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Test anxiety and procrastination in
physiotherapy students
Manasi Desai, Unnati Pandit1, Amruta Nerurkar2, Chhaya Verma3, Shruti Gandhi4

Website: Abstract:
www.jehp.net BACKGROUND: Short‑term academic procrastination may be accompanied by negative outcomes
DOI:
such as anxiety, stress, and depression. The current study aims to evaluate the two parameters of
10.4103/jehp.jehp_851_20 procrastination and test anxiety in physiotherapy students and explore whether a relationship exists
between them.
MATERIALS AND METHODS: A descriptive, cross‑sectional survey with a prospective study design
was carried out over a period of 6 months. The study used a two‑staged cluster sampling method:
Assistant Professor, 220 undergraduate and postgraduate physiotherapy students from colleges in Mumbai and Navi
Department of Mumbai participated in the study, ensuring participation of students from each year of the course.
Neurophysiotherapy, The Westside Test Anxiety Scale was administered to evaluate test anxiety, and the Academic
D. Y. Patil School of Procrastination Scale was used to evaluate procrastination. To illustrate the basic demographics
Physiotherapy, Navi of the participants, descriptive statistics were used. A correlation matrix was used to analyze the
Mumbai, Maharashtra, correlation between the two parameters.
India, 1Professor and RESULTS: The mean procrastination score of the physiotherapy students was 74.1. Amongst
Director, Department undergraduates, the highest procrastination was seen in the 3rd Bachelor of Physiotherapy
of Physiotherapy in students (mean = 76.7), whereas among postgraduates, the highest procrastination was seen in
Community Health, Master of Physiotherapy 1 students (mean = 75.7). The mean test anxiety score was 3, indicating
D. Y. Patil School of moderately high test anxiety among students. There was a statistically significant, positive correlation
Physiotherapy, Navi between test anxiety score and procrastination score (P value = 0.000, Pearson’s correlation
Mumbai, Maharashtra, co‑efficient = 0.383).
India, 2Associate CONCLUSION: Both test anxiety and the tendency to procrastinate were present among
Professor, Head undergraduate and postgraduate physiotherapy students, in varying degrees. There was a positive
of Department of correlation between the two factors.
Neurophysiotherapy,
Keywords:
D. Y. Patil School of
Physiotherapy, Navi Academic success, motivation, physiotherapy students, procrastination, Test Anxiety Scale, time
Mumbai, Maharashtra, management
India, 3Professor and
Head, Department of
Physiotherapy, T. N. Introduction these objectives, factors that affect student
Medical College, B. Y. L. learning should be explored.[3] Educational

I
Nair Charitable Hospital, ndia’s higher education system is the research exploring the issue of academic
Mumbai, Maharashtra,
world’s third largest in terms of students, achievement or success has extended
India, 4BPTh, D.Y.Patil
next to China and the United States. beyond “simple” issues of intelligence and
School of Physiotherapy,
Navi Mumbai, Ensuring quality in higher education is prior academic achievement.[4] According
Maharashtra, India among the foremost challenges being faced to Newble and Entwistle,[5] these factors can
in India today.[1] Quality in higher education be classified into two categories: (a) Those
Address for is a multidimensional, multilevel, and a related to students’ characteristics and (b)
correspondence: dynamic concept. The general objective for those related to the learning environment.
Dr. Manasi Desai,
D. Y. Patil School higher education is to teach, facilitate, and Important factors that consistently occur
of Physiotherapy, encourage students to learn.[2] To achieve throughout the academic success literature
Sector 7, Nerul, Navi are: Cognitive strategies, locus of control,
Mumbai ‑ 400 706, procrastination, test anxiety, motivation,
This is an open access journal, and articles are
Maharshtra, India. distributed under the terms of the Creative Commons
E‑mail: manasind11@ Attribution‑NonCommercial‑ShareAlike 4.0 License, which
gmail.com allows others to remix, tweak, and build upon the work How to cite this article: Desai M, Pandit U,
non‑commercially, as long as appropriate credit is given and Nerurkar A, Verma C, Gandhi S. Test anxiety and
Received: 18‑07‑2020 procrastination in physiotherapy students. J Edu
the new creations are licensed under the identical terms.
Accepted: 24‑09‑2020 Health Promot 2021;10:132.
Published: 20-05-2021 For reprints contact: WKHLRPMedknow_reprints@wolterskluwer.com

