Media as a determinant of the sexuality of young Poles

Objective of the work: The aim of this study is to learn about the influence of the media on the sexuality of young Poles. Material and methods: The diagnostic survey method and the survey technique were used, based on the research tool which was the original questionnaire. 310 respondents, different in terms of sex, faith, place of residence and education, current family situation, aged from 16 to 21, participated in the study. Statistical analysis was carried out with the use of Exel 2019 and the SPSS Statisctics package, version 25, using the ANOVA analysis of variance and the Mann-Whitney and H Kruskal-Wallis t-tests. The data collection stage was carried out in the period from October to December 2019, via the Internet.

Introduction
Sexuality is described as one of the main components of existence. It creates a multidimensional sphere of life for every human being [1]. It deals with sex, gender identification, desire, sexual orientation, and reproduction. Is experienced and manifested in relationships, social roles, values, fantasies, behaviors, or personal beliefs [2]. It develops on five main levels, which include sociology, psychology, physiology, anatomy and interpersonal relations [1]. The parallel development of each of the above areas is a great challenge during the processes of upbringing, education or self-education, especially in the stage of individual maturation. [3].
The period of sexual maturation ranges from about 12 to 18 years of age. It is characterized by turbulent biological changes. The action of the gonads influences the development of secondary and tertiary sexual characteristics. The stimulus for the development of sexuality in this period is also a group of peers, which intersect with the influence of parents, the Internet, media, schools and other institutions. For both girls and boys, the growing up process tends to level out the differences between the emotional and sexual aspects [4].
The social plane is also the generator of sexual development, especially the conflict between the child and parents, who only create a model of femininity and masculinity, but not sexuality. At some point, a teenager starts rebelling against his parents and their sexuality.
This results in directing the development of one's sexuality towards peers or attitudes propagated by the broadly understood media. Initially, the discharge of sexual tensions takes place in homogeneous groups, and only later in mixed groups [4].

Objective of the work
The aim of the study is to learn about the influence of the media on the sexuality of young Poles.

Material and methods:
The conducted study was based on the diagnostic survey method and the questionnaire technique. The research tool was a self-construction questionnaire containing 3 main questions together with items in which the respondents assessed the degree of compliance with their beliefs on a 5-point Likert scale (definitely no, rather no, hard to say, rather yes, definitely yes). The first question concerned the type of content (sexual, erotic, pornographic) watched in the media available to young people. Then, the respondents were asked about the sources of knowledge about sexuality, and then the respondents were asked to refer to the influence of the media on the acceleration of sexual initiation, their credibility as a source of knowledge about sexuality and their influence on the personal attitude of the respondents to sex. The second part of the questionnaire was a record containing socio-demographic data of the participant, such as gender, age, place of residence and education, attitude to religion and the current social situation regarding the family.
The study was conducted among a group of adolescents aged 16 to 21 through an online survey questionnaire on the website. The sample was selected randomly, with the age restriction to 21 years of age. 310 people were included in the study. The respondents were informed about the anonymity of the study and the use of data solely for scientific purposes.
The research was carried out in the period from October to December 2019.
Statistical analyzes were performed through the use of softwareandExel 20219 of SPSS Statisctics version 25. A p-value of <0.05 was assumed to be statistically significant. The analysis of variance ANOVA in mixed schemes was used to assess the differences between the measurements and the groups. Such a choice, despite the Likert format response variables used to measure the response variables, was dictated by the recommendations of Glass (1972) and Carifio (2007). Moreover, in order to compare the variables expressed on ordinal scales, which were either not measured with the Likert-format answers, or the research question posed did not require the use of a multivariate scheme, the Mann-Whitney and H Kruskal-Wallis tests were used.

Results
Among 310 participants, the mean age was 18.09 years, the median was 18 years, and the standard deviation was 1.507. Most of the people were between the ages of 16 and 19, which means the distribution was right-skewed. Concentration of results around the mean value was low, the distribution was flattened -platokurtic.
In the studied group, the majority of people were women, and men accounted for only 13.55% of the total sample. Most of the respondents attended high school, while the smallest percentage of the research group studied in technical schools.
Also in terms of the place of residence, there were statistically significant disproportions in the research group. Most of the respondents came from the city.
The number of believers was similar to the number of non-believers. Believers constituted 53.55% of the entire group, while non-believers constituted 46.45%.
The largest percentage of the respondents came from complete families. In terms of the number, the second place was taken by people brought up only by their mother, and the third place was for people brought up only by their father. The remaining groups accounted for 1.29% of the total sample of respondents.
A multi-factor ANOVA in a mixed scheme (3x2x3x2x2x5, where the intra-group factor was the self-assessment of behavior related to viewing sexual, erotic and pornographic content, while the intergroup factors were selected demographic variables: gender, place of study, place of residence, attitude to religion, situation at home), testing The influence of the The conducted analyzes showed that there was a statistically significant difference between women and men in the frequency of viewing pornographic content. Men watched them more than women.  Chart 3. Sources of information on sexual behavior used by the respondents Figure 4 presents the profile of respondents' answers regarding the frequency of using various sources of information on sexual behavior.

Chart 4. Sources of information on sexual behavior used by the respondents 203
Post hoc analyzes showed that television is statistically significantly less frequent source of information than: educational lessons, teachers, siblings, parents, meetings with a psychologist, professional literature, colleagues, and the Internet. There were no statistically significant differences between the given source of information and the others. Moreover, the obtained data show that the Internet is statistically significantly more frequent source of information for respondents than: colleagues, professional literature, meetings with a psychologist, parents, siblings, teachers, educational lessons, television, youth magazines, erotic magazines, lessons religion.
Chart 5 presents a summary of the respondents 'answers to questions about the influence of the media on the acceleration of sexual initiation, their credibility as a source of information on sexual behavior and the impact on the participants' attitude to sex.

Chart 5.The influence of the media on the sexual behavior of the respondents
Calculated for the variables presented in Figure 5, the medians along with 95% confidence intervals are: media accelerate sexual initiation 3 (95% CI [3.3]), media are a reliable source of information on sexual behavior 2 (95% CI [2.2] ]), the media influence the attitude to sex in respondents 2 (95% CI [2.2]).
In order to compare the groups distinguished by demographic variables, analyzes were carried out using the Mann-Whitney U test and H Kruskal-Wallis test. The analyzes showed a statistically significant correlation between the attitude to faith and the belief in the credibility 204 of the media in the field of sexuality, as well as the place of study and the belief in the influence of the media on one's sexuality. The surveyed believers were less convinced of the credibility of the media in the field of sexuality than the non-believers. The respondents studying in high school were more convinced about the influence of the media on their sexuality than the respondents learning in higher education. There was no statistically significant difference between the pairs of high school -technical high school, technical high school -college.

Discussion:
Contemporary media undoubtedly influence many aspects of human life. This impact applies not only to adults, but also to children and adolescents, as shown by studies on the impact of the mass media on the process of upbringing, socialization and education in the school environment [5].
E. Pęczkowska's research confirmed that the psychological and sexological problems of adolescents arise with important role of the media in their lives, where they mentioned cinema and small-screen films among the sources of knowledge [6].
The EU NET ADB research shows that over a quarter of the surveyed adolescents have contact with pornography on the Internet at least once a week, including boys more often.
In the group of respondents, some explore pornographic content of their own free will, the other accidentally [7]. The results of the EU Kids Online research, which showed that for the vast majority of young people, the contact with pornography on the Internet is the most worrying threat that exists on the Internet, may be the optimistic fact. It can be assumed that the results obtained are the result of the spreading trends in sex education among school-age youth and the more and more often emerging new tools preventing the display of pornographic content [8].
The obtained results may prove useful for the development of effective tools for the sexual education of adolescents, which would help teenagers find their gender identity and awareness, also through the use of media. Proper sex education, in the long term, may lead to responsible sexual activity in accordance with the principles of sexual health. It can also prevent many negative consequences of irresponsible sex life, such as unwanted pregnancies, underage pregnancies, or diagnosing many sexually transmitted diseases [9].
Broadly understood media have become a carrier of many values for young people, but also anti-values, carrying both positive and negative effects of this impact. The media (mainly the Internet and television), as the main source of knowledge about sexuality among 205 young people, should promote the principles of sexual life in accordance with WHO recommendations [10].
The strength of the study was definitely the size of the study group and the distribution of independent variables such as faith or the current family situation, while the limitation was the small differentiation of the study group primarily in terms of gender (the vast majority of women), but also in terms of the place of confusion (city).
The conducted research with the use of the proprietary questionnaire may constitute the basis for future, extended research on the sexuality of young Poles and the influence of independent variables other than the media.

