Factors Contributing to Low Academic Performance of First-Generation Students in Occupational Therapy

Higher education in the United States is a tool to promote social equity, because it can provide students with opportunities and access to well-paid careers (Billson & Terry, 1982; D’Amico & Dika, 2013; Fox et al., 2023). First-generation students, whose parents or guardians have not received at least a baccalaureate degree, generally have lower academic performance than their non-first-generation counterparts (D’Amico & Dika, 2013; López et al., 2023; U.S. Department of Education, 2018). Many first-generation students in higher education, including those in occupational therapy programs, face myriad obstacles to academic success, which leaves them at risk and vulnerable to attrition (Ivemark & Ambrose, 2021; McCarthy et al., 2023; Romero et al., 2020; Taff et al., 2023; van Rensburg & Kapp, 2014; Zabat et al., 2021).

Research focused on first-generation students in professional programs is limited. Some professional programs, including occupational therapy programs, provide courses for students to improve their social mobility and pursue their career; therefore, the stakes are higher for students to succeed academically and complete the program. A failure by professional programs to support first-generation students may perpetuate the disparities that exist in education and professional sectors in which diversity and inclusion are increasingly valued (Beagan & Chacala, 2012; Banks, 2022; Ramirez & Kiraly-Alvarez, 2023). The success of first-generation students in occupational therapy programs has implications for social equity because most first-generation students are from ethnic minority and low socioeconomic backgrounds (McCarthy et al., 2023; Taff et al., 2023; van Rensburg, 2011; van Rensburg & Kapp, 2014; Zabat et al., 2021). Finding ways to improve these students’ academic and social experience will positively influence social change by widening the network of various health care professionals to meet the diverse needs of an ever-evolving health care system.

Despite the increase in diverse student enrollment in higher education, the academic success and graduation rates of first-generation students are disproportionately lower than those of other students (Fry, 2021; Taff et al., 2023). Differences between one’s home environment and the culture of higher education can pose obstacles for first-generation students navigating the occupational therapy program. For example, van Rensburg and Kapp (2014) conducted a qualitative longitudinal analysis of a first-generation student in occupational therapy to analyze the student’s learning journey. This student withdrew from school social activities as a coping mechanism and struggled academically because of language barrier, low sense of self-esteem, and lack of support from her teachers. The challenges that exist for first-generation students in occupational therapy also resonate in a study by Taff et al. (2023). The participants in their study reported not feeling safe in their neighborhoods and lacking money, reliable transportation, adequate shelter and clothing, knowledge of school resources, social integration, and time because of family and personal responsibilities, all of which negatively affected their sense of health, well-being, and academic engagement.

Factors such as ethnic minority status, socioeconomic status, and lack of social capital contribute to low academic performance for first-generation students in allied health (Donini-Lenhoff & Brotherton, 2010; Gupta, 1991; Jack, 2016; McCarthy et al., 2023). These factors place the students at high risk for attrition, leaving the health care community with a shortage of health care professionals and negative repercussions on the community (Donini-Lenhoff & Brotherton, 2010).

According to Bandura (1986), academic self-efficacy is one’s belief in one’s capabilities to complete an academic task. First-generation students in higher education, including occupational therapy, generally tend to have a lower level of academic self-efficacy compared with their non-first-generation peers (Andonian, 2017; Chemers et al., 2001; McCarthy et al., 2023; Ramos-Sanchez & Nichols, 2007). A low sense of academic efficacy results in low academic performance (Foulstone & Kelly, 2019; Ramos-Sanchez & Nichols, 2007). Higher academic self-efficacy for first-generation students in occupational therapy could translate to more effort and persistence in their studies, which in turn supports academic success.

Academic engagement, or effectively participating in educationally purposeful activities in class, is positively linked to academic outcomes for students in higher education (Ahlfeldt et al., 2005; Kuh et al., 2008; Mazumder et al., 2020). Pike and Kuh (2005) assessed the college experiences of first-generation and non-first-generation students by examining 3,000 college students across the country. The study found that first-generation students in higher education were less academically engaged compared with their non-first-generation peers (Pike & Kuh, 2005). Similarly, Taff et al. (2023) discussed how first-generation students in occupational therapy struggled with having their basic needs met, which negatively affected their academic engagement, health, and well-being.

