Universities role in helping students cope with stress: A multiple case study on Swedish business schools and student health organizations

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Lisa Eriksson & Elena Palani Jafi

Universities role in helping students cope with stress

A multiple case study on Swedish business schools and student health organizations

Business Administration Master’s Thesis

30 ECTS

Term: Spring 2020

Supervisor: Bertrand Pauget

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Acknowledgments

This thesis represents the final work of our 2-year master studies in Business Administration at Karlstad University. We would like to express our gratitude to our supervisor Bertrand Pauget who challenged our ideas and thoughts, offered valuable support and advice throughout the research process. To our respondents who participated in the study and shared their knowledge with us. To each other for valuable social support during this thesis. And finally, to our families for their constant support during two years of study and in the process of research and writing this thesis.

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Abstract

Background: Stress is increasing rapidly in society and especially among those studying. Some studies highlight the unique potential of universities, as a social coping resource, to help students maintain mental health and reduce stress. However, there is limited knowledge regarding how universities are reacting to this stress.

Purpose: The purpose of this paper is to investigate how universities react to the problem with stress among business students and how they act as a social coping resource. Further, this paper aims at investigating where more efforts are needed.

Method: The paper has applied a qualitative research method, using a multiple case study where 14 semi-structured interviews were conducted with representatives from business schools and student health organizations from 4 Swedish universities. The study applied a thematic analysis.

Findings: Universities react and serve as a social coping resource by working preventative, establishing a positive study environment, easing the transition and adjustment to the university, and by providing information and feedback to the students. Further, they are looking into course dispositions where workload should be evenly distributed. The student health organizations are available to everyone, no matter reason and offer group-activities and individual conversations in accordance with what the students need help with regarding stress. The university also tries to promote certain coping strategies, where the business schools focus on problem- focused coping and the student health organization on emotion-focused coping. Even though some collaboration is found, especially at the beginning of programs, there is a need to further work on the infrastructure between different instances at the university to react faster to issues regarding student stress.

Conclusion: Universities tries to work preventative and react fast to the issue, but students tend to seek support when they already have been stressed for a long time.

Universities focus a lot on students starting their studies and tend to treat student by student rather than applying a holistic and long-term perspective. To react better to this problem there is a need for a better infrastructure to better serve as a social coping resource, where the student health organization are included more during the studies.

Contributions: The study has contributed to further knowledge of universities’ role as a social coping resources and their reaction to student stress, and further contributes

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Table of content

1. Introduction ... 7

1.1. Background ... 7

1.2. Problematization ... 8

1.3. Purpose and research question ... 10

1.4. Disposition ... 10

2. Literature review ... 11

2.1. Swedish universities: their role and stakeholders ... 11

2.2. The concept of stress ... 12

Stress among students ... 13

2.3. Coping strategies ... 14

2.4. The role of universities in offering support ... 15

Universities as a social coping resource ... 15

3. Methodology ... 17

3.1. Research strategy... 17

3.2. Research design ... 18

3.3. Empirical data collection ... 18

Semi-structured interviews ... 18

Respondents ... 19

Operationalization ... 19

3.4. Transcription and method of analysis ... 20

3.5. Quality of the study ... 22

3.6. Ethical considerations ... 23

4. Results ... 24

4.1. University A ... 24

The university as a social coping resource ... 24

Coping strategies ... 25

The university infrastructure ... 25

4.2. University B ... 26

4.3. University C ... 29

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4.4. University D ... 30

4.5. Summary ... 32

5. Analysis ... 33

5.1. The universities reaction to students’ stress and role as a social coping resource ... 33

The universities infrastructure ... 36

6. Conclusion ... 39

6.1. Limitations and suggestions for future research ... 40

List of references... 41

Appendices ... 47

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1. Introduction

This section contains the background of the study where the issue of stress among students is discussed and the coping resources universities constitute. Further, the problematization is presented followed by the purpose and research question of the study. Finally, delimitations and the outline of the paper is presented.

1.1. Background

Stress is increasing rapidly in society and is now referred to as one of the greatest threats towards human health (Hjärnfonden 2017). This problem has been stated in various reports from Swedish authorities (Folkhälsomyndigheten 2019; Myndigheten för ungdoms- och civilsamhällesfrågor 2019) and further manifested in the dramatic growth of people diagnosed with chronic stress-related illnesses. There are several negative outcomes and health issues related to excessive stress such as e.g. burn-outs, heart diseases, exhaustion, and high turnover rates (Buchheit et al. 2016). Therefore, stress is argued to reduce the wellbeing of individuals and their life satisfaction (Hamarat et al. 2001). While conducting the present research there was also an ongoing outbreak of the COVID-19 pandemic, which might contribute to sensitivity and increased levels of stress in society given that previous outbreak situations have been proven responsible for impaired well-being (Lettinga et al. 2002).

While society in general continuously reports high levels of stress, there is one group reporting even higher levels. This group is young people between the age of 16-29 years old, and especially those studying (Folkhälsomyndigheten 2019). In November 2019, the Public Health Agency of Sweden reported that 31% of all students are experiencing stress (compared to 16% in the entire population), and 8% are feeling very stressed (Folkhälsomyndigheten 2019).

However, even though students are reporting the highest levels of stress, the majority of research focuses on stress in the workforce while limited attention is brought to university settings (Law 2010). There are many stressors and challenges facing university students in their everyday life which, if considered excessive for a long time, could have carryover effects to their future workplace (Law 2010). Workload, financial pressure, career uncertainty, poor adjustments to university, conflicts with family and friends, pressure from peers, poor time management skills and loneliness are but a few factors that have been pointed out as academic stressors (Redhwan et al. 2009). For students starting university, it often means moving away from home for the first time and leaving friends and family behind. It also means that they are engaging in a certain career and therefore the pressure of success might be even higher. This is also done at the same time as they are supposed to enter adulthood, where other factors are of importance as well, such as finding a partner or creating a family. According to Schäfer Elinder and Faskunger (2006), the pressure from society is increasing and students

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their life quality (Neveu et al. 2012) and since this stress is increasing rapidly it has given rise to concerns and also the need for more research on the subject (Smith et al.

