Cyberincivility among Filipino Nursing Students in a public university: knowledge, experience, and acceptability

Introduction: The pandemic rapidly shifted nursing education to the online platform, and cybercommunication may expose students to the risk of online uncivil behaviors. Understanding cyberincivility in the primary mode of education during the pandemic is necessary. This study determined the cyberincivility knowledge, experience, and perception of acceptability among nursing students in the Philippines. Methods: A cross-sectional research design was employed with 300 Filipino nursing students of a public university who participated in the survey conducted last June 2021 using the Academic Cyberincivility Assessment Questionnaire. Data were described, and statistical differences and relationships were tested using ANOVA, t-Test, and Pearson correlation. Results: Findings indicated that nursing students generally had high knowledge (M=11.53), low experience (M=1.67), and low acceptability (M=1.41) of online uncivil behaviors. Academic cyberincivility knowledge, experience, and acceptability did not significantly vary (p>0.05) based on sex, year level, and duration of daily internet usage. There was a significant positive moderate correlation (r=.402, p=.000) between cyberincivility experience and acceptability. Conclusions: Nursing schools should continuously strive to avoid the risk of uncivil cyberspace behaviors and promote an online culture of civility in online learning spaces.


Introduction
Online communication has become more predominant in academia as the COVID-19 pandemic shifted most nursing education programs to the online platform (Kim et al., 2020;Oducado, 2020;Oducado & Soriano, 2021).However, the environment in the online setting can present several challenges (Hopkins et al., 2017).Even before the pandemic, it had already been reported that nursing students used online platforms for educational purposes (Duke et al., 2017;Oducado et al., 2019).Cyber or electronic communication is more common nowadays, and such a platform can lead to miscommunications and misunderstandings between faculty and students (Swartzwelder et al., 2019).Moreover, online platforms have become potential sites that could breed incivility, exposing students to the risks and dangers of online uncivil behaviors (Clark et al., 2012;Kim & Choi, 2021;Oducado et al., 2019).Cyberincivility refers to online breaches of professional standards or behaviors in the digital realm that go against the established norms and values shared by the majority of a community or society (Kim et al., 2020;Sternberg, 2012).De Gagne (2018) identified academic uncivil or misbehaviors online, including but not limited to blaming technology for communication failure, attacking or insulting other students' thoughts or comments, posting distributing photos, and breaching privacy.
Student incivility is a persistent problem in nursing education that can threaten patient safety and outcomes (Al-Jubouri et al., 2021;Butler & Strouse, 2022;Muliira et al., 2017;Robertson, 2012).Some scholars noted that uncivil behaviors are increasing in higher and nursing education, with many nursing schools reporting to have encountered at least one incidence of students posting unprofessional content online (Anderson et al., 2021;Marnocha et al., 2015).A substantial lack of cybercivility has been reported through research on the behavior of nurses and nursing students (De Gagne et al., 2016).Prior research has also documented the negative impact of incivility, such that it can create a nuisance in the learning environment and can be detrimental to the learning process and relationships (Hyun et al., 2022;Ibrahim et al., 2015;Natarajan et al., 2017).Experience of incivility among faculty have led to damaged professional and personal life resulting in losing the motivation to teach (Park & Kang, 2020).
The lack of knowledge and adequate preparation to know, understand, and recognize appropriate and acceptable online communication is one possible reason for unintentionally engaging in cyberincivility (Clark et al., 2012;Lampley, 2016).Also, lower knowledge of cyberincivility was found to be linked with higher tolerance of cyberincivility (Kim et al., 2020).Moreover, the increased online presence has blurred boundaries between personal and professional lives (Daigle, 2020).Suler's (2004) online disinhibition effect suggests that some people act out more intensely when online than they would in person.Hence, people may be likely to engage in hostile or aggressive behavior online because of the anonymity and reduced social cues associated with online interactions.Without the social pressure of face-to-face interactions, people may feel more empowered to express their true feelings, including negative or hostile ones.
Meanwhile, a growing body of studies has been conducted on cyberincivility (e.g.Clark et al., 2012;De Gagne et al., 2018;Ibrahim & Qalawa, 2015;Kim et al., 2020).However, despite the negative impact of cyberincivility concerning nursing students, even fewer studies can be accessed online and conducted locally, particularly during the pandemic when instruction shifted online.Such research can serve as a basis for nursing schools that could better guide ethical practice and online etiquette among students.And as future professionals, it is expected that nursing students exhibit online professionalism and civil behaviors (Oducado et al., 2019).The study will be beneficial in providing a practical solution to the lack of cybercivility information among nursing students, emphasizing the need for developing cybercivility policies in academic institutions to prevent cyberincivility and promote a safe online learning environment.As a result, this would help the nursing students improve their awareness of behaviors appropriate to their environment, assist them in creating meaningful relationships in online educational settings and improve the quality of online nursing education.Moreover, these are important because such guidelines could promote an online culture of civility and measure up to the nursing profession's standards (De Gagne et al., 2018).
This study aimed to determine the academic cyberincivility knowledge, experience, and acceptability among nursing students in the Philippines and whether significant differences existed according to sex, year level, and duration of internet use.Also, significant relationships between the three major variables (knowledge, experience, and acceptability) were tested.