Social integration is another significant factor that predicts students’ academic performance and persistence in higher education (Billson & Terry, 1982; Lehman, 2007; Robinson, 2003; Tinto, 1993). Social integration develops when students establish informal positive relationships with their peers and faculty (Tinto, 1993). McCarthy et al. (2023) explored the experiences of 23 first-generation students in an occupational therapy program and found that these students had low social integration in the institution, which negatively affected their academic performance.

There is a scarcity of literature on factors contributing to low academic performance among first-generation students in occupational therapy. The various stressors that are unique to first-generation students in higher education may pose significant challenges to their academic and social experiences. Following a synthesis of the research literature related to low academic performance of first-generation students in higher education, academic self-efficacy, academic engagement, and social integration emerged as factors that warranted further investigation. Therefore, I developed the following research questions:

• 1. How do first-generation students in occupational therapy perceive their academic abilities?

• 2. How do first-generation students in occupational therapy describe their own academic engagement in class?

• 3. How do first-generation students in occupational therapy perceive their social integration in the university?

This study used a mixed-methods, explanatory sequential design (Creswell & Plano-Clark, 2018). I collected preexisting deidentified student demographic data. In explanatory sequential design, the quantitative approach objectively measures the problem, and the qualitative approach expands on the quantitative results to highlight the subjective experiences of the participants (Lochmiller & Lester, 2017). The study received institutional review board approval from Long Island University.

The participants consisted of 18 first-generation occupational therapy students in an occupational therapy program within a private, nonprofit 4-yr university on the East Coast of the United States. Purposeful sampling was appropriate for the research goal of investigating first-generation students in occupational therapy. Inclusion criteria included being a first-generation student in occupational therapy and at least 18 yr old. Students who identified as being a non-first-generation student in occupational therapy were ineligible to participate. Eighteen of 36 (50%) first-generation students responded to the survey, and 5 students participated in a semistructured interview. Table 1 displays the participants’ parental education, cohort, gender, class standing, and race or ethnicity.

The Self-Efficacy for Learning Form–Abridged (SELF-A) is a validated self-report measure that examines students’ academic self-efficacy beliefs regarding their self-regulatory processes during academic learning (Zimmerman & Kitsantas, 2007). SELF-A has 19 items and focuses on studying, test preparation, and notetaking. Participants indicate the level of confidence for each item on a Likert scale from 1 (definitely cannot do it) to 5 (definitely can do it). SELF-A has predictive validity and a Cronbach’s α of .97 (Zimmerman & Kitsantas, 2007).

The Survey of Student Engagement adapts specific items from the National Survey of Student Engagement (Ahlfeldt et al., 2005) and has 14 questions. The survey uses a Likert scale ranging from 1 (very little/never) to 4 (very much/often) for each item. There are four questions on collaborative learning, five items on cognitive development, and five items on personal skills development. The internal consistency reliability coefficient (Cronbach’s α) for the survey is .84 (Ahlfeldt et al., 2005).

The Social Integration Scale is a subscale of Pascarella and Terenzini’s (1980) Institutional Integration Scales. The Social Integration Scale uses a Likert scale ranging from 5 (strongly agree) to 1 (strongly disagree) for each item. The scale has seven items on peer-group interactions and five items on interactions with faculty. The scale has an α internal consistency reliability coefficient of .84 (peer-group interactions) and .89 (interactions with faculty; Pascarella & Terenzini, 1980).

I created a demographic questionnaire ( Appendix A) that included the participants’ parental level of education, cohort, gender, class standing, and race or ethnicity.

The interviews included questions about academic self-efficacy, academic engagement, and social integration to provide the opportunity for first-generation occupational therapy students to share their experiences ( Appendix B).

Quantitative data were collected via the surveys through Qualtrics, and qualitative data were collected via the semistructured interviews on Zoom; interviews lasted 45 min. I asked follow-up or probing questions for clarification and adapted them on the basis of participants’ responses to the interview questions, which allowed for a more conversational and personalized approach. Before the interview, the participants were notified of the purpose of the study and terms of the informed consent document, including that the interviews would be audio recorded and transcribed for data analysis purposes. All data were deidentified, aggregated, and secured in a password-protected computer that only I could access.