2014; Law 2010). That this group of people is reporting high levels of stress from such a young age is troublesome given that they are the future of Sweden and the future welfare of society lies in their hands.

To be able to reduce the negative outcomes of stress previous research is pointing out coping resources as important factors which in turn will affect how students cope with their stress (Connor-Smith & Flachsbart 2007; Phinney & Haas 2003; Garriott & Nisle 2018). Previous research suggests that for students to be able to handle stressful events there is a need for both individual and social coping resources (Phinney & Haas 2003;

Garriott & Nisle 2018). In general, individual coping resources is described as the actions and thoughts (coping strategies), that individuals use when they are facing stressful situations (Lazarus & Folkman 1984) and are reflecting the individual impact in the way to deal with stress (Brougham et al. 2009). Therefore, coping strategies are an individual's emotional and cognitive efforts to reduce concerns between human and environment, or student’s effort to manage, remove and reduce stressful situations to minimize negative outcomes (Folkman & Lazarus 1985). Social coping resources refer to e.g. mentors, family, and friends which can help to manage stressful situations (Garriott & Nisle 2018). Further, institutional support offered by universities is an important social coping resource for students to cope with stressful events (Garriott

& Nisle 2018).

Some studies highlight the unique potential of universities, as a social coping resource, to help students maintain mental health and reduce stress (Kelly et al. 2007; Stallman 2010). Teachers, administrators, faculty members, and student counselors, etc. are all part of an infrastructure that universities could use to prevent and reduce stress among students (McDonald et al. 2006). All Swedish universities are also supposed to offer student health organization which are there to promote and work preventatively with students mental and physical health (Universitets och högskolerådet 2020a). However, how this infrastructure is being used is still unknown, and a study by Malmö University showed that only 23% of students who were categorized with high-stress level use these services (Källoff et al. 2015).

1.2. Problematization

The issue with stress among students is well-established, however, given that this is a problem that keeps on growing, more research is needed on the subject and their

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et al. 2011; Azila-Gbettor et al. 2015; Hamilton-Bailey & Phillips 2016). These studies tend to include especially medical and psychology students (Lima et al. 2016;

Vorontsova-Wenger et al. 2020), which according to Azila-Gbettor et al. (2015) might have to do with the perception that vocational students are exposed to more stress given their programs mix of theory and practice. There are therefore limited studies including stress related to business faculties and how the universities view and react to stress expressed by their students. Further, as Law (2010) stated, the majority of research focuses on stress in the workforce. He argues that this is because students are not yet fully employed, but that this is a misjudgment since studying a business program could be considered an occupation and these students often face many of work stressors which have been linked to job burnout in their future professions, such as time limits, deadlines, assignments and long hours. There are therefore in societies’

interest to be able to better react and prevent excessive stress during studies to enable a healthier workforce in the future which will benefit society in the long term.

Given that previous research is targeting students directly and as mentioned, how stress is affecting their performance, they are mainly focusing on students’ individuals coping resources without considering how the university can or are helping students to create an enabling environment, especially by promoting certain coping strategies.

When it comes to coping strategies there is a broad division between problem-focused and emotion-focused coping, where the first refers to strategies targeting the stressor directly (Tamini Bahman & Abdurahman 2014), and the latter refers to adjusting the feelings or thoughts towards the stressor (Tamini Bahman & Abdurahman 2014). It is argued that various coping strategies might have various outcomes, where some are more harmful than others, and that coping strategy used, therefore, will have a various effect on stress among students (Cabras & Mondo 2018; Dada et al. 2019; Blalock &

Joiner 2000; Çivitci 2015). As stated previously and according to a previous study, there is a positive effect in interaction between students and universities and their personnel (Griebler et al. 2017), meaning that this institutional support could help promote appropriate coping strategies. However, given the high levels of stress which keep growing among students, the Swedish government is asking questions regarding the accessibility to the student’s health organization and other social coping resources at universities, and how they are working with stress-related issues (TT 2019). Further, McDonald et al. (2006) argue that most of the university infrastructure regarding stress among students is treatment-oriented, meaning that they tend to focus on students that already have developed stress issues. Therefore, they conclude that institutional coping resources tend to be reactive rather than proactive. Nevertheless, there is little evidence of which programs and strategies universities use to help students with their health problems and how these are implemented and used by business faculties. There is therefore a gap in the literature on how universities serve as a social coping resource and how they can help to improve the well-being of students.

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Therefore, given that stress among students is reportedly high and still increasing, more research on the subject is needed. Given that research on stress mainly target students directly and tends to exclude certain types of students there is also a need to broaden the perspective to include other perspectives as well, such as the university faculties and student health organizations to see how they react to this issue and how they serve as a social coping resource. Therefore, in this study, the role of universities as institutions are emphasized and how they help business students in stressful environments, which can provide useful information on how to better support and improve wellbeing among business students in Sweden. The main contribution of this study is to contribute to the literature regarding the role of universities when it comes to coping and reducing stress among business students.

1.3. Purpose and research question

According to what is stated above the purpose of this paper is to investigate how the universities react to the problem with stress among business students and how they act as a social coping resource. Further, this paper aims at investigating where more efforts are needed. Based on the purpose the following research questions will be investigated:

• How do the universities react to student stress and act as a social coping resource?

1.4. Disposition

The study contains six chapters with associated subheadings. The first chapter presents the background and problematization of the study, which results in the purpose and research question of the study. The second chapter contains a literature review including literature and theories that are of importance for the study. Chapter three contains the methodology used, such as design, participants, and data collection.

Chapter four contains the empirical study, where the results from the collected data are presented. Chapter five contains the analysis of the study where the results are analyzed in accordance with the literature review. Finally, chapter six contains the conclusions and limitations of the study, as well as suggestions for further research.

The study ends with a reference list and appendices.

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2. Literature review

This section contains a literature review of previous research relevant for this study, such as the role of universities and stakeholder theory, student stress and stressors, coping strategies, and universities role as a coping resource. This literature serves as a foundation for the analysis, where it is discussed together with the empirical findings of the study.

