Fear of positive evaluation mediates the relationship between self-efficacy and fear of negative evaluation in nursing students: A cross-sectional study

Fear of negative evaluation (FNE) is a psychological construct reflecting people's apprehension or distress when they think others might evaluate them negatively (Weeks et al., 2005). FNE is a critical factor in social anxiety disorders and can bias how people learn about social evaluation, especially about themselves (Gilbert, 2001). According to previous studies(Ma & Qiu, 2004; Ye & Liu, 2014; Yue et al., 2022; Yue & Jia, 2023), FNE can affect students' academic performance, motivation, self-esteem, and social interactions. Students with a high level of FNE may avoid participating in class discussions, seeking feedback, or taking risks for fear of being judged negatively by their peers or teachers (Yue & Jia, 2023). On the other hand, students with high FNE may also experience more stress and anxiety when facing exams, presentations, or group projects (Zhu et al., 2019). Individuals who fear negative evaluation are more likely to develop adjustment problems such as alcohol use and eating disorders (Chang et al., 2014; Villarosa-Hurlocker et al., 2018).

Several existing studies suggest that fear of evaluation is the most critical factor in students' social anxiety (Gang et al., 2015; Weeks et al., 2008b; Whiting et al., 2014; Zhong et al., 2021). As one of the most common mental health disorders, social anxiety strongly correlates with other psychological disorders such as depression, generalized anxiety disorder, and substance abuse (Spence & Rapee, 2016).

According to Ding et al. (2008), >60 % of Chinese nursing students scored higher on social anxiety than those with other majors. Our previous studies found that undergraduate nursing students had a moderate fear of negative evaluation. The main influencing factors of fear of negative evaluation in that study were gender, stay-at-home experience, being in a romantic relationship or not, personality, and fear of positive evaluation (Yue et al., 2022; Yue & Jia, 2023). As the mainstay and successor of the nursing profession in the new era, nursing students need to gain better interpersonal communication skills and maintain a more positive emotion to undertake the career mission. As fear of negative evaluation is a critical part of social anxiety, thus it might be helpful and necessary for nurse educators to cope with students' social anxiety by exploring the underlying mechanisms of fear of negative evaluation.

Several previous studies have declared that socially anxious individuals are afraid of negative evaluations from others but also afraid of positive evaluations. Fear of positive evaluation (FPE) refers to the worry and discomfort individuals experience when they receive positive evaluations from others (Weeks et al., 2008b; Weeks & Howell, 2012).

Social anxiety disorder (SAD) is a prevalent mental disorder that affects about 7 % of the population(Leichsenring & Leweke, 2017). One of its features is fear of positive evaluation (FPE), which entails several adverse consequences, such as submissive behaviors, negative and reduced positive emotions in social interactions, and discomfort when receiving positive feedback (Preston et al., 2023; Weinbrecht et al., 2020).

Some risk factors for developing FPE are low self-esteem, negative self-image, perfectionism, and fear of failure4. FPE may also vary depending on cultural factors, such as collectivism and modesty norms (Fredrick & Luebbe, 2020).

FPE is especially prevalent among students, who often face high academic expectations and social pressures. FPE may impair their academic performance, social relationships, and mental health. FPE may also increase their suicidal ideation1, especially when they receive positive feedback that contradicts their negative self-view(Weinbrecht et al., 2020).

According to the cognitive-behavioral model of social anxiety, both are core features of social anxiety. Research has shown that socially anxious individuals worry that initial positive evaluations will lead to subsequent negative evaluations. When socially anxious individuals are given positive feedback for good performance, they expect to experience more significant anxiety in the next version. In addition, a longitudinal study showed a moderate correlation between the fear of positive and negative evaluation (Rodebaugh et al., 2012).

Self-efficacy refers to an individual's subjective judgment of the extent to which they can perform a particular behavior. Since its inception, it has been inextricably linked to negative emotions such as anxiety and fear (Bandura & Lin, 2001). Previous research has suggested that self-efficacy can negatively predict fear of negative evaluation (Cao et al., 2021).

Though the existing studies explore the relationship between any of the above two variables, research on the mechanisms between the three variables is still being determined. Besides, most have focused on participants with some social difficulties, such as students with social anxiety or patients with epileptic/obesity (Ray et al., 2021; Salazar-Ayala et al., 2021; Willemse et al., 2021). There is a lack of relevant research focusing on undergraduate nursing students, which may share some standard but unique characteristic.

Therefore, this study aimed to explore the possible mediating role of fear of positive evaluation in the relationship between self-efficacy and fear of negative evaluation. The hypotheses of this study are as follows: (1) Self-efficacy is a significant direct negative predictor of fear of negative evaluation. (2) Self-efficacy is negatively associated with fear of positive evaluation. (3) Fear of positive evaluation mediates the relationship between self-efficacy and fear of negative evaluation.

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