Exploring the Role of Self-Efficacy in the Relationship Between Research Pressure and Research Integrity Awareness among Healthcare Professionals: A Cross-Sectional Study

Exploring the Role of Self-Efficacy in the Relationship Between Research Pressure and Research Integrity Awareness among Healthcare Professionals: A Cross-Sectional Study | 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 Exploring the Role of Self-Efficacy in the Relationship Between Research Pressure and Research Integrity Awareness among Healthcare Professionals: A Cross-Sectional Study Chenchen Jiang, Yitian Liu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9080506/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background Research integrity awareness is critical for maintaining ethical and credible research practices. Healthcare professionals often face high research pressure, which may affect their awareness of research integrity. Self-efficacy, defined as an individual’s confidence in performing tasks successfully, may influence this relationship. Method A cross-sectional survey was conducted among 412 healthcare professionals from three top-tier hospitals in Southeastern Zhejiang, China. Participants completed validated questionnaires assessing self-efficacy, research pressure (time and promotion), and research integrity awareness related to plagiarism, dishonest authorship, and multiple submissions. Structural Equation Modeling with bootstrapping was used to assess direct and indirect associations. Results Higher research pressure was associated with lower self-efficacy (direct effect = -0.55, 95% CI (-0.716, -0.406), P < 0.001) and poorer research integrity awareness (direct effect = -0.83, 95% CI (-1.062, -0.647), P < 0.001), whereas higher self-efficacy was positively associated with research integrity awareness (direct effect = 0.160, 95% CI (0.066, 0.263), P < 0.001). Bootstrapping indicated a significant indirect effect of research pressure on research integrity awareness via self-efficacy (-0.088, 95% CI (-0.152, -0.039), P < 0.001), with a total effect of -0.919 (95% CI (-1.152, -0.732), P < 0.001). No significant differences were observed across gender, professional title, administrative position, or research area. Conclusion The findings suggest that higher self-efficacy is linked to better awareness of research integrity, while greater research pressure is associated with both reduced self-efficacy and poorer integrity awareness. Exploratory mediation analysis further suggested that self-efficacy may play a role in the association between research pressure and research integrity awareness. These results underscore the crucial influence of self-efficacy and research pressure on promoting ethical research awareness among healthcare professionals. research integrity awareness self-efficacy healthcare professionals research pressure time pressure promotion pressure research misconduct Figures Figure 1 Introduction Research Integrity refers to adhering to the principles of honesty, transparency, and ethical standards throughout the research process to ensure the credibility and reproducibility of scientific findings, thereby building public trust in science. It is the foundation of scientific research, requiring researchers to maintain the highest standards of honesty, accuracy, and transparency [1, 2]. In the medical field, research integrity is particularly important because healthcare professionals play a crucial role in disease monitoring, vaccine promotion, and public health. In recent years, the prevalence of scientific misconduct worldwide has risen, severely impacting the reliability of research and hindering scientific progress [3–5]. Sociological, psychological, gender, and various structural factors can impact the honesty and integrity of researchers [6, 7]. Research misconduct primarily encompasses fabrication, falsification, plagiarism, improper authorship attribution, and redundant publication [8]. When work-related factors interact with individual characteristics, they can lead to psychological and/or physiological state changes, resulting in occupational stress [9]. A survey of 3,236 Chinese general practitioners revealed that 9.7% experienced low occupational stress, 31.8% had moderate stress, and 58.6% reported high occupational stress [10]. Performance management systems in universities and research institutions, which often require researchers to publish in specific journals, apply for projects, and secure funding for promotion, further exacerbate this pressure.[11]. Additionally, the pressure to publish is associated with a higher likelihood of research misconduct and authorship misrepresentation [12]. However, awareness of research integrity remains low, with only 36.5% familiar with misconduct cases in their field, and 30.7% of scholarship recipients indicating they would report suspected research misconduct [13]. Previous studies suggest that time pressure may compromise decision-making by limiting thorough consideration, thereby increasing the risk of shortcuts and questionable research practices in scientific work [13, 14]. These findings suggest that the pressure for career advancement, time constraints, and awareness of research integrity may influence individual research integrity behaviors. Academic misconduct is driven by multiple factors, including external pressures such as career advancement, tenure, and funding competition, as well as intrinsic motivations like the pursuit of fame and a strong belief in one's own theories. Additionally, self-efficacy, which refers to an individual' s confidence in their ability to succeed, shapes motivation and behavior [15]. Those with low self-efficacy are more likely to give up under pressure, while individuals with high self-efficacy tend to invest more effort and persist through challenge [16] Self-efficacy also helps reduce both immediate and long-term stress by boosting confidence and enhancing coping abilities [17]. Therefore, self-efficacy may be involved in the association between pressure and research integrity, and may function as a potential mediator. Although previous studies[18, 19] have explored the relationship between pressure and research integrity, most treated pressure as a broad concept and overlook the direct impact of research pressure and self-efficacy on research integrity, as well as the potential mediator of self-efficacy. This study aims to examine how research pressure and self-efficacy may be related to research integrity awareness, hypothesizing that research pressure may be associated with research integrity awareness, and self-efficacy may be associated with individual research motivation. Additionally, research on healthcare professionals, especially regarding how they avoid research misconduct under high pressure, is limited. Therefore, examining the associations between self-efficacy, research pressure, and research integrity awareness among healthcare professionals is crucial for guiding the development of a healthier research environment. Methods Data collection and participants This cross-sectional study recruited healthcare professionals from three top-tier hospitals in Wenzhou, Southeastern Zhejiang, China, in 2023. The sampling followed a convenience approach, aiming to obtain a sufficiently large sample for structural equation modeling (SEM). A total of 1,100 questionnaires were distributed via Wenjuan.com, WeChat, and email, with 433 returned (response rate: 39.3%). After screening, 412 questionnaires were deemed valid (effective response rate: 37.5%). Participants’ demographic characteristics were collected, including gender, education level, profesionnal title, administrative position, research area and work experience. All surveys were conducted anonymously. Participants were informed that responses were confidential and would only be used for academic research. Measures were taken to reduce social desirability bias, including emphasizing anonymity and avoiding personal identifiers. Questionnaire development Self-efficacy is a psychological construct that reflects an individual's confidence in successfully performing tasks in a specific domain. The self-efficacy questionnaire used the Chinese version of the General Self-Efficacy Scale [20, 21], consisting of 10 items rated on a 7-point Likert scale (0 = completely disagree, 7 = completely agree), with higher scores indicating stronger perceived efficacy. Research pressure was assessed via a two-dimensional questionnaire, measuring 'research time pressure' and 'research promotion pressure' (5 items per dimension), reflecting workload and evaluation-related pressures [22, 23]. Higher scores indicate greater perceived pressure. Research integrity awareness was measured using a 15-item questionnaire covering three domains: plagiarism, dishonest authorship, and multiple submissions [24, 25]. Items were reverse-coded so that higher scores indicate greater awareness or more positive attitudes, which helps reduce social desirability bias and ensures the questionnaire captures cognitive awareness rather than behavior. All items capture perceived awareness, not actual misconduct behavior. All items are presented in Table S1 , rated on a 7-point Likert scale (0 = completely disagree, 7 = completely agree). Hypotheses: H1: Research pressure is negatively associated with self-efficacy among healthcare professionals. H2: Self-efficacy is positively associated with research integrity awareness. Higher self-efficacy is linked to a higher level of research integrity awareness. H3: Research pressure is negatively associated with research integrity awareness. Greater research pressure leads to lower research integrity awareness. H4: Self-efficacy may mediate the association between research pressure and research integrity awareness. The theoretical model underlying these hypotheses is illustrated in Figure S1 . Statistical analyses Exploratory Factor Analysis (EFA) was conducted using Principal Component Analysis (PCA) with varimax rotation. Sampling adequacy was assessed via the Kaiser-Meyer-Olkin (KMO) measure (> 0.800 considered satisfactory) and Bartlett's Test of Sphericity (p 1, parallel analysis, and scree plot inspection. Items with communalities ≥ 0.30 and factor loadings ≥ 0.40 were retained; items with cross-loadings (> 0.30) were carefully reviewed [26]. Confirmatory Factor Analysis (CFA) was performed to validate the factor structure. Model fit was assessed using χ², RMSEA (≤ 0.050 excellent, 0.050–0.080 acceptable), SRMR ( 0.900 acceptable, > 0.950 preferred), and TLI (> 0.900 acceptable). Convergent validity was evaluated via Average Variance Extracted (AVE ≥ 0.500) and Composite Reliability (CR ≥ 0.700). Cronbach’s alpha > 0.800 indicated internal consistency [27]. Common method bias was assessed using Harman’s single-factor test to ensure that the self-reported data did not substantially inflate correlations due to method effects. Pearson correlation analysis was conducted to explore preliminary associations before SEM. Structural Equation Modeling (SEM) was conducted using CB-SEM with maximum likelihood estimation. Two models were tested: 1. First-order model with six latent variables: self-efficacy, time pressure, promotion pressure, plagiarism, dishonest authorship, and multiple submissions. 