Introduction

Classroom is a good place to transfer teachers’ experiences to students and  provide a better understanding for them. Presence in the classroom not only helps the students in understanding the contents, but also places them in a better situation to solve hard problems (1) Those who know the importance of students' attendance in class, believe that presence in class, increases students’ knowledge,  promotes their ideas, and change their attitudes (2) In this regard a study showed that class attendance reduces academic failure. This study also that factors such as poor teaching methods, non usefulness of contents, class over crowding, lack of students’ participation in class discussions, are the absence reasons (3) . Recently, students’ absence is one of the increasing problems in universities of medical sciences and if the teacher does not check the attendance, some of students do not come to class even once (4). This issue disrupts the teaching-learning dynamic environment and converts it into a dull and unpleasant one (5)The core of medical education, are the learners who acquire the knowledge and skills needed for serving the society through to active participation in class discussions (6) . The teacher also plays a special role in medical education by having features such as mastery over the content, power of speech and ability to transfer knowledge (5) . In a study, inappropriate teaching (7) and in the another study, teacher performance and educational problems (8) had the greatest impact on students’ absenteeism. Doyle et al, reported that the main reasons for absence are: travel, dissatisfaction with the class schedule and personal problems (9).  Another study showed that the lesson content and attractiveness of teacher’s speech are effective in increasing of  presence in class (5). In the study was conducted by Fleming et al, most of students reported that stress, weak speech of teacher, inappropriate time of class, and poor contents, as the reasons for their absence (10). Timmins et al reported that the unauthorized absenteeism of nursing students in clinical programs are more than the theoretical classes and in both, the main reasons for absence were personal and family problems and stress (11) . A study which was conducted on medical students in Semnan University of Medical Sciences, reported that inappropriate teaching method, lack of sleep and rest at night, are the most important factors affecting the students' presence in class (12) .Another study in Jahrom University of Medical Sciences, reported that inappropriate teaching method and little class efficiency are the factors that affect the absence (13). The findings of a study which was conducted at Tehran University, implies that inappropriate teaching methods is the most important cause of absence (14). Students’ presence in class has a potential impact on the ability of them in future activities. Despite numerous studies on the causes of absenteeism, the absence reduction strategies have not yet been investigated  from the students’ perspective. Thus, the aim of study was to determine the strategies to reduce the absenteeism from the viewpoints of students in Shahrekord University of Medical Sciences.

Methods

The population of this cross-sectional study were all of students studying in the second semester of the academic year 2014-2015 in ... University of Medical Sciences. The Participants were 401 students from the departments of Medicine, Nursing and Midwifery, Health and Paramedicine. Inclusion criteria were studying in the 2nd to 8th semesters and a willingness to participate in the study. Guest and transfer students were excluded from the study due to their particular conditions. Systematic random sampling was carried out and at the beginning of study, the first sample was selected randomly, then the rest were selected with equal distance from each other. The sample size with 95% confidence interval and α=0.05 was estimated 378 students and due to possible dropouts, 401 subjects  were studied.  For data collection, a questionnaire was developed by the researcher to measure the individual variables and form of students’ suggested strategies with 5 parts scale.

 In order to develop the form,  a pilot study was firstly conducted on 30 students asking "What are your proposed strategies for reducing the absenteeism" and they expressed suggested solutions. Then, based on their suggestions, a form containing 27 items was designed and its content validity was confirmed by 10 experts. To verify the reliability, the form was given to 21 students and by Cronbach's alpha coefficient, the reliability was determined 0.93. Data collection was performed with coordination of education section at the end of the second semester 2014-2015 academic year.  The researchers personally attended in all classes and explained the purpose and significance of study to students. Also they were asked not to consider a partcular teacher and to respond to questions generally. Data analysis was performed with SPSS 16 using descriptive statistics (Mean±SD and Percentage) and analytical statistics (Pearson correlation test) and P

Results

Mean age of students was 22.21±4.69 (range:18-49) years. Eighty-one percent of students were female and 19% were male. Eighty-two percent of the students were single and 18% were married. About 65 percent of students were native to the province and the rest were non-native. The suggested strategies for reducing the absenteeism from the viewpoints of all students in four schools are presented in Table 1, indicating that the students reported the high rates of effectiveness for all of the proposed strategies,  and among them, strategies related to the teacher were more important (Table 1). Mean scores given by the students in each of the proposed solutions are presented in Table 2, indicating that the mean scores of the teacher-related items were of more importance than other items (Table 2).

Table 1: Frequency of students' views on the effectiveness of strategies to reduce absenteeism

Table 2. The mean scores given by the students to the proposed strategies

The pearson correlation test showed that there is not a significant relationship between the individual variables of students such as age (P=0.25), gender (P=0.71), marital status (P=0.10), nativity (P=0.19), department (P=0.32), and grade point average (P=0.65) with the proposed strategies to reduce the absenteeism.

