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Putri Anggraeni, et al / Journal of English Language Teaching 6 (1) (2017)

110

ELT FORUM 12(2) (2023)

Journal of English Language Teaching

http://journal.unnes.ac.id/sju/index.php/elt

SFA-based learning material design to improve English medical terminology
acquisition among South East Asian nursing students

Diannike Putri1, Barlian Kristanto1, Tri Sumarni1, Thanee Glomjai2, Gary Garay3, Dung
Le Hoang4

1Universitas Harapan Bangsa, Purwokerto, Indonesia
2Boromarajonani College of Nursing, Phayao, Thailand
3Arellano University, Manila, The Phillipines
4Vietnam National University, Ho Chi Minh City, Vietnam

Article Info
________________
Article History:

Received on 30 April

2022

Approved on 29 July

2023

Published on 31 July

2023

________________
Keywords: Semantic

Feature Analysis;

learning material

design; English medical

terminology; nursing

students

____________________

Abstract

The study explicates the utility of Semantic Feature Analysis (SFA) in developing
educational resources with the intent to facilitate the acquisition of English medical
terminology among nursing students. This study employs a Research and
Development (R&D) methodology to devise and evaluate the efficacy of pedagogical
resources centered on the Systematic Functional Approach (SFA). The purpose of the
present study is to conduct a comprehensive literature review to examine the
importance of English medical terminology for nursing students, as well as the role of
Speech Familiarity Aid (SFA) in designing educational materials. Furthermore, this
review seeks to investigate contemporary research findings concerning the
effectiveness of SFA in facilitating language acquisition. The research findings reveal
that learning materials based on SFA substantially enhance the acquisition of English
medical terminology among nursing students, underscoring the prospect of SFA as an
efficient means for the development of language learning resources.

Correspondence Address: p-ISSN 2252-6706 | e-ISSN 2721-4532
Jl. Raden Patah No. 100 Ledug, Kec. Kembaran, Purwokerto,
Kab. Banyumas, Jawa Tengah

Campus 1, Universitas Harapan Bangsa

dianputei@gmail.com barlian@uhb.ac.id



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INTRODUCTION
Nurses as global healthcare professionals are in high demand all around the world (Handayani, 2015).
Fluency in English provides nursing students with expanded opportunities to participate in
international nursing programs, job placements, and partnerships, opening up new horizons for their
careers. Moreover, English is important for nursing students to meet specific academic and
professional requirements (Lu, 2018; Syukur & Nugraha, 2019). Not only is it essential for medical
students to comprehand their subjects, but it also plays a vital role in securing future employment
opportunities (Niazi, 2012). Particularly in medical settings, English is unquestionably necessary for
academic and professional purposes. However, in Southast Asia, nursing students encounter difficulty
in acquiring English medical terminology, thereby inhibiting their medical communication skills
(Sibiya, 2018). Understanding medical terminology is essential for nursing students to master their
nursing hard skills. These obstacles may stem from several factors, including insufficient exposure to
English as a secondary language, limited access to medical terminologies, and the complexity of
medical jargon (Lopez et al., 2018). The acquisition of English medical terminology plays a pivotal
role in facilitating effective communication among nursing students and healthcare professionals,
fostering comprehension of medical procedures, and ultimately contributing to the delivery of high-
quality patient care (Huh & Kang, 2018; Wang et al., 2019).

According to Brown (2007), a teaching theory that is congruent with students' shared
understanding of the subject matter to be studied would guide the way to a successful procedure in
days supplied to students under various specific learning context restrictions. In this instance, the
lecturer must give effective teaching materials that have a direct impact on the learning process and
the learning outcomes of the students. To address these issues, effective learning materials specifically
match with the learning needs of nursing students can have a significant impact on the quality of
nursing education. The specific language needs of nursing students can be classified into English for
specific purposes (ESP). A strong collaboration between an English lecturer, an educational specialist,
and a science lecturer is required for creating ESP-based learning material (Wang et al., 2019). Good
ESP materials must stimulate student participation by providing learning activities which can greatly
drive students to attain learning objectives (Bracaj, 2014). To assist nursing student acquiring English
medical terminology, there must be utilize an effective approach to display the learning materials.