2. Second-order model with research pressure (time + promotion) and research integrity awareness (plagiarism + dishonest authorship + multiple submissions) as second-order factors, with self-efficacy specified as a potential mediator. Bootstrapping (5,000 samples) was used to evaluate the significance of indirect effects. Statistical significance was set at P < 0.05. Given the cross-sectional design, these analyses are exploratory, assessing indirect associations rather than definitive causal mechanisms. Subgroup analyses were conducted to examine potential differences in self-efficacy, research pressure, and research integrity awareness across demographic variables, including gender, professional title, administrative position (yes/no) and research area. Analyses for education level and work experience were not conducted because nearly all participants held at least a master’s degree, and work experience was highly correlated with professional title. For continuous variables, independent t-tests were used for comparisons between two groups and one-way ANOVA was used for comparisons among more than two groups. When appropriate, multi-group SEM was conducted to explore whether the structural relationships among latent constructs differed across subgroups. Statistical significance was set at P < 0.05. R-4.5.2 and AMOS version 26.0.0 (IBM Corp., Armonk, NY, USA) were used for data analysis. R was used for data description analysis, EFA, CFA and correlation methods. AMOS was used for SEM, path analysis, and bootstrapped assessment of indirect effects. Statistical significance was set at P < 0.05. Results After the data screening process, 412 completed and eligible responses were included in the analysis (Table 1 ). Among respondents, 241 (58.5%) were female and 171 (41.5%) were male. A total of 71 (17.2%) held a PhD degree, and more than half had a master's degree or higher. In terms of professional titles, 111 (26.9%) held senior or associate senior positions. Clinicians made up the majority of the sample, accounting for 256 (62.1%), and 168 (40.8%) had more than 10 years of work experience (Table 1 ). Table 1 Background characteristics. Characteristics N (%) Gender Male 171 (41.5) Female 241 (58.5) Education Level Bachelor degree 150 (36.4) Master degree 191 (46.4) PhD 71 (17.2) Title Senior professional 28 (6.8) Associate senior 83 (20.1) Intermediate professional 89 (21.6) Junior 121 (29.4) other 91 (22.1) Do you also hold an administrative position 69 (16.7) Research area Clinical 256 (62.1) Nurse 79 (19.2) Imaging medicine 48 (11.7) Pharmacy 15 (3.6) Laboratory medicine 14 (3.4) Work experience, years < 10 244 (59.2) 10–19 92 (22.3) 20–29 56 (13.6) ≥ 30 20 (4.9) The overall mean score for self-efficacy was 4.71 (SD = 1.21, range from 0 to 7), research pressure was 5.37 (SD = 1.08, range from 0 to 7), and research integrity awareness was 3.86 (SD = 1.23, range from 0 to 7) ( Table S2) . Cronbach’s alpha values ranged from 0.839 to 0.932 across all scales, indicating acceptable internal consistency. These descriptive statistics provide a solid foundation for subsequent factor and structural analyses. EFA was conducted on the 35 items covering self-efficacy, research pressure, and research integrity awareness. The Kaiser-Meyer-Olkin (KMO) measures were 0.961 for self-efficacy, 0.902 for research pressure, and 0.932 for research integrity awareness, indicating strong sampling adequacy. Bartlett’s Test of Sphericity was significant for all scales (P < 0.0001), supporting factorability. The overall KMO for all items was 0.952, with Bartlett’ s Test P < 0.001. Using varimax rotation, six factors were extracted, with eigenvalues ranging from 2.802 to 6.600. Three items (RP-Item10, RIA-Item2, and RIA-Item10) were removed due to cross-loadings ( Table S3 ). After removal, Cronbach’s alpha values ranged from 0.838 to 0.932, confirming strong internal consistency. Based on conceptual meaning, factors were labeled F1 "Self-efficacy," F2 "Time pressure," F3 "Promotion pressure," F4 "Plagiarism," F5 "Dishonest authorship," and F6 "Multiple submissions" (Table 2 ). Table 2 EFA results and inter-item reliability test. Factor F1 F2 F3 F4 F5 F6 Communality Eigenvalue Cronbach's Alpha F1: Self-efficacy SE-Item1 0.715 0.557 6.489 0.932 SE-Item2 0.754 0.625 SE-Item3 0.714 0.556 SE-Item4 0.736 0.595 SE-Item5 0.797 0.681 SE-Item6 0.799 0.675 SE-Item7 0.793 0.683 SE-Item8 0.795 0.660 SE-Item9 0.773 0.632 SE-Item10 0.772 0.640 F2: Time pressure RP-Item1 0.670 0.640 3.681 0.901 RP-Item2 0.837 0.808 RP-Item3 0.685 0.636 RP-Item4 0.763 0.722 RP-Item5 0.836 0.834 F3: Promotion pressure RP-Item6 0.782 0.765 3.676 0.838 RP-Item7 0.644 0.588 RP-Item8 0.690 0.624 RP-Item9 0.754 0.738 F4: Plagiarism RIA-Item1 0.701 0.639 3.026 0.868 RIA-Item3 0.820 0.790 RIA-Item4 0.720 0.682 RIA-Item5 0.819 0.779 F5: Dishonest authorship RIA-Item6 0.692 0.737 2.703 0.876 RIA-Item7 0.640 0.741 RIA-Item8 0.787 0.766 RIA-Item9 0.651 0.732 F6: Multiple submissions RIA-Item11 0.746 0.687 2.406 0.888 RIA-Item12 0.703 0.678 RIA-Item13 0.744 0.669 RIA-Item14 0.772 0.741 RIA-Item15 0.727 0.682 CFA tested the six-factor model identified by EFA ( Figure S2 ) and showed an acceptable fit: χ² =649.986, RMSEA = 0.035, SRMR = 0.041, CFI = 0.976, and TLI = 0.973. All items had factor loadings > 0.400, convergent validity was confirmed with AVE ≥ 0.50, and CR ≥ 0.70 for all constructs, confirming good convergent validity and reliability (Table 3 ). Table 3 CFA results of final measurement model. Factor Items Standardized loadings CR AVE F1: Self-efficacy SE-Item1 0.702 0.933 0.581 SE-Item2 0.757 SE-Item3 0.701 SE-Item4 0.734 SE-Item5 0.801 SE-Item6 0.8 SE-Item7 0.807 SE-Item8 0.78 SE-Item9 0.768 SE-Item10 0.762 F2: Time pressure RP-Item1 0.722 0.904 0.656 RP-Item2 0.885 RP-Item3 0.723 RP-Item4 0.79 RP-Item5 0.91 F3: Promotion pressure RP-Item6 0.84 0.842 0.574 RP-Item7 0.664 RP-Item8 0.687 RP-Item9 0.823 F4: Plagiarism RIA-Item1 0.691 0.871 0.630 RIA-Item3 0.86 RIA-Item4 0.768 RIA-Item5 0.845 F5: Dishonest authorship RIA-Item6 0.772 0.875 0.638 RIA-Item7 0.853 RIA-Item8 0.721 RIA-Item9 0.842 F6: Multiple submissions RIA-Item11 0.772 0.888 0.615 RIA-Item12 0.794 RIA-Item13 0.749 RIA-Item14 0.822 RIA-Item15 0.781 Note: SE: self-efficacy, RP: research pressure, RIA: research integrity awareness. Harman’s single-factor test indicated that the first factor explained 38% of the variance (< 50%), suggesting that common method bias is unlikely to substantially affect the results. Pearson correlation analysis revealed significant associations among latent factors. Self-efficacy (F1) was negatively correlated with research pressure factors (F2 and F3; βs < 0, P 0,P < 0.001). Research pressure factors (F2 and F3) were negatively correlated with research integrity awareness factors (F4 - F6; βs < 0,P < 0.001) ( Table S4 ). These correlations indicate that higher perceived research pressure is associated with lower self-efficacy and reduced awareness of research integrity, consistent with the hypothesized relationships (H1 - H3) The first-order SEM model assessed direct relationships among six latent variables, model fit indices showed acceptable fit: χ² = 717.804, χ²/df = 1.588, RMSEA = 0.038, SRMR = 0.048, CFI = 0.968, and TLI = 0.965. Time pressure (F2) was negatively associated with self-efficacy (F1; β = -0.173, P = 0.012), and promotion pressure (F3) was also negatively associated with self-efficacy (β = -0.199, P = 0.001). Self-efficacy (F1) was positively associated with all research integrity awareness (RIA) subscales: plagiarism (F4; β = 0.176, P < 0.05), dishonest authorship (F5; β = 0.512, P < 0.05), and multiple submissions (F6; β = 0.158, P < 0.05). Research pressure factors (F2 and F3) were negatively associated with the RIA subscales: βs ranging from − 0.223 to -0.482, all P < 0.001 ( Figure S3 ). These results provide initial evidence for the hypothesized associations, highlighting potential links between research pressure, self-efficacy, and RIA while clearly showing the contribution of each subscale. The second-order SEM model examined the hierarchical structure, with research pressure (time + promotion) and research integrity awareness (plagiarism + dishonest authorship + multiple submissions) as second-order factors, and self-efficacy as a mediator. Model fit was comparable to the first-order model: χ² = 681.607, χ²/df = 1.495, RMSEA = 0.035, SRMR = 0.049, CFI = 0.973, and TLI = 0.970. (Fig. 1 ). Research pressure was negatively associated with self-efficacy (β = -0.550, 95% CI (-0.716, -0.406), P < 0.001). Self-efficacy was positively associated with research integrity awareness (β = 0.160, 95% CI (0.066, 0.263), P < 0.001). Research pressure was negatively associated with research integrity awareness (β = -0.830, 95% CI (-1.062, -0.647), P < 0.001). Bootstrapping (5,000 samples) revealed a significant indirect effect of research pressure on research integrity awarenes via self-efficacy (β = -0.088, 95% CI (-0.152, -0.039), P < 0.001), suggesting that self-efficacy may partially explain the association between research pressure and research integrity awareness (Table 4 ). The total effect of research pressure on research integrity was − 0.919 with 95% CI of (-1.152, -0.732) (P < 0.001), indicating that research pressure strongly is associated with research integrity both directly and indirectly through reduced self-efficacy (Table 4 ). Table 4 Path and direct, indirect, and total effects from SEM analysis. Hypothesis Path Estimate S.E. C.R. P value Direct effect Indirect effect Total effect H1 Research pressure → Self-efficacy -0.55 0.089 -6.197 < 0.001 -0.55 (-0.716, -0.406) - -0.55 (-0.716, -0.406) H2 Self-efficacy → Research integrity awareness 0.16 0.04 4.019 < 0.001 0.160 (0.066, 0.263) - 0.16 (0.066, 0.263) H3 Research pressure → Research integrity awareness -0.83 0.102 -8.109 < 0.001 -0.83 (-1.062, -0.647) -0.088 (-0.152, -0.039) -0.919 (-1.152, -0.732) Subgroup analyses were conducted to examine potential differences in self-efficacy (F1), research pressure (F2, F3), and research integrity awareness (F4 - F6) across demographic variables, including gender, professional title, administrative position, and research area. The results indicated that there were no statistically significant differences in all factors across any of the examined demographic variables. Complete descriptive statistics and comparisons across subgroups are reported in Table S5 and Figure S4. Discussion This study highlights the critical roles of self-efficacy and research pressure in their association with research integrity awareness among healthcare professionals in the largest hospitals in Southeastern Zhejiang, China. Higher self-efficacy is associated with better awareness toward research integrity, while greater research pressure, both time and promotion pressure, is linked to poorer research integrity awareness. Additionally, self-efficacy may partially account for the relationship between research pressure and research integrity awareness, suggesting that enhancing self-efficacy may help mitigate the negative impact of research pressure, although these findings are exploratory due to the cross-sectional design. These findings emphasize the need for institutional policies that reduce excessive research pressure and promote self-efficacy to uphold research integrity awareness. This study confirms the negative relationship between self-efficacy and research pressure, supporting H1 and aligning with previous findings [28]. A decline in self-efficacy can impair an individual's ability and motivation to manage academic demands, ultimately triggering stress and negative emotions [29]. A study suggests that time-related job demands positively impact time pressure, with time-related self-efficacy playing a mediating role in this relationship [30]. Existing research also suggests that self-efficacy plays