Discussion

The main objective of this study was to determine the strategies to reduce absenteeism from the viewpoints of students in Shahrekord University of Medical Sciences. In this regard, the findings of the study showed that from the opinions of students in four schools, the most important proposed strategies were: the teacher’s mastery over the course content, actively teaching and attention to students’ learning, teacher’s well-behaving and respectful attitude towards students, making the class atmosphere cheerful,  applicational teaching, attending sessions regularly and giving importance to the students' attendance, teaching main contents of the course and  not addressing the irrelevant issues, using a variety of teaching methods and up-to-date contents in teaching , responding to the students’ questions properly, and conducting continuous evaluations throughout the semester. The strategies for reducing the absenteeism from the viewpoints of students have not been studied in Iran and  the previous studies just have examined the factors influencing the absenteeism. Therefore, there was not a similar study that the findings of present study can be compared with its and now refers to studies that have examined the factors affecting the absenteeism. The teacher’s mastery over the course content was the most important effective factor in reducing the absenteeism. The findings of two studies were conducted at Tehran and Semnan Universities of Medical Sciences, implies that inappropriate teaching method is the most important cause of absence ((12), (14)). Another study reported that, lack of sleep and rest at night, are the most important factors affecting students' presence in class (12). In Jahrom University of Medical Sciences, a study reported that inappropriate teaching methods, and little efficiency classes are the factors that affect the absence of class (13).The findings of all noted studies are in line with the findings of  present study.  A study reported that most of the students believed that the teacher’s mastery over the content and power of speech are the main reasons for students' attending classrooms (15). Similar findings have been reported in another study (16, 17)  . Lipscomb et al. has reported that the most important factor in the increasing attending of students in class, is the teacher characteristics such as his teaching and the charm of his words (4).  In another study, mastery of teacher over the subject, was the most important factor contributing to students’ attending in class (15) which is in line with the findings of present study, indicating that a teacher must study continuously to master the materials content.

 In the present study, another important strategy which the majority of students considered as effective in reducing  absenteeism, was actively teaching and attention to students’ learning. This finding has been confirmed in other studies (18), (19), (15) as well. In the present study, another important strategy was the cheerful class atmosphere that 79% of students reported as significant for reducing the absenteeism. Although other studies have not studied the role of this factor directly, in a study, motivating the students played the most important role in students’ attending in class. This study also reported that the teacher should keep the classroom activities in a vibrant state and attract the attention of students to learn (18) . In this regard, Gump reported that teacher’s giving importance to the students attendance in class and making the lesson attractive for them, were the most important motivational factor for students attending in class (19).

In the present study, Applicational teaching and trying to attractive the content, were strategies which most of the students considered as effective in reducing the absence. A study that examined the attendance of medical students in class, reported that use of the materials presented in classrooms at the patient's bedside, was the factor representing the student’s persistently attending classroom (20)  . A study carried out on dental clinical students, has reported that the expression of clinical experience of teacher and identifying the relationship between the content taught in theory and clinical practice, are important factors of adult learning (21) .This finding which was confirmed in another study (5) is in line with the findings of the present study. Teaching the main contents of the course and not addressing the irrelevant issues was the another important strategy which 72% of students reported as important in reducing the absenteeism.  Although this has not been studied in other studies, it seems that the teacher's attention to main content course enables him that integrate his/her content and teach all course content within the time set. In present study, regularly attending sessions and giving importance to the students' attendance were other proposed solutions, reported by the most of students.

The findings of a study reported that in the lack of attendance by the teachers,  the possibility of student absenteeism rises to high levels class (19, 22)  Timmins et al. reported that for the continuing presence of nursing students in the classroom, control and close monitoring should be done for attendance (11)  which the findings of all these studies are in line with current study. Another strategy that the majority of students knew it effective in the reducing of absenteeism, was imposing regulations to facilitate nightly rest and sleep in dormitory. In the literature review, we did not find the similar finding, but our experiences shows that living in a dorm and multiplayer rooms causing makes the students stay up all night and at the next morning due to fatigue do not attend in class. Continuous evaluation throughout the semester, was another suggestion which about 70% of the participants considered it important in reducing the absenteeism. Wittmann et al. reported similar findings (23) . In the continuous evaluation, the strengths and weaknesses of students are identified and given appropriate feedback to them and this will increase their presence in the class.

In current study, involving the students in the class discussions, was the strategy which 71% of the participants considered as effective in the active presence in the class. A study reported that if the teachers engage the students in class discussions, the absence of them will be reduced . Similar findings have been reported in another study (2).  In this regard, teachers should make the students actively participate and involve them in all stages of teaching. By doing so, the student tries to rebuild their learning experiences and institutionalize them (24, 25).

The most important proposed strategies of students for reducing the absenteeism, were related to teacher. In this regard, teacher’s mastery over the content,  activly teaching and attention to students’ learning, teacher’s well-behaving and respectful attitude towards students, making the class atmosphere cheerful, applicational teaching and trying to attractive the content, teaching main contents and not addressing the  irrelevant issues, regularly attending sessions and giving importance to the students' attendance, using a variety of teaching methods and new contents,  responding to the students’ questions properly, continuous evaluation throughout the semester, and involving all of students in the class discussions, are suggested.

 Acknowledgments

This manuscript was obtained from a research project approved by the Research Council of Shahrekord University of Medical Sciences (no. 1862). Hereby, we gratefully thank Research and Technology Deputy of Shahrekord University of Medical Sciences for funding this research and the students for cooperating in it.

Authors´ Contributions

Masoumeh Delaram designed the study and wrote the manuscript; Fariba Asefi gathered the data and revised the manuscript. Sahand Shams analyzed the data and revised the manuscript.

Conflict of Interest

No conflicts of interest were declared by the authors.