key: cord-0862712-adh2fk34
authors: Cheah, Whye Lian; Law, Leh Shii; Teh, Keng Hoong; Kam, Su Ling; Voon, Grace Ern Hui; Lim, Han Yong; Shashi Kumar, Nuhes Seelan
title: Quality of life among undergraduate university students during COVID‐19 movement control order in Sarawak
date: 2021-08-25
journal: Health Sci Rep
DOI: 10.1002/hsr2.362
sha: 2db600674fbe22078abb63523729f3afebcb4e07
doc_id: 862712
cord_uid: adh2fk34

BACKGROUND AND AIMS: This study aimed to examine the quality of life (QoL) and health satisfaction of undergraduate university students in Sarawak during MCO and its association with socio‐demographic profiles. METHODS: In this cross‐sectional study, QoL and satisfaction of health of 503 undergraduate university students (63.4% females) from a public university was assessed online using the World Health Organization QoL (WHOQOL)‐BREF instrument. RESULTS: The overall QoL and satisfaction with health were 3.7 ± 0.87 and 3.9 ± 0.82, respectively. Male students showed significantly lower mean scores for the environmental domains than female students (63.37 ± 16.21 vs 68.10 ± 14.00, P < .01). Students who lived inside the campus (vs outside campus) showed significantly lower mean score for the physical health (61.49 ± 13.94 vs 67.23 ± 13.93, P < .01), environmental health (58.35 ± 15.07 vs 70.49 ± 13.21, P < .01), overall QoL (3.39 ± 0.90 vs 3.84 ± 0.83, P < .01), and satisfaction with health (3.71 ± 0.90 vs 3.97 ± 0.77, P < .01). Students with parent's income below RM5000 (vs parent's income more than RM5000) had significantly lower mean score for the environmental domain (65.06 ± 14.35 vs 68.20 ± 15.74, P < .05). Others ethnicity scored significantly lower than Bumiputera Sarawak and Malay while Bumiputera Sarawak scored significantly lower than Chinese in physical health domain (Malay = 65.73 ± 13.40, Chinese = 63.24 ± 15.35, Bumiputra Sarawak = 67.35 ± 13.30, Others = 60.84 ± 15.88, P < .05). Malay (69.99 ± 15.20) scored significantly higher than other ethnicities (Chinese = 63.58 ± 15.80; Bumiputera Malaysia = 65.23 ± 13.66; others = 63.98 ± 15.59) in environmental domain (P < .01). When comparing between religions, the results also showed there were significant differences between different religion groups in overall QoL (Islam = 3.75 ± 0.93, Christianity = 3.77 ± 0.79, Others = 3.34 ± 1.14, P < .05), physical health (Islam = 65.00 ± 13.86, Buddhism = 68.40 ± 11.99, Christianity = 64.77 ± 14.94, Others = 61.00 ± 16.03, P < .05), and environmental health (Islam = 69.66 ± 15.48, Buddhism = 64.99 ± 11.36, Christianity = 64.87 ± 15.61, Others = 62.13 ± 16.28, P < .05). CONCLUSION: By understanding university students' QoL in this global disaster, relevant authorities would provide a better rehabilitation and assistance to those affected ones.

respectively. Male students showed significantly lower mean scores for the environmental domains than female students (63.37 ± 16.21 vs 68.10 ± 14.00, P < .01).

Students who lived inside the campus (vs outside campus) showed significantly lower mean score for the physical health (61.49 ± 13.94 vs 67.23 ± 13.93, P < .01), environmental health (58.35 ± 15.07 vs 70.49 ± 13.21, P < .01), overall QoL (3.39 ± 0.90 vs 3.84 ± 0.83, P < .01), and satisfaction with health (3.71 ± 0.90 vs 3.97 ± 0.77, P < .01). Students with parent's income below RM5000 (vs parent's income more than RM5000) had significantly lower mean score for the environmental domain Conclusion: By understanding university students' QoL in this global disaster, relevant authorities would provide a better rehabilitation and assistance to those affected ones.

