The Effect of Social Support on Learning Investment among Nursing Students: The Mediating Role of Self-Efficacy

The Effect of Social Support on Learning Investment among Nursing Students: The Mediating Role of Self-Efficacy | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Effect of Social Support on Learning Investment among Nursing Students: The Mediating Role of Self-Efficacy Liping Wu, Yan Chen, Meiqin Xue, Weiyi Zhu, Wei Wang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6139781/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 21 Jul, 2025 Read the published version in BMC Nursing → Version 1 posted 15 You are reading this latest preprint version Abstract Background Social support significantly influences nursing students' academic and professional development, yet its specific impact on learning engagement remains underexplored. Self-efficacy may mediate this relationship, but evidence is limited. Understanding how social support affects learning engagement through self-efficacy is crucial for optimizing nursing education. This study examines the impact of social support on nursing students' learning engagement and the mediating role of self-efficacy,offering insights for educators. Method A total of 309 nursing students from 12 schools participated in this survey, completing a self-designed questionnaire that included scales measuring learning engagement, perceived social support, and self-efficacy, in addition to collecting demographic data such as educational level and age. Data analysis was conducted via SPSS 21.0 to explore the relationships among the variables. AMOS 26.0 software facilitated mediation analysis to assess the moderating effects of self-efficacy. Bootstrap analyses were used to evaluate the mediating effect between variables. Results The study revealed significant positive correlations between learning engagement (84.42 ± 21.24), social support (69.04 ± 11.15), and self-efficacy (27.78 ± 6.63) (p < 0.01). Social support significantly influenced both learning engagement (β = 0.282, p < 0.01) and self-efficacy (β = 0.503, p < 0.01). Furthermore, self-efficacy had a significant impact on learning engagement (β = 0.482, p < 0.01), partially mediating the relationship between social support and learning engagement, with a mediation effect ratio of 46%. Conclusion The findings highlight the significant positive impact of social support on learning engagement among nursing students:, with self-efficacy serving as a critical mediator in this relationship. To promote more active learning engagement, it is recommended that educators prioritize strengthening social support systems and enhancing students' self-efficacy. Special attention should be given to fostering self-efficacy among non-only children, as this may further optimize their learning experiences and outcomes. These insights provide valuable guidance for developing targeted educational interventions in nursing training programs. social support self-efficacy learning engagement mediating effect Figures Figure 1 1 Background Nursing has become a cornerstone of modern healthcare, with the quality of nursing education playing a pivotal role in shaping the professional competence and service quality of future healthcare providers. As the medical landscape grows increasingly complex, with ever-evolving patient needs, nursing students are challenged to acquire not only comprehensive theoretical knowledge but also develop robust practical application skills. Self-determination theory highlights that individuals are innately driven to seek autonomy, competence, and relatedness, which are essential for personal growth and development 1 . The nursing internship represents a critical transitional phase, bridging academic preparation with clinical practice, where students transform theoretical knowledge into practical expertise. The concept of learning engagement is crucial here, serving as a protective factor that enhances the learning performance of nursing students, boosts their learning capabilities, and has a direct effect on their future career development and the quality of the nursing services they provide 2 – 4 . Learning engagement is defined as the time and energy that students devote to their studies and effective educational activities. It embodies profound and constructive involvement in the learning process, accompanied by an appreciation of its importance 5 . Learning engagement is characterized by vitality, dedication, and focus. It represents the manifestation of students' subjective initiative and serves as a medium that influences professional development 6 – 8 . As the demands of modern medical care increasingly vary, nurses students are compelled to invest more time and effort into their education and training, enhancing their professional skills and overall qualities to meet the diverse needs of patients. This investment is vital for equipping them to effectively address the multifaceted needs of patients. Given the pivotal role of learning engagement in the growth of nursing students, it is crucial to explore the factors that influence it and the mechanisms through which it operates. Such exploration will not only shed light on the dynamics of learning engagement but also guide the development of targeted interventions aimed at optimizing the learning experiences of nursing students. By fostering a deeper understanding of these elements, educators and policymakers can design strategies to enhance learning engagement, ultimately advancing nursing education and improving the quality of patient care. The concept of "perceived social support" refers to the emotional experience in which individuals feel understood, respected, cared for, and assisted within their social relationships 5 . This phenomenon reflects an individual's expectations and evaluations of the social support they believe is available to them, representing a fundamentally subjective form of emotional support. Research consistently demonstrates that social support generally exerts a beneficial influence; individuals who perceive high levels of social support, along with the expectation of receiving such support, tend to exhibit enhanced learning motivation and a stronger commitment to learning. This enables them to approach learning with a positive attitude and adapt more effectively to the learning process 9 10 . Empirical studies have further validated that perceived social support significantly enhances students' enthusiasm for learning, increases their engagement in educational activities, and positively predicts their level of learning investment 11 . For nursing students, the level of perceived social support plays a crucial role in shaping their adaptability during clinical internships. When these students feel supported during their clinical placements, they are more likely to maintain a positive and optimistic outlook, which in turn enhances their confidence and ability to manage challenges. This sense of support not only alleviates psychological stress but also contributes to greater job satisfaction and a stronger intention to pursue long-term career development. By cultivating a supportive environment, educators and clinical supervisors can empower nursing students to excel in their roles, ultimately promoting both their professional growth and the quality of patient care they deliver. According to Albert Bandura's social cognitive theory, self-efficacy is a critical determinant of individual behavior, serving as a foundational element in shaping how individuals approach tasks and challenges 12 . Self-efficacy refers to an individual's confidence in their ability to accomplish specific tasks or achieve desired outcomes, and it plays a pivotal role in determining levels of student participation and motivation 10 13 . Research consistently indicates a positive correlation between self-efficacy and learning engagement; students with high self-efficacy tend to experience greater enjoyment and derive more value from their learning activities 14 15 . In the context of nursing education, self-efficacy is particularly significant as it directly impacts students' attitudes and performance when confronted with the challenges of clinical practice. Those with high self-efficacy are more likely to exhibit positive learning attitudes and behaviors, respond constructively to challenges, and adapt more swiftly and persistently to the clinical work environment 16 . Additionally, social cognitive theory highlights that external factors such as guidance, expectations, and support from others can significantly influence an individual's self-efficacy 13 . Nursing students who are highly perceptive are better equipped to recognize and accept external support, fostering the establishment of positive relationships that further enhance their learning attitudes and self-efficacy. Despite the increasing recognition of the importance of social support, self-efficacy, and learning engagement in nursing education, there remains a notable gap in research examining the specific mechanisms through which these factors interact and influence one another. The current literature has yet to fully elucidate the complex interrelationships and pathways linking these variables, particularly within the context of nursing students.Consequently, future studies should focus on exploring the interrelations between learning engagement, general self-efficacy, and perceived social support among nursing students. Such studies should aim to elucidate the relationships and pathways among these variables, providing a clearer understanding of the needs and challenges faced by nursing students during their educational and adaptation processes. This deeper understanding is expected to offer a theoretical foundation for improving nursing education models and methods, ultimately enhancing the training and professional development of nursing students. 2 Method 2.1 Study design A cross-sectional study was conducted in November 2024 to elucidate the relationships among social support, learning engagement, and general self-efficacy in nursing students. 2.2 Setting and sample This study employed a convenience sampling method to conduct a questionnaire survey among nursing students from 12 schools who were undergoing clinical internships at a tertiary Grade A hospital in Shanghai in November 2024. Inclusion criteria mandated that participants had a minimum of three months of clinical internship experience and voluntarily provided informed consent. Exclusion criteria included unwillingness to participate and any health-related absences that prevented involvement in the survey. 2.3 Sample size Based on the sample size calculation formula, which recommends that the sample size should be 5 to 10 times the number of scale items, this study, comprising 39 items, required a minimum sample size of 234 participants, accounting for a 20% attrition rate. Furthermore, structural equation modeling requires a minimum sample size of 200. Therefore, the inclusion of 309 participants in this study meets these requirements. 