442021 39(3): 44-61 http://dx.doi.org/10.18820/2519593X/pie.v39.i3.5 ACADEMIC AND PSYCHOSOCIAL CHALLENGES OF HEALTH SCIENCES STUDENTS DURING THE COVID-19 PANDEMIC: A UNIVERSITY OF TECHNOLOGY PERSPECTIVE ABSTRACT The COVID-19 pandemic resulted in South African universities and institutes of higher learning experiencing an unprecedented shift to online learning in 2020, coupled by limited access to campus, in order to prevent community transmission. However, the potential impact of the outbreak on the academic and psychosocial wellbeing of students warrants further exploration, as the rapid changes and the disruption to normal academic life, has left many students feeling socially isolated and struggling to cope with massive uncertainty. In addition, Health Sciences students may experience added anxiety due to their line of work, which places them at the forefront of the healthcare environment. This study explored the academic and psychosocial challenges experienced by students enrolled in a Health Sciences faculty in a University of Technology (UoT), as they transitioned through the COVID-19 pandemic and the ensuing lockdown. A qualitative approach with an exploratory descriptive design was used to guide the study. A sample of students across all levels of study (first, second and third years as well as postgraduates) from the Faculty of Health Sciences at the Durban University of Technology (DUT) in South Africa were selected. Sample recruitment was done through non-probability sampling techniques which include purposive and convenience sampling. Data saturation was reached after interviewing 15 participants on Microsoft Teams. The interview schedule comprised key points on understanding how the COVID-19 pandemic and the ensuing lockdown affected students personally and academically. Interviews were recorded, transcribed and subjected to content and thematic analyses. Six broad themes emerged from the data, which captured the disruption students experienced within the context of their academic life, their personal fears and anxieties, struggles with online learning and connectivity issues. Students also expressed challenges whilst studying remotely at home. The findings suggested that there is an urgent need for universities to reflect on ensuring students’ mental health wellbeing as well as ensuring academic success amidst a turbulent physical and psychological environment. Keywords: Academic challenges; psychosocial challenges; university students; COVID-19; remote learning; mental health. AUTHOR: Dr Nalini Govender1 Prof Poovendhree Reddy1 Prof Raisuyah Bhagwan1 AFFILIATION: 1Durban University of Technology, South Africa DOI: http://dx.doi. org/10.18820/2519593X/pie. v39.i3.5 e-ISSN 2519-593X Perspectives in Education 2021 39(3): 44-61 PUBLISHED: 16 September 2021 RECEIVED: 15 February 2021 ACCEPTED: 20 April 2021 http://dx.doi.org/10.18820/2519593X/pie.v39.i3.5 https://orcid.org/0000-0002-4047-6340 https://orcid.org/0000-0003-0197-8951 https://orcid.org/0000-0002-1584-9432 http://dx.doi.org/10.18820/2519593X/pie.v39.i3.5 http://dx.doi.org/10.18820/2519593X/pie.v39.i3.5 http://dx.doi.org/10.18820/2519593X/pie.v39.i3.5 452021 39(3): 45-61 http://dx.doi.org/10.18820/2519593X/pie.v39.i3.5 Govender, Reddy & Bhagwan Academic and psychosocial challenges of Health Sciences students 1. BACKGROUND The Coronavirus (COVID-19) pandemic was declared a public health emergency of international concern by the World Health Organization (WHO) during January 2020 (Gilbert et al., 2020) and resulted in a full lockdown in various countries, including South Africa (Bao, 2020). Its exponential growth resulted in a spectrum of psychological aftermath, especially amongst university students (Liu et al., 2020). The rapid academic transformation endured by this vulnerable population has resulted in increased levels of anxiety, depression and/or substance abuse (Zhai & Du, 2020). South African universities remained in varying levels of lockdown, accompanied by the suspension of face-to-face classes and closures of student residences/villages. It was postulated that the aftershock of this pandemic, as experienced by university students worldwide, would have lasting effects on their overall wellbeing (Hedding et al., 2020). A meta-analysis revealed that students in medical education worldwide are more prone to depression, anxiety and stress than the general population as they perceived themselves at higher risk compared to others (Puthran et al., 2016). In addition, public health measures such as social distancing and “lockdowns” may have added psychological effects on students (Pandey et al., 2020) alongside academic concerns related to an “overnight” shift to the online platform. Emergency remote teaching and learning adopted across all higher education centres resulted in major shifts in the teaching, delivery and assessment strategies. Students were expected to transition and adapt to more innovative and flexible ways of teaching, learning and assessment within a short time. However, even though many students lacked the experience/training essential in transitioning to this new model of teaching and learning, they were required to rapidly upskill themselves with online learning platforms (Hedding et al., 2020). Despite the shift to Level 11, which supported the resumption of activities, provided that all necessary precautions and health guidelines were followed, the Durban University of Technology (DUT) opted to continue with a blended approach in order to limit social contact among students and academic staff. Students from the Health Science faculty who had to complete clinics and practicals were brought back during the latter part of 2020. It appears that this limited social contact may negatively affect the academic and psychosocial health of the students. Approximately one in five university students worldwide have suffered one or more mental ailments in the preceding twelve months (Auerbach et al., 2016). Pre- pandemic, significantly high rates of psychopathology-related issues were demonstrated among South African university