Background

As a result of the COVID-19 pandemic, all educational systems were forced to move rapidly toward virtual education, which was referred to as "emergency remote teaching," implying that this transition was temporary in nature (1, 2). But it seems that the flexibility and learning possibilities of virtual education lead the educational systems not to return fully to previous training conditions in the post-corona era (1, 3, 4). Therefore, to provide quality online education, different aspects of this method should be considered by educational planners and policymakers. Barbara found nine dimensions including “modality, student-instructor ratio, instructor and student role in online education, pacing, pedagogy, online communication synchrony, the role of online assessments, and source of feedback” (5).

One of the important issues related to students in an online learning environment is the social presence which assesses the learner's sense of being connected with the instructor and other students in an online learning environment and is often misunderstood or ignored (6, 7).

Some researchers believe that an online learning environment compared to face-to-face education provides less social presence due to a lack of nonverbal communication (8).

Aldheleai and colleagues found a significant relationship between students’ academic performance and all aspects of online social presence (9). Other literature in this regard shows that social presence has a remarkable impact on students' satisfaction, interactive behaviors, development of the virtual world, and community in an online learning environment (8). Due to the importance of social presence in online learning, various tools have been introduced to measure it such as The Social Presence and Privacy Questionnaire (SPPQ), IPO Social Presence Questionnaire (IPO-SPQ), and Online Social Presence Questionnaire (OSPQ) (8).

Almost all training in medical education was held virtually during the Covid era and it has been specified that social presence in distance education is an important factor for students’ learning and satisfaction, their interactive behaviors, and the development of the virtual community in an online learning environment. Therefore, our educational system must assess the social presence of distance education among medical students.

Objectives

Given that the OSPQ had appropriate psychometric properties in the previous study (6, 9) and since the psychometric properties of the Persian version of the questionnaire have not been reviewed, the current study aimed to assess the social presence in distance education among medical students after determining its psychometric properties.

Methods

A cross-sectional study was conducted on
303 medical students who were studying at Kerman University of Medical Sciences in the academic year 2020-21 (second semester). The participants were selected through the quota sampling method. Given that the main purpose of the study was to assess the Psychometric Properties of an instrument, the sample size was considered to be 15 times per item of the tool (10). Inclusion criteria were studying at Kerman University of Medical Sciences as a student during the study period and willingness to participate. Leaving more than 10% of questions unanswered will result in the questionnaire being excluded.

Data was collected using a two-part self-administered questionnaire in which the first part contained demographic information including age, gender, residence, marital status, student’s educational stage (Basic sciences, Introductory to clinical sciences, Clerkship, and Internship), and parents’ educational level and the second part was the Persian version of the Online Social Presence Questionnaire (OSPQ). This questionnaire has 19 questions with five subscales: social respect, social sharing, open mind, social identity, and intimacy which assesses the learner's sense of being connected with the instructor and other students in an online learning environment. Response to each item is rated on a 5-point Likert scale (1 = very little, 5 = very much) (6). The total score and the score of each subscale were then transformed into a score between zero and 100 for better comparison. The higher the score in each area, the better the situation in that subscale.

To provide the Persian version of OSPQ, after obtaining permission to use the questionnaire, the forward and back-translation method was used. The instrument was adapted culturally by an expert panel. Through an expert panel including five community medicine and two medical education specialists, the face and content validity of the instrument was evaluated, and accordingly, the Content validity index (CVI) of the whole questionnaire was determined as 0.86.

To design an electronic questionnaire, the “Porsline” Platform was used through https://porsline.ir/ and its link was shared with the students. The participants completed the questionnaire voluntarily and anonymously. The study was approved by the ethics committee at the Kerman University of Medical Sciences (IR.KMU.REC.1400.085).

Data were analyzed by LISREL version
8.80 (Scientific Software International, Chicago, IL, USA) and SPSS version 20.0 (SPSS Inc., Chicago, IL, USA). In a pilot study on 35 medical students, the internal consistency of the Persian version was determined by the Cronbach Alfa coefficient. These students then entered the study. Exploratory and Confirmatory factor analyses were conducted for construct validity. Furthermore, ANOVA (The comparison of the total score of social presence and its subscales based on students’ educational stage, parents’ educational level, and residence) and Independent
T-test (The comparison of the total score of social presence and its subscales based on gender and marital status), and multiple linear regression (the variables which had P < 0.2 in univariate analysis) were used. The significance level was considered as 0.05.

Results

Out of the 303 medical students who participated in the study, 63.7 percent were female with a mean age of 22.83±2.84 years. Most of them (67.3%) were in the clinical stages.