One solution proposed for this problem is to teach English medical terminology using the
semantic aspect of words. Lamb (2012) describes semantic features as the solitary traits that precisely
describe the meaning of a word. He also claims that semantic feature analysis entails breaking down
the meaning of a word into pieces of certain traits in various ways. For instance, semantic features for
the word “heart” related to the human body system may include {organ} (superordinate category),
{locaed in chest cavity} (location), {pumps blood} (function), {muscular} (physical characeristics), {a
vital part of the irculatory system} {related system), {beats} (rhythmically). Semantic features are
utilized in this example to define many aspects of the word "heart" such as its category, location,
function, characteristics, and related systems within the human body. Semantic Feature Analysis can
be an effective approach for assisting students in comprehending and recalling important information
about specific words or concepts. According to Fattah (2014), numerous studies have been conducted
to establish the usefulness of semantic feature analysis in vocabulary development. He adds that
semantic feature analysis was helpful in dealing with tiny groups as well as the entire class (Fattah,
2014).

This study uses semantic feature analysis (SFA) to create engaging and efficient learning
materials that address the unique issues experienced by nursing students in South East Asia. Empirical
data from several studies supports the SFA pedagogical approach's substantial potential in increasing
lexical acquisition and comprehension (Balc, 2019; Durrani & Khan, 2018). The SFA technique,
which has been shown to improve lexical acquisition and comprehension, entails breaking down
lexical items into their semantic aspects, which allows learners to better grasp and recall the target
language (Osela, 2016). Moreover, SFA assists students with visualizing and comprehending
relationships between familiar and unfamiliar phrases, while bringing the meaning of an unknown
term into focus through the development of analogies and instances. Students can combine past
knowledge with new material while also creating semantically linked categories of words and
concepts. Nursing students can use SFA to expand their vocabulary by examining the full semantic
matrix, recognizing connections, making predictions, and expanding their comprehension of key
themes. Furthermore, the application of SFA as a cognitive technique in language learning has proven
successful in a variety of circumstances, including second language acquisition and vocabulary growth



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for children with language impairment (Chen, 2018; Velázquez, López, & Fernández, 2020). SFA has
also shown efficacy in medical education, assisting students in learning medical terminology
(Bertenshaw, 2018).

Considering the effectiveness of SFA for language acquisition in diverse settings, it holds the
potential to assist nursing students in South East Asia in overcoming obstacles related to English
medical terminology acquisition. Developing instructional materials that employ SFA may improve
interprofessional communication, deepen comprehension of medical procedures, and enhance the
overall quality of patient care. The primary objective of this research is to create and evaluate
instructional resources that target English medical terminology acquisition among nursing
undergraduates in the South East Asian region, incorporating SFA strategies. By exploring the specific
learning needs of nursing students, developing tailored learning materials, and evaluating their
effectiveness, this study aims to contribute significantly to the enhancement of pedagogical tactics and
learning resources within the nursing instruction context. Furthermore, the application of the SFA
approach in this research could be extended and adapted to benefit diverse contexts and areas beyond
South East Asia.

METHODS
The R&D process involves several stages, including needs assessment, design, development, and
evaluation (Morrison, Ross, & Kemp, 2019). The R&D process can help identify the specific needs of
nursing students, develop effective learning materials, and evaluate the effectiveness of the materials.
The study employed a mixed-methods research design, incorporating both qualitative and quantitative
data collection and analysis methods. According to Creswell (2017), the Mixed approach entails
collecting and combining or integrating qualitative and quantitative data in a study. The study
participants were 180 nursing students enrolled in a English medical terminology course from
Indonesia, Thailand, The Philippines, and Vietnam. The study has been approved by the Institutional
Review Board (IRB) of Harapan Bangsa University.

Figure 1. Research procedure

This study consists of three main stages: (1) needs analysis, (2) development of learning
materials, and (3) evaluation. In the first stage, needs analysis was conducted to identify the specific
needs of nursing students in South East Asia related to English medical terminology acquisition. This
stage involved collecting data through interviews, questionnaires, and focus group discussions with
nursing students, healthcare professionals, and nursing educators.

Table 1. The blueprint of need analysis
Aspect Purposes
Learner

demographics
 Collect demographic information about the nursing students, such as age,

gender, and origin
Learning

Objectives
 Determine the learning objectives and outcomes for the training program.
 Identify the specific English medical terminology that nursing students need

to acquire.
 Determine the students' motivation and interest in learning the English

medical terminology.



