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Effect of creativity training on teaching for creativity for nursing

faculty in Taiwan: A quasi-experimental study

Hsing-Yuan Liu, I-Teng Wang, Nai-Hung Chen, Chun-Yen Chao

PII: S0260-6917(19)30268-0
DOI: https://doi.org/10.1016/j.nedt.2019.104231
Reference: YNEDT 104231

To appear in: Nurse Education Today

Received date: 15 February 2019

Revised date: 18 August 2019
Accepted date: 22 September 2019

Please cite this article as: H.-Y. Liu, I.-T. Wang, N.-H. Chen, et al., Effect of creativity
training on teaching for creativity for nursing faculty in Taiwan: A quasi-experimental
study, Nurse Education Today(2019), https://doi.org/10.1016/j.nedt.2019.104231

This is a PDF file of an article that has undergone enhancements after acceptance, such
as the addition of a cover page and metadata, and formatting for readability, but it is
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© 2019 Published by Elsevier.

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Effect of creativity training on teaching for creativity for nursing faculty in Taiwan:

A quasi-experimental study

Hsing-Yuan Liu1, *, I-Teng Wang2, Nai- Hung Chen3, Chun-Yen Chao4

1
Hsing-Yuan Liu, R.N., PhD, Associate Professor; Department of Nursing, Chang Gung

University of Science and Technology, & Associate Research Fellow, Chang Gung

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Memorial Hospital, Taiwan; No. 261, Wunhua 1st Rd., Gueishan Township, Taoyuan,

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Taiwan (R.O.C.) 33303; Tel: 886-3-2118999 ext. 5540; Fax: 886-3- 2118866; E-mail:

[email protected]
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2
I-Teng Wang, Postdoctoral Researcher, Department of Nursing, Chang Gung University

of Science and Technology; No. 261, Wunhua 1st Rd., Gueishan Township, Taoyuan,
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Taiwan (R.O.C.) 33303; Tel: 886-3-2118999 ext.3312; Fax: 886-3- 2118866; E- mail:
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[email protected]
3
Nai- Hung Chen , RN, Lecture ; Department of Nursing, Chang Gung University of Science
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and Technology ; No. 261, Wunhua 1st Rd., Gueishan Township, Taoyuan,Taiwan (R.O.C.)
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33303; Tel: 886-3-2118999 ext. 5540; Fax: 886-3- 2118866; E-mail: [email protected]
4
Chun-Yen Chao, Aassistant Professor ; Department of Cosmetic Science, Chang Gung

University of Science and Technology ; No. 261, Wunhua 1st Rd., Gueishan Township,

Taoyuan,Taiwan (R.O.C.) 33303; Tel: 886-3-2118999 ext. 5540; Fax: 886-3- 2118866; E-mail:

[email protected]

*Corresponding Author: Hsing-Yuan Liu, Email: [email protected]

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Declarations

Competing interests

No competing interests are declared by the authors.

Funding

This study was supported by both research grant from the Ministry of Science and Technology

Taiwan R.O.C. (NMRPF3F0151 andNMRPF3G0161).

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Ethics approval and consent to participate

This study has approved the hospital ethics committees (No.1037492B, 104A010B, research

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ethics committee, Chang Gung Medical Foundation Institutional Review Board). Study

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participants completed an informed consent before beginning the survey. Confidentiality was
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assured in the consent forms and the participants remained the right to withdraw their
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participations at any phase of the research process.

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Acknowledgements

The authors wish to thank all nursing faculty who participated in this study. We are grateful to
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the Ministry of Science and Technology, Taiwan, R.O.C., for their funding support.
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Author Contributions

HIS; Conceptualization, project administration, data analysis and writing.ITW; data analysis and

writing.NHC and CYH: project administration

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ABSTRACT

Background: Creativity and innovation are considered important core competencies in Taiwan

for nursing students. The role teacher’s play is critical to the development of student creativity.

Although studies have investigated creativity training, there is no consensus on how best to

evaluate the effectiveness of the training.

Objective: To evaluate whether a teaching for creativity module (TCM) can enhance teaching

behaviors and self-efficacy of teaching creativity for capstone course nursing faculty. The TCM

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intervention was taught in two stages by experts in diverse areas of industrial design. A 2-day

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teaching creativity workshop was followed by reinforcement of creativity skills in the classroom

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with nursing and design faculties teaching side-by-side for 6 hours of the 18-week capstone
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course.
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Design: This quasi-experimental study employed a pretest-posttest design to compare an

intervention and control group.

