Procrastination is a detrimental behavior that impairs academic performance and well-being by preventing individuals from starting or finishing work within the allotted time. The process of procrastination depicts a tendency that significantly impacts academic performance and mental health. ^{1– 4} Procrastination among university students has been identified as a significant barrier to productivity, often leading to heightened stress levels, particularly for those in healthcare fields.

Procrastination is predominantly viewed as the consequence of an impairment in self-regulation. ^{4, 5} Four self-regulatory models are nullified or overcome by procrastination. The dual-process model of self-control proposes that procrastination arises when the impulsive system dominates the rational system. A core feature of procrastination that repeatedly overrides rational decision-making is dominance of impulsivity, this is the first model. The second model emphasizes the way individuals tend to avoid tasks that make them feel frustrated or bored. However, similar behavior is maladaptive and unreasonable since it results in a brief improvement in mood and permits the accomplishment of short-term, urgent goals at the expense of long-term objectives. The limited resource model of self-regulation is the third model, suggesting that procrastination is strongly linked to low energy and inefficient management of tasks.

Finally, the fourth model highlights that procrastinators are typically less likely to prepare for the future and more present-focused. ⁶ This concept encourages the application of strategies designed to modify one’s surroundings to reduce unwanted prompts of impulsivity and reinforce actions that are consistent with long-term advantages. ^{7, 8}

Previous research has highlighted the complex relationship between stress and procrastination, pointing out that these behaviors are cyclically linked and work together to decrease general well-being. According to the procrastination–health model, procrastinating increases stress by causing negative emotions like regret, guilt, and anxiety as a result of task delays and the resulting time pressure. On the other hand, stress might predispose people to procrastination by limiting their emotional resilience and coping mechanisms, which makes avoidance-based strategies more appealing. ^{5, 9, 10} The stress- and behavior-related routes are the two main ways that procrastination leads to poor health consequences, according to the procrastination–health model. The physiological processes triggered by the stress response are part of the stress-related pathway, and they may eventually lead to the emergence of several health problems. This pathway highlights the excessive and prolonged stress brought on by chronic procrastination, which is driven by behavioral and cognitive processes. For example, the stress system increases susceptibility to infections and autonomic nervous system arousal, thereby raising the heart rate and muscle tension in addition to disrupting sleep and digestion. Alternatively, the behavior-related pathway includes bad lifestyle choices linked to procrastination, like skipping exercise and eating processed, unhealthy meals. This approach increases the risk of disease even though it may have a more minor effect, especially for people who already have health issues. ^{9– 11}

An individual’s view of external stimuli as stressful, which shapes the events’ relevance based on their own cognitive and emotional reactions, is known as stress perception. It demonstrates how internal emotional processes and external pressures interact, indicating that the impact of stressful situations is largely determined by an individual’s cognitive assessment. Cognitive theory states that academic procrastination is greatly influenced by both internal motivation to study and stress perception. A more positive approach to learning thrives when internal drive exceeds perceived stress, hence mitigating its negative impacts. Therefore, in addition to stress perception, academic procrastination also depends on how the individual chooses to utilize the stress information he receives. ^{2, 4, 12, 13}

The precise processes governing the relationship between procrastination and stress in academic settings are still unknown, despite strong theoretical and empirical evidence to the contrary. ⁵ The majority of current research has focused on short-term associations, and there is a lack of many longitudinal studies to clarify the underlying behavioral patterns and long-term effects of these phenomena. ⁵

There is a significant need to understand academic stress and procrastination since they significantly impact students’ well-being. As the demands of education in the healthcare field are high, this study can be helpful for healthcare students who are under extreme pressure due to their workload and need effective ways to cope with stress. Procrastination leads to a range of physiological as well as psychological complications. ¹ Physiological complications include muscle tension, muscular pain, bruxism, diarrhea, stomach ache, and persistent fatigue. ^{1, 13} Psychological issues involve insomnia, anxiety, depression, self-criticism, and low self-esteem, among many more. ^{1, 10, 14, 15}

The purpose of this study is to investigate the level of procrastination among the healthcare students at a Medical University in Ajman, United Arab Emirates. This study examines the patterns and prevalence of procrastination in students and its relation to academic stress to suggest measures to improve academic behaviors.

This was a cross-sectional study conducted from September 2024 to December 2024, targeting students studying in a medical university. We followed STROBE guidelines as given on https://www.equator-network.org/.