students, especially amongst females and those with atypical sexual preferences and students with disabilities (Bantjes et al., 2019). Prior to the onset of this pandemic, about one in four students were either diagnosed with depression/anxiety or were engaged in psychotherapy, with yet higher numbers at risk (Van der Walt et al., 2020). The diagnosis of mental health disorders negatively influenced the social transition of students into the academic setting (Alonso et al., 2018) and negatively affected their academic performance and health (McLafferty et al., 2017). Anecdotal evidence suggests that COVID-19 will significantly compromise the mental health of university students, increasing their risk of psychological consequences. The diversified student populations characterising higher education institutes in SA increases the psychiatric vulnerability of the marginalised 1 Alert Level 1 indicates a low COVID-19 spread with a high health system readiness; Level 2: moderate COVID-19 spread with a high health system readiness; Level 3: moderate COVID-19 spread with a moderate health system readiness; Level 4: moderate to high COVID-19 spread with a low to moderate health system readiness; Level 5: high COVID-19 spread with a low health system readiness (https://www.gov.za/covid-19/ about/about-alert-system) http://dx.doi.org/10.18820/2519593X/pie.v39.i3.5 462021 39(3): 46-61 http://dx.doi.org/10.18820/2519593X/pie.v39.i3.5 Perspectives in Education 2021: 39(3) and historically excluded student populations. The fact that most university students are reliant on the National Student Financial Aid Scheme (NSFAS) funding is indicative of a lower socio-economic status, which correlates to a greater risk for anxiety (Verger et al., 2010), depression (Othieno et al., 2015) and drug abuse (Yi et al., 2017). Continued NSFAS support is dependent on adequate academic progression and students are aware that they are likely to drop out without it (Lebeau et al., 2012). This places an increased mental and emotional strain on students who are already concerned about their physical health and wellbeing during the COVID-19 pandemic. Limited data exists on mental health diseases and the prevalence of psychological consequences amongst university students in low and middle-income countries, especially during a disease outbreak. Limited data exists on mental health diseases and the prevalence of psychological consequences amongst university students in low and middle-income countries, especially during such an outbreak. It has emerged that psychosocial issues and distress experienced by students and staff in response to isolation, physical and social distancing is increasingly common as the emotional impact of the pandemic was pervasive (Motala & Menon, 2020; Naidu, 2020). In South African Universities of Technology (UoT), Health Sciences students may experience added anxiety due to their line of work that places them at the forefront of the healthcare environment. Hence, this study aimed to explore the academic and psychosocial challenges experienced by students enrolled in a Health Sciences faculty in a UoT, as they transitioned through the COVID-19 pandemic and the ensuing lockdown. 2. INTRODUCTION Universities and institutes of higher learning in South Africa have experienced an unprecedented shift to online learning since the first lockdown due to the COVID-19 pandemic, which was announced in March 2020. There was a harried scramble to get the academic fraternity (staff and students) to embrace this transition in the absence of other alternatives (Mhlanga & Moloi, 2020). Apart from preparing online learning materials, contact universities were required to develop innovative ways to offer practical training and find alternative methods of formative and summative assessments while still maintaining academic integrity (Hedding et al., 2020). Numerous publications have quickly surfaced about the closure of higher education institutions (HEIs) to reduce the spread of COVID-19 in developed and developing countries (Chung, Subramaniam & Dass, 2020; Sahu, 2020). However, the potential impact of the outbreak on the academic and psychosocial wellbeing of students warrants further exploration, as the rapid changes and loss of structure has left many students feeling socially isolated and struggling to cope with massive uncertainty (Sahu, 2020). Challenges associated with the shift to online learning in China include a lack of learning discipline, suitable learning materials or good learning environments when students are self-isolated at home (Bao, 2020). In South Africa, students are challenged by technical operational obstacles such as poor connectivity and data limitations and/or accompanied by issues related to inadequate home environments as well as related personal issues such as unplanned pregnancy, substance use, depression and other mental health problems. It appears that technical and personal obstacles are not limited to the developing context. Malaysian university students also reported poor internet connectivity and limited broadband data as their biggest challenge (Chung et al., 2020), while students from the UK have missed being on campus and being able to engage in proximate learning encounters, even though there was a resigned acceptance of the online format (Bryson & Andres, 2020). In Pakistan, http://dx.doi.org/10.18820/2519593X/pie.v39.i3.5 472021 39(3): 47-61 http://dx.doi.org/10.18820/2519593X/pie.v39.i3.5 Govender, Reddy & Bhagwan Academic and psychosocial challenges of Health Sciences students most of the higher education institutions surveyed reported reservations about online/digital learning. Lack of access to internet facilities, lack of proper interaction and contact between students and instructors as well as ineffective technology, were among the major challenges reported (Adnan & Anwar, 2020). Recent studies have explored the challenges and opportunities associated with online learning during the COVID-19 pandemic (Bryson & Andres, 2020; Mailizar & Fan, 2020). A study conducted by Mailizar and Fan (2020) suggested that students’ voices are important on this issue and future research should investigate students’ opinions regarding online learning to examine challenges faced by students. Even though online learning is proving helpful in safeguarding the health, safety and wellbeing of students and faculties amid the COVID-19 pandemic, it may not be as effective as conventional learning, particularly with respect to training healthcare professionals. Student pastoral support is crucial throughout healthcare training and is often delivered through face-to-face contact sessions with academics, clinical instructors and tutors (Hodgson & Hagan, 2020). This rapid change of delivery and loss of structure has left many students feeling socially isolated and struggling to cope with massive uncertainty. Honours and postgraduate students’ research projects have been compromised by lockdown and social distancing regulations, with limited access to laboratories, fieldwork and supervisors. Social science research often relies on interviews, focus groups and survey questionnaires, thus increasing the exposure risk (Hedding et al., 2020). Although the arrangements made by HEIs may have reduced community transmission of COVID-19 as shown by closures of such institutions in previous epidemics (Owusu-Fordjour et al., 2020), it was potentially exclusive, as students living in deprived communities were disadvantaged in terms of technological and psychosocial factors. Technical problems, domestic obligations, changing daily routines and many other forms of behavioural adaptation were reported as barriers to achieving optimal positive adaptation (Huey & Palaganas, 2020). In South Africa, where a large percentage of students depend on financial assistance, where data costs are high and mobile connections are not readily available to all, and where devices such as laptop computers are seen as a luxury, it is unsurprising that students have protested. They argued that universities could not impose online learning without providing the necessary resources. Challenges and tensions relating to the shift in teaching and learning among South African university students was recently reported, suggesting that this transition entrenched exclusion and created barriers to learning (Motala & Menon, 2020). While universities have made several efforts to negotiate with cellular networks and sponsors on behalf of students, they are limited in assisting students living in remote areas where electricity supply is inconsistent and network coverage is poor (Dube, 2020). Moreover, even resources provided by the universities may need to be shared by family members who are working or need to be home schooled. Learning at home can be ineffective as distractors may impede learning and understanding. Many homes in developing countries do not have an adequate learning environment and students learn either in the living room or in their bedrooms. The aspect of guided knowledge transfer is also missing when one is learning alone in households without the guidance of a teacher or other colleagues to enhance their understanding (Owusu-Fordjour, Koomson & Hanson, 2020). Other challenges related to this situation included those related to communication, student assessment, use of technology tools, online experience, pandemic-related anxiety or stress, time management and technophobia (Utama, Levani & Paramita, 2020). http://dx.doi.org/10.18820/2519593X/pie.v39.i3.5 482021 39(3): 48-61 http://dx.doi.org/10.18820/2519593X/pie.v39.i3.5 Perspectives in Education 2021: 39(3) The WHO (2020) has advised universities to expect these adjustments to the “ways of doing” for some time yet, which implies that educational institutions need to design appropriate and effective content, and arrange an effective delivery system to ensure the achievement of learning outcomes and the professional readiness of students (Adnan & Anwar, 2020). This has caused increased stress among students, which may lead to adverse effects on learning and psychological health (Al-Rabiaah et al., 2020). Past pandemics such as smallpox, plague, influenza and severe acute respiratory syndrome (SARS), amongst others, have had severe consequences on societies (Owusu-Fordjour et al., 2020). Identifying challenges arising from such events is the first step towards converting them into opportunities. While the COVID-19 pandemic has made online learning the only practicable alternative, we need to have an inclusive approach that aligns with the lived realities of students. 3. METHODOLOGY 3.1 Ethical considerations Ethical approval was obtained from the Institutional Research Ethics Committee (IREC 061/20). Informed consent was obtained from all participants prior to their participation. Those who volunteered to participate were informed of the non-compulsory nature of the study and reassured that they could withdraw at any time. Any potential form of coercion was minimised through the provision of clear information to participants and that they could cease participation at any time. Participants could also access their recordings at will. 3.2 Study design and setting This study used a qualitative research approach with the objective of engaging participants to understand the challenges they faced related to their studies during the COVID-19 pandemic. Qualitative research methods are predicated on understanding the significance of the “subjective meaning,” that can be brought to research by individual participants and is cognisant of the “social construction” of their reality (Hesse-Biber, 2017). This approach explores the views and experiences of participants linked to their context and in a way that captures their voices (Creswell, 2014). Given the objective to understand the personal individual experiences of students and how it impacted on their academic progress and academic wellbeing, this approach was deemed most suitable. The study was conducted in the Faculty of Health Sciences (FOHS) based in a South African UoT. The FOHS comprises eleven academic departments in which approximately 2971 students are