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Participants and setting: Capstone course nursing faculties were recruited from five science and

technology universities in Taiwan.

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Results: Forty-two capstone faculty members participated; 21 completed the TCM intervention
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and 21 were in the control group. Analysis of covariance (ANCOVA) demonstrated the TCM

intervention group had significantly better post-test mean scores for creative teaching behaviors

and self-efficacy of teaching creativity than the control group. Our findings suggest participation

in a creativity workshop and reinforcement of teaching skills with classroom interdisciplinary

teacher training can augment teaching for creativity of nursing faculty.

Conclusion: The findings of this study indicate that an intervention program in creativity can

increase teaching behaviors as well as perceptions of self-efficacy regarding teaching for

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creativity, which could foster student creativity. These findings have important implications for

educational settings, as they suggest that the workshop and reinforcement of learning with hands-

on guidance in creativity with interdisciplinary teaching should be integrated into the curriculum,

which could facilitate student creativity by increasing teaching behaviors and improving self-

confidence regarding teaching creativity.

Keywords: creativity training, teaching for creativity, nursing faculty

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1. Introduction

Creativity plays a crucial role in education, including the arts and sciences (Liu and Chang,

2017). The Creative Education White Paper (Advisory Office, Taiwan Ministry of Education,

2003) mandated the Taiwanese government must foster student creativity at all educational

levels, which includes nursing (Liu, et al., in press). As a result, capstone courses, designed to

help stimulate students’ creativity, innovation, and entrepreneurship have been integrated into

nursing curricula in order to help students generate innovative healthcare products to solve real-

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world healthcare problems (Ku et al., 2014). This form of ‘design thinking’ for the development

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of healthcare products is also encouraged by the American Association of Colleges of Nurses

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(American Association of Colleges of Nursing, 2008; Beaird et al., 2018). However, teaching
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that fosters student creativity has not been emphasized in Taiwan, where the focus has primarily

been on memorization and passing exams (Tsai et al., 2015). The emphasis on creativity in
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Taiwan, as well as other Asian cultures, has only recently become an important component of
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education (Wu and Albanese, 2013).

Improving creativity for nursing students in Taiwan is in its infancy. A small pilot study
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conducted in 2014 in Taiwan (Ku et al., 2014) involving nursing students (n = 9) found a
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capstone course improved self-perceptions of creativity, however the course was challenging;

students struggled to create two healthcare products. Teaching capstone courses for innovation of

healthcare products involves multiple components: interdisciplinary teaching across departments;

enhancing students’ divergent and convergent thinking; and the ability to judge the patentability

of healthcare products. The success of any capstone course depends not only on a teacher’s

expertise in the area, but also on a teacher’s ability to teach creativity, which can improve with
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teacher training (Göksu, 2017). Student creativity can also be improved through training and

education (Azevedo et al., 2017; Hu et al., 2013; Perry, 2014).

Although studies have investigated creativity training, there is no consensus on how

effectiveness should be evaluated. Empirical studies have measured the effects of creativity on

creative or divergent thinking (Ritter and Mostert, 2016; Salakhatdinova and Palei, 2015),

creative production (Byrge and Tang, 2015), and self-assessment of creativity (Ku et al., 2014）.

Surprisingly, faculty with higher levels of cognitive creativity has been shown to be less

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successful teaching creativity (Soh, 2015; Wibowo and Saptono, 2018). The role teachers play is

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critical to the development of student creativity. Success depends on employing teaching

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behaviors that foster a student’s creativity and the strength of their belief in self-efficacy of
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teaching creativity (Shahvand and Rezvani, 2017; Soh, 2015). Teaching behaviors that foster

creativity include curriculum design, teaching techniques, teaching evaluations, and learning
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environments (Beghetto and Kaufman, 2014; Shahvand et al., 2017). Teaching efficacy, which is
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at the core of any study evaluating teacher effectiveness, includes belief in one’s self-efficacy for

creating effective learning environments that can promote a student’s creativity (Jeng and Tseng,
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2010; Shohoudi et al., 2015).

