International Journal of Noncommunicable Diseases

: 2020  |  Volume : 5  |  Issue : 3  |  Page : 114--122

A cross-national, cross-cultural comparison of predictors of academic performance among Canadian and Malaysian university students

Tricia L da Silva1, Fatimah Shahruddin2, Lai Fong Chan2, Marhani Midin2, Arun V Ravindran3,  
1 Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
2 Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
3 Institute of Medical Science; Department of Psychiatry, Faculty of Medicine, University of Toronto; Centre for Addiction and Mental Health, Toronto, Ontario, Canada

Correspondence Address:
Dr. Arun V Ravindran
University of Toronto, 250 College St., Toronto, Ontario M5T 1R8


Background: Poor academic outcomes among postsecondary students are a concern to academic institutions globally. Several sociodemographic, psychosocial, and academic functioning factors are proposed as contributory. As most literature is from Western countries, global generalizability is limited. The aim of this 1-year study was to conduct a prospective cross-cultural comparison of factors impacting academic performance among university students from Canada and Malaysia. Methods: First-year undergraduate students were recruited from University of Toronto Scarborough and Universiti Kebangsaan Malaysia at the start of their academic year. Participants completed a comprehensive range of self-report measures on relevant factors. Information on their year 1 academic performance was obtained from the universities. The data were assessed using Chi-square, analyses of variance, and multiple linear regressions. Results: For Canadian students (n = 224), parents' educational levels, self-reported stress, coping, mental health knowledge, and physical activity were predictors of year 1 academic performance. For Malaysian students (n = 139), gender, ethnicity, academic amotivation, and peer engagement were predictors of year 1 academic performance. Attrition over the year was higher among Canadians (6%) than Malaysians (0%), but numbers were insufficient to determine likely predictors of dropout. Conclusions: The differences in predictors of academic performance between the Canadian and Malaysian students suggest that cultural factors may play an important role in academic outcomes. Intervention and prevention strategies customized to the local context are supported.

How to cite this article:
da Silva TL, Shahruddin F, Chan LF, Midin M, Ravindran AV. A cross-national, cross-cultural comparison of predictors of academic performance among Canadian and Malaysian university students.Int J Non-Commun Dis 2020;5:114-122

How to cite this URL:
da Silva TL, Shahruddin F, Chan LF, Midin M, Ravindran AV. A cross-national, cross-cultural comparison of predictors of academic performance among Canadian and Malaysian university students. Int J Non-Commun Dis [serial online] 2020 [cited 2021 Jun 19 ];5:114-122
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Full Text


Postsecondary institutions worldwide share a common concern about student academic failure, which is characterized by underperformance, noncompletion of degree, and dropout.[1],[2]

Diverse factors are thought to influence academic outcomes. Sociodemographic and psychosocial influences include older age and male gender,[3] minority ethnicity,[4] lack of parental role models with postsecondary degrees and low social support,[5] stress/distress,[6] poor coping,[7] and financial concerns and work/family commitments.[8] Also, contributory are academic functioning factors such as poor adjustment to postsecondary studies,[9] low academic engagement,[10] low intellectual engagement,[11] low academic motivation,[12] and poor sense of fit with the institution/program.[13]

However, most published literature comes from Western countries, with limited data available from other world regions. Comparisons between Western and non-Western nations are also lacking.

Current investigation

This 1-year prospective investigation was conducted in an attempt to fill some of the above knowledge gap. The aims were to compare Canadian and Malaysian students at entry into university across a wide range of sociodemographic, psychosocial, and academic functioning domains and to determine the relationship between these factors and academic outcomes at year end.


The study was conducted at two postsecondary institutions: University of Toronto Scarborough (UTSC) in Canada, and Universiti Kebangsaan Malaysia (UKM) in Malaysia. Both are large postsecondary institutions located in key metropolitan centers in their countries.

Ethics approval was obtained from UTSC's ethics review board in January 2015 and from UKM's ethics review board in August 2016.

At both institutions, notices about the study were shared with 1st-year students via information boards and correspondence from the registrar's offices. At UTSC, the study was also registered with the campus Research Participation System, which offers students extra course credit for research participation. Such a system is not currently available at UKM.