2.1. Swedish universities: their role and stakeholders

In Sweden, most universities are governed and decided upon by the Swedish state (Universitets- och högskolerådet 2020b). However, once they become universities they are independent authorities and therefore the layout of the studies or which programs to offer are decided by each university itself and might, therefore, differ between the universities. The role of universities can be divided into three main tasks: the first task is to conduct research and education, the second task is to collaborate with the surrounding society, and the third task is to ensure that results from the research come to use and reach the public (Universitetskanslersämbetet 2018).

Universitetskanslersämbetet is in charge of controlling the quality of higher education in Sweden (2018).

That the quality of education is high is important for the universities’s stakeholders.

According to the stakeholder theory developed by Freeman (1984), stakeholders are those, individuals or groups of individuals, that are impacted by or able to impact the company or institution and further its achievements. Stakeholder theory further states that the result of activities performed by institutions should consider the return for all included stakeholders, and therefore take a broader perspective than solely owners or shareholders (Wagner Mainardes et al. 2010). It is based on the idea that organizations are not self-sufficient and to keep the business operating or legitimate it needs to establish relationships with their stakeholders, where they involve these stakeholders to know the perceived value of their services and how this value can be increased.

Stakeholders could be both internal and external and have different importance for the organizations depending on their power. Stakeholders for higher education institutions are both diverse and hard to quantify, but previous research mentions personnel, national government, companies, future employers, former students, etc. Further, students are pointed out as core stakeholders or definitive stakeholders, meaning that they hold legitimacy, power, and urgency attributes. They are of great importance given that the number of students enrolling in a specific university will impact its fundings and have a huge impact on the reputation of the university. This means that when students have urgent needs, universities should and must react to these needs to stay legitimate.

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2.2. The concept of stress

Given the important stakeholder position, it is disturbing that students are reporting higher and more severe levels of stress and other mental health issues. Stress has been defined in many ways and there is still an ongoing debate regarding the definition.

Selye’s (1956) popular definition states that stress is the individual’s response to strain or pressure, and as an unpleasant feeling which arises in demanding situations with an imbalance between the surroundings expectations and the individual’s resources. Stress has an impact on performance where it can either heighten the drive tension or created distraction, manifested in an inverted U-shaped curve (Lazarus & Folkman 1984). For students, that means that stress is viewed as positive up to a certain point, which might lead to higher academic performance, but when the stress becomes too excessive, academic stress would lead to decreased performance. However, individual differences regarding responses to stress and its impact on performance led to the realization of the importance of personal factors such as coping (Lazarus & Folkman 1984).

Lazarus and Folkman's introduced the Transactional model of stress and coping which remains the cornerstone of psychological stress and coping research (Biggs et al. 2017).

It states that stress is experienced as an appraisal of our situations. Before we feel or respond to stress we go through two stages of appraisal, primary (evaluating the situation and decide its relevance) and secondary (what, if anything, can be done about the situation) (Lazarus & Folkman 1984).

The primary appraisal can be distinguished into three different kinds: irrelevant, benign-positive (promises of enhanced well-being), and stressful (Biggs et al. 2017).

Stressful appraisals include harm/loss, threat, and challenge. Regarding harm/loss, the damage has already been obtained which refers to an injury, illness, or damage to self- or social esteem. Threat refers to anticipated harms or losses and therefore common feelings are fear, anxiety, and anger. The last stress appraisal is a challenge that differs from threat since it rather focuses on the potential for gain or growth and therefore is characterized by more positive emotions such as eagerness and excitement. However, these are not opposites and can occur simultaneously and shift. An event which at first appraisal was deemed more challenging can, therefore, become more threatening and vice versa.

When a first appraisal has been done, the secondary appraisal refers to managing the situation and is therefore a crucial feature of every stressful encounter (Biggs et al.

2017). The secondary appraisal considers which coping available options. Secondary appraisal and primary appraisal together are shaping the degree of stress and the

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Stress among students

For universities to react/respond to stress among students there is a need for them to understand the phenomenon, given the evidence that educational stress is an integral part of students’ lives. As stated, the current generations of students' high levels of stress might have to do with high or unrealistic expectations from society, given their knowledge regarding technology (Ramli et al. 2018). Stress is also common during major life changes, and the transition to university is often pointed out as one of these life changes (Lee et al. 2016) since students have to adjust to new environments. There are several other academic stressors pointed out by previous research that contribute to stress, e.g.: examinations, workload, and studying. Stress regarding examinations is mostly associated with preparing for the test rather than stress itself (Gadzella et al.

1998), workload regards the course disposition and the number of assignments (Ramli et al. 2018) and studying relates to meeting deadlines, fear of failure and whether students feel that they have control of their time (Robotham 2008). Stress perceived by students might have various outcomes, from mild excitement, eruption of sleep and eating habits, depression, to heavy psychosomatic post-traumatic stress disorder and suicidal thought depending on their appraisal of the situation. The responses to these stressors also take various forms, which are categorized into emotional (anxiety, depression, etc.), cognitive (appraisal and strategies to handle the situation), behavioral (crying, self-abuse, etc.) and psychological (weight loss or gain, headaches, sweating, etc.) (Robotham 2008). However, as stated not all forms of stress are viewed as bad.

McGowan et al. (2006) found that positive forms of stress might result in positive outcomes for students such as “being energized, stimulating and growth-producing as abilities are extended and new accomplishments made” (p.92). This is also in line with the inverted U-shaped curve (see 2.2.) However, increasing evidence show that stress experienced by students have negative outcomes, ultimately affecting their well-being and learning process, which reduce their academic performances (Campbell et al.

1992).

The negative effects of stress and other health problems are according to Kitzrow (2003) affecting three levels: individual, interpersonal, and institutional. On an individual level, it affects the students’ emotional, cognitive, physical, and interpersonal functioning mentioned above, negatively affecting their academic performance, retention, and graduation rates. Students experiencing distress are less likely to manage their time efficiently and also less likely to make use of study resources. Finally, on an institutional level, it might have impacts through new legislation and legal challenges to risk management and mental health services.

