Research September 2017, Vol. 9, No. 3 AJHPE 111 Student departure from universities without completing a qualification is a major concern for higher-education institutions.[1] Three-quarters of undergraduate students who terminate their studies prematurely leave during the first year, and most of those who depart do so during the first 6 weeks of the first semester.[2] Higher Education South Africa reported in 2009 that in undergraduate studies 35% of students depart after the first year and that only 15% of students who enrol complete their degrees within the minimum permissible time.[3] At postgraduate level, the rate of premature departure from Masters programmes in South Africa (SA) was estimated at 46% in 2013.[4] Premature departure varies across fields of study, and is higher for science and lower for arts, social science and legal studies.[5] The high number of students prematurely departing from higher education has a major impact on national resources and robs the labour market of highly skilled personnel.[6] In SA, a 20% premature departure rate for both undergraduate and postgraduate students costs the government ZAR1.3 billion each year. [6] Premature departure costs are not only borne by institutions, society and professions but also by students, who suffer financial, emotional and psychological consequences.[6] Despite the post- 1994 increase in access to higher education in SA, premature departure remains a critical issue for postgraduate programmes.[6] The process of premature departure from higher education is complex, and factors and reasons vary from student to student and from institution to institution.[2,3] Furthermore, factors contributing to student departure during the first semester are different from factors associated with students leaving in the later years.[1,2,7] Leaving an academic programme before completing the first semester of study is referred to as ‘early departure’. Factors reported to influence early departure include financial constraints, poor academic progress, and incompatibility between the student and the institution.[2,7] Persistence and resilience during the first semester of the first year are viewed as crucial for students to succeed in higher education. [2,3,7] This article will examine early departure from the Master of Public Health (MPH) programme offered at one higher-education institution in KwaZulu- Natal Province, SA. MPH programmes are structured to cater for a diverse, multidisciplinary and multiprofessional range of students. The programmes are aimed at equipping public health practitioners with collaborative strategies to address major risk factors contributing to the global and national burden of disease. The MPH under investigation comprises a 50% coursework and 50% research component. The qualification is offered only part-time over a period of 2 years, on a flexible modular system basis, with each module requiring an initial 2 - 3 days’ face-to-face contact at the beginning of the semester, and a subsequent 2 - 3 days’ face-to-face session later in the same semester. Students are expected to complete five core modules and one elective, of which four core modules should be completed Background. Student departure from university without completing a qualification is a major concern in higher education. Higher Education South Africa reported that in undergraduate studies, 35% of students depart after the first year and only 15% of students who enrol complete their degree within the minimum permissible time. At postgraduate level, the departure from Masters programmes in South Africa (SA) ranged from 30% to 67% in 2010. Early departure refers to students who leave an academic programme within the first semester of commencing their studies. At one SA university, there were a total of 109 first-time Master of Public Health (MPH) student registrations in 2013 and 2014. By the end of the first semester in the respective years, a total of 27 students actively deregistered from the programme and 11 students did not sit the first-semester examinations, representing an aggregate 35% rate of early departure. The factors associated with early departure at the University of KwaZulu-Natal are not well understood. Objective. To understand factors associated with early departure in the MPH programme at the University of KwaZulu-Natal. Method. A mixed-methods design was implemented. Students who departed within the first semester of commencing the MPH programme in 2013/2014 were followed up. Data were collected using self-administered questionnaires and in-depth interviews. Results. Failure to balance work and academic obligations with poor time management, stress and academic demands related to the programme, and insufficient academic progress were found to be associated with student early departure from the MPH programme. Conclusion. Student early departure from the MPH programme was influenced by multifaceted factors. Senior students can mentor new students as early as possible in their programme. The orientation block should include development activities such as time management, stress management and effective study skills to assist mature students to cope with the demands of part-time postgraduate studies. Afr J Health Professions Educ 2017;9(3):111-115. DOI:10.7196/AJHPE.2017.v9i3.793 Understanding student early departure from a Master of Public Health programme in South Africa T Dlungwane,1 BSc (Physio), MPH; A Voce,1 PhD; R Searle,2 MA, MSc; J Wassermann,3 PhD 1 Discipline of Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa 2 Department of Higher Education Studies, School of Education, University of KwaZulu-Natal, Durban, South Africa 3 Discipline of History Education, School of Education, University of KwaZulu-Natal, Durban, South Africa Corresponding author: T Dlungwane (dlungwane@ukzn.ac.za) This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0. Research 112 September 2017, Vol. 9, No. 3 AJHPE within the first year. Ongoing interaction and module-related support are provided between contact sessions through the on-line learning system of the institution. In 2013 and 2014, 109 first-time MPH students were registered. By the end of the first semester in the respective years, a total of 27 students actively deregistered from the programme, while a total of 11 students did not sit the first-semester examinations. This represents an aggregate 35% early-departure rate. Understanding the reasons for the early departures will assist the programme in developing appropriate strategies to ensure greater student retention and throughput. Objective To investigate the factors contributing to early departure of students in the MPH programme at the University of KwaZulu-Natal in 2013 and 2014. Methods This was an exploratory study to describe the features of early-departure students. A mixed-methods research design was applied. All 38 students who were registered for first-year MPH studies in 2013 and 2014 and departed in the first semester were invited to participate in the study via email. Early-departure students were sent weekly reminders to complete the questionnaire by email for a period of 8 months, and those who had not responded were contacted by telephone. Firstly, data were collected using self-administered questionnaires electronically distributed to all early-departure students. The questionnaire consisted of closed-ended questions. Data were collected on demographics, educational and employment background, and programme-related, institutional and personal reasons for leaving the programme. The data were captured into Microsoft Excel 2003 (Microsoft, USA), and then exported into SPSS 15 (Microsoft, USA). The data were analysed using descriptive summary statistics. Secondly, from early-departure students who completed the self- administered questionnaire, a convenience sample for in-depth interviews was drawn of respondents within reach and available and who responded positively to the invitation to be interviewed. An interview guide approach was implemented in face-to-face in-depth interviews until saturation was reached. A total of eight in-depth interviews were conducted. The purpose of the interviews was to gain further insights into the responses emanating from the self-administered questionnaires. The respondents were asked open-ended questions about their experiences as MPH students with regard to programme, institutional and personal characteristics. In addition, the interviewer sensitively enquired about the reasons that had influenced their departure from the programme. The interviews took about 30 minutes each, and were tape recorded and transcribed verbatim. Thematic analysis was used to analyse transcriptions. Coding was done and then emergent themes were identified. Trustworthiness of the findings was achieved through: (i) dependability; and (ii) triangulation. Dependability of the data collected was ensured through an audit trail. The main researcher and supervisor served as peer reviewers of the individual in-depth interviews, the level of probing, and the sequence in terms of how the data were collected. Triangulation of data was achieved through the use of individual in-depth interviews, field notes during the interviews and a self-administered questionnaire. Ethical approval was granted by the University of KwaZulu-Natal Human and Social Sciences Research Ethics Committee (ref. no. HSS/0561/014D), and permission to conduct the study was granted by the registrar. Results Of the 38 early-departure students who were invited to participate, 25 (66%) returned the questionnaire. Of the 25 respondents, 19 (76%) were female and 14 (56%) were between the ages of 30 and 39 years. Twenty (80%) were employed in the public sector and 11 (44%) were clinicians (Table 1). All were in full-time employment. The age, gender and education background data for other graduates (non-responders) were available from the alumni records: females comprised 62%, 38% were aged 40 - 49 years, and 77% were clinicians. The profile of the respondents is in line with the report by the Council of Graduate Schools, which revealed a shift in the age distribution of postgraduate students in SA.[8] In 2007, 22% of all postgraduate students were ≥40 years of age, compared with 18% in 1987. Projections suggest that the number of mature students will continue to increase.[8] Reasons provided for early departure from the MPH programme Respondents were asked what had influenced their decision to leave the programme. The most cited reason was heavy workload on the programme Table 1. Demographic and social characteristics of early- departure students (N=25) Categories Respondents, n (%) Age (yr) 20 - 29 3 (12) 30 - 39 14 (56) 40 - 49 6 (24) ≥50 2 (8) Gender Female 19 (76) Marital status Married 17 (68) Single 6 (24) Widowed 1 (4) Living with partner 1 (1) Educational background Medical 8 (32) Nursing 7 (28) Allied science 8 (32) Social science 2 (8) Current position Programme manager 6 (24) Middle manager 3 (12) Medical manager 1 (4) Researcher 1 (4) Clinician 11 (44) Academic 3 (12) Current employment Public sector 20 (80) NGO 1 (4) Research 1 (4) Academic 2 (12) Research September 2017, Vol. 9, No. 3 AJHPE 113 (76%), stress related to the demands of the programme (64%), demands of employment while studying (60%), not enough time spent on studies outside face-to-face sessions (56%), the difficulty of the programme (52%) and insufficient academic progress (44%) (Table 2). Analysis of the self-administered questionnaires and interviews with the early departures revealed three main and strongly inter-related reasons provided for withdrawing from the programme. The themes identified were balancing responsibilities and time management, stress and the demands of the MPH programme, and insufficient academic progress. Balancing responsibilities and time management Respondents reported that the decision to depart was influenced by not having enough time outside the face-to-face sessions to commit to their studies, within the context of heavy job demands. Conflicting demands, work/life balance, time management and student preparedness for post- graduate studies were additonal factors that led to some respondents' decision to leave. ‘My job has timelines. Also, whatever assignment the lecturer gives you it has got timelines and all these people need you. Also at church there are timelines, you know. I was failing to balance all these three aspects in my life.’ (R2) ‘… it came to a point where, you know you get so exhausted at the end of the day working and then you get back home and then having to fit in time to go over your work and so I felt that was a challenge for me. I was not able to balance it, and I think I needed to have some skills development on how to have managed it [studying]. So perhaps the balancing act was not well done because of the lack of structured plan on how to go about it [managing the studies].’ (R4) ‘And to have time actually to do the assignments was quite difficult for me.’ (R3) Stress and the demands of the MPH programme The academic demands of the MPH programme were reported to cause stress and to contribute to early departure. Aggravating the inherently demanding academic programme were poorly managed peer-learning activities, personal factors, and anxieties about academic performance, particularly in the case of students who had been absent from higher education for some time. ‘… it was quite heavy for me because there were lots of assignments to be done within a very short period, and also we have to work in groups and you find that people are not pulling their weight and you do more of the work and I was pregnant and was mindful that I do not want to be too stressed …’ (R3) ‘It was hectic and was actually stressing me and draining me. I did not think with that workload and the amount of work that I have to do I will be able to get the mark that they require for me to proceed.’ (R5) ‘I had not been studying for about 14 years, it was really difficult. It was like I am in a new land. I was struggling.’ (R2) Insufficient academic progress Fear of failure and insufficient academic progress were highlighted as contributing to early departure, exacerbated by unfamiliar subject matter and a lack of clarity regarding academic expectations. ‘… when it came to me having to prepare for my exam, I just felt lost. So I said to myself, there is no use in continuing with something that I do not understand now and do the next module. What if it happens again? It was actually the fear of failure again, I failed, and then what if I fail again? I have never failed in my life.’ (R8) ‘… I could not even pass and I think it discouraged me and yet I had made a good effort. I was trying my level best to get to there [passing], but when I tried so badly then I realised I have not even passed and yet I think I take out all my energy to go for it [studying].’ (R6) Discussion The characteristics of the sample of early-departure students indicate a profile of part-time mature, married women working as clinicians and managers in the public sector. Mature part-time postgraduate students are faced with numerous challenges such as adjusting to postgraduate demands when returning to higher education many years after obtaining an undergraduate qualification.[9,10] Four inter-related factors were foregrounded by the respondents as contributing to early departure in the MPH programme: a struggle on how Table 2. Reasons provided by students for early departure from the Master of Public Health programme (N=25) Importance of reason, n (%) Not at all A little Moderately/very The difficulty of the programme 6 (24) 6 (24) 13 (52) The programme was not what I expected 11 (44) 5 (20) 9 (36) The way the programme was taught did not suit me 9 (36) 6 (24) 10 (40) The overall organisation of the programme 9 (36) 7 (28) 9 (36) The timetabling of the programme did not suit my needs 9 (36) 6 (24) 10 (40) Too heavy a workload on the programme 4 (16) 2 (8) 19 (76) I felt I was making insufficient academic progress 7 (28) 7 (28) 11 (44) Not enough time spent on studying outside timetabled sessions 8 (32) 3 (12) 14 (56) Stress related to the demands of the programme 5 (20) 4 (16) 16 (64) Lack of personal support from colleagues 12 (48) 3 (12) 10 (40) The needs of dependants (e.g. family, partner) 13 (52) 4 (16) 8 (32) Emotional difficulties involving others (e.g. family, partner, friend) 17 (68) 3 (12) 1 (4) The demands of employment while studying 8 (32) 2 (8) 15 (60) Research 114 September 2017, Vol. 9, No. 3 AJHPE to balance the demands of complex academic, personal and professional worlds, with competing demands on time, stress brought about by the academic demands of the MPH programme, and insufficient academic progress. The reasons cited for early departure are not unique to the respondents in this study.[7,10] The complex competing roles resulting from enrolling for a Master’s degree contributed to their decision to depart. The transition into postgraduate education brought about additional stress and time pressures that competed with existing personal and professional roles for time, space and mental energy.[11] Schlossberg[12] defines transition as an event that results in changed routine and roles. The change has a potential to cause stress and anxiety.[12] For mature students, the transition to postgraduate education usually brings conflict with existing roles and could lead to a questioning of the roles.