First-year students who could give voluntary informed consent to the study were eligible subjects. Consent included permission for study staff to gather data from their academic records. Written informed consent was obtained from all participants.

At both universities, academic performance is evaluated by grade point average (GPA) or cumulative GPA (CGPA) on a scale of 0.0–4.0, and persistence or dropout is determined by term-to-term registration status. Poor academic performance was, therefore, defined as lower GPA/CGPA scores compared to the average scores for the cohort, based on a maximum score of 4.0. Dropout was defined as nonregistration for the next academic year.

Data sample

For UTSC, the selected cohort was from the 2015-2016 intake year and participants were recruited at the start of the Fall 2015 academic term, i.e., the first term of their 1st year of study, from all faculties. These students were concurrent participants in a parallel 2-year study conducted by two of the authors with identical data collection measures to this study; for the purposes of the current 1-year study, only their year 1 data from that study were included in analyses.

For UKM, the selected cohort was from the 2016-2017 intake year and participants were recruited at the start of the Fall 2016 academic term, i.e., the first term of their 1st year of study, from the Faculty of Medicine.

By its nature, cross-cultural research often needs adaptations for situational differences. For this study, two such specific accommodations were made. First, postsecondary students in Canada and Malaysia were assumed to be similar, even though students in Canada are a diverse mix of local-born, immigrant, and international students,[14] while the majority of Malaysian postsecondary students are local-born.[15] Indeed, the UKM cohort for the current study consisted solely of local-born students. Therefore, only data from local-born students from UTSC were utilized in the current study, to enhance comparisons. Second, while recruitment was open to 1st-year students from any faculty at UTSC, recruitment at UKM focused on 1st-year students at Faculty of Medicine for logistical and other strategic reasons. While Canadian medical schools require students to complete an undergraduate degree before entry, Malaysian medical schools allow entry directly from high school. As a result, the UKM medical student cohort was similar in age to the UTSC undergraduate cohort in this study.

No sample size calculation was performed specifically for this study. The UTSC cohort was drawn from an existing dataset, as mentioned previously, and at UKM, convenience sampling was used to recruit all 1st-year medical students. Sample size was, thus, determined pragmatically.

Data collection

Participants completed a series of questionnaires at a single time point, i.e., at the start of the Fall 2015 term for UTSC and at the start of the Fall 2016 term for UKM. Data were gathered on several sociodemographic, psychosocial, and academic functioning factors drawn from a comprehensive review of the literature. A general questionnaire was created to gather sociodemographic information. A comprehensive array of self-report measures with established psychometric and cross-cultural adequacy in postsecondary student populations, including Asian students, was used to assess psychosocial and academic functioning domains. Data on participants' academic performance and continued enrolment (i.e., persistence) were obtained from the registrar's database for the 2015–2016 academic year at UTSC and the 2016–2017 academic year at UKM.

The dataset was as follows:


Age at enrolmentGender (female; male; transgender; other)Citizenship status in Canada or Malaysia (local-born citizen; immigrant/naturalized citizen; international student)Ethnicity (aboriginal/First Nations; aboriginal/indigenous; East Asian; South Asian; South East Asian; Black African; Black Caribbean; Black North American; Indian Caribbean; Latin American; Middle Eastern; White European; White North American; Mixed heritage; other)Faculty of study (Arts, Medicine, Science, etc.)Parents' education level (at least 1 parent has a postsecondary degree; neither does)Living situation while in school – home status (living at home; living away)Living situation while in school – family network status (local; distant)Student loans taken (yes; no)Financial concerns related to education (yes; no)Current self-rated stress levels (high; moderate; low)

Psychosocial functioning:

