Introduction
The United Nations Educational, Scientific and Cultural Organization (UNESCO) stated in 2013 that
students must be prepared to perform jobs that do not yet exist and must continuously renew a significant portion of their knowledge and skills. They must acquire new competencies aligned with this new order: information management, communication, problem-solving, critical thinking, creativity, innovation, autonomy, collaboration, teamwork, among others (UNESCO, 2013, p. 15).
Providing learning resources that incorporate Information and Communication Technologies (ICTs) can facilitate the development of the necessary skills to improve university students’ professional performance, provided that pedagogical designs allow for the effective use of their potential and the mitigation of negative externalities (Maluenda-Albornoz, 2021).
ICTs strong influence contemporary life across domains. This has brought changes in the structure of the economy, politics, society, culture, and education, among other areas (Islas, 2017; Piñón et al., 2022).
Universities cannot remain detached from these transformations. Since the emergence of ICTs, there has been a gradual shift in the way knowledge is delivered, establishing diverse teaching environments using these tools. Some experts argue the trend toward virtuality, accelerated by the COVID-19 pandemic, is here to stay (Baladrón Pazos et al., 2020). ICTs have become essential elements in the development of teaching and learning processes through new knowledge environments within universities (Basilaia et al., 2020). Consequently, ICT-mediated practices must acknowledge the key factors that enable their effective use for educational purposes.
Various studies conducted in virtual environments have highlighted the importance of maintaining a climate of engagement and participation (Baladrón Pazos et al., 2020; Essa Al Lily et al., 2020), as well as the need for support, guidance, and orientation from instructors (Maluenda-Albornoz et al., 2022d), and the proper design and planning of activities to ensure meaningful learning experiences (Essa Al Lily et al., 2020). Additionally, factors such as uncertainty (Maluenda-Albornoz et al., 2022b; Jung et al., 2021) and the lack of interpersonal connection within educational contexts (Maluenda-Albornoz et al., 2022a; Maluenda-Albornoz et al., 2022c) have been observed to generate negative impacts.
Cooperation among countries within the same geographic region that share common characteristics, such as language and historical background, strengthens their exchange of knowledge, experiences, and technologies across various fields, including health. It fosters change and contributes to dialogue around shared realities and challenges, in the pursuit of more efficient and contextually appropriate solutions. Universities actively participate in cooperation efforts, both as implementers and promoters. The cooperation approach is designed to respond to internal logics associated with capacity development and institutional strengthening. Educational cooperation in Latin America has intensified over the past decade, driven by the need for countries to strengthen intra-regional relations and by regional integration agreements. This has occurred within a broader context that increasingly advocates for the internationalisation of higher education, science, technology, and innovation (Perrota, 2015; Bruhn-Zass, 2022).
In response to these dynamics, a course was created to contribute to students’ interdisciplinary and international education. This initiative involved cooperation among various Latin American universities, which provided a virtual and distance learning platform for training. The course included professors and students from diverse disciplines and cultures, working together to address health-related challenges in the region. Additionally, it aimed to foster interaction, exchange of experiences and ideas, and the recognition and acceptance of the similarities and differences in the cultural environments of students from universities in Chile, Colombia, and Mexico.
Engagement
Engagement is a multidimensional phenomenon that can be examined through the three-dimensional framework based on Self-Determination Theory (SDT). It defines engagement as a meta-construct composed of three interrelated dimensions: behavioural engagement (participation, effort, and persistence), emotional engagement (interest, enthusiasm, and low anxiety), and cognitive engagement (concentration, strategic thinking, and self-regulation) (Fredricks et al., 2004). This approach emphasises the satisfaction of the three basic psychological needs – autonomy, competence, and relatedness – as essential for fostering engagement (Deci et al., 2017).
Understanding the importance of academic engagement involves recognising its role in enhancing students’ quality of life, motivation, and learning outcomes. Students who demonstrate high levels of engagement tend to employ more adaptive behavioural patterns that contribute to psychological well-being (Tuominen-Soini & Salmela-Aro, 2014). Conversely, low engagement is negatively associated with higher dropout rates, avoidance of academic activities, exhaustion, and burnout (Salanova et al., 2009).
Self-Determination Theory (Deci & Ryan, 1985) posits that self-motivation is necessary for learning, social interaction, and task involvement. Self-motivated students understand and retain information more effectively and experience lower levels of academic anxiety, which strengthens their continuous desire to learn (Oriol-Granado et al., 2017).