2.4 Data collection The online questionnaire was distributed to nursing students via “Wenjuanxing (a Chinese online survey platform)”. To ensure data quality, an on-site, face-to-face survey method was employed, requiring nursing students to complete the questionnaire on the spot. Researchers were available to address any questions in real time. To ensure completeness, all questions were set as mandatory, and each IP address was restricted to a single submission to prevent duplicate responses. A total of 309 questionnaires were collected, with a valid response rate of 100%. 2.5 Instrments General Information Survey This survey, developed by the researchers, collects demographic information about the nursing students, including their educational level, age, place of origin, and whether they are only children. The Perceived Social Support Scale (PSSS) Developed by Zimet 17 and translated into Chinese by Jiang Qianjin, the PSSS is a psychological instrument designed to assess individuals' self-perceptions and perceptions of social support. The scale comprises 12 items that evaluate both familial and external family support dimensions 18 . Each item is scored using a 7-point Likert scale, ranging from 1 to 7, and is divided into seven levels: strongly disagree, disagree, slightly disagree, neutral, slightly agree, agree, and strongly agree.The total scores can vary from 12–84, with higher scores reflecting a stronger perception of social support.In this study, the scale demonstrated high reliability, with a Cronbach's α coefficient of 0.951 and a KMO value of 0.936. General Self-Efficacy Scale (GSES) Localized, translated, and revised by Wang Caikang et al. in 2001 19 , the General Self-Efficacy Scale (GSES) is a tool designed to assess an individual's self-confidence in coping with stress and overcoming challenges. 20 . The GSES comprises 10 items scored on a 4-point Likert scale ranging from 1("completely incorrect" )to 4("completely correct"), with total scores ranging from 10 to 40. Higher scores indicate stronger self-efficacy. In this study, the reliability of the GSES is supported by a Cronbach's α coefficient of 0.954 and a KMO value of 0.921, demonstrating its robustness and suitability for application. Learning Engagement scale The Utrecht Work Engagement Scale-student(UWES-S)was used to measure nursing students learning engagement. Originally developed by Schaufeli et al. 21 and adapted into Chinese by Fang Laitan et al. 22 in 2002, the Utrecht Work Engagement Scale-student(UWES-S) assesses students' engagement in learning activities. This scale consists of three dimensions, vigor (6 items), dedication (5 items), and absorption (6 items). Responses are measured using a 7-point Likert scale ranging from 1representing "never" to 7 representing "always/daily",with total scores ranging from 17 to 119.Higher scores indicate greater engagement.In this study, the scale's reliability is supported by a Cronbach's α coefficient of 0.964 and a KMO value of 0.954, demonstrating its robustness and applicability. 2.6 Ethical considerations This study received ethical approval from the Research Ethics Committee of Ruijin Hospital, affiliated with Shanghai Jiao Tong University School of Medicine (Approval Number: 2024 − 455).Informed consent was obtained from all participants, and the questionnaire incorporated a statement guaranteeing anonymity, confidentiality, and the right to withdraw from the study at any time. 2.7 Statistical methods The SPSS 21.0 software program was used to analyze data. Normally distributed measurement data are presented as the means ± standard deviations (x̄ ± s), whereas categorical data are presented as frequencies and percentages. One-way ANOVA and Pearson correlation analysis were applied to explore the relationships between learning investment, social support, and self-efficacy. Structural equation modeling (SEM) was performed using AMOS 26.0 software to evaluate mediating effects, with bootstrap methods applied to test the significance of these effects. Statistical significance was set at p < 0.05 and p < 0.01. 3 Results 3.1 General Information A total of 309 students from 12 schools participated in the survey. The mean age of the participants was 20.56 years (SD = 0.97 years). Of the participated nursing students, 81 students (26.2%) had a bachelor's degree, and 228 students (73.8%) had an associate degree. The gender distribution included 54 male students (17.5%) and 255 female students (82.5%). Geographically, 204 students (66%) were from Shanghai, whereas 105 students (34%) were from other regions.Regarding family demographics, 193 students (62.5%) were only children, and 116 students (37.5%) were not. 3.2 The scores of learning engagement, social Support, and self-efficacy among nursing students As shown in Table 1 , the mean score for learning engagement among nursing students was 84.42 (SD = 21.24), with the highest mean score observed in the dedication dimension (5.33 ± 1.23). The mean scores for social support and self-efficacy were 69.04 (SD = 11.15) and 27.78 (SD = 6.63), respectively. Table 1 The scores of learning engagement, social Support, and self-efficacy among nursing students(n = 309) Variables Number of item Scoring range total score mean score per item Learning engagement score 17 17 ~ 119 84.42 ± 21.24 4.97 ± 1.25 vigor 6 6 ~ 42 28.29 ± 8.62 4.71 ± 1.4 4 dedication 5 5 ~ 35 26.64 ± 6.14 5.33 ± 1.2 3 absorption 6 6 ~ 42 29.50 ± 7.97 4.92 ± 1.3 3 Social support score 12 12 ~ 84 69.04 ± 11.15 5.74 ± 1. 10 familial support 4 4 ~ 28 22.91 ± 4.40 5.77 ± 0.92 external family support 8 8 ~ 56 46.12 ± 7.37 5.76 ± 0.93 Self-efficacy score 10 1 ~ 40 27.78 ± 6.63 2.78 ± 0.66 3.3 Correlation analysis of learning engagement, social support, and self-efficacy As shown in Table 2 , learning engagement had significant positive correlation with social support (r = 0.478, p < 0.01), and self-efficacy (r = 0.583, p < 0.01). As shown in Table 2 ,social support had significant positive correlation with self-efficacy (r = 0.473, p < 0.01). These findings indicate strong positive interrelationships among the studied variables. Table 2 Correlation analysis between learning engagement, social support and self-efficacy (n = 309) Variables Learning engagement score vigor dedication absorption Social support score familial support external family support Self-efficacy score Learning engagement score 1.000 — — — — — — — vigor 0.941** 1.000 — — — — — — dedication 0.929** 0.821** 1.000 — — — — — absorption 0.934** 0.795** 0.818** 1.000 — — — — Social support 0.478** 0.463** 0.452** 0.425** 1.000 — — — familial support 0.422** 0.434** 0.382** 0.361** 0.910** 1.000 — — external family support 0.470** 0.441** 0.455** 0.427** 0.969** 0.780** 1.000 — Self-efficacy score 0.583** 0.536** 0.550** 0.551** 0.473** 0.423** 0.462** 1.000 **. Significantly correlated at the 0.01 level (bilateral) 3.4 Comparison of learning engagement, social support, and self-efficacy scores between only-child and non-only-child nursing students As shown in Table 3 , no significant differences were observed between only child and non-only child in terms of learning engagement and social support. However, a significant difference in self-efficacy scores was found, with only child scoring higher (28.47 ± 6.65) than non-only child (26.64 ± 6.46), p < 0.05. Table 3 Comparison of learning engagement, social support, and self-efficacy scores between only-child and non-only-child nursing students(n = 309) Variables only child n mean Standard deviations t P Learning engagement Yes 193 83.65 21.64 -0.823 0.411 No 116 85.71 20.59 Social support Yes 193 69.88 10.81 1.725 0.086 No 116 67.63 11.60 Self-efficacy Yes 193 28.47 6.65 2.372 0.018 No 116 26.64 6.46 3.5 Mediating effect analysis of self-efficacy on the relationship between social support and learning engagement Using AMOS 26.0, a structural equation model was constructed with social support as the independent variable, self-efficacy as the mediating variable, and learning engagement as the dependent variable. As shown in Table 4 ,the model was fitted using maximum likelihood estimation.The fit indices(χ2/df = 2.310, CFI = 0.975, GFI = 0.923 RFI = 0.947, TLI = 0.969, RMSEA = 0.065)demonstrated a satisfactory model fit in Table 4 . As shown in Table 5 ,the analysis indicated that social support significantly influences both learning engagement (β = 0.282, p < 0.01) and self-efficacy (β = 0.503, p < 0.01). Similarly, self-efficacy significantly affects learning engagement (β = 0.482, p < 0.01), confirming its partial mediating role. Mediation analysis using the bootstrap method (n = 2000) revealed an indirect effect of 0.252(Bootstrap 95% CI=[0.162, 0.354]). The 95% confidence interval of Bootstrap did not contain 0. As shown in Fig. 1 and Table 5 , this confirms the significant mediating effect of self-efficacy, which accounts for 46% of the total effect. Table 4 Fit indicators of the structural equation model of social support, self-efficacy and learning engagement model X 2/df RMSEA GFI RFI IFI TLI CFl actual value 2.310 0.065 0.923 0.947 0.976 0.969 0.975 ideal value < 5.0 0.9 > 0.9 > 0.9 > 0.9 > 0.9 Table 5 Analysis of the mediating effect of self-efficacy on the impact of social support on learning engagement (n = 309) effect way β S.E. P 95% CI Effect ratio (%) indigo effect Self-efficacy ← social support 0.503 0.005 < 0.001 0.162 ~ 0.354 46 direct effect Learning engagement ← self-efficacy 0.482 0.926 < 0.001 0.157 ~ 0.439 54 gross effect Learning engagement ← social support 0.282 0.063 < 0.001 0.413 ~ 0.676 — 4 Discussion The findings of this study demonstrate that social support and self-efficacy among nursing students positively influence their learning engagement. This research not only examines the direct effects of social support on learning engagement but also identifies self-efficacy as a significant mediating variable, thereby establishing a robust mediation model: social support → self-efficacy → learning engagement. The validity of this model was confirmed through structural equation modeling using AMOS, which offers a novel theoretical perspective on how social support contributes to learning engagement. These insights contribute to the growing body of literature on nursing education by offering a deeper understanding of the psychological and social factors that drive learning engagement among nursing students. Furthermore, the study highlights the importance of fostering supportive environments and enhancing self-efficacy to optimize learning outcomes in clinical training settings. The mean learning engagement score of the nursing students in this study was above average, with the highest scores observed in the dedication dimension and the lowest in the