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A curriculum-based laboratory kit for flexible teaching and learning of practical chemistry

  • Hee Ting Wong and Siong Fong Sim EMAIL logo
Published/Copyright: October 11, 2022
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Abstract

Laboratory practical is an essential component for effective learning of science. To provide laboratory experience can be a challenge to some rural schools with limited laboratory facilities. The situation was exacerbated when schools were close due to the COVID pandemic. This paper reports a laboratory kit designed based on the Standard Curriculum for Secondary Schools in Malaysia (KSSM). The kit was evaluated by students and experienced teachers from town and rural schools. Pre- and post-test was conducted with the students before and after using the kit. A questionnaire was disseminated to appraise the students’ perceptions on practical learning. There was a significant improvement (p < 0.05) in the overall score of the post-test comparing to the pre-test. Both rural and town schools demonstrated a marked increase in the overall mean scores in the post-test. There was also improvement in affection for chemistry among students after using the kit. The practical kit can be deployed in schools with laboratory constraints and to be used outside the school settings. It was designed to be affordable, safe and environmental-friendly, providing individualized hands-on exposure.

Introduction

Laboratory practical plays an important role for effective learning of science. Woolnough and Allsop (1985) infers that laboratory activities are exercises aid to develop practical skills in students giving them the ‘feel’ for phenomena, and to be actively and immensely involved as a ‘problem-solving scientist’.

Malaysia adapted British educational framework after its independence in 1957 (Suminotono, 2015). The curriculum has evolved incorporating culture and religion of multiracial society in Malaysia leading to formation of the Integrated National Curriculum for Primary School (KBSR) and Secondary School (KBSM). This curriculum was introduced in 1980s, emphasizing on reading, writing and arithmetic skills in balance with spiritual, emotion and physical development, inculcating life-long learning (Lee, 1992). The curricular structure was later revised and replaced with KSSR (Standard Based Curriculum for Primary School) and KSSM (Standard Based Curriculum for Secondary School), shifting towards student-centered learning with focus on the 21st century skills such as communication, critical thinking, problem solving, innovation etc. (Malaysia Education Blueprint).

One of the changes upon reformation of curriculum from KBSM to KSSM is the re-introduction of practical assessment in Malaysian Certificate of Education (SPM). The practical assessment was fully implemented in 2021 replacing the written test; students are expected to conduct experiments individually. This is to ensure students demonstrate mastery of science process and manipulative skills which include handling of apparatus, implementing the experiment, recording the observation, analyze and evaluate the data.

To conduct practical assessment can be challenging, especially for schools in the rural areas. Some schools do not even have a laboratory or the laboratories are too old with shortage of chemicals and consumables (ASM Advisory Report, 2011). This situation is exacerbated during the COVID (Coronavirus Disease) pandemic; classes were forced online causing another level of challenge for less privileged schools. Some teachers have innovatively delivered the practical lesson via online video demonstration however this approach does not warrant a similar experience with hands-on exposure (Bradley, 1999). When the practical test was implemented in 2021, students and parents continuously expressed their concerns over the learning of students and their readiness for practical assessment. A SPM student articulated her concern saying, “This is an important exam (SPM) for me and, as a science student, I am sitting for nine subjects. However, the paper 3 for all my science subjects cover lab work and we hardly did them during online classes” (TheVibes.com, 2021).

A breakthrough is motivated to overcome the challenge of maintaining practical classes when schools are closed or when laboratory facilities are unavailable. In the traditional setting, laboratory classes are carried out within the school timetable with teachers facilitating the lessons. The conventional laboratory lessons for Chemistry inherits two major limitations – it is inflexible and it incurs high maintenance cost. A readily available solution is the science kit which is often sold as a learning tool. Most of the kits are designed to provide entertaining experience in the learning of science. These kits aims to stimulate interest, enhance learners’ understanding and create positive habits of mind for science (Hodson, 1993; Hofstein & Lunetta, 2004). The learning process is unstructured, informal and ungoverned by a syllabus. The microscale apparatus can be an alternative for experimental learning however they are expensive and are usually designed to teach very specific topics. Given the high laboratory maintenance cost and the needs for hands on experiment, a practical kit is hence developed based on the syllabus of KSSM for Chemistry. It offers flexibility as it can be deployed in schools with laboratory constraints or to be used outside the school settings. The kit is affordable, safe and environmental-friendly providing individualized hands-on exposure. The effectiveness of the kit for learning of chemistry was evaluated through pre and post-test and questionnaires.