Conclusions:
1. The obtained results of own research showed that men viewed pornographic content statistically significantly more often than women.

The main source of knowledge about sexual behavior of young Poles is the Internet.
Television is rarely one. There was no statistically significant advantage of one of the sources of knowledge available to young people.
3. The surveyed believers were less convinced about the credibility of the media in the sexual sphere than non-believers.

4.
High school students were more convinced about the influence of the media on their sexuality than high school students.


s2fieldsofstudy: Education Psychology

text:
Physical Fitness, Exercise Behaviors, and Sense of Self-Efficacy Among College Students: A Descriptive Correlational Study

Background Self-efficacy is an important component of the mental well-being of college students. This study aimed to evaluate the development and the correlation between physical fitness (PF), exercise behavior, and self-efficacy in college students. To examine whether PF in individual college students can predict self-efficacy, and whether exercise behavior mediates this relationship. Methods This was an observational study of 1923 randomly selected college students (50.5% girl). Measures included the Physical Activity Rating Scale, the Self-Efficacy Scale, and PF testing. Results Self-efficacy was weakly correlated to both PF (r = 0.240) and exercise behavior (r = 0.248). In regression analysis, PF explained 24.7% of the variance in self-efficacy, increasing to 29.4% when exercise behavior was considered. Therefore, the predictive effect of PF on self-efficacy is partially realized through healthy exercise behavior. Conclusion Physical fitness can predict self-efficacy among college students, with exercise behavior being an important mediation of this relationship. Strategies to improve positive exercise behaviors and PF could improve students’ self-efficacy and overall mental health.

INTRODUCTION
The span of college education is a sensitive period for the psychological development of young adults, during which they develop coping strategies in terms of their mental health. The spread of the new coronavirus pneumonia  throughout the world has posed a great risk to human health. The COVID-19 pandemic and the resulting psychological problems pose an unprecedented health crisis and challenge for university students, who are a special group in the context of public health emergencies (Stowe et al., 2020). It has also been shown that people who are socially isolated have poorer cognitive skills, including memory and reaction time, and lower gray matter volume in many parts of the brain (Shen et al., 2022). Self-efficacy, the core concept of Bandura's social cognition theory (Bandura, 1997), refers to the judgments and beliefs that individuals have regarding their ability to organize themselves to perform actions and achieve their goals. Self -efficacy has the following functions: (1) determine people's choice of activities and the persistence of the activity; (2) affect people's attitudes in front of difficulties; (3) affect the acquisition and performance of new behaviors; and (4) affect the emotions during the event (Bandura, 1997). The primary function of self-efficacy is behavioral regulation, which is manifested in the strength of an individual's self-confidence (Bandura, 1997).
People with a high sense of self-efficacy are more likely to exert tremendous effort and perseverance to reach their goals. In comparison, individuals with a low sense of self-efficacy are more likely to have doubts about their abilities, to worry when they encounter failures and setbacks, and to generally be satisfied with mediocre achievements (Milne, 1999). Considering the recent evidence regarding the positive effects of physical exercise on mental health, improving individual self-efficacy through exercise has become an important means by which to promote the healthy development of individuals (Anderson and Feldman, 2020;Levy et al., 2020). Considering that some parts of China were in the period of the COVID-19 pandemic during the study period. Relevant evidence shows that high self-efficacy among college students during campus re-entry were only 50.4%, the level is low, respectively (Tadese and Mihretie, 2021). During the COVID-19 epidemic restraint management has a negative impact on mental health, about 40% college students experienced anxiety symptoms in China (Fu et al., 2021). And existing studies have shown that positive self-efficacy is closely related to the mental health of college students (Abdel-Khalek and Lester, 2017;Zeng et al., 2021), it is necessary to conduct special research on self-efficacy.
Physical fitness (PF) is a multifaceted construct involving physical and physiological components, including cardiorespiratory endurance, strength, speed, reaction, agility, balance, coordination, flexibility, etc. (Dong et al., 2019). PF is strongly associated with health (Xu et al., 2020). The Chinese government has always attached great importance to the PF of students. Since 2002, the National Student Physical Health Standards has been implemented, requiring all primary schools, middle schools and universities in China to conduct a Student Physical Fitness Test every year, and the test results are reported to the China Education department. The connotation of standard is an evaluation standard for measuring students' physical health status and exercise effect. The main goals of the standard include three parts: education function, feedback function, and guiding students to do physical exercise (Ma et al., 2022). To this end, the relevant test indicators and results of the national student PF test can guide the development of Chinese students' PF policy guidance (Xu et al., 2020).
We need to explore strategies to help students improve their sense of self-efficacy. Research on the self-efficacy of college students in China has shown that physical exercise exerts several positive effects, including improved happiness (Chen and Yu, 2015), self-concept and life satisfaction (Zeng and Zhao, 2007), and interpersonal trust and national identity (Han and Huang, 2019). Physical exercise is also an effective method to improve PF, which is an indicator of physical and mental health among college students. Extending from the existing research, this study aimed to evaluate the development of healthy PF, exercise behavior, and self-efficacy among college students and to explore the correlation between these constructs. The study of mediating variables can not only explain the mechanism behind the relationship, but also integrate existing research or theories, which has significant theoretical and practical significance. We hypothesized that there would be a positive relationship between exercise behavior and PF and self-efficacy in this population. PF in individual college students can predict self-efficacy, and exercise behavior mediates this relationship.

Study Group
We used a cluster sampling method to recruit first, second, and third-year undergraduate students from Nantong University, and Yangzhou University. Given that the senior year is at the stage of internship and dissertation (design) completion, this study did not sample seniors. All students provided informed consent before enrolling in the study. Students with previously diagnosed mental or physical health problems were excluded from the study group. The study protocol has been approved by the Ethics Committee at the Nantong University (NTU-ISS-2019-001).
The calculation of the minimum sample size is completed by Equation 1 (Shao, 2012), where the type I error α is set to 0.05, the allowable error δ is set to 0.01, and the sample rate ρ is set to 0.05. A total of 54,689 people (data updated in 2019), so the limited overall number N sets 75% of the total number of students to be about 41,017. The minimum sample size required for this study was calculated to be 1,748.
In all, 2,188 students were randomly selected and they completed our PF test. After the test, students were asked to complete a questionnaire regarding their physical activity and self-efficacy. Of the 2,188 students who completed the PF test, 2,094 returned their questionnaires. Of these, 1,923 questionnaires were complete (effective response rate, 91.8%), and those individuals formed our study sample, comprising 951 men and 972 women. The characteristics of the study sample are summarized in Table 1. The data obtained were verified against student identification to match physical test results and completed questionnaires.

Testing Method
Physical Activity Rating Scale The physical exercise rating scale was compiled by the Japanese scholar Takao Hashimoto, which was subsequently introduced and completed by Liang (1994) in China. Physical exercise volume was examined with respect to the exercise intensity, frequency, and time of one exercise activity to measure physical exercise participation.
Each parameter was evaluated using five score levels. The level standards were as follows: small exercise volume ≤ 19 points, moderate exercise volume = 20-42 points, and large exercise amount ≥43 points (Liang, 1994). The re-test reliability of this scale was 0.820. Follow-up related research shows that the internal consistency reliability of Physical Activity Rating Scale is Cronbach's α = 0.85. The value of the scale was used to reflect the physical exercise behaviors of college students (Collins et al., 2022).

