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Article History

Received: 4 January 2025

Accepted: 29 July 2025

First Online: 7 August 2025

Competing interests

: The authors declare no competing interests.

: This study was approved by the Research Ethics Committee at the National Changhua University of Education. It was approved on July 11, 2018, with an approval number NCUEREC-106-024. All research was performed in accordance with the relevant guidelines and regulations, including the Declaration of Helsinki.

: Prior to participation, all subjects received a detailed participant information sheet outlining the study objectives, procedures, potential risks, and benefits. They were explicitly informed that participation was voluntary and that they could withdraw at any time without consequences. Participants were assured that all data collected would remain confidential and anonymized, with no identifying information disclosed in research outputs. Written informed consent was obtained during the week of September 10–14, 2018, from all participants before their inclusion in the study, and each participant received a copy of their signed consent form for personal records.

: This paper used Claude 3 for manuscript proofreading and reference style conversion. All AI-generated content underwent rigorous human verification and validation. The author is solely responsible for the findings and conclusions presented.