This population-based study was conducted among the students enrolled in various programs at a medical university. Students who were willing to participate in the study were recruited. This cross-sectional study was conducted among 938 students enrolled in health-related academic programs. Those who were unwilling to participate in the study and those who were not present at the university during data collection were excluded.

A convenience sampling technique was adopted to recruit the participants within the university. Informed consent was obtained from each participant before the commencement of the research, digitally through the first page of the online Google Form. The inclusion criteria include students who are over the age of 18 and from any country who are willing to engage in this study. The exclusion criteria were, those who do not show up for the research, those who are unable to participate, and those who were not present at the time of data collection, were not allowed to participate in the research.

The research was approved by the Institutional Review Board (IRB) of a Medical University in Ajman, United Arab Emirates (Ref. no. IRB-COM-STD-27-JAN-2024). The research purpose was communicated clearly, and informed consent was obtained from all voluntary participants. Confidentiality and Anonymity were ensured as no identifying information was requested from the respondents. The research was conducted in line with the Helsinki declarations.

A self-administered questionnaire comprising sociodemographic variables and questions to assess participants’ procrastination levels and stress levels was used. The first section consisted of sociodemographic variables that included information on participants’ age, gender, nationality, and education. Procrastination Assessment Scale for Students (PASS) was used in the second section, in which the questionnaire explores three key aspects of procrastination across six areas of academic life: (1) how often someone procrastinates, (2) the extent to which it interferes with their ability to fulfill obligations, and (3) their motivation to reduce procrastination. The six areas assessed include writing term papers, preparing for exams, keeping up with weekly reading assignments, managing administrative tasks, attending meetings, and completing academic tasks in general. A total of 18 questions were rated using a five-point Likert scale, ranging from 1 (Never) to 5 (Always). The greater the score of PASS, the more the academic procrastination. Finally, the Perceived Stress Scale (PSS) section used a standardized iteration of PSS to quantify the stress levels. Respondents provided answers on a five-point Likert-type scale spectrum ranging from “Never” to “Very often”.

Data collection was conducted by researchers who approached eligible participants aged over 18 years on campus. It was administered in English, and participants required approximately 5–7 minutes to complete the form. To maximize participation, multiple methods were used to distribute questionnaires, including QR codes, electronic devices, and printed forms. The data has been anonymized as no identifying information was requested from the respondents. Data analysis was conducted in December 2024 using IBM ^® Statistical Package for Social Sciences (SPSS) (version 29.0). Descriptive statistics were utilized to summarize categorical data, while chi-square tests assessed the association between dependent and independent variables. Statistical significance was set at p value <=0.05. The Procrastination Assessment Scale for Students (PASS) score ranges from 18-90. The score has been categorized into a low level of academic procrastination (18-41), a moderate level of academic procrastination (42-65), and a high level of procrastination (66-90). The Perceived Stress Scale (PSS) score was computed by summing the responses (ranging from 0-4) to 10 items, applying reverse scoring to positively stated questions, and then categorizing the total score (ranging from 0-40) into stress levels: Low Stress (0-13), Moderate Stress (14-26), and High Stress (27-40).

Table 1 details the distribution of sociodemographic factors of the participants. A total of 938 students participated in this research. The age of the participants was divided into two groups of less than 20 years with 397 (42.3%) students and greater than or equal to 20 years with 534 (57.7%) students. The remaining seven students did not want to reveal their age. The gender of the participants was self-reported. There was a greater participation from the female gender, with 683 (72.8%) students, than males, who had 255 (27.2%) students. The students from the College of Medicine had the highest representation with 445 (47.4%) participants, second highest from the College of Health-Sciences (n = 157, 16.7%), and the least from the College of Management and AI In Healthcare (n = 68, 7.2%). Most participants were from the South-East Asia Region (SEAR) (n = 403, 43.0%). Second year students participated the most in the survey (n = 348, 37.1%), while higher fourth and fifth years of study showed the least participation. Details are given in Table 1.

Table 2 demonstrates the distribution of procrastination according to different academic domains. Majority of the participants reported moderate level of procrastination when writing a term paper (n = 540, 57.6%), when studying for exams (n = 506, 53.9%), when reading assignments (n = 505, 53.8%), when Performing Administrative Tasks (n = 498, 53.1%), when performing academic tasks (n = 486, 51.8%). Writing term papers (n = 216, 23%) and studying for exams (n = 234, 24.9%) showed the highest levels of procrastination. Performing administrative tasks (n = 125, 13.3%) and attending meetings (n = 114, 12.2%) showed the lowest levels of high procrastination.