General Self-Efficacy Scale
Self-efficacy was evaluated using the Chinese version of the General Self-Efficacy Scale developed by Luszczynska et al. (2005). This scale is appropriate to use for individuals ≥12 years of age. The reliability and validity of this scale have previously been reported in a Chinese population. The scale has good reliability, with a Cronbach's α of 0.87, test-retest reliability correlation (r) of 0.83 (p < 0.001), and half-reliability agreement (r) of 0.82 (n = 401, p < 0.001) (Wang and Liu, 2001). The 10 items of this scale were scored on a 4-point Likert scale, with higher scores indicative of higher self-efficacy.

Physical Fitness Test
Physical fitness levels were quantified in a physical fitness index (PFI) using The National Student Physical Health Standards (Revised in 2014) of the Chinese Student PF Standards. The student fitness tester (Model: HK6800; Shenzhen Hengkang Jiaye Technology Co., Ltd.) was used to measure the following components of PF. The PF test was performed as part of the college physical education curriculum. Before the test, students needed to perform a standardized warm-up for 5 min, including muscle stretching and joint exercises. According to the curriculum arrangement of the test school, college physical education is generally arranged between 9:00 and 11:00 in the morning and 2:00 and 5:00 in the afternoon, and the physical education class is only available under clear and conducive weather and temperature conditions. The test was conducted in the physical education class, enabling suitable temperature and humidity during the test. Participants completed each test item once per day for three days, and the best score of the three was used in the analysis. After participants had completed the physical tests, they were asked to complete the questionnaire on physical activity and self-efficacy.
The tests and questionnaires were completed during March-April, 2020. After we have collected the data, we need to calculate the physique score of college students according to the norm of The National Student Physical Health Standards (Revised in 2014). For the conversion norm, refer to Supplementary Appendix 1.
The main test procedures are as follows.
(1) Body shape: test the body mass index (BMI, kg/m 2 ). Standing height barefoot will be measured using a stable stadiometer (GMCS-SGZG3, Jian-Min, Beijing) to the nearest 0.001 m. Bodyweight with light clothes will be measured using a portable scale (GMCS-YERCS3, Jian-Min, Beijing) to the nearest 0.1 kilograms (kg). BMI was calculated by height and body weight: (2) Cardiorespiratory endurance: the test items were time required to run distances of 1,000 m for boys and 800 m for girls.
The test equipment includes 400, 300, and 200 m orbiting tracks, and the geology is not limited. Other irregular venues can also be used, but the measurement must be accurate and the venue flat. Several stopwatches need to be corrected before use, and the error per min should not exceed 0.2 s. The standard stopwatch is selected based on Beijing time, with an error of no more than 0.3 s per h. At least two subjects will be tested in pairs, commencing from a standing start point. Start running after hearing the "Run" command. The timekeeper will see the flag to start the watch, and stop the watch when the subject's torso reaches the vertical plane of the finish line. Record the test results in seconds, accurate to one digit after the decimal point, and the second digit after the decimal point is considered according to the principle of non-zero advancement: for example, 10.11 s as 10.2 s.
(3) Flexibility, measured using the seated forward flexion test. Before the test, the subject should prepare a preparation to prevent zooming. The subject is sitting on the cushion connected to the box. The legs are straightened and should not be bent. The heels are close together. The toes are separated by about 10-15 cm. The two arms and hands are straight, gradually make the upper body to flex, gently push the cursor on the rib in both hands (not suddenly reaching it) until it continues to extend before extending. The inner plane of the pedal of the test score is 0 points, the inward is negative, and the forward is positive. Record in the units of centimeters, take a decimal point. If it is a positive value, add the "+" symbol before the value, and the negative value will be added with the "−" symbol.
(4) Power, measured using the standing long jump test. The subject stands separately on both feet. After standing behind the starting line, the toes must not be stepped on (it is best to use a wire rope to start the line). Both feet are jumping at the same time, and there must be no steps or jumping movements. Measure the vertical distance from the rear edge of the jump line to the rear edge of the nearest place. Each person trial three times and record the best results. In the unity of centimeters, regardless of decimal.

Data Analysis
All analyses were performed using IBM SPSS (version 25.0).
Step 1: the association between PF, exercise behavior and selfefficacy was evaluated using Pearson's or Spearman's rank order correlation, as appropriate for the data distribution.
Step 2: a linear regression analysis was used to evaluate the specific association between an individual's exercise behavior and the components of PF measured (body shape, cardiorespiratory endurance, flexibility, and power).
Step 3: a hierarchical regression analysis (Model A) was used to evaluate the predictive effect of each component of PF (independent variables) on self-efficacy (dependent variable). In the Model B regression, exercise behavior was also included as an independent variable. Steps 1 and 2 together constitute the methodology of stepwise regression analysis, which is the most commonly used method for testing mediation effects (MacKinnon et al., 2007).

RESULTS
The descriptive data (mean and SD) of the participants according to course and gender in the dependent variables in Table 2.

Correlation Analysis
The outcomes of the correlation analysis between PF, exercise behavior, and self-efficacy are summarized in Table 3. Selfefficacy was weakly correlated with PF (r = 0.240) and exercise behavior (r = 0.248). Nonetheless, the correlation between students' self-efficacy and the components of PF and exercise  behavior was positive and significant (p < 0.05 and p < 0.01, respectively).

Regression Analysis of Exercise Behavior and Physical Fitness
Results of the regression analysis are reported in Table 4. Exercise behavior exerted a significant effect (p < 0.05) on the components of PF, except body shape exercise intensity, duration, and frequency were all predictors of PF. Exercise intensity was specifically associated with two components of PF: flexibility (β = 0.083) and power (β = 0.084). Exercise duration was associated with cardiopulmonary fitness (β = 0.054) and power (β = 0.057), with exercise frequency being associated with flexibility (β = 0.026) and power (β = 0.030). Each subindicator of exercise behavior had a predictive effect on the total score for PF.

Hierarchical Multiple Regression
Analysis of Physical Fitness, Self-Efficacy, and Exercise Behavior As shown in Table 5, both regression Models A and B were significant (p < 0.01). In Model A, with self-efficacy as the dependent variable and PF as the independent variable, all components of PF exerted a strong predictive effect on selfefficacy. Model B, in which PF and exercise behavior were considered simultaneously, increased the variance accounted for in Model A (R 2 -value increase from 0.247 to 0.294). Therefore, exercise behavior exerted a significant impact on the relationship between PF and self-efficacy.

DISCUSSION
Our results show that PF predicted self-efficacy overall, with a further significant predictive effect of the components of PF on self-efficacy. Overall, PF explained 24.7% of the variance in self-efficacy. When we added physical exercise behavior as an intermediary variable, the fit of the regression model improved, the variance explained went from 24.7 to 29.4%. This finding underlines the importance of exercise behavior for PF and ultimately, self-efficacy. Of note is that when exercise behavior was included, only BMI, flexibility, and power were retained as predictors of self-efficacy. In addition to the above results, this study also found that college students had lower PF overall, with power being the worst.

Power Is the Worst Physical Fitness Among Them
This result is similar to other studies (Cui et al., 2018;Wang, 2019;Li et al., 2022). The college student population is a reserve of high-quality national talent. However, the decline in the PF of college students is of great concern. From 1985 to 2014, 1,513,435 students participated in the Chinese National   (Dong et al., 2019). This confirms the decline in the PF of college students. There are many reasons for this phenomenon, with existing research focusing on the overall decline in physical activity among college students and the increase in sedentary time. World Health Organization released a new version of the Guidelines on Physical Activity and Sedentary Behavior, reminding adults (aged 15-64 years) to engage in 150-300 min of moderate-intensity or 75-150 min of high-intensity activity every day (Bull et al., 2020). The latest statistics show that one-quarter of adults and four-fifths of adolescents are not meeting these physical activity guidelines (Guthold et al., 2018). For the time period in which the data was collected in this study, the decline in physical activity among college students appears to be more severe due to the impact of COVID-19. In order to cut off the spread of COVID-19, Chinese local governments have implemented related confinement policies, which is the main reason for the decline in physical activity. The resulting negative phenomenon of human mental health is also very clear. A recent study published in Neurology suggests that social isolation is associated with reduced brain volume in cognitively relevant areas and an increased risk of dementia. Its results suggest that unlike risk factors such as depression and loneliness, social isolation is associated with a 26% increased risk of dementia (Shen et al., 2022). Students whose family residence was worst hit by the pandemic tend to report poorer mental health during the pandemic outbreak, risk perception of being infected with COVID-19 has a negative direct and indirect impacts on college students' mental health (Han et al., 2021). During the COVID-19 epidemic restraint management has a negative impact on mental health, more than 40% college students experienced anxiety symptoms in China (Fu et al., 2021). Another study showed that of participants, 32.5% reported that COVID-19 negatively impacted their stress levels very much or an extreme amount, 29.0% reported a moderate negative impact and only 38.5% reported little to no negative impacts (Prowse et al., 2021).