Materials and methods

Development of kit

Scopes of learning

The kit is designed based on Chemistry syllabus of Form 4 and Form 5, equivalent to Year 10 and Year 11 in Cambridge curriculum. Table 1 shows the scopes of the syllabus; a total of twelve (12) experiments were identified and incorporated in the kit. A manual was prepared to provide background, objective and experimental procedure with columns for records of observations/results and post-lab activity. The manual was prepared in bilingual (English and Malay language) and was completed with access to Materials Safety Data Sheet.

Table 1:

Syllabus of Chemistry and experiments for Form 4 and Form 5.

Form Theme Scopes of learning Experiment
4 Importance of chemistry
  1. Introduction to chemistry

Basic chemistry
  1. Matter and atomic structure

  2. Mole, chemical formula and chemical equations

  3. Periodic table

  4. Chemical bonding

Interactions between matters
  1. Acid, base and salts

  2. Chemical reactions

  1. To prepare a standard solution

  2. Dilution

  3. Solubility of salt in water

  4. Precipitation (double decomposition reaction)

  5. Preparation of insoluble salts

  6. The role of water in showing acidic property

  7. The role of water in showing alkaline property

Industrial chemistry
  1. Manufacturing industry

5 Chemistry process
  1. Redox reactions

  1. Displacement reaction

Organic chemistry
  1. Carbon compounds

Heat
  1. Thermochemistry

  1. Exothermic and endothermic reactions

  2. Heat of displacement

  3. Heat of precipitation

  4. Heat of neutralization between strong alkali and weak acid

Technology in chemistry
  1. Polymer

  2. Consumer chemistry and industry

Optimization and design of kit

The procedures were optimized to ensure minimal quantity of chemicals were used to observe the experimental changes. The optimization takes into account of the chemicals used, the amount made available to the users, the suitable apparatus size and type, safety as well as disposal of the chemicals. This is to ensure that the kit is meets the criteria of reasonable cost, minimum hazard to users and no wastage. The chemicals are stored in individual screw cap vials and the experiment manual is included. Personal protective equipment including gloves and safety googles are provided. A mercury free thermometer is supplied to ensure users are not exposed to any hazardous risk. All chemicals and apparatus provided in the kit are summarized in Table 2. The chemicals and apparatus are provided in a kit of dimensions 32 cm (Length) × 23 cm (Width) × 16 cm (Height) as shown in Figure 1.

Table 2:

List of chemicals and apparatus provided in the kit for the experiments.

No. Chemicals/Apparatus Quantity provided
1 Ammonium sulphate, (NH4)2SO4 1.5 g
2 Barium chloride, BaCl2 0.5 g
3 Barium sulphate, BaSO4 0.5 g
4 Calcium carbonate, CaCO3 0.5 g
5 Copper (II) sulphate, CuSO4 5.0 g
6 Lead (II) chloride, PbCl2 0.5 g
7 Lead (II) nitrate, Pb(NO3)2 3.3 g
8 Oxalic acid, C2H2O4 5.5 g
9 Potassium iodide, KI 2.7 g
10 Sodium carbonate, Na2CO3 2.6 g
11 Sodium hydroxide, NaOH 5.0 g
12 Zinc metal, Zn 2 pcs
13 Beaker (50 mL) 2 units
14 Brush 1 unit
15 Conical flask (50 mL) 1 unit
16 Dropper 2 units
17 Filter funnel (40 mm) 1 unit
18 Filter paper (90 mm) 10 units
19 Glass rod 1 unit
20 Hand gloves 2 pairs
21 Litmus paper (red) 1 unit
22 Litmus paper (blue) 1 unit
23 Measuring cylinder (25 mL) 1 unit
24 Note book 1 unit
25 Pipette 1 unit
26 Pipette pump 1 unit
27 Pocket weighing scale (200 g/0.1 g) 1 unit
28 Polystyrene cup with lid 2 units
29 Reagent bottle (50 mL) 1 unit
30 Spatula 1 unit
31 Thermometer 1 unit
32 Volumetric flask (25 mL) 1 unit
33 Volumetric flask (50 mL) 1 unit
34 Washing bottle (250 mL) 1 unit
35 Weighing boat (rhombus) 55 × 35 mm 2 units
36 Safety goggles 1 unit
Figure 1: 
Photo of the laboratory practical kit.
Figure 1:

Photo of the laboratory practical kit.