registered. The research took a “reflexive approach” (Guilleman & Gillam, 2004) throughout data collection, by making micro-ethical decisions based on reflections of participants’ dignity and privacy, responsiveness to their emotional state and by regularly checking in on participants. Methodological rigor and trustworthiness of the data was ensured by adhering to the following principles: prolonged engagement (the research team members have been teaching in the higher education context for a significant period, giving them insight into the personal and academic struggles of disadvantaged students and through peer debriefing whereby the transcripts were reviewed and engaged with by multiple team members before the emerging themes were derived (Lincoln & Guba, 1985). http://dx.doi.org/10.18820/2519593X/pie.v39.i3.5 492021 39(3): 49-61 http://dx.doi.org/10.18820/2519593X/pie.v39.i3.5 Govender, Reddy & Bhagwan Academic and psychosocial challenges of Health Sciences students 3.3 Study population and sampling The target population represented a sample of students from all departments in the FOHS. The students were recruited across all levels of study (i.e. first, second and third years as well as postgraduates). A sample is a sub-set of the defined population and mirrors the characteristics of the entire population. Qualitative inquiries are guided by smaller samples, as the intent is to seek information richness about the experiences of participants. Sample recruitment was done through non-probability sampling techniques that include purposive and convenience sampling. Purposive sampling refers to the intentional selection of participants by virtue of their ability to contribute to the study (Daniel, 2012). Sampling continued until data saturation was reached. A total of fifteen students eventually participated in the study, of which nine were undergraduates and six were postgraduates. Of this total, fourteen were females; only one white student participated and the balance included 10 Black and 4 Indian students. 3.4 Recruitment and data collection An invitation comprising the information letter and consent form was electronically emailed to heads of departments in the FOHS requesting their assistance to distribute this appeal to all registered undergraduate and postgraduate students. Those who were willing were invited to a virtual 30-minute interview. A semi-structured interview guide was used to guide the data collection process on Microsoft Teams. The interview schedule comprised key points on understanding how the COVID-19 pandemic and the ensuing lockdown affected students personally and academically. Participants were asked to share their experiences of the COVID-19 pandemic in terms of understanding of transmission, effects and understanding and experience of lockdown personally and in the context of their family. In addition, they were invited to share their anxieties, stressors and challenges in relation to their personal lives and academic progress. They were requested to share being disconnected from university life and their experiences of the online teaching and learning strategy. Semi-structured interviews are “knowledge-producing conversations” (Hesse-Biber, 2017) in which the openness of the interview will enable the participants to move the conversation in a direction that is personal, but simultaneously creating a boundary for the researcher to pursue information related to the research questions. The interviews were recorded and then transcribed. 3.5 Data analysis Qualitative content analysis and thematic analysis are classified under the qualitative descriptive design (Vaismoradi et al., 2016). Thematic analysis, which is a method for “identifying, analysing, organizing, describing, and reporting themes found within a data set” (Nowell et al., 2017), was used to guide the analysis. Key themes and sub-themes were identified within the data which was guided by the research objectives. This process enabled a systematic procedure for generating codes for qualitative data. Thematic analysis is advantageous because it allows flexibility in the research question and sample size and allows the researcher to identify themes or shared concepts within and across the data for the study. It is also advantageous as it allows for inductive and deductive analyses in order to capture the underlying themes (Clarke & Braun, 2017). 4. RESULTS AND DISCUSSION There were six broad themes that emerged in the data, which captured the disruption students experienced within the context of their academic life, their personal fears and anxieties, as http://dx.doi.org/10.18820/2519593X/pie.v39.i3.5 502021 39(3): 50-61 http://dx.doi.org/10.18820/2519593X/pie.v39.i3.5 Perspectives in Education 2021: 39(3) well as struggles with online learning and connectivity issues. The first theme highlighted the disruption students experienced in relation to multiple aspects of their academic life following the lockdown. Theme 1: Disruption of academic life There are just too much of distractions. We were discussing we might even be able to finish our lab work efficiently but now it’s like we just sitting and waiting. We don’t know when they are going to call us (P6). You have a schedule, you wake up in the morning, you go to go to campus, at around 5:00 I come back home and then there was library and there were other people doing the same thing as you saw. And if I couldn’t get something, I just asked the librarian there to help me and printing and everything. And a lot of my things, I used I printed. That was also a downside to now currently studying away from university (P4). Being a first year PhD student with a new topic, there are so many videos I need to YouTube, how to work with certain instruments. I’m going to a new lab, I don’t want to go there not knowing anything. If I was at campus it would be so much better (P5). This uncertainty of not knowing when it will be, because in the beginning I actually thought, we might be back to campus (soon) (P4). It created a disruptive period, in the sense that we have no direct contact with