Perceived Factors Influencing Academic Performance Among Nursing and Midwifery Students at Institutes of Health Sciences in Botswana: A Convergent Mixed-Methods Study

Abstract

Background: Ensuring strong academic outcomes in nursing and midwifery programs is vital for producing graduates capable of safe clinical practice. In Botswana, concerns persist about graduate preparedness; however, empirical evidence on contextual factors influencing academic performance remains limited. This study explored perceived student- and institution related factors influencing academic performance among third-year nursing and midwifery students at two Institutes of Health Sciences (IHSs) in Botswana. Methods: A descriptive cross-sectional convergent mixed-methods design was used. The study population included all third-year General Nursing and Midwifery students (N = 94) at the Gaborone and Lobatse IHSs. Using simple random sampling, 30 students (32% of the accessible population) were selected for participation. Data were collected via a structured electronic questionnaire that included demographic items, Likert-scale questions on student and institutional factors, and open-ended questions on educator attributes. Quantitative data were analyzed using descriptive statistics in SPSS (Version 28.0). Qualitative responses were analyzed using Braun and Clarke’s six-phase thematic analysis framework. Findings were integrated using a joint display to identify areas of convergence and divergence between quantitative and qualitative findings. Results: Participants were primarily female (90%) and aged 21–30 years (63.3%). The majority preferred experiential and auditory learning methods (80% and 83.4%, respectively). More than half (56.7%) reported that skills laboratories were inadequately equipped to support hands-on learning. Qualitative analysis identified three themes related to educator influence: Pedagogical Clarity, Evidence-Based Mastery, and Adaptive Teaching Competence. The combined findings indicated a perceived mismatch between students’ experiential learning preferences and the institutional infrastructure available. Conclusions: Educator expertise and institutional resources were perceived as key contributors to academic performance. Enhancing simulation infrastructure and faculty development may improve alignment between theoretical instruction and clinical practice. Further multi-site studies using inferential designs are recommended to examine associations between these factors and measurable academic outcomes.