vigor dimension. This distribution aligns with findings from prior studies 3 23 24 . Consistent with existing literature, self-efficacy was confirmed as a significant and positive predictor of learning engagement 25 , a conclusion supported by the current study. Pearson correlation analysis revealed a positive correlation between the self-efficacy and overall learning engagement score, as well as its individual dimensions: vigor, dedication, and absorption. Interns with higher self-efficacy tend to exhibit greater confidence when facing learning challenges, showing heightened motivation ,effort and energy dedicated to learning tasks. They are more likely to set challenging learning objectives and adopt effective coping strategies to achieve optimal outcomes. Furthermore, self-efficacy positively influences students' learning attitudes, emotional investment, and choice of learning strategies, creating a self-reinforcing cycle that enhances overall learning engagement. These findings are consistent with self-determination theory, which posits that students' behavioral choices, driven by intrinsic motivation, foster a sense of autonomy and control 26 . When external motivations are aligned with students' needs, they are internalized as intrinsic motivations, thus synergizing to stimulate and enhance learning behaviors. This study not only provides new insights into the mechanisms underlying nursing students' learning engagement but also offers a theoretical foundation for developing targeted interventions to improve their engagement levels. By understanding the interplay between self-efficacy, motivation, and learning behaviors, educators can design more effective strategies to support nursing students in achieving their full potential. Further analysis using AMOS 26.0 deepens the understanding of the robust interrelationship among social support, self-efficacy, and learning engagement. The results reveal that social support influences learning engagement both directly and indirectly, with self-efficacy serving as a key mediating variable. This dual pathway underscores the multifaceted role of social support in shaping learning behaviors. Previous studies have indicated that family members can create a conducive learning environment and family support can effectively motivate students to concentrate on and engage in their studies 5 27 . Importantly, self-efficacy acts as a moderating factor, influencing how students perceive and utilize social support, which is critical for enhancing their learning engagement 5 . For nursing interns, the support they receive, whether from family or other sources, plays a vital role in their professional and personal development. This support not only provides emotional comfort and material assistance but also, and perhaps more crucially, helps students cultivate positive psychological self-perceptions of their potential and capabilities. This perception significantly enhances their self-efficacy, empowering them to approach challenges with confidence and resilience. This dynamic process sees social support as an input that reinforces individuals' intrinsic beliefs (self-efficacy), which, in turn, positively influences their long-term learning behaviors and professional development. These findings highlight the importance of fostering supportive environments for nursing students, as such environments can catalyze a virtuous cycle of increased self-efficacy, enhanced learning engagement, and improved professional outcomes. By recognizing and leveraging the interplay between social support and self-efficacy, educators and policymakers can design targeted interventions to optimize the learning experiences and career trajectories of nursing students. Enhancing self-efficacy among nursing students is crucial for boosting their confidence and initiative during clinical training. Students with higher self-efficacy are more likely to approach challenges with a positive mindset, actively seek learning opportunities, and maintain an optimistic attitude toward their educational responsibilities. This proactive approach enables them to stay focused on learning tasks, tackle difficulties with resilience, and continuously improve their nursing competencies. The motivation derived from elevated self-efficacy not only strengthens their drive to acquire new knowledge and skills but also deepens their engagement in the learning process. Such engagement is essential for the comprehensive development of professional attributes and overall capabilities within the nursing field. Research consistently highlights the profound implications of these findings for improving learning engagement and nursing proficiency among interns. Specifically, the interplay between social support and self-efficacy emerges as a critical factor in fostering a supportive learning environment. By enhancing social support systems and cultivating self-efficacy within educational frameworks, educators can effectively promote students' learning engagement and facilitate their professional growth. These strategies not only address the immediate needs of nursing interns but also contribute to their long-term success as competent and confident healthcare professionals. Furthermore, while no significant differences were observed in the overall scores of learning engagement and social support between only child and those with siblings, only child exhibited higher levels of self-efficacy.This finding suggests that only child may have developed greater confidence and self-management skills during their upbringing, potentially due to the undivided attention and resources they often receive from their families. Consequently, it is imperative to place particular emphasis on fostering self-efficacy among non-only child to help them build robust confidence and enhance their ability to handle challenges effectively. Moreover, it remains crucial to continue nurturing and reinforcing the positive self-efficacy traits observed in only child, ensuring that their strengths are further developed and sustained. These insights highlight the importance of tailored educational strategies that address the unique psychological and developmental needs of both only child and those with siblings. By implementing targeted interventions to increase self-efficacy across all student groups, educators can create a more inclusive and supportive learning environment that empowers all nursing interns to achieve their full potential. This study proposes three strategic approaches for the instruction of nursing interns. First, hospital nursing educators should enhance collaboration with the families of nursing students to collectively concentrate on their development, providing essential emotional and financial support. Establishing comprehensive internship guidance and feedback mechanisms is vital for offering extensive training in nursing skills and psychological support services. Encouraging communication and cooperation with seasoned nurses will foster a supportive environment that is beneficial for mutual learning. Second, educators must define clear and precise short-term and long-term learning objectives for ursing students, ensuring that they possess a defined trajectory. Providing abundant practical experience that allows these interns to achieve success in real-world applications is essential for increasing their confidence and sense of accomplishment. It is equally important to offer timely, positive feedback and acknowledgment of their efforts and advancements, which reinforces their self-efficacy. Third, educational content and activities should be tailored to align with the interests and professional demands of nursing students, thereby enhancing their enthusiasm and proactive engagement in learning. Emphasizing the integration of theoretical knowledge with practical skills enables interns to continually apply and refine their knowledge in real-world settings. Additionally, implementing effective incentive mechanisms, such as scholarships and awards for outstanding performance, can further inspire and motivate nursing students to excel. In summary, the educational process for nursing students should prioritize enhancing social support, self-efficacy, and active learning participation. By adopting these strategies, educators can robustly support the development and career progression of nursing students, ultimately contributing to the cultivation of competent and confident healthcare professionals. 5 Limitation This study has several limitations that should be acknowledged. First, the use of a cross-sectional design limits the ability to establish causal relationships among social support, self-efficacy, and learning engagement. Longitudinal studies are needed to explore the dynamic interactions and long-term effects of these variables. Second, the sample was limited to nursing students from a single tertiary hospital in Shanghai, which may restrict the generalizability of the findings to other regions or healthcare settings. Future research should include a more diverse and representative sample. Third, self-reported data may introduce response bias, as participants might provide socially desirable answers. Incorporating objective measures or mixed-method approaches could enhance the validity of the findings. Lastly, while the study identified self-efficacy as a mediator, other potential mediating or moderating factors were not explored. Future studies could investigate additional variables, such as resilience or motivation, to provide a more comprehensive understanding of the mechanisms underlying learning engagement in nursing interns. 6 Conclusion This study demonstrated that both social support and self-efficacy significantly and positively influence the learning engagement of nursing students. Notably, self-efficacy acts as a critical mediating factor between social support and learning engagement, highlighting its pivotal role in translating external support into active learning behaviors. Educators and clinical mentors are encouraged to adopt a dual-focused approach that prioritizes the enhancement of social support systems while simultaneously fostering self-efficacy among students. By strengthening social support networks—such as through mentorship programs, peer collaboration, and family involvement—and nurturing self-efficacy via goal-setting, positive feedback, and skill-building opportunities, we can more effectively enhance learning engagement. This, in turn, will increase the overall quality and efficacy of clinical internships, ultimately contributing to the development of competent, confident, and engaged nursing professionals. Declarations Acknowledgements The authors extend their heartfelt gratitude to all participants for their invaluable involvement and contributions to this study, with special thanks for their essential role in the data collection process. Author contributions L.W. and Y.C. was responsible for research design, data collection and analysis, manuscript drafting, and revision.W.W. and W.Z. was responsible for research design guidance, manuscript review, and revision.M.X. was responsible for questionnaire distribution and data collection. All authors reviewed the manuscript. Funding There was no Funding in this study. Data availability The datasets used and analysed during the current study available from the corresponding author on reasonable request. Ethics approval and consent to participate The study was reviewed by the Research Ethics Committee at the Ruijin Hospital ,Shanghai JiaoTong University School of Medicine, which granted permission to conduct the study (Approval No.2024-455). The study was performed in accordance with the ethical guidelines, protocol, and regulations stated in the Declaration of Helsinki. Informed consent was obtained from all participants. Consent for publication Not applicable. 