a protective role in high-pressure environments, such as mitigating academic burnout [31]. This study also highlights that healthcare professionals experience generally high levels of research pressure. However, stress levels among healthcare professionals vary significantly across studies due to differences in stress assessment tools, job roles, and work environments [32]. For instance, those working in intensive care units, might encounter greater occupational stress due to heavier work-spaces and frequent exposure to critical patients [33, 34]. Future studies could explore how specific work settings influence the relationship between research pressure and self-efficacy across different healthcare specialties. According to H2, this study found a positive association between self-efficacy and research integrity awareness, suggesting that higher levels of self-efficacy may be linked to greater research integrity awareness. Conversely, lower self-efficacy may reflect weaker integrity awareness, such as multiple submissions, plagiarism and dishonest authorship, as self-efficacy supports impulse control and correlates positively with research competence, reducing reliance on unethical behaviors [35, 36]. Although there is no direct evidence suggests that higher self-efficacy leads to poorer research integrity awareness, some theories propose that excessive self-efficacy may result in overconfidence, increasing the risk of risky or non-compliant behavior, especially under pressure to meet academic expectations [37]. However, the relationship between self-efficacy and integrity may not be strictly linear. Future studies could further explore whether an optimal range of self-efficacy exists to support ethical judgment in academic settings. H3 was validated, with the findings showing a significant negative relationship between research pressure and research integrity awareness among healthcare professionals. Both time pressure and promotion pressure in research were associated with poorer research integrity awareness. This aligns with previous research, which suggests that academic pressure can foster tolerance of unethical practices, such as plagiarism [35]. A survey found that 59.8% of doctors reported feeling pressured to publish for career advancement, while 4.1% admitted they would be willing to fabricate data to improve funding applications [38, 39]. This may be related to the nature of healthcare work in China, where most hospitals are overcrowded, and healthcare professionals often work 40 hours or more per week, with little time for vacation or sick leave [40]. Due to limited time, healthcare professionals must balance clinical and teaching duties, with little time for research. The relationship between time pressure and performance is often considered to be an inverted U-shape, where both excessive and insufficient pressure can lead to performance decline [41]. In addition, the growing number of researchers and the increasing academic environment pressure exacerbate the situation. These factors strongly highlight the impact of the traditional "publish or perish" culture on academic integrity [42]. Regarding H4, the exploratory findings suggest that self-efficacy may be involved in the association between research pressure and research integrity awareness. This suggests that research pressure may be associated with integrity awareness both directly and indirectly through its relationship with individuals’ self-efficacy. Some studies have shown that work pressure can be associated with performance through self-efficacy, with moderate pressure linked to enhance outcomes in certain contexts [43]. Strengthen Research Integrity Education and Training The global emphasis on research integrity awareness underscores the importance of education and training in raising awareness and promoting responsible conduct [44]. In the hospitals surveyed, healthcare professionals generally showed low levels of research integrity awareness and often struggled to distinguish integrity. Research shows that both the training on scientific research integrity and the surrounding research environment will influence students' attitudes towards and behaviors regarding scientific research integrity [45]. Regular training sessions should be implemented, drawing on international best practices to strengthen researchers’ understanding of ethical standards. And scientific research integrity awareness education should be continuously implemented in order to achieve better results [46]. Hospitals should provide psychological support services to help staff cope with research-related stress. This could include counseling hot-lines, pressure management workshops, and resilience-building programs such as team-building activities, drawing from proven international models, to reduce integrity issues driven by psychological strain. Theoretical and Practical Implications According to the Job Demands-Resources model [47], high job demands deplete personal resources, leading to burnout and negative outcomes, while sufficient job resources fulfill psychological needs and promote positive outcomes. This aligns with the findings of our study: time pressure and promotion pressure represent job demands that diminish researchers' cognitive resources, resulting in poorer awareness of research integrity. In contrast, self-efficacy functions as a psychological resource, reinforcing motivation and cognitive engagement, thereby enhancing research integrity awareness and reducing the likelihood of misconducts. Limitations This study has several limitations that should be considered when interpreting the findings. First, the cross-sectional design precludes causal inferences; therefore, the mediation analysis conducted has been interpreted as exploratory. Future studies using longitudinal data are needed to examine whether self-efficacy functions as a mediator between research pressure and research integrity awareness. Second, research integrity awareness was assessed only in relation to selected questionable practices, including authorship, plagiarism, and multiple submissions, rather than more severe forms of misconduct such as data fabrication, falsification, or AI-assisted writing. Third, the measurement relied on participants’ self-reported perceptions rather than objective behavioral indicators, which may be influenced by recall and social desirability biases. Fourth, the sample was drawn from top-tier hospitals in Southeastern Zhejiang, which may limit the generalizability of the findings to other regions or hospital types. Conclusion This study confirms that higher research pressure reduces self-efficacy (H1) and is associated with poorer research integrity awareness (H3), while self-efficacy plays a protective role by promoting better awareness and attitudes toward integrity (H2). Furthermore, exploratory mediation analysis suggests that self-efficacy may partially explain the association between research pressure and research integrity awareness (H4), although these findings are exploratory due to the cross-sectional design. These findings highlight the importance of balanced research expectations and institutional support in alleviating undue pressure and fostering a culture of research integrity awareness among healthcare professionals. Declarations Acknowledgments The authors would like to thank all participating during this study. Author contributions C.J. and Y.L. made substantial contributions to the conception and design of the study. Y.L. conducted data collection, and C.J. performed the analysis and interpretation of data. Both C.J. and Y.L. contributed to drafting the article and critically revising it for important intellectual content. All authors read and approved the final manuscript. Funding This work was supported by Wenzhou Science and Technology Bureau (R20220009); Wenzhou basic scientific research project (Y20220308); National Science and Technology Major Project (ZJ00003). Data availability The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Ethics approval and consent to participate The study design received ethical approval from the the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University (2022115 & 2025-K-48-01), which is the official institutional review board responsible for ethical oversight. 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(2001) Evidences for Reliability and Validity of the Chinese Version of General SelfEfficacy Scale. Chinese Journal of Applied Psychology;7(1):37–40. Guiru G, Shuangjin W. (2008) Pressures on university teachers and self-regulating countermeasures. Higher Agricultural Education(8):33 − 6. https://doi.org/10.3969/j.issn.1002-1981.2008.08.010 . Shusheng T, Zhangbao W. (2007) An analysis of the phenomenon of excessive stress in college teachers and the strategies of stress management. Journal of Hefei University of Technology (Social Sciences);21(4):5. https://doi.org/10.3969/j.issn.1008-3634.2007.04.020 . Notice of the Ministry of Science and Technology and Other Twenty-Two Departments on Printing and Distributing the "Rules for Investigation and Handling of Research Dishonesty Behaviors": Ministry of Science and Technology of the People's Republic of China; 2022 [Available from: https://www.gov.cn/zhengce/zhengceku/2022-09/14/content_5709819.htm . Chengdong X. A Study on the Impact Mechanism of Research Performance Pressure on Research Integrity among University Teachers Based on Structural Equation Modeling [thesis]. China: Zhejiang University; 2010. Hair JF. Multivariate Data Analysis: Prentice Hall; 2010. Kline RB. Principles and Practice of Structural Equation Modeling, Fourth Edition: Guilford Publications; 2015. Chongjun Z, Jing L, Seung-Yong K. (2023) The Structural Relationships among Academic Pressure, Independent Learning Ability, and Academic Self-Efficacy. Iran J Public Health;52(5):1008-18. https://doi.org/10.18502/ijph.v52i5.12719 . Flett GL, Panico T, Hewitt PL. (2011) Perfectionism, Type A Behavior, and Self-Efficacy in Depression and Health Symptoms among Adolescents. Current Psychology;30(2):105 − 16. https://doi.org/10.1007/s12144-011-9103-4 . Zhong C, Tzaichiao L, Xianghua Y, Jie W. (2022) How Time Pressure Matter University Faculties’ Job Stress and Well-Being? The Perspective of the Job Demand Theory. Frontiers in Psychology;13. https://doi.org/10.3389/fpsyg.2022.902951 . Ling-Na K, Li Y, Yi-Nan P, Shuo-Zhen C. (2021) Proactive personality, professional self-efficacy and academic burnout in undergraduate nursing students in China. J Prof Nurs;37(4):690-5. https://doi.org/10.1016/j.profnurs.2021.04.003 . Dianat I, Azemi S, Abdollahazade F, Bazazan A, Asghari Jafarabadi M. (2021) Does self-efficacy mediate the relationship between occupational stress and mental health problems? A study among nursing professionals. Health Promot Perspect;11(3):344 − 50. https://doi.org/10.34172/hpp.2021.44 . Abdolhamid T, Gebraeil NS, Amin G, Leila O, Seyed SSH, Ali SSA. (2015) Occupational stress and mental health among nurses in a medical intensive care unit of a general hospital in Bandar Abbas in 2013. Electron Physician;7(3):1108-13. https://doi.org/10.14661/2015.1108-1113 . Milutinović D, Golubović B, Brkić N, Prokeš B. (2012) Professional Stress and Health among Critical Care Nurses in Serbia. Archives of Industrial Hygiene and Toxicology;63(2):171 − 80. https://doi.org/10.2478/10004-1254-63-2012-2140 . Fatima A, Sunguh KK, Abbas A, Mannan A, Hosseini S. (2020) Impact of pressure, self-efficacy, and self-competency on students' plagiarism in higher education. Account