Figure 1 shows the overall distribution of academic procrastination among healthcare professional students. It was observed that 626(66.7%) of students reported a moderate level of procrastination, followed by 161(17.2%) of low levels of procrastination, and 151(16.1%) of high levels of procrastination.

Table 3 indicates the association between Sociodemographic Variables and the Level of Academic Procrastination. Only male gender and students enrolled at the College of Medicine have a significant association with the level of academic procrastination, with gender having a p-value of 0.009 and college having a p-value of 0.02. Other sociodemographic factors like age groups, nationality, and year of study do not have a strong association with academic procrastination.

Table 4 indicates the association between the categories of academic procrastination and perceived stress levels. Here, all the variables show a strong association with p-values less than 0.001. Writing a term paper, studying for an exam, reading assignments, performing administrative tasks, attending meetings, and performing academic tasks all show significance with p-values less than 0.01.

Table 5 depicts the association between overall procrastination assessment scale (PASS) levels against Perceived Stress levels (PSS). Most students report feeling moderate (n = 510, 76.5%) stress overall. Procrastination levels and perceived stress have a strong association, with students who procrastinate the most reporting the highest levels of stress (n = 63, 48.8%). The majority of students in the low procrastination group stated that they felt less stressed (n = 86, 60.6%), which may indicate that procrastination minimization lowers stress levels. With almost half of the high procrastination group reporting high stress, there was a definite association between procrastination and high stress.

This research aimed to understand the prevalence and patterns of academic procrastination and factors related to it among healthcare students in a Medical University, Ajman, United Arab Emirates. The study observed that healthcare students have a habit of procrastinating due to various concerns. This result is further supported by studies that found a moderately positive association between students’ reported stress levels and the frequency of academic procrastination. ^{16– 18}

The present study found that there were more female students than male students who took part in the study. Higher female enrollment could be due to as women are more prone to select careers in healthcare because they emphasize more nurturing responsibilities. Furthermore, women are more likely to take part in survey-based research, potentially due to a greater sense of volunteerism or personal resonance with the topic, particularly when it involves psychological well-being and self-improvement. Gender emerged as a key variable in the research, and the study’s findings also showed a significant association between academic procrastination and gender. ^{19, 20}

Females show lower levels of procrastination as compared to males, with higher levels of procrastination. There is a similar trend in the high levels of procrastination, where females show lower levels of procrastination as compared to males showing higher levels of procrastination. Research now highlights that females tend to procrastinate less and achieve better academic outcomes than males. ^{21, 22} A meta-analysis done by Bo Yan et al. ²¹ also indicates that females tend to perform lower levels of procrastination than their male counterparts. A similar result was also found in Lu et al.’s ²² study, which stated that men have a lower degree of self-control, which is a major factor in procrastination. Men may procrastinate more because they are less able to process information in a goal-directed manner and overcome the urge to do so. Internet addiction is also a significant factor in procrastination, as males tend to spend more time online than females do, as reported by Hayat et al., who found a significant association between academic procrastination and internet addiction. ¹⁹

However, overall, females tend to show increased moderate procrastination as compared to males. This tendency can be indicative of the notion that more time or a more focused work environment can lead to better results.

Studies relating procrastination to emotional regulation suggest an additional explanation for the gender differences in procrastination, especially in low- and high-stress situations. Higher levels of procrastination are linked to maladaptive coping mechanisms and are frequently employed as a coping method for unpleasant feelings like anxiety. ^{10– 13} Considering that anxiety is an unpleasant emotional condition, female students may be more likely than their male counterparts to avoid experiencing it by acting more proactively and organized. ²³ Avoiding unpleasant tasks is a key method that procrastination functions as a short-term emotional control tactic. Even though it could provide instant psychological relief, it also causes stress, guilt, and uncertainty, all of which raise the possibility that procrastination will continue to occur. This cyclical process is reinforced by individuals seeking short-term mood enhancement in an attempt to escape bad emotional states in a process known as a ‘hedonistic shift’. ¹⁰

Most participants were from the South-East Asia Region (SEAR), which may be because women are enrolled more in the university and tend to be driven by societal or cultural expectations. Women are often encouraged to seek careers in healthcare occupations like nursing and medicine in nations like Bangladesh and India since these occupations are seen as raising social status, improving marriage prospects, and providing more opportunities for migration and employment overseas. ²⁴ In this study, higher degrees of procrastination were consistently associated with higher stress levels across a range of academic procrastination domains, such as writing term papers, studying for exams, reading assignments, handling administrative activities, attending meetings, and completing academic tasks.

