Abstract
Background
Nursing is the focal point in the delivery of healthcare services; however, it is still facing challenges related to the image of the nursing profession, especially in resource-constrained countries like Palestine, where societal attitudes and limited resources can negatively impact the perception and recruitment of nursing professionals. The aim of this study was to assess the perceptions of the nursing profession among Palestinian nursing students across academic years.
Methods
A cross-sectional design was used in July 2025, consisting of 323 nursing students from southern West Bank universities. Perceptions were measured by a 26-item instrument, the Nursing Image Scale (NIS), which includes subscales for General Appearance, Communication, and Occupational/Educational. SPSS software was used for data analysis.
Results
The overall mean Nursing Image Scale (NIS) score was 4.09 ± 0.29 (out of 5), indicating generally favorable perceptions of the nursing profession. The overall NIS score did not significantly differ across academic years (p = 0.941). Domain-level descriptive patterns suggested relatively stable perceptions of general appearance, with minor variations observed in communication and occupational/educational domains, indicating that while general appearance is viewed positively, there may be concerns or mixed feelings about how nurses communicate and their educational qualifications. Marital status (p = 0.045) and having a family member in nursing (p = 0.049) were significantly associated with perception scores.
Conclusion
Although the overall mean NIS score indicated generally positive perceptions of nursing, the domain-level patterns suggest the presence of some uncertainty regarding aspects of the profession.
Introduction
Nursing is a vital component of healthcare systems worldwide, playing a central role in delivering safe, effective, and patient-centered care. But stereotypes, gender roles, and misunderstandings about the profession’s scope and independence have often shaped the public and professional image of nursing (López-Verdugo et al., 2021; Poorchangizi et al., 2019). Although the professional image of nursing has improved over time, challenges related to professional recognition and societal perception persist (Moghbeli et al., 2025).
The way nursing is perceived influences public attitudes and affects how students form their professional identity during education and training. Initial perceptions developed in nursing education can shape students’ career commitment and motivation to remain in the field (Prosen, 2022; Wu et al., 2020). For example, during recruitment at University, many prospective students described nursing in terms of basic tasks, indicating ongoing misconceptions that may undermine the profession’s perceived value.
In resource-constrained and fragile healthcare settings, factors such as societal narratives, educational experiences, and clinical exposure may uniquely shape students’ understanding of nursing. In Palestine, nurses are essential to the healthcare system, yet their professional image may be influenced by economic instability, workforce pressures, and limited visibility of advanced nursing roles (Abuejheisheh et al., 2025; Farajalla, 2026; Sbaih et al., 2025; Farajalla, 2025). Despite the critical role of nurses, little is known about how Palestinian nursing students perceive the profession within this unique context. Addressing this gap is important for informing educational strategies and strengthening professional identity in the local workforce.
Literature Review
An increasing amount of international research underscores the intricacy and development of nursing students’ perceptions. Studies from Europe and Asia report that while students may enter nursing with idealized views, these perceptions often become more nuanced as they gain practical experience (Dost & Bahcecik, 2022; Prosen, 2022; Wu et al., 2020).
Diverse factors shape perceptions of nursing across different regions. For instance, in Uganda, most nursing students expressed positive attitudes toward the profession, yet concerns regarding status, remuneration, and social recognition persisted (Neumbe et al., 2023). Sociocultural expectations and gender roles significantly influence the professional image of nursing in Saudi Arabia (Godsey et al., 2020). Jordanian research found that a substantial proportion of students entered the profession due to academic grade limitations rather than personal interest, complicating the formation of a strong professional identity (Salim, 2020).
Broader influences such as gender norms, organizational structures, and societal expectations continue to shape the image of nursing in many contexts (López-Verdugo et al., 2021; Poorchangizi et al., 2019). Even though the profession’s status has gotten better, there are still stereotypes and misunderstandings that affect motivation and identity development. This is especially true for students who may feel like they have to enter the field even though they don’t really want to.
Theoretical frameworks offer explanations for these dynamics. Social Representation Theory emphasizes the role of shared societal beliefs and cultural narratives in shaping the collective understanding of professions (Moscovici, 1984). Professional Socialization Theory addresses how students internalize professional values and identity through interactions with educators, peers, and clinical environments (Prosen, 2022; Wu et al., 2020). Both perspectives highlight the interplay between individual experiences and broader social forces in the formation of professional identity.
Despite extensive research in various international contexts, empirical studies exploring nursing students’ perceptions in conflict-affected, resource-constrained environments remain scarce. In Palestine, persistent sociopolitical instability, economic difficulties, and a disjointed healthcare system foster a distinctive environment that may influence students’ professional perceptions in unique manners (Abuejheisheh et al., 2026; Farajalla et al., 2026a, 2026b, 2026c; Sbaih et al., 2025). There is limited evidence on how these contextual factors influence the development of professional identity among nursing students throughout their academic training. Addressing this gap is essential for guiding educational initiatives and supporting a resilient nursing workforce in Palestine. This study aimed to assess perceptions of the nursing profession among undergraduate nursing students across academic years in Palestine to inform educational strategies and professional socialization efforts that strengthen nursing identity and workforce capacity. Specifically, the study focused on: 1. Assessing students’ overall perceptions of the nursing profession using the Nursing Image Scale. 2. Examining whether these perceptions vary across academic years from first to fourth year. 3. Identifying demographic and experiential factors associated with variations in nursing image perceptions.
Methods
Design and Setting
A cross-sectional design was used. The design was selected for its suitability in achieving the research objectives, as it enables the assessment of multiple variables and their associations at a single point (Wang & Cheng, 2020). The study was conducted in the southern West Bank of Palestine, specifically in four universities offering undergraduate nursing programs, including two universities located in Hebron and two in Bethlehem.
Population and Sampling
The specific population of undergraduate nursing students was considered the most suitable target population in relation to the subject matter of the research, owing to their direct involvement in the process of professional socialization. According to the records of the registrars from the participating universities, the estimated population of the target audience was approximately 1,700 students in four universities.
To determine the sample, the Raosoft Sample Size Calculator was used, considering the confidence level (95%), margin of error (5%), and response distribution (50%). The minimum sample was determined to be 314. A convenience sampling method was used for participant recruitment.
Inclusion and Exclusion Criteria
Participants were required to be aged 18 years or older and currently enrolled in a BSc nursing program at a university in the Southern West Bank. Bridging students and nursing students with prior professional nursing experience were excluded to prevent bias, as their previous exposure to nursing practice could influence their perspectives compared to those of other students. Additionally, the exclusion criteria had to include incomplete data to ensure the quality, consistency, and reliability of the data collected, since the data might otherwise become inaccurate or false. These criteria ensured that the data collected was representative of the perspectives of the students in the population in question.
Instrumentation
Pattern Matrix of Exploratory Factor Analysis for the Modified 26-Item NIS
Extraction Method: Principal Axis Factoring. Rotation Method: Oblimin with Kaiser Normalization. Only loadings ≥ .30 shown. h2 = communality after extraction.
The second section included the Nursing Image Scale (NIS) developed by Özsoy (2000) after necessary approval. The selection of the NIS was guided by social representation theory and professional socialization theory, as the scale reflects both societal and professional dimensions of the nursing image. NIS assesses individuals’ perceptions of the nursing profession. The original scale contained 28 items divided into three subscales: General Appearance (Items 1–7), Communication (Items 8–13), and Occupational and Educational Characteristics (Items 14–28).
In the present investigation, two items of the General Appearance subscale were deleted: “Nurses are usually attractive women” and “In the media, the facts are consistent with the projected nurses.” Guiding the removal process included cultural and contextual factors. The first question was identified as gender-bias related and misaligned in terms of sociocultural norms in the country, as well as the emerging trend of male nursing in Palestine. The second question was identified as culturally ambiguous in the Palestinian context, given the limited exposure in the country’s media concerning nursing staff, which may lead to misunderstandings about the role and perception of nurses in society. As such, the final version had 26 questions (see Supplemental File 1).
The scale of response to the questions was based on a 5-point Likert scale ranging from Strongly Disagree to Strongly Agree. The mean scores of the NIS (Nursing Impact Scale) were calculated, ranging from 1 to 5. The questionnaire was administered in English because English is the official language of instruction in Palestinian nursing programs. All students receive their education and assessments in English. To ensure linguistic and cultural appropriateness, the instrument was reviewed by nursing educators and pilot-tested, with no major comprehension issues reported.
Validity and Reliability
Psychometric properties of the NIS were previously reported by Çınar and Demir (2009), with a Cronbach’s alpha of 0.81. In this study, the questionnaire’s validity was evaluated through the content validity assessment. Three experienced research professors and educators reviewed the instrument to assess the relevance, clarity, and cultural appropriateness of the items. According to their feedback, some questions about the instrument were revised to improve clarity and relevance based on the reviewers' suggestions, specifically addressing issues such as ambiguous wording and ensuring that the questions were culturally sensitive to the target population. The revised version was reassessed and found to be valid for application in the study context. A pilot study was then carried out among 25 nursing students who were excluded from the final sample. The pilot was designed to test the instrument for simplicity, understanding, and feasibility.
In the present study, internal consistency of the modified 26-item Nursing Image Scale was acceptable. The Cronbach’s alpha coefficient for the total scale was 0.78. Subscale reliability coefficients were acceptable, with Cronbach’s alpha of 0.71 for the General Appearance domain, 0.72 for the Communication domain, and 0.82 for the Occupational and Educational Characteristics domain.
To assess the factorial validity of the modified 26-item NIS, we performed an exploratory factor analysis (EFA) using principal axis factoring with oblimin rotation. Sampling adequacy was confirmed (KMO = .793), and Bartlett’s Test of Sphericity was significant (χ2 = 2284.35, df = 325, p < .001). The number of factors was fixed at three, in line with the original scale structure. Items with factor loadings ≥ .40 were considered significant.
EFA identified a three-factor solution consistent with the hypothesized subscales. The three factors explained 30.7% of the variance (Factor 1: 16.9%; Factor 2: 9.3%; Factor 3: 4.4%). Most items loaded strongly (> .40) on a single factor (Table 1). Modest factor correlations (r = .19) supported the use of oblique rotation. Some items, mainly from the Communication domain, showed lower communalities and weaker loadings, indicating that these items may not be as strongly related to the underlying factors as others in the analysis.
Data Collection Process
Data collection commenced after gaining ethical approval. Data collection was conducted during the month of July 2025. Meetings with participants were arranged in conjunction with faculty schedules and student lecture hours to minimize disruption. Participation was entirely voluntary, and students were fully informed about the study’s aim, procedures, confidentiality, and their right to withdraw at any time without penalty. The questionnaire was administered in person, allowing participants to complete it at a convenient time and place. Clear instructions, both written and verbal, were provided to maintain precision and consistency in responses. The English version of the questionnaire was used, and every form was coded for tracking. To prevent loss or misplacement, members of the research team remained present while participants completed the questionnaires and collected them at the end of each day.
Data Analysis
Data were analyzed using SPSS version 29.0. Descriptive statistics were used to describe the sociodemographic and academic characteristics of the participants. Initially, independent t-tests and one-way ANOVA were conducted to assess unadjusted associations between participants’ characteristics and NIS mean scores. To avoid confounding and multiple comparisons, multivariable regression analysis was performed. Tests of assumptions, including linearity, independence, homoscedasticity, absence of multicollinearity, and normal distribution, were satisfactory. The mean NIS score was entered as the dependent variable, while age, gender, marital status, residence, high school stream, cumulative GPA, year of study, clinical training, family income, prior hospital exposure, and having a family member in nursing were entered simultaneously as independent variables. Statistical significance was set at p < 0.05.
Ethical Consideration
Ethical approval for the conduct of the study was obtained from the Ethical Committee of the College of Nursing, Palestine Polytechnic University (Approval No. EA/2025/53). Written informed consent was obtained from all participants prior to their enrollment in the research. Rapport was built with the participants, and they were informed that their participation was voluntary. Confidentiality during data collection was ensured. Additionally, participants were assured that all personal information would be protected, secured, and kept confidential. The research adhered to the ethical standards outlined in the Declaration of Helsinki regarding the rights, protection, and well-being of research participants.
Results
Distribution of Socio-Demographic Characteristics of Participated Nurses (N= 323)
*N= number, %= percentage.
The Overall Mean of NIS Domains Across Academic Years
M: Mean; SD: Standard deviation.
Comparison of Perception Mean by Selected Socio-Demographic Variables
N= Number; M= Mean; SD= Standard Deviation; t= t- test; F= F test (ANOVA).
To examine independent predictors of nursing image perception while controlling for potential confounders, a multivariable linear regression analysis was conducted. The overall model was not statistically significant (F = 1.69, p = 0.075) and explained a small proportion of the variance in NIS mean scores (adjusted R2 = 0.023).
Multivariable Linear Regression Analysis Predicting Mean NIS Score (N = 323)
B = unstandardized coefficient; SE = standard error; β = standardized coefficient; CI = confidence interval.
Discussion
The present study included 323 nursing students, mostly female; the majority were single and from a scientific stream. Students from all study years were represented. Sixty-two percent had received clinical training, and most had previously been in a hospital or had a family member who worked in nursing. Students chose nursing for a variety of reasons, including personal interest and a desire to help others and make their communities better.
The overall mean NIS score indicates that nursing students generally hold favorable perceptions of the nursing profession. The domain-level findings indicate that students assess various dimensions of nursing in nuanced ways, rather than exhibiting a uniform perception across all aspects of the profession, reflecting their diverse experiences and expectations within the field. Although the overall NIS score did not significantly differ across academic years, descriptive domain-level patterns suggested minor variations in communication and occupational/educational domains. Fourth-year students reported slightly lower communication scores but higher occupational and educational characteristic scores compared with earlier academic years. One possible explanation is that senior students are more frequently exposed to demanding clinical environments in which workload pressures and task completion are prioritized, potentially limiting opportunities to practice patient-centered communication. Prior studies indicate that during advanced clinical placements, nursing students frequently redirect their attention toward technical proficiency and procedural duties in preparation for professional practice (Prosen, 2022; Wu et al., 2020). Additionally, hierarchical structures within clinical settings may reduce students’ confidence in initiating communication with senior staff or patients, particularly in contexts where decision-making authority is strongly physician-centered (López-Verdugo et al., 2021). These contextual factors may gradually redirect students’ attention toward operational tasks rather than interpersonal aspects of care. Future studies could examine whether clinical workload, mentorship quality, and structured communication training during clinical placements influence these perceptions (Ghrayeb et al., 2025).
Importantly, the observed variation in NIS mean scores across domains should not be interpreted as indicating apathy, lack of interest, or low professional commitment. Conversely, these may suggest a situation of professional uncertainty, which is inherent in the socialization process (Prosen, 2022). This pattern aligns with international findings; for example, a 2025 cross-sectional study of Ethiopian undergraduate nursing students reported similarly favorable overall perceptions driven by altruistic values, yet noted growing concerns about underappreciation and professional demands as students advanced through training (Hailu et al., 2025). The professional socialization theory suggests that students may begin their professional education with an idealized image of the profession, which is gradually influenced by the reality of practice, the constraints of the practice environment, and the hierarchical nature of practice settings (López-Verdugo et al., 2021; Wu et al., 2020). This phase may result in a situation of ambivalence, professional uncertainty, and the lack of professional identity. This stage has been conceptualized in the literature to suggest a situation of cognitive and professional dissonance, whereby the student holds in tension the positive image of the nurse’s role in the healing process yet questions the autonomy, power, or social status of the nurse’s role (Wu et al., 2020). Different educational settings, particularly those where the practice environment’s constraints limit professional visibility, have observed this pattern, indicating that students may struggle to reconcile their training with the realities of the nursing profession in those contexts.
When placed in the Palestinian context, such findings must be interpreted carefully. Students with previous hospital exposure and those with family members in nursing reported greater perception scores, as exposure to actual nursing practice offers a counterweight to societal misunderstandings, which can lead to a more informed and positive view of the nursing profession. These results are consistent with research indicating that hospital exposure is crucial for favorable perceptions (MacLean et al., 2019; Salim, 2020). Demographic variables, however, had mixed impacts. Marital status was significant (p = 0.045), indicating that single students had higher scores, while gender and academic background did not show significant effects. Importantly, although marital status showed an association with nursing image perception in the multivariable regression analysis, the overall regression model was not statistically significant. Consequently, this finding must be interpreted with caution and regarded as an exploratory association rather than a validated independent predictor. The association between having a family member in nursing and perception, which was significant in bivariate analysis, did not persist after adjustment. This suggests that family exposure may act through overlapping social or experiential factors rather than exerting an independent effect (Salim, 2020). These results underscore the necessity for prudent interpretation of unadjusted associations and advocate for the implementation of multivariable methodologies in perception research. These domain-specific patterns and the absence of overall differences across academic years resonate with cross-cultural evidence. A recent cross-cultural study comparing public (including student) perceptions in China and the United States found that while overall nursing brand image remains positive, advanced students and those with clinical exposure increasingly prioritize leadership and scientific dimensions over traditional caregiver stereotypes (Zhou et al., 2024). Similarly, an integrative review of global public image studies concluded that such nuanced shifts reflect evolving professional socialization rather than declining commitment, emphasizing the need for targeted educational interventions to address persistent stereotypes (Moghbeli et al., 2025).
Although no statistically significant differences were noted in terms of gender variables, the existing literature suggests that male and female nursing students may perceive and cope differently in terms of nursing as a profession, influenced by societal gender roles, expectations, and socialization processes. Male nursing students may be influenced by challenges related to nursing being a female-dominant field, whereas female nursing students may be influenced by challenges related to nursing professional status and workload (Ahmadi et al., 2023), which can affect their career choices and professional development in a context where gender roles are strongly defined. Quantitative differences in gender variables may not fully explain the current context in Palestine. The lack of differences in Palestine may be attributed to economic factors (Alqaissi et al., 2025a, 2025b; Farajallah et al., 2026a), given that unemployment rates exceed 25% in Palestine (PCBS, 2023). This finding contrasts with studies in other Middle Eastern and African contexts where gender stereotypes more strongly influenced perceptions (Aboelola, 2026; Hailu et al., 2025), highlighting how local economic security can mitigate traditional biases. Within the current context in Palestine, nursing is considered a secure field of employment for both males and females. This minimizes stereotypes and maximizes nursing’s reputation in terms of providing employment opportunities (Elibol & Seren, 2017).
Comparisons with local and international studies reveal both similarities and differences. For example, a cross-sectional Iranian study stated that women showed greater perceptions of nursing role functions (Ahmadi et al., 2023). In Taiwan, a qualitative investigation among senior students emphasized changing perceptions based on clinical exposure (Tseng et al., 2013), resonating with the present finding that views varied across academic years. In contrast, the Ugandan study (Neumbe et al., 2023) revealed urban predominance (57.6%), compared to the rural majority in Palestine, suggesting access to healthcare and professional visibility could influence perceptions in the Palestinian situation.
Cultural differences also show up in the reasons people choose nursing. In the current study, personal interest and altruism prevailed, in line with Rodríguez-Pérez et al. (2022), who stressed vocational inclinations and humane values as being at the heart of nursing’s attractiveness. However, Neumbe et al. (2023) observed that in Uganda, just 18.75% selected nursing out of interest, with many considering it a second choice after medicine. This highlights how, in Palestine, altruistic and personal motivations can combine with structural ones like job security to produce positive attitudes toward the profession (Mesk et al., 2025). The Palestinian findings revealed statistically significant yet comparatively modest correlations, whereas Ahmadi et al. (2023) emphasized the relationship between motivation and academic performance, and Salim (2020) indicated that nurse relatives significantly impacted the career choices of Jordanian students. The existing literature does not clearly indicate whether family members had a positive or negative influence on perceptions of nursing as a field of employment.
Comparison of the NIS domains also indicates changing attitudes. General appearance scores were stable over years, but fourth-year students had higher occupational/educational scores and lower communication scores. This study indicates that more advanced students, tempered by clinical experience, refine their perceptions to prioritize professional capability over symbolic elements. This trajectory echoes results in Taiwan (Tseng et al., 2013) and Uganda (Neumbe et al., 2023), where more advanced students developed professional identity nuance through practicum and exposure. The focus on “general appearance” indicates that visible and superficial elements of nursing, like uniforms, continue to influence perceptions, echoing persistent societal stereotypes (López-Verdugo et al., 2021).
According to López-Verdugo et al. (2021), social perceptions worldwide still view nursing as secondary to medicine. In Palestine, where the general public is not highly aware of nurses’ independence and such roles are often perpetuated by media representation, neutrality can indicate uncertainty as much as negativity. The results indicate specific areas for curriculum improvement, particularly in communication and holistic care, to address the gaps that contribute to the undervaluation of nursing. These results carry important implications for nursing education and policy beyond the Palestinian context. International literature consistently recommends early integration of simulation-based training, structured mentorship, and media literacy modules to counteract stereotypes and strengthen professional identity (Duan et al., 2024; Moghbeli et al., 2025). Nursing schools should prioritize curriculum enhancements that emphasize autonomy, leadership, and communication skills from the first year, while policymakers can support public awareness campaigns featuring nurses in advanced roles. Such evidence-based strategies, grounded in global studies, are essential to sustain positive perceptions, improve recruitment and retention, and elevate the profession’s visibility in resource-constrained and conflict-affected settings worldwide.