Res;27(1):32–48. https://doi.org/10.1080/08989621.2019.1699070 . Wenhui J, Yuan Y, Lanfang Z. (2019) Self-Efficacy and Research Capacity of Clinical Nurses in China. The Journal of Continuing Education in Nursing;50(11):509 − 16. https://doi.org/10.3928/00220124-20191015-07 . Eric J I, Kathy N, Bijal M S, Shadi D, Monica K B. (2016) Motivations and Predictors of Cheating in Pharmacy School. American Journal of Pharmaceutical Education;80(8):133. https://doi.org/10.5688/ajpe808133 . Habib R, Stephen A. (2020) Dishonesty and research misconduct within the medical profession. BMC Medical Ethics;21(1):22. https://doi.org/10.1186/s12910-020-0461-z . Geggie D. (2001) A survey of newly appointed consultants' attitudes towards research fraud. Journal of Medical Ethics 27(5):344-6. https://doi.org/10.1136/jme.27.5.344 . Wei Z, Zhi-Ming W, Mian-Zhen W, Ya-Jia L, Si-Ying W. (2006) Job burnout and contributing factors for nurses. Journal of Sichuan University (Medical Sciences);37(2):281-3, 308. Tams S, Ahuja M, Thatcher J, Grover V. (2020) Worker stress in the age of mobile technology: The combined effects of perceived interruption overload and worker control. The Journal of Strategic Information Systems;29(1):101595. https://doi.org/10.1016/j.jsis.2020.101595 . Taraneh M, Mohammad A. (2020) A review of the current concerns about misconduct in medical sciences publications and the consequences. DARU Journal of Pharmaceutical Sciences 28(1):359 − 69. https://doi.org/10.1007/s40199-020-00332-1 . Xiaobin M. A Study on the Relationship between Managers' Work Stress, Self-efficacy, and Work Performance [thesis]. China: Zhejiang University; 2004. National Research C, Institute of Medicine Committee on Assessing Integrity in Research E. Integrity in Scientific Research: Creating an Environment That Promotes Responsible Conduct. Washington (DC): National Academies Press (US); 2002. Wu X, Zheng T, Nie Y, Wu J, Chen J, Pathak JL, et al. (2025) Status of scientific research integrity knowledge in dental undergraduates from 34 universities in China. BMC Med Ethics;26(1):29. https://doi.org/10.1186/s12910-025-01183-8 . Pizzolato D, Dierickx K. (2021) Stakeholders' perspectives on research integrity training practices: a qualitative study. BMC Med Ethics;22(1):67. https://doi.org/10.1186/s12910-021-00637-z . Demerouti E, Bakker AB, Nachreiner F, Schaufeli WB. (2001) The job demands-resources model of burnout. Journal of Applied Psychology;86(3):499–512. https://doi.org/10.1037/0021-9010.86.3.499 . Additional Declarations No competing interests reported. Supplementary Files Supplementarymaterial2026.3.10.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 17 Apr, 2026 Reviewers agreed at journal 13 Apr, 2026 Reviewers invited by journal 08 Apr, 2026 Editor invited by journal 14 Mar, 2026 Editor assigned by journal 11 Mar, 2026 Submission checks completed at journal 11 Mar, 2026 First submitted to journal 10 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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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-9080506","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":623916985,"identity":"c33b00a7-772e-46f7-8fd3-a2c12e8574ac","order_by":0,"name":"Chenchen Jiang","email":"","orcid":"","institution":"The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Chenchen","middleName":"","lastName":"Jiang","suffix":""},{"id":623916986,"identity":"722c7ccc-5607-4637-8afc-3bad9017afe6","order_by":1,"name":"Yitian Liu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6ElEQVRIie2PMQrCMBSGUyLt0ur6oGDPUALaQfEqCUImEcTFQUpA6BkUxDPERXALFHTpAepYvYBjR0M3l6ajYD54Dx78H7wfIYvlB+ljvSgChDBWeb2BYWRS3EahWvEy9kJFQmJhUppN9fgFIU62YUiZFM8fQVUn0Rg4D1cnoI7A1bNsfUwr+rH4up/fwsMFlh5yCVl0UBxZcg7BBdaO8N2wizKT5WIEwRGYUB0VJgtdPxCdFHedUA5zec9Ytb8BiXeGLoNBfn7Uk3Qqc6zUe5sOI29XvdoUTQ++b9webyJvc8ZisVj+mg9Xo0UA+3yp2wAAAABJRU5ErkJggg==","orcid":"","institution":"The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University","correspondingAuthor":true,"prefix":"","firstName":"Yitian","middleName":"","lastName":"Liu","suffix":""}],"badges":[],"createdAt":"2026-03-10 07:25:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9080506/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9080506/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107246201,"identity":"c03e4499-fc96-4d99-992a-a9c3739a0927","added_by":"auto","created_at":"2026-04-19 08:10:00","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":982617,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eParsimonious second-order SEM\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRP, Research Pressure (TP, Time Pressure and PP, Promotion Pressure) and RIA, Research Integrity Awareness(PLA, Plagiarism; DA, Dishonest Authorship; MS, Multiple Submissions) were modeled as second-order constructs, with SE, Self-Efficacy specified as a potential mediator in the exploratory model. Standardized path coefficients and item loadings are shown.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9080506/v1/46f0c5318868f74ca064ca8e.jpeg"},{"id":107246702,"identity":"333aaa46-c368-4588-8b7b-799656ac3362","added_by":"auto","created_at":"2026-04-19 08:10:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1718618,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9080506/v1/4ee71de6-4e79-4125-a069-2eadde729832.pdf"},{"id":107246260,"identity":"42628246-2b09-4dfd-9b16-6282996e10df","added_by":"auto","created_at":"2026-04-19 08:10:03","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":662274,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementarymaterial2026.3.10.docx","url":"https://assets-eu.researchsquare.com/files/rs-9080506/v1/0c833dfea29c50b378aabcb1.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Exploring the Role of Self-Efficacy in the Relationship Between Research Pressure and Research Integrity Awareness among Healthcare Professionals: A Cross-Sectional Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003e Research Integrity refers to adhering to the principles of honesty, transparency, and ethical standards throughout the research process to ensure the credibility and reproducibility of scientific findings, thereby building public trust in science. It is the foundation of scientific research, requiring researchers to maintain the highest standards of honesty, accuracy, and transparency [1, 2]. In the medical field, research integrity is particularly important because healthcare professionals play a crucial role in disease monitoring, vaccine promotion, and public health. In recent years, the prevalence of scientific misconduct worldwide has risen, severely impacting the reliability of research and hindering scientific progress [3\u0026ndash;5].\u003c/p\u003e \u003cp\u003eSociological, psychological, gender, and various structural factors can impact the honesty and integrity of researchers [6, 7]. Research misconduct primarily encompasses fabrication, falsification, plagiarism, improper authorship attribution, and redundant publication [8]. When work-related factors interact with individual characteristics, they can lead to psychological and/or physiological state changes, resulting in occupational stress [9]. A survey of 3,236 Chinese general practitioners revealed that 9.7% experienced low occupational stress, 31.8% had moderate stress, and 58.6% reported high occupational stress [10]. Performance management systems in universities and research institutions, which often require researchers to publish in specific journals, apply for projects, and secure funding for promotion, further exacerbate this pressure.[11]. Additionally, the pressure to publish is associated with a higher likelihood of research misconduct and authorship misrepresentation [12]. However, awareness of research integrity remains low, with only 36.5% familiar with misconduct cases in their field, and 30.7% of scholarship recipients indicating they would report suspected research misconduct [13]. Previous studies suggest that time pressure may compromise decision-making by limiting thorough consideration, thereby increasing the risk of shortcuts and questionable research practices in scientific work [13, 14]. These findings suggest that the pressure for career advancement, time constraints, and awareness of research integrity may influence individual research integrity behaviors.\u003c/p\u003e \u003cp\u003eAcademic misconduct is driven by multiple factors, including external pressures such as career advancement, tenure, and funding competition, as well as intrinsic motivations like the pursuit of fame and a strong belief in one's own theories. Additionally, self-efficacy, which refers to an individual' s confidence in their ability to succeed, shapes motivation and behavior [15]. Those with low self-efficacy are more likely to give up under pressure, while individuals with high self-efficacy tend to invest more effort and persist through challenge [16] Self-efficacy also helps reduce both immediate and long-term stress by boosting confidence and enhancing coping abilities [17]. Therefore, self-efficacy may be involved in the association between pressure and research integrity, and may function as a potential mediator.\u003c/p\u003e \u003cp\u003eAlthough previous studies[18, 19] have explored the relationship between pressure and research integrity, most treated pressure as a broad concept and overlook the direct impact of research pressure and self-efficacy on research integrity, as well as the potential mediator of self-efficacy. This study aims to examine how research pressure and self-efficacy may be related to research integrity awareness, hypothesizing that research pressure may be associated with research integrity awareness, and self-efficacy may be associated with individual research motivation. Additionally, research on healthcare professionals, especially regarding how they avoid research misconduct under high pressure, is limited. Therefore, examining the associations between self-efficacy, research pressure, and research integrity awareness among healthcare professionals is crucial for guiding the development of a healthier research environment.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData collection and participants\u003c/h2\u003e \u003cp\u003eThis cross-sectional study recruited healthcare professionals from three top-tier hospitals in Wenzhou, Southeastern Zhejiang, China, in 2023. The sampling followed a convenience approach, aiming to obtain a sufficiently large sample for structural equation modeling (SEM). A total of 1,100 questionnaires were distributed via Wenjuan.com, WeChat, and email, with 433 returned (response rate: 39.3%). After screening, 412 questionnaires were deemed valid (effective response rate: 37.5%).\u003c/p\u003e \u003cp\u003eParticipants\u0026rsquo; demographic characteristics were collected, including gender, education level, profesionnal title, administrative position, research area and work experience.\u003c/p\u003e \u003cp\u003eAll surveys were conducted anonymously. Participants were informed that responses were confidential and would only be used for academic research. Measures were taken to reduce social desirability bias, including emphasizing anonymity and avoiding personal identifiers.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eQuestionnaire development\u003c/h3\u003e\n\u003cp\u003eSelf-efficacy is a psychological construct that reflects an individual's confidence in successfully performing tasks in a specific domain. The self-efficacy questionnaire used the Chinese version of the General Self-Efficacy Scale [20, 21], consisting of 10 items rated on a 7-point Likert scale (0\u0026thinsp;=\u0026thinsp;completely disagree, 7\u0026thinsp;=\u0026thinsp;completely agree), with higher scores indicating stronger perceived efficacy.