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The ability to foster creativity can be facilitated by (1) educating individuals about

creativity, thereby building a solid theoretical understanding, and (2) training in the use of

creative tools and processes that can increase problem-solving skills (Scott et al., 2004). The

process of creative problem solving (CPS), developed by Parnes (1967), and Amabile’s

componential theory of creativity (Amabile, 1983; Amabile and Pillemer, 2012) support the

success of increasing creativity through training. Therefore, this study examined creativity in

teaching a capstone course for nursing faculty who received creativity training with a teaching
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for creativity module (TCM). The TCM training program in this study was based on the CPS

model and was designed to help capstone nursing faculty responsible for teaching a required

capstone in product-based healthcare improve students’ creative and innovative abilities. The

TCM program provides instruction in creative teaching behaviors and teaching technology

creatively. This study compared capstone nursing faculty who had received the TCM

intervention and a control group to address the following research questions: (1) Would nursing

faculty in the TCM intervention group exhibit a significant change in teaching behaviors that

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foster creativity compared with controls?; and (2) Would the TCM intervention result in

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significant changes in perceived levels of self-efficacy of teaching for creativity compared with

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controls? We hypothesized the TCM intervention would nurture and enhance teaching behaviors
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and levels of self-efficacy of teaching for creativity.
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2. Methods

2.1 Research design

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This quasi-experimental study used an equivalent experimental group and a control group
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with a pretest-posttest design. These designs are frequently used when it is not logistically

feasible or ethical to conduct a randomized controlled trial. Pretest-posttest designs are also one
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of the simplest methods of testing the effectiveness of an intervention. However, in many quasi-

experimental studies there may be nonrandom selection of units to both control and experimental

groups, and it is not necessarily the same selection variable that governs the selection process for

controls and experimental groups (Shadish et al., 2001). In this study, experimental group

selection was determined by capstone nursing faculty who had completed the teaching for

creativity module (TCM) described below.

2.2 Participants
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Nursing faculty who taught a required 18-week product-based capstone course were

recruited from five healthcare universities of science and technology in Taiwan. The capstone

nursing course focuses on helping nursing students develop healthcare-related products that can

be applied to clinical care. The capstone nursing faculties were provided with information packs

containing a description of the design and purpose of the study and self-administered

questionnaires; 64 information packs were distributed to faculties who had signed a written

consent form. A total of 26 capstone nursing faculties were enrolled for the introductory TCM

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workshop at the time packets were distributed. The remaining 38 capstone nursing faculty were

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not enrolled in the TCM workshop. When packets were returned, capstone nursing faculty who

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had completed the introductory and advanced two-day workshop (n = 21) were classified as the
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intervention group; 21 completed packets were randomly selected as the control group. The 21

participants in the intervention group had also taught 6 hours of the capstone course, which
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focuses on creative techniques and tools, alongside faculty members from the design department
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of a university of science and technology. A total of 56 information packs were returned

following the 18-week capstone course, for a response rate of 87.5%. However, only 42 of the
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information packs were used for this study.

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2.2 The TCM intervention program

The TCM intervention program was designed with the intention of providing capstone

nursing faculty with teaching skills that would enhance nursing students’ divergent thinking and

innovative abilities for the development of healthcare products. Lin et al. (2008) based the TCM

on Parnes’ Creative Problem Solving (CPS) model (Parnes, 1967) and Amabile’s componential

theory of creativity (Amabile, 1983; Amabile et al., 2012). The TCM integrates autonomous

learning and creative thinking with divergent and convergent thinking to develop healthcare
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products, which occurs in three stages: creation, design and implementation (Lin et al., 2008),

which are similar to the conceptual stages of clarification, transformation and implementation

proposed by the CPS model. Each stage in the CPS model requires a dynamic balance between

divergent (creative) and convergent (critical) thinking (Sanchez, 2011), while simultaneously

being influenced by specific cognitive and affective skills (Parnes, 1967). The CPS model solves

problems with systematic thinking; various solutions should be considered before choosing one

solution. The model also requires postponing judgement to avoid missing a better solution to the

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problem (Weng et al., 2010). CPS promotes creative behaviors; individuals or groups can acquire

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creative, innovative or effective solutions through interactions of divergent and convergent

thinking (Chang, 1998).

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According to Amabile’s componential theory of creativity, four components are necessary
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for a creative response: domain-relevant skills, creativity-relevant skills, task motivation, and
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social environment. The first three components represent an individual’s abilities; the forth
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component is the environment in which the work is performed. The design of our TCM was

based on providing capstone nursing faculty with the ability to teach creative thinking skills and
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facilitate strategies that would help students implement healthcare products using personal
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domain-relevant knowledge and skills.