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2.3. Coping strategies

In general, coping is described as the actions and thoughts that individuals use when they are facing stressful situations (Brougham et al. 2009) and related to the secondary appraisal (Lazarus & Folkman 1984). Several studies show that coping has a significant impact on health, well-being, and life satisfaction (Carver et al. 1989; Folkman 1997), and there is evidence that students are more satisfied with life when they use appropriate coping strategies (Mudhovozi 2011). Coping is therefore the student’s effort to manage, remove or reduce stressful situations to minimize the negative outcomes. This process predicts both psychological and behavioral reactions and responses to stress (Carver et al. 1989). There are multiple ways students can cope with stress, e.g. through denial, seeking support, planning or humor (Brougham et al. 2009).

While denial is argued to be negative, planning is more positive forms of coping.

Folkman and Lazarus (1984) transactional model of stress and coping proposed a classification of coping strategies that focuses on two main types: problem-focused coping (PFC) and emotionally-focused coping (EFC). PFC is associated with a person’s attempts to improve the “person-environment” relationship by changing the cognitive assessment of the current situation. PFC therefore, aim at targeting the stressor directly (Tamini Bahman & Abdurahman 2014) by searching for information about what to do, conceptualizing, minimizing effects, etc. (Folkman & Lazarus 1984).

EFC includes thoughts and actions that aim to reduce physical or psychological stress, e.g. avoiding a problem situation, denying a situation, emotional experience, etc.

(Folkman & Lazarus 1984). This give a sense of relief but are not aimed at the threatening situation, but simply making a person feel better by adjusting the feelings or thoughts towards the situation (Tamini Bahman & Abdurahman 2014). Folkman and Lazarus (1984) emphasize the need to consider both functions in assessing psychological overcoming and while most people use both, the use of EFC strategies dominated over PFC (Brougham et al. 2009).

There is a general view which suggest that PFC is more efficient than EFC, and researchers point out that students should try to cope with the stressful situation by using active coping such as emotional support, planning and acceptance (Sreeramareddy et al. 2007; Mudhovozi 2011). van Zyl and Dhurup (2016) found that when stress increases, so do EFC and more specifically seeking emotional support, denial, and negativism and they state that there is a need to help students cope with stressful situations in a more problem-oriented way meaning that universities should promote PFC.

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2.4. The role of universities in offering support

Research is pointing out that universities can provide great support to students’ mental health and reduce stress (Baik et al. 2019). Students with the ability to cope with stress in appropriate ways can manage stress themselves, but it is also important for universities to contribute to the academic environment to cope with students' stress.

It has long been recognized that environments such as universities allow for the distribution of information about stress and activities to build positive experiences (WHO 1986). In a study by Orme and Dooris (2010) they stated that universities should be involved in modifying the learning process to contribute to better health, but that in practice this is not so simple. Mudhovozi (2011) stated that academic stress among students is experienced as more stressful when there are scarce resources offered by universities and concludes that universities have to better involve students to increase their wellbeing during their studies. Further, Agolla and Ongori (2009), believe that institutions have not taken the steps needed when it comes to finding out the mental health among students and that this ultimately might affect the quality of the education. However, Malmö University in Sweden took steps regarding this by implementing Support Education, which focuses on how to improve students’

conditions regarding mental illnesses to complete their studies (Warne 2019). In Europe, this method continues to be implemented. The method deals specifically with supporting students and provide individual adaptation, where they can overcome obstacles related to studies, and get tools to deal with stress. Support requires students’

active involvement and Baik et al. (2016) accent the significance of involving students in university programs, policies, and activities related to the mental health of students.

Universities as a social coping resource

Universities and their infrastructure can therefore serve as an important coping resource for their students. While coping refers to processing stressful events, coping resources can help to cope with these events (Taylor & Stanton 2007). According to previous research, individuals who are lacking coping resources are more likely to have trouble in their daily lives. According to Taylor and Stanton (2007), coping resources, if available, are correlated to less distress, better health, and better management of stress. There are several types of coping resources, such as self-esteem, self-mastery, and finally social support, and they are argued to have various effects on psychological health. The latter of the three, social support, refers to individual’s perception of being loved or the feeling that they are being taken care of, further that they are valued and that are participating in a social network where obligations and assistance are mutual (Wills 1991). Social support has been proven to be of great importance by reducing stress, depression, and anxiety and further helps to promote psychological adjustments (Taylor & Stanton 2007). For students enrolled at universities, they are facing several stressful events, and therefore the need for social support and coping resources are

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argued to be high and the university itself should therefore serve and offer social support to reduce stress and ease the transitioning to university.

Therefore, there is a need for all faculty members to be aware of problems regarding stress to be able to act as a social coping resource and further support students regarding their educational and personal development (Yearwood & Riley 2010). To function as a social coping resource mutual trust has to be established between students and the personnel, which enables students to feel safe and respected throughout their studies. According to Reeve et al. (2013), as a coping resource, there is a need to promote a positive study environment and to work with effective communication, feedback, and information which also will have an impact on student’s motivation to learn. This is further stated by Rowbotham (2010) who found that when faculty members care for their students and understand them it promotes a positive perception towards the university.

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3. Methodology

This chapter includes the methodology used for the study including the research strategy and design, data collection (semi-structured interviews and respondents), operationalization, transcription and method of analysis, quality of the research, and ends with ethical considerations.

3.1. Research strategy

The purpose of this paper is to investigate how universities react to problems with stress among business students and how they act as a social coping resource. Further, this paper aims at investigating where more efforts are needed. Two research strategies could be applied for this purpose: quantitative and qualitative. Quantitative research strategy emphasizes quantification of data which often means measuring or drawing statistical conclusions (Bryman & Bell 2011). As a first draft, a quantitative research strategy targeting students directly was planned to get their view of stress-related issues but given the sensitive nature of information regarding health among students’ full anonymity would need to be guaranteed which was not possible at the given time.

