faculty, and industry
professionals, toward the goal of professional success (Mission Statement, 2011). HSU is one
campus within a university system which has locations in California, Texas, and Florida.
Following extensive remodeling, HSU has been operational since 2007. HSU employs
nearly a hundred professionals in several departments including admissions, academics, financial
aid, student services, information technology, campus security, facility maintenance, and human
resources. The main functions of these staff members are to facilitate student success. In 2011,
total enrollment in the university was over 1,400, comprising of predominately female (86%)
students of Filipino (30%), White (26%), Latino (15%), and Asian (18%) ethnicities. The
majority of these students, spanning the ages of 18 to 64 years old, were enrolled full-time in the
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 13

Bachelors of Nursing program (82%) (Fact Book, 2011). Since this institution is for-profit, the
organization is under great scrutiny for delivering satisfactory student outcomes, in the form of
students finding gainful employment following their degree completion from the institution.
Related Literature

Student attrition from degree programs has been persistent even with the increased
attention to providing enrollment access and improving student outcomes (Hu & McCormick,
2012). There are certain characteristics of age, ethnicity, gender, and parental education that
place students at the highest risk for attrition (Bergman Gross, Berry & Shuck, 2014; Hunt,
Boyd, Gast, Mitchell & Wilson, 2012). As such, students are classified into subgroups including
traditional students (entry soon after high school graduation), non-traditional (delayed entry and
are financially independent from parents), first-generation college student (first member of the
family to attend college, not immigrant student), and minority students (groups historically
underserved in the general population) (Martinez, Sher, Krull & Wood, 2009; Monroe, 2006).
College students find degree completion difficult due to a multitude of factors including
competing commitments, excessive work hours, or scheduling conflicts. In addition to limited
time for their college studies, these students often also lack family support, including financial
needs for education, and living expenses. Furthermore, these students often enter college ill
prepared with poor academic and study skills (Bergman, Gross, Berry & Shuck, 2014). At the
institutional level, college students may demonstrate poor social integration into their collegiate
community and receive inadequate academic support from their faculty, and administrators
(Mannan, 2007).
In response to these challenges, institutions of higher learning have implemented a
multitude of strategies to stem student attrition rates including mentoring programs (Miller &
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 14

Tyree, 2009), learning communities (Popiolek, Fine & Eilman, 2013), administrative support
(Bass & Ballard, 2012), and restructured curriculum with problem or inquiry-based learning for
active learning (Popkess & McDaniel, 2011). However, these methods are often institution-
unique and are not universally applicable to other institutions (Monroe, 2006; Taylor, 2006).
Importance of Addressing the Problem

The problem of student attrition in higher education is important to solve for a variety of
reasons. As a result of socioeconomic factors, which place students at-risk for attrition, students
who withdraw prior to degree completion are faced with bleak prospects for employment. By
2018, most entry-level positions in the United States will require a college degree (Hu &
McCormick, 2012). From the perspective of the national economy, it is also predicted that the
labor force will be short of college-prepared applicants by three million college graduates
(Bergman, Gross, Berry, & Shuck, 2014). To address this shortage of qualified applicants,
institutions of higher learning, including Health Sciences University (HSU), are preparing their
graduates to successfully enter the workforce by educating, helping to receive licensing, and
placing them at career level work positions following graduation, which also helps meet the
career needs of the national economy. In particular, those who benefit the most from HSU
programs are students typically classified as at-risk for attrition, by withdrawing from college
without their degree completion. These students, have specific demographics, backgrounds,
needs, and level of engagement, places them at higher risk levels for attrition. Without these
institutions, students who withdrew from college would face limited career opportunities,
feelings of disenfranchisement, and would not have opportunities for future academic success
(Bass & Ballard, 2012). However, the problem of student attrition has significant impacts on
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 15

institutions like HSU (Monroe, 2006), affecting their funding level, which negatively affects
their ability to provide educational services.
Student attrition would negatively impact the fiscal ability of HSU in the context of its
goal to offer its students the educational opportunities necessary in the employment marketplace.
As a consequence of reduced student tuition revenue due to enrollment attrition, HSU would
have to reduce or close its program offerings or even close campuses. Should HSU close their
programs or campuses, many of the stakeholders of HSU, including the officials, administrator,
faculty, staff and students would lose important social, academic, and economic opportunities. In
particular, HSU offers opportunities to students who would not otherwise be able to attend other
higher education institutions due to their socioeconomic and academic backgrounds.
Furthermore, as an institution of higher learning, HSU has proven itself as an innovator to
industry leaders and closure of such an institution would result in a significant lost to the field
and its professionals (WASC, 2016).
Organizational Performance Goal
Currently, HSU’s performance level is 73% retention of returning students. Retention is
checked at the beginning of each semester, when the students enroll in courses. Presently, the
percentage of this organization graduates finding gainful employment is 90% within the first 90
days of graduation. The organizational performance goal of HSU is to have 90% enrollment
retention of returning students in the core programs by 2020. The academic programs offered at
HSU are nursing and dental hygiene. Students enrolled in these majors’ courses are considered
core students. In contrast, students who are enrolled in general education courses, in order to
satisfy graduation requirements, are considered pre-core students.
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 16

The Director of Student Services established this organizational performance goal after
consultation with campus leadership where several areas of student learning outcomes were
identified as needing improvement. Accomplishment of this goal is important for the university
to satisfy as part of the institution’s commitment to student learning. If there is a 90% enrollment
retention rate and students continue making degree progress, there is increased likelihood that
student learning is indeed occurring. This level of learning is required for students to passing
their courses and gaining their licensure, which contributes to the organizational goal of 90%
enrollment retention. Progress toward this goal will be measured with internal audits completed
by the Department of Student Services through the end of 2020.
Description of Stakeholder Groups
The stakeholders who directly contribute to and benefit from the achievement of the
HSU’s goal include the students, faculty and staff. The student population is diverse and includes
the subgroups traditional, non-traditional, and minority students. In 2011, total enrollment in the
university was over 1,400, comprised of predominately female (86%) students of Filipino (30%),
White (26%), Latino (15%), and Asian (18%) ethnicities. The majority of these students,
spanning the ages of 18 to 64 years old, were enrolled full-time in the Bachelors of Nursing
Program (82%).
The institution’s faculty are academic professionals with graduate or doctoral credentials
in diverse fields of study including the arts and sciences. In addition, the faculty who serve in
clinical specialties also hold board certified licenses to practice healthcare. The faculty have the
most direct and abundant interaction with students. HSU also employs nearly a hundred staff
members in several departments including admissions, academics, financial aid, student services,
information technology, campus security, facility maintenance, and human resources. The main
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 17

functions of these staff members are to facilitate student success and for this study will be
referred as Success Coordinators.
Stakeholder Group for the Study

Although the combined efforts of all the stakeholders will contribute to the achievement
of the organizational goal, it is important to determine the current level of HSU student
performance regarding their performance goal. Students’ individual performance goals include:
passing all required courses, maintaining the minimum GPA for degree completion
requirements, and passing their licensure exams.
Currently, no data other than achievement data, exist that would allow the organization to
understand and support the students’ experience and increase the retention rates. As such, the
stakeholders of focus for this study are the HSU students. The students’ long term goal,
supported by the university, is to pass their licensure exam 90% on their first attempt. Failure to
pass their licensure exam prohibits their ability to find healthcare related employment. Such
student outcomes would discourage current core students to continue with their program.
Discontinuing core students consequently has adverse effects on the organization’s ability to
retain 90% of returning students within the core programs of the organization. Passing of the
student licensure exams requires knowledge, motivation, and organizational acumen by the
students spanning their years of study at HSU which included successfully completing all pre-
core and core courses. However, in order for students to remain enrolled in their core courses,
they must first pass all their pre-core courses. Thus a major intermediate goal for the students is
to pass all pre-core courses.

STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 18

Purpose of the Project and Questions
The purpose of this project is to conduct a gap analysis to examine the underlying causes
of the organizational problem described above, the high rate of student attrition within the core
programs at HSU, and generate context-specific recommendations to increase retention at HSU.
This study will determine the quality of learning that it taking place at HSU and identify
solutions to improve learning as further recommendations.
While a complete gap analysis would focus on all HSU stakeholders, for practical
purposes, this analysis will only focus on one stakeholder group, the HSU students. The analysis
will focus on the possible or perceived causes for this problem due to gaps in the areas of
students’ knowledge, skill, motivation, and organizational issues and then continue by examining
these causes systematically to focus on actual or validated causes.
As such, the questions that guide this study are as follows:
1. What are the HSU students’ knowledge and skills, motivation, and organizational
influences that may interfere with them passing their classes and gain licensure?
2. What are the recommended knowledge and skills, motivation, and organizational
solutions?
Conceptual and Methodological Framework
The conceptual framework used in this study is the gap analysis. This analysis is the
study of performance gaps impacted by deficiencies in students’ knowledge, motivation or
university organizational causes. The methodological framework used in this study is a
qualitative case study with descriptive statistics. This case study will help to clarify
organizational goals and understand the causes of the gap between the actual performance level
and the preferred performance level within an organization (Clark & Estes, 2008). Based on
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 19

personal knowledge and related literature, the assumed knowledge, motivation, and
organizational influences that impact organizational goal achievement will be generated. These
influences will be assessed by using surveys, document analysis, interviews, literature review,
and content analysis. Research-based solutions will be recommended and evaluated in a
comprehensive manner.
Organization of the Project
The remainder of this dissertation is organized in the following way. Chapter One
contains key concepts and terms common to the discourse of student attrition. The discussion of
these concepts encompassed the general topic of student attrition in college as well as the
particular problem of student attrition at Health SciencesUniversity (HSU). Within this chapter,
the organization’s mission, goals, and stakeholders goals are identified, as well as the initial
concepts of gap analysis were introduced. Chapter Two contains a review of current literature
surrounding the scope of the study, including a discussion of factors contributing to student
attrition will be addressed. In Chapter Three, the underlying assumptions about the knowledge,
motivation, and organizational elements are discussed, as well as this study’s methodology when
it comes to choice of participants, data collection, and analysis. Chapter Four contains the
assessment and analysis of the data and results. Chapter Five contains the proposed solutions,
based on the data and literature, for closing the perceived gaps. Also within this chapter are
recommendations for an implementation and evaluation plan for such solutions.

STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 20

CHAPTER TWO:
REVIEW OF THE LITERATURE
Chapter Two outlines several factors that contribute to student attrition,
concluding with poor student engagement as a leading contributor to student attrition. The first
section focuses on student and institutional characteristics. The second section extends the
discussion to the fit of students within their institutional contexts. The chapter ends with an
analysis of student engagement from the lens of the education literature and utilizing the
performance gap analysis of knowledge, motivation, and organizational causes from Clark and
Estes (2008).
Student Attrition

Student attrition is the process in which students leave a college institution prior to degree
completion. This is a topic which is intensely studied by researchers in the US and
internationally. Within the United States, much of educational policy has been directed toward
increasing access to post-secondary education (Whitehead, 2012). However, degree completion
rates for Bachelor’s and higher degrees are as low as 50% in public institutions (NCES, 2014).
Approximately half of all attrition is after the first year (Willcoxson, Cotter & Joy, 2011). The
impact of this low rate is that many Americans, and the nation at-large, will not benefit from
collegiate learning, which has been linked to important individual and societal benefits. Attrition
for students can result in loss of their money, time, self-confidence, and future earnings. For
institutions, student attrition can result in loss of revenues in tuition, state and federal financial
aid and legislative support (Shaw & Mattern, 2013). Nationally, college attrition creates barriers
to upward social and economic mobility since higher education attainment has been correlated to
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 21

higher measures of employment and income (Martinez, Sher, Krull & Wood, 2009; NCES,
2014).
Factors Influencing Performance in Student Attrition
Demographic Factors
There are several factors that influence student attrition. Some of these factors are related
to their demographics including their age when enrolled in school and the educational
background of their parents.
Student age. Students of the greatest risk for attrition belong to groups that have certain
age, ethnicity, gender, and parental education characteristics. Specifically, students who are
older, are working adults, are ethnic minorities, have low socioeconomic status, or have limited
educational experiences within their families are at high risk for attrition (Bergman, Gross, Berry
& Shuck, 2014; Hunt, Boyd, Gast, Mitchell & Wilson, 2012). Given these risk factors for
attrition, at-risk students can be classified into categories: traditional, non-traditional, first
generation, and minority student groups (Martinez, Sher, Krull & Wood, 2009; Monroe, 2006).
Traditional students are those who are newly transitioned from high school and with limited
family and work commitments (Gilardi & Guglielmetti, 2011; Martinez, Sher, Krull & Wood,
2009). In contrast to traditional students, students who are 25 years and older and have more
career experiences are classified as non-traditional students. These students represent more the
half of the all part-time enrollments and roughly a third of all enrollments in higher education
institutions (Bergman, Gross, Berry & Shuck, 2014. For these students, their diverse entry
characteristics more of an effect on their attrition rates than those of traditional students.
Traditional entry characteristics are less relevant to persistence for the adult student. For some
students, their age and work experience places them at greater risk of withdrawing from college
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 22

without their degree completed. The non-traditional students are at higher risk of attrition than
younger students. However, other factors may confound their attrition characteristics, including
familial educational background.
Familial educational background. Another classification of students is by the parental
level of education. Parental level education has been argued to affect student attrition. Students
lack role models of collegiate success if their parents did not complete college (Ishitani, 2006;
Martinez, Sher, Krull & Wood, 2009). Thus due to lack of parental collegiate experience, some
students transition to higher education without the essential knowledge, skills, support, and role
models for success (Hoyne & McNaught, 2013). Non-traditional students transition to the
university from diverse, social, economic, academic, professional and personal backgrounds.
Due to their diverse background, some may require academic remediation or developmental
education (Bergman, Gross, Berry & Shuck, 2014; Gilardi & Guglielmetti, 2011). From the
education background of non-traditional students, their risk for attrition is also increased by their
deficient knowledge of academic skills and resources to educational role models. These
deficiencies are part of a greater barrier to their academic success, which include poor familial
support, financial need for educational costs, and poor social integration into their collegial
community.
Barriers to Success
The barriers to student success and degree attainment include conflicting commitments
which are grouped as entry factors and institution factors. These barriers include poor family
support, off campus job commitments, personal and academic barriers, and poor social
integration into campus community (Bergman, Gross, Berry & Shuck, 2014; Ishitani, 2006).
Students with pressure to discontinue school, due to lack of family support or family obligations,
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 23

negatively impacts their social integration and involvement into campus culture (Hunt, Boyd,
Gast, Mitchell & Wilson, 2012). Moreover, non-traditional students experience poor social
integration into collegiate community and inadequate academic support from faculty and
administrators. Thus poor social integration is associated with poor academic integration
(Mannan, 2007).
In addition to their age, work experiences, and prior education, non-traditional students
contend with several barriers to their academic success. Some of these barriers are inherent to
their commitments to their family including work obligations, yet others arise from their
engagement within their collegial community. Non-traditional students with work obligations
face the barriers of both being adult learners and having low income. For non-traditional students
without work commitments, they may still face poor engagement in their college community
resulting in higher risk for low GPAs, which place then at higher risks for academic dismissal
and attrition.
Academic Progress
Achievement and GPA. Low GPA is a good predictor of attrition in addition to other
entry scores such as high school GPA and SAT scores (Martinez, Sher, Krull & Wood, 2009;
Shaw & Mattern, 2013). For non-traditional students, who have higher risk of low academic
achievement, maintaining an adequate GPA is vital for their academic progress toward degree
completion. Failure to maintain such a GPA places them at-risk for academic dismissal from the
institution (Martinez, Sher, Krull, & Wood, 2009). However, one factor that helps non-traditional
students maintain their GPAs is their academic major. An academic major that has a market
utility-value helps these students complete their studies.
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 24

Academic major and goals. Enrollment in chosen career-oriented majors is an
important factor to degree completion. Students who chose a career-oriented degree are less
likely to depart the university since they have a clear reason to attend (Willcoxson, Cotter & Joy,
2011; Willcoxson & Wynder, 2010). Exit interview data indicated the main reasons for
discontinuation were family related, academic difficulties and wrong career choice (Glossop,
2002). In addition to the choice of study, lack of commitment and educational goals are
significant to persistence and affected attrition (Bergman, Gross, Berry & Shuck, 2014;
Willcoxson & Wynder, 2010). Educational goals significantly correlated to positive rates to
persistence by as much as 90%. Clear career goals with a chosen major from the onset are more
important than instruction (Willcoxson & Wynder, 2010).
Although studying in a major that has market value increases the likelihood of degree
completion, non-traditional student must also set goals for their academic achievement. For these
students, active choice to stay within their studies and complete their degrees is also important to
their risk of attrition. Some level of attrition may be attributed to other factors such as personal
choice or by participation in purposeful educational activities and effort by students (Hu &
Mccormick, 2012). These students must choose to engage with their studies in order to complete
their degrees.
The Role of Student Engagement in Student Attrition
Student attrition negatively impacts student academic and personal success. However,
factors which positively affect student success include student persistence and engagement in
educationally purposeful endeavors that contribute to their success. Student engagement
contributes to foundational skills and dispositions for success after college (Evans, Hartman &
Anderson, 2013). Lack of these skills can jeopardize graduate prospects and national
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 25

competitiveness in the global economy (Hu & Mccormick, 2012). Thus, achieving student
success necessitates students increasing their engagement and effectiveness in order to improve
their academic outcomes (Zepke, 2013). Through the lens of student attrition risk factors, student
choice to engage in their studies is an important factor to the completion of their degrees.
Helping students to choose and engage in their studies is a goal for institutions wanting to
increase student academic outcomes.
Student Engagement in Higher Education

Although student engagement is important to mitigate student attrition, higher education
institutions struggle to effectively engage their students (Hu, 2011). Student engagement,
measured as a percentage of students actively involved in higher education is low compared to
the percentage of overall collegiate enrollees. For example, in the areas of collaborative learning,
discussions with diverse persons and student-faculty interaction, the 2014 report by the National
Survey of Student Engagement indicated median scores of 30, 40 and 20 percent, respectively
(NSSE, 2014). Overall, student engagement is low in higher education settings, although some
types of student typologies may not benefit from more engagement and may not lead to higher
academic performance. For example, one type of student typology, the grinds, have been
reported to not benefit from more engagement (Hu, 2011). However, for certain student
engagement typologies, strategies for increasing engagement do not directly influence attrition.
Therefore, identifying factors that influence student engagement could also enlighten the larger
problem of student attrition.
Participation and social engagement. The typology of student engagement
encompasses a spectrum of issues, which are multi-dimensional and complex. Student
engagement correlates to participation, time, and effort by the student involved in purposeful
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 26

activities including academic and social engagement (Flynn, 2014; Kahu, 2013). College transfer
degree completion at 4-year institutions is a function of social and academic student engagement
and is based on student typology as described by Coates in 2007 (Flynn, 2014). In particular,
social engagement is a capacity of institutions as part of their strategic plan to develop
institutional capacity for social capital tailored to student engagement typology (Mendan, 2012).
A vital factor to engagement of students in their academic goals is their contribution of effort and
time in academic and social endeavors related to achievement of their academic success.
However, certain types of students are at greater risk for low engagement including non-
traditional, transfer students (Lester, Leonard & Mathias, 2013).
Engagement demographics. Similar to attrition, students at greatest risk for low
engagement fall with certain subgroups including gender, ethnicity, transfer status, and academic
major. Male students are more disengaged and reluctant to seek support than female students
(Hoyne & McNaught, 2013; Hu & Wolniak, 2013). Studies suggested that, for some student
typology (the Grinds), more student engagement was not necessarily better for persistence (Hu,
2011). Among the disengaged typology, males were overrepresented (39.3%) compared to the
overall sample (33.6%) (Hu & Mccormick, 2012). Moreover, minority students are also less
engaged than non-minority students. In academic engagement, Hispanics were the highest,
however, in social engagement, African Americans were the highest among the groups.
American Indians were the lowest group in both academic and social engagement (Hu &
Wolniak, 2013). Thus, among engagement typologies, male and minority students are at greater
risk for disengagement. However, in addition to gender and ethnicity, prior educational
background also influences student engagement. Similarly to familial education, the transfer
status of non-traditional students also places them at-risk for disengagement.
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 27