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Learning
Preferences

 Identify the students' preferred learning styles, formats, and resources.
 Determine the constraints and resources available for the program (e.g., time,

budget, materials, technology).
Learning

Lacks
 Identify any gaps or deficiencies in the students' learning that need to be

addressed
 Identify any specific challenges or barriers to learning that the students may

face.
 Determine the students level of English proficiency and medical terminology

knowledge
Learning

Necessities
 Determine the students' needs for additional support, resources, or

instruction.

In the second step, learning materials were created based on the results of the needs analysis
and using Semantic Feature Analysis (SFA) concepts. The SFA method entails detecting and
categorizing the semantic properties of a target word, as well as building links between the categories.
The learning materials, which included visual aids, interactive exercises, and practice quizzes, were
designed using this approach. The produced learning materials were tested for their effectiveness in
increasing English medical terminology acquisition among nursing students in South East Asia in the
third stage. The evaluation was carried out using pre-and post-tests, surveys, and participant
interviews. To measure the efficiency of the learning materials, the data obtained will be analyzed
using descriptive statistics and inferential statistics. Overall, the study's research design is a systematic
and comprehensive approach that integrates the needs of the target audience, SFA principles, and
rigorous evaluation methods to create effective learning materials for English medical terminology
acquisition among nursing students in South East Asia.

FINDINGS AND DISCUSSION
Learning Needs of Nursing Students in Medical English Acquisition
Demographic data
The findings of the need analysis could provide useful insights into the language learning needs and
preferences of nursing students from Indonesia, Thailand, the Philippines, and Vietnam, as well as
shape the design of learning resources to help them learn English medical terminology.

Table 2. The demographic data of the respondents
Origin Gender Age

∑n
Institutions Countries Male Female 18-20 21-23 24-26

Harapan Bangsa University, Purwokerto Indonesia 24 36 6 52 2 60
Arrilano University, Manila Philippines 18 22 31 9 0 40
Boromarajonani College of Nursing, Phayao Thailand 11 49 40 20 0 60
National Vietnam University, Ho Chi Min City Vietnam 9 11 0 20 0 20

n = total number of respondents

Learner demographics and background information are important for designing effective
language learning materials and programs because learners' age, gender, and educational background
can influence their language learning needs and preferences (Celce-Murcia et al., 2014, p. 22). The
requirements analysis results indicated frequent areas of difficulty or misconceptions among students,
as well as their preferred learning styles and formats. Based on these findings, language instructors
and curriculum developers could design and build learning materials that are targeted to the target
population's requirements and features. Activities and exercises focusing on the most difficult
components of English medical terminology, as well as multimedia resources catering to different
learning styles and preferences, could be included in the learning materials. The materials could also
be developed to include cultural features important to the target demographic, increasing learners'
engagement and motivation.

Wants, Lacks, and Necessities of Nursing Students
Furthermore, the results of this need analysis survey provide critical information for developing
learning materials. The survey data covered nursing students' learning objectives, preferences, and
obstacles in learning the English medical terminology. The majority of responders stated a great desire



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to enhance their communication skills with patients and medical professionals, emphasizing the
significance of this training program in improving patient care and safety.

Table 3. The result of the need assessment

Key Information Options ∑n M SD

Learning Objectives and
Outcomes

Improving English medical terminology
Knowledge

120 4.2 0.7

Specific English medical
terminology

Terminology related to human body systems
and diseases

85 3.8 0.9

Student Motivation and
Interest

Improve communication with patients and
medical professionals

140 4.5 0.5

Preferred Learning Styles,
Formats, and Resources

Visual aids and interactive activities 100 4.0 0.8

Constraints and Resources Limited time and access to technology 75 3.5 1.0
Gaps or Deficiencies in
Learning

Grammar and syntax in medical terminology 55 3.3 1.1

Challenges or Barriers to
Learning

Pronunciation and accent differences 45 3.1 1.2

English Proficiency and
Medical Terminology
Knowledge

Basic proficiency and limited medical
terminology

70 3.7 0.9

Additional Support,
Resources, or Instruction

More practice and feedback opportunities 90 4.1 0.8

According to the results of the need assessment in Table 3, the most important learning target
for nursing students was to acquire an understanding of English medical terminology for efficient
communication in the workplace. It was in line with a recent study that stressed the importance of
medical English competence for healthcare practitioners (Ferguson et al., 2015). Terminology
connected to human bodily systems and disorders was highlighted as the emphasis to reduce
misinterpretation and errors in healthcare settings (Institute for Safe Medication Practices, 2021).
Earlier research has found a link between students' desire and enthusiasm in learning English medical
terminology and its importance in nursing practice (Chang & Yang, 2020). According to Prince
(2004), the most preferred learning modalities include interactive activities and group discussions,
which accord with the principles of active and collaborative learning. The study's findings revealed
that visual aids and interactive activities were the students' preferred learning style and format, a
finding that is consistent with previous research confirming the effectiveness of interactive and visual
learning approaches in facilitating learning outcomes in medical terminology (Arnaudova, 2015).