Given the Covid-19 outbreak, which transmitted all lectures, etc. to online classes, it was not possible to hand out questionnaires in classrooms and an electronic questionnaire could not fully guarantee anonymity given the collection of IP-addresses.

However, given that the purpose of the new draft refers to universities as institutions where focuses lie on the personnel in contact with business students the research strategy shifted, and a qualitative research strategy was applied for this study.

This was done since the purpose and research question benefits from a more in-depth research strategy, where close involvement with the respondents is possible (Bell et al.

2019). Further, a qualitative research strategy rather emphasized words than quantification of data which is suitable when there is a need to understand how the universities are working and reacting to a certain phenomenon. Quantitative research strategies often have pre-designed answers to questions that would limit the respondent’s ability to speak freely about the subject were important factors could be overlooked or missed (Sreejesh et al. 2014). Thus, the pros of a qualitative research strategy are that it enables a richer data collection and allows for close involvement with the respondents, ultimately leading to a better understanding of the phenomenon regarding universities’ reactions to student stress (Bell et al. 2019). Further, qualitative research allows for more flexibility, where wrongly formulated or irrelevant questions can be removed or corrected throughout the study (Saunders et al. 2016). Given that before the present study the universities’ reaction to stressed students was rather unknown, it was suitable to be able to adapt and ask probing questions throughout the study and the learning process. Therefore, the present study is an iterative process where theories and questions were developed throughout the data collection process.

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3.2. Research design

The research design is the framework for data collection and how the data will be analyzed (Bryman 2012). In this study a multiple case study with a comparative design was applied, where different parts of Swedish universities were investigated. A multiple case study enables comparison among the cases, and it also enables to contrast the results (Bryman & Bell 2011), which makes it easier to find patterns between answers (Bell et al. 2019). This could contribute to the understanding of how Swedish universities react to the increasing levels of stress and act as a social coping resource.

By applying a comparative design less attention is brought to the context of each case and focus more on generalizing the results (Bell et al. 2019).

3.3. Empirical data collection

The data collection usually refers to either primary or secondary data or a combination of both (Saunders et al. 2016). In this study, the empirical data collection mainly refers to primary data collected through semi-structured interviews with representatives from business schools (BS) and student health organizations (SHO) from Swedish universities.

Semi-structured interviews

Semi-structured interviews refer to when the interviewers often have a prepared interview guide which aims to cover specific questions and topics, but the respondent has a lot of freedom in how to respond (Bryman & Bell 2011). This was chosen since it allowed for the interviews to stay on the relevant topics and ensured that the same topics were discussed throughout all interviews (Sreejesh et al. 2014). The interview guides covered the subjects stress, coping strategies, and how the universities are working and cooperating with stress-related issues (see 3.3.3 and Appendix 2 & 4).

This type of interview technique was deemed suitable for the present study since it allows for flexibility (Bryman & Bell 2011) and it gave opportunities for asking probing questions that are useful for receiving details on relevant answers (Sreejesh et al. 2014).

Therefore, the questions did not need to follow a distinct order and could vary between the interviews, but the questions asked are still similar or the same.

Given that the respondents (see. 3.3.2 & Appendix 1) represents personnel from BS and SHOs from multiple universities from Sweden, the interviews were held over the video conferencing service program Zoom. This allowed for interaction where the

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used is telephone interviews, which are argued to have some benefits compared to face-to-face interviews such as the ability to ask sensitive questions (Bryman & Bell 2011). By not being physically present, those being interviewed might feel more comfortable answering the questions. Therefore, it could be argued that the chosen method for semi-structured interviews has a bit of both, where it allowed to see the interviewees and read their facial expressions and body language but given that there was no physical interaction, benefits related to telephone interviews were also applied.

Further, before the interviews, the respondents received an email with the link to the meeting and also the interview guide, where they could read the questions. This was done for all interviews which further strengthens the quality of the research (see. 3.5).

Respondents

To select respondents, a probability sampling technique was used. Given that institutions with Business Administration faculties were of interest for this study, a list compiling all Swedish universities offering business programs was conducted. This resulted in 12 universities. After that, an email with information about the study was sent out to personnel at the BS and the SHO at these universities as a first contact. If no email address could be found on their webpage a call was made instead. Given the purpose of this study, to investigate how the universities react to the problem with stress among business students and how they act as a social coping resource, a criterion for participation was that the respondents should have a position where they are in direct contact with the students since they have the greatest knowledge about these subjects. Since a multiple case study was applied several interviews from each university were necessary and therefore a snowball sampling was used, where the first contact was asked if they could help find other personnel who could participate in the study. If they agreed to participate in the study, the date and time were set for the interview. This resulted in 14 interviews, representing 6 SHO and 8 faculty members from 4 different universities (see Appendix 1). Given that the participants were offered anonymity, their names and the name of the university are not stated.

Operationalization

To fulfill the purpose of the study and to answer the research question, the two interview guides (Appendix 4 & 6) were performed with respondents from both SHO and BS and the operationalization can be viewed in Appendix 2 and 3. The interview started with some general questions regarding the respondent, to later cover the specific topics: stress, coping strategies, and social support/infrastructure.

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3.4. Transcription and method of analysis

The transcription process began with the conversion of the recorded interviews into text. Krag Jacobsen (1993) stated that conversion from recording material to written material can be difficult but it was done by simply writing down what was said during the interview. This preserved the clarity of the transcription.

After transcribing the data, the results were compiled, and analysis was made. Given that the data derived from the interviews often is unstructured and not straightforward, analyzing the data is a common problem in qualitative research (Gray 2017; Bryman &

Bell 2011). The method of analysis used in this paper is coding using thematic analysis.

According to Gray (2017), a theme found in the qualitative data should represent important findings to the research question. These themes could be either inductive or theoretical (Gray 2017), where this paper focuses more on the latter. This means that the themes used to analyze the data where derived from the theoretical framework presented in section 2. Possible limitations of using thematic analysis are that it might result in paraphrasing, leading to weak analysis and that it lacks a clear procedure which is something that has been thought off throughout the process.