Physical Fitness Can Effectively Predict the Self-Efficacy of College Students
According to the analysis, college students with better PF will also have higher overall self-evaluation and evaluation of specific aspects of the body. In other words, college students with higher PF have higher body self-esteem (Xie, 2012). Selfconfidence in one's own body also extends to other areas. When encountering different environments, facing new environments or encountering difficult problems, self-confidence in adapting to the environment and solving problems will also increase, that is self-efficacy increases. However, the results of this study show exercise behavior does not predict weight status. This is quite different from previous studies (Zhang et al., 2020). The possible reason is that the body shape used in this study is the norm for BMI of college students in A, which is only developed based on the situation of Chinese college students and the norm is relatively old.
Exercise Behavior Has Strong Predictive Effect on Self-Efficacy, With a Demonstrated Improvement in Individual Self-Confidence in Exercise Our findings revealed a high degree of positive correlation between self-efficacy and exercise behavior. This is consistent with previously reported findings, which state that the more active exercise behavior, the higher the self-efficacy (Anderson and Feldman, 2020). Self-efficacy is considered an important source of internal motivation for individuals to participate in exercise. Moreover, self-efficacy among college students can also play a significant role in predicting exercise activity (Yu et al., 2013). Evidence also points to a significant positive correlation between the self-efficacy of participating in exercise and motivational readiness, walking steps, and calorie consumption (Barr- Anderson et al., 2007). Therefore, improving college students' self-efficacy to participate in exercise can increase the frequency of students' participation in exercise, leading to improvement in their PF status (Annesi, 2006).

Exercise Behavior Is an Important Mediating Variable Between Physical Fitness and Self-Efficacy
The purpose of studying the mediating effect is to explore the internal mechanism of the relationship based on the known relationship between PF and self-efficacy. In this process, the original research on the same phenomenon can be linked together, the theories originally used to explain similar phenomena can be integrated, and the existing theories can be made more systematic (Preacher et al., 2007). The establishment table of the mediation model for the three variables of PF, exercise behavior and self-efficacy, there may be a "Matthew effect" among the three. Specifically, when a college student's PF is better, he has a more active exercise behavior and thus has a higher self-efficacy. The reverse is also true. PF in individual college students can predict self-efficacy, and exercise behavior mediates this relationship. This will provide reference for scholars who are engaged in the research of college students' mental health.
The limitations of our study should be acknowledged when interpreting the results. First, both exercise and self-efficacy involve multiple dimensions, and the mechanisms may differ across dimensions. Second, we only considered the association between exercise and self-efficacy. In reality, self-efficacy may be influenced by other variables; therefore, the relationship between exercise and self-efficacy may be more complex than shown in this study.

CONCLUSION
Physical fitness can improve self-efficacy among college students, with exercise behavior being an important mediator to this relationship. Our findings provide a theoretical basis for developing strategies to improve the self-efficacy and overall mental health of college students by promoting positive exercise behaviors and PF.

DATA AVAILABILITY STATEMENT
The original contributions presented in this study are included in the article/Supplementary Material, further inquiries can be directed to the corresponding author.


Crossword puzzle as a learning tool to enhance learning about anticoagulant therapeutics

Background Educational games make the learning process more enjoyable, fun, and create a competitive classroom environment that can positively affect learning. The purpose of this study was to evaluate pharmacy students’ perceptions of crossword puzzles (CWPs) as a learning tool in the pharmacotherapy cardiovascular module focusing on anticoagulants’ therapeutics and assessing if students’ preference of learning style influenced their perception. Methods Clues for the puzzle were developed, validated, and piloted by course faculty. A free internet puzzle generator was used to create puzzles with 10 to 20 clues. Students were given 30 min to solve the puzzle following six hours of didactic lectures about the topic. An 8-item survey instrument and Pharmacists’ Inventory of Learning Styles (PILS) questionnaire were administered to examine students’ perceptions of the game and their learning style preference, respectively. Results Two hundred sixty-seven students participated in the activity from both undergraduate programs (BPharm and PharmD) over three consecutive course offerings. Most students expressed favorable perceptions of the puzzle. Female and BPharm students had significantly more favorable perceptions than male and PharmD students on several perception items. The dominant preferred learning style (PLS) was converger (35.6%), followed by assimilator (25.3%), while 15.1% had mixed learning styles. The study did not find a significant association between PLS and students’ perceptions toward the CWP. Conclusions The CWP game presented an innovative, creative, and easy active learning tool to enhance information recall, retention, and class engagement while accommodating all learning style preferences.

Background
Old habits are hard to break. Didactic lectures continue to resemble the school days of Charlie Brown and his schoolteacher in the classroom. The COVID-19 pandemic has further complicated the effective delivery of didactic lectures without visual confirmation that students are actively participating and understanding the information. Such a barrier has led to a lack of learner engagement, as evident by an increase in absenteeism in pharmacy school lectures, students underestimating the importance of lectures, and a corresponding decrease in performance, particularly in therapeutics courses [1,2]. Contrarily, students who are stimulated by effective learning methods are more likely to attend lectures than their colleagues [3]. On average, the first 10 min of a lecture are associated with the peak of student attention and highest retention of information [4][5][6]. Student interest declines from that point and is barely salvaged in the last 5 to 10 min. In totality, students are disengaged for approximately 75% of the lecture. This is not surprising since millennials have been weaned upon technological advances and various means of communication and entertainment, and the absence of consistent stimulation make things no longer intriguing [7,8].
Evidence supports the positive impact of using innovative educational tools to benefit the teaching and learning process for health professions, and pharmacy education is no exception [9]. The Accreditation Council for Pharmacy Education (ACPE) placed high emphasis in "Standard 10: Curriculum Design, Delivery, and Oversight" on student engagement through teaching and learning activities that promote self-directed learning and accommodate the diverse learning needs of students [10]. Gleason and colleagues categorized classroom-based active learning methods into five types: Cooperative Learning, Problem-Based Learning, Team-Based Learning, Case-Based Learning, and Ability-Based Education and Assessmentas-Learning [11]. Stewart et al. surveyed 114 US colleges and schools of pharmacy faculty members to evaluate the extent and the promoting factors for using active learning techniques [12]. 87% of the faculty members reported using active-learning activities such as case-based learning (71%), deliberative discussion (50%), team-based learning (47%), clickers (45%), simulation (25%), Interactive Web-based learning (19%) and process-oriented guided inquiry learning (12%). Promoters for active learning techniques include younger faculty age, lower faculty rank, and pharmacy practice or social/behavioral/administrative sciences departments. In the Middle Ease, Alruthia et al. surveyed faculty members in health colleges from 17 countries throughout the region [13]. The majority of pharmacy colleges respondents (n = 202) acknowledged utilizing various active learning strategies including class discussions (87%), small group discussions (56.9%), learning by teaching (49.5%), case studies and problem-based learning (41.1%). Several other studies have also described the incorporation of active learning techniques into pharmacy curriculum [12,[14][15][16][17][18].
Gamification or serious games have gained popularity recently [19][20][21]. In their overview of game implementation in the classroom, Biehle and Jeffres provided four essential fundamentals toward game development and use [21]. These fundamentals are, first, external motivation should be initiated to internally motivate the student to master the material. Second, students should benefit from the material whether they win or lose. Third, all students should equally be engaged in participating, and lastly, the objective of the game should be clearly explained to the students. Several systematic reviews concluded that gamification could improve the learning outcomes of health professions education, including pharmacy [22,23]. The published literature includes descriptions of a lengthy list of the different types of games used to aid students in learning [17,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41]. The use of crossword puzzle (CWP) has been used occasionally in the literature with studies conducted in several pharmacy courses. Gaikwad et al. reported a significant improvement between CWP pre-and post-test scores when used in a pharmacology course covering antihypertensive and antiepileptic drugs for second-year Bachelor of Medicine and Bachelor of Surgery (MBBS) medical students [37]. Medical students in their fifth year of the MBBS degree indicated satisfaction with a CWP covering hormonal contraceptives [38]. Student perceptions toward the activity were also positive. Shah and colleagues developed a CWP during the pharmacology and medicinal chemistry module about anti-ulcer agents [36]. Over two years, post-activity surveys revealed that most students enjoyed the CWPs and felt as if it enhanced their learning.
Although it is assumed that active learning strategies will increase student engagement for most participants, there is scarce literature investigating whether there is an association between student learning styles and their preference for active learning strategies in the classroom. Conversely, when a mismatch occurs in the instructor's teaching style and a student's learning style, student learning may be impacted [42]. A study describing millennial students in the Philippines found that most students are application-oriented, focusing on applying what they studied to what they learned in practice [43]. This finding is important because modern pharmacy curricula include more application courses and experiential education. Crawford et al. compared the dominant learning styles of pharmacy students and faculty members and found no significant differences between faculty members and student learning styles [44]. However, the study found that learning styles differed by gender and faculty track (tenure vs. clinical).
Studies evaluating the CWP in pharmacy are still scarce. Additionally, none of the published work addressed pharmacy students' learning style preferences and their perception of educational games. Moreover, the educational pathway for entry to practice as a pharmacist is different across the world [45]. In some countries, the Bachelor's in pharmacy sciences (BPharm) is the only program to graduate pharmacists; in others like the United States, Doctor of Pharmacy (PharmD) is the sole program that graduates pharmacy practitioners. At the same time, some countries offer both programs (BPharm or PharmD) where graduates are licensed to practice pharmacy, such as the case in Saudi Arabia. The structure, educational level and focus of the BPharm and PharmD programs are different. In addition, each has its own set of competencies that suggest variations in teaching and learning approaches [46]. Hence for this study, we aimed to (1) evaluate the perception of BPharm and PharmD students toward the use of CWPs as an educational tool for enhancing their learning about anticoagulant therapeutics taught in the pharmacotherapy courses, (2) identify the preferred learning style among pharmacy students and (3) determine whether students' learning style preferences, pharmacy program influenced their perception of this active learning technique.