Transfer status effects social integration. Transfer status also has an impact on student
engagement. A growing portion of the student body is the transfer student, which is at higher risk
for disengagement (Roberts & McNeese, 2010; Wintre, Bowers, Gordner & Lange, 2006). The
adult, non-traditional student carries obligations with enrollment and residence characteristics
including degree transfer, commuter, and part-time status that place them at-risk for lower
engagement (Monroe, 2006). Transfer students to four-year universities from community
colleges view social engagement in the context of family and community rather than their
college environment in building their self-efficacy in academic work (Lester, Leonard &
Mathias, 2013). Transfer students often have little in common with non-transfer students, they
may feel that the new university is only a place to complete their degree and often feel
disconnected (Roberts & McNeese, 2010). Thus, engaged students will likely complete their
degrees whereas disengaged students will likely withdraw. Students, who have transferred from
another college, have less in common with the students of the new institution and are therefore
participate less in academically and socially activities in their new collegial community. As a
consequence, they are less engaged and at greater risk for attrition, withdrawing from their
studies. However, a positive influence in increasing student engagement is enrollment in a
chosen academic major.
Academic major in student engagement. Similarly to attrition, academic major has
significant impact on student engagement. Majority of coursework in major and interactions with
peer and faculty and each major has opportunity for engagement (Pike, Smart & Ethington,
2012). Students seek out majors compatible with personality type, student abilities, and interests
according to Holland (1997) theory of personality types (Roberts & McNeese, 2010).
Differences in the types of engagement varied with academic major. For instance, healthcare
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 28

students were less engaged than education students (Popkess & McDaniel, 2011). Thus, the
impact of academic and social engagement varies by student gender, ethnicity, and prior
academic preparation (Hu & Wolniak, 2013). Although the impact of student engagement is
influenced by gender, ethnicity and prior educational background, a student’s chosen academic
majors positively enhances engagement. This is significant because an institution has influence
over the availability of academic majors and how these courses of study are offered to at-risk
students. The methods of curriculum delivery as well as student support services also have
impacts on student engagement and attrition.
Student support in student engagement. Changes in the delivery of curriculum enhance
engagement and student success. Institutions that create programs that meet the needs of non-
traditional students are better positioned to attract and retain at-risk students (Monroe, 2006).
These changes are intended to mitigate the risk factors for poor engagement and have included
several approaches including enhanced student support such as tutoring and scholarships.
Influence of tutors varies considerably on attrition either through effective teaching or facilitating
the departure of poorly prepared students (Foster, 2010). Group tutoring created peer
relationships that created positive influence on student engagement (Mendan, 2012). Students
show increased engagement due to efficiencies provided by tutoring for administrative,
academic, career advisement (Lodge, 2012). In addition, other tutoring types of support have
shown up to a 50% reduction in the failure rate of at-risk students in a core literacy course with
the introduction of mandatory support courses (Hoyne & McNaught, 2013).
Aside from academic support, financial support has also shown to have impacts on
student engagement and attrition. Awarding scholarships influenced student college selection
and engagement. Such awards increased probability of attending private 4-year institutions over
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 29

public 2-year colleges. Among blacks and Hispanics, scholarships increased likelihood of
enrolment in 4-year private colleges (Hu, 2011). Addressing the needs of the non-traditional, at-
risk students involves attending to their characteristic needs including offering student support
services for deficiencies in academic knowledge, skills, or other influences such as financial
support for their familial obligations. To better understand the factors which lead to the problem
of attrition, an analysis of the known and perceived influences in student attrition and
engagement will be conducted using the conceptual framework by Clark and Estes (2008).
Influences on Student Engagement through the
Clark and Estes (2008) Gap Analysis Framework
Within this study, the gap analysis by Clark and Estes (2008) is used as the conceptual
framework that bridges the educational literature on student engagement as part of student
attrition. As a major influence on student attrition, student engagement can be understood
through this framework. Gap analysis is particularly useful in examining organizational
performance in the context of organizational goals and can be incorporated into
recommendations for organizational change, enhancing institutional performance in areas of
student attrition, engagement, and success.
The gap analysis is a process of organizational performance evaluation using measures in
knowledge, motivation, and organizational factors for analysis, the KMO model (Clark & Estes,
2008). The KMO model consists of steps that: 1) identifies performance goals, 2) gaps in
achievement of these goals, 3) identifies three dimensions of solutions to solve this performance
gap: (a) knowledge, (b) motivation, and (c) organization, and lastly, 4) evaluated the results for
tuning and revision of the analysis process.

STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 30

Student Knowledge, Motivation and Organizational Influences
Student Knowledge and Skills’ Influences
The mission of Health SciencesUniversity (HSU) is to ensure student learning and
success. Learning is dynamic, ubiquitous, and evolving that results in cognitive change in
students (Alexander, Schallert, & Reynolds, 2009). According to Alexander and colleagues
(2009), learning is both a process and a product and can be influenced by interactions with
ourselves, others and our environment. In Chapter 2, the current literature on influences that
affect student learning is reviewed with the focus of understanding performance related issues
within this study. Achievement of the students’ learning requires consideration of the different
types of knowledge, skill, motivation influences, and organizational factors that facilitate student
learning (Clark & Estes, 2008). Different knowledge types have been originally framed in the
taxonomy by Benjamin Bloom in 1956 which contained six major cognitive processes:
knowledge, comprehension, application, analysis, synthesis, and evaluation. However, more
recently, these processes have been revised into include the type “create” (Krathwohl, 2002).
Factual knowledge is defined as the basic elements that students must know for
proficiency within a discipline including related terms and specific details. Conceptual
knowledge considers the inter-relationships between the basic elements and their functioning
with one another within a discipline. These relationships include classifications, categories,
structures, models, principles, theories, and generalizations. Procedural knowledge considers
discipline-specific processes, including their methods for performing tasks and criteria for task
completion. The last type of knowledge within the revised taxonomy is metacognitive
knowledge. Metacognition is awareness of self and knowledge of cognitive processes within
one’s self including strategic knowledge, knowledge about cognitive tasks, contextual and
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 31

conditional knowledge. Thus, metacognition is self-awareness of one’s cognition, and not
necessarily one’s cognitive ability (Baker, 2006; Krathwohl, 2002).
Self-awareness leads to self-regulation (Barber, Grawitch & Munz, 2012). Self-regulation
can be defined as the multifaceted aspects of skills, which can be influenced over time by
contextual cues, to help students promote their own academic achievement. These skills include
students’ control of the physical and social environment, use of time, methods of learning,
managing their motivation, and performance (Dembo & Eaton, 2000; Peverly, Brobst, Graham &
Shaw, 2003). Studies of college students have shown that they are generally poor at self-
regulation, note-taking and test taking (Peverly, Brobst, Graham & Shaw, 2003). When students
quit college, they may lack critical knowledge and skills to complete job tasks. Moreover, self-
regulation may be subject to depletion of resources, where students lose motivation and energy
to maintain self-regulatory behaviors (Barber, Grawitch & Munz, 2012).
Student knowledge influences. There are several influences that affect student learning
of these four types of knowledge: factual, conceptual, procedural, and metacognitive. In this
portion of the chapter, influences that affect the types are discussed and how these influences
impact the learning of knowledge, skills and students’ ability to self-regulate learning.
Factual knowledge. In order for the students to enroll and pass all of their required
courses, they are influenced by their curriculum. Influences that affect their factual knowledge
base include their textbooks, manuals, simulation software, supplemental materials, videos and
adaptive learning activities. These influences that affect student acquisition of factual knowledge
can be found in environments on campus including their classrooms, laboratories, libraries and
study rooms (Daly, 2006). For example, students must learn the medical sciences including
Human Anatomy and Human Physiology. In order for the students to have sufficient academic
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 32

progress in their programs, they must maintain a minimum GPA. Influences that help students
maintain minimum GPAs for degree completion requirements include knowledge of how course
grade points are computed to develop GPAs and how course policies affect students’ ability to
earn course grade points (Batsell & Grossman, 2009). For students to pass their licensure exams,
the required factual knowledge acumen was gathered over several years of study. Influences that
impact students’ learning of factual knowledge for their licensure exam are the availability of
academic resources offered by the institution, including library services, tutoring, and
supplemental instruction (Tuckman, 2006).
Conceptual knowledge. In order for students to pass their required pre-core courses, they
need to understand how the concepts of the pre-core courses are related to their core
competencies. The ability to understand these concepts, as they are repeated and scaffolded
within these courses, is vital to passing the course assessments (Daly, 2006). The biggest test of
students’ ability to conceptualize the knowledge of their coursework is their licensure exam. The
influences that effect students’ ability to pass the conceptual components of their licensure
exams include their ability to control their learning environment. Examples of such control
includes locating environments without distractions, their self-confidence in their effectiveness
and their belief of being able to achieve licensure (Shell & Husman, 2008). In addition, students
are influenced by personal experiences from other students or faculty from whom they can learn
concepts or critical information that facilitate metacognitive thinking rather than just
memorization for passing their licensure exams (Schraw & McCrudden, 2006).
Procedural knowledge. Students can learn procedural knowledge including study
techniques and strategies while in their classroom and laboratory environments. Learning these
skills is required for them to pass their classes. Students are influenced to learn performance
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 33

management strategies within their coursework including goal setting, self-evaluation, time
management, and self-motivation (Dembo & Eaton, 2000). These learning strategies help
students maintain their coursework GPAs required for degree progress. Also, during these
processes, students develop schemas of how they understand and relate new procedural
knowledge with prior declarative knowledge (Lee, Lim & Grabowski, 2009). For example,
students learn to apply the factual and conceptual knowledge learned in their courses to patient
care. In addition, scaffolded coursework helps students continue to practice developing
automaticity in their learning tasks and reduce the working load of cognition (Schraw &
McCrudden, 2006). Passing the licensure exam requires procedural knowledge about the format
of the exam and test taking strategies that enhances the likelihood of passing the exam. Students
who are influenced to prepare for their licensure exam in a proactive approach, as opposed to a
reactive approach, are more successful in achieving licensure (Buckner, Mezzacappa &
Beardslee, 2009).
Metacognitive knowledge. Metacognition is important to the students since it allows the
students to reflect on their learning abilities (Baker, 2006). This reflection is an important
component in the process of the students improving their learning abilities including study skills,
note taking, or test taking strategies. The pre-core courses are challenging for students. These
courses require students to learn and integrate large amounts of complex information,
representing the learning of declarative, procedural and metacognitive knowledge types. In order
for students to pass their pre-core courses, they have to learn and implement metacognitive
awareness. Development and implementation of metacognitive knowledge is required for
students to maintain their course GPAs. As students fluctuate in their course performance, their
ability to develop and implement various learning strategies, including underlying, note-taking,
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 34

paraphrasing and adjunct questioning, as needed, is important to maintaining their GPAs (Lee,
Lim & Grabowski, 2009). Similar to the metacognitive knowledge requirements of maintaining
student GPAs, students also require metacognitive knowledge to prepare for and pass their
licensure exam. Students are influenced by their ability to self-regulate their learning endeavors,
while preparing for their licensure exams. Self-regulation, like working memory, can also be
subject to resource depletion. Self-regulation can lead to student perception that time is delayed.
Such a perception by the students may be unpleasant and therefore negatively affect these
students’ likelihood of subsequent to attempts of further self-regulation (Vohs & Schmeichel,
2003).
In sum, Table 1 indicates the knowledge influences of the students matched with the
knowledge type according to the revised Bloom’s Taxonomy.
Table 1
Knowledge Influences on Students

Assumed Knowledge
Influence Knowledge Type
Knowledge Influence
Assessment
Students do not have the
knowledge base of pre-core
subjects

Declarative
(Factual)

Students are asked to
identify in surveys
knowledge of their pre-core
subjects

Students do not know how the
pre-core courses relate to core
competencies

Declarative
(Conceptual)

Students are asked to
hypothesize through surveys
how their pre-core courses
are related to their core
courses
Students do not have the study
strategies or experiences to
implement and improve their
learning

Procedural

Students are asked to
identify different learning
strategies through surveys
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 35

Student Motivation Influences
In addition to the knowledge and skills, another important component for learning and
achievement outcomes is motivation. Motivation is the integration of social - cognitive
constructs and involves the needs for self-efficacy or competence, control or autonomy, and
value or relatedness by those who aspire to be motivated (Pintrich, 2003). Motivation is
classified into intrinsic, such as enjoyment derived from positive experience or challenges, and
extrinsic influences, such as rewards and promotions (Lawrence & Jordan, 2009). Moreover,
motivation is also influenced by emotions such as enjoyment or anxiety. Such emotions can
affect cognitive development in students (Pekrun, 2011). These definitions of motivation imply
that it is a drive to satisfy needs or wants. Motivational influences can be generalized into
categories including: values, control beliefs, and self-efficacy. More specifically these needs are
framed within the Expectancy-Value Theory, Attribution Theory, and Self-Efficacy Theory
(Pintrich, 2003).
Expectancy Value Theory. According to EV theory, individuals are likely to engage
with tasks if they both want to do them (i.e., have value) and believe that they can do them (i.e.,
have self-efficacy) (Pintrich, 2003). Specifically, students may have more motivation to learn if
they perceive the learning to have utility value. In other words, learning can have higher value to
the students if the materials and activities are relevant, useful to the learners with real world tasks
(Pajares, 2006). Factual and conceptual knowledge that can be applied to the workplace
environment may have higher value to students than knowledge that is not readily applicable.
Students do not have accurate
ability to predict their
studying effectiveness when
attempting study strategies

Metacognitive

Students are asked through
surveys to reflect on the
effectiveness of their study
strategies based on their
perceived level of studying
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 36

Student utility value. Students are motivated to learn course materials and pass their
courses if the materials are relevant and useful to them, and taught in the context of real world
tasks (Pajares, 2006). Similarly, having high utility value for passing the licensure exam will
bring HSU students to invest more choice, persistence and mental effort into studying and these
activities predicts better chances of passing the exam. Moreover, students must believe that the
material they are learning in their courses will lead to their desired career success. In addition to
believing the value of the courses, students are influenced in believing that they can successfully
complete the program through progressive successes in the courses. The students develop
positive values in learning through increasing their self-expectations for success and perceptions
of self-confidence (Eccles, 2006; Pintrich, 2003). Part of these incremental successes in the
courses is the students’ ability to read the technical course materials. For students in general, the
majority of the knowledge materials come in the form of reading textbooks, manuals, and
journals needed to form professional knowledge (Guthrie, Hoa, Wigfield, Tonks, Perencevich &
Winter, 2006). In addition to passing their courses, for some students, maintaining an adequate
GPA has utility toward a longer term goal. In such cases, students maintaining a certain level of
GPA are intended to help them achieve admittance to graduate or professional programs
following college graduation. Moreover, students who maintain their GPAs also demonstrate
personal interest in the material. In practice, such students may exercise more opportunities for
making academic choices and control over their learning processes including incorporating
problem or cased based applications (Ecles, 2006). These students may have greater enjoyment
of their learning process though collegial relationships and situational motivation (Guthrie, Hoa,
Wigfield, Tonks, Perencevich & Winter, 2006). Based on the EV theory, it is important that HSU
students have high utility value for their courses.
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 37

Attribution Theory. Perhaps one of the more influential contributions to student
motivation is how students attribute their success or lack thereof in learning to external or
internal, controllable or uncontrollable factors. Learning and motivation are enhanced when
learners attribute their success to their levels of effort at learning (Anderman & Anderman,
2006). Having adaptive control beliefs motivates learners to place more effort in learning. In
contrast, control beliefs can also be maladaptive such as students believing that they have no
control over their learning (Pintrich, 2003). Thus, Attribution Theory emphasizes that it is
adaptive for students to attribute their failures or success to their level of effort, an internal and
controllable cause, as opposed to internal but uncontrollable factors or natural ability (Anderman
& Anderman, 2006).
Student attributions. In general, students who attribute their course performance to their
level of internal effort and preparation are more motivated to perform their coursework than
students who attribute their performance to external, uncontrollable factors (Anderman &
Anderman, 2006). Similarly, students who are adaptive and have control beliefs are motivated
learners and place more effort in learning (Pintrich, 2003). For HSU students, in addition to
passing courses, students are required to maintain a minimum GPA for appropriate degree
progress. Students who attribute success and failure in their course work to effort will facilitate
development of appropriate learning strategies including self-control, and identifying and
learning the required knowledge or skills for course assessments (Anderman & Anderman, 2006;
Pintrich, 2003). As a consequence, these learning developments lead to higher levels of self-
regulation and such self-regulation predicts higher passage rates on exams. When students fail a
cumulative exam such as their licensure exam, they often do not know why they failed. In such
cases, students who hold internal viewpoints, attribute their failures to their low level of effort as
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 38

opposed to external factors or natural ability (Anderman & Anderman, 2006). Moreover, to
avoid subsequent failures, students who attribute internal factors to their learning success will
consider these factors when planning for studying. These planning factors may include
increasing their level of effort in learning and developing their own intrinsic motivation, which
might contribute to its ancillary type of enjoyment called “flow” enjoyment (Janus & Browning,
2014).
Self-Efficacy Theory. Student expectations of success contribute to their ability to be
effective learners. The Self-Efficacy Theory indicates that students are capable of learning and
performing. Moreover, students with higher levels of self-efficacy are like to perform better than
students with lower levels of self-efficacy. Self-efficacy develops active choice, persistence and
mental effort in learning. In addition, expectancy for success and self-efficacy also contributes to
student self-motivation (Pajares, 2006).
Student self-efficacy. Students may have difficulty believing that they can be effective in
completing their required courses. These students may have had a long gap in time since they
last enrolled in school and therefore are out of practice in their academic skills. In other
instances, these students may not have the necessary knowledge base typically learned in the
earlier courses within a progression of courses. Some students may have not completed
prerequisite courses when they were studying different fields. In any of these cases, students with
low levels of self-efficacy will have difficulty completing their required courses. However,
students will develop self-efficacy as they choose to take more challenging courses (Pintrich,
2003). In addition, for students to believe that they can maintain an adequate GPA, they must
also persist toward their desired course grade. For their licensure exam, students need to dedicate
mental effort and believe that they can pass the exam. Without high levels of self-efficacy,
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 39

student motivation is negatively affected (Job, Walton, Bernecker, & Dweck, 2015). The lack of
motivation is an influence that leads to procrastination in studying and preparing for the exam.
Procrastination is a problem encountered by many college students and is an indication of poor
of self-regulatory skills in students (Lee, Mar 2005). Moreover, student ego and limited self-
beliefs of will-power also affects students’ success at self-control (Barber, Grawitch & Munz,
2012; Job, Walton, Bernecker, & Dweck, 2015). Students who believed in limited will-power
will procrastinate more and self-regulated less, which compounds to poor performance outcomes
(Job, Walton, Bernecker, & Dweck, 2015).
In sum, Table 2 indicates the motivational influences on student learning of the four type
of knowledge. Utility value, level of effort, belief in self, setting high academic goals, and
organization structures can effect student motivation to learn.
Table 2
Motivational Influences on Students
Assumed Motivation Influences Motivational Influence Assessment
Utility Value – Students do not see value of
learning their pre-core courses, including how
successes in these pre-core courses will lead them
to their success in the core courses and
professional careers.
Students will be surveyed on their beliefs
about the value of the pre-core courses and
why they are needed.
Attributions – Student do not attribute their
performance to internal and controllable factors
such as effort and interest. Instead, students
attribute their lack of passing the exam to internal,
uncontrollable factors such as low ability or
external, uncontrollable factors such as work,
family, and recreation.
Students will be surveyed on their beliefs,
interests, and competing commitments to
completing the coursework.
Self-Efficacy – Students do not believe that they
can successfully accomplish learning the course
in a timely manner.
Students will be surveyed about their level of
preparation, effort level, and confidence
about learning the course curriculum.

STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 40

Student Organizational Influences
In addition to these assumed knowledge and motivational influences, the stakeholder
group of this study is also assumed to be influenced by several organizational cultural models.
These models include student settings, including scholarship and trust, and organizational
settings, including conflict and role models.
Cultural Models and Settings. A model of an organization’s culture involves a system
of shared knowledge, communication, values, actions, and assumptions (Berger, 2014). It is
influenced by its members on how it is created, maintained and changed in a reciprocal
relationship. Organizations are comprised of people and, if these people do not change, then the
organizations do not change (Schneider, Brief & Guzzo, 1996). Important to organizational
change is a culture that values continuous learning, two-way communication, and empowerment
(Berger, 2014). When stakeholders are engaged, they outperform those less engaged with
increased productivity and client satisfaction. To create engaged stakeholders, organizations
must create supportive environments, with open communications, empowerment, and
efficiencies in administration (Berger, 2014). Another critical component of culture is
communication, since communication influences culture through formal and informal routes,
shared experiences, and activities (Berger, 2014). In turn, culture influences communication due
to how stakeholders establish structures, protocols, and practices. In the following sections, these
influences to an organization’s cultural model are discussed in relation to student scholarship and
trust.
Moreover, organizational culture is difficult to change since it is not directly controllable.
Instead, changes in organizational culture can be achieved by focusing on climate.
Organizational climate consists of behaviors, including policies, practices, procedures, routines,
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 41

that produce culture and which have impacts on stakeholder beliefs and values (Schneider, Brief
& Guzzo, 1996). These behaviors are specific to the settings of an organization. In the following
sections, these influences to an organization’s climate or setting are discussed in relation to
student conflict.
Scholarship Model. An example of organizational culture is focusing on performance.
By focusing on performance, organizations unfortunately create conditions that lead to mediocre
performance (Senge, 1990). To create leading performance, organizations need to explore new
growth and innovation. How organizations can accomplish this growth depends on their ability
to learn. By adapting to standards and needs, organizations acquire adaptive learning and also
require generative learning strategies when it needs new ways of understanding itself or its
stakeholders (Senge, 1990). Similarly, individuals within organizations may resist change due to
habit, inertia, fear of uncertainty, absence of skills, or fear of losing control. Organizations resist
change due to inertia, costs, scarcity of resources, threats to the power balance (Agocs, 1997). In
such contexts, resistance is definable as the behaviors that actively deny, reject, fail to
implement, dismantle changes. Examples of such behaviors include refusal to: work in joint
problem solving, seek commonality with others, silencing proponents for change, and sabotage
(Agocs, 1997). For students, their resistance is toward learning knowledge needed to pass their
classes and pass their licensure exams.
Goals of scholarship. Organizational culture that emphasizes performance, as measured
by grades or pass rates, over learning mastery inhibits student motivation to learn. This inhibition
of motivation to master learning also inhibits student scholarship and results in low student
performance. Organizations that focus on mastery of the learning material experience more
achievement in its students passing their required courses. These students are less concerned
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 42

about performance comparisons with their peers but instead choose to focus on their mastery of
learning (Pintrich, 2003; Yough & Anderman, 2006).
Scholarship incentives. How an organization creates its incentives affects student
motivation to perform. Students are guided by these incentives, set by organizational standards,
to perform. Incentives that are directly tied to performance may negatively influence and
diminish intrinsic motivation (Cerasoli, Nicklin & Ford, 2014). In contrast, when incentives are
not directly tied to performance, intrinsic motivation tends to be higher. Students who value
mastery are intrinsically motivated to learn, as compared to students who are only extrinsically
motivated (Lawrence & Jordan, 2009). Thus, performance incentives predict quantity of
performance, as opposed to incentives for mastery, which predicts quality work (Cerasoli,
Nicklin & Ford, 2014). Therefore, having organizational incentives that link to learning mastery,
as opposed to direct performance, will lead to higher motivation to perform and results in higher
performance results.
Model of Distrust. The willingness or ability to empower and gain student trust is
critical to organizational improvement. Through purposeful communication with students about
strategic information including their engagement, on-boarding, retention and change
management, organizations can create trust (Berger, 2014). These communications can occur in
the form of face-to-face meetings, including listening to the students, and offering them
opportunities to make decisions which could strengthen their organizational identity (Berger,
2014).
Social interaction. Through social interaction with peers and instructors, students can
learn how to collaborate with one another (Denler, Wolters & Benzon, 2006). When these social
interactions with peers are positive, they lead to building trustful relationships, and student
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 43

performance is positively affected. In contrast, when peer interactions result in peer distrust,
student performance may be hindered. Organizations can foster positive social interaction
through course work, social clubs, and field trips. In addition, organizations can also create
learning communities within peers, where students support one another, and accept mistakes
when taking risks in their learning process (Anderman & Anderman, 2006).
Curriculum design. In addition to peer interaction, curriculum design also influences
trust. Through collaborative classroom activities that links prior knowledge with new knowledge,
curriculum that provides multiple opportunities for practice integrating knowledge (Schraw &
McCrudden, 2006), and increases self-efficacy in students, creates opportunities to develop trust
among students (Pajares, 2006). The amount of curriculum within an accelerated and condensed
course schedule also impacts development of trust by creating fatigue to learn information.
Fatigue in students decreases the likelihood that they will participate in social interaction and
collaborate with the peers which may, in turn, negatively impact student performance.
Faculty feedback. Beyond peer interaction and course design, faculty feedback also
influences trust, contributes to increased performance outcomes and ultimately, facilitates
retention. Limited or absent feedback on course progression or assignments influences the
students’ ability to learn these concepts (Tuckman, 2006). Part of developing credibility with
students is faculty providing elaborative feedback on course assessments. Feedback should be
balanced between the students’ strengths and weaknesses of their progress (Borgogni, Russo &
Latham, 2011). Similarly, for the students who have not taken a licensure exam, the main source
of tests taking strategies for these tests are the faculty. Therefore the credibility, likeness and
culture commonality of the faculty to the students is an important influence to developing the
needed trust in leading the students to pass the exam (Denler, Wolters & Benzon, 2006).
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 44

Cultural Setting of Conflict Efficacy
Necessary to perforating work is individual or group efficacy where efficacy is the
confidence that one can perform up to one’s goals (Alper, Tjosvold & Law, 2000). Conforming
to performance requirements, individuals and groups experience conflicts over several issues
including effective or fair work distribution and social loafing. Groups that have low levels of
conflict efficacy become unable to perform, are unproductive, and do not contribute to solutions
(Alper, Tjosvold & Law, 2000). In contrast, groups that manage their conflicts with efficacy
contribute greatly to overall organizational performance. Resolving conflicts requires viewing
the conflict as a mutual problem that needs common consideration and solution. In addition,
conflicts can either be competitive or cooperative conflicts, where competitive groups view the
conflicts as win-lose possibilities as opposed to cooperative groups that view the conflicts as
win-win possibilities. Competitive groups may focus highly on performance and less on
innovation or creative tension (Senge, 1990). As such, cooperative groups are expected to yield
higher levels of conflict efficacy than competitive groups (Alper, Tjosvold & Law, 2000).
Therefore, it is important to study whether work groups at HSU have conflict efficacy and are
cooperative with each other since these abilities positively affect student performance.
Student Conflicts. Within groups that are trying to promote student learning, including
faculty and student affairs, collaboration needs to occur between such groups for the benefit of
the students (Pearson & Bowman, 2000). A cooperative collaboration should not promote
competition among students since this competition would yield lower student support efficacy.
Instead, groups such as faculty and student affairs should work together, holding joint
appointments within each other’s academic department (Carpenter, Patitu & Cuyjet, 1999).
Faculty should consider time directly supporting students, such as teaching, mentoring, advising,
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 45

or supervising student research, as part of a broader view of faculty scholarship. Likewise,
student affairs should be involved in the student learning process as part of collaboration with
faculty to promote student learning. As such, many student affairs programs are designed to help
faculty to promote student learning, including academic advising of at-risk students (Pearson &
Bowman, 2000).
Table 3
Organizational Influences on Students

Assumed Organizational Influences

Organization Influence Assessment
Cultural Model Influence 1:
There is a general culture of not
valuing scholarship unless it results in
passing their courses. This perception applies
to grade points or near term career prospects.

Surveys of student perception on the utility
value of scholarship in classroom
assignments and outside of class student
portfolio development
Cultural Model Influence 2:
Students distrust each other to help
them accomplish their goals, including
academic and career goals. There is a poor
climate of student peer collaboration.

Surveys of students on their level of trust of
their peers and collaborations on course
assignments
Cultural Setting Influence 1:
Students are confused by the
administrative and student support
inefficiencies and conflicts.

Surveys of students on their experiences with
administrative support and student services
support
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 46

Table 4

Summary of Assumed Influences for Knowledge, Motivation, and Organizational Issues

Sources Knowledge Motivation Organization
Learning
and
Motivation
Theory
Students do not
have the
knowledge base
of pre-core
subjects
Students do not see value of
learning their pre-core courses,
including how successes in these
pre-core courses will lead them to
their success in the core courses
and professional careers
There is a general
culture of not valuing
scholarship (learning
knowledge) among
students unless it results
in immediate rewards.
This perception applies
to grade points or near
term career prospects

Students do not
know how the
pre-core courses
relate to core
competencies
Students do not attribute their
performance to internal and
controllable factors such as effort
and interest. Instead, students
attribute their lack of passing the
exam to external, uncontrollable
factors such as work, family,
recreation and ability

Students distrust each
other to help them
accomplish their goals,
including academic and
career goals. There is a
poor climate of student
peer collaboration

Students do not
have the study
strategies or
experiences to
implement and
improve their
learning

Students do not believe that they
can successfully accomplish
learning the course in a timely
manner
There are inefficiencies
and conflicts within the
administrative and
student support services

Students do not
have accurate
ability to predict
their studying
effectiveness
when attempting
study strategies

STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 47

Conceptual Framework: The Interaction of Students’ Knowledge
and Motivation and the Organizational Context
The term conceptual framework is often used interchangeably with the term theoretical
framework (Merriam & Tisdell, 2016). However, the term theoretical framework has a broader
connotation in its application. The theoretical framework is derived from the lens, orientation, or
position that is brought to a study through the socialization of researchers within a discipline of a
study. Thus, this socialization brings with it its own vocabulary, definition, concepts, models and
theories (Merriam & Tisdell, 2016). Such a framework is often found in the literature review of a
study.
In contrast, the term conceptual framework is narrower in it application, with a focus in
how concepts are operationalized and measured. The conceptual framework helps to understand
phenomena through simplification and clarification of aspects that are not fully understood
(Maxwell, 2013). Through this pairing of the conceptual framework and its related literature, the
relevance of the literature review to the purpose of the study is maintained. Therefore, the
conceptual framework is something that is constructed based on concepts supported by the
related literature as well as the knowledge or experiences of stakeholders involved in the
problem (Maxwell, 2013).
The conceptual framework of this study draws on the assumptions, beliefs, and theories
that inform the whole of this study. The research questions of this study are part of the
conceptual framework of this study and are a key part of this study’s design (Maxwell, 2013).
This framework includes the key factors, concepts, and presumed influences that affect student
attrition along with their interactions are describes herein, Figure 1.

STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 48

Figure 1. Conceptual framework to contributing and mitigating influences to student attrition.

Conceptual framework to contributing
and mitigating influences to student
attrition.

STAKEHOLDER KNOWLEDGE AND
MOTIVATIONAL INFLUENCES
Entry Characteristics

 Pre-course knowledge, core
competencies, study strategies

 Expected value, self-efficacy,
attributions
ORGANIZATIONAL INFLUENCES
Institutional Factors

 Poor scholarship

 Student distrust

 Conflict efficacy

Blend of
Influences

 Risk of
Attrition
STAKEHOLDER GOALS
Student Success =

- Passing courses

- Maintaining GPA

- Passing Licensure Exam

STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 49

Student Knowledge and Motivational influences

As depicted here, this study’s conceptual framework is viewed from the perspective of
students. Students enter the college environment with characteristics unique to their situation
such as their prior knowledge, core competencies and study strategies. In addition to knowledge
influences, motivational influences includes expected value, self-efficacy and attributions are
also acquired through their age, work history or family support. Categorically these attributes are
characteristics of students entering their collegiate experience (Monroe, 2006). The related
literature has shown that these entry characteristics have contributed to increased risk of student
attrition from college degree completion through early withdraw from enrollment (Martinez,
Sher, Krull & Wood, 2009). Through deficits in their knowledge and/or motivation, entering
characteristics may contribute to the performance gap in achieving the organizational goal.
Following entry characteristics, the students’ collegiate environment also has influences on their
risk for attrition.
Organizational Influences
This collegiate environment may influence the level of attrition risk in two ways. The
first way is through reducing barriers to student goal achievement created by deficits in the
students’ entry characteristics (Bergman, Gross, Berry & Shuck, 2014). The second way is
through beneficial institutional characteristics that help students achieve their goals, including
preparing their students to complete their degree using effective instruction, engaging student
support and optimum organizational efficiencies (Hoyne & McNaught, 2013). The related
literature has shown that these institutional characteristics have impacted student attrition. For
example, tutoring has shown a significant reduction rate in academic failures of at-risk students
in a core literacy course (Hoyne & McNaught, 2013).
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 50

Blend of Influences
Although the students’ knowledge and motivational influences are individually identified
and may independently influence the problem of student attrition, these influences may also
interact with each other and contribute to the problem in confounding and unknown ways. Often
in the case of complex problems, influences to these problems do not act in isolation but rather
they interact with one another (Maxwell, 2013). Similarly to the knowledge and motivation of
the student stakeholders, the organizational influences may also contribute to the problem of
student attrition. Through a blend of the student characteristics and organizational influences
achieving the organizational goal and closing the performance gap may be possible.
Student Goals
The last diagram component of the conceptual framework is achievement of the
organizational goal and closing the performance gap. Through reduction of the risk factor for
attrition, students are able to increase their performance rate of student success, as indicated by
their course passage rates, graduation rates and board licensure passage rates.
Conclusion
Student attrition is a problem for students, institutions, and the nation. The factors that
contribute to student attrition include those that are unique to the students, such as age and
educational background, as well as those that can be influenced by institutions such as academic
major and curriculum design. Through the Gap Analysis by Clark and Estes (2008), the
influencers to the performance problem of students and organizations are evaluated and potential
solutions are developed. Based on what is known in the educational psychology literature related
to student attrition and assumed influencers to the knowledge and motivation of the students, as
well as the organizational factors that may contribute to student attrition such as student trust and
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 51

role models, this gap analysis-based dissertation can be implemented through several
methodological approaches including quantitative, qualitative or a mixture of both methods
(mixed methods). In Chapter 3, the methodological approaches and conceptual framework of the
Gap Analysis are discussed further.

STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 52

CHAPTER THREE:
METHODS
In this chapter, the research methods to this study are discussed, including the stakeholder
group, participant sampling criteria, data collection, and research instruments. Furthermore, as a
part of ensuring rigor, this chapter further discusses issues of credibility or trustworthiness,
validity or reliability, and the ethical considerations within the study. To examine the influences
that contribute to student attrition, the research questions for this study are:
1. What are the HSU students’ knowledge and skills, motivation, and organizational
influences that may interfere with them passing their classes and gain licensure?
2. What are the recommended knowledge and skills, motivation, and organizational
solutions?
Participating Stakeholders
The stakeholder populations for this study were the students of HSU. These students were
a blend of several types of students which include the socioeconomic classifications of
traditional, non-traditional, first-generation, and ethnic minority. Since studying this entire
population was not practical, given the limited time and resources available for this study,
several sample student populations were recruited. These sample populations would provide data
that are reasonable estimates, with low probability of sampling error, of the overall student
population (Fink, 2013). Moreover, this study used a blend of quantitative and qualitative
methods in a convergent parallel mixed-methods research approach (Creswell, 2014). Both
quantitative and qualitative methods were implemented simultaneously and the results were
compared and interpreted. This methodological approach limited the study’s risk to data
invalidity though triangulation of the study data among the methods (Maxwell, 2013).
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 53

Since the research questions for this study focuses on the graduation rate of HSU
students, these students are classified based on their level of risk for non-graduation. The first
study methodology was an online survey of HSU students. The second study methodology was
an in-person interview with focus groups of representative HSU students. The criteria for these
sample populations are described as follows for each type of study methodology.
Survey Sampling Criterion and Rationale
Each of the following criteria independently meets the requirement for survey
participation and thus any student who meets these criteria was considered at-risk and was
therefore considered the participant pool.
Criterion 1. HSU students who are not passing any of their courses at HSU, as defined
by having a current course grade percentage of less than 70 percent, at the midpoint of the course
term. Students who are currently not passing their classes are closer to failing their courses since
the course schedule and curriculum are accelerated and that there are fewer opportunities to earn
needed grade points to pass the course as the course nears completion.
Criterion 2. HSU students who have had at least one academic failure in any course
taken at HSU. Students who have had a prior academic failure may experience barriers to their
success and these barriers may still be present during the time of this study. In addition, these
barriers may still prevent these students from accomplishing their goals for current or future
academic success.
Survey Sampling (Recruitment) Strategy and Rationale
The first study method was a quantitative, online survey of at-risk HSU students. The aim
of this quantitative approach is to describe the frequency of which the assumed knowledge (K),
motivation (M) and organizational (O) influences of the conceptual framework impact the
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 54

overall student population at HSU. Thus, the survey incorporated questions identifying the KMO
components of the student experiences as they are present in the student body. Using an online
survey, as opposed to an in-person deliver method, is due to the limited availability of personnel
to conduct this study (Fink, 2013).
The selection for the survey of at-risk students was non-random and purposeful since
identification of at-risk students must meet specific academic performance criteria. Thus some
element of this sampling was based on the convenience of students’ completing the survey
(Merriam & Tisdell, 2016).
The sample size for the online survey was dependent on the total enrollment of the HSU
campus. The total population of students at HSU is currently a little less that 1,600. Sampling
was taken from the pre-core students, which is approximately 567 students. In addition, the at-
risk population sampled was a sub-population of the pre-core student population. Identification
of at-risk students will be through student lists populated by student services. This list of student
names stem from faculty identifying which students are at-risk of failing.
The timing of the online survey was conducted after the middle of the term when new at-
risk students are identified and when prior at-risk students are monitored for adequate academic
progress. Contrasting the responses between at-risk students after the middle term of the course,
when pressures for academic performance are heightened to achieve a desired grade or to pass
the course, may enhance or illuminate differences between students. Moreover, the possibility of
a history effect in the participants’ responses could be negated by a timely eliciting of data
(Creswell, 2014).

STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 55

Interview and/or Focus Group Sampling Criterion and Rationale
Each of the following criteria independently meets the requirement for survey
participation and thus any student who meets these criteria is considered at-risk and is therefore
considered the participant pool.
Criterion 1. HSU students who are at-risk and work outside of school either at a part-
time or full time job. Heavy work demands on students for filling off-campus jobs increases the
students risk for academic failures and early withdrawal from college. Students who are
interviewed in this group shared their experiences related of heavy off-campus work
commitments and how the influences affect their risk for non-graduation.
Criterion 2. HSU students who are at-risk and who have prior educational or work
experiences that influence their knowledge and motivation to meet academic performance goals
for graduation. Prior educational or career backgrounds have impacts on the dedication and
motivation of older and experienced students to stay within their programs to completion. The
students interviewed in this group shared how their prior knowledge influenced their
performance or how it impacted their motivation to degree completion.
Criterion 3. HSU students who are at-risk and who have family obligations including
young children. Students who have low levels of familial support and/or high loads of familial
responsibilities are at increased risk for prematurely withdrawing from school. These familial
responsibilities may include earning income to pay for their: family’s living expenses, cost of
attending college, and caretaking of the young or the elderly. The students interviewed in this
group shared how their level of familial support influences their ability to reach degree
completion. In addition, this group also shared how the school can help the students through
changes in its organizational influences.
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 56

Interview and/or Focus Group Sampling (Recruitment) Strategy and Rationale
The second study approach incorporated qualitative focus group interviews and sampled
HSU students within their at-risk academic classification. The reason why these students are
interviewed is that they have special experiences that place them in the at-risk population and, in
order for this study to discover, understand and gain these knowledge insights into these
experiences, these students were the most suitable participants (Merriam & Tisdell, 2016). As
such, this qualitative methodology implemented a two tiered approach to sampling and selected
participants based two factors: 1) convenience and willingness of students to participate and 2)
specific risk factors for academic withdrawal (Fink, 2013; Merriam & Tisdell, 2016). Students
were broadly recruited from the campus as well as nominated from faculty and from lists of
students from student services (Krueger & Casey, 2009).
The composition of the interviews contained structured questions which ensure
compatibility of data between participants, reduces the variation in data analysis, and yet, will
hopefully illuminate differences between the participants (Maxwell, 2013).
The number of participants per focus group varied depending on the availability of at-risk
students. Given that these students are already struggling in their courses, any extracurricular
activities such as participation in focus group interviews may be difficult for them to
accommodate within their impacted work/life/study schedules. Moreover, their level of
motivation may also negatively impact their willingness to participate. However, the selection of
these students as participants was most appropriate to understanding the range of issues and
possibly gaining insights into the issues affecting theses students (Krueger & Casey, 2009). To
increase chances of participation, the selection of the participants will contain a high degree of
homogeneity but with enough variation in terms of racial, ethnic and economic backgrounds to
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 57

create multiple perspectives (Bogdan & Biklen, 2007). A high degree of homogeneity will
increase participant understanding of one another’s views and possibly avoid undesirable group
interactions such as the deterring group responses to male or spouse participants (Krueger &
Casey, 2009). As such, the size of the focus groups was limited to small groups of four to six
participants (mini-focus groups), to ensure enough at-risk students will be available and to ensure
sufficient collection of undeferred participant responses (Krueger & Casey, 2009).
The focus group interviews were conducted early in the academic term. The reason for
this is to have more time during the academic term to interview students and to avoid the
midterm and late term pressures on students to study for their courses which could negatively
affect student participation in the focus group interviews. The location of the interviews was on
campus in the staff meeting rooms, away from other students, faculty, and staff which enhances
confidentially, lowers fears for repercussions from other students and faculty, and limits
intrusions for the participants by not occupying their personal areas (Maxwell, 2013). Along with
confidentially, other ethical considerations were maintained by the interviewer regarding
questioning of the participants including not pressuring them with painful or culturally sensitive
topics (Rubin & Rubin, 2012).
Data Collection and Instrumentation
This study incorporated several methods to answer the research questions. These methods
include surveys and interviews. The survey used in this study will be a self-administered, closed
question survey (Fink, 2013) that is administered online. The respondents completed them at the
privacy of their computer which facilitates anonymous reporting. This survey was a cross-section
of the general study body to measure their attitude, beliefs, values or ideas related to the
knowledge and motivation or organizational issues influencing the students’ performance gap.
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 58