The thematic analysis process began by reading the transcriptions. According to Braun and Clarke (2006), the purpose of “re-reading” is to give a first idea of the results, to see if it is already possible to identify different meanings and patterns. Our analysis process was carried out by a Computer Assisted Qualitative Data Analysis Software NVivo 11 and began with data reduction which is a process designed to enable fast data processing and understanding of information and/or timely detection of key evidence or intelligence (Quick & Choo 2016). Data reduction can be done using various approaches, such as coding, creating clusters, writing memos, and summaries (Choi et al. 2009). Data reduction was done by creating codes and breaking the data into smaller parts. The coding process began by inserting the transcriptions of the interviews into the “document” section of NVivo and named the interviews, respondent A1, respondent A2, etc., to separate each respondent and their answers (see Figure 1).

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Figure 1. Inserting the transcripts

After the transcripts were inserted, the text appeared on the right side (see Figure 2).

The transcriptions of the interviews revealed the answers from the interview guide, and nodes were created for each question, to make it easier to compare the answers.

Figure 2. First step of coding

The coding process started by carefully examining the answers to the questions of each respondent. This process made it easy to focus on one topic at a time and use the same code for each company. Codes were created by selecting text from a data segment, highlighting important text, and dragging it into the code system. Codes and sub-codes where based on relevant topics and the interview questions. The coding system in NVivo generates numbers automatically for tracking. There were 157 codes in the program. The codes included both the main topics and the subtopics of the study, and below is an example with codes in NVivo.

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Figure 3. Last part of coding

The software made it easy to see the corresponding answers using codes and creating analysis in the Word document.

3.5. Quality of the study

In quantitative studies, validity and reliability are important quality factors for the research. However, when performing qualitative studies, they are not as relevant given that qualitative studies are less subject to statistical measurements (Bell et al.

2019). Therefore, to better suit qualitative research, the concept of validity has been adopted by changing some terms and perspectives (Gray 2017), where internal and external validity is those who will be mentioned. Further, there is also a discussion regarding the reliability of the study.

Internal validity refers to whether the collected data from the interviews reflect reality.

Given that this study is based on interviews the researchers mustn't influence or make subjective interpretations to establish internal validity (Gray 2017). In this study

“internal replication” has been applied, meaning that the procedure has been inspected by both researchers to avoid subjectivity (Gray 2017).

External validity refers to the ability to generalize the results to other similar situations (Gray 2017). Given that this is a qualitative study this might be troublesome given that

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opens up for interesting follow up studies which could provide interesting information regarding stress and universities as coping resources.

Reliability instead refers to whether if another researcher would get the same results if making the same study, relating to the stability of the findings (Gray 2017) and further also whether the researchers agree regarding what they hear (Bryman & Bell 2011). Reliability has been thought about in this study by triangulating the data, meaning that data has been collected from various sources (Gray 2017). This study includes data from various universities and people from various positions, further, it also includes other documents that have been found on the university's web pages which have been used to confirm the results. Reliability is further strengthened by letting the respondents receive the interview guide beforehand so that they all had the chance to prepare for the interview and also make clear answers which can be argued to increase the stability of the findings.

3.6. Ethical considerations

Throughout this study, ethical considerations have been considered. By interviewing personnel, the sensitive nature of students’ health was overcome given that no individual student could be identified. Those who participated in the study where all doing it voluntarily, which is an important ethical consideration according to Saunders et al. (2016). This is further proven given that upon interviews, all respondents signed a consent form (Appendix 9) where they stated that they participated out of a free will and that they knew that they could withdraw their participation at any given time.

Before starting the interview, the respondents further agreed that the interview would be recorded and transcribed, and they were informed that this data would be deleted ones the study had been completed. Further, all personal information was handled in accordance with GDPR, and the collected data have only been available to the researchers of this study without any access by unauthorized persons.

To make the respondents feel more comfortable, and to reduce the ability of them to get harmed by any of the information they provided, anonymity was offered (Bell et al. 2019). The respondents were informed that neither their names or the name of the university would be mentioned in the final report. By making the respondents anonymous, there is less focus on those participating and more focus on the information they provide (Saunders et al. 2016).

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4. Results

This chapter includes the empirical results of the study, where each university is presented separately.

It starts with a short introduction of each university followed by their responses Finally, a table summarizing the findings of all universities is presented.

4.1. University A

University A is a small university in Sweden. The empirical findings consist of 4 respondents including: 2 students’ counselors, 1 faculty administrator from the BS and 1 curator from the SHO.

The university as a social coping resource

The respondents agree that stress levels among students are high. It is a growing issue and students who seek support often have been stressed for a long time. However, respondent A¹ states that it is more acceptance regarding seeking support and help as well. Common academic stressors pointed out are transitioning difficulties, other native languages, relationships with teachers, group assignments, financial issues, falling behind, lack of information and reading academic literature. The SHO state that stress is an issue among students throughout the studies since some tend to overperform and get exhausted at the end of the studies.

The role of the SHO is to be a preventative health support instance. According to respondent A1, there are no limitations for the reasons why students contact them, all students are welcome. However, if they need therapy or medical treatment students are forwarded to health care centers or psychiatry. They offer counseling and teach strategies regarding stress. They act as an advisory sounding board for personnel at the university regarding student questions or student’s mental health. They focus on program starts by presenting themselves during introduction weeks. Further they make themselves visible in the university’s hallways, a website with clear instructions how to contact them, social media where they advertise group activities such as mindfulness and mediation, practice recovery and have group events talking about stress and stress management. However, they cannot offer support to all students with problems regarding stress, making it important that students have other forms of social support such as teachers, friends, and family.

Faculty administrators on the BS serve both students and personnel. According to

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and complaints towards teachers. The BS also have regular meetings about the course dispositions and tries to make changes based on what the students express, for example, difficulties to read parallel courses or too much work during certain periods in the semester.

The student counselors’ goal is to support students with their planning and study techniques. Together with the program manager, they ensure that students learn about different types of support from the BS during the introduction to the business program, where they inform students to search for help before it has gone too far.