The TCM intervention was conducted in two stages: 16 hours of course work and 6 hours of

teaching creativity in the classroom. Faculty members from various fields of industrial design

provided the instruction. The 16 hours of course work involved a 2-day workshop with

introductory and advanced levels of creative thinking techniques used in the production of

patentable and practical healthcare products. The second stage of the TCM intervention

reinforced the creative techniques learned in the workshop. The capstone nursing faculty taught
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alongside the industrial design faculty for 6 hours of the 18-week capstone course. Nursing

students were instructed in the same five creative techniques and tools the intervention group had

acquired during the TCM workshop: learning how to apply for design thinking: brainstorming,

attribute listing technique, human-centered design thinking, assessment matrix technique, and

paired comparison method. The industrial design faculty and the capstone nursing faculty guided

students during small-group meetings in (1) generating ideas about healthcare needs and

products, (2) evaluating the strength of needs and products, and (3) choosing the best solution.

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These techniques employed divergent thinking, convergent thinking, and idea generation,

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respectively. The industrial design faculty helped reinforce the techniques learned by the

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capstone nursing faculty during the TCM workshop, which provided hands-on experience for the
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intervention group while simultaneously providing interdisciplinary teaching for the students.

This style of interdisciplinary teaching has been shown to provide a supportive and encouraging
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environment for nursing students over the 18-week capstone course (Liu et al., 2019). An outline
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of the courses and their content provided to faculty in the TCM intervention is shown in Table 1.
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[Table 1 here]
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2.3 Procedures

The effects of the TCM intervention were evaluated by comparing the intervention and

control group using a pre-test/post-test design. Pre-test and post-test data was collected using

self-assessment instruments included in the information packs distributed to the participants.

Each information pack contained a description of the design and purpose of our study,

questionnaires regarding demographics of age, gender, teaching background, and self-assessment

instruments regarding teaching creativity (described below). In order to maintain the anonymity

of the participants, a coding number was assigned to each packet. Pre-test data for faculty in the
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intervention group was generated prior to participating in the interdisciplinary TCM program; for

faculty in the control group, pre-test data was generated prior to teaching the 18-week capstone

course. Post-test data was obtained upon completion of teaching the 18-week course when the

instruments were completed a second time. The flowchart of study process is shown in Figure 1.

[Fig. 1. here]

2.4 Instruments

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2.4.1 Creativity Teaching Behavior Scale (CTBS)

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Teaching behaviors which encouraged creativity were measured with the CTBS (Chang et

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al., 2010), which is based on the Creativity Fostering Behaviour Index developed by Soh (Soh,

2000). The CTBS is a 14-item self-assessment checklist to determine what opportunities teachers
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provide to facilitate student creativity. The CTBS uses four subscales: autonomous learning
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(AL), creative thinking (CT), characteristics/motivation (CM), and environment/opportunity

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(EO), which are similar to Amabile’s four components of creativity (Amabile et al., 2012;

Shadish et al., 2001). AL (four items) determines how teachers foster a student’s independent
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learning, which involves providing opportunities for exploration, self-teaching, and learning. CT
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(four items) assesses a teacher’s ability to encourage and explain creative thinking, which

includes creative approaches to problem solving as well as obstacles to creativity. CM (four

items) determines how teachers encourage students to master basic requirements and approach

conflict situations with a positive attitude. EO (two items) is the effort a teacher makes to foster

student creativity in small groups through cooperation and interpersonal interactions. Items are

scored with a 5-point Likert scale: 1 = never to 5 = always. The subscale score is the mean score

for the items; total score is the sum of the four subscales. Cronbach’s alpha for the CTBS was
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0.91, and satisfactory validity was established for this scale through factor analysis (Chang et al.,

2010). In this study the Cronbach’s alpha was 0.89. Table 1S contains the items for the CTBS.

2.4.2 Creativity Teaching Efficiency of Technology Institute Teacher’s Scale (CTETITS)

The Creativity Teaching Efficiency of Technology Institute Teacher’s Scale (CTETITS) (Chen,

2005) measures six qualities needed to teach technology creatively: ability to evaluate patents

and trademarks (EPT), ability to teach about patents (ATP), general ability to teach creatively

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(ATC), knowledge of intellectual property rights (KIPR), ability to design courses (ADC), and

the teacher’s belief in the creativity of students (BCS). Each item is phrased as a statement; for

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example, the EPT item states, “My ability to evaluate patents and trademarks is excellent”. The

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item is scored on a 5-point Likert scale: 1 = strongly disagree; 2 = disagree; 3 = neutral; 4 =
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agree; or 5 = strongly agree; the total scale score is the average of the sum of the six qualities;
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higher scores indicate a greater perception in self-efficacy of teaching technology creatively. The

average total score has been reported to be 3.57; average subscale scores for qualities range from
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3.22 to 4.09 (Chen, 2005). Cronbach’s alpha coefficient for the CTETITS is 0.97. Factor analysis
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established satisfactory validity for the scale (Chen, 2005). Reliability of the CTETITS for this

study, determined by Cronbach’s alpha coefficient, was 0.73.