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Appl Psychol. 2001;7(1):37–40. https://doi.org/10.3969/j.issn.1006-6020.2001.01.007 . Molero Jurado MDM, Perez-Fuentes MDC, Oropesa Ruiz NF et al. Self-Efficacy and Emotional Intelligence as Predictors of Perceived Stress in Nursing Professionals.Medicina(Kaunas).2019;55(6). https://doi.org/10.3390/medicina55060237 [published Online First: 20190601]. Schaufeli WB, Martinez IM, Pinto AM, et al. Burnout and Engagement in University Students: A Cross-National Study. J Cross-Cult Psychol. 2002;33(5):464–81. https://doi.org/10.1177/0022022102033005003 . Tan FL, Kan S, Fenghua Z. Reliability and validity study of the Chinese version of the Learning Input Scale for Clinical Psychology Journal of China.2008; 16(6):618 – 20. https://doi.org/CNKI:SUN:ZLCY.0.2008-06-022 Wang JBL, Li Y, et al. The mediating effect of academic engagement between psychological capital and academic burnout among nursing students during the COVID-19 pandemic: A cross-sectional study. Nurse Educ Today. 2021;102:104938. https://doi.org/10.1016/j.nedt.2021.104938 . [published Online First: 20210426]. Zou Jinyi G, Wen. The Mediating Role of Learning Investment on Future Time Insight and Academic Achievement among Undergraduate Nursing Students. J Nurs Res. 2023;38(18):85–9. https://doi.org/10.3870/j.issn.1001-4152.2023.18.085 . Wu L, Ma C. An Empirical Study on the Relationship among Mental Health,Learning Engagement, and Academic Self-Efficacy of Senior High School Students. J Environ Public Health.2022;2022:4253142. https://doi.org/10.1155/2022/4253142 [published Online First: 20220922]. Huang H, Wang HHX, Donaghy E, et al. Using self-determination theory in research nd evaluation in primary care. Health Expect. 2022;25(6):2700–08. https://doi.org/10.1111/hex.13620 . [published Online First: 20221001]. Zhao Y, Zheng Z, Pan C, et al. Self-Esteem and Academic Engagement Among Adolescents: A Moderated Mediation Model. Front Psychol. 2021;12:690828. https://doi.org/10.3389/fpsyg.2021.690828 . [published Online First: 20210603]. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6139781","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":444694174,"identity":"3f27f225-1ef7-4bde-b703-85e84518bffb","order_by":0,"name":"Liping Wu","email":"","orcid":"","institution":"Operation Room of Ruijin Hospital Affiliated with School of Medicine, Shanghai Jiao Tong University","correspondingAuthor":false,"prefix":"","firstName":"Liping","middleName":"","lastName":"Wu","suffix":""},{"id":444694175,"identity":"a1f9c5c1-697c-4723-b3e6-55b5d20ef663","order_by":1,"name":"Yan Chen","email":"","orcid":"","institution":"Nursing Department of Ruijin Hospital Affiliated with School of Medicine, Shanghai Jiao Tong University","correspondingAuthor":false,"prefix":"","firstName":"Yan","middleName":"","lastName":"Chen","suffix":""},{"id":444694177,"identity":"03a84291-f1b6-419c-84d2-3eb5ba3a905d","order_by":2,"name":"Meiqin Xue","email":"","orcid":"","institution":"Nursing Department of Ruijin Hospital Affiliated with School of Medicine, Shanghai Jiao Tong University","correspondingAuthor":false,"prefix":"","firstName":"Meiqin","middleName":"","lastName":"Xue","suffix":""},{"id":444694178,"identity":"bcd3283f-dcb1-4ace-b7c6-4656196e47c4","order_by":3,"name":"Weiyi Zhu","email":"","orcid":"","institution":"Nursing Department of Ruijin Hospital Affiliated with School of Medicine, Shanghai Jiao Tong University","correspondingAuthor":false,"prefix":"","firstName":"Weiyi","middleName":"","lastName":"Zhu","suffix":""},{"id":444694179,"identity":"371e7c1e-7545-4d9c-b8ae-f3522d128aba","order_by":4,"name":"Wei Wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzklEQVRIiWNgGAWjYFAC5gMHPvCwyTEwnCFaC1viwxkyfMakaOExNuaxkUtsYOAhUoPBjQQzaZ4cs/TtjWcPMPyo2MbAP7uBoJY0yTln0nLnHDiXwNhz5jaDxJ0D+LWY3U44JvG251juDIYzBsyMbbcZDCQSCGlJbJPg/fc/XYIELcnMhjw8bAnEa7G//4zx4QweNkOQww4C/cIjcYOAFsme8x9AUSkvIXHG8MGPitty/DMIaEEAiQMMB4AUsbEDAvwNJCgeBaNgFIyCEQUAlWlG1APALFIAAAAASUVORK5CYII=","orcid":"","institution":"Nursing Department of Ruijin Hospital Affiliated with School of Medicine, Shanghai Jiao Tong University","correspondingAuthor":true,"prefix":"","firstName":"Wei","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2025-03-02 13:53:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6139781/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6139781/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12912-025-03615-7","type":"published","date":"2025-07-21T15:57:36+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":81938307,"identity":"d14ee17f-c584-4ea1-b34c-bfa51acda495","added_by":"auto","created_at":"2025-05-05 06:36:20","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":100671,"visible":true,"origin":"","legend":"\u003cp\u003ePath analysis model of social support, self-efficacy and learning engagement\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6139781/v1/09a85206665c8dccf83dce52.png"},{"id":87756699,"identity":"23f5fce0-dbe8-4ec9-b940-9decd171ab5f","added_by":"auto","created_at":"2025-07-28 16:07:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":720573,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6139781/v1/1a35dc02-3699-44d2-a376-5417e94aa292.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Effect of Social Support on Learning Investment among Nursing Students: The Mediating Role of Self-Efficacy","fulltext":[{"header":"1 Background","content":"\u003cp\u003eNursing has become a cornerstone of modern healthcare, with the quality of nursing education playing a pivotal role in shaping the professional competence and service quality of future healthcare providers. As the medical landscape grows increasingly complex, with ever-evolving patient needs, nursing students are challenged to acquire not only comprehensive theoretical knowledge but also develop robust practical application skills. Self-determination theory highlights that individuals are innately driven to seek autonomy, competence, and relatedness, which are essential for personal growth and development\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. The nursing internship represents a critical transitional phase, bridging academic preparation with clinical practice, where students transform theoretical knowledge into practical expertise. The concept of learning engagement is crucial here, serving as a protective factor that enhances the learning performance of nursing students, boosts their learning capabilities, and has a direct effect on their future career development and the quality of the nursing services they provide\u003csup\u003e\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eLearning engagement is defined as the time and energy that students devote to their studies and effective educational activities. It embodies profound and constructive involvement in the learning process, accompanied by an appreciation of its importance\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. Learning engagement is characterized by vitality, dedication, and focus. It represents the manifestation of students' subjective initiative and serves as a medium that influences professional development \u003csup\u003e\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. As the demands of modern medical care increasingly vary, nurses students are compelled to invest more time and effort into their education and training, enhancing their professional skills and overall qualities to meet the diverse needs of patients. This investment is vital for equipping them to effectively address the multifaceted needs of patients. Given the pivotal role of learning engagement in the growth of nursing students, it is crucial to explore the factors that influence it and the mechanisms through which it operates. Such exploration will not only shed light on the dynamics of learning engagement but also guide the development of targeted interventions aimed at optimizing the learning experiences of nursing students. By fostering a deeper understanding of these elements, educators and policymakers can design strategies to enhance learning engagement, ultimately advancing nursing education and improving the quality of patient care.\u003c/p\u003e \u003cp\u003eThe concept of \"perceived social support\" refers to the emotional experience in which individuals feel understood, respected, cared for, and assisted within their social relationships\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. This phenomenon reflects an individual's expectations and evaluations of the social support they believe is available to them, representing a fundamentally subjective form of emotional support. Research consistently demonstrates that social support generally exerts a beneficial influence; individuals who perceive high levels of social support, along with the expectation of receiving such support, tend to exhibit enhanced learning motivation and a stronger commitment to learning. This enables them to approach learning with a positive attitude and adapt more effectively to the learning process\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. Empirical studies have further validated that perceived social support significantly enhances students' enthusiasm for learning, increases their engagement in educational activities, and positively predicts their level of learning investment \u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. For nursing students, the level of perceived social support plays a crucial role in shaping their adaptability during clinical internships. When these students feel supported during their clinical placements, they are more likely to maintain a positive and optimistic outlook, which in turn enhances their confidence and ability to manage challenges. This sense of support not only alleviates psychological stress but also contributes to greater job satisfaction and a stronger intention to pursue long-term career development. By cultivating a supportive environment, educators and clinical supervisors can empower nursing students to excel in their roles, ultimately promoting both their professional growth and the quality of patient care they deliver.