our supervisors. Without that proper face to face supervision it becomes difficult to move forward with our research (P11). Having to complete our academic year because today it keeps on increasing the lockdown. First they said, it was 21 days and then they added two weeks [which], really decreased our hopes of completing our goals and securing our future (P6). In terms of finances, in terms of schoolwork, because we had a lot to cover, we had assignments that we had to do, most of them they were in group work… research…. we had a lot to cover… it was hectic (P1). As evidenced in the data, students experienced significant disruptions to their academic life, due to the COVID-19 pandemic. They experienced a disruption to the normal routine of attending university and a disruption to their daily academic schedule. Many experienced feeling helpless within the context of not knowing when the lockdown would be lifted and when they could return to their normal routine of campus academic life. As participant six remarked, what began as a 21-day lockdown continued into weeks, bringing with it the increasing reality that she would be unable to complete her degree timeously. Not only was the undergraduate programme disrupted, but it was also extended. Similar fears were voiced by a postgraduate student who was afraid that her PhD study would take longer to complete. She felt the lockdown would delay her progress as it had interfered with her ability to visit the university laboratory. Another participant lamented the inability to receive face to face supervision, which contributed to difficulties experienced with meeting deadlines. Furthermore, the opportunity to work face to face with peers as part of project-based learning was disrupted. Prescheduled assessments set as part of project-based learning continued despite the physical distancing measures being implemented, creating difficulties for students to complete these assessments. Another student highlighted that http://dx.doi.org/10.18820/2519593X/pie.v39.i3.5 512021 39(3): 51-61 http://dx.doi.org/10.18820/2519593X/pie.v39.i3.5 Govender, Reddy & Bhagwan Academic and psychosocial challenges of Health Sciences students community service was affected, as students could not travel provincially or attend placements, thereby disrupting work integrated or service-learning programmes of departments. The literature is replete with descriptions of similar disruptions (Mossa-Basha et al., 2020; Ojo & Onwuegbuzie, 2020). Hall et al. (2021) in particular described COVID-19 as bringing a substantial disruption to the clinical and academic learning environments and suggested that students receive individualised learning plans and increased coaching with academic tutors virtually or in person to obviate learning and assessment related difficulties. Theme 2: Personal fears and anxiety The second theme that emerged from the data related to the personal fears and anxieties of the participants. They reported as follows: We are just taking all taking strain psychologically, financially (P3). For me, it’s been a tough time because I felt so alone without knowing what is going on, in trying to understand it led to being anxious and having a lot of stress of how we are going to deal with this (P6). We have to finish this year … maybe the academic year will be cancelled, that’s the first thing that came to my mind, which was stressing me a little bit and looking at the assignments. The workload that we had … I was a bit scared that maybe I wouldn’t be able to finish it when we were told (P1). There is a lot to do in such a short time since we’ve got like three months to finish the first semester (P2). My biggest fear and anxiety and stress has been … about how much practical hours we are going to have to make (P7). Participants also expressed significant fear and anxiety related to their academic life and progress. One student commented specifically on experiencing both financial and psychological strain. The recent #feesmustfall campaign that prompted student protests nationally, exemplified the plight of students’ hardship in terms of financial and basic needs such as food (Sundarasen et al., 2020). Black African households make up the majority of poor households in South Africa (Letseka, Letseka & Pitsoe, 2018). With the COVID-19 pandemic exacerbating the living circumstances of these households due to job losses (Ornellas, Engelbrecht & Atamtürk, 2020) an even greater strain is placed on university students. One participant described the fear of being unable to complete the requisite practical hours towards her module, which left her feeling distressed. She felt immense strain with respect to additional work. Another participant expressed feeling “alone” and anxious in terms of understanding the pandemic and in terms of trying to understand how the pandemic was going to affect their future. The inability to attend university left one student, akin to “being in the dark” and unaware of when a sense of normality and return to university life would resume. Undeniably, this prompted significant levels of stress amongst all the participants, as they felt that that they would not complete the academic year timeously. One participant described the “pressure” she felt, generated by the shortened semester that needed to be completed, despite the difficult circumstances that the pandemic had induced. http://dx.doi.org/10.18820/2519593X/pie.v39.i3.5 522021 39(3): 52-61 http://dx.doi.org/10.18820/2519593X/pie.v39.i3.5 Perspectives in Education 2021: 39(3) Pandemics bring on feelings of loneliness, helplessness and stress, despair and mental fatigue (Cao et al., 2020, Dube et al., 2020). For many students in South Africa, the financial hardship of tertiary education places even greater pressure on them as they endeavour to complete in the requisite time to support their families. These descriptions of fear, anxiety, stress and loneliness reflected the description of mental health symptoms associated with the pandemic (Serafini et al., 2020). Theme 3: Online learning There were three sub-themes that