Materials and Methods
A descriptive cross-sectional research design was utilized in this study.The participants were the three hundred (n=300) nursing students of an undergraduate nursing program in a public university in the Philippines who responded to the survey.The eligibility criteria were all bonafide or officially enrolled Level 1, Level 2, and Level 3 nursing students who were enrolled in an undergraduate nursing program.Students from other colleges as well as students with no or limited internet connectivity during the conduct of the online survey were excluded.The response rate for this study was 71.77% or 300 out of all 418 nursing students invited to participate.The university's ethics review committee approved the study's conduct (Protocol Number WVSU.URERC-2021.CONS_004).Electronic informed consent was obtained prior to answering the actual survey.The researchers followed the principles of voluntary participation, confidentiality, and anonymity throughout the study.Permission to conduct the study was secured from the Office of the Dean and the level chairpersons.The data were collected through an online survey (Google Forms) in June 2021, which contained informed consent, questions, and answer options based on data gathering instruments.The class chairpersons were asked to facilitate the posting and distributing the link of the Google Forms to each student in their respective Facebook groups and Messenger group chats according to year level and section.
The study adopted the Academic Cyberincivility Assessment Questionnaire (ACAQ) by De Gagne (2018) to assess cyberincivility knowledge, experience, and acceptability.The original English version of ACAQ was used because the medium of instruction in Philippine nursing schools is English and also to allow comparison of results to prior research conducted in other countries using the same tool.The reported internal consistency of the instrument dimensions are as follows: knowledge Kuder-Richardson (KR) Formula 20 = 0.58, experience: Cronbach's α coefficients = 0.95, and acceptability: Cronbach's α coefficients = 0.94 (De Gagne et al., 2018).The Korean version had the following reliability indexes: knowledge KR Formula 20 = 0.22, experience: α = 0.96, and acceptability: α coefficients = 0.96 (Hong et al., 2020).For this study, KR Formula 20 for knowledge was 0.31, and Cronbach's α coefficients for experience and acceptability were 0.93 and 0.86, respectively.In this study, the first part assessed the demographic characteristics and duration of internet use ("How many hours do you spend using the internet daily?").The knowledge part evaluated the knowledge domain of uncivil behaviors of the nursing students, which contains 15 items and can be answered by "1-true," "0-false," or "0-I don't know."Experience (how often uncivil events are observed and encountered) and acceptability (how tolerable or allowable uncivil events are) scales evaluated the 28 uncivil behaviors using the 5-point Likert scale.For experience, the respondents were asked to rate how often they have observed and encountered uncivil events in cyberspace.The choices included "1never" to "5-very."The scale of acceptability asked how acceptable they perceive cyberincivility behavior with options ranging from "1-not at all" to "5-extremely." All statistical computations were processed using the IBM Statistical Package for the Social Sciences (SPSS) version 23.0 for Windows.Frequency, percentage, mean, and standard deviation were used to describe the data.Statistical differences and relationships were tested using a one-way ANOVA, t-Test for Independent samples, and Pearson correlation with the alpha level of significance set at 0.05.