© 2021 Journal of Education and Health Promotion | Published by Wolters Kluwer - Medknow 1
 Desai, et al.: Test anxiety and procrastination in physiotherapy students

learning environment, student engagement, and keep students task orientated; however, excessive
academic entitlement. worry or fear debilitates and affects student academic
achievement.[16] Anxiety is acquired in a strict testing
Procrastination means a purposive, habitual, intentional, situation when the subjective anxiety state allocates
and needless delay in beginning or completing tasks, individuals to have inverse psychological effect and
which prevents individuals from reaching their conceptualize examination as a threat of failing and fear
goals.[6] Academic procrastination, defined as postponing of imperfection, causing them to tense up profoundly.[14]
academic assignments and tasks[7] is a prevalent issue.[8] The effect of test anxiety not only affects thoughts and
In a study on college students, Ferrari reported that behavior, but also coping with exam evaluation situation.
70%–95% of the students procrastinated on their
assignments.[9] Short‑term academic procrastination Test anxiety is considered as one of the major problems
may be accompanied by negative outcomes such as among medical students as it most likely causes
anxiety, stress, and depression.[10] Procrastination is underachievement, low performance, demotivation, and
connected with negative behaviors and outcomes, psychological distress.[17]
such as submitting late assignments, cramming, test
and social anxiety, use of self‑handicapping strategies, Anxiety affects learning, social interaction, physical, and
fear of failure, under‑achievement, and can result in mental health. Anxiety in physiotherapy students may
damaging mental health outcomes such as depression be due to various reasons such as last‑minute study,
and anxiety.[11] sleep deprivation, poor time management, and lack of
confidence. This may lead to mugging up before exam,
The results of some studies have indicated that fear of forgetting information, lack of hard work, poor
procrastination goes in tandem with a lack of academic performance and under achievement, and poor
self‑determined motivation, intrinsic reasons for pursuing engagement in class.
academic tasks,[6] and low academic self‑efficacy and
self‑esteem.[7] Procrastination is also correlated positively Thus, procrastination and anxiety may have adverse
and significantly with test anxiety.[8] In consequence, effects on the student’s well‑being and on their academic
academic procrastination is likely to interfere with performance. A review of literature has revealed that
academic achievement.[9,10] The significance of the different anxiety and procrastination have been separately studied
medical fields dictates that medical students study deeply in students from various fields.[18‑24] The correlation
and gradually. It is advisable that procrastinating medical between anxiety and procrastination has been studied
students and the reasons behind their procrastination be among pre‑licensure nursing students, [25] college
pinpointed so that information can be provided to them students,[26] and high‑school children.[27] Thus, there
as regards the consequences of their procrastination.[11] is a paucity of literature regarding the prevalence of
anxiety and procrastination in physiotherapy students
Anxiety is experienced as an emotion by everybody and also regarding the relationship between these two
in day to day life, and it is defined as a state of fearful parameters.
expectation or apprehension as a result of real external
danger or intrapsychic conflict such as anxiety in the face The current study, therefore, aims to study the two
of examination and before delivering a lecture. This is parameters in physiotherapy students and explore
called normal, adaptive, or realistic anxiety. Contrary whether a relationship exists between them.
to that, anxiety as an abnormal state is pathological,
maladaptive, and unrealistic.[12] Materials and Methods
The American Psychological Association defines Ethical Moral Code and Consideration: The study was
anxiety as “an emotion characterized by feelings of approved by the Institutional Ethics and Research
tension, worried thoughts, and physical changes such Committee of our institution. Written informed consent
as increased blood pressure”.[13] was obtained from the participants before the study was
initiated, and their confidentiality was ensured.
Test anxiety is a widespread phenomenon when an
extreme nervousness arising from an anxiety‑inducing Study design
test situation prevents one from demonstrating their The study used a quantitative research method. It was
true potential and thus lowers performance, especially a descriptive, cross‑sectional survey with a prospective
in the educational environment.[14] Test anxiety is a study design carried out over a period of 6 months.
multidimensional construct combining with worry,
emotionality, interference, fear of failure, self‑esteem, The study used a two‑staged cluster sampling method:
and lack of confidence.[15] Little worry is essential to undergraduate and post‑graduate physiotherapy
2 Journal of Education and Health Promotion | Volume 10 | April 2021
 Desai, et al.: Test anxiety and procrastination in physiotherapy students