Research has consistently confirmed the relationship between academic motivation and student engagement. Findings suggest that students’ adjustment is directly influenced by their level of motivation (Truta et al., 2018), which affects the intensity and persistence of their efforts towards achieving their goals (Werner & Milyavskaya, 2018). Motivated students not only employ more effective learning strategies, but also optimise their tasks, regulate their emotions, and engage more deeply with the academic environment (Ben-Eliyahu et al., 2018). Similarly, student engagement is closely linked to the use of learning strategies and task control. This association manifests at two levels: a more concrete level, related to effort and involvement in specific tasks (such as exam preparation), and a more general level, concerning enthusiasm and motivation for learning (Biggs, 1993). Both associations are explained through cognitive and emotional processes that help students to develop strategies to meet academic demands through control, involvement, and motivation (Agger & Koenka, 2019).
Ultimately, the interplay of academic motivation and student engagement enhances the development of effective learning strategies. Engaged students are more willing to face new challenges, which leads to deeper learning experiences, improved study habits, greater persistence, and a more adaptive learning process (Perkmann et al., 2021). This results in better long-term academic performance (Larson et al., 2019). In contrast, students who are less engaged are more likely to be less motivated.
Active Methodologies: A Framework to Enhance Student Motivation and Engagement
Historically, educational approaches have been centred on a hierarchical and unidirectional relationship, where students have been viewed as passive agents, merely recipients of new subjects and knowledge, thereby limiting their potential (Cardoso & Ramos, 2021). In response, an alternative perspective has emerged, shifting traditional approaches into active methodologies, in which instructors design opportunities that foster active student participation (Labrador & Andreu, 2008), resulting in a learning process focused on activities rather than content (Silva & Maturana, 2017).
Collaborative work is considered an active methodology, that optimises academic performance, and boosts student engagement and motivation through activities with a sense of joint purpose and efforts toward a shared goal. Collaborative learning promotes an environment where students become active participants in their learning process. The collective discussion of ideas, knowledge sharing, and problem solving reinforce existing knowledge. In addition, this process also facilitates the acquisition of new perspectives through interaction and dialogue (Educarchile, 2023). According to Qureshi et al. (2023), this social interaction inherent in collaborative work fosters greater commitment, which in turn facilitates knowledge transfer, creating a more positive learning environment.
When students feel part of a group and perceive their success as linked to collective achievement, their sense of belonging and responsibility increases (CBB, 2024). Peer connection and the attainment of shared goals foster an environment that inspires active and sustained participation in learning. Research also indicates that collaborative learning promotes intrinsic motivation by encouraging students to take ownership of their learning and receive immediate feedback from their peers (Añorve et al., 2024).
In this context, Project-Based Learning (PBL) has also emerged as a pedagogical strategy that invites students to take an active role in their learning by engaging in practices that develop skills such as research, exploration, and problem-solving (Enríquez, 2021). Given the educational demand for knowledge retention, the incorporation of methodologies like PBL represents a transformative strategy. Beyond shifting the student’s role to a more active one, it allows learners to identify with the task, giving academic achievement a purpose that transcends personal interest and granting students a protagonist and autonomous role that increases motivation and engagement, thereby strengthening their commitment to learning (Luy-Montejo, 2019).
Moreover, when project-based learning is aligned with a meaningful purpose for students, a “purpose for learning” emerges. This is defined as a self-oriented goal motivated by the opportunity for personal benefit and the impact of contributing to others through self-transcendence (Yeager & Bundick, 2009). The coexistence of both goal types yields benefits that self-oriented goals alone cannot achieve. By adding a self-transcendent component, motivation is sustained due to its intrinsic nature, which in turn supports self-regulation when tasks become challenging (Yeager, 2024).
Additionally, Inquiry-Based Learning also qualifies as an active learning methodology. It stands out not only for its ability to intersect collaborative work and project-based learning, but also for enabling students to connect theory and practice (Mora, 2009). This approach transforms learning into an opportunity for analysis, experimentation, and innovation (Rodríguez & Bustillos, 2017), generating intrinsic motivation through students’ active participation in constructing meaning from content (Biggs, 2008).
Considering the above, this study explores how collaboration and the development of purpose-driven projects within a framework of international research cooperation enhance students’ engagement experiences. The objective of this study is to evaluate the outcomes in student engagement within a course designed in an international online format and to identify the technological factors that supported this experience.
