Data analysis
Data obtained in the present study were analyzed using SPSS 26.0 (SPSS Inc. Chicago, IL, USA). Descriptive statistics (percentage, mean, standard deviation) were applied, and skewness and kurtosis values were calculated to assess whether numerical variables fit a normal distribution. Each dependent variable was z-standardized before the generalized estimating equation (GEE) and independent analyses to facilitate interpreting the effect. The dependent t-test was used to compare the mean PBQ scores between the two study groups, and GEE [