Effects of blended active methodology on learning about blood pressure control, students’ perception, and test-induced stress and anxiety

Abstract

This study aimed to analyze the effect of blended active method (BAM) on blood pressure (BP) control learning, pretest stress and anxiety, and students' perceptions. With approval from the institutional ethics committee, two freshman Dentistry classes were assigned to either a traditional method (TM; <i>n</i> = 50) or BAM (<i>n</i> = 49) group. All students completed the State-Trait Anxiety Inventory (STAI) and provided saliva samples for cortisol and alpha-amylase measurements at baseline and before the exam. The TM group attended two lectures on BP control. In BAM, <i>class 1</i> involved team discussions of clinical scenarios involving BP alterations. Before <i>class 2</i>, students watched pre-class videos with embedded questions (Edpuzzle) and completed an interactive online lesson (Lt-Kuracloud) with exercises and immediate feedback. In <i>class 2</i>, students took an individual test and, in teams, analyzed which BP control systems were activated in the previous scenarios, explaining the physiological responses involved. In <i>class 3</i>, both groups completed the STAI, performed saliva collection, and a summative exam on BP control. Test scores were compared using <i>t</i> tests; anxiety and biomarker stress levels were analyzed with two-way ANOVA. BAM students achieved significantly higher exam scores (8.75 ± 1.17) compared to TM (7.27 ± 1.82). Before the exam, the TM group showed higher alpha-amylase, cortisol, and anxiety levels than BAM. According to student perceptions, BAM strategies effectively supported BP control learning. Overall, BAM improved learning outcomes and helped reduce pretest stress and anxiety compared to traditional teaching.<b>NEW &amp; NOTEWORTHY</b> This study demonstrates that a blended active method (BAM), combining team discussions, interactive online lessons, and formative assessments, improves learning outcomes and reduces pretest stress and anxiety in university students studying blood pressure control. Unlike traditional lectures, BAM provided immediate feedback and opportunities for collaborative problem-solving. The study also measured physiological stress markers (cortisol and alpha-amylase), confirming BAM's effectiveness in promoting both cognitive performance and emotional well-being in a higher education health sciences setting.