\u003c/p\u003e \u003cp\u003eAccording to Albert Bandura's social cognitive theory, self-efficacy is a critical determinant of individual behavior, serving as a foundational element in shaping how individuals approach tasks and challenges\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. Self-efficacy refers to an individual's confidence in their ability to accomplish specific tasks or achieve desired outcomes, and it plays a pivotal role in determining levels of student participation and motivation \u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. Research consistently indicates a positive correlation between self-efficacy and learning engagement; students with high self-efficacy tend to experience greater enjoyment and derive more value from their learning activities \u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. In the context of nursing education, self-efficacy is particularly significant as it directly impacts students' attitudes and performance when confronted with the challenges of clinical practice. Those with high self-efficacy are more likely to exhibit positive learning attitudes and behaviors, respond constructively to challenges, and adapt more swiftly and persistently to the clinical work environment\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. Additionally, social cognitive theory highlights that external factors such as guidance, expectations, and support from others can significantly influence an individual's self-efficacy\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. Nursing students who are highly perceptive are better equipped to recognize and accept external support, fostering the establishment of positive relationships that further enhance their learning attitudes and self-efficacy.\u003c/p\u003e \u003cp\u003eDespite the increasing recognition of the importance of social support, self-efficacy, and learning engagement in nursing education, there remains a notable gap in research examining the specific mechanisms through which these factors interact and influence one another. The current literature has yet to fully elucidate the complex interrelationships and pathways linking these variables, particularly within the context of nursing students.Consequently, future studies should focus on exploring the interrelations between learning engagement, general self-efficacy, and perceived social support among nursing students. Such studies should aim to elucidate the relationships and pathways among these variables, providing a clearer understanding of the needs and challenges faced by nursing students during their educational and adaptation processes. This deeper understanding is expected to offer a theoretical foundation for improving nursing education models and methods, ultimately enhancing the training and professional development of nursing students.\u003c/p\u003e "},{"header":"2 Method","content":"\u003cp\u003e2.1 Study design\u003c/p\u003e \u003cp\u003eA cross-sectional study was conducted in November 2024 to elucidate the relationships among social support, learning engagement, and general self-efficacy in nursing students.\u003c/p\u003e \u003cp\u003e2.2 Setting and sample\u003c/p\u003e \u003cp\u003eThis study employed a convenience sampling method to conduct a questionnaire survey among nursing students from 12 schools who were undergoing clinical internships at a tertiary Grade A hospital in Shanghai in November 2024. Inclusion criteria mandated that participants had a minimum of three months of clinical internship experience and voluntarily provided informed consent. Exclusion criteria included unwillingness to participate and any health-related absences that prevented involvement in the survey.\u003c/p\u003e \u003cp\u003e2.3 Sample size\u003c/p\u003e \u003cp\u003eBased on the sample size calculation formula, which recommends that the sample size should be 5 to 10 times the number of scale items, this study, comprising 39 items, required a minimum sample size of 234 participants, accounting for a 20% attrition rate. Furthermore, structural equation modeling requires a minimum sample size of 200. Therefore, the inclusion of 309 participants in this study meets these requirements.\u003c/p\u003e \u003cp\u003e2.4 Data collection\u003c/p\u003e \u003cp\u003eThe online questionnaire was distributed to nursing students via \u0026ldquo;Wenjuanxing (a Chinese online survey platform)\u0026rdquo;. To ensure data quality, an on-site, face-to-face survey method was employed, requiring nursing students to complete the questionnaire on the spot. Researchers were available to address any questions in real time. To ensure completeness, all questions were set as mandatory, and each IP address was restricted to a single submission to prevent duplicate responses. A total of 309 questionnaires were collected, with a valid response rate of 100%.\u003c/p\u003e \u003cp\u003e2.5 Instrments\u003c/p\u003e \u003cp\u003eGeneral Information Survey\u003c/p\u003e \u003cp\u003eThis survey, developed by the researchers, collects demographic information about the nursing students, including their educational level, age, place of origin, and whether they are only children.\u003c/p\u003e \u003cp\u003eThe Perceived Social Support Scale (PSSS)\u003c/p\u003e \u003cp\u003eDeveloped by Zimet\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e and translated into Chinese by Jiang Qianjin, the PSSS is a psychological instrument designed to assess individuals' self-perceptions and perceptions of social support. The scale comprises 12 items that evaluate both familial and external family support dimensions\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. Each item is scored using a 7-point Likert scale, ranging from 1 to 7, and is divided into seven levels: strongly disagree, disagree, slightly disagree, neutral, slightly agree, agree, and strongly agree.The total scores can vary from 12\u0026ndash;84, with higher scores reflecting a stronger perception of social support.In this study, the scale demonstrated high reliability, with a Cronbach's α coefficient of 0.951 and a KMO value of 0.936.\u003c/p\u003e \u003cp\u003eGeneral Self-Efficacy Scale (GSES)\u003c/p\u003e \u003cp\u003e Localized, translated, and revised by Wang Caikang et al. in 2001\u003csup\u003e19\u003c/sup\u003e, the General Self-Efficacy Scale (GSES) is a tool designed to assess an individual's self-confidence in coping with stress and overcoming challenges.\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. The GSES comprises 10 items scored on a 4-point Likert scale ranging from 1(\"completely incorrect\" )to 4(\"completely correct\"), with total scores ranging from 10 to 40. Higher scores indicate stronger self-efficacy. In this study, the reliability of the GSES is supported by a Cronbach's α coefficient of 0.954 and a KMO value of 0.921, demonstrating its robustness and suitability for application.\u003c/p\u003e \u003cp\u003eLearning Engagement scale\u003c/p\u003e \u003cp\u003eThe Utrecht Work Engagement Scale-student(UWES-S)was used to measure nursing students learning engagement. Originally developed by Schaufeli et al.\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e and adapted into Chinese by Fang Laitan et al.\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e in 2002, the Utrecht Work Engagement Scale-student(UWES-S) assesses students' engagement in learning activities. This scale consists of three dimensions, vigor (6 items), dedication (5 items), and absorption (6 items). Responses are measured using a 7-point Likert scale ranging from 1representing \"never\" to 7 representing \"always/daily\",with total scores ranging from 17 to 119.Higher scores indicate greater engagement.In this study, the scale's reliability is supported by a Cronbach's α coefficient of 0.964 and a KMO value of 0.954, demonstrating its robustness and applicability.\u003c/p\u003e \u003cp\u003e2.6 Ethical considerations\u003c/p\u003e \u003cp\u003e This study received ethical approval from the Research Ethics Committee of Ruijin Hospital, affiliated with Shanghai Jiao Tong University School of Medicine (Approval Number: 2024\u0026thinsp;\u0026minus;\u0026thinsp;455).Informed consent was obtained from all participants, and the questionnaire incorporated a statement guaranteeing anonymity, confidentiality, and the right to withdraw from the study at any time.\u003c/p\u003e \u003cp\u003e2.7 Statistical methods\u003c/p\u003e \u003cp\u003eThe SPSS 21.0 software program was used to analyze data. Normally distributed measurement data are presented as the means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviations (x̄ \u0026plusmn; s), whereas categorical data are presented as frequencies and percentages. One-way ANOVA and Pearson correlation analysis were applied to explore the relationships between learning investment, social support, and self-efficacy. Structural equation modeling (SEM) was performed using AMOS 26.0 software to evaluate mediating effects, with bootstrap methods applied to test the significance of these effects. Statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 and p\u0026thinsp;\u0026lt;\u0026thinsp;0.01.\u003c/p\u003e"},{"header":"3 Results","content":"\u003cp\u003e3.1 General Information\u003c/p\u003e \u003cp\u003eA total of 309 students from 12 schools participated in the survey. The mean age of the participants was 20.56 years (SD\u0026thinsp;=\u0026thinsp;0.97 years). Of the participated nursing students, 81 students (26.2%) had a bachelor's degree, and 228 students (73.8%) had an associate degree. The gender distribution included 54 male students (17.5%) and 255 female students (82.5%). Geographically, 204 students (66%) were from Shanghai, whereas 105 students (34%) were from other regions.Regarding family demographics, 193 students (62.5%) were only children, and 116 students (37.5%) were not.\u003c/p\u003e \u003cp\u003e3.2 The scores of learning engagement, social Support, and self-efficacy among nursing students\u003c/p\u003e \u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, the mean score for learning engagement among nursing students was 84.42 (SD\u0026thinsp;=\u0026thinsp;21.24), with the highest mean score observed in the dedication dimension (5.33\u0026thinsp;\u0026plusmn;\u0026thinsp;1.23). The mean scores for social support and self-efficacy were 69.04 (SD\u0026thinsp;=\u0026thinsp;11.15) and 27.78 (SD\u0026thinsp;=\u0026thinsp;6.63), respectively.