One of the most striking patterns observed was the clear increase in stress as procrastination increased. Students with much higher feelings of stress reported higher procrastination than those with low procrastination when it came to completing term papers. ²⁵

Students exhibited moderate degrees of procrastination when completing academic tasks, writing term papers, preparing for tests, reading assignments, and administrative duties. The most procrastinating tasks were those involving term paper writing and exam preparation. A study by Ahmed et al. ²⁴ showed similar results to our study in which the reasons for procrastination included social anxiety, poor time management, lack of drive, and fear of failing. Another reason for stress due to academic procrastination can be because of ineffective or improper use of some study techniques. According to a study by Pereira et al., ²⁰ students with high levels of academic procrastination are unable to set aside enough time to use their study techniques effectively, which hinders their performance and increases their anxiety levels because they are forced to meet tighter and shorter deadlines.

Academic procrastination levels and perceived stress were found to be significantly associated. While students in the low procrastination group reported lower stress levels, those in the high procrastination group reported the highest levels of stress. These results suggest that improved stress management may be associated with less procrastination. ²⁸ In Ahmed et al.’s study, ²⁴ 65% of students felt stressed due to their procrastination, and the participants said that it led to a lack of sleep, ineffective time management, and unfulfilling incomplete work. In that study, poor academic performance was due to 60% of students feeling guilty, while 24% of students also felt a sense of low self-esteem. The results of the study by Bolbolian et al. ²⁶ show that dentistry students who procrastinate academically have more stress, irrational and negative thoughts, and test anxiety and humiliation fear.

A paper by Kurniawan et al. ²⁷ highlighted their findings, which suggested that the primary causes of procrastinating behavior in people were excessive laziness and procrastination. More specifically, this study can identify several factors that contribute to students’ academic procrastination. These factors include procrastination, ineffective time management, laziness, fatigue, additional tasks that need to be completed, confusing assignments, and due to additional responsibilities or activities. A paper by Cho et al. highlighted that even though self-oriented perfectionism may be adaptive in reducing academic procrastination among medical students, when fear of failure increases, self-oriented perfectionism may have the opposite effect, causing academic procrastination to increase. ²³

Through this research, including a multitude of others, it is well established that procrastination directly relates to various factors such as stress, and therefore, it is possible to target the cause of procrastination and mitigate its effects. Such tendencies that students display should be immediately caught and corrected so that they do not become a habit that will cause responsibility issues later. ^{29– 31} Interventions should be kept in place to first, help individuals understand their behaviour of delaying things, secondly, provide a place where they can ask for help, and thirdly, they should have an intervention to address this procrastination inclination.

The results of this study reveal that procrastination is widespread, with the overall prevalence of academic procrastination among healthcare students in Ajman, UAE, showing that moderate procrastination was the most common, affecting about two-thirds of students.

Additionally, this study identified that academic procrastination considerably amplifies the likelihood of perceiving stress in healthcare students. Increased levels of procrastination were significantly related to increased stress levels, affecting various educational areas such as preparation for exams, carrying out administrative duties, and completing reading assignments. Moreover, gender-based differences in the inclination to procrastinate and in the particular college of study indicate the role of social and demographic variables. It was found that moderate procrastination was more common among female students, while male students tended to be both low and high procrastinators. This dichotomy alludes to possible differences in gender-based coping and stress management strategies. In addition, male students who procrastinate the most are the ones who perceive the most stress, which implies that such a group may be more prone to stress. Furthermore, there is a notable difference in procrastination among students of different colleges. Procrastination levels among students studying medicine and management, and AI in Healthcare were higher than those in dentistry and pharmacy colleges. The College of Management and AI in Healthcare reported higher levels of students prone to extreme procrastination, indicating specific problems likely arising from their architecture or academic requirements. On the other hand, the lowest procrastination rates were among the College of Dentistry students.

Arranging peer mentoring meetings and involving students in group discussions to provide academic guidance will thereby help students cope better and develop resilience. Effectively addressing stress and procrastination can improve students’ academic performance, general quality of life, and mental health.

Not applicable.