Unlike previous research on academic engagement in virtual environments, this study offers an innovative perspective by simultaneously integrating three key elements: interdisciplinarity, internationalisation, and the strategic use of collaborative digital tools. This combination enabled the design of a learning experience focused on the development of health research projects, carried out by students from diverse disciplines and Latin American countries. This approach not only fosters academic engagement from emotional, cognitive, and behavioural perspectives, but also encourages intercultural dialogue, the formation of collaborative networks, and the development of global competencies. In this regard, the study makes an original contribution to the field of higher education in Latin America, demonstrating how deliberate pedagogical design can enhance engagement in complex and diverse virtual contexts.
Methodology
Design and Instruments
A mixed-method study was conducted, combining qualitative and quantitative approaches within a descriptive cross-sectional design. Prior to the start of the study, participants completed a digital informed consent form, which outlined the objectives, procedures, benefits, risks, and rights associated with their voluntary participation. To ensure confidentiality, no identifiable information was collected, and all data were managed exclusively by the principal investigator. The analysis was conducted in aggregate form, guaranteeing the anonymity of both students and instructors.
Participants attended a course delivered in a virtual format, facilitated by an interdisciplinary and international teaching team, with a strong emphasis on the use of collaborative digital tools, the design and implementation of which are detailed in subsequent sections.
Upon completion of the course, students were administered a questionnaire consisting of nine items aimed at capturing their experience of academic engagement. These items were developed based on the three-dimensional engagement model by Fredricks, Blumenfeld, and Paris (2004), which considersthree interrelated dimensions: emotional engagement, behavioural engagement, and cognitive engagement. Greater emphasis was placed on the emotional dimension due to the specific characteristics of the course, which was designed to be delivered entirely online, with a strong component of synchronous and international interaction In such contexts, emotional connection with activities, instructors, and classmates is essential to sustain motivation, sense of belonging, and active participation, especially in the absence of face-to-face contact (Maluenda-Albornoz et al., 2022a; Jung et al., 2021). Several studies have indicated that the lack of interpersonal connection in virtual environments can negatively affect the educational experience, whereas pedagogical designs that foster enthusiasm, enjoyment, and emotional engagement contribute to a positive virtual classroom climate (Li & Tsai, 2020; Molina et al., 2021). Therefore, priority was given to evaluating indicators related to emotional engagement, which is considered key to understanding the emotional impact of pedagogical design on the learning experience. The emotional dimension was assessed through four items that explored enthusiasm and affective connection with the course activities and learning process, such as:
“During the activities, I felt full of energy and eager to participate.”
“During the activities, I felt I enjoyed participating and time flew by.”
“During the activities of this course, I felt full of energy and eager to participate.”
“During the activities of this course, I felt I enjoyed participating and time flew by.”
The behavioural dimension was evaluated through three items reflecting active participation, sustained effort, and persistence, such as:
“During the activities of this course, I felt I could stay engaged for a long time.”
“During the classes, I shared my preferences and opinions.”
“When I needed something during class, I asked the instructors.”
These items allowed for observation of the observable involvement in course dynamics. The cognitive dimension was represented by two items that explored the use of learning strategies, self-regulation, and reflection, such as:
“During class, I used to ask questions to improve my learning.”
“During the course, I allowed my instructors to learn about what interested me.”
These questions aimed to identify students’ intellectual engagement with the content and their ability to connect it with their personal interests.
This classification allowed for a more precise evaluation of the academic engagement experienced by students, considering their quantitative responses through a Likert-type scale ranging from 1 to 10, where 1 indicated complete disagreement, 2 strong disagreement, 3 moderate disagreement, 4 slight disagreement, 5 mildly disagree, 6 mildly agree, 7 slight agreement, 8 moderate agreement, 9 strong agreement and 10 complete agreement. In the context of this study, the use of the Likert scale is justified by its ability to convert subjective attitudes and perceptions into quantifiable data, allowing for a richer and more nuanced analysis of the complex constructs addressed, such as emotional, behavioural, and cognitive engagement (Fredricks et al., 2004; Matas, 2018). Specifically, the 10-point scale is particularly relevant in this context, as individual experiences may vary significantly in diverse and virtual learning environments (Méndez Hinojosa et al., 2021). Furthermore, Likert-type scales are widely recognised in educational research for their methodological robustness and suitability for descriptive cross-sectional designs, allowing for the use of measures of central tendency and dispersion to identify general patterns (Fabila Echauri et al., 2013). After completing the questionnaire, students were asked an open-ended question to capture their perceptions: “In your opinion, which aspects related to the tools used in this course provided the greatest benefit to your engagement?”This question aimed to explore key elements related to the use of collaborative digital tools implemented to support academic engagement.
