Introduction:The widespread prevalence of exam anxiety and its detrimental effects on students' personality and social identity highlight the importance of investigating this issue. Therefore, the present study was conducted with the aim of determining the relationship between academic achievement motivation, academic stress, and academic self-efficacy with exam anxiety among medical science students in the western region of Mazandaran Province.
Materials & Methods: The research method was descriptive-correlational, and the statistical population included all medical sciences students in the western region of Mazandaran province during the academic year 1403–1404 (2024–2025). Using convenience sampling, 150 students were selected. The research tools included the Academic Stress Questionnaire by Gadzella (1991), the Academic Self-Efficacy Questionnaire by Jinks and Morgan (1999), the Achievement Motivation Questionnaire by Hermans (1970), and the Test Anxiety Questionnaire by Alpert and Haber (1960). The data were analyzed using Pearson correlation coefficient.
Results: Based on the data analysis of 150 participants,The results of data analysis indicated a significant relationship between academic achievement, motivation, academic stress, and academic self-efficacy with test anxiety (p<0.001). Specifically, higher academic achievement motivation was associated with lower levels of exam anxiety, whereas academic stress showed a positive and significant relationship with increased test anxiety (p < 0.001). Moreover, the findings revealed that academic self-efficacy plays a crucial role in reducing test anxiety; the more students believed in their ability to perform academic tasks, the lower their levels of test anxiety were.
Conclusion: Academic motivation and self-efficacy were associated with reduced test anxiety, while academic stress was positively correlated with higher levels of test anxiety. Based on these results, designing strategies to reduce exam anxiety such as educational programs focused on coping skills, time management, and enhancing academic self-concept can be effective in reducing exam anxiety and improving academic performance among students.
Acknowledgments:The authors would like to thank the Vice-Chancellor for Research of Islamic Azad University, Tonekabon Branch, for their support in conducting this study.

Availability of data and materials:The datasets generated and analyzed during the current study are available from the corresponding author, Khadijeh Hatamipour, on reasonable request.

Conflicts of interest:The authors declare that they have no conflicts of interest.

Consent for publication:The study participants and the authors consent to the publication of the article.

Ethical approval and consent to participate:This study was approved by the Research Ethics Committee of Islamic Azad University, Tonekabon Branch (ethics code: IR.IAU.TON.REC.1404.060). Participants were assured that their information would remain confidential and that they were not required to provide their names, and written informed consent to participate was obtained from all of them. The participants were informed that their participation in the study was voluntary. The participants’ data were analyzed and reported anonymously and confidentially. The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki.

Funding:The authors declare that this study received no financial support.

Authors' Contributions:Conceptualization: H.N. (50%), K.H. (50%). Study design: H.N. (50%), K.H. (50%). Data collection and/or processing: H.N. (100%). Data analysis and/or interpretation: H.N. (80%), K.H. (20%). Writing the original draft: H.N. (50%), K.H. (50%). Critical review and editing: H.N. (50%), K.H. (50%). Final approval: H.N. (50%), K.H. (50%). Accountability for all aspects of the work: H.N. (50%), K.H. (50%). (H.N.: Hoora Nabizadeh; K.H.: Khadijeh Hatamipour.).

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