Protocol for a multi-perspective exploration of technology requirements for home-based upper-limb tabletop functional task training with minimal supervision: a mixed-methods and qualitative descriptiv

In many countries, medical students are frequently exposed to elevated levels of stress, which can substantially affect their mental health and overall well-being [,], and recent evidence indicates that psychological distress remains common among health sciences students, including those in Saudi Arabia and other medical science settings [,]. A key contributor to this stress is the inherently competitive nature of medical education, where students often compare their academic performance and clinical competencies with those of their peers [,], as their career advancement, such as admission to residency programs, depends on outperforming others. While medical training involves multiple stressors [], peer comparison is especially important because it is both pervasive and socially embedded, shaping how students evaluate themselves in relation to others rather than in absolute terms []. In such environments, relative performance may become internalised as a marker of social standing among peers []. Students who view themselves as falling behind may experience a diminished sense of subjective social status (SSS), defined as individuals’ perceived rank relative to others and inherently shaped by social comparison processes. Evidence shows that low SSS is consistently associated with poorer health outcomes across diverse populations [,]. This association is thought to arise because perceptions of lower social rank can trigger psychological and physiological stress responses that adversely affect health. From a theoretical perspective, Social Rank Theory provides a useful framework for understanding these associations [,]. This theory conceptualises social hierarchies as biologically and psychologically salient systems, in which perceptions of lower rank can trigger feelings of inferiority and shame, particularly when individuals compare themselves to others with higher perceived status []. Consistent with this framework, such negative emotions may activate the body’s threat response and trigger chronic stress and sustained increases in stress hormones such as cortisol, especially among those who perceive themselves as unable to improve their relative standing []. These psychosocial and biological processes help explain why individuals who view themselves as lower on the social ladder consistently report poorer physical and mental health, including increased depressive symptoms and lower overall well-being, compared to those who perceive their status as higher [,]. The role of peer SSS may be especially pronounced in honour-based societies, such as Saudi Arabia [], where identity and self-worth are closely tied to social perception, family expectations, and community standing []. In such contexts, students may place greater emphasis on how they are perceived relative to their peers, especially in high-stakes fields like medicine, which are viewed as prestigious and socially valuable []. Moreover, the centrality of family prestige and socioeconomic reputation in many Middle Eastern cultures, including Saudi Arabia, further amplifies the importance of peer SSS []. Consequently, medical students may experience pressure not only to achieve personal success but also to uphold or enhance their family’s social standing, thereby intensifying peer comparisons. However, the present study did not directly measure honour values; cultural considerations are presented as contextual background, rather than as directly tested mechanisms.