Context and participants
This is a cross-sectional study, where we used CWP as an active learning tool in therapeutic courses for students in the PharmD and BPharm programs. The PharmD program is a 6-year study plan (200 credit units) with considerable focus on pharmacotherapy (8 courses) and pharmacy practice lab (6 courses); these in total constitute (14%) of the curriculum. On the other hand, The Bachelor's program is a 5-year study plan (173 credit units) considerably focused on pharmaceutical sciences, with only 6% of the credits going for pharmacotherapy (2 courses) and pharmacy skill labs (2 courses). Both programs are ACPE accredited, and faculty in the college teach in both curricula. However, the Bachelor's program is delivered mainly by non-practicing faculty. The focus of this research is on therapeutic courses, PHCL 412 (PharmD course) and PHCL 416 (BPharm course), which start in the seventh level (third professional year). We targeted content related to the cardiovascular disease's module, particularly anticoagulant therapeutics. The faculty covered the management of venous thromboembolism and atrial fibrillation with an overview of anticoagulant drugs over six didactic hours.

Game objectives and development
The learning objectives related to anticoagulant therapy are presented in Table 1. CWP was created using a free online CWP generator (TheTeachersCorner.net). The course instructors developed the puzzle clues (questions and answers) based on the material covered during the lectures and designed to cover Bloom's taxonomy of knowledge, comprehension, and application levels. The content validity of these CWPs was mapped to the intended learning outcomes of the modules and was peer-reviewed by another course instructor. Additionally, the CWP was piloted among a group of student interns in their advanced pharmacy practice experiential training. Printed copies of the CWP were provided to the students to solve immediately after the lecture (BPharm group, 10 clues CWP) or during the pharmacy practice lab (PharmD group, 20-clues CWP). Students were divided into groups, and 30 min was allocated for solving each CWP. Although students were expected to self-correct the answers to solve the puzzle, a debriefing session was provided to discuss any confusing points or misconceptions related to the topic. An example puzzle is shown in Fig. 1.
At the end of the activity, students were asked to complete two post-activity surveys administered via SurveyMonkey. The first survey was the Pharmacists' Inventory of Learning Styles (PILS), a survey tool validated for pharmacy practice adapted from Kolb's learning style inventory [47]. The instrument categorizes learning styles into four groups: accommodator, assimilator, converger and diverger. The second survey was an 8-item questionnaire to measure students' attitudes towards the use of games in learning developed by Shah et al. [36]. Both surveys were anonymous; students were asked to complete the PILS survey first to identify their PLS and include it in a mandatory field in the perception survey. Students in the study consented to participate. Participation in the surveys was voluntary, and no extra marks were given to the students for completing the puzzle or the surveys. Students were also informed that their grades in the course would not be impacted by their participation, or lack thereof, in the activity. We implemented the CWP over three consecutive years using different puzzles.

Statistical analysis
The data were analyzed using IBM SPSS Statistic version 22. Categorical data were presented as frequencies (N) and percentages (%), while continuous data were expressed by the mean and standard deviation (SD). A normality test (Kologrove-Smirnov and Shapiro-Wilk test) was conducted for the dependent variables (student perceptions of CWPs) and the independent variables (gender and education degree) to determine whether students' perceptions were normally distributed among gender categories (i.e. male and female) and education degree categories (i.e. PharmD and BPharm). In the perception survey, we consolidated the data for the 5-Likert scale by combining the positive responses (strongly agree and agree) as one data set and the negative responses (strongly disagree and disagree) as another data set to facilitate statistical analysis. As data were not normally distributed, the Mann-Whitney U test was used to test for the differences in perception among the independent groups. We used ANOVA to compare between the survey questions means and the different learning styles.
Responses to the open-ended question of the survey were analyzed and presented as perception themes based on keywords/phrases in the students' responses. The reliability of the scale was assessed by Cronbach's alpha value. A value of alpha ≥ 0.7 was considered acceptable reliability. The Cronbach's Alpha for the instrument in this study was 0.881.

