Assessment of health-promoting lifestyle
in medical students of Rafsanjan University of Medical Sciences, Iran, in 2014
Esmaili A, PhD1, Salem
Z, MSc2*, Sheikh Fathollahi M, PhD3, Rezaeian M, PhD4,
Ebrahimi Nejad S, GP5
1-Associated Professor, Occupational Environment Research Center, Dept. of Social Medicine,
Medicine Faculty, Rafsanjan University of Medical Sciences, Rafsanjan, Iran. 2-
Faculty Member, Dept. of Social Medicine and Occupational
Environment Research Center, Medical
School, Rafsanjan University of Medical Sciences, Rafsanjan, Iran. 3- Assistant
Prof, Dept. of Epidemiology and Biostatistics, , Medical School, Rafsanjan
University of Medical Sciences, Rafsanjan, Iran. 4- Professor, Dept.
of Epidemiology and Biostatistics, Occupational Environmental Research Center,
Medical School, Rafsanjan University of Medical Sciences, Rafsanjan, Iran. 5-General Practitioner, Rafsanjan
University of Medical Sciences, Rafsanjan, Iran.
Abstract Received:
December 2015,
Accepted: February 2016
Background: Health-promoting lifestyle is one of the
determination criteria for health factors and the prevention of
health-threatening factors. According to the available statistics, 53% of
deaths are related to lifestyle. The aim of this study was to evaluate health-promoting lifestyles in medical students of
Rafsanjan University of Medical Sciences (RUMS), Rafsanjan, Iran. Materials
and Methods: This
was a descriptive study conducted in 2014 on
262 volunteer medical students. To collect data, a demographic information
questionnaire and the Health-Promoting Lifestyle Profile II (HPLP-II) were
used. Minimum and maximum scores of HPLP-II were 48 and 192, respectively.
Data analysis was conducted using t-test, one-way ANOVA, Tukey's multiple
comparison test, and non-parametric Kruskal-Wallis test. Results: In this study, 58.8% of the
participants were women. The mean age of the participants was 22.50 ± 2.16
years. The mean and standard deviation of the HPLP-II score of the medical
students was 109.74 ± 18.65. There was a significant relationship between
health-promoting lifestyle and variables of age (P = 0.007), university
entrance year (P < 0.001), mother’s education level (P = 0.003), and
father’s education level (P = 0.011). However, no relationship was observed
between health-promoting lifestyle and parental occupation and place of
residence (P > 0.050). Conclusions: This study showed that the
status of health-promoting lifestyles in
medical students of RUMS was at a moderate level, but it is still at a great
distance to the optimal level. Therefore, it is necessary to implement
programs to promote a healthy lifestyle in order to maintain health in the
youth until graduatio. |
Keywords: Student, Life Style, Health
Promotion, Iran.
Introduction
Health is a
complex and dynamic process that constantly changes throughout life (1). One of
the main strategies for maintaining health is to have a healthy lifestyle. In
other words, lifestyle is one of the most important factors affecting an
individual's health and sickness (2). Lifestyle is the pattern of daily life,
including nutrition type, dietary habits, relaxation and rest, smoking,
physical activity, stress management, and use of health services (3). One of
the most important objectives of promoting health is for individuals in a
community to be able to control their health and increase their health level
(4, 5). In fact, a healthy lifestyle is considered a valuable resource by which
to reduce health problems, promote health, manage health, and improve lifestyle
(1). Lifestyle plays an important role in the biological and psychological
health of a society (6). The Health-Promoting Lifestyle Profile II (HPLP-II) is*
one of the criterions of health and prevention of health-threatening factors. The
HPLP-II consists of the 6 dimensions of spiritual growth, health
responsibility, nutrition, stress management, interpersonal relationships, and
physical activity (7).
In the
twenty-first century, the leading cause of morbidity and mortality in the world
is still the non-communicable diseases such as cardiovascular problems,
hypertension, cancer, and diabetes (1). The HPLP-II is the most important
factor in the prevention of chronic diseases. According to statistics, 53% of
deaths due to chronic diseases are related to lifestyle (2, 8).
Entering the
university is one of the most important periods in the lives of young people
and it is a bridge that connects the life of the youth to adulthood. In a
study, unhealthy lifestyle among university students was reported (1).