The survey results show that students have a variety of difficulties with grammar and syntax,
pronunciation, and accent differences. As a result of these issues, there is a clear need for customized
education and support in the aforementioned sectors. Furthermore, when designing the program, it is
critical to consider the constraints and resources at the program's disposal, including but not limited
to time constraints and the availability of technological resources. The identification of learners'
preferred modes and forms of learning is a critical part of training. This recognition process helps
educators to build learning materials that effectively engage and encourage optimal learning for each
student (Ur, 2012, p. 238). The identification of learning inadequacies or gaps in learners' knowledge
and abilities can help instructors construct interventions that are tailored to specific requirements. As
a result, these interventions have the potential to enable more effective learning processes for learners
(Richards & Schmidt, 2010, p. 19).

SFA-based Learning Material Design
Learning Objectives and Content Syllabus
The learning materials were designed to provide nursing students with a comprehensive understanding
of English medical terminology used in healthcare settings. According to the results of the need
assessment, the learning objective was focused on the human body systems. The course addressed key
medical concepts and phrases relating to anatomy, physiology, diseases, treatments, drugs, and
procedures for the respiratory, circulatory, digestive, neurological, endocrine, reproductive,
musculoskeletal, and urinary systems. Students learned how to use English medical terminology
effectively in a variety of healthcare contexts through a combination of lectures, discussions, and



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practical exercises. The following are the learning objectives for the course book on English medical
terminology presented using semantic feature analysis to assist nursing students' acquisition, with an
emphasis on the human body systems:
1. Define and use appropriate medical terms relevant to the major human body systems, including

the urinary system, cardiovascular system, respiratory system, digestive system, neurological
system, endocrine system, and musculoskeletal system.

2. Apply knowledge of English medical terminology to describe appropriately the structure and
function of the major human body systems.

3. Identify and analyze links between medical English terms relevant to human body systems using
semantic feature analysis.

4. Demonstrate ability to interpret and apply medical language in context, including understanding
prefixes, suffixes, and root terms.

5. Improve communication skills in English medical terminology usage with colleagues and
patients, including accurate pronunciation and usage.

6. Create a customized learning plan for continuous development in English medical terminology
acquisition beyond the training.

These learning objectives are specific, measurable, achievable, relevant, and time-bound
(SMART) and are aligned with the overall goals of the training program. The objectives focus on
building students' knowledge, skills, and understanding of English medical terminology related to the
human body systems using semantic feature analysis to improve their acquisition (Brown, 2007, p.
258).

Table 4. Content syllabus
Unit Topic Learning Activities
1 Introduction to English

medical terminology
 Define English medical terminology and its importance in

healthcare
 Introduce the major human body systems and their functions
 Overview of semantic feature analysis and its use in English

medical terminology acquisition
2 The Cardiovascular System  Define medical terms related to the cardiovascular system

 Discuss the structure and function of the cardiovascular system
 Use SFA to identify relationships between medical terms related

to the cardiovascular system
3 The Respiratory System  Define medical terms related to the digestive system

 Discuss the structure and function of the digestive system

 Use semantic feature analysis to identify relationships between
medical terms related to the digestive system

4 The Digestive System  Define medical terms related to the digestive system

 Discuss the structure and function of the digestive system
 Use semantic feature analysis to identify relationships between

medical terms related to the digestive system
5 The Nervous System  Define medical terms related to the nervous system

 Discuss the structure and function of the nervous system
 Use semantic feature analysis to identify relationships between

medical terms related to the nervous system
6 The Endocrine System  Define medical terms related to the endocrine system

 Discuss the structure and function of the endocrine system
 Use semantic feature analysis to identify relationships between

medical terms related to the endocrine system
7 The Musculoskeletal

System
 Define medical terms related to the musculoskeletal system
 Discuss the structure and function of the musculoskeletal system
 Use semantic feature analysis to identify relationships between

medical terms related to the musculoskeletal system
8 The Urinary System  Define medical terms related to the urinary system

 Discuss the structure and function of the urinary system

 Use semantic feature analysis to identify relationships between
medical terms related to the urinary system



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9 Effective Communication
in English medical
terminology

 Discuss the importance of proper pronunciation and usage of
English medical terminology

 Practice using medical terminology in communication with
colleagues and patients

 Provide strategies for effective communication in English medical
terminology

10 Personal Learning Plan and
Future Directions

 Develop a personal learning plan for continued improvement in
English medical terminology acquisition

 Review course material and progress
 Discuss future directions for English medical terminology

acquisition and use.