\u003c/p\u003e \u003cp\u003eResearch pressure was assessed via a two-dimensional questionnaire, measuring 'research time pressure' and 'research promotion pressure' (5 items per dimension), reflecting workload and evaluation-related pressures [22, 23]. Higher scores indicate greater perceived pressure.\u003c/p\u003e \u003cp\u003eResearch integrity awareness was measured using a 15-item questionnaire covering three domains: plagiarism, dishonest authorship, and multiple submissions [24, 25]. Items were reverse-coded so that higher scores indicate greater awareness or more positive attitudes, which helps reduce social desirability bias and ensures the questionnaire captures cognitive awareness rather than behavior. All items capture perceived awareness, not actual misconduct behavior.\u003c/p\u003e \u003cp\u003eAll items are presented in \u003cb\u003eTable \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e\u003c/b\u003e, rated on a 7-point Likert scale (0\u0026thinsp;=\u0026thinsp;completely disagree, 7\u0026thinsp;=\u0026thinsp;completely agree).\u003c/p\u003e\n\u003ch3\u003eHypotheses:\u003c/h3\u003e\n\u003cp\u003eH1: Research pressure is negatively associated with self-efficacy among healthcare professionals.\u003c/p\u003e \u003cp\u003eH2: Self-efficacy is positively associated with research integrity awareness. Higher self-efficacy is linked to a higher level of research integrity awareness.\u003c/p\u003e \u003cp\u003eH3: Research pressure is negatively associated with research integrity awareness. Greater research pressure leads to lower research integrity awareness.\u003c/p\u003e \u003cp\u003eH4: Self-efficacy may mediate the association between research pressure and research integrity awareness.\u003c/p\u003e \u003cp\u003eThe theoretical model underlying these hypotheses is illustrated in \u003cb\u003eFigure \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e\u003c/b\u003e.\u003c/p\u003e\n\u003ch3\u003eStatistical analyses\u003c/h3\u003e\n\u003cp\u003eExploratory Factor Analysis (EFA) was conducted using Principal Component Analysis (PCA) with varimax rotation. Sampling adequacy was assessed via the Kaiser-Meyer-Olkin (KMO) measure (\u0026gt;\u0026thinsp;0.800 considered satisfactory) and Bartlett's Test of Sphericity (p\u0026thinsp;\u0026lt;\u0026thinsp;0.050). Factors were extracted based on eigenvalues\u0026thinsp;\u0026gt;\u0026thinsp;1, parallel analysis, and scree plot inspection. Items with communalities\u0026thinsp;\u0026ge;\u0026thinsp;0.30 and factor loadings\u0026thinsp;\u0026ge;\u0026thinsp;0.40 were retained; items with cross-loadings (\u0026gt;\u0026thinsp;0.30) were carefully reviewed [26].\u003c/p\u003e \u003cp\u003eConfirmatory Factor Analysis (CFA) was performed to validate the factor structure. Model fit was assessed using χ\u0026sup2;, RMSEA (\u0026le;\u0026thinsp;0.050 excellent, 0.050\u0026ndash;0.080 acceptable), SRMR (\u0026lt;\u0026thinsp;0.080), CFI (\u0026gt;\u0026thinsp;0.900 acceptable, \u0026gt;\u0026thinsp;0.950 preferred), and TLI (\u0026gt;\u0026thinsp;0.900 acceptable). Convergent validity was evaluated via Average Variance Extracted (AVE\u0026thinsp;\u0026ge;\u0026thinsp;0.500) and Composite Reliability (CR\u0026thinsp;\u0026ge;\u0026thinsp;0.700). Cronbach\u0026rsquo;s alpha\u0026thinsp;\u0026gt;\u0026thinsp;0.800 indicated internal consistency [27].\u003c/p\u003e \u003cp\u003eCommon method bias was assessed using Harman\u0026rsquo;s single-factor test to ensure that the self-reported data did not substantially inflate correlations due to method effects. Pearson correlation analysis was conducted to explore preliminary associations before SEM.\u003c/p\u003e \u003cp\u003eStructural Equation Modeling (SEM) was conducted using CB-SEM with maximum likelihood estimation. Two models were tested: 1. First-order model with six latent variables: self-efficacy, time pressure, promotion pressure, plagiarism, dishonest authorship, and multiple submissions. 2. Second-order model with research pressure (time\u0026thinsp;+\u0026thinsp;promotion) and research integrity awareness (plagiarism\u0026thinsp;+\u0026thinsp;dishonest authorship\u0026thinsp;+\u0026thinsp;multiple submissions) as second-order factors, with self-efficacy specified as a potential mediator. Bootstrapping (5,000 samples) was used to evaluate the significance of indirect effects. Statistical significance was set at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Given the cross-sectional design, these analyses are exploratory, assessing indirect associations rather than definitive causal mechanisms.\u003c/p\u003e \u003cp\u003eSubgroup analyses were conducted to examine potential differences in self-efficacy, research pressure, and research integrity awareness across demographic variables, including gender, professional title, administrative position (yes/no) and research area. Analyses for education level and work experience were not conducted because nearly all participants held at least a master\u0026rsquo;s degree, and work experience was highly correlated with professional title. For continuous variables, independent t-tests were used for comparisons between two groups and one-way ANOVA was used for comparisons among more than two groups. When appropriate, multi-group SEM was conducted to explore whether the structural relationships among latent constructs differed across subgroups. Statistical significance was set at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003cp\u003eR-4.5.2 and AMOS version 26.0.0 (IBM Corp., Armonk, NY, USA) were used for data analysis. R was used for data description analysis, EFA, CFA and correlation methods. AMOS was used for SEM, path analysis, and bootstrapped assessment of indirect effects. Statistical significance was set at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAfter the data screening process, 412 completed and eligible responses were included in the analysis (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Among respondents, 241 (58.5%) were female and 171 (41.5%) were male. A total of 71 (17.2%) held a PhD degree, and more than half had a master's degree or higher. In terms of professional titles, 111 (26.9%) held senior or associate senior positions. Clinicians made up the majority of the sample, accounting for 256 (62.1%), and 168 (40.8%) had more than 10 years of work experience (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\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\u003eBackground characteristics.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e171 (41.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e241 (58.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation Level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBachelor degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e150 (36.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaster degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e191 (46.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e71 (17.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTitle\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSenior professional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28 (6.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAssociate senior\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e83 (20.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntermediate professional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e89 (21.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJunior\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e121 (29.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eother\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e91 (22.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDo you also hold an administrative position\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e69 (16.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResearch area\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e256 (62.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e79 (19.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImaging medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e48 (11.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePharmacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15 (3.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLaboratory medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14 (3.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWork experience, years\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e244 (59.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u0026ndash;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e92 (22.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u0026ndash;29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e56 (13.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20 (4.9)\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\u003eThe overall mean score for self-efficacy was 4.71 (SD\u0026thinsp;=\u0026thinsp;1.21, range from 0 to 7), research pressure was 5.37 (SD\u0026thinsp;=\u0026thinsp;1.08, range from 0 to 7), and research integrity awareness was 3.86 (SD\u0026thinsp;=\u0026thinsp;1.23, range from 0 to 7) (\u003cb\u003eTable S2)\u003c/b\u003e. Cronbach\u0026rsquo;s alpha values ranged from 0.839 to 0.932 across all scales, indicating acceptable internal consistency. These descriptive statistics provide a solid foundation for subsequent factor and structural analyses.\u003c/p\u003e \u003cp\u003eEFA was conducted on the 35 items covering self-efficacy, research pressure, and research integrity awareness. The Kaiser-Meyer-Olkin (KMO) measures were 0.961 for self-efficacy, 0.902 for research pressure, and 0.932 for research integrity awareness, indicating strong sampling adequacy. Bartlett\u0026rsquo;s Test of Sphericity was significant for all scales (P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), supporting factorability. The overall KMO for all items was 0.952, with Bartlett\u0026rsquo; s Test P\u0026thinsp;\u0026lt;\u0026thinsp;0.001.\u003c/p\u003e \u003cp\u003eUsing varimax rotation, six factors were extracted, with eigenvalues ranging from 2.802 to 6.600. Three items (RP-Item10, RIA-Item2, and RIA-Item10) were removed due to cross-loadings (\u003cb\u003eTable S3\u003c/b\u003e). After removal, Cronbach\u0026rsquo;s alpha values ranged from 0.838 to 0.932, confirming strong internal consistency. Based on conceptual meaning, factors were labeled F1 \"Self-efficacy,\" F2 \"Time pressure,\" F3 \"Promotion pressure,\" F4 \"Plagiarism,\" F5 \"Dishonest authorship,\" and F6 \"Multiple submissions\" (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\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\u003eEFA results and inter-item reliability test.