Results
During the three consecutive years of the puzzle implementation, 380 students enrolled in PHCL 412 and 76 enrolled in PHCL 416 course. Data were available on 267 students who participated in the game (response rate of 59%). The mean age of the students was (21.34 ± 1.21), the majority were females (67%), and two-thirds (71%) were enrolled in the PharmD program. Table 2 summarizes the student demographics. On the PILS survey, the most preferred learning styles across all students were converger (n = 93, 35.6%) followed by assimilator (n = 66, 25.3%), while 41 students (15.7%) were multimodal. Learning style order of preference based on gender showed a significant difference (p < 0.05), with female students preferring assimilator and converger learning styles, while male students' preference was higher for accommodator and diverger learning styles. Less than 10% of students could complete the puzzle in 30 min, and a few numbers had correct answers.
On the perception survey, items related to the value of CWP as a learning tool scored positively high by most students, 220 students (82.4%) perceived that CWPs helped them to identify the most important topics to focus on, 214 students (81.3%) perceived that the CWP served as a good review of the lecture material, 206 students (77.2%) thought CWP enhanced their learning, while 180 students (67.4%) believed they learned from the class because of the CWP. Majority of students (n = 194, 74.2%) perceived material on the CWP was pertinent to what they learned in class and that they enjoyed the classmate interaction while solving the puzzle (n = 211, 79%). Most of the students (n = 195, 73%) perceived the amount of time given was sufficient to solve the puzzle and expressed a preference to have extra credits for such activities (n = 196, 73.4%). Table 3 summarizes students' perceptions of CWP as a learning tool.
There was a significant difference in students' perception of CWPs among gender groups. Female students had a significantly higher mean score for the statement "length of time provided for solving the puzzles was sufficient" than their male counterparts (p = 0.001) ( Table 4). Furthermore, there was a significant difference in student perceptions about CWPs among the two different undergraduate programs. The BPharm students' mean score was significantly higher on several perception survey items compared to PharmD students, specifically on statement items "CWPs oriented them to the topics they should focus on" (p = 0.003), "the length of time provided for solving the puzzles was sufficient" (p = 0.001), and "the material on the puzzles was pertinent" (p = 0.038). There was no association observed between learning style and students' perception of CWP (p = 0.19). using the analysis of variance (ANOVA) to compare between the mean scores of the perception survey items and the PLS was also not significant. a significant association Table 5 summarizes the perceptions of CWPs across the different PLS.
For the first open ended-questions at the end of the survey, 154 students provided feedback to the first question "Please share any additional thoughts and feedback about using the game in the teaching-learning process (Feel free to write in Arabic or English)". We grouped the different responses and identified four types of perceptions. (1) Perceptions about how student's felt about the game itself (n = 57) as indicated by words such as "fun", "enjoyable", "interesting", "exciting", "amazing" "good" "great" and "mind refreshing".
(2) Perceptions about the game effectiveness as tool to improve learning (n = 54) that was mainly captured by phrases such as "Break from the traditional teaching", "helpful", "information retention", "review of learned knowledge", "beneficial and creative", "well organized" and "useful". (3) Perceptions about the game as a selfassessment tool for learning (n = 22) through phrases such as "enhance memorization", "focus on spelling skills", "pay attention during class", "aid recall", "focus my learning", "a way to understand" and "facilitated my learning". (4) Perceptions about the learning environment (n = 12) with student's using words such as "interactive", "engaging", "motivating", "stimulating" and "competitive".
For the second open ended question about "What topic(s) in pharmacy curriculum you like to see taught in a game format?", there were 144 responses. Students suggested that CWP is an effective way to teach confusing subjects, or prior to exams and suggested to extend the

Mean (SD) Mean (SD) Mean (SD) Mean (SD)
The   Table 6 Themes of students' free comments on the CWP activity Feedback about using the game in the teaching-learning process (N = 154)

Perceptions about how student's felt about the game itself
• "Very exciting we'd love more of this" • "I like the idea it is creative and fun" • "Exciting And enjoyable" • "I find it fun, and I truly enjoyed it" • "It was fun learning process solving the puzzle with my classmate" • "I liked how we did not use any reference to answer it was a mind refreshing activity. " Perceptions about the game effectiveness as tool to improve learning • "it's an effective method to enhance learning in fun way, it should be in every topic" • "I found the idea very different than our usual methods which is truly appreciated" • "It gives us a good review and it is not associated with marks" • "Solving crossword puzzles is good review of material I hope to get more for next subject" • "Interactive learning is fun and efficient way to obtain knowledge and should be used more in all classes rather than the traditional way of teaching" • "Change the narration style and create a stimulating learning environment for students" • "It is much better studying in game format rather than normal assignments. " Perceptions about the game as a self-assessment tool for learning • "It makes me focus more on the spelling which is important" • "The activities enhance memorization of the information" • "Perfect method to evaluate our knowledge" • "It was fun and forces us to learn the spilling of drugs" • "Was great help to remember as reviewing after study " • "Improves thinking and memorizing" • "I think it's a good idea change in the routine it made me want to pay more attention in class" • "It facilities the learning and being familiar with the drugs" Perceptions about the learning environment • "it's good and make the class more active" • "It makes the group more comfortable with each other, so has a good process in communication" • "It is an amazing activity to be engaged in learning" • "It's getting quite competitive" • "I had good time doing this game with my classmates and it makes me revise the information that I studied in therapeutic" use of CWP for other topics such as therapeutics (commonly mentioned topics: hypertension, atrial fibrillation, heart failure and ischemic heart disease), diabetes, antibiotics, drug-drug interactions, microbiology, medicinal chemistry, and several students suggested to use in all courses. The remaining of the comments were suggestion to improve future use of CWP. Students suggested to have shorter CWP clues, to give them enough time to prepare for the CWP, assign bonus grades, and use it as a pre-exam review. Table 6 summarize the comments shared by students under each perception theme.