COVID-19, movement control order, quality of life, university students, World Health Organization quality of life WHOQOL-BREF

Coronavirus disease (COVID-19), a highly contagious disease, caused traumatic events in the population 1,2,3 especially due to its devastating effects on the health. Pneumonia like symptoms were observed on the patients including dry cough, dyspnea, fever, and eventually acute respiratory distress syndrome (ARDS) and multiple organ failure. 4 To control the transmission of the COVID-19 virus, governments all over the world including Malaysia implemented the "Movement Control Order (MCO)." In Malaysia, all mass movements and gathering activities were prohibited and people were advised to do home isolation 5 beginning from March 18, 2020. As a precedent in the country, every individual was expected to switch their lifestyles by following the new norms that were seemingly distinguishable from that of before the pandemic period and the changes were believed to exert negative effects on quality of life (QoL). 6 Therefore, this research was planned to understand the implications of these MCO restrictions on the health and QoL of the community.

QoL is a perception consisting of life satisfaction, emotional wellbeing, and individual functional characteristic. According to the World Health Organization (WHO), QoL is defined as "Individuals" perceptions of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards, and concerns. 7 This definition is consistent with the view that QoL refers to a subjective assessment incorporated in a societal, social, and environmental sense. It is commonly measured in 4 domains: physical, psychological, social, and environment. 8 A survey carried out by UNESCO (2020) reported about 1.646 million (peaked on April 30, 2020) learners in 163 countries were required to stay at home due to the closure of educational institutions and a high proportion of them were university students. In Malaysia, students at several public universities and private institutes of higher education were ordered to stay on campus and were not allowed to return home during MCO. 9 Not limiting to such uncertain conditions, the students also needed to confront other undesired issues in academic work and social life, as well as their personal financial situations, and emotional health. These issues included switch to online lessons, lack of face-to-face interaction with their lectures, introduction of new assessment methods, remaining trapped in the hostel, no meetings with friends, worries about their own financial condition, boredom, frustration, and fear. 10, 11 Such experiences could create psychological effects, including symptoms of stress, anxiety, and depression that are associated with low QoL. 12,13,14 Age, living with family, income, gender, ethnicity were among contributing factors that were associated with the mental and physical health of the students. In some countries like Russia, China, and Bangladesh, a sharp rise of mental health problems including suicide attempts were observed. 15, 16, 17 These information consistently provide evidence that there is a necessity to have a closer observation into the QoL of the university students.

Given these unexpected circumstances, it was of important to have a closer monitor on the mental and physical health experiences of the students as the states were closely related to their QoL. Therefore, this study was planned to obtain deeper understanding on these issues so that institutions of higher education were provided with accurate information to help formulate a more effective strategy and approach in handling the well-being of the students during a pandemic. This study aimed to assess the QoL among undergraduates of Universiti Malaysia Sarawak during MCO and its association with socio-demographic background.

It was a cross-sectional study and data collection was carried out from May to June 2020. Participants of the study comprises of students from various academic years and nine different faculties at University Malaysia Sarawak. Universiti Malaysia Sarawak is one of the public universities located in Borneo or more specifically Kota Samarahan, Sarawak. Similar to other universities, it was affected by the MCO as well where many students from Sabah and Peninsular Malaysia, as well as Sarawak itself were stranded in the campus, unable to return to their home. The inclusion criteria were those who were staying either in the campus or outside rented house during the MCO and unable to return to their home.

The data collection was conducted during the movement control order (MCO) of COVID-19 period in Malaysia, using Snowball sampling technique. Due to restriction in the MCO, after the potential respondents were approached, they were further asked to recruit other people to participate in this study. These steps were repeated until the sample size was achieved. The questionnaire was developed using Google Form and the link was shared to students in each faculty using WhatsApp as the medium. Other than that, link of the Google Form was uploaded into social media pages such as Facebook, Twitter, and Telegram. The respondents were briefed on the objectives and purpose of the research before consent was taken. The respondents were given the option to accept or decline their invitation to join the study.

The instrument used in this study was WHOQOL-BREF [7] .

WHOQOL-BREF contains four major domains: physical, psychological, social relationships, and environment. The original instrument composed of 26 items, but question number 21 was removed because it was not applicable for students in a local setting (about sexual activity). The first two items are to assess the general QoL of the students. 

From Table 1 , a total of 503 subjects (mean age = 21.9 ± 1.21 years; female = 63.4%) participated in the study. About one third of the respondents were Chinese (36.4%), followed closely by Malays (32.4) .

For parent's monthly income, more than half of the students were below RM5000 (58.4%). Higher number of respondents (66.0%) were staying outside campus.

The WHOQOL-BREF mean score for overall QoL and satisfaction with health were (3.7 ± 0.87) and (3.9 ± 0.82) respectively. The results on the four domains revealed that the social relationship domain has the highest mean score of 69.4 (SD 18.08), while psychological health showed the lowest mean score (59.5 ± 15.90; Table 2 ). Besides that, social media platforms that were popping up like mushrooms after rain, helped students to follow activities of the people they care for, as it has become a trend to share such information with friends and families. 18 Students also are utilized digital technologies and social media networks to attend their online classes, submit assignments, and even sat for online examination. 19 Such trends have become integrated in the fabric of young people life. 20 However, in term of psychological domain, its score was found to be the lowest compared to the others (59.5 ± 15.9). Long-term isolation or home-confinement may have negative effects on mental health of the students during MCO. 21 Despite having been able to connect socially with others using technology, some research suggested that long hours of social media engagement may cause increased stress, anxiety, depression, and other adverse mental health issues. 22 It is believed that such situations happen due to the lack of balance between time spent in school and for leisure when the students were confined to just one space without any outside movement. In addition, long hours of internet use could lead to addictive behavior that causes improper life style and change of personalities, particularly the young adults. 23 In addition, coronaphobia is linked to the fear of COVID-19, the over concern regarding disease contraction and dying, as well as associated socio-occupational stress. This affected those from lower income group. The findings were consistent with Patricia Aguilera-Hermida. 27 The Malaysian Department of Statistics reported that the unemployment rate was as high 5.3% in May 2020 with 826 100 individuals being unemployed, the highest rate in 27 years. 28 In terms of religion, there were significantly higher scores in physical health, environmental health, and overall QoL in one religion over another. In many mental health studies, religion played an important role in boosting positive emotions and helped neutralize negative emotions as it served as both life-enhancing factors as well as a coping resource. 29 Research has shown that religious beliefs and practices had improved health status, such as coping with disease, recovery after disease, and more optimistic in addressing disease situation. 30 In a pandemic situation like now, many people are turning toward faith in response to the economic, social, and health crisis. 31 32 These findings attributed to the fact that Indians are more "psychological attuned" and their level of awareness of the "mindbody relationship" was more pronounced, compared to the Chinese who were more stoic. Moreover, several studies also provided consistent findings regarding the associations. 33, 34 As such, a more comprehensive research should be done in order to understand the complexity of this psycho-social factors in relation to their perception of QoL.

Like most studies carried out during COVID-19 pandemic, the challenge of this study was to reach more respondents through online platform. Although the questionnaire link was distributed through social media such as Whatsapp to other UNIMAS students, but the response rate was low and the progression was slow. It was also difficult to assess every student since some of the students do not have mobile data or Wifi at home. It might introduce biases as that group of students was more susceptible toward QoL due to their financial incapability. In addition, the study was based on a cross-sectional survey, as such no cause-effect can be derived. Differences in the QoL status before and after COVID-19 was impossible as the related data were not available. Due to our recruitment methods and sample size,

we are unable to generalize the results to the entire population of university students in Malaysia. Despite that, the study achieved its objectives by improving our understanding on the issues related to QoL among university students better.

The results highlight the importance of socio-demographic background, especially for gender, ethnicity, religion, parent's income, and place of stay during pandemic to alleviate the impact of the COVID-19 pandemic on QoL of the university students. To improve the QoL of the university students, not only does the university need to strengthen the support system through mentoring and counseling, but students should be imparted with better coping mechanisms in dealing with their stress, anxiety, and depression during this pandemic.

No funding was used to support this research and/or the preparation of the manuscript.

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Quality of life among undergraduate university students during COVID-19 movement control order in Sarawak

The authors declare there is no conflict of interest. Whye Lian Cheah affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

The authors affirm that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

https://orcid.org/0000-0001-5963-0881