emerged under theme three. These included dealing with poor connectivity, the challenges of online learning and the disconnect from university. Sub theme 1: Poor connectivity and data issues Sometimes I had to wait and wait for network to be good for me…. So when the network is good… then I can watch the videos again (P2). The main issue is just connectivity… there are certain spots (in the rural areas at home), that I need to be at in order to access proper connectivity (P3). The network is not so great….I’m always losing connectivity when searching for articles (P4). We still have to do assignments online. We still have to do everything which is a bit strenuous financial wise to us because data is costly and being on MS Teams… it also consumes lots of data (P3). We actually have “to catch” up later on because the day data is just not sufficient. So when you get time you can actually go through the videos in midnight’s which is also difficult though (P3). Since I’m doing my final year, I was busy doing my research, …. I had to stop that now because I had to travel back home. I have to buy my own data to access internet. The network is very bad at home. So, it was so hectic (P9). Even though the school provide other students with data but me personally, I had some issues with data because I had to change the number on the portal. So, the first month I didn’t receive the data (P9). The data issue demonstrated that students experienced challenges with connectivity, which further impacted their academic progress and wellbeing. Students who lived in remote, rural areas had to seek out spots to access proper connectivity whilst some indicated not being able to access connectivity at all. One student stated, “the network is very bad at home….so it was very hectic” and another expressed the difficulty associated with the network, saying that she could only watch videos when the network was stable. Yet another student observed that the poor network and loss of connectivity created huge challenges, especially when trying to source research articles. Despite the provisioning of data by certain universities, it did little to help the plight of students living in remote areas, those who lacked electricity and had poor network coverage (Hedding et al., 2020). The viability of online leaning is questionable since this marginalises many rural learners regarding access to teaching and learning caused by a lack of resources to connect to the internet (Dube, 2020). Moreover, the lack of connectivity disadvantages http://dx.doi.org/10.18820/2519593X/pie.v39.i3.5 532021 39(3): 53-61 http://dx.doi.org/10.18820/2519593X/pie.v39.i3.5 Govender, Reddy & Bhagwan Academic and psychosocial challenges of Health Sciences students students and their families regarding academic matters and prevents online education and access to information related to the fight against COVID-19. Participants also expressed their difficulties with data. Despite the university provisioning them with data, the “day” data was insufficient. One student indicated that they had to watch videos at midnight, which is not the norm in terms of their traditional learning. Some students did not receive data at all, which affected their learning in the first month of the lockdown. Data is expensive and beyond the reach of many poorer families in rural communities. South Africa is characterised by a large percentage of students who are dependent on financial assistance. Since data costs are high and mobile connections are not readily available, laptops/ computers are considered a luxury (Hedding et al., 2020). Whilst universities have negotiated with cellular networks to provide data, many universities will be compelled to reconstruct their financial budgets to ensure that disadvantaged students receive devices as well. These challenges influenced their ability to complete online assignments timeously and the ability to progress with research related activities. One student mentioned that certain journal articles were not accessible and had to be purchased, which further affected their research progress. Chung et al. (2020) stated that poor connectivity and limited broadband data was the biggest challenge for degree students at a university in Malaysia. They reported that the understanding of course content by diploma level students through online learning, remained their most significant difficulty. Zhong (2020) however, drew attention to the limited resource availability in academic institutions and the marginalisation of students, where insufficient availability of the internet and the lack of latest technology thwarted students’ ability to participate in digital learning (Zhong et al., 2020). These are factors requiring greater consideration by university management, as the country braces itself for the long haul in terms of the pandemic. Sub theme 2: Challenges of online learning The second sub-theme that emerged linked to the challenges of online learning. Most challenging moments; it was learning online. And since I’m from like rural areas, the network is not so good (P2). It was really scary and academically, it was very hard having to adjust to online learning. I’m not good with technology. So it was a very tough experience….and I’ve tried to engage in everything that was done, like learning and submitting on time, doing an assignment and writing all the quizzes (P6). It’s still affecting us even though the lecturers are trying their best to cover the work, they introduced Moodle and Teams to us just to cover all the work but some of us are not used to online learning. I used to have a lecturer in front of us. It’s how we were being raised. So, we are still struggling with the online learning. It is the only way that we can continue with the learning and be safe because it’s safer when we are home and doing the online learning (P9). Adjusting from the fact that we are studying like on campus and we using … contact learning …teaching and learning and now having to adjust into much more than learning and teaching (P3). I had to make sure that I stay up late at night