The interview method in this study was the focus group interview. Focus group
interviews are interviews within a group of participants that foster group discussion about
selected topics and that stimulates discussion from the multiple perspectives of the group
participants. This dynamic contributes to the volume of data as compared to individual
interviews where the participant may not respond to a topic thoughtfully (Bogdan & Biklen,
2007).
Surveys
Requests for participants to take the survey will be posted in classrooms, circulated to the
students around the school, by word of mouth by faculty and also by word of mouth by co-
curricular administrators. Once potential participants were identified, they were screened for
their type of participation for the survey, they were briefed through an Informed Consent (IC)
form about the protection of their privacy and the confidentially of the responses (Fink, 2013).
Then, the administration of the survey was through an anonymous, self-administered (Fink,
2013), online questionnaire through the commercial survey service Qualtrics. The survey will be
delivered only in English with no option for delivery in any other language. Respondents of the
survey were proficient in English since they are required to pass an English proficiency exam
prior to enrolling in the university.
The items of the survey were closed questions, which are in the form of yes or no
responses, checklists with multiple responses or several rating scales (Fink, 2013). The surveys
measured the students’ attitudes, beliefs, values or ideas related to their knowledge and
motivation or organizational issues (Fink, 2013) and attempted to answer questions that connect
to the conceptual framework of the study. In particular, the items of the survey began with
questions about participant demographics, and then the questions addressed elements of the
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 59

participants’ knowledge and motivation in accomplishing their goals. Lastly, the survey items,
will address participant issues within the university organization which may hinder their ability
to accomplish their goals.
To increase the reliability of the survey to produce consistent results, potential survey
questions were test piloted for the clarity of their language and feedback from the pilot was
incorporated into the survey (Fink, 2013). Unclear language in the survey questions will produce
inconsistent results. Testing the survey will enhance the likelihood that the survey administration
will run smoothly. To increase the validity of the survey to produce accurate results, the survey
questions must measure what is intended to be address by the research questions of the study
(Salkind, 2014) and the results of the survey will be triangulated (Creswell, 2008) with the
results of the interview of this study. This survey would take about 20 minutes to complete. An
accurate survey will yield results that closely matched the results of the other study methods.
Focus Groups

Several mini-focus groups of four to six students will be implemented in a one-time
session. These groups were formal and used a standardized focus group protocol (Johnson &
Christensen, 2015). These focus groups included students who have: part-time and full-time
employment, family issues, poor study strategies, and personal choices that have negative
impacted their academic work.
These groups were conducted on campus in the staff meeting rooms, which are away
from other students, faculty, and staff. By being away from other stakeholders, the group
location enhances confidentially for the study, lowers fears for repercussions for the participants,
and limits privacy intrusions for the participants by not occupying their personal spaces
(Maxwell, 2013).
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 60

All the focus groups were conducted in English with no options for translation into other
languages. Group participants must satisfy English proficiency requirements in order to enroll in
the university as students. Therefore, there are no expected English language barriers for the
participants to participate in the study interviews.
The focus group protocols used were conducted in-person, with qualitative, and
standardized open-ended questions (Johnson & Christensen, 2015). This group protocol reduces
variation in responses since it also reduces variation in the types of questions asked by the
interviewer (Patton, 2002). This approach also minimizes interviewer effects by asking the same
questions from each respondent (Patton, 2002). However, probe or follow-up questions are used,
as determined by the interviewer, to deepen the responses to a question in order to answer the
research questions (Patton, 1987). These detail-oriented probes include the: who, what, where,
when and how questions (Patton, 2002). Through this method, the interviewer was able to obtain
systematic data that also reduced of the amount of spontaneous variation during the interview
process. Moreover, analysis of the data was also made easier since locating, organizing and
comparing responses to the same questions is quicker (Patton, 1987).
The types of questions asked during the interview were specific, singular questions which
avoided requiring the respondent to interpret the question. These questions were also neutral, to
avoid passing judgment on the respondents. Six types of questions are used: opinions/beliefs,
feelings, knowledge, sensory, demographic, and timeframe (Patton, 1987). The main focus of the
questions was indications of the students’ knowledge and motivation toward their goal
achievement. In addition, questions also focused on students experiences with organizational
difficulties that hinder that progress toward their goal achievement. The wording of the questions
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 61

was truly open-ended to avoid imposition of predetermined responses or bias (Patton, 1987). The
focus group interviews took about 10 minutes and followed the survey questionnaire.
Data Analysis
The analysis of the data was performed according to the type of data. For the quantitative
survey, descriptive statistical analysis was conducted once all survey results are submitted.
Using MS Excel, frequencies and percentages will be calculated for the responses. The
percentage of stakeholders who strongly agreed or agreed will be presented in relation to those
who strongly disagreed or disagreed. In addition, means and standards deviation, with items that
measure using interval or ratio scales, was presented to identify average levels of responses
(Johnson & Christensen, 2015). In the event of missing data, a data value of “zero” will be
entered to allow for statistical computation. Also, in the event of conflicting data, conflicting
data will be excluded from the statistical analysis (Salkind, 2017).
For interview data, data analysis will begin during data collection. While in the field,
analytic memos were written after each interview. These memos documented initial thoughts,
concerns, and conclusions about the data in relation to this study’s conceptual framework and
research questions (Corbin & Strauss, 2008). After having left the field, interviews were
transcribed and coded in a codebook that was developed for this study. This codebook contained
several types of qualitative data codes.
In the first phase of analysis, open coding was used, looking for empirical codes and
applying a priori codes from the conceptual framework (Harding, 2013). A priori codes were
identified in the interview transcripts from unique terms or usage of terms relevant to the
students’ experiences.
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 62

During the second phase of analysis, the empirical and a prior codes were aggregated into
analytic or axial codes. The frequency of the empirical codes can be grouped into common
categories relevant to the student experiences. These categories may be identified as the analytic
or axial codes.
Lastly, in the third phase of data analysis, I will identify pattern codes and themes that
emerge from the codebook, in relation to the conceptual framework and study questions
(Harding, 2013). This identification of patterns and themes will come from my interpretation of
the analytic or axial codes from the codebook.
During this process of identifying empirical or a priori codes, analytic or axial codes, and
developing patterns or themes, Corbin and Struass’s (2008) analytic tools were used. The tool I
will use in particular is questioning. Questioning will be used to consider gaps in the data
presented by the students and whether this data is reliable.

Credibility and Trustworthiness
The credibility of this study is contingent on the study’s internal validity (Merriam &
Tisdell, 2016). The strategies used in this study to maintain interval validity fall into two
categories: researcher bias and reactivity (Maxwell, 2013). Some of the steps to limit researcher
bias occur during the data collection for the study. These strategies include: 1) adequate
engagement data collection, 2) researcher self-reflection (reflexivity), 3) peer review with
colleagues, and an 4) audit trail of how the study was conducted (Merriam & Tisdell, 2016).
Further steps to limit researcher bias occur during analysis of the study data. These strategies
include: 5) data triangulation of data, 6) weighing of results, 7) determining the significance of
data outliers, 8) seeking negative evidence, and 9) consideration of rival explanations (Miles,
Huberman & Saldaña, 2014). All of these strategies were conducted within this study. Reactivity
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 63

to the presence of the researcher also affects the validity of the study (Maxwell, 2013). This
study limited participant reactivity to the interviewer by conducting the focus group interviews
with the predetermined protocols.
The trustworthiness of this study is contingent on its external validity (Merriam &
Tisdell, 2016). Maintaining the study’s external validity enhances the generalizability of the
study, where the results or processes of this study can be applied or transferred to other settings
(Maxwell, 2013). The transferability strategies implemented in this study included: 1) maximum
variation in sampling for broader applicability and 2) user generalizability of the results
(Merriam & Tisdell, 2016). Further strategies to increase transferability of this study also include
use of: 3) rich/thick descriptions for users to extrapolate the results and 4) explicit statements of
any limitations on sampling or related theories that impacts generalization to other settings
(Miles, Huberman & Saldaña, 2014).
Validity and Reliability
This study maintains its validity for the quantitative survey through several approaches.
Through these approaches, meaningful and useful inferences can be inferred from the results of
the study (Creswell, 2008). These approaches include: 1) content validity (ensuring that the
instruments measure what they are intended to measure), 2) predictive or concurrent validity
(ensuing that the results are predictive or correlate with other results), and 3) construct validity
(ensuring that the instruments measure concepts) (Creswell, 2008).
In terms of reliability, maintaining the consistency or stability of the study is also
achieved through several approaches. The issue of reliability has a particular focus with the
study method of quantitative surveys. Since surveys have unique sampling and design elements,
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 64

the question of maintaining reliability needs addressing in these additional strategies: 1) pilot
testing the administration of the survey to ensure that potential participants understand and can
answer the survey questions, 2) ensuring adequate survey response rates by directly contacting
and reminding participants and offering incentives to complete the survey (Fink, 2013). In the
event of a low response rate, analysis of the data may be subject to bias inherent in non-
responses. How this study will handle bias from non-responses will be through post-stratification
or non-response weights (Fink, 2013). Given that the student population of HSU has certain
characteristics unique to its particular student body, including age, education, ethnicity, gender,
and residence, this post-stratification strategy compensates the results according to the likelihood
that students of certain characteristics are less likely than other characteristics to respond to the
survey.
Ethics

Trustworthiness of this study depends on the demonstrated competence and the ethics of
the researcher (Merriam & Tisdell, 2016). The use of human subjects in this research is a source
of ethical dilemma. Resolution of these dilemmas is within the guidelines of ethical codes and
under the purview of Institutional Review Boards (IRBs) within the respective universalities
involved (Glesne, 2011; Rubin & Rubin, 2012). Therefore, the responsibilities of this study
include the ethical treatment of its human participants by all of its researchers and consultants.
The ethics of the researchers include their integrity and their ethical decisions made in
relation to the study (Merriam & Tisdell, 2016). As part of the ethical treatments in this study, all
participants will receive an Information Sheet (IS), informing them of: 1) their voluntary
participation, 2) requesting permission to record the interviews, 3) maintaining their privacy, and
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 65

4) the researchers’ confidentially with storing or dissemination of study data (Rubin & Rubin,
2012).
In addition to the IS, the relationship of the researcher to the participants could pose more
dilemmas. The principal researcher of this study has a dual role, both as a faculty member of
HSU and as the researcher where the study data will be collected, on the campus of HSU. The
participants of this study also have dual roles, both as students on the campus of HSU and as
voluntary participants in the study. The pairing of these dual roles creates an inherent power
imbalance which may lead to participant coercion by the researcher and feelings of pressure to
participate by the students (Rubin & Rubin, 2012). In such a case, the students may perceive that
their decision to not participate may negatively affect their grades. Therefore, the planned
solution to this dilemma is to implement outside consultants in the recruitment, collection and
transcription of the study data. This study data will be scrubbed of any identifying student data
prior to data analysis by the principle researcher. Use of outside consultants will remove the
possibility of participant coercion as well as the perception of students feeling pressured to
participate.
Furthermore, possible assumptions and biases of the researcher could lead to other
dilemmas during the data analysis and reporting phases of the study. Such predispositions by the
researcher could stem from working experience interacting with the students at the university.
Moreover, the socioeconomic and educational backgrounds of the researcher could also have an
impact on their views toward the study participants (Glesne, 2011). In particular, the researcher
may feel that the students gravitate toward low levels of academic performance and scholarship.
For example, students may want less content rich curriculum and easier course assessments. In
short, these views could impact how and what data is analyzed and reported, leading to concerns
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 66

of internal study validity. Through the use of triangulation and recognizing how these views
could impact the study limits the views impact on the study (Maxwell, 2013; Merriam & Tisdell,
2016).

STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 67

CHAPTER FOUR:

RESULTS

Selection of General Education Courses
The general education (GE) courses at HSU are tailored to satisfy the various
accreditation standards required by the university in order for the university to confer Bachelor’s
level degrees. Thus these general education courses may or may not be required of students
enrolling at HSU. Transfer students who have completed the general education courses prior to
enrolling at HSU have satisfied the general education requirements in order for them to receive
their degree. However, students who have not completed these general education courses must
complete them at HSU in order for the university to be able to confer on these students their
Bachelors degree. The significance of selecting these general education courses for this study is
that students who are taking the general education courses at HSU may not be as prepared as
students who have transferred their general education courses, and therefore these GE students
are at-risk with early withdrawal from the university.
HSU admits five cohorts of students annually into two academic programs, Bachelors of
Nursing (BSN) and Bachelors of Dental Hygiene (DH). There are no students who enroll in HSU
as undeclared majors. Of the HSU students, the majority (83%) are enrolling for the nursing
degree, approximately 120 students per cohort. The balance of the cohort are students with a DH
as a major. Therefore, presumably, the majority of the survey and interview responses are from
students who are BSN majors. As stated in Chapter One, the students who are enrolled in general
education course are considered pre-core since they have not enrolled in their academic major
courses, the core of their degree programs.

STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 68

Quantitative Survey Results
The survey data was collected from five general education courses, and was based on a
convenience sampling of students who volunteered to participate in the survey. The overall
survey response rate was 27%, which comprised of 155 students who responded to the survey
from a total population of 567 students within all the pre-core courses at HSU.
Student Age and Gender

Of these 155 student respondents, over two-thirds were female, 69.03%, compared with
the males, 30.97%.
Table 5

Survey Item 1: What is your gender?
Answer % Count
Male 30.97% 48
Female 69.03% 107
Total 100% 155

The age of the respondents ranged from 18 to over 51, distributed between three aged groups,
18-21, 22-30, 31-40. However, the majority of the respondents, 63.87%, were within the 22-30
age group. Considering this age group, these students are classified as adult learners.
Table 6

Survey Item 2: Which is you age?
Answer % Count
18-21 18.71% 29
22-30 63.87% 99
31-40 13.55% 21
41-50 3.23% 5
51-+ 0.65% 1
Total 100% 155

STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 69

Educational Attainment

The educational levels of the majority, 82.58 %, of the respondents are post-secondary,
having completed high school, technical training or an Associate’s degree, although a portion of
the student body have attained an educational level of Bachelor’s, 17.42%.
Table 7

Survey Item 3: What is your highest educational level completed?
Answer % Count
High school 43.87% 68
Associate’s or Technical Certificate 38.71% 60
Bachelor’s 17.42% 27
Master’s 0.00% 0
Doctoral 0.00% 0
Total 100% 155

The parental education levels of the majority of the respondents ranged from having
completed high school, 31.17%, to Associate’s, 22.73%, and to Bachelor’s, 35.06%. Only a
small percentage of the respondents had parents with graduate or higher levels of educational
attainment, 11.04%.
Table 8

Survey Item 4: What is your parents’ highest educational level?
Answer % Count
High school 31.17% 48
Associate’s or Technical Certificate 22.73% 35
Bachelor’s 35.06% 54
Master’s 6.49% 10
Doctoral 4.55% 7
Total 100% 154

STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 70

Chosen Major and First Year Students

Students often confuse being enrolled in the general education courses (pre-core) as
equivalent to being enrolled in their technical training courses (core). Although all of the
respondents surveyed were attending pre-core, General Education courses, 92.9% of them
identified as enrolled in a core program. Thus they identified as core program students even
though they have not completed their pre-core courses as part of their Bachelor’s degree.
Table 9

Survey Item 5: What program are you attending?
Answer % Count
General Education 7.10% 11
BSN or DH 92.90% 144
Total 100% 155

The majority of the respondents are within their first year of attending the university,
79.35%. Returning students in their second year comprised only 18.71% of the respondents.
Lastly, third year students, the most seasoned students, were only 1.94% of the respondents.
Thus the responses in this survey are mostly first year experiences.
Table 10

Survey Item 6: How long have you attended this university?
Answer % Count
First year 79.35% 123
Second year 18.71% 29
Third year 1.94% 3
Beyond third year 0.00% 0
Total 100% 155

STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 71

Student Work Obligations
Over two-thirds of the participants are working while attending the university, 70.97%.
Such a high percentage of the respondents working outside of their school commitments may
impact their ability to study for their academic programs.
Table 11

Survey Item 7: Are you currently working in a paid job or other related activities such
as volunteering?
Answer % Count
Yes 70.97% 110
No 29.03% 45
Total 100% 155

Although over two-thirds of the participants are working while attending the university,
only 40.65% have jobs related to their field of study, healthcare. Such a decision to work in non-
healthcare related jobs may impact the students’ ability to stay motivated in their school work.
Table 12

Survey Item 8: If you are working, is your job related to healthcare?
Answer % Count
Yes 40.65% 63
No 30.97% 48
I am not working 28.39% 44
Total 100% 155

In addition to having working obligations unrelated to their field of healthcare, 70.78% of
the working students are working off-campus. When compared to the proximity of an on-campus
job, such off-campus work obligations can further detract from the respondents’ ability to
dedicate time for their studies.
Table 13

Survey Item 9: If you are working, is your job on this campus?
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 72

Answer % Count
Yes 1.30% 2
No 70.78% 109
I am not working 27.92% 43
Total 100% 154

The working obligations of the respondents ranged from part-time, from 0 to 20 hours per
week, 56.87% to full-time, 21-40 hours per week, and 41.18%. Although it is possible the
35.95% of the respondents have little work obligations, 0-10 hours per week, 64.06% of the
respondents have significant work obligations. Surprisingly, nearly 2% of these students report
working full time while attending their program full time.
Table 14

Survey Item 10: How many hours a week are you working?
Answer % Count
0-10 35.95% 55
11-20 20.92% 32
21-30 23.53% 36
31-40 17.65% 27
41-+ 1.96% 3
Total 100% 153

Household Income and Financial Need
The majority of the respondents, 66.45%, reported annual household income below
$60,000. Considering the metropolitan area of HSU, this income level is classified as low-
income. Of these respondents, 39.35% of them reported annual household incomes below
$30,000, which is near poverty levels. Due to their reported low level of income, it is possible
that these students are living with financial stress to meet their living needs in addition to the
academic stress of attending their programs.
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 73

Another consideration related to the financial stress of the students is whether these
students have financial dependents. Although this data was not directly collected from the
respondents, the researcher of this study is aware that approximately 33% of HSU students have
to provide financial support to either child dependents or to other adult family members.
Table 15

Survey Item 11: What is your household income level?
Answer % Count
Below $30,000 39.35% 61
$30,000 - $40,000 12.26% 19
$40,001 - $60,000 14.84% 23
$60,001 - $100,000 22.58% 35
Above $100,000 10.97% 17
Total 100% 155

Student and Familiar Health Needs
Although some students may require an absence from school due to their health needs or
the health needs of their dependents and extended family members, the respondents of this
survey reported being in good health and not having the need to attend to other family members’
health concerns.
Table 16

Survey Item 12: What is your health status?
Answer % Count
Chronic condition 1.29% 2
Poor 0.00% 0
Fair 10.97% 17
Moderate 23.23% 36
Healthy 64.52% 100
Total 100% 155

Table 17

Survey Item 13: Since you have been at this school, how many times have you been
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 74

hospitalized?
Answer % Count
0 88.96% 137
1-3 10.39% 16
4-7 0.65% 1
8+ 0.00% 0
Total 100% 154

Table 18

Survey Item 14: Since you have been at this school, how many times has your immediate
family (spouse, kids, parents, etc.) been hospitalized?
Answer % Count
0 76.13% 118
1-3 22.58% 35
4-7 1.29% 2
8+ 0.00% 0
Total 100% 155

Prior Educational Preparation
Only 135 of the respondents, 87%, indicated that they completed one of four science
courses required within their pre-core courses while in high school. The most frequently taken
course was Anatomy, 26.67%, and Chemistry, 65.93%.
Table 19

Survey Item 15: Did you take any of these science courses in high school? Select all that
apply.
Answer % Count
Anatomy 26.67% 36
Physiology 2.96% 4
Chemistry 65.93% 89
Microbiology 4.44% 6
Total 100% 135

Although many, 96.8%, of the respondents of the survey had prior academic preparation in the
required science subjects, the majority of the respondents indicated as having some level of
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 75

confidence in being prepared for their courses, as “somewhat prepared,” 58.67%. This level of
confidence may not be sufficient to adequately meet the needs of an accelerated, impacted
program such as the ones offered by HSU. Moreover, some participants feel poorly prepared,
11.33%, or unprepared, 9.33%. These results suggest that self-efficacy of the students is not
optimum and can be improved.
Table 20

Survey Item 16: To what level would you agree that your prior knowledge of the sciences
before attending this university prepared you to successfully take courses in Anatomy,
Physiology, Microbiology or Chemistry in college?