Researchers have reported that many students engage in risky behaviors such as
smoking, drinking alcohol, physical inactivity, unhealthy diets, and poor sleep
and rest. These high-risk behaviors will lead to
poor health status among the youth and will continue into later stages of their
lives (9). Studies have shown that living in dormitories, the specific living
conditions, and obtaining relative independency will trigger high-risk
behaviors that jeopardize the health of these young people (10). In a research
conducted at Dezful University of Medical Sciences, Iran (11), the students’
lifestyle was reported as poor, but in Kerman and Yazd Universities of Medical
Sciences, Iran, the students had a good and suitable lifestyle
(12, 13).
Due to the above facts,
the increasing prevalence of chronic diseases associated with unhealthy
lifestyle (2, 6), and the lack of studies on the lifestyles of students of
Rafsanjan University of Medical Sciences, Iran, the aim of this study was to evaluate the health-promoting
lifestyle among students of Rafsanjan University of Medical Sciences (RUMS) in
the year 2014.
Material and Methods
This cross-sectional study was
conducted in 2014 at RUMS. Census sampling was performed and all 350 medical
students of Rafsanjan University of Medical Sciences were invited to
participate in this study which was conducted under the supervision of the
faculty members. Consequently, 262 students volunteered
to participate in the study.
The inclusion
criteria included being a medical student, studying basic sciences and
physiopathology, or internships and interns were studying. The exclusion
criteria included the lack of willingness to participate in the study and
suffering from a particular disease such as chronic diseases. A two-part questionnaire
was used in this study. The first part contained demographic information
including age, gender, and university entrance year, place of residence,
education level, and parental occupation. The second part consisted of the
HPLP-II questionnaire.
The HPLP-II
questionnaire contains 48 questions, which assess health promoting behaviors in
6 dimensions including spiritual growth and self-actualization, responsibility
towards health, interpersonal relationships, stress management, sport and
physical activity, and nutrition. In this questionnaire, each question was
scored on a 4-point Likert scale with the options of never (1 points),
sometimes (2 points), often (3 points), and normally (4 points). The total
score of health-promoting lifestyle was obtained by answering all 48 questions.
The minimum and maximum scores of this questionnaire were 48 and 192,
respectively. To evaluate the health promoting lifestyle in this study, a mean
lifestyle score of less or equal to 49% of the total score was considered as
poor status, 50% to 75% was considered as average status, and above 75% showed
a good status among students (14). Higher scores indicated the superior
lifestyle of the students. The reliability and validity of the questionnaire
was evaluated by Mohammadi et al. at Ghazvin University of Medical Sciences,
Iran. Cronbach's alpha for the whole questionnaire in this study was 0.82 and
for the subcategories of nutrition, physical activity, responsibility for
health, stress management, interpersonal relationships, and spiritual growth,
it was 0.81, 0.79, 0.86, 0.91, 0.81, and 0.79, respectively (15). The HPLP-II
and demographic questionnaires were distributed among the medical students by
one of the researchers. After completion through self-report, the questionnaires
were collected and the obtained data were entered into SPSS software (version
18, SPSS Inc., Chicago, IL, USA). In order to investigate the relationship
between lifestyle and its dimensions, and the
demographic variables, including age, gender, education, parental occupation,
and university entrance year, independent two-sample t-test, one-way ANOVA, Tukey's multiple comparison test, and
Kruskal-Wallis H test were used. The significance level was determined as 0.05.
Results
Of the 262
students participating in the study, 154 (58.8%) were girls, 164 (62.6%) were
residents of dormitories, and 113 (43.1%) had entered
the university during the years 2012-2014. In addition, 173 (66%) participants
were under 23 years of age. Their mean age was 22.50 ± 2.16 years. The
education level of mothers of 110 participants (42%) was diploma and fathers of 134 (51.1%) students was higher than diploma.
Moreover, mothers of 175 (66.8%) students were housewives and fathers of 162
(61.8%) of the students were employees.
The mean score of health-promoting lifestyles in students was 109.74 ±
18.65 (Table 1). In other words, in this study,
the students obtained 56.83% of the total score of HPLP-II.
This percentage reflected the lower-middle level of health-promoting lifestyles
(50% to 75% of the total score was considered as the average status) (14). Each
dimension of health-promoting behaviors is shown in table 1. As shown, the
highest score was related to health responsibility (25.37 ± 6.10). Sports and
physical activity obtained the lowest score (10.43 ± 4.39).
