Academic Stress among High School Students in a Rural Area of Nepal: A Descriptive Cross-sectional Study

ABSTRACT Introduction: The period of adolescence undergoes many physical and mental changes. Changing emotional and physical status along with increasing social, family, and academic pressure lead to various impairments in the mental health of adolescents. Academic failure leads to the suicide rate in adolescents, predominantly high during the declaration of exam results which is significantly high in a rural area in comparison with urban. The study examined the prevalence of academic stress among high school students in a rural area of Rolpa, Nepal. Methods: A descriptive cross-sectional study was conducted in 6 schools in Rolpa from July to October 2019. The sample size calculated was 521. A convenient sampling technique was used for this study. The target population was adolescents enrolled in high schools of Rolpa. Ethical approval was taken before data collection. The scale for assessing academic stress was used to find out the prevalence. A questionnaire was translated in local language and pre-testing was done in Nepal Police School, Sanga among 10% of the calculated sample size. Data entry was done in Statistical Package for the Social Sciences version 18. Descriptive statistical analysis was done for prevalence calculation. A Results: Out of a total of 521 students, the prevalence of academic stress was seen among 138 (26.5%) students at a 95% confidence interval (22.72-30.28). Conclusions: The prevalence of academic stress in our study was high and was consistent with other South Asian studies. Understanding academic stress and providing help and support to the students would help ease the burden for them.


INTRODUCTION
Academic stress is distress for some anticipated frustration associated with academic failure or even unawareness of the possibility of such failure. A significant source of stress for many school students is academic pressure. 1 Identified sources of academicrelated stress have included fear of falling behind with coursework, finding the motivation to study, time pressures, financial worries, and concern about academic ability. 2 Academic failure leads to the suicide rate in adolescents, predominantly high during the declaration of exam results which is significantly high in a rural area in comparison with urban. 3 The main objective of this study is to find out the prevalence of academic stress among high school students in a rural area of Rolpa, Nepal. This study provides baseline information for policymakers to effectively manage and plan academic stress among high school students in Nepal. The study populations were grade 11 and 12 students. Each grade had 1-2 classrooms and all the students from grade 11-12 from each classroom participated in the study. Written consent was taken from the parents. The teachers were first contacted and an orientation about the questionnaire, purpose of the study, the importance of privacy, and ensuring the confidentiality of the respondents was done. Secondly, the parents of the students were informed and asked to participate in an orientation program. The parents were then explained about the research and consent was taken from them for their children to be involved in the study. Convenient sampling was done. where, n= sample size, Z= 1.96 for Confidence Interval of 95%, p= prevalence of academic stress among high school students in Nepal, 0.5, q= 1-p, e= margin of error, 5%.
In case of high school students and due to past experiences of drop out cases, incomplete answering, inappropraite answers, answers outside the box that confuse the researcher, scribblind in the options box and many other issues the researcher took a high nonrespondent rate of 35% of the sample size. Hence 135 was added.
Therefore, n= 384 + 135= 519. There were total students of 521 in the area and cent percent of data was collected.
Inclusion criteria included students who were aged between 17-19 years of age, enrolled in grades 11-12, willing to participate in the study, and whose parents willingly gave consent. Exclusion criteria included students who were not willing to participate, whose parents did not give consent to be involved in the study and those who did not complete the questionnaire.
The tool used for data collection in the study was a Semi-structured questionnaire with SAAS (Scale For Assessing Academic Stress). SAAS was used to calculate the prevalence of stress among high school students. The semi-structured questionnaire consisted of a socio-demographic profile. The SAAS consisted 30 sets of questions and the total scores were classified into low stress (<22) and high stress (>22) by using the third quartile (75%) as the cutoff point Each level had more sublevels and it was then classified according to various categories based on literature review and standard levels.
The questionnaire was translated to the Nepali language and was sent to review the consistency and contextual meaning of the questions in both languages to the responsible organization. For reliability, data was pretested on 10% of the sample size which was the representative study population other than the sample, to know about the problem related to sequence, meaning, components, and understanding of the questions in a different are than the study area. Another additional editing to the questionnaire was done according to the comments and responses from the pre-test. The questionnaires were self-administered by the students in the class. If any questionnaires were incomplete then it was returned to the student and asked for completion.
Cronbach's Alpha Coefficient test was carried out to ensure the reliability and final adjustment was done accordingly. The alpha coefficient of Cronbach was 0.726 for overall components. The study site was Nepal Police School, Sanga, a site in the outskirt of Kathmandu valley that reflected the population of Rolpa.
Data was entered and exported to a statistical analysis system program (SPSS) version 18. Descriptive analysis was made to assess inconsistencies, outliers, and missing values, and data are presented by tables.

RESULTS
The overall prevalence of academic stress was 138 (26.5%) at a 95% confidence interval (22.72-30.28). Students answered the SAAS scale and it was seen that many students had low stress which means; they had some form of stress and were not stress-free. The students with high stress were 138 (26.5%) out of 521  Table 2 shows the general characteristics of the respondents in this study include age, sex, grade, family type, birth order, mother's occupation, father's occupation, and family income ( Table 2).

DISCUSSION
The adolescent life stage is a crucial period that makes them highly vulnerable to the various stressors in the environment. The transition is not limited to just the bodily changes and social role, but even at the institutional setting, the transition from high school to higher secondary and even graduate studies require a lot of adjustment and change. High School education in Nepal is a significant turning point in the life of academic students for their further career move. As their educational prerequisites become increasingly tough, students experience stress at this level.
In our study, 26.5% of students had high academic stress. WHO states "the consequences of not addressing adolescents' mental health conditions extend to adulthood, impairing both physical and mental health and limiting opportunities to lead fulfilling lives as adults". 4 Academic stress is one of the major factors affecting adolescence. Children these days face more stress due to increased academic curriculum, competition in school, and over-expectation from parents. Our study had academic stress lesser than compared to a study done in 2019 in Banepa, Nepal. 5 A study conducted in India reported that 66% of students were stressed because of academic pressure, which is significantly higher than our study. 6