Results
Table 1 shows that the majority of nursing students were female (70.3%), and about half (47.3%) spent approximately 8-11 hours on the Internet daily.There were 34.7% in Level 3, 34.3% in Level 2, and 31% in Level 1. Table 2 shows that the mean scores of the participants in the academic cyberincivility knowledge, experience, and acceptability were 11.53 (SD=1.58)out of 15, 1.67 (SD=.49)out of 5, and 1.41 (SD=0.28)out of 5, respectively.Table 3 shows no significant differences (p>0.05) in academic cyberincivility knowledge, experience, and acceptability according to sex, year level, and duration of daily internet usage.Table 4 shows a significant moderate positive correlation (r=0.402,p=0.000) between cyberincivility experience and acceptability.On the other hand, cyberincivility knowledge was not significantly related to experience (r=-0.008,p=0.884) and acceptability (r=-0.084,p=0.144).

Discussions
This study assessed the academic cyberincivility knowledge, experience, and perception of acceptability among Filipino nursing students.While teaching cybercivility needs thoughtful consideration to deliver content and curriculum development (De Gagne, 2021), nursing students in this study generally had high knowledge of cyberincivility.Similar results were obtained in the earlier survey of De Gagne (2018) among four healthcare disciplines students.A relatively high knowledge was also noted in another recent study, although the cyberincivility knowledge of nursing students in Hong Kong was lower than that of the students from the United States and Korea (Kim et al., 2020).
Notably, despite some arguments that younger people who have been exposed to computers and the occurrence of cyberbullying at young age may be more accepting of this conduct, they may grow even more tolerant of cyberincivility as its frequency rises (Harper, 2019).This study demonstrated that nursing students had low experience with cyberincivility.However, this study's low incidence of cyberincivility cannot be interpreted as students having no personal incivility experiences.Similarly, the study of McNeill et al. (2016) revealed that the frequency of incidents of uncivil student behavior was relatively low.Earlier research by Clark et al. (2012) disclosed that nursing students found incivility to be a mild or moderate problem.On the other hand, the study by Kim et al. (2020) among three countries showed a mean score of 2.15 in cyberincivility experience, which was higher than this study.Asian culture is generally less assertive (Oducado & Montaño, 2021).
The authors explained that the low level of cyberincivility experience could be attributed to a characteristic of Asian students being less likely than their Western counterparts to communicate their feelings and views because they are concerned that doing so will offend others (Kim et al., 2020).However, Crosslin and Golman (2014) reported that the incidence of uncivil behaviors like cyberbullying among students in college ranges from 8-21%, but it was noted that the respondents indicated the failure to report the incident due to a belief that as adults, they should be able to manage such incidence.Careful analysis of each item revealed that 'Blaming technology for failure of communication, assignment completion or submissions' was the most frequently uncivil behavior experienced by students.The poor internet connection in the country and the lack of appropriate technology, possibly causing difficulty in passing academic requirements, may be a reason for this behavior.Rotas and Cahapay (2020) disclosed that one difficulty in university Filipino students' responses during remote learning is the inadequacy of learning resources.Furthermore, the item in this study with a higher mean score than the other items was 'Working on an assignment with others (via email or Instant Messaging) when the instructor asked for individual work.'This study's finding parallels that of Kim et al. (2020).This result could be related to the leniency in cyberspace, wherein students can easily share their output with their peers through instant messaging.Unfortunately, because student activities on the internet cannot be meticulously monitored, this could lead students to commit academic misconduct such as plagiarism (Debuque et al., 2023).
This study also reported a low acceptability of cyberincivility.This may indicate that the nursing students were well aware of cybercivility, its consequences, and its impact; hence, they perceived it as an issue and considered such behaviors unacceptable.Likewise, in the study by Kim et al. (2020), most respondents recognized cyberincivility as a serious problem.Another careful analysis of each item revealed that nursing students' most acceptable uncivil cyber behaviors could be related to time sensitivity.Lack of timely feedback on assignments was considered incivility by students in another study (McNeill et al., 2016).The Filipino time culture can explain the nursing students' acceptability of late submissions and email responses.Filipino time is primarily the practice of being late, followed by cultural tolerance and acceptance (Chua, 2019).However, this low regard or indifference to time may not be tolerated in other settings or countries.