I viewed the survey results in Qualtrics and exported the data to Excel and SPSS (Version 29.0.0) for descriptive analysis. Descriptive statistics, including mean and standard deviation, were calculated for the participants’ responses to the surveys.

I used deductive or a priori analysis to interpret the interview questions (Merriam & Tisdell, 2016). In the first cycle coding (Miles et al., 2014), I assigned codes to the data to identify the recurring patterns. A priori codes (Lochmiller & Lester, 2017) were developed before the interviews based on the literature relating to low academic performance of first-generation students in higher education. The codes included the constructs of academic self-efficacy, academic engagement, and social integration. In the second cycle coding (Miles et al., 2014), the codes were grouped together to create a theme, which was academic experience. A series of quotes and their interpretations were also included. The analysis was complete when saturation indicated that no new data were generated.

The findings reflect the analysis of the survey and interview data examining the academic self-efficacy, academic engagement, and social integration of first-generation students in occupational therapy. Academic experience emerged as the theme. It entailed the first-generation students’ experiences related to their perceptions of their academic abilities, engagement in their courses, and interactions with their faculty and peers.

The first research question asked how first-generation students in occupational therapy perceived their academic abilities. Fifteen participants responded to the SELF-A. Overall, the participants reported challenges in the following: writing an effective summary of their notes when the lecture was complex (M = 2.20, SD = 0.75), remembering technical details of a concept for an exam (M = 2.80, SD = 0.87), focusing their attention to finish their assignment when they felt moody or restless when studying (M = 2.10, SD = 1.30), and engaging in effective studying and test preparation (M = 2.22, SD = 0.80).

There were mixed responses regarding the participants’ perceptions of their academic self-efficacy. Most participants (80%) reported having difficulty organizing their notes and writing an effective summary when the lecture was long and very complex. According to a first-generation participant in the junior class,

In addition, 60% of the participants mentioned being unaware of various effective strategies and lacking self-awareness on how they learn best. According to a participant in a junior class,

All participants reported struggling to remember the technical details of a concept for a test and not using association to ensure recall. According to a participant in the graduating class,

Most participants (80%) reported challenges in their test preparation to prevent cramming at the last minute for an exam. A participant in the senior class commented, “Sometimes cramming seems to be the only option. With all the content that needs to be learned and the other things going on in my life, I sometimes struggle to maintain good study habits or spend enough time studying.”

On the other hand, the participants discussed a few strategies that helped them to study and learn the material. One participant in the junior class summarized, “I use a to-do list and write down deadlines on my calendar.” Other participants mentioned using the mnemonic system to help remember the material and noise-canceling headphones or ear plugs to focus.

The second research question asked how first-generation students in occupational therapy described their engagement in class. Eighteen participants responded to the Survey of Student Engagement. Most participants reported not asking questions during class or contributing to class discussion (M = 2.1, SD = 0.87). Collaborating with their peers on group projects and assignments was perceived to be a challenge (M = 2.90, SD = 0.92). The participants disclosed that they faced challenges with evaluating and analyzing data (M = 1.90, SD = 1.20) and that some courses emphasized their personal and cognitive development more than others (M = 3.11, SD = 0.78).

All participants mentioned that the professor’s teaching style helped them to become more engaged with the content. They described how interactive and clinically related content made the course more engaging. One participant in the junior class mentioned, “I like especially when professors show their experience in the field and relate the course material to them. This makes the material more interesting and engaging and I better understand the material that way.” Another participant in the senior class divulged, “I prefer teachers that are interactive and not so didactic. My mind tends to drift elsewhere easily if the class is didactic. I tend to stay engaged if the class is interactive.”

Most participants (80%) have a relatively low level of academic engagement in their course as it pertained to class participation and collaboration with peers. According to a participant in the senior class,

All participants emphasized the value of engaging in collaborative group work to improve their overall engagement and learning. One participant in the junior class shared, “I prefer to work with others rather than myself because we can bounce ideas off each other and learn more that way. I tend to become more motivated when I have others who hold me accountable.”

Evaluating information or methods was a challenge for 60% of the participants. A participant in the senior class disclosed, “I still do not feel 100% comfortable evaluating or interpreting information like assessment or research data. I wish I got more practice with this.”

