The Relationship Between Procrastination, Self-Efficacy, and Self-Control in Relation to Anxiety Among Medical Students

Introduction: Anxiety is a condition characterized by apprehension and the persistent concern that something negative is about to occur, accompanied by physical, cognitive, and behavioral symptoms. There are two main factors influencing anxiety: internal and external factors. However, other contributing factors include procrastination, self-efficacy, and self-control. Methods: This study used an observational analytic design with a cross-sectional approach. A stratified random sampling technique was employed, yielding a sample size of 83 respondents. The data collected were analyzed using the chi-square correlation test. Results: The prevalence of high procrastination levels was observed in 37 respondents (44.6%). Low self-efficacy was reported in 49 respondents (59%), and low self-control in 41 respondents (49.4%). A total of 47 respondents (56.6%) experienced anxiety. There was a significant association between procrastination and anxiety, with a p-value of 0.000 (p < 0.05). Similarly, significant associations were found between self-efficacy and anxiety (p-value = 0.000, p < 0.05) and between self-control and anxiety (p-value = 0.000, p < 0.05). Conclusions: Significant associations were observed between procrastination, self-efficacy, and self-control with anxiety among students of the Faculty of Medicine at Universitas Islam Al-Azhar.

INTRODUCTIONS

Anxiety disorders are among the most common mental health disorders. According to Nevid et al. (2002), anxiety is a condition of apprehension or worry, accompanied by the sense that something negative is imminent, along with associated physical, cognitive, and behavioral symptoms[1][1]. Data from the World Health Organization (WHO) indicates that 26.67%, or 4 out of every 15 healthy individuals, suffer from anxiety and depression[2]. WHO also reports that around 10% of individuals in North America, Western Europe, Australia, and New Zealand experience clinical anxiety, compared to approximately 8% in the Middle East and 6% in Asia[3].

Indonesia is one of the Asian countries with an anxiety prevalence rate of 11.6% of the total population, amounting to approximately 24,708,000 individuals[4]. Data from the Ministry of Health (Kemenkes, 2023) indicates several provinces with the highest number of mental disorder cases, including DKI Jakarta (24.3%), Aceh (18.5%), West Sumatra (17.7%), West Nusa Tenggara (10.9%), South Sumatra (9.2%), and Central Java (6.8%). Consequently, West Nusa Tenggara ranks fourth among the regions with the highest prevalence of severe mental disorders[5].

College students are a group highly vulnerable to anxiety, with anxiety prevalence among students ranging from 15% to 64.3% across universities[6]. Medical students, in particular, are at high risk for anxiety[7]. The prevalence of anxiety among medical students remains considerably high, ranging from 30% to 70%. A study on anxiety involving 90 medical students at an Indonesian university reported an anxiety rate of approximately 71%[7]. Anxiety can affect students throughout the various stages of medical education, which employs a learning method distinct from other faculties. Research has highlighted that stress and anxiety are particularly prevalent among first-, second-, and third-year students[7].

Freud (2009) proposed two theoretical perspectives to explain the concept of anxiety: psychodynamic theory and behavioral theory. According to psychodynamic theory, anxiety arises from unconscious mental conflict. In contrast, behavioral theory suggests that anxiety results from a response to specific stimuli (facts) that persist long enough for an individual to develop a conditioned response to these significant stimuli[7]. Factors influencing anxiety are categorized into internal and external types. Internal factors include gender, age, education level, and experiences with hospitalization, while external factors encompass medical conditions or diagnoses, access to information, therapeutic communication, the environment, and healthcare facilities[8].

Other studies have also identified procrastination as a contributing factor to anxiety. Steel defines procrastination as the intentional delay of desired activities, despite knowing the potential negative consequences of such behavior. The term "procrastination" was first introduced by Brown and Holzman in 1967, derived from the Latin word procrastinare, meaning "to postpone until the next day"[8]. Steel (2006) further explains that procrastination comes from the Latin components Running Title pro, meaning "forward, ahead, or favoring," and crastinus, meaning "tomorrow"[9]. It refers to the intentional postponement of tasks, even when individuals are aware of the possible negative outcomes. According to Solomon and Rothblum (1984), procrastination is often driven by a fear of failure. Students who procrastinate are typically linked to higher levels of anxiety, depression, and significantly lower self-esteem[9]. Research by Gautama and Hadi (2022) and Mulyana et al.

In addition to procrastination, low self-efficacy can also contribute to anxiety. Individuals with low self-efficacy and high levels of anxiety often exhibit avoidance behaviors[10]. The concept of self-efficacy was first introduced by Albert Bandura, who defines it as an individual's belief in their ability to perform tasks or actions required to achieve specific outcomes[11]. It also involves evaluating one's competence in completing tasks, reaching goals, and overcoming obstacles[12]. Studies by Purnamasari et al. (2020) and Singoro (2021) have shown a negative relationship between self-efficacy and anxiety, indicating that individuals with lower self-efficacy are more likely to experience higher levels of anxiety, and vice versa. However, research by Faramarzi and Khafri (2017) found no significant association between self-efficacy and anxiety.

Low self-control also plays a significant role in the development of anxiety. Anxiety in individuals may arise from poor self-regulation[13]. Averill (2011) defines self-control as the ability to modify behavior, manage both desired and undesired information, and make decisions based on personal beliefs[12]. Widiana et al. ( 2004) describe self-control as a mechanism that helps regulate and direct individual behavior. Research by Fachrozie et al. (2021) shows a strong relationship between self-control and anxiety, suggesting that lower levels of self-control are associated with higher levels of anxiety. However, a study by Hakim (2018) found no significant relationship between self-control and anxiety.

Based on the background and previous research data, it can be concluded that anxiety levels among medical students remain considerably high, affecting both early-and late-stage students, which can have a negative impact on them. Research on the relationship between procrastination, self-efficacy, and self-control with anxiety among first, second, and third year medical students has not yet been conducted. Therefore, addressing this research gap, the researchers are interested in studying the relationship between procrastination, self-efficacy, and self-control with anxiety among students in the Faculty of Medicine at Universitas Islam Al-Azhar.

Methods

It was conducted in August 2024 at the Faculty of Medicine, Universitas Islam Al-Azhar. The study population includes all academic-phase medical students from the 2021, 2022, and 2023 cohorts who meet the inclusion criteria. A stratified random sampling technique

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