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\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=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eF2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eF3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eF4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eF5\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eF6\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCommunality\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eEigenvalue\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eCronbach's Alpha\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"9\" rowspan=\"10\"\u003e \u003cp\u003e\u003cb\u003eF1: Self-efficacy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSE-Item1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.715\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.557\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\" morerows=\"9\" rowspan=\"10\"\u003e \u003cp\u003e6.489\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\" morerows=\"9\" rowspan=\"10\"\u003e \u003cp\u003e0.932\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSE-Item2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.754\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.625\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSE-Item3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.714\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.556\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSE-Item4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.736\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.595\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSE-Item5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.797\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.681\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSE-Item6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.799\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.675\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSE-Item7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.793\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.683\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSE-Item8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.795\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.660\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSE-Item9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.773\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.632\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSE-Item10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.772\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.640\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eF2: Time pressure\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRP-Item1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.670\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.640\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e3.681\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e0.901\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRP-Item2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.837\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.808\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRP-Item3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.685\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.636\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRP-Item4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.763\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.722\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRP-Item5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.836\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.834\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eF3: Promotion pressure\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRP-Item6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.782\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.765\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e3.676\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.838\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRP-Item7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.644\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.588\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRP-Item8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.690\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.624\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRP-Item9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.754\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.738\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eF4: Plagiarism\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRIA-Item1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.701\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.639\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e3.026\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.868\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRIA-Item3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.820\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.790\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRIA-Item4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.720\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.682\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRIA-Item5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.819\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.779\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eF5: Dishonest authorship\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRIA-Item6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.692\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.737\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e2.703\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.876\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRIA-Item7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.640\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.741\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRIA-Item8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.787\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.766\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRIA-Item9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.651\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.732\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eF6: Multiple submissions\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRIA-Item11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.746\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.687\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e2.406\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e0.888\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRIA-Item12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.703\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.678\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRIA-Item13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.744\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.669\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRIA-Item14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.772\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.741\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRIA-Item15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.727\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.682\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\u003eCFA tested the six-factor model identified by EFA (\u003cb\u003eFigure S2\u003c/b\u003e) and showed an acceptable fit: \u003cb\u003eχ\u0026sup2;\u003c/b\u003e=649.986, RMSEA\u0026thinsp;=\u0026thinsp;0.035, SRMR\u0026thinsp;=\u0026thinsp;0.041, CFI\u0026thinsp;=\u0026thinsp;0.976, and TLI\u0026thinsp;=\u0026thinsp;0.973. All items had factor loadings\u0026thinsp;\u0026gt;\u0026thinsp;0.400, convergent validity was confirmed with AVE\u0026thinsp;\u0026ge;\u0026thinsp;0.50, and CR\u0026thinsp;\u0026ge;\u0026thinsp;0.70 for all constructs, confirming good convergent validity and reliability (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\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\u003eCFA results of final measurement model.\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=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStandardized loadings\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAVE\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"9\" rowspan=\"10\"\u003e \u003cp\u003e\u003cb\u003eF1: Self-efficacy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSE-Item1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.702\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"9\" rowspan=\"10\"\u003e \u003cp\u003e0.933\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"9\" rowspan=\"10\"\u003e \u003cp\u003e0.581\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSE-Item2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.757\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSE-Item3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.701\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSE-Item4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.734\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSE-Item5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.801\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSE-Item6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSE-Item7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.807\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSE-Item8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSE-Item9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.768\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSE-Item10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.762\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eF2: Time pressure\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRP-Item1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.722\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e0.904\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e0.656\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRP-Item2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.885\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRP-Item3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.723\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRP-Item4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRP-Item5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eF3: Promotion pressure\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRP-Item6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.842\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.574\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRP-Item7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.664\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRP-Item8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.687\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRP-Item9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.823\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eF4: Plagiarism\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRIA-Item1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.691\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.871\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.630\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRIA-Item3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRIA-Item4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.768\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRIA-Item5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.845\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eF5: Dishonest authorship\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRIA-Item6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.772\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.875\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.638\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRIA-Item7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.853\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRIA-Item8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.721\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRIA-Item9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.842\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eF6: Multiple submissions\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRIA-Item11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.772\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e0.888\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e0.615\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRIA-Item12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.794\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRIA-Item13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.749\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRIA-Item14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.822\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRIA-Item15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.781\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cb\u003eNote: SE: self-efficacy, RP: research pressure, RIA: research integrity awareness.