Framework and participants

A national cross-sectional multicenter study was conducted with a total of 329 public health students undertaking postgraduate studies as part of their master’s degree. The study was conducted from January 16 to February 28, 2018.

We invited 31 universities, public and private, to participate in the study. In 2017 there were a total of 1362 students [20] in master’s programs (level 7 of the European Qualifications Framework). Eight universities decided to participate in the study. A total of 653 continuing education students in master’s programs were qualified for the study, and complete datasets were obtained from 329 students (50.38% response rate). With this sample size and the number of public health students in master’s programs in Poland (NOT= 1362), the margin of error was 3.17% (95% confidence level).

Pedagogical context

In Poland, public health education is carried out according to the Bologna process. Higher education programs are divided into: bachelor’s studies (undergraduate studies), master’s studies (second cycle studies) and doctoral studies (postgraduate studies). These programs are conducted independently of each other, and universities have the capacity or organize these cycles [21].

During the second cycle study programs, students must achieve specific learning outcomes in terms of knowledge, skills and social competences. After completing a second-cycle study program, the graduate reaches the 7th level of the European Qualifications Framework and obtains the professional title of Master of Public Health [22].

During second cycle studies, students can choose a major (specialization path) that interests them. Due to the unregulated nature of the curricula at the Faculty of Public Health, each university determines its own curriculum and offers specializations. In Poland, there is a wide range of specialization tracks, for example, health education and social marketing, healthcare analytics, clinical research and health technology assessment, or epidemiology with health promotion elements. [23] as well as European public health and medicine and lifestyle management in healthcare [24].


Four research tools were used in the study

The Authentic Leadership Self-Assessment Questionnaire (ALSAQ) developed by Walumbwa et al. [8] and recommended by Northouse [25] was used to perform the self-assessment. The Polish version of the ALSAQ, validated by Panczyk et al. [19], comprises 16 items and makes it possible to measure the overall indicator of Authentic Leadership skills and its three components: moral treatment, self-awareness and relational transparency. The Polish version of the ALSAQ has good internal consistency (Cronbach’s alpha 0.84) and a test-retest analysis confirmed the stability of the measure for particular subscales and items. In our study, we only analyzed the overall level of authentic leadership skills, that is, the sum of the points of the three subscales listed above. We chose not to analyze these subscales separately because they are correlated with each other.

The Moral Foundations Questionnaire (MFQ) was developed by Graham et al. [26]. The MFQ measures five universal moral foundations: harm/care, fairness/reciprocity, ingroup/loyalty, authority/respect, and purity/inviolability. The codes provide the basis for assessing its behavior for mortality [26]. We used the Polish version of the MFQ-PL questionnaire, which has good validity and reliability [27]. In order to ensure the validity of the psychological test, the study participants answered all the questions of the MFQ-PL questionnaire. However, based on the literature review, we only considered results from two subscales, namely prejudice/attention and fairness/reciprocity. The harm/care subscale (KODT) refers to empathy and compassion and the principles of not hurting others and helping the weak and those in need [28]. This subscale was selected for study because it reflects an empathetic attitude, which is a key aspect of authentic leadership [7]. The Fairness/Reciprocity Subscale (KODS) refers to the reciprocity of helping others and helping others, as opposed to taking advantage of others and only getting involved in the action. [28]. This subscale was chosen for study because it is consistent with the general concept of authentic leadership, which involves treating others equally, providing equal opportunities, and acting for the benefit of the group. [7].

The General Self-Efficacy Scale (GSES) was originally developed by Matthias Jerusalem and Ralf Schwarzer in 1981 and was designed to assess optimistic beliefs in oneself and the ability to cope with a variety of difficult situations in life. . This is a short psychometric scale of 10 items [15]. The scale is one-dimensional and provides an overall measure of self-efficacy. We used the Polish version of the GSES, which has good validity and reliability [29].