Discussion
The pathophysiology and therapeutic of cardiovascular diseases, specifically topics about thromboembolism and atrial fibrillation are essential topics taught in the Pharm.D. and Bachelor programs in King Saud University, Riyadh, Saudi Arabia. These cardiovascular topics are usually introduced in the first therapeutic course series, and they require students to use critical thinking and clinical decision-making skills when implementing guideline recommendations, which most student perceive it to be challenging. The courses also rely on student's prior knowledge on the pharmacology of cardiovascular drugs. Feedback from students and course faculty showed students' knowledge about anticoagulant drugs pharmacology was suboptimal due to misalignment of some topics in the curriculum. To ease out student's trepidation, the course instructors utilized variety of active learning pedagogy to engage students in this first therapeutic course, including CWP activity. To the best of our knowledge, this is the first study conducted to evaluate the pharmacy' students' perceptions about the use of CWP for enhanced learning about the anticoagulating therapeutics and their preferences of learning styles in Saudi Arabia.
In the present study, student perceptions about the value of CWP was generally positive. Overall, most of the students agreed that CWP enhanced their learning, oriented them to key information they need to focus on, improved retention of information and was a good review for the material covered in the lectures. These findings in consistent with other published studies [48][49][50]. Shah et al. reported higher agreement on the same survey items compared to the present results. 90% of students indicated positive perceptions such as CWPs enhanced their learning, helped them focus on important topics in the lectures, and served as a good review of the lecture material [36]. Mirroring the results from other studies about the recreational and fun aspects of the puzzles, most students enjoyed the classroom interactions while solving the puzzle. They felt the puzzle was interactive, enjoyable, and encouraged a competitive environment within the classroom [38,[50][51][52][53][54][55][56].
In the current study, students from the BPharm program reported statistically significant positive perceptions compared to PharmD students specifically on the following items: "CWP oriented us to the topics we should focus on" and "the material on the puzzle was pertinent". This difference could be explained by the fact that traditional teaching is more predominant in BPharm curriculum. Crawford et al. found significant differences between tenure track and clinical track learning styles among faculty at the University of Illinois at Chicago Pharmacy college [44]. The tenure track had a predominantly abstract sequential learning style that focuses on theoretical concepts and analytical approaches. The clinical faculty have a more concrete sequential learning style that focuses on application and practicality of information. The use of active learning is reported to be higher in clinical faculty members and faculty members in the social/behavioral/administrative sciences [12] In KSU, BPharm curriculum is focused predominantly on pharmaceutical sciences, with only two therapeutic courses.
On the perception item about "the length of time provided for solving the puzzle was sufficient", students from the BPharm program have a significantly higher agreement than the PharmD students (p = 0.001). We attributed this difference to the shorter puzzle administered to the BPharm group (10 clues) compared to the PharmD group (20 clues). Nonetheless, different studies reported described variable clues numbers ranging from 12 to more than 50 and completion time from 5 to 60 min, and all showed favorable agreement that the allocated time was adequate regardless of the size of the puzzle or completion time [36,38,48,[51][52][53][57][58][59][60]. Notably, in the current study male students were less satisfied with the time provided for solving the puzzles than female students. Two factors could have produced such difference. First, active learning, specifically games, are less utilized by male faculty. This is supported by a recent study that found that female faculty are more likely to implement active learning strategies in classroom teaching than male faculty [13]. Furthermore, faculty from different generations could be differ in their interaction, learning, and teaching skills regardless of gender [8]. Second, gender variation in learning styles could have affected their perceptions about the time. Although some studies have reported more men being diverger and women have an assimilator learning style, others did not find such differences [44,[61][62][63].
The present study found that the predominant learning style in our student population is consistent with the learning styles of pharmacists and pharmacy students reported in the literature [43,44,47,61,[64][65][66].
The learning styles primarily reported with the pharmacy profession are assimilator and converger. Similarly, in this current study, the converger learning style was predominant in both male (35%) and females (36%). The second most prominent learning style was assimilator in female students (33%) and divergent in male students (26%). It is worth noting that male representation in this study is only one third of the sample studied. We did not find a significant difference between student perceptions about CWP and their learning styles. One possible reason is that games in general are designed to accommodate all learnings styles [67]. Indeed, the attributes of the two predominant learning styles in this study (converger and assimilator) is consistent with the high perception of students to CWP as a learning tool. Converger has highly competitive nature and enjoy problem solving, application and activities such CWP appeal to this learning style [48]. Assimilator, on the other side, prefers organization, highly attentive to detail, inductive reasoning and prefer to get feedback regarding their performance all of these attributes are accommodated in activities such as CWP. For the remaining PLS, the diverger's imaginative ability, and capability to see things from different perspectives games also appeals to this learning style. Accommodator learning style likes active experiences and CWP appeal to their ability to problem solve, risk taking and immediate reaction to circumstances.
We did not explore the perception of the game and or the PLS on student's academic performance due to logistic factors. However, studies on the relationship between pharmacy students learning styles and academic performance are scarce and with divergent conclusions. A study conducted among medical students in Thailand showed that students' learning styles differed between pre-clinical and clinical years. Furthermore, the learning style is only associated with students' academic achievement during the pre-clinical years, with the reflective learning style associated with high academic success [68,69]. Another study found a similar correlation between reflective abilities and academic success in undergraduate pharmacy education [70]. With assimilator and converger being the most common learning styles among pharmacy profession, reflective learning process is associated with assimilator but not converger who process actively [71]. Several other studies did not find an association between learning styles and academic achievement [62].
Millennials (those born between 1981 and 1996), represented by students participating in the current study, could have different approaches to learning and different preferences of learning styles, hence, different perceptions towards the variable approaches of learning. Corrido et al. showed that based on Vermunt's Inventory of Learning Styles (ILS), millennial Filipino pharmacy students have a predominantly application-directed learning style (i.e. those who try to discover relationships between things and apply what they learned); followed by a reproduction-directed learning style (i.e. those who memorize the learning content in order to be able to reproduce it in a test) [43,72]. Eng et al. also concluded that learning styles inventory could influence the learning environment during experiential education of millennial pharmacy students [73].
The previous studies and others raise an important issue to consider for both educators as well as students about identifying learning styles to improve learning experience rather than to stigmatize. Student's selfawareness about their learning styles can help them refine their study habits and encourage them to reach out to faculty members when struggling academically due differences in teaching and learning styles; therefore, the learning environment can be catered to maximize students' gain, confidence, and ability to transfer learning. At the same time, for faculty and preceptors, self-awareness of their own learning style and that of their students could help improve teaching styles and promote better approaches to better facilitate teaching and assessment.
Although the study didn't include a qualitative component, our analysis of the feedback response on the open-ended questions agrees with several literature that also identified similar predominant themes such as fun, engaging, and promoting understanding [51,54]. One of the interesting comments repeated by several students is the fact that spelling was an obstacle while solving the puzzle. Other researchers reported similar spelling challenges surfaced while solving CWPs [50,56,74,75]. For pharmacy students, such accuracy is vital to patient and medication safety. The positive reception toward this tool encourages faculty members to develop creative tool that carry low burden (such as the CWP) to engage students especially in large class-size, which can be deterrent to incorporating active learning in teaching [76].
This study had several limitations. First, due to logistic reasons, administering the puzzle in relation to the lecture delivery was variable among the cohorts (right after the lecture, during the same week, or two weeks later). Although this might have affected the recall of information, the several open comments about spelling difficulties could be the main reason for not getting the right answers. Secondly, there was only one BPharm cohort group compared to three PharmD cohort groups. Thirdly, the length of the puzzle used for the BPharm group was shorter (10 questions and clues vs. 20 for the PharmD group); this is mainly because the content material for the BPharm is less than the PharmD and the need to deliver the puzzle in the short break after the lecture immediately. The learned information could have still been fresh and easy to retrieve. Hence, the perception of time sufficiency was satisfactory. Fourthly, the preferred learning style of the faculty was not assessed to determine if the high student's perception is influenced by the educator learning style. Lastly, we did not assess the impact of the game on short-or long-term retention of the information, nor on student's final grade in the course or pre-and post-testing examination, or academic performance; however, the activity was purposely implemented to guide students towards the most important information about the topic and assist them to identify any gaps in knowledge or understanding.

Conclusions
The study demonstrated that students valued active learning engagement in the class environment using the CWPs. CWPs presented an easy and versatile tool that can be customized in difficulty to enhance students' educational experience and promote more self-awareness of the teaching and learning trends for both students and faculty. Providing students with a self-learning tool and engaging them during the learning process may lead to better understanding, retention, and application of the learned material and eventually in academic performance. Future studies should investigate the impact of CWPs on both short-and long-term retention of the lecture material.


Development of Inverce Matrix Module Related to Student’s Mathematical Connection Skills

Abstract

INTRODUCTION
Covid-19 pandemic made a lot of changes in various sectors, one of them in the education sector. This pandemic was a special condition that causes different learning lags or learning losses in the achievement of student competencies.
In addition to learning loss, many national and international studies state that Indonesia has also experienced a learning crisis for a long time. These studies found that many children in Indonesia have difficulty understanding simple reading or applying basic mathematical concepts. The findings also show that there was a fairly steep education gap between regions and social groups in the country (Kementrian Pendidikan, Kebudayaan Riset dan Teknologi, 2022).
The Ministry of Education has published an alternative curriculum to overcome this problem. That was a follow up of the learning policy in response to the covid-19 pandemic. Later in February 2022, The Ministry of Education revised the curriculum to deepen its essence with aim the curriculum was focused on material and development of the student's competencies that according with mental development phase. In other side, with recommendation from Government of Indonesia, the school must develop a simplified curriculum with the principle of diversification in accordance with the conditions of the school, regional potential, and student (Sanjaya & Rastini, 2020).
The curriculum was a competency-based curriculum to support learning recovery by implementing project-based learning. Educational units in school have been able to choose three options for implementing the curriculum. One of those was developing their own various teaching tools in the form of module. The module was a learning plan with the concept of project-based learning. Its aim was to arranged the material according to the phase or stage of student's mental development, to the learning's themes and topics, and to student's long-term development.
Mathematics learning in Indonesia was entering a new paradigm. Curriculum development was directed at achieving all domains in knowledge, not only cognitive domain but also affective and psychomotor domains. It also was to develop students' mathematical power through innovation and implementation of various approaches and methods. The goal was to build confidence in their mathematical abilities through the process of: 1) solving problems; 2) provide inductive and deductive reasons for making, defending, and evaluating mathematical arguments; 3) communicate, convey ideas/ ideas mathematically; 4) appreciating mathematics because of its relevance to other disciplines, its application to the real world (Abidin & Jupri, 2017).
If a topic was given to the student's separately, the learning will lose a moment in an effort to improve student learning outcomes in learning mathematics. Therefore, it was important for students to develop mathematical connection skills in studying mathematics so that they can see the relationship between one topic and another (Romiyansah, Karim, & Mawaddah, 2020). Furthermore, students will lose the moment to improve their learning outcomes if the mathematics topic that given to them were independent. Therefore, it was very important for students to understand the relationship between one topic and other topics that were interconnected in learning mathematics. Understanding or seeing the relationship between one topic and another was one of the mathematical connection skills.
One of the subjects that was closely related to mathematical connection skills was the matrix and vector course. In this course, there are several topics require mathematical connection skills such as connecting a problem to a mathematical model, solving a mathematical model, and reasoning in concluding a solution (Fitriawan, 2020).
Based on the facts found by researchers from document studies and interview results at the Mathematics Education Study Program, the achievements of students that learning in matrix and vector algebra courses was relatively low. This was evidenced by the results of the mid-semester exams where the class of 2019 has an average score of 81.93, the class of 2020 has an average score of 62.12, and the class of 2021 with an average score of 49.76. The result showed a declining trend every year. In addition, the last class of 2021 showed the lowest score in according to the assessment system in the university. These values were obtained from the Inverce matrix problems in exam which contains one of the mathematical connection skills, namely the relationship between one topic and another topic. Some of the factors were student's experience distance learning that caused learning loss during Covid-19 pandemic, learning activity that carried out only through Whatsapp Groups, and the unavailability of teaching materials in accordance with the needs of students and curriculum development.
The results of the cognitive diagnostic tests that conducted on students on the Inverce matrix material related to mathematical connection skills shown an average value of 17.67 on a scale of 0-100. In according to Arikunto (2010), this shows that the students' mathematical connection skill in Inverce matrix material was still relatively low.
Based on theoretical studies and problems obtained in the field, the low students' mathematical connections skills were due to the unavailability of teaching materials. Yet according to Andesta, Lestari, & Pratiwi (2021), the availability of teaching materials can improve learning outcomes. Therefore, in this study the researcher wanted to describe the process and results of the development of the Inverce matrix module related to students' mathematical connection abilities, as well as describe the quality of the module in terms of validation and practicality, so that it was hoped that it can be an alternative learning resource that can be used.