All participants reported that some courses contributed to their knowledge, skills, and cognitive development more than others. A participant in a senior class revealed that the content and structure of some courses equipped her to become more of an independent learner than other courses:

Educators play a pivotal role in shaping students’ personal and academic development. All participants echoed the significant impact educators have on their knowledge and skills. A participant in the graduating class disclosed how professors affected her growth:

The third research question asked how first-generation students in occupational therapy perceived their social integration in the university. Eighteen participants responded to the Social Integration Scale. Overall, participants reported that they have developed positive and satisfying relationships with their peers (M = 3.80, SD = 0.82). However, the participants disclosed that they did not develop a close, personal relationship with faculty (M = 1.62, SD = 1.12).

Most participants (80%) reported having positive interactions with their classmates but generally negative experiences in their interactions with faculty. As one participant in the junior class summarized about interactions with classmates, “I made amazing friends and it’s been so helpful and makes the whole process so much easier and exciting.” A participant in the senior class echoed the same sentiment: “I had difficulty opening up and making friends when I first started the program but once I found ways to relate to others, it made the journey more bearable.”

Overall, all participants had limited interactions with the faculty and felt that it was up to them to seek interactions with faculty. A participant in the graduating class described,

This study examined how academic self-efficacy, academic engagement, and social integration contributed to the academic performance of first-generation students in occupational therapy. Approximately 76% of occupational therapy students in the United States identify as White (American Occupational Therapy Association, 2020). As the racial and ethnic diversity of individuals continues to increase, it is paramount to have occupational therapists reflect the diversity of the population. Given that most first-generation students in higher education are of ethnic minority backgrounds and face numerous obstacles to their academic success, it is critical that institutions, occupational therapy programs included, provide the necessary supports for a more inclusive, supportive, and diverse educational environment to support student success.

The findings pertaining to academic self-efficacy were similar to previous studies in which first-generation students in higher education, including occupational therapy programs, had low levels of academic self-efficacy (Köseoğlu, 2015, McCarthy et al., 2023; Pucillo & Perez, 2023). Occupational therapy program courses are academically rigorous and require a deep understanding of various topics in a short period of time. The high academic expectations and personal responsibilities and demands of a first-generation student contribute to challenges in their academic performance. Many of the participants frequently crammed to study and lacked the confidence in their abilities to use effective study strategies, self-regulate, and prepare for exams. Receiving the appropriate guidance and support and developing self-regulatory mechanics in the beginning of their academic journey may contribute to academic success for first-generation students in occupational therapy.

This study’s results on the academic engagement among first-generation students in occupational therapy are consistent with other studies, which found that first-generation students in higher education had low academic engagement as it related to collaborative learning, cognitive development, and personal skills development (Asbjørnslett et al., 2022; Mazumder et al., 2020; Pike & Kuh, 2005). The participants reported a low level of engagement in their courses. They disclosed that the course content, format, and instructor’s teaching style affected their level of engagement. If the instructor read the lecture slides verbatim and did not provide opportunities for discussion and reflection, the participants reported being less engaged. To promote academic engagement, occupational therapy educators need to provide students with effective educational practices and promote a dynamic, supportive learning environment (Ahlfeldt et al., 2005) in which content has clinical application and students are encouraged to problem-solve and collaborate. Being able to effectively collaborate with others will help them, as future occupational therapists, to provide comprehensive client-centered care and lead to improved client outcomes. In addition, students should become adept at interpreting and analyzing data to inform their clinical decision-making.

A comparison of this study’s results on the social integration of first-generation students in occupational therapy with the results of previous studies (McCarthy et al., 2023; van Rensburg, 2011) confirmed that the participants had positive interactions with their classmates but generally negative interactions with faculty. The participants’ experiences with peers contributed to their sense of belonging, which affected their experience of social integration in the occupational therapy program, but they felt limited in their interactions with the faculty. First-generation students are still more likely to have low academic performance and drop out of university because of a low sense of social integration with their faculty (Lehmann, 2007). Factors relating to faculty that the participants felt contributed to their sense of belonging and increased their sense of self-efficacy included being approachable, offering support, engaging in conversations inside and outside the classroom, inviting students to office hours and other means of contact outside office hours, and being willing to offer content through various modalities.