The Youth Leadership Life Skills Development (YLLSD) scale was developed by Seevers et al. based on Miller’s concept of developing life skills in leadership [13]. The YLLSD scale contains 30 items from seven domains (communication skills, decision-making skills, skills to get along with others, learning skills, management skills, skills to understand oneself and skills to work with groups ) which together form a complete picture of leadership skills. The final summation scale of 30 indicators had a Cronbach’s alpha reliability coefficient of 0.98. In our study, we have chosen to analyze only decision-making skills, because these skills appear to be crucial for public health specialists. [1].

In addition, the research tool was supplemented with a question regarding reported participation in social skills training. To this end, the following yes/no question was asked: Have you attended any trainings/workshops on soft skills (e.g. leadership, communication, social skills, etc.)? Based on the answers to this question, the study group was divided into two subgroups. The first group was composed of students reporting having participated in at least one life skills training (LST extra group), while the second group was composed of students reporting not having participated in such training (no extra group LST).

Model assumptions

Based on the assumptions made (H1a-H1c), a theoretical model was developed (Fig. 1) assuming the impact of self-efficacy (GSES) and fairness in group cooperation (F) on decision-making skills (DMS). Additionally, DMS influences the development of Authentic Leadership Skills (ALS). Empathetic attitudes (C/E) are an important addition to this model, as they directly affect ALS and interact with F.

Fig. 1

A theoretical model of the relationship between variables. AL—authentic leadership, C/E—attention/empathy, DMS—decision-making skills, SE—self-efficacy, F—fairness, H—assumption

Data gathering

The data was collected by means of a paper questionnaire distributed to a group of students at the end of regular university classes. Trained interviewers limited themselves to stating the purpose of the study and instructing participants on how to complete the questionnaire. They were also responsible for collecting the completed questionnaires and securing them before sending them to the central unit coordinating the study. ABBYY® FlexiCapture software version 9.0 was used to digitize the data from the paper questionnaire. Questionnaires with missing data were discarded and not included in the analysis.

Data analysis

In order to analyze the variables collected in the study, we used descriptive statistics (mean, standard deviation) and structural coefficients (counts and frequency). The chi-square test of independence and Student’s t-test were used to compare the two subgroups (additional life skills training group vs no additional life skills training group) in terms of the characteristics examined based on the type of variable (categorical or continuous variables, respectively). Calculations were performed using the STATISTICA package, version 13.3 (Tibco Software Inc., Palo Alto, CA, USA). A significance level of 5% was set.

All analyzes were performed using Mplus version 7.0 structural equation modeling software [30]. We used two-group structural equation modeling: additional LST versus no additional LST groups. The purpose of this analysis was to determine whether the relationships between the theoretically assumed variables would be confirmed by the empirical data collected. For this, the model parameters (trajectory coefficients, variance and covariance) were estimated and used to construct the theoretical variance-covariance matrix of the variables used in the model (Fig. 2). We checked whether the parameters of the calculated model differed in the supplemental LST groups compared to the groups without supplemental LST. Maximum likelihood estimation with robust standard errors was used to calculate the structural model parameters.

Figure 2
Figure 2

The formal form of the structural equation model. AL—authentic leadership, C/E—attention/empathy, DMS—decisional skills, SE—self-efficacy, F—fairness, eLST—additional life skills training group, no eLST—no additional life skills training group life skills, e – residual, γ – trajectory coefficient, φ – correlation coefficient, Cov – covariant

Model fit was assessed using the following statistics and indices: Chi-Square Test of Model Fit (CMIN), Chi-Square Normal (CMIN/DF), Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), Root Mean Square Error of Approximation (RMSEA), and Standardized Root Mean Square Residual (SRMR). For model evaluation, the chi-square statistics were expected to be insignificant. Both CFI and TLI evaluate the fit of a user-specified solution against a more restricted nested reference model, in which the covariance between all input indicators is set to zero or has no no relationship between the variables that are postulated; that is, the number of dependent variables equals the number of factors. The TLI imposes an additional correction for over-parameterization [31]. The expected values ​​of the recommended indices were as follows: χ2 divided by the degrees of freedom (CMIN/DF) ≤ 3.00; RMSEA 0.95 [32].

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