The Psycho-Social Factors of Health Promoting Lifestyle

Chapter I

Introduction

Quality of life (QoL) is a desirable thing for every individual. In order to achieve or maximize QoL individuals strive in a variety of domains and try to indulge into health promoting lifestyle (Ogden, 2004). Health promoting behaviors include being physically active, lively, energetic, not smoking and eating at least five portions of fruit and vegetables a day. These behaviors may enhance/improve the individual life up to 14 years (Khaw, 2008). But, there are fewer people who eat healthy food and take part in regular physical activity. While considering the students of university, they are passing through different periods of physical, psychological, social and sexual development. If the health promoting behaviors are endorsed in this age then it will increase the chance that they will be healthy adults in the future (Hoyt, Chase-Lansdale, McDade & Adam, 2012). Even though the profits of health improving behaviors are recognized, but the results of many studies showed that university students do not have healthy way of living. Therefore, it needs further attention (Rezaei-Adaryani, 2012).

Many life threatening diseases which are related to the lifestyle, such as type II diabetes may be prevented by adopting the health promoting behaviours. One of the positive behaviour that adds up in the life is the physical activity may take down the risk of diabetes, tumour and osteoporosisand heart decease (Warburton, Nicol, &Bredin, 2006).

Similarly, there is a need to change the lifestyle of the individuals as by changing their habits. One’s habits can be changed easily. In order to change the behaviour of the people and help them to adopt and continue the healthy behaviour, psychosocial factors that play an important role in the successful behaviour change should be thoroughly studied. In children and teenagers the behaviour can be changed easily than in young adults (Uchino, 2009).

Globally, 35 million (more than 60%) deceases are occurring due to the rapidly rising epidemic of non-communicable diseases. Among them 80% deaths happened in the developing countries in which Pakistan is included. The 6^th most populous country in the World is Pakistan. It is a country in which 50% of the inhabitants are suffered from one or more of the chronic ailments, that is close to approximately 80 million (World Health Organization [WHO], 2002).

Nowadays, deaths happening due to the non-communicable diseases are more than the communicable ailment. In Pakistan, 77 of age standardized losses are due to the NCDs and injuries (Global Burden of Disease, 2010). The burden is mostly to stroke and injuries and burden is termed as disability. Approximately 100 people go through amputations per day due to diabetes and distress and experience dialysis due to renal failure that is induced by the diabetes. By following the current rate of burden, it is estimated that burden rate will be increased by 10-15% over the next 10 years.

Using population level death proportions it has been anticipated that between 2010 and 2025, 3.87 million inhabitants of Pakistan will be lifeless. They will lose their lives to NCDs like cardiac diseases, malignancies and lasting lung illnesses. From 2010 to 2025, the economic drain that is associated with NCD deaths will increase from 152 million dollar (Jafar et al., 2013).

All over the world, Pakistan’s population is the 6^th largest population. It was 165 million in 2007. Every year, it is increasing at about 1.83%. National Health survey data showed that 33% inhabitants of Pakistan who are above the age of 45 suffered from the hypertension. In individuals of age 15 or above the incidence is 19%. Furthermore, globally the Pakistan is at the 6^th number in terms of number of people suffering from diabetes. In 2002, it is anticipated that the number of diabetic patients will increase from 5.2 million to 13.9 million. At that point, the Pakistan will be at the 4^thrank having more patients of diabetes mellitus (WHO, 2002).

Apart from living in a healthy way and giving more attention to the behavioral aspect of the individuals’ life, there are many other aspects that affect the individual way of living. Among the other various concerns are socio-economic status, level of education, family, social networks, gender, age and personal relationships. All in all, a supportive environment is needed or most important for the well-being of the individual and assists people to enjoy a healthy life (Jackson, Tucker,& Herman, 2007). Family size, marital and work status, education, learning about how to live a healthy life also influenced the lifestyle (Ahmadi&Roosta, 2015). The strongest predictors of living a healthy life are self-efficacy, social support, perceived benefits, self-concepts and perceived barriers(Gillis, 1993).

1.1 Health Promoting Life Style

According to Delaun, Ladner and Delmar (2002) the definition of lifestyle is as normal and predictable day-to-day activities which people accept in their life and can have impact on the health of persons.

Any actions or activities that individual took to sustain, repair and improve their health or to prevent the disease; these behaviours or actions are called health behaviours. For example, workout, nutrition, introspection, washing hands, and cleaning teeth behaviours are associated with health (Conner & Norman, 1996).

Health promotion is a notion that involves the promotion of actions/activities of living a healthy life defined by Pender (1996) as promoting those activities that are focused on developing resources that sustain or heighten the health of an individual.