The Brief COPE measures current adaptive and maladaptive coping styles in response to stress through two subscales.[16] Higher scores indicate higher levels of each coping style.The General Help-Seeking Questionnaire assesses current help-seeking intentions in relation to personal/emotional difficulties and suicidality through two subscales and a total score.[17] Higher scores indicate greater help-seeking tendencies.The Global Appraisal of Individual Needs–Short Screener measures the occurrence of internalizing disorders, externalizing disorders, substance abuse, and crime and violence problems in the recent past through four subscales and a total score.[18] Higher scores indicate more dysfunction. The internalizing disorder subscale was excluded in this study due to significant overlap with the Kessler Psychological Distress Scale listed below.The Health Promoting Lifestyle Profile II measures the current frequency of behaviors related to health responsibility, physical activity, nutrition, interpersonal relations, self-actualization/spiritual growth, and stress management through six subscales and a total score.[19] Higher scores indicate better health choices.The Kessler Psychological Distress Scale–10 items measures psychological distress related to depression and anxiety symptoms in the past month through an overall score.[20] Higher scores indicate more psychological distress.The Mental Health Knowledge and Attitudes Scale assesses current mental health knowledge and attitudes toward mental illness (stigma) through two subscales.[21] Higher scores indicate better knowledge or better attitudes.The Multidimensional Scale of Perceived Social Support measures perceptions of social support from family, friends, and significant others at the present time through three subscales and a total score.[22] Higher scores indicate more perceived support.The Quality of Life Scale assesses current satisfaction with life domains such as school/work, leisure, health, independence, and interpersonal relationships through an overall score.[23] Higher scores indicate better life quality.The Resilience Scale–14 items short form measures present ability to cope well with and recover quickly from stress through an overall score.[24] Higher scores indicate greater resilience.

Academic functioning:

The Academic Motivation Scale measures intrinsic motivation, extrinsic motivation, and amotivation at the present time through three subscales.[25] Higher scores indicate a greater level of the particular type of motivation.The First Year Experiences Questionnaire measures 1st-year students' current engagement with their academic institution.[26] Seven subscales assess transition engagement (adjustment to university), academic engagement, peer engagement, student–staff engagement, intellectual engagement, online engagement (comfort with online learning and socializing), beyond class engagement (sense of belonging), and there is also a total score. Higher scores indicate better engagement.

Academic outcomes:

CGPA (from the Registrar's database), based on a scale of 0.00–4.00, provides information on students' academic performance for each term.Registration status (from the Registrar's database) confirms students' continued enrolment or nonenrolment for each term.

Data analysis

Data analysis was conducted using IBM Statistical Software for Social Sciences (SPSS), version 21.0 (SPSS Inc., Chicago, Ilinois, USA). All data were anonymized and deidentified prior to analysis. Descriptive statistics were conducted on the sociodemographic variables. For functional measures, only the subscales were used in analyses. Similarities and differences between the student groups in sociodemographics, functional measures, and academic outcomes were evaluated using Chi-square and analyses of variance, as appropriate. Multiple linear regression was used to predict academic performance, with variables entered stepwise to obtain models containing only significant predictors.


The sample consisted of 363 1st-year students, 224 from UTSC (Canadians) and 139 from UKM (Malaysians), who were all local-born citizens of their respective countries. At UTSC, 76% of participants were in the Faculty of Science (47% of these in Health Sciences programs), 18% were in the Faculty of Arts, and 6% were in the Faculty of Business Administration. At UKM, 100% of participants were in the Faculty of Medicine.

Similarities and differences in sociodemographics between the student groups were examined [Table 1]. There were significant group differences in age at enrolment, ethnicity, living situation, student loans taken, and self-rated stress levels (P ≤ 0.05). There were no group differences in gender distribution, parental education levels, or financial concerns related to education (P > 0.05).{Table 1}

There were also similarities and differences between the study groups on functional measures [Table 2]. Among psychosocial measures, there were significant group differences in adaptive coping, externalizing behaviors, substance use, crime/violence problems, help-seeking for suicidality, spiritual growth, stress management, psychological distress, mental health knowledge, attitudes toward mental illness, perceived support from family and friends, quality of life, and resilience (P ≤ 0.05). Among academic functioning measures, there were significant group differences in intrinsic motivation, transition engagement, academic engagement, peer engagement, student–staff engagement, intellectual engagement, and beyond class engagement (P ≤ 0.05). There were no group differences in maladaptive coping, help-seeking for personal issues, health responsibility, physical activity, nutrition, interpersonal relations, perceived support from significant others, extrinsic motivation, amotivation, and online engagement (P > 0.05).{Table 2}

Academic outcomes were assessed at end of year 1 and showed significant group differences in both performance and attrition rates (P ≤ 0.05) [Table 3].{Table 3}

Predictors of academic performance at end of year 1 were assessed for the two student groups. Since only a very small number of Canadians (and no Malaysians) had dropped out, estimations of predictors of dropout were not conducted due to the high likelihood of a Type II error.