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2.4.3 Self-efficacy for Creativity Teaching Scale (SECTS)

The second measure of creativity was the Self-efficacy for Creativity Teaching Scale

(SECTS), which is a 5-point Likert scale developed by Lin and Chou (2008). The SECTS

measures three personality traits associated with creative teaching self-efficacy: positive self-

appraisal (SA), lack of negative consciousness (NC), and belief in one’s resistance to stress

(BRS). Traits are rated from 1 - 5; 1 = strongly disagree to 5 = strongly agree. The total score

(range = 1-5) is the average of the sum of the three subscale scores; a higher score indicates a
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greater level of creative teaching self-efficacy. The average total score has been reported to be

3.94; the average score for the three subscales is between 3.51 and 4.34 (Lin et al., 2008).

Cronbach’s alpha coefficient for the SECTS is 0.92. Confirmatory factor analysis established

satisfactory validity for both the content and construct of the scale. Reliability of the SECTS for

this study, determined by Cronbach’s alpha coefficient, was 0.76.

2.4.4 Efficacy of Teaching Creativity (ETC)

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Efficacy of teaching creativity (ETC) was determined using the total scores for the

CTETITS and SECTS instruments for the intervention group and control group. The mean total

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scores on the CTETITS and SECTS were summed; the average of the summed score was defined

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2.5 Data collection and analysis
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Data were collected between September 2017 and January 2018; questionnaires were
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analyzed using SPSS version 20.0. Descriptive statistics of the mean, standard deviation (SD),

frequency and percent were used to describe the demographics of the participants. Scale scores
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were compared using the mean and SD. To determine differences in mean post-test scores for the
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control and intervention groups, analysis of covariance (ANCOVA) was conducted. ANCOVA

determines whether post-test means, adjusted for pre-test scores, differ between two groups

(Brown and Forsythe, 1974). Prior to conducting ANCOVA, we tested the assumption of

homogeneity of regression slopes (HOS) to determine if there was an interaction between the

treatment (independent variables of intervention and control groups) and the covariates (pre-

post-test total score and subscale scores of the CBTS, CTETIS, and SECTS). If a treatment-

covariate interaction was detected, data were analyzed with the Johnson-Neyman technique

(Johnson and Neyman, 1936).

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2.6 Ethical considerations

Approval was obtained from the Institutional Review Board (IRB) of the hospital ethics

committees prior to data collection. The director of each healthcare program provided capstone

nursing faculty with a form explaining the purpose of the study, assurance that confidentiality

would be maintained, and that participants had the right to withdraw from the study at any time

and for any reason. Capstone nursing faculty who signed the written informed consent form were

provided with a coded information pack containing the questionnaires to be completed at home

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and returned by mail.

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3. Results

3.1 Participant characteristics -p

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Characteristics for the 42 capstone nursing faculty who participated in the study are shown
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in Table 2. There was no significant difference in age between the control and intervention

groups (51.48 years, SD = 5.21 and 50.90, SD = 4.05, respectively). One participant in the
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intervention group was male. The percent of participants with 19 or more years of teaching
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experience was greater in intervention group (57.1%) than the control group (42.9%); the percent

with more than 3 years’ experience teaching capstone courses was also greater for the
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intervention group (57.1%) than control (33.3%). The percent of participants who expressed

some level of interest in teaching courses in creativity was similar for both groups.

[Table 2 here]

3.2 Homogeneity of regression slopes (HOS)

Prior to comparing the changes in pre-post test scores for the intervention and control

groups for teaching behaviors and teaching for creativity, we tested the homogeneity of
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regression slopes (HOS) to ensure there was no interaction between variables (D’Alonzo, 2004).

With the exception of the covariate of the CTBS subscale for AL, all interactions between the

independent variable (group) and the pre-post test scores for scales and subscales of teaching

efficacy were greater than 0.05, indicating that they did not violate homogeneity of regression

(Table 3). However the interaction between groups and the covariant of the pre-post test score

for AL was less than 0.05 (F (1, 38) = 9.96, p = 0.003) indicating a violation of HOS. Hence,

ANCOVA analysis was appropriate for the covariates of total and subscale scores for the CBTS,

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CTETITS, SECTS, as well as for the ETC.

