Associations of learning style with cultural values and demographics in nursing students in Iran and Malaysia

Purpose: The goal of the current study was to identify associations between the learning style of nursing students and their cultural values and demographic characteristics. Methods: A non-probability purposive sampling method was used to gather data from two populations. All 156 participants were female, Muslim, and full-time degree students. Data were collected from April to June 2010 using two reliable and validated questionnaires: the Learning Style Scales and the Values Survey Module 2008 (VSM 08). A simple linear regression was run for each predictor before conducting multiple linear regression analysis. The forward selection method was used for variable selection. P-values ≤0.05 and ≤0.1 were considered to indicate significance and marginal significance, respectively. Moreover, multi-group confirmatory factor analysis was performed to determine the invariance of the Farsi and English versions of the VSM 08. Results: The perceptive learning style was found to have a significant negative relationship with the power distance and monumentalism indices of the VSM 08. Moreover, a significant negative association was observed between the solitary learning style and the power distance index. However, no significant association was found between the analytic, competitive, and imaginative learning styles and cultural values (P>0.05). Likewise, no significant associations were observed between learning style, including the perceptive, solitary, analytic, competitive, and imaginative learning styles, and year of study or age (P>0.05). Conclusion: Students who reported low values on the power distance and monumentalism indices are more likely to prefer perceptive and solitary learning styles. Within each group of students in our study sample from the same school the year of study and age did not show any significant associations with learning style.


INTRODUCTION
Although the relationship between learning styles and culture has been studied for decades, gaps remain in the understanding of individual learning style in various cultural groups. The cultural backgrounds of students may lead to cultural synergy, or sometimes may cause misunderstanding in cases where conflicts exist with the pedagogical methodologies employed in academic programs. Consequently, it is crucial to understand how cultural values influences learning style. However, the question of which learning styles are associated with which cultural values has not yet been fully resolved. Moreover, understanding socio-cultural associations with learning styles might help to identify potential differences in students' learning behaviors. The goal of this study was to identify associations between the learning style of nursing students in Iran and Malaysia with their cultural values and demographic characteristics.

Subjects
Out of 243 subjects, only female, Muslim, and full-time de-"PD indicates that the less powerful members of a society expect and accept that power is distributed unequally. IDV refers to a society in which a person is expected to look after himself or herself and his or her immediate family only. MAS stands for a society in which social gender roles are clearly distinct; men are supposed to be assertive, tough, and focused on material success and women are supposed to be more modest, tender, and concerned with the quality of life. UA is the extent to which the members of institutions and organizations within a society feel threatened by uncertain, unknown, ambiguous, or unstructured situations. LTO stands for a society that fosters virtues oriented towards future rewards, in particular adaptation, perseverance, and thrift. IVR stands for a society that allows or restricts relatively free gratification of some desires and feelings, especially those that have to do with leisure, merrymaking with friends, spending, consumption, and sex. MON stands for a society which rewards people who are, metaphorically speaking, like monuments: proud and unchangeable. " These parameters reflect core cultural values and are very stable across time. All questions were scored on a five-point Likert type scale. The scores of the indices were calculated based on the formulas described by Hofstede et al. [3]. The score for each cultural value was derived based on the mean score of the corresponding questions based on the formula outlined by Hofstede et al. [3]. Every cultural value normally has a range of approximately 100 points.
The demographic characteristics investigated in this study were age and year of study (first, second, third, or fourth year of study). Dummy variables were created for the year of study variables, and the first year of study was assigned as the reference group. Male nursing students and non-Muslims were excluded because only one male nursing student was in the USM cohort and only one non-Muslim nursing student was in the ZBUMS cohort.
The nursing students at USM and ZBUMS were administered English and Farsi versions of the instruments, respectively. Two bilingual experts translated the original English instruments into Farsi and translated them back to English. The researchers then evaluated the invariance of the English and Farsi questionnaires. Permission to use the VSM 08 for the purposes of this study was obtained from Professor Geert Hofstede, its author, via e-mail.

Ethical approval
Ethical approval was obtained from the Ethics and Research Board (Human) of USM and was applied to both study settings. Informed consent was obtained through a cover letter. The questionnaires were distributed and collected from April to June 2010 during regular class time, in order to achieve an optimal response rate.

Statistics
The data were analyzed using IBM SPSS ver. 20.0 (IBM Co., Armonk, NY, USA) and AMOS ver. 18.0 (SPSS Inc., Chicago, IL, USA). Since the year of study was a categorical variable, it was transformed into dummy variables and the first year of study was assigned as the reference group. Cultural values and age were entered into the regression model as continuous predictors. We ran a simple linear regression (SLR) for each predictor before conducting a multiple linear regression (MLR). The forward selection method was used for variable selection. P-values ≤ 0.05 and ≤ 0.1 were considered to indicate significance and marginal significance, respectively.
In addition, multi-group confirmatory factor analysis was run to determine the invariance of the Farsi and English versions of the VSM 08. The metric of equivalence was examined because it is an essential and adequate condition for measuring regression coefficients and covariance across groups [4]. Furthermore, the comparative fit index and the root mean square error of approximation were calculated. Comparative fit index values close to 0.95 indicate a well-fitted model and root mean square error of approximation values < 0.06 indicate a good fit, while values of 0.08-0.10 indicate a medium fit and values > 0.10 indicate a poor fit [5].