so that I can have enough time to study. But it’s not always good because sometimes I feel very tired and sleepy (P6). http://dx.doi.org/10.18820/2519593X/pie.v39.i3.5 542021 39(3): 54-61 http://dx.doi.org/10.18820/2519593X/pie.v39.i3.5 Perspectives in Education 2021: 39(3) Participants described online learning as “challenging”. One participant expressed that this was a “scary” and a “tough” experience, having to adjust to the new norm of online classes and that she struggled because of her unfamiliarity with technology. Another indicated that students had grown accustomed to having a lecturer in front of them and was therefore struggling with the alternative teaching method. A participant highlighted that beyond the adjustment of contact teaching, they also had to adjust to a COVID-19 pandemic world. The “unprecedented massive migration from traditional in-class face to face education to online education”, is evident globally (Bao, 2020). The migration from traditional or blended learning to a fully virtual online strategy was associated with multiple challenges, including the inability to access online and virtual content remotely (Crawford et al., 2020). Chung, Subramaniam and Dass (2020) found that students at a Malaysian university were slightly to moderately ready for online learning amidst the COVID-19 pandemic. Moreover, communication efficacy and poor self-directed learning abilities were cited as the biggest challenges within this context. Data from their study correlated with our findings where students expressed their unpreparedness for the transition of face-to-face approaches to an online platform. Sub theme 3: Disconnect from university Access to the library is unavailable so we cannot get books for research purposes. When it comes down to doing work, there are too many distractions in the home environment, whereas being on campus, it becomes a proper working environment where there is focus and discipline (P11). When I’m having a problem... I just have to rely on the fact that I have to send an email. Sometimes a lecturer will respond sometimes they’ll take some time to respond (P3). Sometimes you just send a WhatsApp message then someone just don’t have data. So you’ll have to wait for the next person (P3). I had no access to internet, library equipment nor physical assistance/consultations with my research supervisor, of which I feel I could have presented more profound work had the lockdown not taken place (P10). Being disconnected from normal university has been hard because you can’t access the libraries. I was used to studying at the library, without having the library now, I felt like it was hard (P6). If you have a problem … you can ask the librarian and she can help you. But now we don’t have access to them. Then calling, we don’t have airtime (P4). “Having your mentor and your supervisor there at any time if I encountered any problems. Your door is always open and you give me a solution to the problem but now it’s a bit better because we video call. So I feel a lot better now that we started this video meetings and chats. In the first month it was stressful because I didn’t know where I was standing (P5). Most participants lamented the disconnect from university and its resources whilst having to study from home. This emerged as a sub-theme under the broader theme of the home milieu. One aspect of isolation identified was isolation from lecturers and research supervisors. Participants reported struggling with this lack of personal contact and support. Other participants lamented their isolation from their peers, saying that communication via a “WhatsApp” message depended on the prompt response of the recipient. The delay in http://dx.doi.org/10.18820/2519593X/pie.v39.i3.5 552021 39(3): 55-61 http://dx.doi.org/10.18820/2519593X/pie.v39.i3.5 Govender, Reddy & Bhagwan Academic and psychosocial challenges of Health Sciences students response from lecturers was also evident in the data collected. Adnan and Anwar (2020) found that students had reported that a lack of instruction from instructors, tardy response time and the absence of classroom socialisation were some of the challenges endured with studying from home. Moreover, 43% of the students reported experiencing difficulties in undertaking their group projects effectively. Similar to the current study, almost 80% of the students in Adnan and Anwar’s (2020) study believed that face to face contact with their instructor was important for online learning, which created a huge void in the distance learning mode. Participants also described that they felt isolated from the university infrastructure, library and access to the internet, which collectively compromised their ability to study and make academic progress. One participant said that the inability to reach the librarian was problematic, asserting that had she been physically on campus, immediate help would have been available. The notion of being disconnected and isolated resonated within the literature. Bryson and Andres (2020) suggested that whilst the “forced imposition of online learning was accepted as a necessary response to COVID-19 and social distancing”, students “missed being on campus and being able to engage in proximate learning encounters”. Hodgson and Hagan (2020) emphasised the importance of student support, saying that this was critical through face-to-face meetings with academic personal tutors. They further maintained that “the rapid and unexpected change of circumstances and loss of structure,” had left students feeling socially isolated and “struggling to cope with massive uncertainty”. Theme 4: The home milieu There were two sub-themes that emerged under theme four. This included struggles with the home milieu and lack of understanding from family. Sub-theme 1: Struggles with the home milieu The most difficult parts [was] getting sufficient time or sufficient space to do my school work that is also difficult and also in terms of academically accessing a good connectivity (P3). We don’t even have study areas at home (P3). Sometimes you try to sit down and do