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[Table 3 here]

3.3 ANCOVA for the control and intervention group

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Differences between the control and intervention group on post-test scores for teaching
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behaviors and teaching creativity were compared using one-way ANCOVA, controlling for pre-
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test scores (Table 4). ANCOVA results showed a significant effect of group type on post-test

scores for the CTBS (p < .001) and the subscales of CT, CM and EC. Total post-test scores for
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the CTETITS (p < .001) and all subscales were also significantly different between groups. Total
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post-test scores were also significantly different for the SECTS (p < .001); although two

subscales, SA and BRS, were significantly different between groups, there was no significant

difference for NC (p = .238). Finally, efficacy of creative teaching (ECT), as determined by the

sum of the total scores for CTETIS and SECTS, was also significantly greater for the

intervention group (p < .001).

[Table 4 here]

3.4 Johnson-Neyman analysis for the covariant of AL

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The violation of HOS for the covariant of AL indicated a treatment-covariate interaction,

suggesting treatments had different effects depending on an individual’s characteristics

(D’Alonzo, 2004; Johnson, 2016). Therefore, in order to overcome the violation of HOS,

analysis with the Johnson-Neyman technique (Johnson, 2016) was performed using the

PROCESS software program (Hayes, 2013). Analysis showed when pre-test scores were

between 3.0 and 4.30 for AL, there was a significant difference in post-test AL scores between

the intervention and control groups (p < .001). However, when the pre-test scores were 4.70 or

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greater for AL, there was no significant difference in post-test scores between groups (Table 5).

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These findings suggest the TCM intervention program was effective at increasing AL only for

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capstone nursing faculty with low pre-test scores for AL.
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[Table 5 here]
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4. Discussion

This study explored the effects of a teaching for creativity intervention program on teaching
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behaviors, perceived self-efficacy of teaching, creative teaching self-efficacy, and efficacy of

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teaching creativity among capstone nursing faculty in Taiwan. Capstone nursing faculty who
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participated in the TCM intervention program demonstrated a significant increase in scale scores

for the CTBS, CTETIS, SECTS, and the value for efficacy of teaching creativity (ETC). These

results suggest that TCM program enhanced teaching behaviors and self-efficacy of teaching

creativity for capstone course nursing faculty. Exposure to creative thinking techniques and tools

during the 2-day workshop and reinforcement of these techniques from experts in industrial

design during the capstone course resulted in increased creative teaching, as well as an increase

in confidence for capstone nursing faculty, which could foster students’ creative thinking for

production of patentable and practical healthcare products. Creative teaching self-efficacy and
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overall efficacy of creative teaching also increased for participants in the intervention group.

These findings confirm our hypothesis that the TCM intervention program could have a positive

effect on both behaviors of teaching for creativity and efficacy of creative teaching.

Although the TCM intervention program improved total scores for the CTBS, the subscale

for behaviors that encouraged students’ autonomous learning only significantly improved scores

if the participant’s pre-test score for AL was 4.8 or lower. This might be a result of the

constraints of the scoring for the CTBS instrument. It has been suggested that the range of data

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collected by an instrument is limited by the instrument design, such as the ceiling value, which

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restricts the range of the instrument (Vogt and Johnson, 2011). Therefore, it is possible that the

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ceiling effect prevented detecting any change in behaviors. However, these findings might also
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suggest that the capstone nursing faculty were already skilled at providing students with tools

that promote creativity.

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Our findings regarding the effectiveness of creativity training programs on creative abilities
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expand on previous findings showing significant improvement in student creativity following a

program in creative skill training (Azevedo et al., 2017; Ritter et al., 2016). Our findings are the
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first to demonstrate that providing capstone nursing faculty with an intervention program focused
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on creativity training can increase behaviors associated with stimulation and facilitation of

students’ creativity, which further supports enhanced creativity through training (Ritter et al.,

2016; Tzivinikou, 2015). Participants also reported significant increases in positive perceptions

of self-efficacy for teaching creativity. This increased confidence in the ability to train students

to be more creative provides evidence of the positive effects of the TCM intervention, which

provided not only instruction in techniques to increase creativity, but also provided hands-on

training in the classroom with interdisciplinary teaching.