Table
1: Descriptive indicators of the overall score and scores of the six dimensions
of health-promoting lifestyle of the medical students in RUMS in 2014 (n = 262)
Health-promoting
lifestyle and its dimensions |
Minimum |
Maximum |
Mean±SD |
Health-promoting lifestyle |
61 |
176 |
109.74±18.65 |
Spiritual growth and self-actualization |
10 |
36 |
23.29±4.60 |
Responsibility for health |
13 |
45 |
25.37±6.10 |
Interpersonal relationships |
14 |
36 |
23.92±4.25 |
Stress management |
5 |
20 |
11.31±2.65 |
Sport and physical activity |
6 |
24 |
10.43±4.39 |
Nutrition |
7 |
28 |
15.43±4.83 |
Although in the
present study the mean score of health-promoting lifestyle was higher in girls
(110.51 ± 16.69) compared to boys (108.64 ± 21.16), this difference was not
statistically significant (P = 0.443). The overall mean score of lifestyle of
dormitory residents was 110.41 ± 18.68, and it was higher compared to the
students living in single homes (108.54 ± 22.62) and students living with their
parents (108.68 ± 15.66). However, this difference was not statistically
significant (P = 0.780). Health-promoting lifestyle score did not show any
statistically significant relationship with parental occupation (P > 0.050).
The lifestyle score is presented in terms of different variables in table 2.
Tukey's multiple comparison test showed that the mean
score of health-promoting lifestyles in the age
group of 18-20 years was significantly higher than the other age groups (P <
0.050). Moreover, the mean score of health-promoting
lifestyles in students of the entrance years of 2012-2014 was significantly
lower than other entrance years (P < 0.05). The students whose mothers had a
high school degree and lower had lower mean score of health-promoting lifestyle
compared to students whose mothers had education degrees of higher than high
school diploma (P = 0.005). While, students whose fathers had a high school
degree and lower had significantly lower mean score of health-promoting lifestyle
compared to students whose fathers had education degrees of higher than diploma
(P = 0.034). There was no statistically significant difference between the
other groups (P > 0.050).
The mean score of
responsibility in the age group of 18-20 years was significantly higher than
the other age groups (P < 0.050). The mean scores of stress management (P =
0.005) and sports and physical activity (P =0.025) in the same age group (18-20
years) was significantly higher compared to the age group over 23 years. The
mean score of the dimension of responsibility was significantly higher in women
(26.10 ± 6.07) compared to men (24.32 ± 6.03) (P = 0.020). However, the mean
score of sports and physical activity in men (11.56 ± 4.75) was significantly
higher than women (9.63 ± 3.94) (P = 0.001).
Table 2: Comparison of health-promoting
lifestyle scores based on the different demographic variables of the medical
students in RUMS in 2014 (n = 262)
Variables |
Total score of health-promoting
lifestyle |
P-Value |
||
N (%) |
Mean±SD |
|||
Age groups (years) |
18-20 |
58(22.1) |
116.34±20.38 |
0.007 |
21-23 |
115(43.9) |
108.66±18.12 |
||
>23 |
89(34.0) |
106.83±17.27 |
||
University entrance year |
85-88 |
69(26.3) |
105.68±17.03 |
0.001 |
89-90 |
80(30.5) |
106.16±18.03 |
||
91-93 |
113(43.2) |
114.75±18.98 |
||
Mothers’ education level |
High school and lower |
60(22.9) |
102.50±16.04 |
0.003 |
Diploma |
110(42.0) |
111.77±18.12 |
||
Higher than diploma |
92(35.1) |
112.03±19.80 |
||
Fathers’ education level |
High school and lower |
32(12.3) |
103.88±16.18 |
0.011 |
Diploma |
96(36.6) |
107.21±17.21 |
||
Higher than diploma |
134(51.1) |
112.96±19.66 |
One-way ANOVA, P
< 0.050 was considered as statistically significant.