Predictors of academic performance in year 1

Canadian students

Lack of parents with postsecondary degrees, high or low self-rated stress (versus moderate levels), higher maladaptive coping, higher physical activity, and lower mental health knowledge predicted lower academic performance at end of year 1 among Canadian students (P ≤ 0.05) [Table 4]. The prediction model explained 16% of the variance in performance.{Table 4}

Malaysian students

Female gender, South Asian or South East Asian ethnicity (versus East Asian ethnicity), higher amotivation, and higher peer engagement predicted lower academic performance at end of year 1 among Malaysian students (P ≤ 0.05) [Table 4]. The prediction model explained 17% of variance in performance.


This investigation is among the very few to conduct a cross-national, cross-cultural comparison of academic outcomes between students from different world regions, in this case, from Canada and Malaysia. Predictors of poorer academic performance in the 1st year of study were found to be distinctive for each student group, with no commonalities. The strengths of the study include the reasonable sample size and the moderate effect sizes (16%–17%) of the predictive models. Dropout was significantly lower in the Malaysian group, which aligns with published evidence that postsecondary attrition tends to be much lower in Asia[27] than in the West.[5]

Most of the findings on predictors of performance are in accordance with the published literature, but there are some of particular interest, as below.

Canadian students

In relation to high and low stress versus moderate stress, the stress response curve proposes that while excessive or inadequate pressure may reduce performance, moderate pressure may benefit performance by boosting motivation and enhancing function.[28] In relation to physical activity levels, it is suggested that more time spent in physical activities may reduce time dedicated to and/or interest in studying, with resulting impact on performance.[29] In relation to mental health knowledge, lower scores have been linked to lower resilience,[30] which is in turn linked to lower academic achievement.[31]

Malaysian students

In relation to gender, the better performance among the male students is in contrast to the literature, even other Malaysian studies.[32] This difference may reflect the nuances of a highly patriarchal culture where females experience more inequities[33] and female medical students report much higher stress than male counterparts,[34] which is known to impact performance.[6] In relation to ethnicity, East Asians (ethnic Chinese), South Asians (ethnic Indians), and South East Asians (ethnic Malays) are the three main ethnic groups in Malaysia.[15] Local Malaysian studies have also found better postsecondary performance among ethnic Chinese than ethnic Indians or ethnic Malays,[35] which may be attributable to the extra tutoring and academic supports commonly provided by ethnic Chinese parents to even high-performing students that the other two ethnic groups may not do.[36] In relation to peer engagement, its effects on performance are mixed,[37],[38] and may relate to whether peer interactions focus on academics or socializing.[39]

It is notable that there was no overlap in predictors between the Canadian and Malaysian student groups despite many similarities in demographics and functioning. Canadian students appeared to be primarily impacted by psychosocial factors while Malaysian students seemed to be influenced mainly by academic functioning factors (and by sociodemographic factors that may be better explained by academics-related influences). This suggests that culturally based influences may play an important role in their academic outcomes. Regarding the dominance of psychosocial predictors for the Canadian group, mental illnesses and stress conditions show much higher prevalence in the West (including in Canada) than in Asia,[40] with highest rates in the 15–24 year age group.[41] Malaysian data show both lower rates of mental disorders compared to Canada,[42] and also no age-related differences in prevalences.[43] While this could be attributed to disparities in reporting,[44] it is also possible that Canadians either experience more stressors or are poorer at coping than Malaysians, across the lifespan. Supporting this, Canadian students in the current study reported higher psychological distress, and lower adaptive coping, stress management, and resilience, than Malaysian students (P ≤ 0.05) [Table 2]. As for the importance of academic functioning predictors for the Malaysian group, this may not be surprising as there is much greater emphasis in Asian than Western countries on students' academic involvement and academic success.[36] Indeed, Malaysian students in the current study showed higher intrinsic motivation and academic and intellectual engagement, as well as lower dropout, than Canadian students (P ≤ 0.05) [Table 2] and [Table 3].