a quiz and there’s noise in the background. It so difficult with online quizzes, because not everybody is doing it in the same environment that a controlled environment that we have at university (P7). Our house is constantly busy, constantly, and they have little kids, which makes it very difficult to do work… our house is small. If the TV is on…I can hear it in my room. That made it very difficult to focus. And then the first month my phone broke and I was not in contact with you (P5). Sometimes when I’m busy with my work, then they’ll say like when are you going finish your work. So I try to explain when you doing a paper there’s no time to finish. And you need to stop and then you have to come back and the thoughts flow (P5). It will be hard to concentrate at the time, because even in the morning I have to wake up since my mom, aunt and my cousin are going back to work. So I had to wake up and look after the kids in the morning. So it has been a very tough time (P6). Many participants expressed various difficulties that they encountered with studying in their home environments, such as a lack of or inadequate space to study. Moreover, several http://dx.doi.org/10.18820/2519593X/pie.v39.i3.5 562021 39(3): 56-61 http://dx.doi.org/10.18820/2519593X/pie.v39.i3.5 Perspectives in Education 2021: 39(3) participants expressed challenges linked to noise and overcrowding within their home milieus and how this created disturbances that affected their focus and concentration. Many homes in developing countries do not have adequate learning environments, which compels students to use their bedrooms or the living room to study (Owusu-Fordjour et al., 2020). It is widely known that many poor households in rural communities lack access to basic running water and electricity, all of which further compounds the problem students experience in relation to learning environments. Bao (2020) found that students at a Chinese university experienced technical obstacles as well as challenges related to self-discipline, suitable learning materials and good learning environments whilst studying from home. Many participants expressed that their study times had to be rearranged for quieter times by staying up late to study. Some participants complained that family members did not understand their academic demands. Family members often created pressure by asking when they were going to finish university tasks or by expecting students to babysit children while their parents worked. Students within the home environment are also known to have to manage their children, other elders or siblings in the home who are not attending school (Rajab, Gazal & Alkattan, 2020). Sub Theme 2: Lack of understanding from family It is impossible to actually keep up with my studies … my family … don’t understand studying from home. They don’t understand that you have to sit for three hours just to hear a lecture (P3). As a student, everything revolves around academia… the most challenging thing for me is writing at home, the perceptions and …coming from a family where nobody studied (P5). Having to divide my time into doing house chores and also trying to get time to study and submit on time, having to write assignments and having to deal with making time for each module, not focusing on one (P6). Participants also described the complexities of trying to study at home, saying that family members did not understand the demands of university studying. Some of the issues raised included that family did not understand how they could listen to an online lecture for one hour; being unable to write and study in a context where family could not relate to the challenges of studying and having to juggle household chores and academic work. One participant expressed the difficulties not only with the university-home life disjuncture, but that they had to make decisions regarding prioritising all their modules from home, as opposed to merely concentrating on one. 5. CONCLUSION The study found that the COVID-19 pandemic disrupted normal academic life and created huge uncertainty and anxiety, particularly amongst university students. The pandemic has affected the personal wellbeing and academic life of students not only locally but across the globe. As is evident within the present study, students who lived a distance away from the university and who had to travel were faced with increased fears for their safety and wellbeing, whilst most countries, including South Africa, grapple with surging infections and increasing mortality. It is within this context that this study uncovered salient issues around http://dx.doi.org/10.18820/2519593X/pie.v39.i3.5 572021 39(3): 57-61 http://dx.doi.org/10.18820/2519593X/pie.v39.i3.5 Govender, Reddy & Bhagwan Academic and psychosocial challenges of Health Sciences students online teaching that should be considered in ensuring students’ mental health wellbeing, as well as academic success amidst a turbulent physical and psychological environment. Based on the findings it is crucial that academics become more sensitive to the plight of students from remote areas. Alternative ways of teaching and supporting the academic journey of such students requires deeper consideration in the absence of connectivity in rural areas. it is crucial that such students receive greater academic support once they return to campus to ensure they stay aligned with the academic programme. The study also highlighted the psychosocial sequelae emerging from a disruption to their normal academic and heightened fears of academic failure amidst the challenge of online learning. To counter same virtual academic support workshops and the need for telephone calls to vulnerable students will be important to ensuring their academic and psychological wellbeing amidst the pandemic. 6. ACKNOWLEDGEMENTS The authors wish to thank all the students for their participation and Sapna Ramdin for her administrative assistance. REFERENCES Adnan, M. & Anwar, K. 2020. Online learning amid the covid-19 pandemic: Students’ perspectives. 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