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe scores of learning engagement, social Support, and self-efficacy among nursing students(n\u0026thinsp;=\u0026thinsp;309)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of item\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eScoring range\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003etotal score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003emean score per item\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLearning engagement score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u0026thinsp;~\u0026thinsp;119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e84.42\u0026thinsp;\u0026plusmn;\u0026thinsp;21.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e4.97\u0026thinsp;\u0026plusmn;\u0026thinsp;1.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003evigor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u0026thinsp;~\u0026thinsp;42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e28.29\u0026thinsp;\u0026plusmn;\u0026thinsp;8.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e4.71\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4 4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ededication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u0026thinsp;~\u0026thinsp;35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e26.64\u0026thinsp;\u0026plusmn;\u0026thinsp;6.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e5.33\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2 3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eabsorption\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u0026thinsp;~\u0026thinsp;42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e29.50\u0026thinsp;\u0026plusmn;\u0026thinsp;7.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e4.92\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3 3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial support score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u0026thinsp;~\u0026thinsp;84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e69.04\u0026thinsp;\u0026plusmn;\u0026thinsp;11.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e5.74\u0026thinsp;\u0026plusmn;\u0026thinsp;1. 10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003efamilial support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u0026thinsp;~\u0026thinsp;28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e22.91\u0026thinsp;\u0026plusmn;\u0026thinsp;4.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e5.77\u0026thinsp;\u0026plusmn;\u0026thinsp;0.92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eexternal family support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u0026thinsp;~\u0026thinsp;56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e46.12\u0026thinsp;\u0026plusmn;\u0026thinsp;7.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e5.76\u0026thinsp;\u0026plusmn;\u0026thinsp;0.93\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-efficacy score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u0026thinsp;~\u0026thinsp;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e27.78\u0026thinsp;\u0026plusmn;\u0026thinsp;6.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e2.78\u0026thinsp;\u0026plusmn;\u0026thinsp;0.66\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e3.3 Correlation analysis of learning engagement, social support, and self-efficacy\u003c/p\u003e \u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, learning engagement had significant positive correlation with social support (r\u0026thinsp;=\u0026thinsp;0.478, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), and self-efficacy (r\u0026thinsp;=\u0026thinsp;0.583, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). As shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e,social support had significant positive correlation with self-efficacy (r\u0026thinsp;=\u0026thinsp;0.473, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). These findings indicate strong positive interrelationships among the studied variables.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation analysis between learning engagement, social support and self-efficacy (n\u0026thinsp;=\u0026thinsp;309)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLearning engagement score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003evigor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ededication\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eabsorption\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSocial support score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003efamilial support\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eexternal family support\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSelf-efficacy score\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLearning engagement score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003evigor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.941**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ededication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.929**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.821**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eabsorption\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.934**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.795**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.818**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.478**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.463**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.452**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.425**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003efamilial support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.422**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.434**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.382**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.361**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.910**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eexternal family support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.470**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.441**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.455**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.427**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.969**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.780**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-efficacy score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.583**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.536**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.550**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.551**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.473**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.423**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.462**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"9\" nameend=\"c9\" namest=\"c1\"\u003e \u003cp\u003e**. Significantly correlated at the 0.01 level (bilateral)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e3.4 Comparison of learning engagement, social support, and self-efficacy scores between only-child and non-only-child nursing students\u003c/p\u003e \u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, no significant differences were observed between only child and non-only child in terms of learning engagement and social support. However, a significant difference in self-efficacy scores was found, with only child scoring higher (28.47\u0026thinsp;\u0026plusmn;\u0026thinsp;6.65) than non-only child (26.64\u0026thinsp;\u0026plusmn;\u0026thinsp;6.46), p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of learning engagement, social support, and self-efficacy scores between only-child and non-only-child nursing students(n\u0026thinsp;=\u0026thinsp;309)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eonly child\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003emean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eStandard deviations\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003et\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eLearning engagement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e193\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e83.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e-0.823\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.411\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e85.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSocial support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e193\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.725\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.086\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSelf-efficacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e193\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e2.372\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e3.5 Mediating effect analysis of self-efficacy on the relationship between social support and learning engagement\u003c/p\u003e \u003cp\u003eUsing AMOS 26.0, a structural equation model was constructed with social support as the independent variable, self-efficacy as the mediating variable, and learning engagement as the dependent variable. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e ,the model was fitted using maximum likelihood estimation.The fit indices(χ2/df\u0026thinsp;=\u0026thinsp;2.310, CFI\u0026thinsp;=\u0026thinsp;0.975, GFI\u0026thinsp;=\u0026thinsp;0.923 RFI\u0026thinsp;=\u0026thinsp;0.947, TLI\u0026thinsp;=\u0026thinsp;0.969, RMSEA\u0026thinsp;=\u0026thinsp;0.065)demonstrated a satisfactory model fit in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e,the analysis indicated that social support significantly influences both learning engagement (β\u0026thinsp;=\u0026thinsp;0.282, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and self-efficacy (β\u0026thinsp;=\u0026thinsp;0.503, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Similarly, self-efficacy significantly affects learning engagement (β\u0026thinsp;=\u0026thinsp;0.482, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), confirming its partial mediating role. Mediation analysis using the bootstrap method (n\u0026thinsp;=\u0026thinsp;2000) revealed an indirect effect of 0.252(Bootstrap 95% CI=[0.162, 0.354]). The 95% confidence interval of Bootstrap did not contain 0. As shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e, this confirms the significant mediating effect of self-efficacy, which accounts for 46% of the total effect.