The study findings have several inferences for institutional intervention strategies to enhance academic outcomes. The moderate strengths of the predictive models underscore the significant impact of factors present at postsecondary entry on year-end academic performance, indicating that interventions are likely to have greater efficacy if delivered from the first term of studies onward. In addition, the distinction in predictors between the two student groups suggests that intervention programs should be customized and culturally adapted as needed for respective student populations, and not simply transplanted from external research. While initiatives that boost wellness and academic skills are likely to benefit all students, programming that strengthens resilience to stress, such as mental health education and stress management training,[45] may be especially useful for Canadian students. On the other hand, programming that increases academic engagement and integration, such as peer mentoring and academic skills enhancement,[46],[47] may be particularly advantageous for and appealing to Malaysian students.

Limitations of the study

Some limitations of the study must be noted. One is the short time frame. Another is the fact that factors assessed were drawn from Western literature due to a paucity of non-Western sources, but influences relevant to non-Western cultures may have been overlooked, as a result. A third limitation is that though all the measures had been previously used with ethnic minority and/or Asian postsecondary populations, some had not been previously validated specifically in Malaysian student samples. Finally, there were differences in the programs of study of the two student groups; the higher academic standards required of medical students worldwide[48],[49] may have contributed to the academic-focused predictors of performance in the Malaysian group independently of cultural influences.


The current study provides preliminary data on similarities and differences in academic outcomes between postsecondary students from two culturally distinct world regions. The results emphasize the need for further research in this area to fill the knowledge gap and broaden the international scope of the literature.


The authors gratefully acknowledge the following persons for supporting and facilitating the study: At UTSC, in the Office of the Registrar, Dr. Curtis Cole, Registrar and Assistant Dean of Enrolment Management; Dr. Naureen Nizam, Associate Registrar and Director of Systems and Operations; and Mari Motrich, Application Developer and Data Analyst. At UKM, Dr. Tuti Iryani Mohd Daud, Senior Lecturer in the Department of Psychiatry; Dr. Siti Mariam Bujang, Head of the Department of Medical Education; Dr. Nurul Husna Abdul Rahman, Medical Officer in the Department of Medical Education; and Dr. Roslina Abdul Manap, Deputy Dean of the Department of Undergraduate Studies.

Many thanks are also extended to Dr. Marcos Sanches at the Centre for Addiction and Mental Health for statistical advice.

Ethical approval

All study procedures were performed in accordance with the ethical standards of the respective institutional research committees and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Financial support and sponsorship

Study implementation in Canada was conducted without funding from any agencies in the public, commercial, or not-for-profit sectors.

Study implementation in Malaysia was supported by Dr. Marhani Midin's institutional research grant from UKM (grant number UKM DIP-2014-009). However, UKM's funding department was not involved in the study design, data collection and interpretation, manuscript preparation, or the decision to submit the manuscript for publication.

Conflicts of interest

There are no conflicts of interest.