students from colleges in Mumbai and Navi Mumbai Results

were requested to participate in the study, ensuring
participation of students from each year of the course. The study was conducted on a sample size of 220
physiotherapy students. Age of respondents ranged
Inclusion Criteria: Undergraduate and postgraduate between the age group of 17 and 25 years; their mean age
physiotherapy students from Mumbai and Navi Mumbai was 20.7 ± 1.56 years. Among the participants, 22.7% were
who were willing to participate in this study were male and 75.9% were female. The maximum number of
included. students who participated in this study was from the 4th
Bachelor of Physiotherapy (BPT) (32.3%), whereas the
Exclusion criteria: Students who were not willing least were from Master of Physiotherapy (MPT) 2 (5.9%).
to participate in the study or who had pre‑existing
neurological, learning, psychological, or other Interpretation: The above Table 1 shows that
impairments which could interfere in their academic undergraduate physiotherapy students had a slightly
performance and learning were excluded. higher procrastination as compared to postgraduates.
Anxiety can be measured using various scales such as Interpretation: The above Table 2 shows that among
Westside Test Anxiety Scale, Statistical Anxiety Rating the undergraduate students, the procrastination is the
Scale (STARS), Cognitive Test Anxiety Scale, Hamilton highest in 3rd BPT students and lowest in 1st BPT students.
Anxiety Rating Scale, and the State Trait Anxiety Among the postgraduate students, MPT 1 students had
Inventory. Westside Test Anxiety Scale shows good a higher procrastination as compared to MPT 2.
reliability and validity and hence has been used to
measure test anxiety in the present study.[28] Interpretation: The above Graph 1 shows that maximum
students had moderately high test anxiety (27%),
Westside Test Anxiety Scale has 10 questions, with
whereas minimum students had comfortably low test
scoring using Likert scale. Sum of the score of the
anxiety (8.2%), as measured by the Westside test Anxiety
10 questions is then divided by 10. The scores are
Scale.
interpreted as follows:
• 1.0–1.9 comfortably low test anxiety Interpretation: The above Table 3 shows that
• 2.0–2.5 normal or average test anxiety
undergraduate and postgraduate physiotherapy
• 2.5–2.9 high normal test anxiety
students had moderately high test anxiety, as measured
• 3.0–3.4 moderately high (some items rated 4 = high)
by the Westside test Anxiety Scale.
• 3.5–3.9 high test anxiety (half or more of the items
rated 4 = high) Interpretation: The above Table 4 shows that among
• 4.0–5.0 extremely high anxiety (items rated 4 = high the undergraduate students, 3rd year BPT students had
and 5 = extreme). slightly higher test anxiety as compared to students from
other years. Among the postgraduates, MPT 2 students
The Academic Procrastination Scale, Tuckmann
had slightly higher test anxiety than MPT 1.
Procrastination Scale, General Procrastination Scale,
and Procrastination Assessment Scale for students are
Interpretation of Correlation Matrix: Table 5 and Graph 2
the various measures of procrastination. Academic
shows a positive correlation between test anxiety score
Procrastination Scale shows good reliability and validity
and procrastination score. Correlation between the two
and hence has been used to measure procrastination in
variables (P = 0.000) is statistically significant, but the
the present study.
value of Pearson’s correlation co‑efficient shows weak
The Academic Procrastination Scale consists of 25 association between these two variables.
questions and the maximal score that can be obtained
is 125. Higher score indicates high procrastination.[29]

Statistical analysis
To illustrate the basic demographics of the participants,
descriptive statistics were used. A Correlation Matrix
was used to analyze the correlation between the two
parameters (procrastination and test anxiety) using
the Pearson’s correlation co‑efficient. The data were
statistically analyzed using the Data Analysis add‑on
in MS Excel. Graph 1: Percentage distribution of test anxiety score

Journal of Education and Health Promotion | Volume 10 | April 2021 3

 Desai, et al.: Test anxiety and procrastination in physiotherapy students

Table 1: Procrastination score in undergraduate and postgraduate students

Descriptive statistics procrastination score in UG and PG students
Students Mean Maximum Minimum Range Standard deviation n
UG student 74.2 113.0 28.0 85.0 15.1699 192
PG student 73.2 102.0 47.0 55.0 12.4664 28
Total 74.1 113.0 28.0 85.0 14.8319 220
UG=Undergraduate, PG=Postgraduate