Evaluation of the kit for learning of chemistry

The kit was subjected to three-stage of evaluation. The kit was first introduced to two selected students of Year 11 and Form 5 from Lodge International School and SMK Jalan Arang [“SMK” refers to the national secondary school in Malay language (Sekolah Menengah Kebangsaan)]. The preliminary assessment aims to assess the adequacy of the kit (whether the chemicals/apparatus are appropriate and sufficient) and the manual clarity. The students were provided with the kit to try out. After experiencing the kit, the students provided their feedback on the manual along with a reflection report. The kit was improved based on the feedback gathered.

The kit was then evaluated by 10 Chemistry teachers with more than 10 years of teaching experience from 9 schools around Kuching: SMK Kuching High (1), SMK Bandar Kuching No.1 (1), SMK Seri Setia (1), SMK Jalan Arang (1), SMK Padungan (2), SMK Siburan (1), SMK Paku (1), SMK Matang Jaya (1), SM Sains Kuching (1). Their feedback and suggestions were collected for improvement of the kit.

The final stage involves a total of 30 Form 5 students from 3 town schools and 1 rural school: SMK Jalan Arang (town, 13 students), SMK Pending (town, 1 student), SMK Stampin (town, 1 student) and SMK Paku (rural, 15 students). Note that a rural school is defined as a school located in areas with total population less than 10,000 according to the Ministry of Education. All the schools participated in this study are equipped with laboratories. Figure 2 shows the locations of the schools where teachers and students were involved in the assessment of the kit. The kits were delivered to the students and were given 2 months to complete the experiments at home. The students were given an assessment before and after using the kit. The pre- and post-test was conducted to evaluate the level of theoretical and empirical knowledge. It consists of 4 components – handling of materials and apparatus, theoretical fundamental, practical knowledge and laboratory safety. The score of each respondent was tabulated for statistical analysis. A questionnaire was disseminated to appraise the students’ perceptions on practical learning before and after using the kit. This study was conducted in 2021 during the COVID pandemic when schools were online. The pre- and post-test and the questionnaire were carried out using Google Form. The questionnaire was designed based on Vermaak (1997) to gauge the students’ interest in performing practical, satisfaction in practical experience, opinions and values on the importance of practical in learning of chemistry. The responses are a 5-point Likert scale of 5: Strongly Agree, 4: Agree, 3: Neutral, 2: Disagree and 1: Strongly Disagree. The responses obtained was analyzed using t-test to determine whether there is any significance difference in the followings before and after using the kit (α = 0.05):

  1. the knowledge level of students;

  2. the attitude of students towards learning of chemistry;

  3. the knowledge level of students in rural and town schools;

  4. the attitude of students in rural and town schools.

Figure 2: 
Locations of schools involved in assessment of the practical kit.
Figure 2:

Locations of schools involved in assessment of the practical kit.

The process of evaluation was facilitated where demonstration videos were uploaded in YouTube (https://youtube.com/playlist?list=PLj4JnmNj-rhPLO7uMrQ8FUnwHQ8yWfm0U) and the learning was guided via Google Meeting.

Results and discussion

The practical kit received positive responses from two selected students during the preliminary assessment. The students expressed that the practical experience makes their learning in the classroom relatable.

“There were many activities that were very relatable to what I have been studying in textbooks.”

“The kit helps me in understanding reaction and analyzing chemical reaction in a different way”.

The teachers’ responses on the kit were highly encouraging. All teachers agree that the manual is easy-to-read, and the procedure is easy-to-follow. The list and description of apparatus help the students to recognize common glassware used in the laboratory. The background knowledge provided in each experiment serves to remind the students on the related fundamental. The materials and apparatus in the kit are adequate and easy to find. The post-lab questions can be used to evaluate the students’ learning after the experiment.

The mean scores of pre- and post-test are summarized in Table 3. There is a significant improvement in the overall score after using the kit in which the improvements were recorded in all components including handling of materials, practical knowledge and the safety awareness, except theoretical fundamental. Studies evidenced that the achievement of students is profoundly governed by the science process skills which allows students to involve directly in conducting experiments, interpreting data and solving problems (Baser & Durmus, 2010; Irwanto et al., 2018).