1Bowler M. Dropouts loom large for schools. U. S. News & World Report; August 19, 2009. Available from: [Last accessed on 2019 Aug 01].
2Paton G. University drop-out rate soars by 13pc in a year. The Telegraph; March 29, 2012. Available from: [Last accessed on 2019 Aug 01].
3Adam J, Bore M, Childs R, Dunn J, Mckendree J, Munro D, et al. Predictors of professional behaviour and academic outcomes in a UK medical school: A longitudinal cohort study. Med Teach 2015;37:868-80.
4Green JA. The effect of English proficiency and ethnicity on academic performance and progress. Adv Health Sci Educ Theory Pract 2015;20:219-28.
5Shaienks D, Gluszynski T, Bayard J. Postsecondary Education– Participation and Dropping Out: Differences across University, College and Other Types of Postsecondary Institutions. Catalogue No. 81-595-M– No. 070. Statistics Canada, Ottawa; 2008.
6American College Health Association. American College Health Association-National College Health Assessment II: Canadian Consortium Reference Group Executive Summary Spring 2013. American College Health Association, Hanover; 2013.
7Trucchia SM, Lucchese MS, Enders JE, Fernández AR. Relationship between academic performance, psychological well-being, and coping strategies in medical students. Rev Fac Cien Med Univ Nac Cordoba 2016;70:144-52.
8Pleskac TJ, Keeney J, Merrit SM, Schmitt N, Oswald FL. A detection model of college withdrawal. Organ Beh Hum Decis Process 2011;115:85-98.
9Credé M, Niehorster S. Adjustment to college as measured by the student adaptation to college questionnaire: A quantitative review of its structure and relationships with correlates and consequences. Educ Psychol Rev 2012;24:133-65.
10Casuso-Holgado MJ, Cuesta-Vargas AI, Moreno-Morales N, Labajos-Manzanares MT, Barón-López FJ, Vega-Cuesta M. The association between academic engagement and achievement in health sciences students. BMC Med Educ 2013;13:33.
11Grass J, Strobel A, Strobel A. Cognitive investments in academic success: The role of need for cognition at university. Front Psychol 2017;8:790.
12Maurer T, Allen D, Gatch DB, Shankar P, Sturges D. A comparison of student academic motivations across three course disciplines. J Scholar Teach Learn 2013;13:77-89.
13Anderson CM. Linking perceptions of school belonging to academic motivation and academic achievement amongst student athletes: A comparative study between high-revenue student athletes and non-revenue student athletes. PhD dissertation, University of California Berkley; 2010. Available from: [Last accessed on 2019 Aug 01].
14Canadian University Survey Consortium. First-year University Student Survey Master Report. Prairie Research Associates, Winnipeg; 2010.
15Department of Statistics Malaysia. Current population estimates, Malaysia, 2014-2016. Available from: hUZzJyRUcvZEYxZz09. [Last accessed on 2019 Aug 01].
16Carver CS. You want to measure coping but your protocol's too long: Consider the Brief COPE. Int J Beh Med 1997;4:92-100.
17Wilson CJ, Deane FP, Ciarrochi J, Rickwood D. Measuring help-seeking intentions: Properties of the General Help-Seeking Questionnaire. Can J Couns 2005;39:15-28.
18Dennis ML, Chan YF, Funk RR. Development and validation of the GAIN Short Screener (GSS) for internalizing, externalizing and substance use disorders and crime/violence problems among adolescents and adults. Am J Addict 2006;15:80-91.
19Walker SN, Sechrist KR, Pender NJ. The health-promoting lifestyle profile: Development and psychometric characteristics. Nurs Res 1987;36:76-81.
20Kessler RC, Barker PR, Colpe LJ, Epstein JF, Gfroerer JC, Hiripi E, et al. Screening for serious mental illness in the general population. Arch Gen Psychiatry 2003;60:184-9.
21Mcluckie A, Kutcher S, Wei Y, Weaver C. Sustained improvements in students' mental health literacy with use of a mental health curriculum in Canadian schools. BMC Psychiatry 2014;14:379.
22Zimet GD, Dahlem NW, Zimet SG, Farley GK. The multidimensional scale of perceived social support. J Pers Assess 1988;52:30-41.
23Burckhardt CS, Anderson KL. The quality of life scale (QOLS): Reliability, validity, and utilization. Health Qual Life Outcomes 2003;1:60.
24Wagnild G. The Resilience Scale User's Guide for the US English Version of the Resilience Scale and the 14-item Resilience Scale (RS–14). Resilience Center, Worden; 2009.
25Vallerand R, Pelletier L, Blais M, Briere N, Seneca C, Vallieres E. The academic motivation scale: A measure of intrinsic, extrinsic, and amotivation in education. Educ Psychol Measure 1992;52:1003-17.
26Krause K, Coates H. Students' engagement in first-year university. Assess Eval Higher Educ 208;33:493-505.
27Chan J. Academic: National drop out rate on the decline but still worrying. The Malaya Mail Online; May 18, 2017. Available from: [Last accessed on 2019 Aug 01].
28Nixon PG. The human function curve. With special reference to cardiovascular disorders: Part I. Practitioner 1979;217:765-70.
29Cotton D, George R, Joyner M. The Gender and Ethnicity Attainment Gap Research Project. Plymouth University, Plymouth; 2013.
30Ravindran AV, Herrera A, da Silva TL, Henderson J, Castrillo ME, Kutcher S. Evaluating the benefits of a youth mental health curriculum for students in Nicaragua: A parallel-group, controlled pilot investigation. Glob Ment Health (Camb) 2018;5:e4.
31Hartley MT. Examining the relationships between resilience, mental health, and academic persistence in undergraduate college students. J Am Coll Health 2011;59:596-604.
32Wider W, Halik MH, Mustapha M, Bahari FB. The effect of demographic factors on academic adjustment among freshmen in Malaysia. J Res Human Soc Sci 2016;4:1-9.
33Hussein N. Workforce to Reckon with. Women are a Valuable Resource for Economic Development. The Star Malaysia; November 7, 2016. Available from: [Last accessed on 2019 Aug 01].
34Salam A, Mahadevan R, Abdul Rahman A, Abdullah N, Abd Harith AA, Shan CP. Stress among first and third year medical students at University Kebangsaan Malaysia. Pak J Med Sci 2015;31:169-73.
35Alfan E, Othman MN. Undergraduate students' performance: the case of University of Malaya. Qual Assur Educ 2005;13:329-43.
36Mansell W. Hidden tigers: Why do Chinese children do so well at school? The Guardian; February 7, 2011. Available from: [Last accessed on 2019 Aug 01].
37AbdelSalam M, El Tantawi M, Al-Ansari A, AlAgl A, Al-Harbi F. Informal peer-assisted learning groups did not lead to better performance of Saudi dental students. Med Princ Pract 2017;26:337-42.
38Vrioni R. Effects of group learning on the academic performance of university students. Prob Educ 21st Cent 2011;33:111-7.
39Hammar Chiriac E. Group work as an incentive for learning - students' experiences of group work. Front Psychol 2014;5:558.
40Steel Z, Marnane C, Iranpour C, Chey T, Jackson JW, Patel V, et al. The global prevalence of common mental disorders: A systematic review and meta-analysis 1980-2013. Int J Epidemiol 2014;43:476-93.
41World Health Organization. Cross-national comparisons of the prevalences and correlates of mental disorders. WHO International Consortium in Psychiatric Epidemiology. Bull World Health Organ 2000;78:413-26.
42Wong CH, Sultan Shah ZU, Teng CL, Lin TQ, Majeed ZA, Chan CW. A systematic review of anxiety prevalence in adults within primary care and community settings in Malaysia. Asian J Psychiatr 2016;24:110-7.
43Kader Maideen SF, Sidik SM, Rampal L, Mukhtar F. Prevalence, associated factors and predictors of depression among adults in the community of Selangor, Malaysia. PLoS One 2014;9:e95395.
44Baxter AJ, Patton G, Scott KM, Degenhardt L, Whiteford HA. Global epidemiology of mental disorders: What are we missing? PLoS One 2013;8:e65514.
45Davies EB, Morriss R, Glazebrook C. Computer-delivered and web-based interventions to improve depression, anxiety, and psychological well-being of university students: A systematic review and meta-analysis. J Med Internet Res 2014;16:e130.
46Gaughf NW, Foster PS, Williams DA. Student-reported satisfaction with academic enhancement services at an academic health science center. Educ Health (Abingdon) 2014;27:208-12.
47Hryciw DH, Tangalakis K, Supple B, Best G. Evaluation of a peer mentoring program for a mature cohort of first-year undergraduate paramedic students. Adv Physiol Educ 2013;37:80-4.
48Barber M. How the medical school admissions process is skewed. University Affairs; November 30, 2016. Available from: [Last accessed on 2019 Aug 01].
49Pak J. Is Malaysia university entry a level playing field? BBC News; September 2, 2013. Available from: [Last accessed on 2019 Aug 01].