The Structure of Lesson Unit
The lesson unit for each of the 10 units in the course book on English medical terminology using
semantic feature analysis to improve nursing students' acquisition could include the following
components.

Table 5. The components of a lesson unit
Unit: Title

Learning
Objectives:

Clearly stated, specific, measurable, achievable, relevant, and time-bound objectives that
outline what students will learn in the lesson.

Pre-
Assessment:

An activity that assesses the students' prior knowledge and understanding of the English
medical terminology related to the human body system is being covered in the lesson.

Vocabulary
Development:

Introducing new English medical terminology related to the human body system using
semantic feature analysis, and providing opportunities for students to practice using the
terminology in context.

Practice
Exercises:

Activities and exercises that allow students to apply their understanding of the English
medical terminology to accurately describe the structure and function of the human body
system being covered in the lesson.

Collaborative
Learning:

Group work or pair work allows students to develop their communication skills in English
medical terminology usage with colleagues and patients.

Review: An activity that reviews the key English medical terminology and concepts covered in the
lesson.

Post-
Assessment:

An activity that assesses the student's understanding and mastery of the English medical
terminology related to the human body system covered in the lesson.

Extension
Activities:

Optional exercises for students to develop their grasp of medical English vocabulary
connected to the human body system, including the chance to construct a personal study
plan for continuous improvement in English medical terminology acquisition beyond the
course.

Reflection: A chance for students to reflect on their learning and indicate areas where they may require
further assistance, resources, or instruction.

Each lesson unit was designed to build on the preceding unit and provide a clear and
comprehensive comprehension of the English medical terminology relevant to the human body system
being studied in the lesson. Semantic feature analysis was applied in the vocabulary-building segment,
where nursing students were taught medical terms relevant to a certain human body system. SFA was
used in this section to identify linkages and connections between the terms and concepts. Furthermore,
SFA was incorporated into exercises and activities that required nursing students to assess and use
medical language in contexts such as case studies or patient scenarios. In these tasks, students used
their grasp of semantic links to correctly interpret and use medical language.



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Figure 2. Sample of a lesson unit preview

The Effectiveness of SFA-based Learning Material Design
Test Results
The study's findings could include statistical analysis like mean scores, standard deviations, t-tests,
ANOVA, or regression analysis to detect differences or correlations between variables. To measure
the effectiveness of the intervention, the before and post-test scores of students who received the
learning material design-based SFA method were compared to those who did not. Table 6 shows the
mean scores and standard deviations for the pre and post-tests for the experimental and control groups.
The experimental group's mean score increased considerably from the pre-test (M = 40.1, SD = 3.2)
to the post-test (M = 55.3, SD = 4.1), t(90) = 14.3, p.001. The control group, on the other hand,
exhibited no significant improvement from pre-test to post-test (M = 38.9, SD = 3.5), t(90) = 0.6, p
=.548.

Table 6. Mean & standard deviations of pre and post-test
Group Pre-test Post-test

Mean SD Mean SD
Experimental 40.1 3.2 55.3 4.1
Control 38.9 3.5 39.2 3.9

An analysis of variance (ANOVA) on the post-test scores was used to determine the differences
between the experimental and control groups. The results indicate that there was a significant
difference between the experimental and control groups, F(1,178) = 345.7, p < .001. Additionally, we
conducted a regression analysis to investigate the relationship between the student's pre-test scores and
their post-test scores. The results show a significant positive relationship, R^2 = .65, F(1,178) = 467.2,



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p < .001. Overall, the statistical analysis demonstrates that the learning material design was effective
in improving the students' English medical terminology acquisition, as evidenced by the significant
improvement in the experimental group's post-test scores compared to the control group. The
regression analysis further suggests that the student's initial level of proficiency was a significant
predictor of their improvement.