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFit indicators of the structural equation model of social support, self-efficacy and learning engagement\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003emodel\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eX\u003c/em\u003e\u003csup\u003e\u003cem\u003e2/df\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRMSEA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGFI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRFI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIFI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eTLI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eCFl\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eactual value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.310\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.065\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.923\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.947\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.976\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.969\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.975\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eideal value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAnalysis of the mediating effect of self-efficacy on the impact of social support on learning engagement (n\u0026thinsp;=\u0026thinsp;309)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eeffect\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eway\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eS.E.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eEffect ratio (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eindigo effect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelf-efficacy \u0026larr; social support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.503\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.162\u0026thinsp;~\u0026thinsp;0.354\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003edirect effect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLearning engagement \u0026larr; self-efficacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.482\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.926\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.157\u0026thinsp;~\u0026thinsp;0.439\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003egross effect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLearning engagement \u0026larr; social support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.282\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.063\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.413\u0026thinsp;~\u0026thinsp;0.676\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e "},{"header":"4 Discussion","content":"\u003cp\u003eThe findings of this study demonstrate that social support and self-efficacy among nursing students positively influence their learning engagement. This research not only examines the direct effects of social support on learning engagement but also identifies self-efficacy as a significant mediating variable, thereby establishing a robust mediation model: social support \u0026rarr; self-efficacy \u0026rarr; learning engagement. The validity of this model was confirmed through structural equation modeling using AMOS, which offers a novel theoretical perspective on how social support contributes to learning engagement. These insights contribute to the growing body of literature on nursing education by offering a deeper understanding of the psychological and social factors that drive learning engagement among nursing students. Furthermore, the study highlights the importance of fostering supportive environments and enhancing self-efficacy to optimize learning outcomes in clinical training settings.\u003c/p\u003e \u003cp\u003eThe mean learning engagement score of the nursing students in this study was above average, with the highest scores observed in the dedication dimension and the lowest in the vigor dimension. This distribution aligns with findings from prior studies\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e. Consistent with existing literature, self-efficacy was confirmed as a significant and positive predictor of learning engagement\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e, a conclusion supported by the current study. Pearson correlation analysis revealed a positive correlation between the self-efficacy and overall learning engagement score, as well as its individual dimensions: vigor, dedication, and absorption. Interns with higher self-efficacy tend to exhibit greater confidence when facing learning challenges, showing heightened motivation ,effort and energy dedicated to learning tasks. They are more likely to set challenging learning objectives and adopt effective coping strategies to achieve optimal outcomes. Furthermore, self-efficacy positively influences students' learning attitudes, emotional investment, and choice of learning strategies, creating a self-reinforcing cycle that enhances overall learning engagement. These findings are consistent with self-determination theory, which posits that students' behavioral choices, driven by intrinsic motivation, foster a sense of autonomy and control\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. When external motivations are aligned with students' needs, they are internalized as intrinsic motivations, thus synergizing to stimulate and enhance learning behaviors. This study not only provides new insights into the mechanisms underlying nursing students' learning engagement but also offers a theoretical foundation for developing targeted interventions to improve their engagement levels. By understanding the interplay between self-efficacy, motivation, and learning behaviors, educators can design more effective strategies to support nursing students in achieving their full potential.\u003c/p\u003e \u003cp\u003eFurther analysis using AMOS 26.0 deepens the understanding of the robust interrelationship among social support, self-efficacy, and learning engagement. The results reveal that social support influences learning engagement both directly and indirectly, with self-efficacy serving as a key mediating variable. This dual pathway underscores the multifaceted role of social support in shaping learning behaviors. Previous studies have indicated that family members can create a conducive learning environment and family support can effectively motivate students to concentrate on and engage in their studies \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e. Importantly, self-efficacy acts as a moderating factor, influencing how students perceive and utilize social support, which is critical for enhancing their learning engagement \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. For nursing interns, the support they receive, whether from family or other sources, plays a vital role in their professional and personal development. This support not only provides emotional comfort and material assistance but also, and perhaps more crucially, helps students cultivate positive psychological self-perceptions of their potential and capabilities. This perception significantly enhances their self-efficacy, empowering them to approach challenges with confidence and resilience. This dynamic process sees social support as an input that reinforces individuals' intrinsic beliefs (self-efficacy), which, in turn, positively influences their long-term learning behaviors and professional development. These findings highlight the importance of fostering supportive environments for nursing students, as such environments can catalyze a virtuous cycle of increased self-efficacy, enhanced learning engagement, and improved professional outcomes. By recognizing and leveraging the interplay between social support and self-efficacy, educators and policymakers can design targeted interventions to optimize the learning experiences and career trajectories of nursing students.\u003c/p\u003e \u003cp\u003eEnhancing self-efficacy among nursing students is crucial for boosting their confidence and initiative during clinical training. Students with higher self-efficacy are more likely to approach challenges with a positive mindset, actively seek learning opportunities, and maintain an optimistic attitude toward their educational responsibilities. This proactive approach enables them to stay focused on learning tasks, tackle difficulties with resilience, and continuously improve their nursing competencies. The motivation derived from elevated self-efficacy not only strengthens their drive to acquire new knowledge and skills but also deepens their engagement in the learning process. Such engagement is essential for the comprehensive development of professional attributes and overall capabilities within the nursing field. Research consistently highlights the profound implications of these findings for improving learning engagement and nursing proficiency among interns. Specifically, the interplay between social support and self-efficacy emerges as a critical factor in fostering a supportive learning environment. By enhancing social support systems and cultivating self-efficacy within educational frameworks, educators can effectively promote students' learning engagement and facilitate their professional growth. These strategies not only address the immediate needs of nursing interns but also contribute to their long-term success as competent and confident healthcare professionals.\u003c/p\u003e \u003cp\u003eFurthermore, while no significant differences were observed in the overall scores of learning engagement and social support between only child and those with siblings, only child exhibited higher levels of self-efficacy.This finding suggests that only child may have developed greater confidence and self-management skills during their upbringing, potentially due to the undivided attention and resources they often receive from their families. Consequently, it is imperative to place particular emphasis on fostering self-efficacy among non-only child to help them build robust confidence and enhance their ability to handle challenges effectively. Moreover, it remains crucial to continue nurturing and reinforcing the positive self-efficacy traits observed in only child, ensuring that their strengths are further developed and sustained. These insights highlight the importance of tailored educational strategies that address the unique psychological and developmental needs of both only child and those with siblings. By implementing targeted interventions to increase self-efficacy across all student groups, educators can create a more inclusive and supportive learning environment that empowers all nursing interns to achieve their full potential.