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While the current study provides evidence that the combined effects of training in cognitive

thinking can positively influence behaviors for teaching creativity as well as improvements in

perceived self-efficacy of teaching creativity, our findings have some limitations. The TCM

intervention in this study employed two teaching methods: course instruction during the 2-day

workshop and reinforcement of learning through hands-on application with instruction in the

classroom. The assumption was that the combination of the two methods would result in

improvements in self-assessments of performance. However, we did not evaluate the methods

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independently of one another to determine if only one of the training methods would be

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necessary to obtain similar results in teaching for creativity performance (behavior and efficacy).

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We also did not conduct any objective assessments of whether the intervention improved student
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creativity following the capstone course, which would provide valuable information regarding

the success of these training techniques. Therefore, future studies should examine the impact of
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each of these techniques in isolation and also compare the outcomes for students taught by
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faculty who have completed a TCM intervention and those who have not.
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5. Conclusion

The current study provides evidence that an intervention program in creativity can increase
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teaching behaviors that foster student creativity as well as perceptions of self-efficacy regarding

teaching for creativity. These findings have important implications for educators. They suggest

that creativity training employing a workshop and reinforcement of creativity skills with

interdisciplinary teaching in the classroom should be integrated into the teaching curriculum

when training instructors needing to improve teaching behaviors and self-confidence regarding

teaching creativity, which could facilitate student creativity.

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Capstone nursing course

faculty
N = 42

Pre-test for CBCT, Pre-test for CBCT,

CTETITS, SECTS CTETITS, SECTS

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Completion of TCM program Control Group
Intervention Group n = 21
n = 21

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18-week capstone course
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with instruction from 18-week capstone course

interdisciplinary teachers
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Post-test for CBCT, Post-test for CBCT,

CTETITS, SECTS CTETITS, SECTS
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Fig. 1. Flowchart of study process.

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Table 1. The TCM program: courses during the 2-Day workshop and interdisciplinary teaching

provided during the 18-week capstone course

Course Time Content

Introductory workshop 8 hours
1. Capstone course Design of product-based healthcare
2. Brainstorming Incorporate fluency, flexibility, originality, elaboration
3. Use of thinking tools Practice divergent and convergent creative thinking
4. Innovative products Process of drawing and design sketching of products
5. Analysis of feasibility Product testing, marketing, patent application
6. Product preparation Domestic and international competition; transform for
academic outcomes

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Advanced workshop 8 hours
1. Healthcare products Understanding on-site medical needs

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2. Trends in IT Internet technology for healthcare needs
3. Trends in AI Artificial intelligence in healthcare
How “big data” can inform medical innovation
4. Big data
5. Prototyping -p
Introduction to Taiwan Rapid Innovation Prototyping
League for Entrepreneurs
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6. Commercialization How to launch commercial healthcare products
Interdisciplinary teaching* 6 hours
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1. Five tools for creative Introduction to service design and case studies of
design inventions of healthcare products
2. Design thinking Learn how to guide small groups of students in defining
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problems from a viewpoint of empathy; group

presentations were given
3. Product Learn how to guide students in product generation by
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implementation applying divergent and convergent thinking tools

* Provided by faculty from departments in industrial design and nursing during the 18-week
capstone course.
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Table 2. Characteristics of faculty participants (N = 42) in the control and intervention group.
Control (n = 21) Intervention (n = 21)
Characteristic n (%) Mean (SD) n (%) Mean (SD)
Age (years) 51.48 (5.21) 50.90 (5.05)
Gender (female) 21 (100) 20 (95.2)
Teaching experience (years)
1-18 12 (57.1) 9 (42.9)
19+ 9 (42.9) 12 (57.1)
Capstone course teaching (years)
1-3 14 (66.7) 9 (42.9)

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3+ 7 (33.3) 12 (57.1)

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Faculty advisor for students (yes) 20 (95.2) 18 (85.7)
Intellectual property rights training (hours)
0-9
10+
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16 (76.2)
5 (23.8)
16 (76.2)
5 (23.8)
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Interest in teaching courses in creativity
Very interested 5 (23.8) 9 (42.9)
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Interested 14 (66.7) 8 (38.1)

Not interested or neutral 2 (9.5) 4 (19.0)
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Abbreviation: SD, standard deviation

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Table 3. Homogeneity of regression slopes for treatment (Group)-Covariate interactions