Nursing Students’ Satisfaction
The satisfaction questionnaire was administered to 180 nursing students from Indonesia, Thailand,
the Philippines, and Vietnam to evaluate their satisfaction with the learning materials design based on
a semantic feature analysis approach to improve their English medical terminology acquisition. The
questionnaire consisted of 10 Likert-scale items, ranging from 1 (strongly disagree) to 5 (strongly
agree). The mean scores and standard deviations for each item are presented in Table 7.

Table 7: Mean scores and standard deviations for satisfaction questionnaire items
Statements Mean SD

The learning materials were well-organized. 4.3 0.8
The learning materials were easy to understand. 4.2 0.9
The learning materials helped me learn English medical terminology. 4.5 0.7
The learning materials were visually appealing. 4.1 0.8
The learning materials were engaging. 4.4 0.7
The learning materials provided clear explanations. 4.3 0.8
The learning materials included relevant examples. 4.0 0.9
The learning materials included useful exercises. 4.3 0.8
The learning materials were appropriate for my level of English proficiency. 4.2 0.9
I would recommend the learning materials to other nursing students. 4.4 0.7

The findings show that nursing students were generally pleased with the design of the learning
materials based on the semantic feature analysis approach. All items had mean ratings of more than
4.0, suggesting that students agreed or strongly agreed with the claims. Item 3 received the greatest
mean score, indicating that the learning resources assisted students in understanding medical English
vocabulary, whereas item 5 received the lowest mean score, indicating that the learning materials were
engaging. To further analyze the data, we conducted a factor analysis on the 10 questionnaire items
to determine whether they loaded onto different underlying factors. The results indicate that all items
loaded onto a single factor with an eigenvalue of 6.0, explaining 60.1% of the variance. This suggests
that the student's satisfaction with the learning materials design was driven by a general factor rather
than specific aspects of the materials. Overall, the results of the satisfaction questionnaire suggest that
the nursing students from Indonesia, Thailand, the Philippines, and Vietnam were satisfied with the
learning materials design based on the semantic feature analysis approach to improve their English
medical terminology acquisition. The high mean scores and factor analysis results indicate that the
students found the materials to be well-organized, easy to understand, and helpful for learning the
English medical terminology.

CONCLUSION
Finally, this study focuses on applying semantic feature analysis (SFA) to develop vocabulary learning
materials that increase the acquisition of English medical terminology among Southeast Asian nursing
students. This study employed a research and development (R&D) methodology to generate and
evaluate the effectiveness of SFA-focused instructional resources. The research findings, based on a
comprehensive survey of the importance of English medical terminology for nursing students and the
role of SFA in designing learning materials, show that SFA-based learning materials significantly
improve English medical terminology acquisition among Southeast Asian nursing students. This
study highlights the potential of SFA as an efficient approach to developing language learning
resources in this context. Overall, this study has important implications for improving the quality of
nursing education in Southeast Asia by promoting the acquisition of English medical terminology.
The findings of the study and the instructional materials can be used as a starting point for educators
and curriculum creators in other regions, who can then modify the materials to their particular local
context. In conclusion, the research and instructional materials developed based on SFA for South
East Asian nursing students have the potential to be applied in a broader context, providing valuable



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insights and strategies for promoting the acquisition of English medical terminology in diverse
healthcare settings around the world.

ACKNOWLEDGEMENT
We would like to thank and appreciate The Ministry of Education, Culture, study, and
Technology for their financial support of this study effort. This research would not have been
possible without this funding. We are grateful to the Department of Education for its faith in our
research and dedication to improving educational research and development. This funding
enabled us to conduct research and gain useful insights into the use of semantic feature analysis
(SFA) to improve English medical terminology acquisition among Southeast Asian nursing
students. We would like to thank the Ministry of Education, Culture, study, and Technology once
more for their assistance and participation in this study effort.

FUNDING STATEMENT
We, the authors, hereby declare that the funding source received for the research submitted to this
journal is solely from the Ministry of Education, Culture, Research, and Technology. The funding
provided by the Ministry has enabled us to conduct the research and produce the results presented in
this article. We confirm that no other sources of funding, financial or otherwise, have been used to
support this research. We also attest that the Ministry of Education, Culture, Research, and
Technology does not influence the research design, data collection, analysis, interpretation, and
publication of the results. We acknowledge the Ministry for their support and appreciate their
contributions to this research project.

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