RESEARCH METHODS
This study was used Design research methode. Design research can be used for research that has a function to design or to develop an intervention with the aim of solving complex problems in the field of education (Plomp & Nievee, 2013;Plomp, 2007). The development design used in this research is the Plomp model design. The Plomp model was chosen because the model more flexible than other models. The Plomp development model consists of three stages, namely the preliminary research phase, the prototyping phase, and the assessment phase. However, this research has implemented only to the preliminary research phase (initial research phase) and the prototyping phase (development phase). The subjects of this study were high school mathematics teachers and lecturers in mathematics education at the Universitas Islam Nusantara.
The research and development trial design wa carried out in three stages, that is: 1) the validation of material and media expert that intended to obtain product validity, 2) product practicality tests given to educators, and 3) the effectiveness of the module that would be given to students in the form of evalution questions. The product trial in this research and development was carried out on a small group of students of mathematical education at the Universitas Islam Nusantara. The overall research and development stages of the module can be seen in Figure 1.
The score guide for validation was using Likert scale with four alternative score that displayed on

Validation Analysis
The analysis of validation was determined by: a. Evaluate the score of validation using formula (Rohmaini et.al, 2020). % 100 maximum score Total obtained score Total Validity  = b. The result then categorized to validation criteria which is displayed on Table 2 (Source: Fatmawati, 2016).  Table 3 (Source: Rahma et al., 2022). Not Practical 4 01,00 -50,00 Impractical

RESULT AND DISCUSSION
The result of the initial research indicates that the student's score on the Inverce matrix material related to mathematical connection skill was not good. The learning resources used are also only books written by Howard Anton in 1997 and Dr. Ruminta and lessons are given via Whatsapp Group. Thus, it was relatively easy to understand by students and according to the demands of curriculum development. The learning reource developed was in the form of an Inverce matrix module related to the students' mathematical connection skill. The process wa carried out throught the plomp model. Students' mathematical connection skills were discussed further in the third phase. The following are two stages of research and development of the plomp model.

Preliminary Research Phase
At the preliminary research phase, there are two steps of analysis, namely needs analysis and context analysis. At the needs analysis step, it was carried out through document analysis, questionnaires, and cognitive diagnostic tests to students regarding the mathematical connection skills in Inverce matrix material and conducting interviews with lecturers of matrix and vector algebra courses related to the learning process and student achievement on Inverce matrix material. Meanwhile, at context analysis step, it was done by analyzing the Inverce matrix material syllabus, learning outcomes, mathematical connection skill indicators, and learning model syntax that was adapted to the material.

Prototyping Phase
At the prototyping phase, the researcher collects information that supports the development of the Inverce matrix module. The collected data has been integrated to the module. The initial product written in the form of a temporary module draft. Then, the module will be designed iteratively as perfect as possible by carefully matching the components of the module for suitability to the curriculum. The following was display of the cover page and its component of the module that was developed as shown in Figure 2.

Validation of the Development of Inverce Matrix Module Related to Student's Mathematical Connection Skill
After the module was designed, the researcher validates the initial product to material experts and media experts. The validators of material experts and material experts are mathematics education lecturers and high school mathematics teachers. Expert validation results are used as initial product suggestions or improvements. The module validation steps are as follows.
a. Material Expert Validation The validation consist: (1) aspects of content or material feasibility, (2) presentation feasibility, and (3) language feasibility. Mathematical connection skills are integrated into examples and evaluation test questions. The material expert validator checks whether or not mathematical connection capabilities are integrated into the module. Validation data was obtained by using a questionnaire. The results of material expert validation can be seen in Table 4. Based on Table 4, the result has an average score of 80.83% with quite valid criteria. That mean the developed module was declared feasible to be used as teaching materials and learning resources.
b. Media Expert Validation. The Validation was carried out after the product was finished. That was carried out to determine the feasibility of the media listed in the Inverce matrix module. The assessment that was carried out by media experts consist of; aspects of module size, module cover design, and module content design. The experts filled out the validation sheet that had been provided by the researcher. The results of media expert validation can be seen in Table 5. Based on Table 5, the result has an average score of 75.93% with quite valid criteria. That mean the developed module was declared quite feasible to be used as teaching materials and learning resources.
Based on the description of several validations as a whole, both material expert and media expert validation, the results of the Inverce matrix module validation related to mathematical connection capabilities can be seen in Figure 3.

Practicality of Inverce matrix Module Related to Student's Mathematical Connection Skills
The practicality test was used to determine the practicality of the Inverce matrix module that developed. That was carried out by high school mathematics teachers and mathematics education lecturers at the Universitas Islam Nusantara in the form of questionnaire. The result of practicality test was shown as follows.
Based on Table 6. The result has an average score of 76.90% with quite practical criteria. That mean the developed module was declared quite practical to be used as teaching materials and learning resources.
The product produced in this research was a Inverce matrix module related to students' mathematical connection skills. The modules used as teaching materials in studying matrix Inverce material were developed by reviewing the conditions of curriculum development and learning conditions. Conditions were analyzed through preliminary studies which included field studies and literature studies. Field studies were carried out through interviews, distributing questionnaires, and formative tests to students to find out how learning was being carried out, whether The Result of Validation or not products were being developed, and the level of student and educator needs for the products being developed. The development of the Inverce matrix module related to the student's mathematical connection skills that have met valid and practical criteria was due to the following factors. First, the developed module was designed according to the characteristics of project-based learning and mathematical connection skills so that it can see the interrelationships between topics and understand topic relationships in the real world. Second, the problems presented were problems that are known to be close to everyday life. Presentation of material that connects students to provide an overview of the benefits of the material so as to make learning mathematics more meaningful in students' memory and thinking power. This was in accordance with what was stated by Triyanto (in Widyaningrum, Sarwanto, & Karyanto, 2013), that meaningful learning will not be realized if students only listen to lectures from the teacher. Third, the developed modules were arranged in a unified whole and are interconnected. In addition, the feasibility of the content, the feasibility of presentation, and the eligibility of language that was easy to understand, as well as the module design make the module practical for use in learning. The findings of this study were in line with previous studies (e.g. Fitriawan, 2020). The matrix Inverce module produced in this study was expected to enrich teaching materials for educators, especially in order to increase students' active participation in learning mathematics.
The advantages of this Inverce matrix module were that it was easy to share for anyone to access at any time, it was easy for developing further learning resources, the flexibility of this learning resource because it can be used and changed based on the needs of educators and students, the examples of questions presented in real contexts, and can be used independently by students. The drawback of this module was that it can be accessed only via devices such as laptops and cell phones.

CONCLUSION
Based on the results of the study, it was found that the Inverce matrix module related to the student's mathematical connection skill was declared quite feasible to be used as teaching materials and learning resources in mathematics learning by overall average score of 80.38% from material experts and 75.93% of media experts. The results of the practicality test of the module from the validator has an average score of 76.90% and the criteria is quite practical. It was hoped that the developed module can contribute to developing student knowledge and used in learning activities to improve student's insight.