To gather instructors’ perspectives on the contribution of digital tools to student engagement, a different question was posed: “Of the tools used, which aspects do you consider contributed most significantly to student engagement in this course?” This question focused on collecting their insights regarding the differential impact of these tools on students’ academic engagement. The results of the nine-item questionnaire were analysed using descriptive statistics. Meanwhile, responses to both open-ended questions were categorised through content analysis, identifying predominant categories based on the frequency of associated responses.
Course Characteristics
A multidisciplinary teaching team was assembled, composed of faculty members from various Latin American countries, representing the following institutions: Universidad de Concepción, Chile (1 professor); Universidad San Sebastián, Chile (1 professor); Instituto Tecnológico Metropolitano, Colombia (1 professor); Corporación Universitaria del Caribe, Colombia (1 professor); Universidad de La Sierra del Sur, Mexico (1 professor); and Universidad de El Salvador (1 professor). These faculty members specialise in the fields of chemistry and pharmacy, psychology, electronic engineering, social work, economics, and chemistry, respectively.
Students in the final years of their degree programmes were invited to participate in the course voluntarily. The course was organised into 12 sessions over a three-month period, focusing on the following topics: Major health issues in Latin America and the current approaches to address them, Research methods, epistemology of knowledge, and scientific inquiry across disciplines, Innovative solutions considering social, economic, climatic, and cultural differences, Teamwork and effective communication.
Parallel with the classes, a three-month module was conducted, to develop health research projects. The objective of this module was to identify the most viable projects for implementation at the Ibero-American level, using project relevance evaluation methodologies. Six interdisciplinary and international student groups were formed, each guided by a faculty advisor. Each group developed a health research project proposal during the course.
Experience Design
The entire experience was pre-designed to be delivered virtually. The lectures, working groups, and collaborative analysis sessions were conducted online using the Zoom® platform.
Lectures were held weekly over one academic semester, each lasting 30 minutes, and aimed to introduce key concepts and initiate group discussions. Following each lecture, a 30-minute collective discussion was held, guided by pre-designed questions intended to stimulate debate and reflection on the topic. Virtual breakout groups were organised for these discussions. For example:
a) In the session on current health issues, students were asked to identify the most prevalent health problems in their city and reflect on possible reasons for their prevalence.
b) In the session on research methodologies across disciplines, students were asked to compare differences in scientific approaches based on their own academic experiences.
At the end of each session, students returned to the main room to briefly present their insights and conclusions in a plenary format.
In addition to the live sessions, short video capsules of approximately 15 minutes were created and uploaded to YouTube®, focusing on specific content or work methods. For instance, one capsule explained the key milestones in developing a health research project, while another taught how to approach reading a research article. These capsules were intended to be reviewed by students before each session to enhance the quality of analysis and discussions. These materials remained available for future reference according to individual needs.
Biweekly meetings with the assigned faculty advisor were held to address questions, review progress, discuss critical issues, and provide additional materials and guidance for each project. Students and their advisor collaboratively defined objectives and activities using a Gantt chart organised on the Trello® platform. This chart included individual and collaborative tasks, submission deadlines, and progress tracking. This space was essential for maintaining real-time activity, monitoring progress, and fostering co-responsibility in task completion.
Additionally, the course included a repository of guides, activities, and materials hosted on Google Drive®, available from the beginning of the course and accessible at all times. Materials were progressively uploaded to the repository as required by the course activities.
Results
The 59 students who completed the evaluation participated in a course delivered entirely in an online format, which involved synchronous and international interaction dynamics mediated by collaborative digital tools. The sample consisted of 44% male and 56% female students, with an age range between 18 and 24 years.
Regarding the level of academic engagement experienced, average scores ranged from 5.28 to 8.2. The highest-rated aspects were those related to emotional engagement, such as feeling energised, eagerness to participate, and losing track of the time during the activities. In contrast, the lowest-rated aspect was active participation by asking questions, which may be associated with the inherent limitations of interaction in digital environments (see Table 1).