There is a crucial need to diversify the student body in occupational therapy to promote a workforce that mirrors the diversity of the client population. Efforts to actively recruit and retain first-generation students can signal an institution’s appreciation for diversity and inclusivity. A diverse student body contributes to an enriching, vibrant learning environment by incorporating a diversity of experiences and insights into the classroom. The diversity improves the cultural competence of occupational therapists, increases workforce representation, reduces health care disparities, and leads to improved client outcomes (Beagan & Chacala, 2012; Blyth, 2022; Figueroa, 2024; Ramirez & Kiraly-Alvarez, 2023).

This study had several limitations. First, a small sample size limited the generalizability of the study. However, I asked the participants to review the transcript of their responses to their interview; this member checking may improve the internal validity of the study (Creswell & Miller, 2000). Future research may entail recruiting participants from multiple occupational therapy programs. Also, although the literature provides ample evidence that first-generation students in higher education face numerous academic and personal challenges compared with non-first-generation students, there is a lack of comparison with non-first-generation students in this study. Although not a necessity for a qualitative exploration, conducting a comparison study with non-first-generation occupational therapy students to identify barriers that may be unique to first-generation students in occupational therapy is recommended.

Occupational therapy is integrated into occupation-based learning, highlighting occupational engagement as its primary focus (Coppola, 2013; Hooper et al., 2015; Howarth et al., 2018). In the domain of education, educators must be able to grasp the aim of education so that they can teach successfully upon course completion (Harðarson, 2018). The World Federation of Occupational Therapists (2024) acknowledged the importance of diversity and culture in the practice of occupational therapy. The achievement of first-generation students in occupational therapy programs is vital for promoting social mobility, enhancing educational equity, and nurturing diversity and inclusion (Asbjørnslett et al., 2022; van Rensburg & Kapp, 2014; Zabat et al., 2021).

The following are implications for occupational therapy education based on the results of this study:

• ▪ An academic self-regulation program or services in the occupational therapy program should be implemented to improve the academic self-efficacy and self-regulatory processes of first-generation students in occupational therapy.

• ▪ A dynamic, interactive, collaborative classroom should provide the first-generation students with opportunities for hands-on activities or discussion and clinical application of the content in a supportive, nonjudgmental environment.

• ▪ First-generation students in occupational therapy should be provided with mentorship and informal and formal opportunities for socialization and support with their peers and faculty outside the classroom.

This study examined how academic self-efficacy, academic engagement, and social integration contributed to the academic performance of first-generation students in occupational therapy. First-generation students bring with them unique insights and experiences that can augment their learning experience. It would be beneficial for educators and administrators in occupational therapy to carefully consider the academic and social needs of these students. It is essential to understand the challenges faced by first-generation students in occupational therapy and provide them with the appropriate access and support for their academic success. These students’ academic and social experience in occupational therapy education is critical for preparing them to deliver high-quality, client-centered care as future therapists, thus making a positive impact on the health and well-being of both individuals and communities.

I thank Dr. Iris Saltiel at the Johns Hopkins University School of Education for her invaluable support and guidance on my research.

• 1. What is the highest educational degree attained by either of your parents or the person/people who raised you?

  • a) Did not complete high school

  • b) High school diploma

  • c) Postsecondary school other than college

  • d) Some college or associate’s degree

  • e) Bachelor’s degree

  • f) Graduate school degree

• 2. Cohort

  • a) Day

  • b) Evening

• 3. Gender

  • a) Male

  • b) Female

• 4. Class Standing

  • a) Junior

  • b) Senior

  • c) Graduating

• 5. Race/Ethnicity

  • a) White

  • b) Black or African American

  • c) Hispanic/Latino

  • d) Asian

  • e) American Indian or Alaskan

  • f) Native Hawaiian or other

  • g) Two or more races

  • h) Non-resident alien

• 1. Describe how you manage/tackle academically challenging tasks?

• 2. How do you prepare for an exam?

• 3. What helps you to be more involved with course content?

• 4. How do courses contribute to your knowledge and skills?

  • (I can provide clarification with examples such as, writing clearly, memorizing facts, thinking critically, applying what is learned, working effectively with other individuals, etc.)

• 5. Please describe the way(s) you interact with your classmates? In what way, if any, do interactions with classmates help you academically? In what way, if any, do interactions with classmates negatively impact you academically?

• 6. Please describe the way(s) you interact with the faculty? In what way, if any, do interactions with faculty help you academically? In what way, if any, do interactions with faculty negatively impact you academically?