Group interactions
Covariate F (1,38) p
CTBS
Total score 1.90 0.18
Subscales
Autonomous Learning (AL) 9.96 0.003a
Creative Thinking (CT) 0.65 0.65
Characteristics/Motivation (CM) 1.15 0.29
Environment/Opportunity (EO) 0.04 0.04
CTETIS
Total score 1.37 0.55
Subscales

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Evaluate Patents and Trademarks (EPT) 4.85 0.49
Ability to Teach Patents (ATP) 0.06 0.81

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Ability to Teach Creatively (ATC) 1.33 0.26
Knowledge of Intellectual Property Rights (KIPR) 0.42 0.52

SECTS
Creatively Design Courses (ADC)
-p
Belief in Creativity of Students (BCS)
1.01
2.36
0.32
0.13
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Total score 1.41 0.24
Subscales
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Self-appraisal (SA) 0.50 0.49

Negative Consciousness (NC) 1.29 0.20
Belief in Resistance to Stress (BRS) 2.71 0.11
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ECT (Sum of CTETIS and SECTS) 0.001 0.98

Abbreviations: CTETITS, Creativity Teaching Efficiency of Technology Institute Teacher’s
Scale; SECTS, Self-efficacy for Creativity Teaching Scale; ECT, Efficacy of Creative Teaching.
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a
p-value less than 0.05, indicating violation of homogeneity of regression.
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Table 4. One-way analysis of covariance (ANCOVA) for self-assessment instruments and

Efficacy of Teaching for Creativity (ETC) between pre-post scores for intervention and control
groups
Mean group post-test
scores
Construct Intervention Control SS df MS F p
CTBS
Total score 4.49 3.92 3.41 1 3.41 17.18 < .001***
Subscalesa
Creative Thinking (CT) 4.48 3.91 3.34 1 3.34 11.76 < .001***
Characteristics/Motivation (CM) 4.23 3.71 2.78 1 2.78 6.74 0.01**
Environment/Opportunity (EO) 4.58 4.16 1.80 1 1.80 5.06 0.003**
CTETITS

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Total score 4.28 3.53 5.80 1 5.80 46.60 < 0.001***
Subscales

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Evaluate Patents & Trademarks (EPT) 4.23 3.38 7.26 1 7.26 30.36 < 0.001***
Ability to Teach Patents (ATP) 4.26 3.64 3.92 1 3.92 10.63 0.002**
Ability to Teach Creatively (ATC) 4.76 4.12 4.21 1 4.21 16.66 < 0.001***
Knowledge of Intellectual Property Rights
(KIPR)
Creatively Design Courses (CDC)
-p
4.05

4.29
3.26

3.47
6.35

6.90
1

1
6.35

6.90
26.32

23.25
< 0.001***

< 0.001***
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Belief in Creativity of Students (BCS) 4.18 3.66 2.66 1 2.66 9.46 0.004**
SECTS
Total score 3.70 3.26 2.05 1 2.05 18.17 < 0.001***
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Subscales
Self-appraisal (SA) 3.67 3.10 3.29 1 3.29 14.64 < 0.001***
Negative Consciousness (NC) 3.45 4.07 4.09 1 4.09 1.44 0.238
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Belief in Resistance to Stress (BRS) 3.94 3.44 2.65 1 2.65 10.19 0.003**
ECT (Sum of CTETIS and SECTS) 4.10 3.44 4.51 1 4.51 46.02 < 0.001***
Abbreviations: SS, sum of squares; df, degrees of freedom; MS, mean square; CTETIS,
Creativity Teaching Efficiency of Technology Institute Teacher’s Scale; SECTS, Self-efficacy
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for Creativity Teaching Scale; ECT, Efficacy of Creative Teaching.

a
Subscale for autonomous learning not determined because it did not pass the assumption of
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homogeneity of regression.
*p < 0.05, **p < 0.01, ***p < 0.001
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Table 5. Results of Johnson-Neyman analysis: relationship between pre-test scores and

intervention and control group post-test scores on the subscale for autonomous learning
Pre-test score s.e. t p
3.00 0.31 4.85 > .001
3.10 0.29 4.93 > .001
3.20 0.28 5.02 > .001
3.30 0.26 5.11 > .001
4.00 0.16 5.65 > .001
4.10 0.15 5.59 > .001
4.20 0.14 5.44 > .001

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4.30 0.13 5.16 > .001
4.70 0.14 3.09 0.004

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4.80 0.15 2.50 0.017
4.89 0.16 2.02 0.050
4.90
5.00
0.16
0.18 -p1.95
1.46
0.059
0.154
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s.e. = standard error
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Figure 1