The COVID-19 pandemic reshaped higher education worldwide, creating unprecedented challenges for students,

particularly those enrolled in health science programs that depend heavily on laboratory work, clinical exposure,

and competency-based assessments. This study investigates the academic stressors, coping strategies, and online

to high levels of psychological strain. Key stressors included unclear assessment expectations, increased

academic workload, disrupted practical and clinical training, and difficulties adapting to rapidly shifting online

learning formats. The absence of in-person laboratory and clinical sessions created substantial anxiety regarding

future professional competence. Many students expressed fear of graduating without adequate practical skills, a

concern intensified by inconsistent access to simulation tools and limited lecturer-student interaction in virtual

environments. Technological barriers further compounded stress levels. Challenges such as unstable internet

connectivity, limited access to personal digital devices, and unconducive home learning environments were

widespread, particularly among students from lower-income households. These inequities not only affected

academic engagement but also contributed to frustration, demotivation, and academic fatigue. Coping strategy

analysis revealed that students predominantly relied on adaptive methods such as social support seeking,

opportunities to rebuild student confidence. By understanding these stressors and coping patterns, policymakers

and educators can develop a more resilient and equitable post-pandemic educational landscape that safeguards

student well-being while ensuring academic continuity and professional readiness.

Index Terms- High prevalence of psychological distress (depression, anxiety, stress). Online learning barriers

and lack of clinical exposure worsened mental health. Socioeconomic inequality impacted access to digital tools.

Advocates for mental health support systems, hybrid learning, and policy interventions

The COVID-19 pandemic created an unprecedented global disruption across all levels of education, reshaping

teaching, learning, and assessment in ways that had never been experienced before. As higher education

institutions rapidly transitioned from traditional face-to-face instruction to fully online platforms, students were

employability.

routines and expectations. Many found themselves struggling with increased academic workload, unclear

instructions, inconsistent communication, and challenges associated with remote assessments. The sudden loss

of structured schedules and physical learning environments also created uncertainty, making it difficult for

students to maintain motivation, concentration, and self-discipline. For health science students, the cancellation

or postponement of clinical attachments, laboratory sessions, and practical skill evaluations became a major

source of anxiety. Without the opportunity to engage in hands-on learning, students expressed concern about

their preparedness for real-world healthcare settings, contributing to elevated levels of academic stress.

Moreover, the shift to online learning exposed deep-rooted inequalities in digital access. Students from rural

critical determinant of academic continuity during the pandemic.

Academic stressors during this period were further compounded by emotional and mental health challenges. The

uncertainty of the pandemic, fear of infection, financial strain on families, and social isolation contributed to

heightened levels of stress and anxiety. Research conducted both globally and locally highlights a significant

rise in psychological distress among students, with many reporting symptoms such as fatigue, decreased

motivation, irritability, and emotional exhaustion. Health science students, in particular, were vulnerable to these

effects due to the demanding nature of their programs and the expectation to achieve competency in both

theoretical and practical components. The pressure to excel in online assessments, coupled with reduced

academic support and the absence of physical classroom interactions, intensified academic stress throughout the

pandemic period. Despite these challenges, students employed a range of coping strategies to manage academic

research has documented the psychological and academic impact of COVID-19 on university students, there

remains limited empirical data focusing specifically on Malaysian diploma-level health science students. Their

experiences are unique due to the competency-based structure of their programs and the requirement for practical

skill development. Most existing studies focus on degree-level medical, nursing, or allied health students, leaving

a research gap in understanding how diploma students navigated academic stressors, adopted coping strategies,

and confronted online learning challenges within the constraints of limited digital resources and reduced clinical

exposure. This study aims to address this gap by examining the academic stressors, coping strategies, and online

learning difficulties experienced by Malaysian health science students during the COVID-19 pandemic. By

doing so, it provides a deeper understanding of how multidimensional stressors influenced learning experiences,

mental well-being, and academic performance during a time of crisis. The findings offer valuable insights for

administrators, and lecturers in refining academic systems to better support student well-being and academic

for health science students whose programs depend heavily on laboratory work, clinical practice, simulation

sessions, and hands-on learning that could not be fully replicated through virtual platforms. As conventional

routines collapsed, academic stress escalated dramatically due to increased workloads, higher academic

expectations, and the overwhelming shift to digital instruction, with many educators assigning additional

quizzes, online projects, and asynchronous modules in an effort to compensate for the loss of face-to-face

interaction, ultimately contributing to cognitive overload, academic fatigue, and feelings of being overwhelmed

among students globally and in Malaysia (Misra & McKean, 2020; Aristovnik et al., 2020; Rahman et al., 2021).

