# The Influence Mechanism of Extracurricular Activity Participation on the Perceived Improvement of Comprehensive Literacy Among Medical Students: The Mediating Role of Self-Efficacy

## TL;DR

This study shows that participating in extracurricular activities helps medical students improve their literacy skills, partly by boosting their self-efficacy.

## Contribution

The study identifies self-efficacy as a mediator linking extracurricular participation to perceived literacy improvement in medical students.

## Key findings

- Higher extracurricular participation frequency correlates with greater perceived improvement in comprehensive literacy.
- Self-efficacy partially mediates the relationship between extracurricular participation and literacy improvement.
- Structural equation modeling confirms a significant indirect effect through self-efficacy.

## Abstract

Objectives: The present study aims to examine how participation in extracurricular activities influences medical students’ perceived improvement in comprehensive literacy. Specifically, it seeks to analyze the direct effect of extracurricular activity participation on perceived improvement in comprehensive literacy, investigate the mediating role of self-efficacy in this relationship, and validate a structural equation model illustrating the interrelationships among these variables. In this study, comprehensive literacy was operationalized as students' self-perceived improvement in critical thinking, innovation, collaboration, responsibility, and social concern.

Methods: A questionnaire survey was conducted in July 2025 with 264 valid participants (sophomore to fifth-year students) from Qilu Medical University. The perceived improvement of comprehensive literacy was measured using an adapted scale based on the "4Cs" framework, comprising six items that assessed dimensions such as multi-perspective reflection, creative application, collaboration, taking initiative, and social concern. Measures also included the General Self-Efficacy Scale and self-reported participation frequency. Data were analyzed using IBM Corp. Released 2018. IBM SPSS Statistics for Windows, Version 27.0. Armonk, NY: IBM Corp. for one-way ANOVA and correlation analysis, and AMOS 29.0 for structural equation modeling with a bootstrap procedure (5000 samples) to test the mediating effect.

Results: One-way ANOVA revealed significant differences in comprehensive literacy perceived improvement scores across different participation frequency groups (F=5.436, p<0.001), with a trend of higher scores associated with more frequent participation. Confirmatory factor analysis indicated a good measurement model fit (χ²/df=2.386, CFI=0.994, RMSEA=0.073). Path analysis confirmed that participation frequency not only directly and positively predicted comprehensive literacy perceived improvement (β=0.197, p<0.001) but also had an indirect effect through enhancing general self-efficacy. The mediating effect of self-efficacy was significant (effect=0.073, 95% CI [0.004, 0.106]), accounting for 27.04% of the total effect.

Conclusion: Extracurricular activity participation is a significant pathway for promoting comprehensive literacy development among medical students, with higher participation frequency leading to more pronounced effects. General self-efficacy plays a partial mediating role in this relationship. Universities should encourage students to actively participate in extracurricular activities and intentionally foster their self-efficacy within these activities to more effectively enhance their comprehensive literacy.