Answer % Count
Unprepared 9.33% 14
Poorly prepared 11.33% 17
Somewhat prepared 58.67% 88
Well prepared 18.67% 28
Highly prepared 2.00% 3
Total 100% 150

Furthermore, some of the participants, 76.13%, indicated that they completed the
required science course at the college level prior to enrolling at this university, with Anatomy,
38.14%, being the most frequently completed course, followed by Chemistry, 25.42%,
Microbiology, 21.19%, and Physiology, 15.25%, being the least taken course. Therefore, it may
be possible that those students who have taken and passed the required science courses at other
colleges or universities may have higher levels of self-efficacy.
Table 21

Survey Item 17: Have you taken any of the following classes at another university or
community college?
Answer % Count
Anatomy 38.14% 45
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 76

Physiology 15.25% 18
Chemistry 25.42% 30
Microbiology 21.19% 25
Total 100% 118

Student Self-Efficacy

Several of the survey questions target identifying influences to the students’ self-efficacy.
The number of hours students are committing to studying for their courses range from 0 to 25
hours per week. However, the median response was 6–10 hours per week, 38.82%. This result is
in contrast to what is expected by accelerated programs such as the ones offered by HSU, where
students are usually prescribed to study 16-20 hours a week for students who are registered as
full-time students. Surprisingly, only a small percentage of students, 12.50%, study these 16-20
hours per week and even a smaller percentage study the recommended 20+ hours per week,
5.26%.
Table 22

Survey Item 18: On average, how many hours a week are you studying for your courses?
Answer % Count
0-5 21.05% 32
6-10 38.82% 59
11-15 22.37% 34
16-20 12.50% 19
21-25 5.26% 8
Total 100% 152

Moreover, the participant confidence level in their study habits to maintain adequate grades
ranged from low, 8.5%, to high, 18.3%, with the median response, 40.52%, being moderate.
Table 23

Survey Item 19: To what level would you say that your study habits are enough to
maintain a 3.0 GPA?
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 77

Answer % Count
Low level 8.50% 13
Fair level 32.68% 50
Moderate level 40.52% 62
High level 18.30% 28
Total 100% 153

In addition to their confidence, student prior knowledge of study strategies were
surveyed. Similar to their levels of confidence, they reported levels of familiarity with different
ways of studying ranged from fair, 30.92%, to high, 26.32%.
Table 24

Survey Item 20: To what degree would you agree that you know enough study strategies
(different ways of studying) to maintain a 3.0 GPA?
Answer % Count
Low level 5.26% 8
Fair level 30.92% 47
Moderate level 37.50% 57
High level 26.32% 40
Total 100% 152

Specifically, the most reported study strategy used by students were pre-reading or
outlining, 38.82%, followed by flash cards, 23.68%, and then sample questions or reviewing past
questions, 21.05%. Although these strategies may be the most expedient in how students would
allocate their time to study, these strategies may also not allow students to interconnect
conceptual knowledge. Rather, the least reported study strategies, flow or concept maps, 5.26%,
and, study groups, 11.18%, could help students with development of their conceptual knowledge.
Table 25

Survey Item 21: Which of the following study strategies do you commonly use during an
exam week?

STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 78

Answer % Count
Pre-reading or Outlining 38.82% 59
Flow or concept maps 5.26% 8
Flash cards 23.68% 36
Sample questions or reviewing past question 21.05% 32
Study groups or with a friend 11.18% 17
Total 100% 152

Student Interest and Work Influences

Student success in an academic program is influenced by their level of interest in
attending the program. Both initial and current interest levels were accessed. The majority of the
respondents, 63.95%, indicated high levels of initial interest and current interest. Although this
portion of the students, who indicated high interest, represented two-thirds of the respondents, a
significant portion, approximately one-third of the students, indicated moderate to fair levels of
interest.
Table 26

Survey Item 22: What was your initial interest level in attending your program?
Answer % Count
Low level 0.00% 0
Fair level 10.88% 16
Moderate level 25.17% 37
High level 63.95% 94
Total 100% 147

Table 27

Survey Item 23: What is your interest level now in attending your program?
Answer % Count
Low level 0.00% 0
Fair level 9.52% 14
Moderate level 26.53% 39
High level 63.95% 94
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 79

Total 100% 147

Student interest to study in the healthcare programs at HSU may be influenced by work
related experiences while working in healthcare. More than half, 58.50%, of the students
indicated that they work in healthcare, and that they are highly motivated to stay in school due to
their work experiences in healthcare, 41.89%.
Table 28

Survey Item 24: Have you worked in healthcare?
Answer % Count
Yes 58.50% 86
No 41.50% 61
Total 100% 147

Table 29

Survey Item 25: To what level has your work in healthcare motivated you to stay in school to
learn more about healthcare?
Answer % Count
I have not worked in healthcare 35.81% 53
Low level 1.35% 2
Fair level 4.73% 7
Moderate level 16.22% 24
High level 41.89% 62
Total 100% 148

In contrast, nearly one-third to one-half of the respondents, 35.81% - 41.50% have not
worked in healthcare, and therefore cannot be influenced by such work experiences. These
respondents may be influenced in other ways from non-healthcare related work experiences.
Social, Non-Healthcare Work and Familial Influences

In addition to work, the social support of students may also influence their academic
performance in school. The overwhelming majority, 93.20%, of the respondents have friends
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 80

who work in healthcare. Presumably, these students include those who report not working in
healthcare in Questions 24-25. Thus, it is arguable that these students, whose direct work
experience is non-healthcare related, are indirectly influenced by their friends who do work in
healthcare, Questions 26. As such, Question 27 indicates that slightly more than half, 53.74%, of
the respondents are highly influenced by their friends in terms of motivating them to stay in
school.
Table 30

Survey Item 26: Do you have friends who work in healthcare?
Answer % Count
Yes 93.20% 137
No 6.80% 10
Total 100% 147

Table 31

Survey Item 27: To what level have your friends motivated you to stay in school to continue to
learn healthcare?
Answer % Count
I have no have friends who worked in healthcare 4.08% 6
Low level 4.08% 6
Fair level 14.29% 21
Moderate level 23.81% 35
High level 53.74% 79
Total 100% 147

Aside from friends, family influences can also motivate students to continue school.
Three-quarters of the respondents, 75.51%, reported having family who worked in healthcare.
Moreover, in a similar way as their friends, the family members are also reported as being highly
influential to more than half of the respondents, 51.70%.
Table 32

STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 81

Survey Item 28: Do you have family who work in healthcare?
Answer % Count
Yes 75.51% 111
No 24.49% 36
Total 100% 147

Table 33

Survey Item 29: To what level did your family influence your desire to attend a healthcare
school?
Answer % Count
I do not have family who works in healthcare 11.56% 17
Low level 6.80% 10
Fair level 11.56% 17
Moderate level 18.37% 27
High level 51.70% 76
Total 100% 147

Other than friends and family influences, for the students who reported no having
healthcare related jobs, their jobs have also influenced them to stay in school, 81.82%, and to
also attend a healthcare related school, 44.37%. Presumably, the work experiences of these
students were not what the students wanted as their chosen career major and therefore drive these
students to attend a program that is related to their chosen major.
Table 34

Survey Item 30: Has your current job made you want to stay in school?
Answer % Count
Yes 81.82% 117
No 18.18% 26
Total 100% 143

Table 35

Survey Item 31: To what level did your non-healthcare job influence your desire to attend a
healthcare school?
Answer % Count
My non-healthcare job did not influence me in wanting to stay in
school
23.94% 34
Low level 3.52% 5
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 82

Fair level 13.38% 19
Moderate level 14.79% 21
High level 44.37% 63
Total 100% 142

Student Attributions and Time Management

Related to the chosen majors of these respondents, how these students attribute their
success or failures may be influenced by how they manage their time, their perceptions of their
courses, and instructors. The vast majority of the respondents, 67.81%, preferred to spend time
with friends and family, as opposed to working and studying for their least favorite class, 8.22%.
In addition, the respondents viewed that the main influences of their performance was due to too
much to study, 23.81%, and the instructor is ineffective, 32.65%. This is counter intuitive since
the students planned and agreed to attend an accelerated academic program where there would be
a lot to study in a short duration.
Table 36

Survey Item 32: Please select the activity of greatest personal importance to you:
Answer % Count
Spending time with friends and family 67.81% 99
Getting a good night’s sleeping 16.44% 24
Playing your favorite game 6.85% 10
Working and studying for your least favorite class 8.22% 12
Career planning for a job that is not your first choice 0.68% 1
Total 100% 146

Table 37

Survey Item 33: What do you think is the most likely cause of you not doing well in a
course?
Answer % Count
Too many hours at work 19.73% 29
Too much to study 23.81% 35
The subject is too difficult 6.12% 9
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 83

The subject is not interesting to me 17.69% 26
The instructor is ineffective 32.65% 48
Total 100% 147

Furthermore, the students attribute their success not to their abilities or effort but instead
to having too many work hours, 19.73%, too much to study, 23.81%, or the effectiveness of their
instructors, 32.65%. These student attributions suggest that their self-efficacy is not optimum
since they were informed that the programs at HSU are accelerated and therefore their heavy
work schedules will negatively impact their school performance.
In the instance of planning and implementation, the majority preferred to prioritize an
important task after other tasks, 58.50%. Presumably these other tasks are equally important to
academic success. However, these tasks may also have a neutral or even negative impact on their
academic success. In addition, the majority of the respondents feel that they are able to read the
course textbook, 51.02%, at a moderate level, which is the main source and authority in the
course, and that the instructor is a significant factor in motivating them to do well in the course,
51.70%. Both of these reported results suggest that the respondents feel that the instructor is
more influential to their performance than their ability to perform.

Table 38

Survey Item 34: When you have an important task to complete, you start it:
Answer % Count
Right away 19.05% 28
When you have time 14.97% 22
After you prioritize your tasks 58.50% 86
When the task is due 6.12% 9
You sometimes forgot to complete the task 1.36% 2
Total 100% 147

STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 84

Table 39

Survey Item 35: How would you rank your ability to read and understand the course
textbook?
Answer % Count
Low level 3.40% 5
Fair level 31.29% 46
Moderate level 51.02% 75
High level 14.29% 21
Total 100% 147

Table 40

Survey Item 36: To what level does the course instructor motivate you to study for a course?
Answer % Count
Low level 3.40% 5
Fair level 22.45% 33
Moderate level 51.70% 76
High level 22.45% 33
Total 100% 147

Drop in Response Rate

Interestingly, a number of the students who took the survey elected to not respond to the
last several questions of the survey regarding the institution and faculty, questions Q 37 through
Q 43. The number of respondents for these last survey items dropped by about 15 respondents,
from an initial 155 respondents to about 140 respondents. A factor that might explain this small
decline in the response rate is respondent fatigue. HSU issues numerous surveys to the general
student body throughout the year, and thus the students who did respond to this study’s survey
may have felt that they have already answered questions regarding the organization and faculty.
However, considering the size of the pre-core student body population at HSU, the number of
students who did respond to these last for questions is still a high response rate, 25% for the
student body.
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 85

Organizational Influences

Organizational culture is an important influence to organizational performance.
Accordingly, many of the students, 42.86%, reported that the university only moderately
stimulated their interest in their studies. For some of the respondents, 6.43%, the school culture
has a low level of influence in stimulating their interest in their studies.
Table 41

Survey Item 37: To what degree has the student culture of this school stimulated your interest
in your studies?
Answer % Count
Low level 6.43% 9
Fair level 25.00% 35
Moderate level 42.86% 60
High level 25.71% 36
Total 100% 140

In contrast, the survey respondents indicated that study groups was the most influential
among several other common course activities that stimulated their interest in studying for their
major, in Question 38, although study groups was one of the lowest indicated study strategies
earlier in this survey, Question 21. An organization that is effective at facilitating student study
groups within the framework of the courses could dramatically enhance student performance.

Table 42

Survey Item 38: Please select the following activities that have stimulated your interest in your
major.
Answer % Count
Study groups 40.29% 56
Group presentation 13.67% 19
Homework assignments 23.74% 33
Course exams 22.30% 31
Total 100% 139

STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 86

In order to create an organizational culture that promotes student study groups, a high
level of student trust is required to engage these students in these groups. As indicated by the
survey Question 39, the level of student trust ranges from fair, 36.43%, to moderate, 30.71% to
high, 25.00%. Thus the level of trust among students may not be sufficient to effectively have
student study groups as an organization wide program.
Table 43

Survey Item 39: To what degree do you trust your classmates to help you learn the course
materials?
Answer % Count
Low level 7.86% 11
Fair level 36.43% 51
Moderate level 30.71% 43
High level 25.00% 35
Total 100% 140

Faculty Influences

In addition to the level of student trust of their peers, the level of student trust of their
faculty also ranges. Only about one-third of the respondents feel that the faculty stimulated their
interest in their program, 33.81%, and trusted the faculty to help them accomplish their course
goals, 37.86%.
Table 44

Survey Item 40: To what degree has the professionalism of faculty at this school stimulated
your interest in your major?
Answer % Count
Low level 5.76% 8
Fair level 26.62% 37
Moderate level 33.81% 47
High level 33.81% 47
Total 100% 139

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Table 45

Survey Item 41: To what degree do you trust your professors to help you learn the course
materials?
Answer % Count
Low level 4.29% 6
Fair level 14.29% 20
Moderate level 43.57% 61
High level 37.86% 53
Total 100% 140

Organizational Support Services

Closely connected to student and faculty are their support services. As indicated by the
respondents, their level of interest in their program and trust from interacting with student
services also ranges.
Table 46

Survey Item 42: To what degree has student services at this university stimulated your interest
in your major?
Answer % Count
Low level 17.14% 24
Fair level 29.29% 41
Moderate level 32.86% 46
High level 20.71% 29
Total 100% 140

Table 47

Survey Item 43: To what degree would you trust student services to help you to learn the
course materials?
Answer % Count
Low level 15.83% 22
Fair level 29.50% 41
Moderate level 36.69% 51
High level 17.99% 25
Total 100% 139

STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 88

Overall, from these survey results regarding trust, the student body at HSU appears to
have subsets of students who either have enough trust of the organization and other students who
lack sufficient trust of the organization to help them enhance their academic performance.
Focus Group Interview Results

The focus group interview data was collected from the five general education courses that
responded to the survey data. Thus the student participants selected for the interviews were
volunteers from the students who also completed the survey. Five mini-focus group interviews
were conducted. During the process of recruitment of student respondents for the interviews, it
was realized that the interviews needed to be truncated. The need for reducing the number of
questions asked during the interviews is due to the nature of the student body as student
commuters and are therefore only on campus during class times. These students are unwilling to
come to campus when they do not have classes to participate in a non-mandatory, voluntary
study. In addition, since these students are only on campus during class times, the interview
needed to accommodate these class times. This accommodation allowed only about half of the
original, planned interview questions to be asked during the interviews. The questions selected
for the condensed interview were believed to best determine the Knowledge, Motivation, and
Organizational influences that impact the student academic performance.
As a reminder, the research question of this study is:
1. What are the HSU students’ knowledge and skills, motivation, and organizational
influences that may interfere with them passing their classes and gain licensure?
2. What are the recommended knowledge and skills, motivation, and organizational
solutions?
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 89

In the process of determining the knowledge base of the students this interview question
was asked.
1 [K- Declarative] What do you think are the qualities of a well-prepared student?
A Well-Prepared Student
The responses indicated that the students are aware of the some of the qualities of a well-
prepared student. Students responded with their needs to have appropriate learning tools and
materials for coursework, including “Paper, pencils,” and “Computer if needed, depending on the
class.” In addition to these materials, the students are aware of critical behaviors necessary for
academic success, including “Coming to class on time,” “Having a good attendance,” “Taking
notes,” and “Preparing ahead of time.” Other critical behaviors indicated by the students also
included “Organization,” “Time management,” and “Participation.” Lastly, the students also
indicated that, in addition to the knowledge of successful behaviors, successful students also
need to have motivation to learn, “Someone that has the desire to learn,” “Motivation is
definitely important.”
In addition to being aware of the qualities of a well-prepared student, the student
respondents are also aware of the some of the strategies that such a student can perform to
prepare for their courses.
2 [K- Procedural] Can you describe some of the things that a well-prepared student
would do to prepare for these courses?
Student Study Strategies
These strategies include “Read ahead. Uh, make sure they have their classes set up, uh
and registrations,” “Be organized with test dates and uh, like homework assignment due dates,”
“Planning out study time before it gets close to the test time,” “And actually if you study like in
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 90

groups, um, to actually prepare for the study group.” In order to implement these strategies, the
students indicated that they also required learning materials, including “Have a planner,” “Study
guide,” “…the library…their teacher to, to clarify…information if they have any questions.”
When determining the respondents’ level of motivation and their believed attributions for
doing well in their courses, the following question was asked during the interview.
3 [M- Attribution] What do you think are some of the reasons why a college student
would not do well in a course?
Personal Attributions to Success
The students believed that barriers to student success arrive from being “Overwhelmed
by all the work and all the tests, and all the information that's being thrown at them.” Others
believed that “If you're working and don't have time to study.” From these responses, it is
possible that these school and work conditions attribute to other students responses including,
“Inadequate sleep,” “And sometimes there's things that happen at home or with friends and
family that can also affect the mind of the person.” This poor balance between school and work
may contribute to the students’ responses of how “They don't understand the [course]
information.” Yet other students indicated that receiving “Improper directions [presumably from
faculty]” is a factor.
Several students attribute their academic success to a good balance between school and
work, “Time management between work and school,” and not “Waiting until the last minute to
start studying.” One student adamantly stated, “That's the biggest. Yeah, that's the biggest. Not
studying, not really putting in the effort into what you're learning. I mean, everyone works
differently. But there are tricks and ways to doing it.” Yet, some students believed that other
students “Don't really care about learning, they just want to copy other people and they don't
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 91

understand the material.” From these responses, it appears that there is a portion of the student
body at HSU that do not value the scholarship of learning.
Moreover, these students also believe that their course performance outcomes are
influenced by institutional factors.
4 [M- Attribution] What do you believe influences your performance outcomes?
Organizational Attributions to Success
The institutional factors include their interaction with faculty, “Sometimes the interaction
between the teacher and the student. The teacher is teaching one thing and the student's learning
that, and then sometimes the tests are completely different. There's that miscommunication
between what's needed to be known as to what the student's being taught.” In addition, to
miscommunication between students and faculty, students also believed faculty motivation is
also a contributing factor, “How active your teacher is, your professor is. And how can you learn
information. How enthusiastic they are.” Other respondents indicated, that their performance is
influenced by “The amount of money we're paid (laughter),” “Outside, or society's factors of not
wanting to be a failure,” and “The support outside the school as well.”
In addition to these factors, the students feel that the pace of the school also effects their
performance outcomes.
5 [M- Attribution] How do you feel about the pace (speed) of the courses here at
this school?
6 [M- Attribution] How do you believe this pace influences your academic
performance?

STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 92

Work Life Balance Impacts Students
Some of the students indicated that they have achieved a good balance between school
and other commitments, “Thanks to the syllabus you know what's coming up. So, if you're able
to prepare ahead of time, it's not too bad. It just depends on how many classes you're given. And
how many things are piled up on top of each other.” Yet other students were having some
difficulty balancing work loads, “Some of them are manageable, some of them are on the outer
limits of manageable.”
A critical factor to work balance is the need of some students to work outside of school.
Some students admit that their ability to balance school workloads is contingent on whether they
have other commitments, “I feel like it's manageable but I don't, I don't have to work yet.”
From a functional perspective, for students who manage to balance their school workload, they
attribute their success to acclimation, “They get used to, but once you get into the hang of it, it's
not too bad.” Moreover, as a consequence from the pace of the courses at HSU, students’
academic performance is affected by such a pace.
Academic Pace Impacts Students
In terms of the school’s academic pace, some of the students felt that “It's at a good pace.
But if you slip up a little bit, it's easy to fall behind and just get, like, overwhelmed with trying to
catch up.” Other students feel that the pace creates incentive for students to timely perform in
their courses, “I believe it increases that, cause if you slack off you pretty much fall behind
permanently, so it keeps you on your toes.” In addition, to students’ timely performance in their
courses, the school’s academic pace also prompts students to increase their organizational study
skills by planning, “Since it's a high pace, you have to plan everything out, make sure that you're
doing well.”
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 93

Another student indicated that the pace of the school effected students differently
depending on their circumstances, “It depends on your life situation. If you're motivated to get
through school quickly, then like it's up to you to obtain that information.” Other students
indicated that they have experienced negative outcomes due to the accelerated pace of the
schools’ programs, “Forget vacations. I took one vacation. Came back and I was like, uh-“. Other
students were more direct, “The outcome is not what it used to be, because it's too fast,” “I
question whether I really retain ... if I'm going to retain the information or if it's just short term
memory?,” and “I feel like maybe I could do a little bit better, if I had a regular semester, other
than like a nine week period semester.”
Considering these responses, one student indicated how they balanced the pace of the
school with their commitments in order to maintain a level of academic performance that meets
their expectations, “I'm like I'm able to put in the time, I mean it's a lot of time so my grades
aren't suffering but if I didn't have the amount of time that I do by not working then my grades
would definitely be suffering.”
Lastly, in determining the students’ motivational level and beliefs for self-efficacy, these
interview questions were asked.
7 [M- Self-Efficacy] What do you think is required for students who work to be
successful in school?
8 [M- Self-Efficacy] How do you feel about your ability to be successful?
9 [M- Self-Efficacy] Describe the strategies that you used to match your school
workload with your work workload.

STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 94

Influences on Student Self-Efficacy
Students’ indicated that certain behaviors, including time management, and life choices,
limiting work hours, are important for a working student to be successful while attending HSU.
One student indicated, “Time management. And if you work, I suggest part-time. Full-time isn't
... I know some people need full-time, but, not really at this school. It's hard to do”. Another
student agreed, adding nuanced insight regarding student learning demands, “Yeah. Especially
once you get into Core when ... Like right now in the Gen Ed we only have to come a couple
days a week, if anything. But once you're at Core I believe it's almost every day you're here. And
either you go to school and pass, or you go to work and you make your life difficult and probably
don't pass. That's probably what it would come down to at that point.” In addition to these
behaviors and choices, mindset and motivation are also important to student success, “It's a mind
thing. I mean, if you put yourself into it you can. You just have to put yourself into it.”
Social support from other students is also important and influences self-efficacy and
motivation, “You have to surround yourself, I think, with other groups that are, um, doing well.
That likes to study and just ... Because especially when you're struggling when, if you just go out
and study with someone I think it's gonna help you out.” Another student agreed, “That's what I
love about study groups. Everybody understands something a little bit differently and they help
each other out.”
To surmise, other students share their perspective, indicating that individual effort is a
large influence to motivation, “It boils down to the individual. The individual has to do their part.
Like, for me, I have to study on my own before I go to the group study because I need to have
something to bring to that table rather than just kind of having everybody drag you. So you have
to,” and “As long as you try, you're going to be successful pretty much. Put forth the effort you
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 95

know get through it.” From these indications, positive student mental focus and determination
for course completion are critical for success, “I feel positive about it as long as I maintain my
focus on school and that it's temporary and everything else will, you know, figure it out, figure
itself out later on. Like school's first.”
Student Strategies to Enhance Self-Efficacy
In terms of individual effort to effect personal motivation, the strategies used by the
respondents to balance their school and workloads indicated that success at prioritizing and
balancing their needs are important to success.
I'm lucky enough to have a flexible schedule so I don't have to worry too much about it.
If I need to take more time to do my schoolwork I can. But, I know for some people, they
can't so they have to worry about their time. Making sure that even if they do have to go
to work that they plan ahead of time and make sure that they get all their work done at the
time.
I think it boils down to time management that you were talking about. You think through
the balance of school, work and family. You need to be able to juggle that. But, um, time
management as long as you, once you plan your day, your, your schedule. And then the
next thing would be actually executing it.
In addition to prioritizing and balancing needs, the respondents also indicated that they
needed the cooperation of both the school and their employers to meet their needs. One student
responded with, “Make sure your bosses are aware of how things are going too. You can't just
expect them to guess that you have a midterm that week and, uh, give you off the hours that if
you're forgetting more than normal.” Another student indicated that in their situation, they felt
that there is no cooperation between their work and HSU, “My work doesn't care about my
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 96

school, and my school doesn't care about my work”. In order to reconcile this work balance
conflict, one student indicated that “You have to determine what's more important, school or
work, so you have to put in the time for whatever matters.”
Organizational Influences that Effect Student Self-Efficacy
To further understand if the student’s level of self-efficacy is influenced by
organizational factors these questions were asked.
11 [O- Conflict] If this applies to you, please describe a time when you had a conflict
between your work and course schedule.
12 [O- Conflict] How could the school have helped with these conflicts?
14 [O- Conflict] Do you think that the services offered by the school for student
services are enough for student needs?
The student responses included these statements about their work and school conflicts.
Conflict between School and Work
The conflicts the students reported depended on the unique circumstances of that student.
Some students reported having to work while attending school, “Some people have to like, work
and go to school at the same time. Like, me, I have to go to work and wanted to take a class. So,
uh, it just depends on the individual.” In addition, other students reported conflicts between work
schedules and their need to study for their course exams, “Well, this past weekend, we had our
Patho[physiology] midterm and I ended up having to work a double at my job on Saturday. So
that, completely took my whole Saturday out from studying. And that was hard, cause then I had
to stay up pretty late, and also had to go to work Sunday morning.” In such a case where students
have to decide between working and studying, these students may have had a negative impact on
their academic performance and outcomes.
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Also, when students participate in study groups, such work schedule conflicts may also
impact their ability to attend these work group meetings, “Specially with like group projects,
because you have to coincide your work schedule and like when you wanna meet with people to
study, or work on things that are mandated that you have to work with other students. And if
your schedule changes, or you work in like customer service industry, you don't really have a lot
of control over when you can do that.”
For students not being able to participate in these study group meetings, their self-
efficacy may also be impacted by such conflicts, “It's very stressful trying to figure out, you
know, coordinate the two schedules, and then I have to go back and go ... now I have to find
people to work for me because I can't work on those days.” As reported by these students, the
added stress they experience from missed meetings may contribute to lowered academic
performance.
In addition, students who also have family obligations in addition to work demands,
experience an even higher level of stress, “I had two jobs, … a school full time and a newborn,
so, I ended up just, decreasing my work hours to make it possible. And the only thing can ...,
school should be a priority so it’s just, gonna affect my future goals.” From such reports of these
conflicts, school demands seem to prioritize just as highly as other demands within these
students’ lives.
Resolving Conflicts
In terms of how the HSU could have helped with these students conflicts, the students
reported that the school has little impact on preventing these conflicts, “It's more up to the
individual than it is up to the school for how you dedicate time, or how you can dedicate time.”
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 98

Other students report that students need to be flexible with their schedule, “You have to … a
more flexible schedule.”
In contrast, some students feel that the school can help by providing more scholarship
options, “Or like, maybe a little more help or advice on like scholarships, so people don't have to
work as much, because it's kind of a difficult thing to do or you don't know what you're doing.”
If students are provided more financing options for paying for their schooling, besides working
outside of school, they will have more time to dedicate to their studies.
In addition, the stress from possibly not being able to meet their financial obligations
negatively impacts their ability to perform in the coursework, “For the things that we have to do.
Because we can't skip out, or like, our core dates pushed back. You know? But then, our work
life scarifies and then we have to worry about am I gonna have enough shifts to pay my bills?
You know?” When correlating this student’s statement with the survey results of the student
household income, where many of the students responded with low household income levels, it
is highly suggestive that a significant portion of the student body at HSU is under notable
financial stress that detracts them from their studies.
Aside from financing options for students, HSU could also provide more options for
meeting dates as students approach their clinical courses, “…..especially going into core, having
dates way ahead of time, as far as when things are planned for, is very helpful for me to schedule
work. Like the core orientation, ITA testing ... I need all those dates way ahead of time.”
Accelerated curriculum increases conflict. Other organizational factors that could
impact work scheduling conflicts pertains to how the curriculum is delivered. Some respondents
indicated that the accelerated course curriculum could be further optimized so that students
would require less time to study. Such curriculum optimization would allow students who were
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not able to work around their scheduling conflicts to still adequately study for their courses and
pass these courses.
I think they should revise the curriculum a little bit so that they can maybe streamline it
to make it easier for people to understand and learn.
More direction on what we need to focus on for studying. I find it very helpful when the
teachers can like, direct us to certain parts of the chapter versus 'here read this whole
chapter and figure out what we want you to know.
Limited use of resources increases conflicts. Student indicated frustration with
available student services, identifying scheduling conflicts between their course times, work
times and the available times of the resources, “Yeah. The only problem is with tutoring is that
sometimes it is not available at the time you specifically can because of other classes like,
clashing with it. So, that's the only issue with that…” In addition, the motivational levels of
student who are not able to utilize these resources are negatively impacted, where their desire to
attend future resources are diminished.
They have some seminars that is offered only on Thursday and Friday. It kinda sucked
for me now because all our classes are Wednesday, Thursday and Fridays. For those
students that are in all those classes are unable to attend it.
Underutilization of student resources may contribute to lowered student performance.
In addition to conflicts with available resources, students also viewed that the
organization could provide more resources, including additional course offerings, tutoring
options, and options for changing course sections.
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 100

I don't think they have enough. Like, I don't member which particular courses but, they
didn't have the available tutoring options for a couple of courses when I looked into it. At
least for the semesters I was in the course.
Uhm, with like slot times and that course availability and stuff, I don't know if that's
applicable to students services, but they don't really leave a lot of leeway for like trades,
or shifting out. Like I had a lot of issues with my like class that I got into this term, like,
conflicting with my work schedule, and I went in there every day in the first week of
core, because that's what they told me to do, and I still couldn't like ... they still wouldn't
make any exceptions for me or whatever. But like, I feel like there should be some kind
of system, like, it feels like, they leave you no option.
As a consequence of not providing additional course options or limited course options,
the organization is contributing to the students’ work school balance conflict. One student
indicated that their resolution to this is to become increasing in-debt, “We have to change
everything for this school. I mean yeah, we accepted to come here, but at the same time, we all
have bills to pay. Barely making it as it is. I think my credit card bill's in the negatives right
now.”
Conflicts in financing education. The impact of students increasing their consumer debt
is that their ability to continue their education is placed at risk, “And you no income, you can't
fill out student loans, cause then the banks and stuff see it as a risk. So it's like, can't really work
as much, but then you can't qualify for a loan to not work, so how does that play?” Students with
high consumer debt are considered unsuitable applicants for further student loans, and without
the aid of student loans, many students would not be able to finance their education.
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 101

Furthermore, the students’ inability to finance their education would force them to withdrawal
from the university.
Administrative conflicts. Some of the students indicated frustration with how the school
provided administrative services intended to help students navigate student services, “I'd say no,
because I don't know like it's very limited and then there's like a time duration that you can go to
and like, um, they don't, they don't even tell us like, really how to use like, the tutor, the science
and stuff, they don't even tell us, like, where we can go, like to sign up or like, I guess like those
programs and stuff, so it's kind of hard to figure out where to go and so…”
Lastly, to determine if the students feel distrustful toward other students or generally the
university, these questions were asked.
10 [O- Distrust] Let’s role play that I am a prospective student, what advice do you
have for me?
13 [O- Distrust] How did you feel about the suggestions made by the school to
prepare you before you started?
Advice for Potential Students
The students responded with indications that potential students have to be well prepared
to enroll in the university. Part of this preparation is allocating enough time to study, “Make sure
you are mentally prepared to dedicate however much time you need to be here. Because you
can't come in this halfway.” Another component of potential student preparation is planning for
coursework, “Look ahead at the information you're going to be going over in class. It makes it
easier to absorb it from the professor.”
Part of the planning advice indicated by the respondents is related to study time
management and regular attendance, “Make sure you're constantly staying up to day with
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everything. Usually it's really easy to fall behind,” and “Stay for the whole class too. Cause not
all professors, at the beginning, like tell us what's due. Some of them wait until the end of class
and if you miss it then you're not going to know what's due the next time you meet.”
Further advice by the students is regarding prioritizing workloads with other conflicting
tasks, “Just be able to prioritize, know when it's time to do your work. I mean there's time for
going out and stuff, but you should do before that.” Lastly, the student indicated that potential
students need to engage in their coursework, “And know that everything is cumulative so if you
start off behind, you're ... there's a very good chance you're gonna fail,” and “Don't be afraid to
ask questions.”
Preparing to enroll at HSU. How the respondents felt about the advice given to them by
HSU differed by the personal level of student applicant preparation. Some students felt that the
advice was direct, “They already tell you from the start that it's hard. That it's gonna be a fast
paced program. And that, they tell you everything”, and “They, you know they do a pretty good
job of letting you know what you are getting yourself into.”
In addition to general advice, potential students are given strategic advice intended to
enhance their academic success, “I think they really emphasized, ‘don't have a job’, because it
gets too difficult to manage work and school. And I think I've been able to keep my full time job
and continue with all of my classes, a lot better than I expected.”
However, as indicated by these responses, current HSU students do not adhere to the
advice given to them by HSU, “Yeah, I think it's unrealistic to not have a job. If we're like
paying for our own school loans in school it's like not okay, like it's not, we can't not have a job
and be going to school. So that was kind of hard when they said that,” and “Yeah, they
emphasized that you're going to have to prioritize school over work so either you have a job
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 103

that's very flexible or don't have a job. Which, kinda makes sense.” Thus, the students who chose
to not adhere to the advice regarding school and workload balance are aware of the risks
involved with maintaining the load commitments of both work and school on their school
performance.
For some of the respondents, these students felt that they were not well informed about
the academic environment prior to their enrollment, “I don't think they quite elaborated how
much work it was going to be. Like, she said, its, a lot of intensive work ...so you learn so many
chapters and you have to like learn all of it, and they don't centralize the key points or what we
really need to focus on, so we just do everything.”

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CHAPTER FIVE:
RECOMMENDATIONS
Recommendations for Practice to Address KMO Influences
The results of this study validated the perceived influences effecting the knowledge,
motivation, and organizational gaps of the students at HSU. These gaps are barriers to these
students in accomplishing their goals, and therefore the organizations’ goals. In the following
sections, the recommendations for narrowing these performance gaps are described. Although
these recommendations are supported by the educational psychology literature, the context in
which these recommendations are implemented are specific to the environment of HSU.
Knowledge Recommendations
Introduction
As stated in Chapter 2, knowledge is classified into several types. Factual knowledge is
defined as the basic elements that students must know for proficiency within a discipline
including related terms and specific details (Baker, 2006; Krathwohl, 2002). Conceptual
knowledge considers the inter-relationships between the basic elements and their functioning
with one another within a discipline. These relationships include classifications, categories,
structures, models, principles, theories, and generalizations. Factual and conceptual knowledge
are grouped as declarative knowledge. Procedural knowledge considers discipline-specific
processes, including their methods for performing tasks and criteria for task completion. The last
type of knowledge addressed in this study is metacognitive knowledge. Metacognition is
awareness of self and knowledge of cognitive processes within one’s self including strategic
knowledge, knowledge about cognitive tasks, contextual and conditional knowledge. Thus,
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metacognition is self-awareness of one’s cognition, and not necessarily one’s cognitive ability
(Baker, 2006; Krathwohl, 2002).
The data collected in this study, through focus groups, and surveys, to achieving the
stakeholders’ goal, indicates that the stakeholders’ knowledge gaps in this study can be
addressed with recommendations for practice. These recommendations are based on the
frequency of identified knowledge influences, as well as, support by the literature review, and
Clark and Estes (2008). The knowledge influences identified in this study are reflected in Table
48, which lists the assumed knowledge influences and their probability of being validated. Table
48 also shows the recommendations for these highly probable influences based on theoretical
principles.
Table 48
Summary of Knowledge Influences and Recommendations
Assumed Knowledge
Influence: Cause, Need, or
Asset*

Validated
Yes, High
Probability,
or No
(V, HP, N)
Priority
Yes, No
(Y, N)
Principle and Citation Context-Specific
Recommendation
Students do not have
the knowledge base of
pre-core subjects. (D)
V Y To develop mastery,
individuals must acquire
component skills, practice
integrating them, and know
when to apply what they
have learned (Schraw &
McCrudden, 2006).

Information learned
meaningfully and connected
with prior knowledge is
stored more quickly and
remembered more
accurately because it is
elaborated with prior
learning (Schraw &
McCrudden, 2006).

Provide job aids
containing a glossary
of key terms found in
pre-core subjects,
along with references
to the text.
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Students do not know
how the pre-core
courses relate to core
competencies. (D)
V Y Creating schemata helps
learners to organize
declarative knowledge in a
domain (Schraw, Veldt, &
Olafson, 2009).

How individuals organize
knowledge influences how
they learn and apply what
they know (Schraw &
McCrudden, 2006).

Provide job aids that
include a clearly
structured chart of the
different types of
themes that pertain to
pre-core subjects’
applications, along
with references to the
text.
Students do not have
the study strategies or
experiences to
implement and improve
their learning. (P)
V Y Integrating auditory and
visual information
maximizes working
memory capacity (Mayer,
2011).

Managing intrinsic load by
segmenting complex
material into simpler parts
and pre-training, among
other strategies, enables
learning to be enhanced
(Kirshner, Kirshner, &
Paas, 2006).

Increasing germane
cognitive load by engaging
the learner in meaningful
learning and schema
construction facilitates
effective learning
(Kirshner et al., 2006).

Provide training that
utilizes case studies to
practice using study
strategies required to
complete course
assignments.

Provide job aids that
include the different
types of study
strategies and a
decision flow chart for
when to use each
strategy.

STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 107

Students do not have
accurate ability to
predict their studying
effectiveness when
attempting study
strategies. (M)
V Y Self-regulatory strategies,
including goal setting,
enhance learning and
performance (APA, 2015:
Dembo & Eaton, 2000;
Denler, et al., 2009).

Modeling to-be-learned
strategies or behaviors
improves self-efficacy,
learning, and performance
(Denler, Wolters, &
Benzon, 2009).

Modeled behavior is more
likely to be adopted if the
model is credible, similar
(e.g., gender, culturally
appropriate), and the
behavior has functional
value (Denler et al.,
2009).

Provide training in
which a peer model
talks through strategic
monitoring activities
of student studying
effectiveness.

Develop new strategies
to establish a schedule
of studying that is
consistent with
students’ needs.

Declarative Knowledge Solutions

Declarative knowledge is classified as ether factual or conceptual knowledge. In order to
address gaps in declarative knowledge, and to master their learning process, students must
acquire component skills, practice integrating them, and know when to apply what they have
learned (Schraw & McCrudden, 2006). The information learned in courses must be meaningful
and connected with their prior knowledge. This connectivity of knowledge is stored more
quickly and remembered more accurately through elaboration with prior learning (Schraw &
McCrudden, 2006). To help create this connectivity, developing schemata can help learners to
organize declarative knowledge into domains which will further help students organize
knowledge influences and how they learn or apply what they know (Schraw & McCrudden,
2006). Therefore, in order to make ready use of declarative knowledge, student must practice the
component skills which are meaningful and are connected to prior knowledge through schemata.
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 108

The recommendations for these declarative knowledge gaps are to: 1) provide job aids
containing a glossary of key terms found in pre-core subjects, along with references to the text,
and 2) provide job aids that include a clearly structured chart of the different types of themes that
pertain to pre-core subjects’ applications, along with references to the text. These job aids would
be delivered by the faculty at the beginning of each pre-core course. The rationale for providing
such aids is that such a job aid would help students to identify and understand important points.
Moreover, these aids would also provide experiences that help students make sense of the
material rather than just focus on memorization (Schraw & McCrudden, 2006).
Procedural Knowledge Solutions

Procedural knowledge allows students to perform discipline-specific processes, such as
coursework. In order to accomplish this, students must integrate auditory and visual information
which maximizes their working memory capacity (Mayer, 2011). By maximizing their working
memory, students must manage intrinsic load by segmenting complex material into simpler parts
and pre-training, which enables learning to be enhanced (Kirshner, Kirshner, & Paas, 2006). In
addition, to enhance efficacy by these processes, increasing germane cognitive load is also
necessary by engaging students in meaningful learning and schema construction, which
facilitates effective learning (Kirshner et al., 2006).
These procedural knowledge recommendations are intended to address discipline-specific
processes including, 1) provide training that utilizes case studies to practice using study
strategies required to complete course assignments, and 2) provide job aids that include the
different types of study strategies and a decision flow chart for when to use each strategy. Such
training could be incorporated into the curriculum schedule of courses as integral study skills or
study strategies courses. The rationale for providing such aids is that such aids model effective
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 109

strategy use, including “how” and “when” to use particular strategies through breaking down
complex tasks and encouraging individuals to think about content in strategic ways (Schraw &
McCrudden, 2006). Also by breaking down complex tasks, students learn to set productive goals
for themselves that are challenging but achievable, and encourage self-evaluation (Denler et al.,
2009).
Metacognitive Knowledge Solutions

Metacognition is awareness of self and knowledge of cognitive processes of one’s self.
This awareness includes strategic knowledge, knowledge about cognitive tasks, contextual and
conditional knowledge. Necessary to this awareness is self-regulatory strategies, including goal
setting (Dembo & Eaton, 2000; Denler, et al., 2009). To help develop this level of awareness,
schools, faculty and peers can model to-be-learned strategies or behaviors which improve self-
efficacy, learning, and performance (Denler, Wolters, & Benzon, 2009). Moreover, in the case of
peers, faculty modeling behavior is more likely to be adopted if the faculty model is credible,
similar (e.g., gender, culturally appropriate), and the faculty behavior has functional value
(Denler et al., 2009).
Therefore, the recommendations for improving metacognition in students are: 1) provide
training in which a peer model talks through strategic monitoring activities of student studying
effectiveness, and 2) develop new strategies to establish a schedule of studying that is consistent
with students’ needs. These metacognitive learning strategies would best be learned in the
contexts of the courses, and therefore these training sessions could be incorporated as part of the
course assignments and learning outcomes. These recommendations are based on the rationale
that development of self-awareness stems from students ability to self-manage through learning
to manage their motivation, time, learning strategies, control their physical and social
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 110

environment, and monitor their performance (Dembo & Eaton, 2000). To help with development
of self-management, schools, faculty and peers can provide opportunities for students to check
their progress and adjust their learning strategies as needed (Denler et al., 2009).
Motivation Recommendations
Introduction
In addition to the knowledge influences, student motivation is another important
component for learning and achievement outcomes. As defined by Pintrich (2003), motivation is
the integration of social - cognitive constructs and involves the needs for self-efficacy or
competence, control or autonomy, and value or relatedness by those who aspire to be motivated.
Furthermore, Clark and Estes (2008) suggest that there are three indicators of motivation in task
performance – choice, persistence and mental effort. Choice is where students go beyond their
intention to start a task. Persistence is where students continuing to pursue a goal even when the
task is difficult or they face of distractions. Lastly, mental effort is where student seek and apply
their knowledge to solve a novel problem or perform a new task. Motivational influences can be
generalized into categories including: values, control beliefs, and self-efficacy. More specifically
these needs are framed within the Expectancy-Value Theory, Attribution Theory, and Self-
Efficacy Theory (Anderman & Anderman, 2009; Eccles, 2006; Pajares, 2006; Pintrich, 2003).
The data collected in this study, through focus groups, and surveys, to achieving the
stakeholders’ goal, also indicates the stakeholders’ motivation gaps in this study. These gaps can
be addressed with recommendations for practice which are based on the frequency of identified
motivation influences. The motivational influences identified in this study are reflected in Table
49, which lists the assumed motivation influences and their probability of being validated. Table
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 111

49 also shows the recommendations for these highly probable influences based on theoretical
principles.
Table 49
Summary of Motivation Influences and Recommendations
Assumed Motivation
Influence: Cause, Need,
or Asset*

Validated
Yes, High
Probability,
No
(V, HP, N)
Priority
Yes, No
(Y, N)
Principle and Citation Context-Specific
Recommendation
Utility Value – Students
do not see value of
learning their pre-core
courses, including how
successes in these pre-
core courses will lead
them to their success in
the core courses and
professional careers.
V Y The importance
and utility value of the
work or learning can
help learners develop
positive values (Eccles,
2006; Pintrich, 2003).