Table 2: Descriptive statistics procrastination score by year of study

Descriptive statistics procrastination score by year of study
Year of study Mean Maximum Minimum Range Standard deviation n
1st BPT 68.0 92.0 34.0 58.0 16.71 18
2nd BPT 75.0 109.0 48.0 61.0 14.68 46
3rd BPT 76.7 107.0 51.0 56.0 14.58 57
4th BPT 73.3 113.0 28.0 85.0 15.33 71
MPT 1 75.7 88.0 57.0 31.0 9.60 15
MPT 2 70.3 102.0 47.0 55.0 15.02 13
Total 74.1 113.0 28.0 85.0 14.83 220
BPT=Bachelor of Physiotherapy, MPT=Master of Physiotherapy

Table 3: Mean score of test anxiety score in the total study population (n=220)
Descriptive statistics test anxiety score by UG and PG students
Course Mean Maximum Minimum Range Standard deviation n
UG student 3.0453 5.0 1.0 4.0 0.8280 192
PG student 3.0240 4.7 1.9 2.8 0.6524 28
Total 3.0427 5.0 1.0 4.0 0.8065 220
UG=Undergraduate, PG=Postgraduate

Table 4: Mean test anxiety score by year of study

Descriptive statistics test anxiety score by the year of study
Year of study Mean Maximum Minimum Range Standard deviation n
1st BPT 2.8 4.2 2.0 2.2 0.70 18
2nd BPT 3.1 4.8 1.4 3.4 0.82 46
3rd BPT 3.2 5.0 1.2 3.8 0.84 57
4th BPT 3.0 5.0 1.0 4.0 0.85 71
MPT 1 3.0 3.9 1.9 2.0 0.63 15
MPT 2 3.1 4.7 2.1 2.6 0.70 13
Total 3.0 5.0 1.0 4.0 0.81 220
BPT=Bachelor of Physiotherapy, MPT=Master of Physiotherapy

Discussion year, within a specific amount of available time. Since

procrastination is known to have far‑reaching negative
The first objective of the study was to evaluate the consequences, research has focused on identifying
prevalence of procrastination in physiotherapy students the factors that produce and sustain academic
using Academic Procrastination Scale. procrastination. Research has reported academic
procrastination to be a self‑perceived problem for
According to the findings of the present study, the mean
college students, with consequences ranging from
of Academic Procrastination Scale in the total sample
reduced academic achievement, increased stress, and
was 74.1 ± 14.83. The undergraduate physiotherapy
students had a slightly higher tendency to procrastinate poor quality of life.[30]
on academic tasks, as compared to postgraduates.
Academic procrastination may be due to the lack
Amongst undergraduates, the highest procrastination was
seen in 3rd BPT students, whereas among postgraduates, of self‑determined motivation and intrinsic reasons
the highest procrastination was seen in MPT 1 students. for pursuing academic tasks [11] and low academic
self‑efficacy and self‑esteem,[12] and may provoke anxiety.
College students are required to complete multiple Feeling that it is too late to be ready for the examinations
tasks and meet several deadlines throughout the or feeling overwhelmed affects mood and wellbeing.
4 Journal of Education and Health Promotion | Volume 10 | April 2021
 Desai, et al.: Test anxiety and procrastination in physiotherapy students

Table 5: Correlation between Test Anxiety and further states that anxiety is like fear‑it involves mental
Procrastination and physical mobilization to meet a perceived danger.
Correlation matrix Anxiety is manifested by mental depletion and inability
Parameter Test anxiety Procrastination to rise to a challenge. Medical and physiotherapy
score score
students are expected to learn and master a huge amount
Test anxiety score
of knowledge, attitudes, and skills for which they have to
Pearson correlation 1 0.383**
work hard which in turn puts them under lot of pressure
Significant (two‑tailed) 0.000
and may thus lead to anxiety.
n 220 220
Procrastination score
Sharma and Wavare observed that academic examination
Pearson correlation 0.383** 1
Significant (two‑tailed) 0.000
for medical and physiotherapy students are stressful
n 220 220 which affects their academic performance. They
**Correlation is significant at the 0.01 level (two‑tailed) concluded that academics and examination are the
most powerful stressors in medical and para‑medical
students.[31]

Shireen et al. aimed to assess examination‑related

anxiety among final professional medical students
using the Visual Analog Scale (VAS). He conducted
a cross‑sectional study among 120 students using
structured self‑administered questionnaire. The average
maximum exam anxiety marked on VAS 64 ± 28, which
indicates a moderate level of exam anxiety based on a
Visual Analog Scale. The author further identified the
factors contributing to examination anxiety as undue
course loads, lack of physical exercise, and long duration
of examinations.[16]