Discussion
The results of
this study showed that from the total score of health-promoting lifestyle which
was 192, the students participating in this study obtained a mean score of
109.74 ± 18.65, which reflected the moderate lifestyle status of the students
of Rafsanjan University of Medical Sciences. This result was consistent with
the results of studies by Nilsaz et al. (11) and Tol et al. (16). The mean
score of health-promoting lifestyle was higher in the age group of 18-20 years
compared to the other age groups. This finding was consistent with that of the
study by Tahmasbi et al. (17). The study by Tahmasebi et al. showed that with
the increase in age, the score of health-promoting lifestyle decreased. It
seems that the youth place more importance on their lifestyle and as their age
increases, they become more involved in other existing problems and their
lifestyle becomes a subsequent priority (17).
The mean score of health-promoting lifestyles in the age group of 18-20
years in students of the entrance years of 2012-2014 was significantly higher
than other entrance years. It seems that with the passing of university years,
increasing study load, harder study courses, and the need to study more, most
of the healthy habits of the students also change. Higher age groups, high
volume of courses, and 24-hour shifts cause students to
pay less attention to their lifestyle and develop unhealthy behavioral
habits. Nola et al. reported that sixth year medical students had developed
poor eating habits and an unhealthy lifestyle.
Furthermore, with increase in education level, the number of meals and snacks
reduced. Becoming busy, having to offer conferences, having different
locations for each course, the need for timely relocation, and the need to
spend more time on these activities are the main reasons for behavior changes
and an unhealthy lifestyle (18). The mean score of health-promoting lifestyle
did not have any significant relationship with the students’ place of
residency. The results of studies by Peker et al(19), Hong et al (20) and Kreutz et al(21) were consistent with that of
the present study.
In this study, the
mean score of health-promoting lifestyle of the women was higher than men, but
this difference was not statistically significant. Nevertheless, in the study
by Farhadi, the quality of life (QOL) of women was significantly lower than
that of the men (22). In the present study, the score of responsibility toward
health was significantly higher in women compared to the men, which was
consistent with the findings of Tol et al. (16). However, it was inconsistent
with the findings of Motlagh et al. studyý. In the
study by Motlagh et al., the score of responsibility was higher in men compared
to the women (13). The differences between the findings of the present study
and Motlagh et al. (13) were due to the differences in the study population.
The study population in the present study consisted of medical students, while
in the study by Motlagh et al. (13), the study population included medicine,
dentistry, health, allied medical sciences, nursing, and midwifery students of
Yazd University of Medical Sciences.
In addition, in
the present study, the mean score of sports was significantly higher in men
than women. Results of studies in Turkey and Hong Kong also showed that the
highest scores of sports were related to boys compared to girls (23, 24). There
findings were similar to that of the present study. In this study, the women
obtained higher scores in interpersonal relationships than the men. This result
was consistent with the results of studies conducted by Maheri (14), Tol et al.ý (16), and Lee (24). However, in the study by Alkandari et
al. in Kuwait (25), boys received higher scores in terms of interpersonal
relationships compared to girls. The difference in the results of this study
and the mentioned study was due to the differences in the participants
regarding their field of education. The participants of the present study were medical
students, but the participants of the study by Alkandari et al. (25) consisted of nursing students. It
seems that the longer duration of the medical course was the cause of the
improved behavior in women compared to men.
In the present
study, lifestyle had a significant relationship with parental education level;
the closer parental education levels were to lower than diploma, the lower the
overall score of students' health-promoting lifestyle. The same results were
obtained by Babanejad et al. (26), Mansourian et al. (27) and Mazloomy
Mahmoodabad (28).
The most important
limitation of this study was the lack of interest and voluntary participation
in the project by medical students. Thus, a considerable number of students did
not enroll in the study due to these reasons. It is suggested that future
studies be conducted on all academic disciplines of Rafsanjan University of
Medical Sciences with a sufficient number of participants.
Conclusion
This study showed
that the overall score of health-promoting lifestyle of the medical students of
RUMS was lower-middle range. Given that the major burden of disease in
developed countries is due to unhealthy lifestyles, it is necessary that
measures be taken and programs be implemented to enhance the lifestyle of individuals in society, especially the youth groups
and students of health sciences.
Acknowledgments
Our
sincere appreciation goes to the university research council for the research
approval and financing, and all the students who participated in this study.
Conflict of
interest: None
declared.
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* Corresponding
author: Zinat Salem, Dept. of Social Medicine and Occupational Environment
Research Center, Medical School, Rafsanjan University of Medical Sciences,
Rafsanjan, Iran.
Email: salemzinat@yahoo.com