Higher expectations for
success and perceptions
of
confidence can
positively influence
learning and motivation
(Eccles, 2006).
Pre-core course
materials and activities
should be relevant and
useful to the learners,
connected to their
interests, and based on
real world tasks.

Faculty should model
values, enthusiasm and
interest in the task.
Attributions – Students
do not attribute their
performance to internal
and controllable factors
such as effort and
interest. Instead, students
attribute their lack of
passing the exam to
internal, uncontrollable
factors such as low
ability or external,
uncontrollable factors
such as work, family,
and recreation.

V Y Focusing on mastery,
individual
improvement, learning,
and progress promotes
positive motivation
(Yough
& Anderman, 2006).

Designing learning
tasks that are novel,
varied, diverse,
interesting, and
reasonably challenging
promotes mastery
orientation (Yough &
Anderman, 2006).

Students should focus
discourse on mastery,
learning, and
understanding.

Students should focus
on self-improvement
and avoid social
comparison or relying
on norm referenced
standards.
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 112

Self-Efficacy – Students
do not believe that they
can successfully
accomplish learning the
course in a timely
manner.
V Y High self-efficacy can
positively influence
motivation (Pajares,
2006).

Feedback and modeling
increases self-efficacy
(Pajares, 2006).

Learning and
motivation
are enhanced when
learners have positive
expectancies for
success
(Pajares, 2006).
Faculty will set close,
concrete and
challenging goals that
allow the learner to
experience success at
the task.

Faculty will provide
instructional support
(scaffolding) early on,
build in multiple
opportunities for
practice and gradually
remove supports.

Faculty will provide
goal-directed practice
coupled with frequent,
accurate, credible,
targeted and private
feedback on progress in
learning and
performance.

Value Solutions
Students may have more motivation to learn if they perceive the learning to have utility
value. In other words, learning can have higher value to the students if the materials and
activities are relevant, useful to the learners with real world tasks (Eccles, 2006; Pajares, 2006).
Factual and conceptual knowledge that can be applied to the workplace environment may have
higher value to students than knowledge that is not readily applicable. Students are likely to
engage with learning if the learning tasks have value and if the students have self-efficacy
(Pintrich, 2003). Therefore, the importance and utility value of the work or learning can help
learners develop positive values (Eccles, 2006; Pintrich, 2003), and students with higher
expectations for success and perceptions of confidence can positively influence their own
learning and motivation (Eccles, 2006). Therefore, creating importance in learning can increase
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 113

the value of the learning and when this value is combined with student expectations for success
in acquiring such value while learning, students develop their own motivation for learning.
In order to enhance learning value in students, the recommendations are directed both at
the instruction and curriculum and are: 1) instruction that models values, enthusiasm and interest
in the task (Eccles, 2006), and 2) curriculum materials and activities should be relevant and
useful to the learners, connected to their interests, and based on real world tasks (Pintrich, 2003).
Demonstration of such value in learning could be incorporated into each class as part of the
course assignments and into the university’s program curriculum by offering elective courses
related to the core curriculum but are either advanced courses or are supplemental to the core
courses, with the intention of broadening and strengthen the capabilities of the school’s
graduates.
Attributions Solutions
Learning and motivation are enhanced when learners attribute their success to their levels
of effort at learning (Anderman & Anderman, 2006). Students who attribute their success in
learning to their level of effort are better adaptive to their learning performance. Having adaptive
control beliefs motivates learners to place more effort in learning. In contrast, control beliefs can
also be maladaptive such as students believing that they have no control over their learning
(Pintrich, 2003). Therefore, students should place more effort on learning than their current
levels of effort by focusing on the discourse of learning mastery, individual improvement, and
progress. Such a focus promotes positive motivation and understanding (Pintrich, 2003; Yough
& Anderman, 2006). By creating a mastery of learning focus, student motivation and
understanding improves, which positively impacts their attributions of their success at learning.
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 114

Demonstration of a mastery of focus in learning could be done in coursework through creative
expression of conceptual knowledge, either through writing, or other modalities of expression.
As such, the recommendations for improving attributions in students fall under both
curriculum design and student support services and are: 1) designing curriculum learning tasks
that are novel, varied, diverse, interesting, and reasonably challenging, which promotes a
mastery orientation in students (Yough & Anderman, 2006), and 2) student support services
should focus on self-improvement and avoid social comparisons or relying on norm referenced
standards (Yough & Anderman, 2006).
Self-Efficacy Solutions

Students with high levels of self-efficacy are capable of learning and performing.
Moreover, students with higher levels of self-efficacy are likely to perform better than students
with lower levels of self-efficacy. High self-efficacy can positively influence motivation
(Pajares, 2006). Also, learning and motivation are enhanced when learners have positive
expectancies for success (Borgogni et al., 2011; Pajares, 2006). Therefore, students who have a
history of better performance could have expectations of success, which could contribute to their
ability to be effective learners. For example, a history of positive feedback and modeling
increases self-efficacy (Borgogni et al., 2011; Pajares, 2006). Consequently, self-efficacy
develops active choice, persistence and mental effort in learning.
In order to enhance self-efficacy in the students, the recommendations for improving are
changes within the curriculum, including: 1) set close, and concrete, yet challenging goals that
allow the students to experience success at learning (Pajares, 2006), 2) provide instructional
support (scaffolding) early on, build in multiple opportunities for practice within the course
assignments and gradually remove supports as the student progress through their program (Scott
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 115

& Palinscar, 2006; Pajares, 2006), and 3) provide frequent, accurate, credible, targeted and
private feedback on student progress in learning and performance throughout the program
(Pajares, 2006; Shute, 2008; Tuckman, 2006). Implementation of such changes in the curriculum
could mean designing courses with frequent and increasing more difficult assignments, where
students are permitted to practice their self-efficacy at learning. Early in these courses the faculty
would provide ample feedback as the students learn to learn and as the students develop efficacy,
the faculty may provide less feedback later in the course.
Organization Recommendations
Introduction
Organizational performance is influenced by resources and alignment with stakeholders’
goals. In particular, Clark and Estes (2008) suggests that organization and stakeholder goals are
often not achieved due to a lack of resources, most often time and money, and stakeholder goals
that are not aligned with the organization’s mission and goals. As part of the alignment in the
organizational culture needed between resources, stakeholder goals and the organization’s goals,
Gallimore and Goldenberg (2001) propose two constructs about culture: 1) the cultural models,
which are the observable beliefs and values shared by individuals in groups, and. 2) the cultural
settings, or activities, in which performance occurs.
Therefore, both cultural models and settings must align within the organization’s
structure, through implementation of its policies and processes, to achieve the organization’s
mission and goals. As such, Table 50, these organizational influences have a high probability of
being validated and have a high priority for achieving the stakeholders’ goal. Table 50 also
shows the recommendations for these influences based on theoretical principles.

STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 116

Table 50
Summary of Organization Influences and Recommendations
Assumed Organization
Influence: Cause,
Need, or Asset*

Validated
Yes, High
Probability,
No
(V, HP, N)
Priority
Yes, No
(Y, N)
Principle and
Citation

Context-Specific
Recommendation
Cultural Model
Influence 1:
There is a general
culture of not valuing
scholarship unless it
results in passing
student courses. This
perception applies to
grade points or near
term career prospects.

V Y Job satisfaction
increases when all
organization
stakeholders agree on
culture, mission, goals,
and resources required
to achieve goals (Clark
& Estes, 2008).

Organizational
performance increases
when processes and
resources are aligned
with goals established
collaboratively (Clark
& Estes, 2008).

Conduct team meetings
with new and
experienced students and
with leadership to
establish goals and time
frames.

Conduct whole
organization meetings to
communicate the vision,
mission and goals, and
individual and team
accomplishments.

Cultivate a culture of
participation with all
stakeholders in
achieving organization
goals by encouraging
feedback and
communication by all
stakeholders.

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Cultural Model
Influence 2:
Students distrust each
other to help one
another accomplish their
goals, including
academic and career
goals. There is a poor
climate of student peer
collaboration.

V N Effective leaders are
aware of various
types of
communication, non-
verbal communication,
storytelling, person
centered
communication, and
how these
communication
modalities influence
change and the
environment within the
Organization
(Denning, 2005;
Lewis, 2011; Conger,
1991).

Effective leaders know
how to create and
manage good working
relationships with
Stakeholders
(Denning, 2005;
Lewis, 2011).

Effective leaders
demonstrate a
commitment to valuing
diversity through
inclusive action.
They promote an
organizational culture
that promotes equity
and inclusion and
cultivate an
atmosphere where
diversity is viewed as
an asset to the
organization and its
Stakeholders
(Angeline, 2011;
Prieto, Phipps & Osiri,
2009).

Actively seek out
opinions that differ and
create a culture of
inclusion in decision-
making.

Establish a committee of
diverse individuals who
best represent the
diversity among your
workforce.

Consider how
organizational decisions
impact staff members
with the least amount of
power.

STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 118

Cultural Setting
Influence 1:
Students are confused
by the administrative
and student support
inefficiencies and
conflicts.

V Y Organizational
performance increases
when top management
is continually involved
in the improvement
process (Clark &
Estes, 2008).

On-site and in-person
inspection reveals
more nuanced
judgments (Jerald,
2012).

Organizational
performance increases
when individuals
communicate
constantly and
candidly to others
about plans and
processes (Clark &
Estes, 2008).

Schedule consistent time
for individual and team
meetings for associate
training and oversight.

Use the organization
website and other social
media to reinforce
communication outside
of team meetings.

Organization Solutions

Cultural model 1. Organizational performance increases when processes and resources
are aligned with goals established collaboratively by stakeholders (Clark & Estes, 2008). To set
such an alignment, between goals and processes or resources, the beliefs and values of these
stakeholders have to align with the organizational goals. As such, the beliefs and values shared
by individuals in groups set the cultural model of the organization. When these individual
stakeholders agree on such a culture, including the mission, goals, and resources required to
achieve the organization’s goals, their performance satisfaction also increases (Clark & Estes,
2008). In the case of HSU, data gathered for this study demonstrated that the students’ beliefs
and values are not aligned with the university’s goals about the scholarship of learning; therefore
the organization’s cultural model is misaligned.
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 119

Therefore, the recommendations for improving the cultural model of the organization,
with that goal that the beliefs and values of students are aligned with the processes and resources
to achieve the university’s goals, are: 1) conduct team meetings with new and experienced
students to establish goals and time frames, 2) conduct whole organization meetings to
communicate the vision, mission and goals of the organization, and individual and team
accomplishments, and 3) cultivate a culture of participation with all stakeholders, including
students, faculty and associates, in achieving organization goals by encouraging feedback and
communication by all stakeholders.
Cultural models 2. The values of an organization create a climate which influences the
organization’s performance. Values that enhance organizational performance include inclusive
action, promote equity and inclusion, and cultivate an atmosphere, where diversity is viewed as
an asset to the organization and its stakeholders (Angeline, 2011; Prieto, Phipps & Osiri, 2009).
In the case where stakeholders of an organization feel disconnected from one another or
the organization, when the organizational barrier is poor stakeholder collaboration, due to trust
issues, an atmosphere of inclusion, equity, and diversity can bridge such a barrier by cultivating
good working relationships with stakeholders (Denning, 2005; Lewis, 2011). In the case of HSU,
the student body lacks trust among each other and the university, and such a barrier can be bridge
through inclusion practices.
As such, the recommendations for improving student trust include: 1) actively seeking
out opinions that differ from the majority opinion, possibly through using surveys and focus
groups for student opinions, and thereby create a culture of inclusion in decision-making, 2)
establish a committees of diverse individuals who best represent the diversity among your
workforce, and 3) consider how organizational decisions impact staff members with the least
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 120

amount of power. Through these strategies at improving organizational policies, achievement of
organizational goals is approached.
Cultural settings and processes. The cultural setting, in which organizational
performance occurs, increases when top management is continually involved in the improvement
process (Clark & Estes, 2008). When university officials are involved in processes, the
organization is led to improve its performance. This level of involvement may also take the form
of site visits, where the on-site or in-person inspections could reveal more nuanced judgments
(Jerald, 2012). Moreover, such nuanced judgments by university officials could prompt further
decision-making and communication. Lastly, when such individuals communicate constantly and
candidly to others about plans and processes, the organizational performance increases (Clark &
Estes, 2008). In the case of HSU, when there is coordination and cooperation between the
respective departments, departmental performance increases and service levels for the university
students also improve.
Therefore, the recommendations for improving processes include: 1) scheduling
consistent times for individual and team meetings to provide associate training and oversight,
and 2) using the university’s websites and other social media to reinforce communication outside
of team meetings. Through these processes, the university can improve its operations toward
achieving its performance goals.
Integrated Implementation and Evaluation Plan
The solutions to the performance gaps recommended by this study can be implemented
through several levels of training and evaluation. Beginning with the desired outcomes of this
training, Level 4, this implementation plans works backwards to the initial reaction following
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 121

training, Level 1. Through this reverse implementation, the intention of the plan is to achieve
desired outcomes of change that is measurable, incremental and predictable.
Implementation and Evaluation Framework
The model that informed this implementation and evaluation plan is the New World
Kirkpatrick Model (Kirkpatrick & Kirkpatrick, 2016), which is based on the earlier work of
Kirkpatrick’s Four Levels Model of Evaluation (Kirkpatrick & Kirkpatrick, 2006). This model
indicates that an effective evaluation plan starts with the goals of the organization and work
backwards. By using this approach, the markers or indicators that connect the recommended
solutions of an evaluation plan to the organization’s goals are both more readily identifiable and
closely aligned with the organization’s goals.
Furthermore, this reverse approach to evaluation planning supported by the New World
Kirkpatrick Model also prescribes a protocol of three other actions: 1) develop solution outcomes
that focus on assessing work behaviors, 2) identify indicators of learning, which occurred during
implementation, and 3) demonstration of indicators that organizational members are satisfied
with the implementation strategies (Kirkpatrick and Kirkpatrick, 2016).
Organizational Purpose, Need and Expectations
HSU offers transformational education for college students in order to improve their
career prospects and to contribute to the national workforce readiness. In order to efficiently
provide this education, the goal of HSU is to have 90% enrollment retention of returning
students. By providing this education, HSU prepares graduates who alleviate the growing
problem of inadequate workforce readiness. Thus, the goal of students of HSU is to prepare for
career readiness by passing their courses, completing their degrees and passing their licensure
exams. In addition, as graduates of HSU, they contribute to HSU’s goal of providing
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 122

transformational education that alleviates workforce demands. Therefore, this study’s
recommendations targets improving the preparedness of the HSU students for the workforce, by
helping them pass their class, completing their degrees and passing their licensure exams.
Level 4: Results and Leading Indicators
The leading indicators that would contribute to the desired results are grouped by external
and internal outcomes. These outcomes are achieved by metrics and methods as shown in Table
51. If the internal outcomes are met as a result of these metrics and methods, then the external
outcomes should also be realized.
Table 51

Outcomes, Metrics, and Methods for External and Internal Outcomes

Outcome Metric(s) Method(s)
External Outcomes
1. Increase the number of
students currently attending
school
1. The percentage of students at-
risk of withdrawing from school
1. Collect data from Student
Support Services every semester

2. Increase the number of
students re-enrolling to school
after withdrawal
2. The number of students who
pass the dismissal appeals process
2. Collect data from Student
Support Services every semester
Internal Outcomes
1. Increase the number of
students passing their licenses
1. Number of students taking the
licensure exam
1. Semester check-in with
university student services on the
number of students registered to
sit for the exam
2. Increase the number of
students passing their courses
2. Number of students at-risk of
failure
2. Collect data from student
support staff and faculty
3. Increased student
confidence/satisfaction
3. End of each semester feedback
from faculty
3a. Compare annual student
satisfaction survey results.
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 123

3b. Schedule regular times for
1:1 conversations between
students and faculty

Level 3: Behavior
Critical behaviors. The stakeholders of focus are the students of HSU completing their
courses and degrees. The first critical behavior is that students must spending appropriate time
and effort in preparing for courses. The second critical behavior is that they must working
collaboratively in study groups. The third critical behavior is that they must developing critical
cognitive skills necessary for career competencies. The specific metrics, methods, and timing for
each of these outcome behaviors appear in Table 52.
Table 52

Critical Behaviors, Metrics, Methods, and Timing for Students
Critical Behavior Metric(s) Method(s) Timing
1. Students will spend
appropriate time and
effort in preparing for
courses
The number of hours
and amount of course
assignments spent in
class and out of class
on course work

Faculty will calculate the
time required to
complete course
assignments and total
course. Design courses
with enough assignments
within classroom and
outside of classroom
course work.
During first semester
reviewing existing
courses for credit
hour calculations.

Thereafter, ongoing
reviewing and
assessment of course
credit hour course
workload.

2. Students will work
collaboratively in study
groups
The number of
assignments in
coursework requiring
and reminders by
faculty for students to
work collaboratively on
course work
Course Lead shall track
the number of
collaborative
assignments through
faculty learning
communities.
Such tracking will
occur each semester.

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3. Students will
develop critical
cognitive skills
necessary for career
competencies
The number of
cognitive and social
skills able to be
performed by students

Course Lead shall
identify and quantify the
types of cognitive skills
required by students to
complete their courses

Such tracking will
occur each semester.

Required drivers. Students require the support of their faculty and the organization to
reinforce what they learn in the coursework and to encourage them to apply what they have
learned to their career applications. Taken from the knowledge, motivation, and organization
recommendations in the previous sections, the motivation and organizational influences that are
necessary to drive the achievement of the stakeholder outcomes are listed below. Rewards should
be established for achievement of performance goals to enhance the organizational support of
new reviewers. Table 53 shows the recommended drivers to support critical behaviors of
students.
Table 53
Required Drivers to Support Students’ Critical Behaviors
Method(s) Timing Critical Behaviors
Supported
1, 2, 3 Etc.
Reinforcing
Job Aid including glossary of
coursework terminology and
different types of study strategies
Ongoing 1, 2, 3
Job Aid including checklist for
competency concepts and progress
toward competency
Ongoing 1, 2, 3
Team meetings with new and
returning students to establish goals
and time frames.
Weekly 1, 2, 3
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 125

Use university and other internal
social media to reinforce
communication outside of team
meetings.
Ongoing 1, 2, 3
Team meeting to troubleshoot
collaboratively and to determine if
additional student support is required
Weekly 1, 2, 3
Encouraging
Collaboration and peer modeling
during coursework and student
meetings
Weekly 1, 2, 3
Feedback and coaching from faculty Ongoing 1, 2, 3
Rewarding
Performance incentives when student
withdrawal rate decreases and time to
degree completion is on time. Such
incentives could include scholarships
and internships
Quarterly 1, 2, 3
Public acknowledgement, including
conferring awards at student
meetings, and notices through
internal social media to reinforce
such acknowledgement, when student
performance meets benchmark levels
Quarterly 1, 2, 3

Monitoring
Chairs and Academic Deans can
create opportunities at All-Faculty
meetings to share success stories
Semi-Annual 1, 2, 3
Faculty can ask students to self-
report their confidence and self-
efficacy in course-related tasks
Semester 1, 2, 3
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 126

Faculty can assess the performance
of students. Frequent, quick checks
can help the organization monitor
progress and make adjustments if
results do not match expectations at
that time.
Monthly 1, 2, 3

Organizational support. Based on the recommendations in the organizational table, the
organization will support the students’ critical behaviors through these actions: 1) to support
students spending appropriate time and effort in preparing for their courses, the university could
conducting meetings with new and experienced students and with faculty and advisors to
establish goals and time frames. In addition, the university could also conduct departmental and
university wide meetings to communicate the school’s vision, mission and goals, and
acknowledge individual and team accomplishments, and 2) to encourage students to working
collaboratively in study groups, the university could cultivate a culture of participation with all
stakeholders by actively seeking out opinions that differ and create a culture of inclusion in
decision-making. Toward this end, the university would establish a committee of diverse
individuals who best represent the diversity at the university, and lastly, 3) to help students in
developing critical cognitive skills necessary for their career competencies, the university could
consider how organizational decisions impact students with the least amount of ability. As part
of this consideration, the university could schedule time for student and faculty meetings for
skills training and oversight. Moreover, the university could use the organization’s website and
other social media to reinforce skills accomplishment through communication outside of
departmental or university meetings.

STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 127

Level 2: Learning
Learning goals. Following completion of the recommended solutions, the student
stakeholders will be able to:
1. Demonstrate the declarative and conceptual knowledge base necessary for pre-core
subjects. (D-C)

2. Apply how the pre-core courses relate to core competencies. (D)

3. Have the study strategies or experiences to implement and improve their learning. (P)

4. Have accurate ability to predict their studying effectiveness when attempting study
strategies. (M)

5. Value learning their pre-core courses, including how successes in these pre-core courses
will lead them to their success in the core courses and professional careers. (Utility)

6. Believe that they can successfully accomplish learning the course in a timely manner.
(Self-Efficacy)

7. Attribute their performance to internal and controllable factors such as effort and interest.
(Attributions)

Program. The learning goals listed in the previous section will be achieved with a
training program that explores in–depth the knowledge, motivation and study strategies of
students of HSU. The training program is delivered through the university’s online learning
management system and is blended in format, consisting of four e-learning modules and one
face-to-face application workshop. Each module and workshop will consist of training that
requires two hours to complete, for a total training program completion time of 10 hours. The
training is offered twice a year, at the start of the Fall and Spring semesters.
During the asynchronous e-learning modules, students will be provided a job aid of key
terms and references to the pre-core subjects, as well as a chart of different types of study
strategies. Another job aid will contain a flow chart of how the pre-core courses relate to core
competencies. The job aids will be demonstrated on e-learning video modules video using
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 128

student's’ role modeling. The video will pause from time to time to enable the learners to check
their understanding. Following the demonstrations, the learners will be provided the opportunity
to practice using the job aids and receive feedback from the learning management system, peer
review, and review by the instructor. The demonstrations practice and feedback approach will
also be used to train the skill set of prioritizing, planning and time management.
During the synchronous in person sessions, the focus will be on applying what students
have learned asynchronously in the e-learning, to verify in training in small groups, role-playing
with peers, group discussions and peer modeling. During the training, more experienced
students will discuss the value and benefits of the learning strategies taught in the training
program and will model how to plan their use of time to implement these strategies in the
training program.
Components of learning. The components of learning include declarative, procedural
and metacognitive knowledge. In addition, motivation is also important to learning. In the case
of using knowledge to solve problems, it is often necessary to demonstrate declarative
knowledge. Therefore, it is important to evaluate the learning goals for both declarative and
procedural knowledge being taught. It is also important that learners value the training as a
prerequisite to using their newly learned knowledge and skills on the job since valuing and
committing to the training impacts their desire to participate in the training program. In addition,
students must also be confident that they can succeed in applying their knowledge and skills and
be committed to using them on the job. Therefore, the components of the student learning are
listed in Table 54, which includes the evaluation methods and timing for these components of
learning.

STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 129

Table 54
Components of Learning for the Program
Method(s) or Activity(ies) Timing
Declarative Knowledge “I know it.”
Knowledge checks using multiple choice. In the asynchronous portions of the
course during and after video
demonstrations.
Knowledge checks through discussions,
“pair, think, share” and other
individual/group activities.
Periodically during the in person
workshop and documented via
observation notes.

Procedural Skills “I can do it right now.”
During the asynchronous portions of the
course using scenarios with multiple-choice
items.
In the asynchronous portions of the
course at the end of each
module/lesson/unit
Demonstration in groups and individually of
using the job aids to successfully perform the
skills.
During the workshops.
Student application of learning skills with
case studies.
During the workshops.
Retrospective pre- and post-test assessment
survey asking participants about their level of
proficiency before and after the training. .
At the end of the workshop.
Attitude “I believe this is worthwhile.”
Instructor’s observation of participants’
statements and actions demonstrating that
they see the benefit of what they are being
asked to do during the training.
During the workshop.
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 130

Discussions of the value of what they are
being asked to do during the training.
During the workshop.
Retrospective pre- and post-test assessment
item.
After the course.
Confidence “I think I can do it on the job.”

Survey items using scaled items Following each module/lesson/unit in
the asynchronous portions of the
course.
Discussions following practice and feedback. During the workshop.
Retrospective pre- and post-test assessment
item.
After the course.
Commitment “I will do it on the job.”
Discussions following practice and feedback. During the workshop.
Create an individual action plan to
implement the learning strategies.

During the workshop.
Retrospective pre- and post-test assessment
item.
After the course.

Level 1: Reaction
The methods and tools used to measure student response to the training program are
grouped in reactions: engagement, relevance, and student satisfaction. The Table 55 below lists
these methods that will be used to determine how the students react to the learning event(s).

Table 55
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 131

Components to Measure Reactions to the Program
Method(s) or Tool(s) Timing
Engagement
Data analytics in the learning management
system
Ongoing during asynchronous portion of
the course.
Completion of online
modules/lessons/units
Ongoing during asynchronous portion of
the course.
Observation by instructor/facilitator During the workshop
Attendance During the workshop
Course evaluation Day after the course
Relevance
Check-in with participants via survey
(online) and discussion (ongoing)
After every module/lesson/unit and the
workshop
Course evaluation Two weeks after the course
Student Satisfaction
Check-in with participants via survey
(online) and discussion (ongoing)
After every module/lesson/unit and the
workshop
Course evaluation Two weeks after the course.

Evaluation Tools
Immediately following the program implementation. During the asynchronous
portion of the course, the learning analytics tool in the learning management system (LMS) will
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 132

collect data about the start, duration, and completion of modules by the participants. These data
will indicate the engagement with the course material. The LMS will also administer brief
surveys after each module requesting the participant to indicate the relevance of the material to
their job performance and their overall satisfaction with the content and delivery of the online
course.
For Level 1, during the in person workshop, the trainer will conduct periodic brief check-
ins by asking the students about the relevance of the content to their work and the organization,
delivery, and learning environment. Checks for Level 2 will include check-ins for understanding
using group work or competition among student groups in responding to questions and scenarios
drawn from the content.
Table 56
Evaluation tools used immediately after the training
Level 1 Likert Type Item
Engagement

Relevance

Customer satisfaction
This training held my interest.

This training is related to my studies.

This training session was worthwhile.
Level 2 Item
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 133

Declarative knowledge

Procedural skills

Attitude

Confidence

Commitment

Which of the following were strategies taught in the
training

I was able to successfully implement the learning
strategies during the training session

I feel that the training was helpful to improve my
study strategies

I feel that I can apply the strategies taught in the
training session

I plan to use the strategies taught in the training as
soon as possible
Delayed 90 days after the training
Level 1, 2, 3 and 4 Item
L1 Reaction What I learned in the training will help me as a
student
L2 Learning I was able to use the learning strategies during the
training
L3 Behavior I plan to use the study strategies in class
L4 Results I am able to use the study strategies to pass my
exams and courses

Data Analysis and Reporting
The Level 4 goal of students is measured by the number of students who graduate from
the university and pass their licensure exam. Each semester, the university will track the number
of students enrolled, the number of students tracked to graduate as planned, the number of
student schedule to take the exam and who passed the exam. This dashboard will report the data
on these measures as a monitoring and accountability tool. Similar dashboards will be created to
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 134

monitor Levels 1, 2 and 3. Below is a mock dashboard, which is a representative example of the
analytics from this plan, Figure 2.

Figure 2. Mock dashboard which a representative example of the analytics from this plan
Summary
This implementation plan used the New World Kirkpatrick Model (Kirkpatrick &
Kirkpatrick, 2016), which is based on the earlier work of Kirkpatrick’s Four Levels Model of
Evaluation (Kirkpatrick & Kirkpatrick, 2006). As in this model, this plan started with the goals
of the organization and worked backwards to ensure that stakeholders are learning the plan and
that their behaviors would change to contribute toward the organizational goals. Moreover, the
plan also integrated evaluation as part of its implementation, which determines that value of the
plan to the organization as contributing to meeting the organization’s goals.

STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 135

CONCLUSION
The phenomena of student attrition from completing their college degrees have been
examined for several decades. The factors that contribute to why students withdraw early from
their college programs and the impact of such decisions on the students themselves, their
families, communities, and the nation-at-large, have been identified at many institutions of
higher education. Within this study, these factors were identified for one university in the
Western United States, with the pseudonym of Health Sciences University (HSU). Through the
framework by Clark and Estes (2008), the factors that influence gaps in the Knowledge,
Motivation and Organizational barriers (the KMO of the Gap Analysis) that affect the student of
HSU were identified and validated. Furthermore, through an additional framework of the New
World Kirkpatrick Model (Kirkpatrick & Kirkpatrick, 2016), recommendations for
organizational improvements were made within the specific contexts of HSU. The author of this
study hopes that the findings and recommendations of this study can positively enhance how
HSU and other institutions similar to HSU can better offer their programs through a better
understanding of the issues that face their students.

STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 136

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APPENDIX A
Survey Items
Demographic questions

1. What is your gender?

Male
Female

2. What is your age?

18-21
22-30
31-40
41-50
51-+

3. What is your highest educational level completed?

High school
Associate’s or technical certificate
Bachelor’s
Master’s
Doctoral

4. What is your parents’ highest educational level?

High school
Associate’s or technical certificate
Bachelor’s
Master’s
Doctoral

5. What program are you attending?

General education
BSN or DH

6. How long have you attended this university?

First year
Second year
Third year
Beyond third year
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 148

7. Are you currently working in a paid job or other related activities such as volunteering?

Yes
No

8. If you are working, is your job related to healthcare?

I am not working
Yes
No

9. If you are working, is your job on this campus?

I am not working
Yes
No

10. How many hours a week are you working?

0-10
11-20
21-30
31-40
41-+

11. What is your household income level?

Below $30,000
$30,000 - $40,000
$40,001 - $60,000
$60,001 - $100,000
Above $100,000

12. What is your health status?

Chronic condition
Poor
Fair
Moderate
Healthy

13. Since you have been at this school, how many times have you been hospitalized?

0
1-3
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 149

4-7
8+

14. Since you have been at this school, how many times has your immediate family (spouse,
kids, parents, etc.) been hospitalized?

0
1-3
4-7
8+

Knowledge questions

15. Did you take any of these science courses in high school?

Anatomy yes no
Physiology yes no
Chemistry yes no
Microbiology yes no

16. To what level would you agree that your prior knowledge of the sciences before attending
this university prepared you to successfully take courses in anatomy, physiology, microbiology
or chemistry in college?

1 Unprepared
2 Poorly prepared
3 Somewhat prepared
4 Well prepared
5 Highly prepared

17. Have you taken any of the following classes at another university or community college?
Anatomy yes no
Physiology yes no
Chemistry yes no
Microbiology yes no

18. On average, how many hours a week are you studying for your courses?

0-5
6-10
11-15
16-20
21-25

19. To what level would you say that your study habits are enough to maintain a 3.0 GPA?

STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 150

1 Low level
2 Fair level
3 Moderate level
4 High level

20. To what degree would you agree that you know enough study strategies (different ways of
studying) to maintain a 3.0 GPA?

1 Low level
2 Fair level
3 Moderate level
4 High level

21. Which of the following study strategies do you commonly use during an exam week? Select
all that apply.

Pre-reading or Outlining
Flow or concept maps
Flash cards
Sample questions or reviewing past question
Study groups or with a friend

Motivation questions

22. What was your initial interest level in attending your program?

1 Low level
2 Fair level
3 Moderate level
4 High level

23. What is your interest level now in attending your program?

1 Low level
2 Fair level
3 Moderate level
4 High level

24. Have you worked in healthcare?

Yes
No

25. To what level has your work in healthcare motivated you to stay in school to learn more
about healthcare?

STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 151

0 I have not worked in healthcare
1 Low level
2 Fair level
3 Moderate level
4 High level

26. Do you have friends who work in healthcare?

Yes
No

27. To what level have your friends motivated you to stay in school to continue to learn
healthcare?

0 I have no have friends who worked in healthcare
1 Low level
2 Fair level
3 Moderate level
4 High level

28. Do you have family who work in healthcare?

Yes
No

29. To what level did your family influence your desire to attend a healthcare school?

0 I do not have family who works in healthcare
1 Low level
2 Fair level
3 Moderate level
4 High level

30. Has your current job made you want to stay in school?

Yes
No

31. To what level did your non-healthcare job influence your desire to attend a healthcare
school?

0 My non-healthcare job did not influence me in wanting to stay in school
1 Low level
2 Fair level
3 Moderate level
4 High level
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 152

32. Please rank in order of greatest personal importance to you:

1. Spending time with friends and family
2. Getting a good night’s sleeping
3. Playing your favorite game
4. Working and studying for your least favorite class
5. Career planning for a job that is not your first choice

33. What do you think is the most likely cause of you not doing well in a course?

Too many hours at work
Too much to study
The subject is too difficult
The subject is not interesting to me
The instructor is ineffective

34. When you have an important task to complete, you start it:

Right away
When you have time
After you prioritize your tasks
When the task is due
You sometimes forgot to complete the task

35. How would you rank your ability to read and understand the course textbook?

1 Low level
2 Fair level
3 Moderate level
4 High level

36. To what level does the course instructor motivate you to study for a course?

1 Low level
2 Fair level
3 Moderate level
4 High level

Organization questions

37. To what degree has the student culture of this school stimulated your interest in your studies?

1 Low level
2 Fair level
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 153

3 Moderate level
4 High level

38. Please rank in order of the following activities that have stimulated your interest in your
major:
Student study groups
Student presentation groups
Student assignments
Student exams

39. To what degree do you trust your classmates to help you learn the course materials?

1 Low level
2 Fair level
3 Moderate level
4 High level

40. To what degree has the faculty professionalism of this school stimulated your interest in your
major?

1 Low level
2 Fair level
3 Moderate level
4 High level

41. To what degree do you trust your professors to help you learn the course materials?

1 Low level
2 Fair level
3 Moderate level
4 High level

42. To what degree have these university departments at this school stimulated your interest in
your major?

1 Low level
2 Fair level
3 Moderate level
4 High level

Admissions
Financial aid
Student services
Sciences department
Nursing department
Dental hygiene department
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 154

43. To what degree would you trust student services to help you to learn the course materials?

1 Low level
2 Fair level
3 Moderate level
4 High level

STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 155

APPENDIX B
Interview Protocol
Introduction
Thank you for agreeing to meet and interview in this focus group among your peer
colleagues. Your participation in this interview will help the university to better understand the
needs of the student body and to better serve these emerging needs.

As a reminder, you are not required to answer any questions you are not comfortable
answering. For the questions you do answer, your names and other identifiable information will
be kept in confidence.

Your identity is completely anonymous in this study so please feel free to be completely
honest but part of the data analysis of this study considers student demographics so please
answer the following questions.

How long have you been at this school?

What courses have you taken at this school?

OK, let’s start our interview discussion. Please feel free to talk among each other and discuss
your different views and beliefs on these different topics.

First, let’s talk about the typical student here at this school.

[K- Declarative] What do you think are the qualities of a well prepared student?

[K- Procedural] Can you describe some of the things that a well prepared student would
do to prepare for these courses?

[Knowledge] Tell me how you prepare for class. What do you do to prepare for exams?

Thank you. Now let’s talk about what drives students to be successful.

[M- Attribution] What do you think are some of the reasons why a college student would
not do well in a course?

[M- Value] How do you feel about your ability to succeed in the program?

[M- Attribution] What do you believe influences your performance outcomes?

STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 156

[M- Attribution] How do you feel about the pace (speed) of the courses here at this
school? How do you believe this pace influences your academic performance?

[M- Expectancy Value] How might working a job impact your likelihood to be successful
in your courses?

[M- Self-Efficacy] What do you think is required for students who work to be successful
in school? How do you feel about your ability to be successful?

[M- Self-Efficacy] Describe the strategies that you used to match your school workload
with your work workload. Describe the strategies that you used to balance the two types
of workload.

[K- Metacognitive] To what degree do you believe the strategies you are using are
effective in reaching your academic goals?

Thank you again. Lastly, let’s shift our discussion to how the school can better help the students
by discussing these following topics.

[O- Scholarship] When you toured the campus, please describe what did you see?

[O- Distrust] What were the students and staff doing?

[O- Distrust] Let’s role play that I am a prospective student, what advice do you have for
me?

[O- Conflict] If this applies to you, please describe a time when you had a conflict
between your work and course schedule.

[O- Conflict] If you were able to resolve the conflict, how would you prevent future
conflicts?

[O- Conflict] How could the school have helped with these conflicts?

[O- Scholarship] What did you know about the academic program before you started?

[O- Conflict] Can you describe the services offered by the school for financial support?

[O- Distrust] How did you feel about the suggestions made by the school to prepare you
before you started?

[O- Conflict] Do you think that the services offered by the school for student services are
enough for student needs?

Thank you everyone for participating in this focus group interview. This concludes the interview.
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 157

APPENDIX C
Informed Consent/Information Sheet
University of Southern California
Rossier School of Education
Waite Phillips Hall
3470 Trousdale Parkway
Los Angeles, CA 90089

INFORMATION/FACTS SHEET FOR EXEMPT NON-MEDICAL RESEARCH

Factors Contributing to Student Attrition at a Healthcare University:
A Gap Analysis

You are invited to participate in a research study. Research studies include only people
who voluntarily choose to take part. This document explains information about this study. You
should ask questions about anything that is unclear to you.

PURPOSE OF THE STUDY

The purpose of this study is to understand the experiences of students who are at-risk of
withdrawing from this college. There are no direct benefits to the participants of this study. This
study is being conducted so that the university can improve its services. Data from this study
may help the university better improve their services and help future student learning outcomes.

PARTICIPANT INVOLVEMENT

If you agree to take part in this study, you will be asked to complete an online survey
which takes about 15 minutes and asked to participate in a 45 minute audio-taped focus group.
You do not have to answer any questions you don’t want to. If you don’t want to be taped, you
cannot participate in this study.

CONFIDENTIALITY

There will be no identifiable information obtained in connection with this study. Your
name, address or other identifiable information will not be collected. Your responses will be
coded and maintained separately for confidentially. The audio-tapes will be destroyed once they
have been transcribed. The data will be stored on a password protected computer in the
researcher’s office for three years after the study has been completed and then destroyed. The
STUDENT ATTRITION AT A HEALTHCARE UNIVERSITY 158

members of the research team, and the University of Southern California’s Human Subjects
Protection Program (HSPP) may access the data. The HSPP reviews and monitors research
studies to protect the rights and welfare of research subjects.

INVESTIGATOR CONTACT INFORMATION

Principal Investigator:
Benjamin Tran at benjamit@usc.edu or at (714) 414-5609

Faculty Advisor:
Dr. Helena Seli at helena.seli@rossier.usc.edu at (213) 740-6742

IRB CONTACT INFORMATION
University Park Institutional Review Board (UPIRB), 3720 South Flower Street #301, Los
Angeles, CA 90089-0702, (213) 821-5272 or upirb@usc.edu

Abstract (if available)

Abstract This study evaluated the phenomena of students prematurely withdrawing from college or university, termed student attrition, at a Health Sciences University (HSU) in the Western United States. This study evaluated the knowledge and motivation influences of HSU students, as well as the organizational (university) influences in achievement of the students’ and university goals. These influences are collectively termed the KMO. Through use of the conceptual and methodological framework by Clark and Estes’ (2008), the performance gap of the HSU students was analyzed. The methods of this study were a mixed methods, convergent parallel approach using surveys and interviews. Analysis of the data indicated that the students of HSU lacked knowledge and motivation to achieve their goals. Moreover, the data also revealed that HSU has organizational inefficiencies that negatively influence achievement of students’ goals. The significance of these results indicates that HSU, and organizations like HSU, may have to restructure their practices to effectively address the gaps in performance by their students due to students’ lack of required knowledge, motivation and inefficient organizational support. This study concludes with context-specific training recommendations for HSU. These recommendations were intended to improve the university’s performance and to close the gap in KMO, based on the educational psychology literature and framed by the New World Kirkpatrick Model (Kirkpatrick & Kirkpatrick, 2016) of training evaluation. This model integrates implementation of training and evaluation of such training in its effectiveness of closing the gap.

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Asset Metadata

Creator Tran, Benjamin (author)

Core Title Factors contributing to student attrition at a healthcare university: a gap analysis

School Rossier School of Education

Degree Doctor of Education

Degree Program Organizational Change and Leadership (On Line)

Publication Date 11/06/2017

Defense Date 10/13/2017

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag evaluation model,gap analysis,Higher education,OAI-PMH Harvest,organizational performance,student attrition

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Seli, Helena (committee chair)

Creator Email benjamit@usc.edu,benjamit2002@yahoo.com

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c40-449901

Unique identifier UC11265624

Identifier etd-TranBenjam-5872.pdf (filename),usctheses-c40-449901 (legacy record id)

Legacy Identifier etd-TranBenjam-5872.pdf

Dmrecord 449901

Document Type Dissertation

Rights Tran, Benjamin

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the a...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA