Predictors of academic referrals among nursing and midwifery students: quantitative insights from Ghana

Academic referrals represent a significant challenge in nursing and midwifery education as they indicate student performance and retention weaknesses. However, the factors contributing to academic referrals have been underexplored, hampering efforts to develop effective interventions to support at-risk students. The study examined the demographic, academic, and institutional factors associated with academic referrals among nursing and midwifery students. A cross-sectional survey was conducted with 402 nursing and midwifery students. The data were collected for demographic characteristics, academic level, marital status, age, institutional support, language barrier and assessment difficulties. Chi-square tests, t-tests, and logistic regression analyses were utilised to identify predictors of academic referrals. Academic level and age were the significant predictors of referrals, with third-year students being 3.38 times more likely to be referred than second-year students (OR = 3.377, p < .001) and referred students were 0.6 years older than non-referred students (t = -2.157, p = .032). Females (60.6%) and married students (87.5%) recorded higher referral rates descriptively, though insignificant. Referred students reported greater language barriers (mean = 3.00 vs. mean = 2.69, p = .002), perceived the language used in exams as less clear (mean = 3.54 vs. mean = 3.79, p = .003), and reported lower institutional support (p = .040 and less helpful feedback (χ² = 11.097, p = .025). Referred students perceived written theory exams (30.6% vs. 18.7%) and multiple-choice assessments (6.8% vs. 6.0%) as more challenging than non-referred students (χ² = 15.130, p = .010). The findings emphasise the need for targeted interventions to support at-risk students, particularly those in advanced academic levels and older age groups. Strengthening institutional support, addressing language barriers, and improving assessment practices are important to reducing referrals and enhancing student success.