Limitations
The cross-sectional nature of this study means the findings represent only a single time point in students’ perceptions of nursing images, and it is not possible to draw any conclusions about perceptions changing over time. The reliance on self-reported data may introduce social desirability bias. The study area in the Southern West Bank and the modifications to the NIS may limit comparability to other contexts, particularly in terms of cultural perceptions of nursing and the educational frameworks in place in different regions. Finally, the omission of bridging students and students with prior professional experience excluded potentially valuable insights from individuals with deeper clinical exposure, which could have provided a more comprehensive understanding of the nursing education landscape and its impact on practice. The modification of the NIS to a 5-point Likert scale and the removal of two items may restrict direct comparability with studies utilizing the original 3-point, 28-item version. Although internal consistency was demonstrated for all subscales and a three-factor structure was supported by exploratory factor analysis, some items displayed low communalities and weaker factor loadings, which may limit construct validity for those specific items. Further research is recommended to refine or revalidate these items.
Implications and Recommendations
The overall mean NIS scores, together with domain-specific patterns, suggest that some degree of ambivalence toward certain aspects of the nursing profession may still exist among Palestinian nursing students. In a context where healthcare resources are stretched, the reputation of nursing as a secure and nurturing profession is known, but its status as a science-based, independent profession is less visible. Palestine must address this ambiguity to cultivate a powerful and motivated nursing workforce.
Nursing schools need to prioritize efforts that expose students to the full scope of nursing activities early on in their training. Simulation technology and structured hospital rotations can demystify the profession, reaffirming both its intellectual and leadership dimensions.
At the societal level, there need to be media campaigns and community outreach to fight stereotypes and show that nursing is a respected, independent profession. Employing nurses themselves as role models and spokespersons can be a powerful influence.
At a policy level, decision-makers need to understand that improving the image of nursing is not merely symbolic; it has immediate consequences for recruitment, retention, and the quality of healthcare delivery. Improving professional status, leadership roles, and positive working conditions are critical steps toward retaining a committed workforce in a fragile healthcare system.
Lastly, future studies should be expanded to Gaza and other areas, where political and social conditions vary, and utilize longitudinal designs to follow perceptional changes over academic years. Qualitative studies are also necessary to better understand the factors shaping variations in students’ perceptions of the nursing profession.
Conclusion
The Palestinian nursing student tends to hold the nursing profession in a positive way; nevertheless, the domain-level patterns from one academic year to another may suggest the existence of certain ambiguity surrounding the professional identity construction process. Variations across the domains and the stages of study may imply the important role of education and practice in the formation of the nursing student’s perspective on the nursing profession.
Such results highlight the importance of nursing education programs that place emphasis on professional identity, communication, and leadership skills, particularly during the early stages of nursing. With respect to nursing practice, enhancing the visibility, autonomy, and professional standing of nurses remains crucial in terms of student motivation, as well as sustainability. Future research should focus on incorporating different research methods, particularly those involving longitudinal research, to examine perception change in nursing education and practice over time, as these findings could provide valuable insights into how professional identity and skills develop among nursing students.
Supplemental Material
Supplemental Material - Perceptions of the Nursing Profession Among Palestinian Nursing Students Across Academic Years: A Cross-Sectional Study
Supplemental Material for Perceptions of the Nursing Profession Among Palestinian Nursing Students Across Academic Years: A Cross-Sectional Study by Fuad Farajalla, Nesreen Alqaissi, Mohammad Qtait, Mousa Farajallah, Ishaq Alskafi in Sage Open Nursing.
Footnotes
Acknowledgments
The author thanks the Students nurses who participated in this study.
Ethical Considerations
This study was approved by the Ethical Committee of the College of Nursing, Palestine Polytechnic University (Approval No. EA/2025/53). Written Informed consent was obtained from all participants.
Consent to Participate
Written informed consent was secured from all study participants.
Consent for Publication
This manuscript does not contain any individual person’s data in any form (including individual details as name, images, or videos).
Author Contributions
All authors have read and approved the final version of the manuscript and agree to be accountable for all aspects of the work.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Declaration of Conflicting Interests
The authors declares no potential conflicts of interest with respect to the research, authorship, or publication of this article.
Data Availability Statement
Data are available from the corresponding author upon reasonable request.
Supplemental Material
Supplemental material for this article is available online.
References
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