The lower mean anxiety score found in the above

study as compared to our findings could be due
to the difference in population (i.e., physiotherapy
Graph 2: Scatter plot of test anxiety score and procrastination score students vs. medical students), their syllabi, and course
demands. Different outcome measures used by both the
Academic procrastination is likely to interfere with investigators may also have led to different components
academic achievement.[14,15] of test anxiety being assessed, which may also account
for the differences in the results.
The second objective of the study was to evaluate the
prevalence of the test anxiety in physiotherapy students The third objective of our study was to evaluate whether
using the Westside Test Anxiety Scale. a relationship exists between the procrastination and
test anxiety in physiotherapy students. According to the
According to the findings of the present study, findings of the present study, there is a strong positive
maximum students had moderately high test anxiety, correlation between the two parameters, but the value
whereas minimum students had comfortably low of Pearson correlation shows weak association between
test anxiety. Moderately high test anxiety was seen these two variables.
in undergraduate and postgraduate physiotherapy
students, as measured by the Westside test Anxiety Scale. Our results are in agreement with other studies which
Among undergraduates, the highest anxiety was seen in have examined the relationship between the two
3rd BPT students. parameters in students.

Our results are in agreement with the findings of a study Carvalho et al. conducted a study on Procrastination,
conducted by Shah et al.[13] who used the depression, Perfectionism, and Test Anxiety in 89 students from
anxiety, and stress questionnaire. Anxiety was found different streams of education across various colleges
to be highest in 3rd BPT students due to their increased in South Mumbai. The results revealed a statistically
self‑study hours, increased level of study from previous significant, positive correlation between procrastination
years, aspiration of scoring more in academics, increasing and test anxiety (P < 0.001). According to the author, a
concern about their profession as a career. The author possible reason could be the past negative evaluative
Journal of Education and Health Promotion | Volume 10 | April 2021 5
 Desai, et al.: Test anxiety and procrastination in physiotherapy students

experiences and lack of confidence of test anxious students (across the years and between undergraduate
students. The students may also believe that their efforts and postgraduate students) would have been ideal.
may not yield the desired results, which may lead to
last minute studying to pass the examinations, further Conclusion
leading to anxiety.[32]
The undergraduate physiotherapy students had a slightly
Cassady and Johnson conducted a study on Cognitive higher tendency to procrastinate on academic tasks, as
Test Anxiety and Academic Performance in 168 students. compared to postgraduates. Among undergraduates,
The results reveal consistently strong correlations the highest procrastination was seen in 3 rd BPT
between performance and the scores on the Cognitive students, whereas among postgraduates, the highest
Test Anxiety Scale, with weak or inconsistent correlations procrastination was seen in MPT 1 students.
between performance and the other measures of test
anxiety or procrastination.[33] Moderately high test anxiety was seen in undergraduate
and postgraduate physiotherapy students, as measured by
Strengths the Westside test Anxiety Scale. Among undergraduates,
Thus, our study has reported a high prevalence of the highest anxiety was seen in 3rd BPT students. There
procrastination and test anxiety in physiotherapy was a statistically significant, strong positive correlation
students and a strong positive correlation between two between Test Anxiety and Procrastination (P value‑0.01),
parameters. It has helped to address the gaps in existing but the value of Pearson correlation showed weak
literature with respect to anxiety and procrastination in association between these two variables.
physiotherapy students.
Acknowledgment
Both these parameters have been previously found to The authors would like to thank all staff members and
be associated with each other and to possibly affect heads of institutions of the participating physiotherapy
academic performance. colleges for permitting us to conduct the study and
extending their full co‑operation during this time. We
Weaknesses are grateful to all the students for co‑operating with
Students from a specific geographical location were us, consenting to participate in our study and giving us
chosen for the study. A larger size, spread over a wider honest feedback about the parameters being assessed
geographical area may improve the generalizability of in the study. We thank our statistician for his technical
the results. expertise during data analysis. Without the co‑operation
of everyone involved, it would have been difficult to
Suggestions complete the study.
It is recommended that physiotherapy institutes should take
appropriate steps for reducing procrastination and anxiety Financial support and sponsorship
among students. This may include undertaking counseling Nil.
for students, highlighting the importance of getting things
done on time, and teaching strategies such as relaxation and Conflicts of interest
mental imagery to reduce test anxiety. These strategies may There are no conflicts of interest.
help to promote well‑being among students and may also
positively impact their academic performance.
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