Table 1
Academic Engagement Results of Students.
| ITEMS | DESCRIPTIVE STATISTICS |
|---|---|
| During the activities, I felt full of energy and eager to participate. | ( = 8.2; σ = 1.65) |
| During the activities, I felt I enjoyed participating and time flew by. | ( = 8.2; σ = 1.70) |
| During the activities of this course, I felt full of energy and eager to participate. | ( = 8.19; σ = 1.611) |
| During the activities of this course, I felt I enjoyed participating and time flew by. | ( = 8.19; σ =1.704) |
| During the activities of this course, I felt I could stay engaged for a long time. | ( = 7.86; σ =1.641) |
| During the classes, I shared my preferences and opinions. | ( = 6.39; σ = 2.589) |
| When I needed something during class, I asked the instructors. | ( = 6.75; σ =2.892) |
| During class, I used to ask questions to improve my learning. | ( = 5.28; σ =3.86) |
| During the course, I allowed my instructors to learn about what interested me. | ( = 6.36; σ = 2.368) |
To examine students’ perceptions of the benefits of the tools used during the course, a content analysis was conducted to identify emerging aspects from the various responses. From a total of 42 student responses, 86 content units were extracted, which were grouped into four emerging aspects (see Table 2). Among these, the most frequently mentioned contributions included the role of technologies in facilitating collaboration and effective exchange in research work despite geographical distance. These tools enabled connections that might not have occurred otherwise, and the potential to establish future collaboration networks. Additionally, in response to the question posed to instructors regarding the contribution of the tools used to student learning, a content analysis was also conducted to identify emerging aspects from their responses. From a total of six instructor responses, 17 content units were extracted and grouped into three emerging aspects (see Table 3). The most frequently highlighted aspects included the organisational and administrative capabilities provided by digital platforms, the possibility of synchronous connection across countries, and the effectiveness of these tools in providing feedback and monitoring project progress.
Table 2
Contribution of Technological Tools.
| THEME | FREQUENCY |
|---|---|
| Collaborative software (Zoom and Trello) facilitated efficient teamwork among individuals from different countries and culturally diverse backgrounds. | 31 |
| The synchronous connection platform (Zoom) enabled interaction and networking with individuals from other countries, fostering the creation of professional collaboration networks. | 23 |
| The project management software (Trello) supported organisation, helped structure tasks and timelines, and encouraged adherence to established commitments. Its continuous and updated notifications, along with easily accessible information, contributed to a sense of ongoing progress. | 17 |
| The platforms used to organise and share materials provided by instructors and developed by students were accessible at all times and clearly structured, helping to save time and reduce confusion and frustration. | 15 |
[i] Note: The reported frequencies indicate that some responses included content related to more than one category.
Table 3
Contribution of Technological Tools.
| THEME | FREQUENCY |
|---|---|
| The tools used (Trello and Drive) enabled more efficient and simplified organisation and administration of the course, accommodating the diversity of participating students, their varying schedules (time zones), and the availability of instructors. This was made possible by the 24/7 accessibility of the platforms, real-time notifications, and the ease of access to information they provided. | 6 |
| The tools facilitated synchronous connection (Zoom) among students from different countries, despite the inherent complexities of international collaboration. | 6 |
| The user-friendly interface and immediate availability of information (Trello) significantly supported the monitoring, correction, and feedback processes regarding student progress, allowing for fluid and real-time interaction between instructors and students. | 5 |
Discussion and Conclusions
This article aimed to evaluate the student engagement outcomes in a course designed in an international online format, incorporating technological tools for learning. Additionally, it sought to identify the technological factors that contributed positively to the learning experience.
In relation to the first objective, the academic engagement experience generally showed positive results, with high average scores in enthusiasm and connection with the course. The lowest scores were observed in active participation through questions and requests, although these values still tended toward the higher end of the scale. These findings align with previous research indicating that courses designed with intentional pedagogical planning and purposeful use of technology can enhance learning processes and improve student experiences (Senkbeil, 2018). Virtual courses that incorporate relevant materials enabling the application of knowledge (Molina et al., 2021) and that utilise technological tools to support specific learning processes (Goldhammer et al., 2017) have shown to foster greater engagement with academic activities.
