Symptom Clusters of Examination Anxiety and Their Association with Academic Performance Among Pioneer Nursing Students in Northern Nigeria: A Cross-Sectional Study

Abstract

Background: Examination anxiety is common among nursing students, but limited evidence describes whether symptoms form distinct profiles among pioneer cohorts. Objective: The present study identifies examination-anxiety symptom clusters among pioneer nursing students, examine predictors of cluster membership, and assess associations with anxiety severity and academic performance. Methods: A multi-wave prospective correlational study involved 49 National Diploma I nursing students at Abdulrashid Dankoli College of Nursing Sciences, Kaduna, Nigeria. Data were collected using a modified six-item Westside Test Anxiety Scale, an examination-period symptom checklist, the Perceived Stress Scale, concern about academic standing, and GPA from college records. Hierarchical cluster analysis, exploratory factor analysis, chi-square tests, analysis of variance, post hoc comparisons, and Kruskal–Wallis tests were conducted. Results: Three clusters emerged: Cognitive, Somatic, and Behavioural. The Cognitive Cluster had the highest examination-anxiety severity (mean = 3.64, SD = 0.72) and perceived stress (mean = 28.4, SD = 6.2). Anxiety severity and perceived stress differed significantly across clusters, whereas GPA differences were not statistically significant. No demographic characteristic significantly predicted cluster membership. Concern about academic standing differed across clusters and was greatest in the Cognitive Cluster. Conclusion: Examination-anxiety symptoms formed three exploratory profiles, with the Cognitive Cluster showing the greatest anxiety severity and perceived stress. Because the sample was small and drawn from one institution, these findings require validation in larger, multi-centre studies before they inform routine screening or tailored support.