\u003c/p\u003e \u003cp\u003eThis study proposes three strategic approaches for the instruction of nursing interns. First, hospital nursing educators should enhance collaboration with the families of nursing students to collectively concentrate on their development, providing essential emotional and financial support. Establishing comprehensive internship guidance and feedback mechanisms is vital for offering extensive training in nursing skills and psychological support services. Encouraging communication and cooperation with seasoned nurses will foster a supportive environment that is beneficial for mutual learning. Second, educators must define clear and precise short-term and long-term learning objectives for ursing students, ensuring that they possess a defined trajectory. Providing abundant practical experience that allows these interns to achieve success in real-world applications is essential for increasing their confidence and sense of accomplishment. It is equally important to offer timely, positive feedback and acknowledgment of their efforts and advancements, which reinforces their self-efficacy. Third, educational content and activities should be tailored to align with the interests and professional demands of nursing students, thereby enhancing their enthusiasm and proactive engagement in learning. Emphasizing the integration of theoretical knowledge with practical skills enables interns to continually apply and refine their knowledge in real-world settings. Additionally, implementing effective incentive mechanisms, such as scholarships and awards for outstanding performance, can further inspire and motivate nursing students to excel. In summary, the educational process for nursing students should prioritize enhancing social support, self-efficacy, and active learning participation. By adopting these strategies, educators can robustly support the development and career progression of nursing students, ultimately contributing to the cultivation of competent and confident healthcare professionals.\u003c/p\u003e"},{"header":"5 Limitation","content":"\u003cp\u003eThis study has several limitations that should be acknowledged. First, the use of a cross-sectional design limits the ability to establish causal relationships among social support, self-efficacy, and learning engagement. Longitudinal studies are needed to explore the dynamic interactions and long-term effects of these variables. Second, the sample was limited to nursing students from a single tertiary hospital in Shanghai, which may restrict the generalizability of the findings to other regions or healthcare settings. Future research should include a more diverse and representative sample. Third, self-reported data may introduce response bias, as participants might provide socially desirable answers. Incorporating objective measures or mixed-method approaches could enhance the validity of the findings. Lastly, while the study identified self-efficacy as a mediator, other potential mediating or moderating factors were not explored. Future studies could investigate additional variables, such as resilience or motivation, to provide a more comprehensive understanding of the mechanisms underlying learning engagement in nursing interns.\u003c/p\u003e "},{"header":"6 Conclusion","content":"\u003cp\u003eThis study demonstrated that both social support and self-efficacy significantly and positively influence the learning engagement of nursing students. Notably, self-efficacy acts as a critical mediating factor between social support and learning engagement, highlighting its pivotal role in translating external support into active learning behaviors. Educators and clinical mentors are encouraged to adopt a dual-focused approach that prioritizes the enhancement of social support systems while simultaneously fostering self-efficacy among students. By strengthening social support networks\u0026mdash;such as through mentorship programs, peer collaboration, and family involvement\u0026mdash;and nurturing self-efficacy via goal-setting, positive feedback, and skill-building opportunities, we can more effectively enhance learning engagement. This, in turn, will increase the overall quality and efficacy of clinical internships, ultimately contributing to the development of competent, confident, and engaged nursing professionals.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eThe authors extend their heartfelt gratitude to all participants for their invaluable involvement and contributions to this study, with special thanks for their essential role in the data collection process.\u003c/p\u003e\n\u003cp\u003eAuthor contributions\u003c/p\u003e\n\u003cp\u003eL.W. and Y.C. was responsible for research design, data collection and analysis, manuscript drafting, and revision.W.W. and W.Z. was responsible for research design guidance, manuscript review, and revision.M.X. was responsible for questionnaire distribution and data collection. All authors reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThere was no Funding in this study.\u003c/p\u003e\n\u003cp\u003eData availability\u003c/p\u003e\n\u003cp\u003eThe datasets used and analysed during the current study available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThe study was reviewed by the Research Ethics Committee at the Ruijin Hospital ,Shanghai JiaoTong University School of Medicine, which granted permission to conduct the study\u0026nbsp;(Approval No.2024-455). The study was performed in accordance with the ethical guidelines, protocol, and regulations stated in the Declaration of Helsinki. Informed consent was obtained from all participants.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eStoffels M, Koster AS, van der Burgt SME, et al. Basic psychological needs satisfaction as a mediator between clinical learning climate,self-regulated learning and perceived learning in the nursing education context. Med Teach. 2023;45(12):1364\u0026ndash;72. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e.https://doi.org/10.1080/0142159x.2023.2225729\u003c/span\u003e\u003cspan address=\".10.1080/0142159x.2023.2225729\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. 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[published Online First: 20210603].\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"social support, self-efficacy, learning engagement, mediating effect","lastPublishedDoi":"10.21203/rs.3.rs-6139781/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6139781/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eSocial support significantly influences nursing students' academic and professional development, yet its specific impact on learning engagement remains underexplored. Self-efficacy may mediate this relationship, but evidence is limited. Understanding how social support affects learning engagement through self-efficacy is crucial for optimizing nursing education. This study examines the impact of social support on nursing students' learning engagement and the mediating role of self-efficacy,offering insights for educators.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eA total of 309 nursing students from 12 schools participated in this survey, completing a self-designed questionnaire that included scales measuring learning engagement, perceived social support, and self-efficacy, in addition to collecting demographic data such as educational level and age. Data analysis was conducted via SPSS 21.0 to explore the relationships among the variables. AMOS 26.0 software facilitated mediation analysis to assess the moderating effects of self-efficacy. Bootstrap analyses were used to evaluate the mediating effect between variables.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe study revealed significant positive correlations between learning engagement (84.42\u0026thinsp;\u0026plusmn;\u0026thinsp;21.24), social support (69.04\u0026thinsp;\u0026plusmn;\u0026thinsp;11.15), and self-efficacy (27.78\u0026thinsp;\u0026plusmn;\u0026thinsp;6.63) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Social support significantly influenced both learning engagement (β\u0026thinsp;=\u0026thinsp;0.282, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and self-efficacy (β\u0026thinsp;=\u0026thinsp;0.503, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Furthermore, self-efficacy had a significant impact on learning engagement (β\u0026thinsp;=\u0026thinsp;0.482, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), partially mediating the relationship between social support and learning engagement, with a mediation effect ratio of 46%.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe findings highlight the significant positive impact of social support on learning engagement among nursing students:, with self-efficacy serving as a critical mediator in this relationship. To promote more active learning engagement, it is recommended that educators prioritize strengthening social support systems and enhancing students' self-efficacy. Special attention should be given to fostering self-efficacy among non-only children, as this may further optimize their learning experiences and outcomes. These insights provide valuable guidance for developing targeted educational interventions in nursing training programs.\u003c/p\u003e","manuscriptTitle":"The Effect of Social Support on Learning Investment among Nursing Students: The Mediating Role of Self-Efficacy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-05 06:36:16","doi":"10.21203/rs.3.rs-6139781/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-04-18T06:15:09+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-17T04:59:24+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-16T07:42:38+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-13T19:54:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"325711147022643302256363560953823674124","date":"2025-04-06T12:58:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"242471955346632608867843607088071453026","date":"2025-04-05T15:15:33+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-04T11:27:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"171928672688387177627611592851121367685","date":"2025-04-03T13:32:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"54393529940983978371598164634200890946","date":"2025-04-03T13:03:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"133782130669485713644587445705570101483","date":"2025-04-03T13:01:01+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-03T12:53:51+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-03T03:05:17+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-03-24T07:25:28+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-23T16:33:08+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2025-03-23T16:32:03+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"be5153c8-a8cf-4c70-9806-34e4d91b4f03","owner":[],"postedDate":"May 5th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-07-28T16:01:26+00:00","versionOfRecord":{"articleIdentity":"rs-6139781","link":"https://doi.org/10.1186/s12912-025-03615-7","journal":{"identity":"bmc-nursing","isVorOnly":false,"title":"BMC Nursing"},"publishedOn":"2025-07-21 15:57:36","publishedOnDateReadable":"July 21st, 2025"},"versionCreatedAt":"2025-05-05 06:36:16","video":"","vorDoi":"10.1186/s12912-025-03615-7","vorDoiUrl":"https://doi.org/10.1186/s12912-025-03615-7","workflowStages":[]},"version":"v1","identity":"rs-6139781","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6139781","identity":"rs-6139781","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}