This lower score in active questioning opens a valuable line of inquiry into potential limitations of the virtual format in fostering cognitive engagement. Several emerging hypotheses may help explain this result: (1) technological mediation may inhibit spontaneous interaction, as students might feel less comfortable or confident asking questions in a virtual setting due to the lack of immediacy or fear of judgment (Maluenda-Albornoz et al., 2022d; Jung et al., 2021); (2) cultural and linguistic diversity among participants may have influenced communication dynamics, as students from different backgrounds may hold varying norms regarding classroom participation and questioning; and (3) the instructional design of the course may have prioritised emotional and behavioural engagement over cognitive stimulation through inquiry. These insights suggest that while digital tools effectively support emotional and behavioural engagement, additional pedagogical strategies are needed to enhance cognitive engagement. Future iterations of the course could benefit from integrating interactive techniques such as breakout room debates, anonymous question boards, or pre-session reflective prompts to encourage deeper intellectual involvement and reduce barriers to active questioning.
Considering the qualitative results related to the second objective, it was observed that the planned use of synchronous collaboration tools (e.g., short meetings and discussion questions) facilitated student interaction and enhanced the effectiveness of these sessions. Previous research has shown that fluid and meaningful interpersonal contact not only contributes to a positive virtual classroom climate, but also stimulates active participation and efficient time-management (Molina et al., 2021; Li & Tsai, 2020).
Activities were planned using project management platforms and a well-structured Gantt chart, allowing both student self-regulation and external monitoring by instructors, while also enabling effective feedback, despite time zone differences and individual schedules. Prior studies have found that well-defined checkpoints enhance students’ self-regulation in long-term tasks (Zambrano et al., 2021), and that timely and effective feedback is essential not only for maintaining motivation but also for ensuring its usefulness in the learning process (Gonzáles Ramírez & García-Hernández, 2020).
In this regard, the virtual support system used in the course allowed for more efficient, user-friendly, and agile management of activities, task distribution, workload, progress notifications, and deadline tracking. The continuous availability of materials and the possibility of real-time collaborative work enabled participants to engage in a continuous learning process, and recognise the steady progress of their projects and activities.
One limitation of this study is that it did not evaluate how interest in the subject matter and connection with instructors may have influenced students’ level of engagement. These factors have been highlighted in previous research, which found that close connections with instructors as well as interest in the course content are significant contributors to academic engagement (Gonzáles Ramírez & García-Hernández, 2020). To some extent, the first factor was indirectly addressed through the open-ended student question, where participants spontaneously mentioned the importance of fluid interaction and communication. However, this component was not considered in the initial design and should be included in future research to better understand the causes of the high levels of engagement observed.
In light of this, a key direction for future research involves evaluating the differential impact of various factors on academic engagement. Specifically, it would be valuable to distinguish the relative contributions of classroom climate, feedback quality, instructional design, and other pedagogical elements, in contrast to the technological tools themselves. Another promising avenue emerging from this study is the perception of a fluid and continuous experience, which appeared in the qualitative responses from both students and instructors. This aspect seems to be a critical factor for engagement, as perceiving a seamless experience may help students remain “connected” to the course, its activities, and their peers. Conversely, when a course is fragmented, slow-paced, or poorly organised due to its design or technological implementation, it may lead to frustration, disconnection, and other demotivating factors. This emerging aspect warrants further investigation in future studies focused on educational technology in virtual learning environments.
Additionally, the study did not include a demographic breakdown by gender, as the sample was provided by a separate research project. This limitation restricts the possibility of analysing potential differences in engagement across demographic subgroups, which could be relevant for future studies.
Ethics and Consent
Before administering the instruments to the participants, they were provided with an informed consent form outlining the objectives, procedures, and activities of the study, as well as the participant’s role, and the potential risks and benefits. Participants were also informed about the voluntary nature of their participation and their rights, as well as the measures taken to ensure anonymity.
Anonymity was guaranteed through the following safeguards. The forms were digital and completed remotely and independently (without supervision). No identifying information was recorded for any of the participants, whether students or teachers. All data were collected, processed, and stored exclusively by the principal investigator. Analyses and results were conducted at an aggregate level, with no individual identification.
Competing Interests
The authors have no competing interests to declare.
Author Contributions
Both authors contributed equally to the conception and design of the study, data analysis, and manuscript writing. Lilian Mardones and Ignacio A. Montoya Rodríguez jointly developed the research framework, interpreted the findings, and revised the final version of the article. Both authors have read and approved the final manuscript.