On the other hand, the behaviors that the participants of this study regarded as less acceptable were related to breaching patient and students' privacy and making racial, ethnic, sexual, or religious insults.Nursing students value confidentiality both in the academic and clinical setting.A prior study in the Philippines among nursing students also reported maintaining confidentiality and privacy was perceived as a responsible behavior on social media (Oducado et al., 2019).Similarly, in a study by Matlakala, (2015), the participants expressed a positive view of keeping patients' information private.They stated they were morally obliged to do so and not reveal such information.According to the study participants, all patients have the right to confidentiality, and the nurse-patient relationship is built on trust between these two parties.After all, nursing educators must ensure that students acquire basic skills in creating a healthy environment that respects patients' rights.
This study found a significant positive correlation between cyberincivility experience and acceptability.This finding may suggest that the more uncivil behavior is considered acceptable, the more likely students will experience it, or vice versa.For instance, privacy breaches may be more unacceptable for students; hence, few are likely to engage in and experience such behavior.Kim et al. (2020) also noted that the acceptability of cyberincivility was positively correlated with the frequency of cyberincivility experience.Meanwhile, it is also possible that people who are more knowledgeable about the internet and online communication may be more aware of the potential harms of cyberincivility, and, therefore, less likely to find it acceptable (Kim et al., 2020).However, this present study noted otherwise.Perhaps, many other factors could influence someone's knowledge about cyberincivility, such as their personal values, cultural background, and social environment.It could be that what constitutes cyberincivility can vary widely depending on the context and the individuals involved (Oducado et al., 2019;Soares et al., 2017).What one person considers professionally acceptable behavior online may be regarded as uncivil by someone else.Therefore, it is essential to consider the nuances and complexities of this issue when attempting to understand the topic of cyberincivility.
Finally, no significant difference in knowledge, experience, and acceptability according to sex, year level, and duration of internet use was noted in this study.This study's result corroborates the prior study conducted by Kim et al. (2020), which revealed no significant difference in cybercivility knowledge based on sex and level of education.This result may be attributed to the homogeneity of the sample and the same curriculum these nursing students attend.The extent of information regarding cybercivility they are being exposed to is the same, thus not making a significant difference in their level of knowledge.Moreover, cybercivility experiences remain similar between males and females.It could be that perpetrators of cyberincivility do not have a marked preference toward their target, and some people online can appear and remain anonymous.In contrast, uncivil behaviors like cyberbullying can be common among females because of their propensity to verbal aggression expression (Navarro et al., 2015).Also, this study was consistent with the results of Kim et al. (2020), wherein the participants from their cross-country study displayed the same frequency of cyberincivility experience regardless of the length of time spent on the internet daily.The study also found that cyberincivility acceptability was associated with having more SNS accounts, spending more time on SNS, receiving more emails, and sending more text messages.
Despite the study findings' relevance, it has limitations, and conclusions can only be generalizable among the study participants.Also, the use of crosssectional design and test of correlation and significant differences according to selected variables (sex, year level, and duration of internet use) means causality between variables cannot be inferred.Other variables such as urban or rural origin, parent's socioeconomic status, etc., may be considered by future scholars.The study is also limited to using a questionnaire subject to self-report bias.Future researchers may further conduct a test-retest reliability to assess the psychometric property of the knowledge scale because of its low internal consistency value.Moreover, given that what constitutes cyberincivility can vary widely depending on the context and the individuals involved, further validation of the tool within the Philippine context is needed to contextualize the research questionnaire, similar to the study conducted by Hong et al. (2020) in Korea.

Conclusions
This study highlights that nursing students have sufficient knowledge of uncivil cyber behaviors.They are aware of what cybercivility is, where cyberincivility usually occurs, and its effects and consequences.It is also noteworthy that, although nursing students spend significant hours on the internet and that the technological landscape has become a significant venue for various activities and expressions for nursing students, cyberincivility is still less encountered by them at present.However, there might be some instances where nursing students still experience uncivil behaviors online.Also, nursing students have a low tolerance for cyberincivility and perceive uncivil cyber behaviors as unacceptable and improper.This study can raise awareness among nursing students, educators, and administrators that is hoped to lead to proactive efforts to address and prevent such negative behaviors online.The academe may utilize the study's findings as baseline data and serve as a guide in building a foundation for enhancing programs and policies to deal with cyberspace behaviors, whether in facilitating what is appropriate or reprimanding harmful behaviors, thus promoting a culture of civility in online learning spaces.

Table 1 .
Profile of participants

Table 2 .
Level of academic cyberincivility knowledge, experience, and acceptability