Table 3:

Mean scores of pre- and post-test.

Component of assessment Mean
Pre- Post-
Handling of materials and apparatus 15.17 23.33a
Theoretical fundamental 21.17 22.83
Practical knowledge 14.83 21.33a
Laboratory safety 19.83 22.83a
Overall score 71.00 90.32a
  1. a p < 0.05.

The performance of the pre- and post-test was examined based on types of schools (town and rural schools). The mean scores according to schools are shown in Table 4. Both rural and town schools demonstrate a marked increase in the overall mean scores in the post-test with improvements exhibited in handling of materials and safety understanding (p < 0.05). Likewise, no statistical difference (p > 0.05) is found in the theoretical knowledge of students from both school types, before and after using the kit. In the aspect of practical knowledge, students from the rural school attain a lower score (mean score = 13.00) compared to those from the town schools (mean score = 16.67). After using the kit, the mean score in practical knowledge achieved by students from both schools showed a significant improvement with a comparable mean score of 23.33. The National Science Education Standards in the United States and other contemporary science education literature ascertained that practical is an important medium to introduce students to central conceptual, procedural knowledge and skills in science (Bybee, 2000).

Table 4:

Mean scores of pre- and post-test according to school types (town and rural).

Component of assessment Mean (rural) Mean (town)
Pre- Post- Pre- Post-
Handling materials and apparatus 15.67 24.67a 14.67 22.00a
Theoretical fundamental 21.00 22.67 21.33 23.00
Practical knowledge 13.00 21.33a 16.67 21.33
Laboratory safety rules 19.00 22.67a 20.67 23.00
Overall score 68.67 91.34a 73.34 89.33a
  1. a p < 0.05.

The attitude of the students towards learning of chemistry, before and after using the kit, was examined. The mean score of attitude according to factors are tabulated in Table 5. The results indicate that the practical kit has boosted the students’ interest in learning chemistry. This positive experience of laboratory work in promoting learning of chemistry is corroborated in numerous studies (Hofstein and Lunetta, 2004; Lunetta et al., 2007; Thompson & Soyibo, 2002). Tesfamariam et al. (2014) supports that a small scale kit allows the students to perform experiments individually, enhancing active learning rendering chemistry classes more interesting and enjoyable. Given the opportunities to handle the equipment and materials, students are able to construct the knowledge of phenomena and make the scientific concept relatable (Tobin, 1990). Laboratory activities play a central role in the science curriculum; educators have consistently supported the benefits accrue from engaging students in the laboratory activities. The practical experience also fosters the development of skills in cooperation and communication (Hofstein and Lunetta, 2004).

Table 5:

Mean score of attitude towards laboratory practical before and after using the kit.

Factors assessed Items Mean (N = 30) p-Value
Pre- Post-
Students’ interest in doing practical work in chemistry
  1. Performing experiments in chemistry increases my interest in the subject.

3.27 4.53 p < 0.05
  1. Learning chemistry without practical is uninteresting.

3.70 4.50
  1. Chemistry practical work is very tiring.

3.37 2.13
  1. The more time I spend on chemistry practical work the greater my interest.

3.70 4.23
Students’ satisfaction in performing laboratory practical
  1. Practical work in chemistry is boring and routine.

3.03 1.53 p < 0.05
  1. I enjoy seeing things for myself during practical.

3.50 4.63
  1. I enjoy handling equipment and chemicals.

3.63 4.33
  1. Performing chemistry experiments is too complicated for me.

3.47 2.00
  1. I am looking forward to the next chemistry experiment.

3.97 4.43
  1. I prefer lessons given by the teacher because practical work is disorganized.

3.36 2.23
  1. I do not like chemistry experiments because the observations are never exact.

3.23 1.83
  1. With the help of practical work, chemistry comes alive.

3.37 4.43
Opinions about laboratory practical
  1. Performing experiments in chemistry is a waste of money

3.37 1.46 p < 0.05
  1. More time should be devoted to chemistry practical works

2.73 3.97
  1. If I do many experiments myself, I will do better in the exams

3.20 4.33
  1. Periods for practical are a waste of times

3.73 1.40
  1. Viewing videos which show experiments being performed is better than doing the experiment myself.