RESULTS
The average ages of 156 nursing students at ZBUMS in Iran and USM in Malaysia was 20.87 ± 1.35 years and 21.74 ± 1.13 years, respectively. All participants were female and Muslim. Among the ZBUMS nursing students, 19 (15.4%), 24 (19.5%), 66 (53.7%), and 14 (11.14%) were enrolled in the first, second, third, and fourth year of study, respectively, whereas among the USM nursing students, 11 (9.3%), 38 (32.2%), 33 (28.0%), and 36 (30.5%) were enrolled in first, second, third, and fourth year of study, respectively. Of the cultural values, only the UA index did not meet the criterion of metric invariance. Consequently, it was excluded from further analyses ( Table 1). Table 2 presents the associations between cultural values    Table 3 presents the non-significant associations between cultural values and the analytic, competitive, and imaginative learning styles (all P > 0.05). Table 4 demonstrates the lack of any significant associations between all learning style (perceptive, solitary, analytic, competitive, and imaginative) and year of study and age (all P > 0.05).

DISCUSSION
The current study investigated associations between the learning style of two groups of female Muslim undergraduate nursing students from Iran and Malaysia and their cultural values, age, and year of study. The construct invariance of the Farsi and English versions of the VSM 08 was evaluated using multi-group confirmatory factor analysis. Of the cultural indices, only the UA index did not meet the criterion of metric invariance, and it was therefore excluded from further investigation.
Our results showed no significant associations between demographic characteristics (year of study and age) and learning style. These findings correspond with the results of some researchers who did not find any significant correlations between age and learning modes or styles in young people [6][7][8]. However, the findings of the current study contrast with those of some other studies; for instance, Joy and Kolb [6] found that age was associated with a preference for the active-experimental and reflective-observation learning modes. Those modes may be comparable to the sensing learning style investigated in the current study. Chen [9] found a significant relationship between grade and kinesthetic, tactile, and individual learning style. In the current study, the participants were between 18 and 24 years of age, reflecting a homogeneous, non-dispersed distribution in the age of the study population.
We found that the PD and MON indices were negatively associated with the perceptive learning style. In large-PD societies, independent behaviors and active experimentation are not encouraged. The educational process is teacher-centered, especially in advanced subjects taught at universities. The students must follow the teachers' strict guidelines [10,11]. MON  refers to pride and stability versus humility, flexibility, and adaptability in changing circumstances. People in MON societies focus on abstract and theoretical sciences in school [10]. In high-MON societies, people are immutable, less cooperative, poorly educated, and low achievers in schools [12]. Our findings suggest that students who reported low values for both the PD and MON indices had a greater preference for the perceptive learning style. Perceptive learners need more studentcentered approaches to learning. Instructors should also be flexible in supervising perceptive learners in both classrooms and clinical situations. We also found that the PD index was associated with the solitary learning style. Solitary students tend to learn and study alone. In contrast, sociable students tend to learn and study in groups [2]. Students who reported large PD and small PD values were found to be more inclined towards the sociable and solitary learning styles, respectively. These findings support the view that the PD index negatively correlates with the independent learning style [10]. Therefore, we can state that the sociable learning style is associated with collectivist and large-PD values.
The results of the SLR showed a positive, marginally significant association between IDV and the analytic learning style. These findings correspond to arguments by Mitsis and Foley [13], as well as those of Joy and Kolb [6], that people with a high sense of in-group collectivism are more abstract and reflective learners. Analytic learners focus on and remember the details of subjects. However, they rely on their own cognitive abilities to learn independently. IDV refers to the importance of the interests of individuals over the interests of the group. In individualistic societies, people look after only themselves and their immediate family members, such as siblings. Individualistic societies aim to enable students to be independent, to have positive attitudes towards innovations, and understand 'how to learn' rather than 'how to do' [10].
Our results showed a marginally significant negative association between MON scores and the imaginative learning style. Imaginative learners create a mental picture of what they read, listen, watch, and study. They are whole-brain learners, which refers to the ability to integrate the right-brain and left-brain functions in learning situations [14]. The MON index refers to pride and stability versus humility, flexibility, and adaptability to changing circumstances. It was found that imaginative learners tended to be more flexible and adaptive to innovations. This also implies that flexible and cooperative learning environments may improve the ability of learners to be imaginative.
In conclusion, students who reported low values for the PD and MON indices had a greater preference for the perceptive and solitary learning styles. In the groups analyzed in this study, year of study and age did not show any significant associations with learning style. Although cultural values explained a small percentage of the variation in learning style according to MLR, the identification of associations between cultural values and learning style is valuable nonetheless. These findings also indicate that cultural values are not the primary factor that explains variation in learning style. However, our findings indicate that cultural differences may affect students' acquisition of new knowledge. Furthermore, students and instructors can overcome cultural differences in teaching and learning environments to achieve improved and more consistent outcomes in global nursing education. Further studies should be carried out with different populations across many countries in order to confirm the robustness of these findings.