Coping strategies

Both the student counselors and the faculty administrators work with planning and teach methods to help students who have fallen behind or having trouble with their study techniques. They can help with a study plan of what courses to take and when.

They can also serve as the first person to talk with, which can serve as a stress relief.

The program managers are aware of which courses that are stressful and adjust so student can finish them. They are offering course evaluations which can be helpful to improve their courses and examinations which can harmonize relationships.

The SHO helps students apply appropriate coping strategies to handle stress. When students contact the SHO, they often either try to avoid the problem or continue their bad habits of studying hard with little recovery. Further, many students are perfectionists who put a lot of pressure on themselves. Another common issue is procrastination, and they therefore offer a procrastination course where students learn strategies on how not to postpone important things in life. In individual conversations, the SHO works by motivating students to make lifestyle changes, focusing on getting enough sleep, recovery, physical exercise and rest. They also work with a method called comparative-focused therapy, where students work with self-compassion, which can be a tool against perfectionism. They have group activities including mindfulness and meditation. They offer lectures and workshops regarding stress and coping, where their goals are to work preventatively so that the stress does not get too severe. According to the respondent A³, the program managers are aware of what the courses are, and which adjustments are made to make students have finished them.

The university infrastructure

According to the respondents they have good cooperation with each other, especially at the beginning of the programs and by serving as a sounding board to each other.

Various departments forward students to the SHO when issues have become severe.

The SHO further cooperates with the priest and pastor at the university. However, the SHO state that the collaboration with other departments is still up to e.g. the program

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mini-lecture together with the SHO with information to students under their first term on two different programs where they educate students regarding what happens in the body when you are stressed and offer some tools. They have noticed many requests in those areas and are planning to continue with this lecture. The respondents from the SHO believe that if they had more collaboration with teachers, program managers, and prefects it could make a huge difference to reduce and prevent stress. Especially since respondent A¹believes that a lot of stress is caused by the planning and disposition of the courses. The respondent states that “sometimes it feels like we are there, but we do not come in and prevent ".

According to the BS respondents, they have a lot of cooperation with the SHO, but maybe not primarily in stress-related questions. However, they are attending courses where they learn about stress coping strategies and mental-wellbeing which not only have to do with students but also the personnel. They could contact the course administrator or the teacher if there are many stressed students during courses, and this cooperation works well. A lot is being done on different levels of the organization:

individual, group, preventative and aftercare, but further states that both students and personnel need to take more responsibility.

4.2. University B

University B is a medium-sized university in Sweden. The empirical findings consist of 4 respondents including 1 student counselor from the BS, 1 university associate professor and program manager of the Business Administration program, 1 curator and Head of Operations from the SHO, and 1 administrative director from the BS.

The respondents agree that there is an issue with high levels of stress among students and that common academic stressors are transitioning to the university, workload, falling behind, “barrier courses”, exams, group assignments with “free riders” and performance pressure.

The main goal of the SHO is to work preventatively with students’ mental wellbeing and their strength should be that there is a low threshold and short waiting time for students who contact them. When there is time they also do efforts towards the HR departments regarding training initiatives, ultimately benefiting the students as well.

Given that they are based on campus a lot of focus is on campus students. They are also working preventatively regarding ANDT-questions (alcohol, narcotics, drugs, and

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The study counselor serves as a first-hand person to help students with individual study plans and study techniques, to figure out what causes the problems. They have education administrators who solve many of the students’ problems by finding roads, information, etc. They also have a study workshop at the university that can help with different issues.

According to the program manager and associate teacher, students get in contact when they have failed important courses that are needed to continue their education. The respondent B2 serves as a sounding board when students feel mistreated by teachers or examiners. They are interested in students’ success, but not by lowering the demands since this would decrease the quality of the studies and their reputation which would impact students' recruitment chances after graduation. They try to balance the course dispositions, but at the same time they must fill the student’s agenda with appropriate workload, follow curriculum and guidance documents. The only time teachers might purposely stress students is during thesis writing, but this is made out of care to ensure that they finish on time. They try to offer support by adding clarification, additional information, or adding an extra exam when it is needed.

The administrating director works with developing the BS, and states that the work is always about students learning process. However, it costs a lot of money to educate students and they need to increase the numbers of students finishing their studies.

They are currently looking at how to ease the transition to the university given that students who failed their first term often did not find the right study technique or are stressed in their study environment. They have applied as a pilot project called Support education, which should now be on a larger scale to help first-year students by using students who have already finished courses as mentors. The BS has been part of the pilot project, and the ambition is that all programs should have this method. Further support is offered by helping to raise questions regarding examinations, home exams or assignments, feedback or grades. They try to support students from the perspective of working and study environment by making sure that there are enough group rooms, open spaces, available teachers, computer halls, etc.

All respondents want to work preventatively with stress-related issues. They are stating that stress is affecting students’ recovery, concentration, sleep, alcohol habits and procrastination. The SHO works with both individual conversations and group activities where they address several issues and help students reduce the distance between how they feel and what they show. However, respondent B¹ state that it is difficult to reach students in time. They are working proactively with ANDT issues.

They have group lectures regarding procrastination which is related to stress

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breathing, and mindfulness, where students can stop and reflect. All students are different and therefore there are no standard solution. They work on making students aware of their situation.

The respondents from the BS try to improve the introductions of the courses, so the students know what they are demanding and can take control of their studies from the beginning without procrastinating. When they design the courses, it is mainly about creating knowledge in the course, and they talk a lot about the work environment for students, and how they can create the best possible conditions. Further, when students contact them they try to help by actively planning their education, especially for students who have fallen behind by improving their study techniques. Other peers are pointed out as important since there are group constellations within each program and course that support each other, and peers can serve as a first step before reaching out to other forms of support.