3.13 2.20
  1. Practical work remains important even after the novelty wears offs

3.27 3.70
  1. It is sufficient for one pupil to perform the experiment and the rest to get the results from him.

3.23 2.13
  1. There is no sense of redoing experiments that scientists have done in the past.

3.50 1.86
Attitude towards laboratory practical
  1. I prefer doing experiments myself to watching the teacher demonstrate them.

2.63 3.70 p < 0.05
  1. I learn more when I do the experiment myself.

3.07 4.50
  1. I prefer reading my chemistry book to doing experiments.

3.33 2.63
  1. Chemistry can be learnt and understood without practical.

3.30 2.20
  1. I understand basic concepts better when I perform the experiment myself.

3.60 4.53
  1. Performing experiments help me understand the theory better.

3.93 4.63
Perception about the importance of practical
  1. Chemistry practical work too relevant with my daily life.

2.90 3.67 p < 0.05
  1. Doing chemistry practical work can apply chemistry knowledge in solving problems.

3.70 4.60

The perceptions of students from rural and town schools towards laboratory practical, before and after using the kit, are summarized in Table 6. There is an improvement in affection for chemistry among students from both school types where a greater increment is recorded in the rural school. The level of satisfaction has also increased when performing practical using the kit. Students find practical work relatively useful and enjoyable compared to other teaching and learning activities (Cerini et al., 2003).

Table 6:

The mean score of attitude towards laboratory practical before and after using the kit for students from rural and town schools.

Factors assessed Mean (Rural) p-Value Mean (Town) p-Value
Pre Post Pre Post
  1. Students’ interest in doing practical work in chemistry: performing experiments in chemistry increases my interest in the subject

3.20 4.53 p < 0.05 3.33 4.53 p < 0.05
  1. Students’ satisfaction in performing laboratory practical: with the help of practical, chemistry comes alive

3.33 4.40 p < 0.05 3.40 4.47 p < 0.05
  1. Opinions about laboratory practical: more time should be devoted to chemistry practical work

2.33 3.93 p < 0.05 2.87 4.00 p < 0.05
  1. Attitude towards laboratory practical: I understand the basic concepts better when I perform the experiment myself.

3.53 4.47 p < 0.05 3.67 4.60 p < 0.05
  1. Perception about the importance of practical: doing chemistry practical work can apply chemistry knowledge in solving problems

3.30 4.60 p < 0.05 3.47 4.60 p < 0.05

The opinions of students on the usefulness of the kit are shown in Table 7. For item 1, 2, 6 and 13, 100% of students agree that the practical kit has helped to improve their skills in handling chemicals and apparatus in the practical exam. It is agreed that the kit provides more opportunity for hands-on and has improved their understanding on the fundamental. For item 4, 5, 9, 10, 11, 12, 14, 15 and 16, above 75% of the students acknowledge increase in their interest for chemistry and they appreciate the experience of working like a chemist. They are willing to do more experiments and indicate that the experiments can be completed quickly without problems in capturing the observations.

Table 7:

Students’ opinion about the practical kit.

Students’ perception Percentage of students (%)
Agree/strongly agree Neutral Disagree/strongly disagree
  1. I like to use the practical kit.

100.00 0.00 0.00
  1. The practical kit helps me to improve my skills in handling chemicals and apparatus in practical exam.

100.00 0.00 0.00
  1. It is difficult to handle the materials and apparatus in the kit.

3.33 20.00 76.67
  1. The practical kit boosts my interest in learning chemistry.

90.00 10.00 0.00
  1. I hope my teacher can use the practical kit in my school.

80.00 20.00 0.00
  1. Doing the experiment in the kit makes me understand chemistry concepts better.

100.00 0.00 0.00
  1. The result of experiments cannot be observed easily.

10.00 30.00 60.00
  1. I was afraid to try out the experiments using the kit.

6.67 16.67 76.66
  1. The experiments in the kit can be completed quickly.

76.67 20.00 3.33
  1. It is fun to do the experiments using the kit.

93.33 6.67 0.00
  1. I am willing to do more experiments.

90.00 10.00 0.00
  1. I am more aware about the safety of chemicals after using the kit.

76.66 16.67 6.67
  1. The practical kit gives me more opportunity to use the chemicals and apparatus than before.