Table 1 shows the central and dispersion parameters of the total score of social presence and its subscales. In the comparison of the total score of social presence and its subscales based on students' characteristics, the mean score of the social identity subscale (P = 0.001) and social presence total score (P = 0.03) was significantly higher in females.

Table 1. Central and dispersion parameters of the total score of social presence and its subscales

Also, the mean of the intimacy subscale was significantly higher in interns and basic sciences students compared to pre-clinical students. (P = 0.006). No statistically significant difference was found in the rest of the comparisons based on the students ‘characteristics (P > 0.05) (Table 2).

Table 3 shows the Cronbach alpha coefficient of the Persian version of the OSPQ and its subscales indicating excellent internal consistency for all subscales and the whole questionnaire.

In construct validity analysis, Bartlett's test of sphericity was statistically significant (P = 0.001,
χ = 3564.94, df =171) and Kaiser-Meyer-Olkin (KMO) measure was 0.93, indicating the proper sample size and suitability of factor analysis (10). Table 2 shows
the exploratory factor loading of the scale. Almost all
of the goodness of fit indices had an excellent level
in confirmatory factor analysis, ((χ2 /df = 2.69,
RMSEA = 0.07, SRMR = 0.04, GFI = 0.90, AGFI = 0.84, NFI = 0.96, IFI = 0.98, and IFI = 0.98).

In multiple linear regression, none of the students ‘characteristics could significantly predict the social presence score.

Discussion

The current study aimed to assess the online social presence among medical students using the Persian Version of the Online Social Presence Questionnaire (OSPQ) and it was revealed that the Persian version of OSPQ had appropriate psychometric properties. The internal consistency of the instrument and its subscales had an excellent level based on the Cronbach alpha coefficient (11) which is consistent with similar studies. Sung and Mayer report that Cronbach’s alpha ranged from 0.847 to 0.863 (4). In a study conducted by Aldheleai on tertiary education students in Malaysia, the Cronbach alpha coefficient was reported between 0.78 and 0.93 (9). Kovari found a Cronbach’s alpha of 0.93 in a study on the students of the University of Pannonia, Hungary (12).

The construct validity of OSPQ was confirmed by factor analysis. The factor loading of all items was at an acceptable level ranging from 0.4 to 0.95 which has concordance with Sung and Mayer and Aldheleai that showed the factor loading between 0.5 and 0.79 and 0.74 to 0.97, respectively (6, 9).

In the current study, almost all goodness of
fit indices yielded excellent results in confirmatory factor analysis, indicating the instrument's five-item
model is valid. This model was confirmed in similar studies in different populations in Malaysia and South Korea (6, 9).

Table 2. The comparison of the total score of social presence and its subscales based on students' characteristics

The values: Mean (SD), BS: Basic sciences, ICS: Introductory to clinical sciences

^**P<0.05

Table 3. Internal consistency and factor loading of the Persian version of the OSPQ items

Therefore, it can be concluded that the Persian version of OSPQ had excellent validity and reliability and can be used to assess medical students’ sense of social presence when virtual/distance learning has almost completely replaced traditional education in the COVID-19 era. Even though the training has returned to face-to-face mode after the corona pandemic subsided, surely the experience of virtual training in this era has made at least part of the training to be presented in virtual form. Since social presence is considered an important aspect of online learning, our educators and education planners should take into account the facilitators and barriers of social presence in the virtual environment. This approach helps medical students trust each other and have a sense of connection with the educators and other students (13). Aldosari found that for improving social presence in online higher education, students and instructors must be competent in technology (14).

Our study revealed that social presence was significantly higher in females compared to males which are consistent with some similar studies and not consistent with others (15, 16). For instance, Kovari
et al found that among the students of the University of Pannonia, the proportion of high scores of social presence was higher in the females (12), meanwhile showed that no significant differences in students’ sense of social presence based on gender among postgraduate students in one of the Malaysian public universities (16). Kear and colleagues emphasized the role of personal profiles which helps online learners to feel connected with others (17).

Therefore, it seems necessary that other factors such as online learning self-efficacy, students’ interest and satisfaction with online education, as well as their skills in using Information and Communications Technology, etc. should be considered by the educational systems to improve the sense of social presence among students.

Limitation: The current study was cross-sectional with its potential limitations and also was limited to medical students, so the results should be generalized with caution. The study tool was an electronic questionnaire, the accuracy of its completion may not have been observed. Considering that the previous experience of the students or their parents in the field of virtual education can affect the sense of social presence in an online environment, it would be better to investigate this relationship as well.

Conclusion

The Persian version of OSPQ is a simple, valid, and reliable tool to assess the sense of social presence in an online environment among medical students. Also, we found that none of the students ‘characteristics could significantly predict the social presence score. Therefore, it is suggested that other factors be considered in future studies.