[12] The process of adjustment to the new role of being a student requires appropriate preparation, support and a strong sense of self-belief.[12] The study participants were overwhelmed by the workload and the demands of the MPH programme. For many, failure to negotiate the learning demands and volume of work in the programme owing to lack of structured planning, time constraints, lack of preparedness and stresses led to a decision to leave the programme. Mature part-time students need structured support systems commencing at the pre-enrolment phase to ensure that they are socially and academically integrated into higher- education institutions and improve their persistence. Moreover, for students to be adequately integrated, mentoring by faculty staff and senior students coupled with academic and peer-support structures help students see beyond the immediate stresses to the future benefits studying will bring by identifying achievable goals.[13-15] Some participants in this study reported that inability to achieve satisfactory results to progress academically, coupled with difficulty in understanding the course material, resulted in their decision to leave the programme. They displayed an inability to overcome the academic setbacks and study pressure that tend to be associated with part-time mature students. The ability to overcome challenging circumstances and bounce back after experiencing failure requires a certain degree of academic resilience.[16] A growing body of research reports that students with high academic resilience and self-efficacy are more likely than those without to persist when confronted with difficult academic material, and that they perceive negative performance evaluations as challenges to overcome and as signposts indicating where learning needs to be deepened rather than as threats to avoid.[13,14,16] Most revealing from the data was that student departure is influenced by multifaceted factors. While 35% of students departed in the first semester, students with presumably equally pressing demands completed the degree. Further research must focus on a more nuanced understanding of the differences in characteristics between early-departure students, students who leave after the first semester but before completion, and completers. Moreover, an investigation of the influence of resilience and self-efficacy on the persistence of MPH students needs to be conducted. Although financial constraints and incompatibility between the student and the institution have been reported in the literature as factors that influence early departure, these factors did not surface in this study. Study limitations This study was conducted in a single MPH programme, and results cannot be generalisable to students in other MPH programmes, although they may be transferrable to MPH programmes with part-time mature students in SA. Further research of a similar nature that compares early-departure students across different programmes in the country is recommended. The non-respondents may have had different reasons for early departure from the MPH programme. Conclusion This study sought to understand early departure in an MPH programme. Student early departure in the programme was seen to be influenced by four interrelated factors contributing to early departure: balancing the world of work and academics and poor time management, stress and academic demands related to the programme, and insufficient academic progress. Further research needs to focus on student transition into postgraduate education, approaches implemented to help students cope with academic workload, and methods employed to help students deal with insufficient academic progress experienced once they are registered. Furthermore, research is needed to understand the coping mechanisms used by part- time mature students at the commencement of their studies. Strategies to assist students to cope with the challenges that they encounter need to be structured within the MPH programme. Orientation and induction should include students’ development activities such as time management, stress management and effective study skills. Creating structured supportive systems, and providing mentorship by senior students as an ongoing process, could assist mature students in dealing with the life changes that studying brings. This can be accomplished using a number of methods, such as inviting faculty staff and past students who struggled initially and eventually completed the MPH programme to serve as mentors to students registering for the first time. Acknowledgements. The authors thank the MPH students for participating in the study. Author contributions. TD had the primary responsibility for the drafting of the manuscript. TD, AV, RS and JW all contributed substantially to the intellectual content and finalisation of the manuscript. All the authors read and approved the final manuscript. Funding. This publication was made possible by grant no. R24TW008863 from the Office of the US Global AIDS Coordinator and the National Institutes of Health (NIH), US Department of Health and Human Services (NIH Office of Aids Research and NIH Office of Research on Women’s Health). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the USA government. Conflicts of interest. None. 1. Hovdhaugen E. Transfer and dropout: Different forms of student departure in Norway. Stud High Educ 2009;34(1):1-17. https://doi.org/10.1080/03075070802457009 2. Elkins S, Braxton J, James G. Tinto’s separation stage and its influence on first-semester college student persistence. Res High Educ 2000;41(2):251-268. https://doi.org/10.1023/A:1007099306216 3. Council on Higher Education, South Africa. The State of Higher Education in South Africa. 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