All respondents agree that the cooperation between the different parts of the university is working effectively. They are also working closely with students’ associations, student pubs, and student unions to lift stressful situations and are having monthly meetings with the student union on various issues. During these meetings they discuss students' concerns, for example, difficulty level of the courses, exams, assignments and how stressed they feel. The SHO is a part of the working environment committee and they work together with the institution where they talk to the personnel, apply cases and let them know what they are up to. Further, they are a part of a bigger organization called “studerande avdelningen” where they are working with guidance for presumptive students, as well as the admission, their intranet, course information, students with disabilities, etc. Other parts of the university forward students to the SHO when they believe it is necessary. The respondent from the student counseling states that they have very good contact with the teachers, where they can present what they have heard from students. Further, the BS looks at the number of students who passed the exams and make use of the course evaluations, however, there are too few students answering them. According to respondent B³, they have regular meetings with the SHO and the student unions and encourage students to reach out to support offered by the university. They try to make sure that when issues appear, students and personnel should use the resources as quickly as possible. However, respondent B³ states that if issues stem from that students have not put in the time needed the only solution is often to put in work efforts.

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4.3. University C

University C is a small university in Sweden. The empirical findings from this university consist of 2 respondents including 1 university lecturer from the BS and 1 curator from the SHO.

The respondents differ in their answers regarding stress among students where the SHO states that there are many stressed students, but the university lecturer does not know or think it is common. Academic stressors pointed out are workload, exams, study technique, transitioning to the university, high demands, language difficulties and lack of time.

The SHO focus on students and almost every meeting relates to stress. The goal is to work preventative, however, almost all of the students reach out to them in a late-stage making it hard to prevent. It is free to come to the SHO. They are making themselves visible by presenting themselves on the programs, participating in student fairs and giving out brochures. Further, they have their webpage where students can contact them. The respondent state that there is a heavy application rate to the SHO and there has been an increasing need to support students with psychological disabilities, e.g.

neuropsychiatric disabilities.

According to respondent C2, teachers can serve as a sounding board during conversations with students, and when necessary they forward students to the SHO.

It is important with compassion and humanity and to help as much as they can.

Further, they support students when developing courses by trying to ensure that there is adequate workload, an appropriate difficulty level and clear instructions. They also support by providing enough information, which is increasing and improving every year, leading students to feel safer and more harmonized in their studies.

According to the SHO, students with stress-related issues tend to procrastinate and have bad sleeping habits. They are often blind to their problems, putting pressure on themselves and isolate their feelings instead of ventilating them. Therefore, they try to make students communicate and share their experiences to provide comfort. They focus on the problem that causes stress since if it is not taken care of it will continue to exist. They educate students regarding stress and work a lot with the mind, changing their ways of thinking and reducing their everyday activities. An issue is that students tend to work beside their studies, causing a lot of time pressure. People are afraid of conflicts and therefore they try to make the students stand up for themselves. They advocate physical exercise and emphasizes the need of working both with the brain

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and the body. The student priest offer meditation in the church but it difficult to make students come to these events.

The lecturer, C², tries to be as accessible as possible to questions and communicate as best as possible. Since many students work beside their studies it is important to for students to find time to complete their studies. There are administrators, teachers, program managers, and study advisors who can answer questions and they focus on making students feel safe and harmony while studying. However, the SHO is questioning whether teachers need to become more pedagogical and listen more to the students when they express concerns.

Both respondents state that the collaboration among the institution regarding stress- related issues could be strengthened. According to respondent C¹, they would like to have more elaborated collaboration with teachers, because even though they can always call the SHO and ask for help, it does not often lead to collaboration. The student coordinator can talk to different classes in cooperation with teachers which was not the case in the beginning but still needs improvement. The SHO is collaborating with health education support and they can also support program managers and teachers who are seeking help with students who are stressed. They have concerns regarding how to reach more students where they think they can both try and do more.

According to the respondent C², there are some obstacles in cooperation between them and the SHO and student union. They have tried to increase the cooperation, but it is still something that needs improvement. Further, there is a need to establish a more active student life and union to increase the community and togetherness among the students.

4.4. University D

University D is a large university in Sweden. The empirical findings consist of 4 respondents including 1 psychologist, 1 business nurse, and 1 nurse from the SHO and 1 university lecturer in the department of Business Administration.

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pedagogical teachers and clear instructions and feedback. Further, part-time-jobs which decrease the number of study hours.

The SHO focus is on the students, working preventative, and they are available for students no matter their problems. Respondent D2 states that ultimately, no students should need their service. Given that it is a large university, there is a lot of loneliness among students since student unions and the student life is not as active and involving as perhaps on smaller universities. They are making themselves accessible and known by using their website, where they advertise their courses and activities, presenting themselves at the beginning of the courses where they try to meet as many students as possible and by having information at a desk near entrances. Further, when possible, they have a lecture regarding the SHO and they try to advertise through student unions, study guide info, Facebook and Instagram. However, according to respondent D2, it is difficult to reach out to the students.

The SHO and the BS is working to ensure both a safe study and institutional environment, where it is important to try to make appropriate schedules and enough spaces to sit and eat. The student unions are the driving force regarding physical and digital study environments. More changes and improvements still need to be done.

Support can also be offered by having pedagogical teachers, which according to some respondents still need improvements, and by providing feedback on time. Further, to make sure that the university is accessible for everybody, such as students with neuropsychiatric disabilities, where a lot can be done given that currently, the way of studying at the university does not fit them very well.

The SHO tries to help students with their coping strategies since students tend to procrastinate or study even harder with minimum recovery, sleep and exercise.

Students also have trouble prioritizing. Many students try to use other social networks before coming to the SHO, which sometimes is enough but not always. They work with workshops, information, training, and individual meetings. They further read up upon research to stay updated. They ask the students a lot of questions regarding stress, eating habits, physical activities and medication.

They try to offer a lot of workshops, e.g. regarding stress management, sleep, self- compassion, yoga, diet and ergonomics, mindfulness, dare to speak, pushing behavior or stop postponing, etc. They try to cover these topics both individually and in groups and they have noticed that it works very well to let students discuss in groups where they can share their experiences. They work a lot with feelings and emotions such as shame and guilt and their work is based on cognitive-behavioral therapy (CBT) and acceptance and commitment therapy (ACT). They learn students how to prioritize,