Disruptions to clinical and practical training further intensified stress, as students were abruptly deprived of

essential hands-on experiences and had to rely on video demonstrations or simulations that could not adequately

build clinical competence, leaving many feeling unprepared for real-world healthcare environments, anxious

about professional readiness, and fearful that they would not meet program outcomes (Son et al., 2020; Mohd

students who were expected to maintain academic performance despite losing essential practical experiences

(Tasso et al., 2021; Brooks et al., 2020). During this period, online learning brought additional obstacles,

including poor internet connectivity, limited access to digital devices, low engagement during virtual lessons,

home distractions, and challenges with online assessments, all of which disproportionately affected students

from rural or low-income backgrounds, widening inequalities in academic performance and digital readiness

(Nagib et al., 2023; Noor et al., 2021). Coping strategies varied widely, with some students adopting adaptive

approaches—such as improving time management, seeking help from lecturers, engaging in peer support groups,

practicing mindfulness, and drawing on religious or emotional coping—while others resorted to maladaptive

behaviors like procrastination, withdrawal, excessive screen use, and emotional suppression, which offered

temporary relief but ultimately worsened academic and psychological stress (Chong et al., 2021; Tasso et al.,

their academic progression (Noor et al., 2021). Despite abundant global research, critical gaps remain, including

limited focus on Malaysian diploma-level health science students, insufficient exploration of how coping

strategies mediate academic stress, inadequate understanding of how the loss of clinical exposure directly affects

academic and psychological outcomes, and a lack of insight into long-term post-pandemic educational

adaptations. Addressing these gaps, the present study seeks to provide a deeper understanding of academic

stressors, coping mechanisms, and online learning challenges faced by Malaysian health science students during

the COVID-19 pandemic.

This chapter presents a rigorously constructed methodological framework designed to systematically examine

the academic stressors, coping strategies, and online learning challenges faced by Malaysian health science

the multifaceted experiences of Malaysian health science students during the pandemic.

Academic stressors arising from online learning are presented in Table 4.3, with heavy workload (78%)

identified as the most intense stressor. This finding is consistent with studies showing that lecturers often

compensated for reduced face-to-face time by increasing assignments, readings, and asynchronous tasks.

Difficulty understanding online lessons (65%) further demonstrates the cognitive load imposed by virtual

instruction, especially for health science subjects requiring hands-on or demonstration-based learning. The fear

of failing examinations (72%) indicates the uncertainty students faced due to sudden changes in assessment

formats, time-restricted online tests, and concerns about technical disruptions. Reduced interaction with lecturers

(59%) reflects the communication gap inherent in online learning systems, reinforcing feelings of academic

isolation and uncertainty, while reduced motivation (68%) reflects cumulative burnout from prolonged exposure

to digital platforms.

Regarding coping mechanisms, Table 4.4 shows that spiritual coping (mean = 4.2) emerged as the most

commonly practiced strategy, reflecting the cultural and religious orientation of Malaysian students, who often

turn to faith-based practices during periods of uncertainty. Peer support (mean = 3.9) was another prominent

strategy, highlighting the importance of social connectedness even in virtual environments. While time

management (mean = 3.4) was moderately used, avoidance behaviours (mean = 3.1) indicated that some students

coped through withdrawal or disengagement, a pattern linked to higher stress levels. Lecturer consultation (mean

Table 4.4. Coping Strategies Used

conducive for learning, with shared spaces, family responsibilities, and noisy surroundings interfering with

attention and academic performance. Internet instability (58%) further exacerbated stress, preventing students

from participating fully in synchronous lessons, completing online assessments, or downloading essential

materials. Technical issues (49%) and limited device availability (42%) underscore the broader digital divide

affecting educational equity.

Table 4.5. Online Learning Challenges

Table 4.6. Internet Stability × High Stress

Table 4.7. Correlation Between Psychological Distress and GPA

need for universities to strengthen mental-health support, enhance digital resources, improve lecturer-student

communication, and redesign teaching strategies to better support health science students in times of crisis.

This study has powerfully demonstrated that the COVID-19 pandemic fundamentally reshaped the academic,

psychological, and technological realities of Malaysian health science students, producing a constellation of

enduring challenges that continue to influence their learning trajectories even as institutions return to hybrid and

physical learning modes. The findings reveal that psychological distress—particularly anxiety, stress, and

disrupted education are far from temporary. These heightened distress levels can be traced to an interlocking set

of academic, pedagogical, and environmental stressors, including overwhelming workload demands, highly

compressed academic schedules, unclear or inconsistent assessment formats, limited access to lecturers for

academic tasks—conditions that contributed not only to academic disruption but also to heightened frustration,

emotional exhaustion, and cognitive overload. These inequities highlight deeper structural concerns regarding

the digital divide in Malaysian education, where students from rural or low-income households faced

disproportionately greater barriers.

The negative correlations identified between psychological distress and academic performance underscore that

emotional well-being is not simply an auxiliary factor but an integral determinant of academic achievement.

Higher anxiety and stress levels were closely associated with lower GPA, reduced concentration, diminished

engagement, and increased likelihood of academic burnout, demonstrating the profound academic consequences

of unaddressed mental health issues. Although coping strategies such as spiritual practices, peer support

networks, and time-management skills offered some degree of emotional relief, the findings highlight persistent

continuous workshops on emotional resilience, mindfulness-based stress reduction, time management, and

internet packages, improved campus Wi-Fi, and designated study spaces with guaranteed connectivity to ensure

equitable learning opportunities. Given the crucial role of practical training in health sciences, institutions should

reinforce clinical readiness by offering supplementary clinical rotations, simulation-based skill training, virtual

laboratory platforms, and collaborative partnerships with healthcare facilities to increase placement

opportunities. Academic flexibility must also be strengthened by providing transparent assessment rubrics,

clearer communication of deadlines, reasonable workload distribution, and open two-way communication

channels that encourage students to seek guidance without fear of judgment. By integrating these reforms, higher

education institutions can cultivate a more inclusive, supportive, and psychologically safe academic

environment. In conclusion, the COVID-19 pandemic acted as a powerful stress test for Malaysia’s higher

education system, exposing systemic weaknesses in digital access, mental health infrastructure, lecturer training,

and academic support mechanisms. For health science students—who are expected to cultivate both technical

science students to meet the complex demands of the healthcare sector with confidence, competence, and

emotional stability. Ultimately, cultivating resilient, well-supported, and adaptable students today is essential for

building a strong, sustainable, and responsive healthcare workforce for Malaysia’s future.

I would like to express my deepest gratitude to all individuals who contributed to the successful completion of

this research. First and foremost, I extend my sincere appreciation to AP. Dr. Alias bin Mahmud, whose academic

guidance, constructive feedback, and continuous encouragement were instrumental throughout every stage of

this study. I am also profoundly grateful to my co-authors—Azmi bin Ab Manan, Zuraida bt. Jorkasi, Siti

Maisarah, Mohd Azroy and Rozila Binti Ibrahim for their invaluable insights, collaboration, and unwavering

commitment to ensuring the quality and integrity of this work. A special acknowledgement is also due to the

Faculty of Applied Sciences (FTAS), Open University Malaysia, for providing the academic platform,

institutional support, and research resources needed for this project. I would also like to extend heartfelt thanks

to all Diploma in Medical and Health Sciences (DMHS) students who willingly participated in the study; their

openness and honest responses made this research possible. Finally, I wish to acknowledge the moral support of