100.00 0.00 0.00
  1. The practical kit makes me feel that I am working like a chemist.

86.67 13.33 0.00
  1. I think the practical exam is easier when my teacher use the practical kit in school.

80.00 20.00 0.00
  1. I will buy this practical kit if it is available in the market.

80.00 16.67 3.33

Students also express their learning experience in chemistry after using the kit. Some of the comments are extracted below. Students’ attitudes toward chemistry are positive and they have developed science process skills through the practical experience. The learning process is shifted to become “student-centered” rather than “teacher-centered”.

“By having a chance doing my own experiment, it increases my interest in Chemistry. I feel like I am a scientist!”

“It enhances and makes me more interested in handling experiment on my own with the guidance of the teacher.”

“I don’t like to do experiment because I’m sacred to handle the chemicals but the kit helps me to overcome that. This kit boosts my love for chemistry.”

“It gives me confident when it comes to chemistry practical. It is great to do the experiment for the preparation of SPM next year.”

“Everything needed is just packed a box. I never thought of doing experiments at home before! I believe this kit will help students since we cannot do the experiments at school.”

“through this practical kit, I can learn Chemistry by theories and also by doing experiments.”

The kit is designed for inquiry-based learning similar to the traditional lab, emphasizing on psychomotor experience involving physical investigation. Research shows that hands-on experiences in science laboratory play a central role in scientific education (Hofstein & Lunetta, 2004; Hofstein & Mamlok-Naaman, 2007; Ma & Nickerson, 2006; Satterthwait, 2010; Singer, Hilton, & Schweingruber, 2006; Tobin, 1990). It contributes to better assimilation of knowledge and help students to acquire critical reasoning skills (Gros, 2012; Lamba, 2015).

Scott (2009) revealed that students who completed science courses using non-traditional lab (virtual and remote) demonstrated significantly lower mean course grades and a lower passing rate than those with traditional labs (hands-on). Sicker et al. (2005) likewise suggests that students with traditional lab experience has out-performed those exposed to virtual laboratories. Although in this study, we observed positive outcomes from the hands-on practical, there are studies demonstrating comparable or greater outcome achievements in non-traditional delivery over the traditional lab (Brinson, 2015; Farrokhnia & Esmailpour, 2010; Frederick, 2013; Hawkins & Phelps, 2013; Tzafestas et al., 2006). Chan et al. (2021) advocates that virtual chemical laboratories can be as effective or even better than the conventional hands-on laboratory. Despite that, Colorado DOHE (2012) compared students who completed biology, chemistry and physics with non-traditional and traditional laboratory learning concluding that the latter group achieved significantly better grades in biology and chemistry with no statistical difference in physics. Various technologically-mediated approaches are made available to substitute or to be blended with the traditional laboratory learning. Nevertheless, the laboratory skills and experience with the specific equipment and supplies are not transferrable via online delivery. Chan et al. (2021) concluded that better learning outcomes are a result of combination of virtual and hands-on laboratory learning.

Conclusions

The laboratory kit developed based on the National Curriculum of Chemistry for Secondary School offered positive learning experience and increased the motivation for learning in students from rural and town schools. In time that schools are closed due to the COVID pandemic, it is an alternative to expose students to laboratory learning. The kit is designed to provide structured learning with flexibility in learning spaces and paces. It can be a take-home laboratory kit or to be used in the classroom setting. The kit is affordable, cost saving and environmental friendly.


Corresponding author: Siong Fong Sim, Faculty of Resource Science & Technology, Universiti Malaysia Sarawak, 94300 Kota Samarahan, Sarawak, Malaysia, E-mail:

Funding source: Ministry of Education, Malaysia

Award Identifier / Grant number: KPM:BBP.700-31/20/

Acknowledgments

The authors thanks Universiti Malaysia Sarawak for supporting this work. Thanks are also due to the Ministry of Education for the scholarship for this study (KPM:BBP.700-31/20/).

  1. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  2. Research funding: The funding organizations played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication. This study was funded by Ministry of Education, Malaysia (KPM:BBP.700-31/20/) and Universiti Malaysia Sarawak.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. Ethical approval: The local Institutional Review Board deemed the study exempt from review.

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Received: 2022-06-29
Accepted: 2022-09-13
Published Online: 2022-10-11

© 2022 the author(s), published by De Gruyter, Berlin/Boston

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