\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eHarman\u0026rsquo;s single-factor test indicated that the first factor explained 38% of the variance (\u0026lt;\u0026thinsp;50%), suggesting that common method bias is unlikely to substantially affect the results.\u003c/p\u003e \u003cp\u003ePearson correlation analysis revealed significant associations among latent factors. Self-efficacy (F1) was negatively correlated with research pressure factors (F2 and F3; βs\u0026thinsp;\u0026lt;\u0026thinsp;0, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001)) and positively correlated with research integrity awareness factors (F4 - F6) (βs\u0026thinsp;\u0026gt;\u0026thinsp;0,P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Research pressure factors (F2 and F3) were negatively correlated with research integrity awareness factors (F4 - F6; βs\u0026thinsp;\u0026lt;\u0026thinsp;0,P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (\u003cb\u003eTable S4\u003c/b\u003e). These correlations indicate that higher perceived research pressure is associated with lower self-efficacy and reduced awareness of research integrity, consistent with the hypothesized relationships (H1 - H3)\u003c/p\u003e \u003cp\u003eThe first-order SEM model assessed direct relationships among six latent variables, model fit indices showed acceptable fit: \u003cb\u003eχ\u0026sup2; =\u003c/b\u003e 717.804, χ\u0026sup2;/df\u0026thinsp;=\u0026thinsp;1.588, RMSEA\u0026thinsp;=\u0026thinsp;0.038, SRMR\u0026thinsp;=\u0026thinsp;0.048, CFI\u0026thinsp;=\u0026thinsp;0.968, and TLI\u0026thinsp;=\u0026thinsp;0.965.\u003c/p\u003e \u003cp\u003eTime pressure (F2) was negatively associated with self-efficacy (F1; β = -0.173, P\u0026thinsp;=\u0026thinsp;0.012), and promotion pressure (F3) was also negatively associated with self-efficacy (β = -0.199, P\u0026thinsp;=\u0026thinsp;0.001). Self-efficacy (F1) was positively associated with all research integrity awareness (RIA) subscales: plagiarism (F4; β\u0026thinsp;=\u0026thinsp;0.176, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), dishonest authorship (F5; β\u0026thinsp;=\u0026thinsp;0.512, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and multiple submissions (F6; β\u0026thinsp;=\u0026thinsp;0.158, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Research pressure factors (F2 and F3) were negatively associated with the RIA subscales: βs ranging from \u0026minus;\u0026thinsp;0.223 to -0.482, all P\u0026thinsp;\u0026lt;\u0026thinsp;0.001 (\u003cb\u003eFigure S3\u003c/b\u003e).\u003c/p\u003e \u003cp\u003eThese results provide initial evidence for the hypothesized associations, highlighting potential links between research pressure, self-efficacy, and RIA while clearly showing the contribution of each subscale.\u003c/p\u003e \u003cp\u003eThe second-order SEM model examined the hierarchical structure, with research pressure (time\u0026thinsp;+\u0026thinsp;promotion) and research integrity awareness (plagiarism\u0026thinsp;+\u0026thinsp;dishonest authorship\u0026thinsp;+\u0026thinsp;multiple submissions) as second-order factors, and self-efficacy as a mediator. Model fit was comparable to the first-order model: χ\u0026sup2; = 681.607, χ\u0026sup2;/df\u0026thinsp;=\u0026thinsp;1.495, RMSEA\u0026thinsp;=\u0026thinsp;0.035, SRMR\u0026thinsp;=\u0026thinsp;0.049, CFI\u0026thinsp;=\u0026thinsp;0.973, and TLI\u0026thinsp;=\u0026thinsp;0.970. (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eResearch pressure was negatively associated with self-efficacy (β = -0.550, 95% CI (-0.716, -0.406), P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Self-efficacy was positively associated with research integrity awareness (β\u0026thinsp;=\u0026thinsp;0.160, 95% CI (0.066, 0.263), P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Research pressure was negatively associated with research integrity awareness (β = -0.830, 95% CI (-1.062, -0.647), P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Bootstrapping (5,000 samples) revealed a significant indirect effect of research pressure on research integrity awarenes via self-efficacy (β = -0.088, 95% CI (-0.152, -0.039), P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), suggesting that self-efficacy may partially explain the association between research pressure and research integrity awareness (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). The total effect of research pressure on research integrity was \u0026minus;\u0026thinsp;0.919 with 95% CI of (-1.152, -0.732) (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), indicating that research pressure strongly is associated with research integrity both directly and indirectly through reduced self-efficacy (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\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\u003ePath and direct, indirect, and total effects from SEM analysis.\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=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" 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\u003eHypothesis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePath\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEstimate\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\u003eC.R.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP value\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eDirect effect\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eIndirect effect\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTotal effect\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eH1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eResearch pressure \u0026rarr; Self-efficacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.089\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-6.197\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.55 (-0.716, -0.406)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-0.55 (-0.716, -0.406)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eH2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelf-efficacy \u0026rarr; Research integrity awareness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.160 (0.066, 0.263)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.16 (0.066, 0.263)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eH3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eResearch pressure \u0026rarr; Research integrity awareness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-8.109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.83 (-1.062, -0.647)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.088 (-0.152, -0.039)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-0.919 (-1.152, -0.732)\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\u003eSubgroup analyses were conducted to examine potential differences in self-efficacy (F1), research pressure (F2, F3), and research integrity awareness (F4 - F6) across demographic variables, including gender, professional title, administrative position, and research area. The results indicated that there were no statistically significant differences in all factors across any of the examined demographic variables. Complete descriptive statistics and comparisons across subgroups are reported in \u003cb\u003eTable S5 and Figure S4.\u003c/b\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study highlights the critical roles of self-efficacy and research pressure in their association with research integrity awareness among healthcare professionals in the largest hospitals in Southeastern Zhejiang, China. Higher self-efficacy is associated with better awareness toward research integrity, while greater research pressure, both time and promotion pressure, is linked to poorer research integrity awareness. Additionally, self-efficacy may partially account for the relationship between research pressure and research integrity awareness, suggesting that enhancing self-efficacy may help mitigate the negative impact of research pressure, although these findings are exploratory due to the cross-sectional design. These findings emphasize the need for institutional policies that reduce excessive research pressure and promote self-efficacy to uphold research integrity awareness.\u003c/p\u003e \u003cp\u003eThis study confirms the negative relationship between self-efficacy and research pressure, supporting H1 and aligning with previous findings [28]. A decline in self-efficacy can impair an individual's ability and motivation to manage academic demands, ultimately triggering stress and negative emotions [29]. A study suggests that time-related job demands positively impact time pressure, with time-related self-efficacy playing a mediating role in this relationship [30]. Existing research also suggests that self-efficacy plays a protective role in high-pressure environments, such as mitigating academic burnout [31]. This study also highlights that healthcare professionals experience generally high levels of research pressure. However, stress levels among healthcare professionals vary significantly across studies due to differences in stress assessment tools, job roles, and work environments [32]. For instance, those working in intensive care units, might encounter greater occupational stress due to heavier work-spaces and frequent exposure to critical patients [33, 34]. Future studies could explore how specific work settings influence the relationship between research pressure and self-efficacy across different healthcare specialties.\u003c/p\u003e \u003cp\u003eAccording to H2, this study found a positive association between self-efficacy and research integrity awareness, suggesting that higher levels of self-efficacy may be linked to greater research integrity awareness. Conversely, lower self-efficacy may reflect weaker integrity awareness, such as multiple submissions, plagiarism and dishonest authorship, as self-efficacy supports impulse control and correlates positively with research competence, reducing reliance on unethical behaviors [35, 36]. Although there is no direct evidence suggests that higher self-efficacy leads to poorer research integrity awareness, some theories propose that excessive self-efficacy may result in overconfidence, increasing the risk of risky or non-compliant behavior, especially under pressure to meet academic expectations [37]. However, the relationship between self-efficacy and integrity may not be strictly linear. Future studies could further explore whether an optimal range of self-efficacy exists to support ethical judgment in academic settings.\u003c/p\u003e \u003cp\u003eH3 was validated, with the findings showing a significant negative relationship between research pressure and research integrity awareness among healthcare professionals. Both time pressure and promotion pressure in research were associated with poorer research integrity awareness. This aligns with previous research, which suggests that academic pressure can foster tolerance of unethical practices, such as plagiarism [35]. A survey found that 59.8% of doctors reported feeling pressured to publish for career advancement, while 4.1% admitted they would be willing to fabricate data to improve funding applications [38, 39]. This may be related to the nature of healthcare work in China, where most hospitals are overcrowded, and healthcare professionals often work 40 hours or more per week, with little time for vacation or sick leave [40]. Due to limited time, healthcare professionals must balance clinical and teaching duties, with little time for research. The relationship between time pressure and performance is often considered to be an inverted U-shape, where both excessive and insufficient pressure can lead to performance decline [41]. In addition, the growing number of researchers and the increasing academic environment pressure exacerbate the situation. These factors strongly highlight the impact of the traditional \"publish or perish\" culture on academic integrity [42].\u003c/p\u003e \u003cp\u003eRegarding H4, the exploratory findings suggest that self-efficacy may be involved in the association between research pressure and research integrity awareness. This suggests that research pressure may be associated with integrity awareness both directly and indirectly through its relationship with individuals\u0026rsquo; self-efficacy. Some studies have shown that work pressure can be associated with performance through self-efficacy, with moderate pressure linked to enhance outcomes in certain contexts [43].\u003c/p\u003e\n\u003ch3\u003eStrengthen Research Integrity Education and Training\u003c/h3\u003e\n\u003cp\u003eThe global emphasis on research integrity awareness underscores the importance of education and training in raising awareness and promoting responsible conduct [44]. In the hospitals surveyed, healthcare professionals generally showed low levels of research integrity awareness and often struggled to distinguish integrity. Research shows that both the training on scientific research integrity and the surrounding research environment will influence students' attitudes towards and behaviors regarding scientific research integrity [45]. Regular training sessions should be implemented, drawing on international best practices to strengthen researchers\u0026rsquo; understanding of ethical standards. And scientific research integrity awareness education should be continuously implemented in order to achieve better results [46]. Hospitals should provide psychological support services to help staff cope with research-related stress. This could include counseling hot-lines, pressure management workshops, and resilience-building programs such as team-building activities, drawing from proven international models, to reduce integrity issues driven by psychological strain.\u003c/p\u003e\n\u003ch3\u003eTheoretical and Practical Implications\u003c/h3\u003e\n\u003cp\u003eAccording to the Job Demands-Resources model [47], high job demands deplete personal resources, leading to burnout and negative outcomes, while sufficient job resources fulfill psychological needs and promote positive outcomes. This aligns with the findings of our study: time pressure and promotion pressure represent job demands that diminish researchers' cognitive resources, resulting in poorer awareness of research integrity. In contrast, self-efficacy functions as a psychological resource, reinforcing motivation and cognitive engagement, thereby enhancing research integrity awareness and reducing the likelihood of misconducts.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis study has several limitations that should be considered when interpreting the findings. First, the cross-sectional design precludes causal inferences; therefore, the mediation analysis conducted has been interpreted as exploratory. Future studies using longitudinal data are needed to examine whether self-efficacy functions as a mediator between research pressure and research integrity awareness. Second, research integrity awareness was assessed only in relation to selected questionable practices, including authorship, plagiarism, and multiple submissions, rather than more severe forms of misconduct such as data fabrication, falsification, or AI-assisted writing. Third, the measurement relied on participants\u0026rsquo; self-reported perceptions rather than objective behavioral indicators, which may be influenced by recall and social desirability biases. Fourth, the sample was drawn from top-tier hospitals in Southeastern Zhejiang, which may limit the generalizability of the findings to other regions or hospital types.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study confirms that higher research pressure reduces self-efficacy (H1) and is associated with poorer research integrity awareness (H3), while self-efficacy plays a protective role by promoting better awareness and attitudes toward integrity (H2). Furthermore, exploratory mediation analysis suggests that self-efficacy may partially explain the association between research pressure and research integrity awareness (H4), although these findings are exploratory due to the cross-sectional design. These findings highlight the importance of balanced research expectations and institutional support in alleviating undue pressure and fostering a culture of research integrity awareness among healthcare professionals.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank all participating during this study. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eC.J. and Y.L. made substantial contributions to the conception and design of the study. Y.L. conducted data collection, and C.J. performed the analysis and interpretation of data. Both C.J. and Y.L. contributed to drafting the article and critically revising it for important intellectual content. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by Wenzhou Science and Technology Bureau (R20220009); Wenzhou basic scientific research project (Y20220308); National Science and Technology Major Project\u0026nbsp;(ZJ00003).\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study design received ethical approval from the the Second Affiliated Hospital and Yuying Children\u0026rsquo;s Hospital of Wenzhou Medical University (2022115 \u0026amp; 2025-K-48-01), which is the official institutional review board responsible for ethical oversight. As this was an anonymous questionnaire-based study with no collection of identifiable personal data, the requirement for informed consent was waived by the ethics committee. All procedures involving human participants were conducted in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclosure statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eZhaksylyk A, Zimba O, Yessirkepov M, Kocyigit BF. (2023) Research Integrity: Where We Are and Where We Are Heading. 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Journal of Applied Psychology;86(3):499\u0026ndash;512. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1037/0021-9010.86.3.499\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"research integrity awareness, self-efficacy, healthcare professionals, research pressure, time pressure, promotion pressure, research misconduct","lastPublishedDoi":"10.21203/rs.3.rs-9080506/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9080506/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eResearch integrity awareness is critical for maintaining ethical and credible research practices. Healthcare professionals often face high research pressure, which may affect their awareness of research integrity. Self-efficacy, defined as an individual\u0026rsquo;s confidence in performing tasks successfully, may influence this relationship.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eA cross-sectional survey was conducted among 412 healthcare professionals from three top-tier hospitals in Southeastern Zhejiang, China. Participants completed validated questionnaires assessing self-efficacy, research pressure (time and promotion), and research integrity awareness related to plagiarism, dishonest authorship, and multiple submissions. Structural Equation Modeling with bootstrapping was used to assess direct and indirect associations.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eHigher research pressure was associated with lower self-efficacy (direct effect = -0.55, 95% CI (-0.716, -0.406), P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and poorer research integrity awareness (direct effect = -0.83, 95% CI (-1.062, -0.647), P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), whereas higher self-efficacy was positively associated with research integrity awareness (direct effect\u0026thinsp;=\u0026thinsp;0.160, 95% CI (0.066, 0.263), P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Bootstrapping indicated a significant indirect effect of research pressure on research integrity awareness via self-efficacy (-0.088, 95% CI (-0.152, -0.039), P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with a total effect of -0.919 (95% CI (-1.152, -0.732), P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). No significant differences were observed across gender, professional title, administrative position, or research area.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe findings suggest that higher self-efficacy is linked to better awareness of research integrity, while greater research pressure is associated with both reduced self-efficacy and poorer integrity awareness. Exploratory mediation analysis further suggested that self-efficacy may play a role in the association between research pressure and research integrity awareness. These results underscore the crucial influence of self-efficacy and research pressure on promoting ethical research awareness among healthcare professionals.\u003c/p\u003e","manuscriptTitle":"Exploring the Role of Self-Efficacy in the Relationship Between Research Pressure and Research Integrity Awareness among Healthcare Professionals: A Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-19 08:09:11","doi":"10.21203/rs.3.rs-9080506/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-18T01:43:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"117514423395593763812915082223521159774","date":"2026-04-14T01:37:33+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-08T20:17:06+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-15T00:24:17+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-12T03:14:17+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-12T03:13:55+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2026-03-10T07:16:22+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"06190e85-f5fc-4c39-ab8c-4ba1556cc62f","owner":[],"postedDate":"April 19th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-19T08:09:11+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-19 08:09:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9080506","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9080506","identity":"rs-9080506","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}