The health promotion lifestyle is defined by Walker (1990) that health promotion way of living is a pattern of perceptions and activities having multi-dimensions and this is initiated by self-motivation. These perceptions and behaviours aid in the persistence and promotion of health and self-improvement.

Pender (1996) postulates that by adopting healthy way of living an individual can maintain and heighten their health and inhibit the beginning of chronic health conditions. By implementing healthy routines in daily life, general physical and mental health may progress in older individuals and physical decline may be slow down that is occurring due to chronic health issues (Speake, Cowart, & Pellet, 1989).

So there is a strong need to promote healthy lifestyle among young adults so that risk of getting any chronic condition can be minimized, the present study examined forecasters of health promoting lifestyle and the mediating role of academic self-efficacy among students of public health, sports sciences and health psychology.

1.2 Psychosocial Predictors of Health Promoting Lifestyle:

• 1.2.1 Personality as a predictor of health promoting lifestyle

Personality is a notion that is defined as steady variation in effect, behavior or thought of the individuals (Williams, Smith, &Cribbet, 2008). Widespread personality characters are relatively constant over time and related to many areas of daily life (Boyle, Matthews, & Saklofske, 2008).

Personality traits are associated with health behavior and health effects. Numerous personality traits have been constantly found probably relate with health outcomes (Williams & Dusinger 2007) such as hostility, antagonism and social supremacy, diligence as well as negative affectivity and neuroticism. There are many schemes who explain the link between personality and health behavior (e.g. smoking), sickness behavior (e.g. take on the sick role) and biological mechanisms, particularly in reaction to life strain (Williams, Smith, & Cribbet, 2008).

It is also significant that the probable relationship between personality characters and resulting illness might not reveal an underlying effect, but other underlying third variable may has an effect like hereditary or legal individual difference. That other third variable may yield a certain personality trait and it results danger and resilience for specific disease and for general health. So, the personality factor plays an important role in behavior change and this one specific path that how personality affects the change of behavior could be propensity for intervention effects (Williams et al., 2008).

Several studies have been conducted to explain the relationship between personality and physical activity, workout and nutrition related behaviors (Booth-Kewley & Vickers, 2004). A meta-analysis was done to find out the correlates of physical activity, it was found that extraversion, lower neuroticism and higher scrupulousness were related to higher levels of activity.

Another meta-analysis displays that over two eras, hostility and BMI increases among males (NabiKivimaki, Sabia, Dugravot, Lajnef, & Marmot, 2009). Low impulsivity and amiability linked with more monitoring and control of intake and body weight (Van den Bree, Przybeck, &Cloninger, 2006). Fewer researches have been conducted to find out the relation between personality and changes in PA/intake behaviors, particularly intervention studies are less. Moreover, Franks and colleagues (2009) conducted a study to find out the predictors of weight control. They studied the pre-treatment predictors. The findings of this study revealed that more studies should be done to find out the effects of stable traits. More studies are needed in this area to identify that how personality is affecting the outcomes of the intervention that is done to change the behavior. In interventions plan, personality might play a role of moderation, moderate the effects of intervention. In a self-management intervention, five factors personality traits that are defined as Big Five traits moderate the psychological effects of the intervention. But nowadays, very little research seems to be conducted on the effects of personality in interventions (Franks, Chapman, Duberstein, & Jerant, 2009).

• 1.2.2 Life orientation and health promoting lifestyle

Health advancement as part of Life Orientation aims to endorse a healthy way of life and provide students awareness and expertise to reach and sustain a healthy standard of living.   Dis-positional hopefulness and cynicism can be defined as general expectations that good and bad consequences will take place across main life areas (Carver, 2007). Both hopefulness and pessimism are linked with a wide range of results related to health (Rasmussen, Wrosch, Scheier, & Carver, 2006).While, negativity is a threat for health illness and impermanence even at modest levels (Raikkonen & Matthews, 2008).

Many health behaviors and related effects have a relationship with optimism, such as devotion to therapy and accomplishment of interventions less often presently smoldering (Giltay, Geleijnse, Zitman, Hoekstra, & Schouten, 2004), quicker recovery and fewer wellbeing difficulties after a most important life incident (Kivimaki, 2005). The individuals who have optimistic personality by nature, they are more likely to engage in healthy dietetic routines and are physically fit and active (Steptoe, Wright, Kunz-Ebrecht, & Iliffe, 2006).

There are numerous probable explanations for how dispositional hopefulness strength well-being by making the behavior attempts. When individuals meet harsh conditions, they answer with that mental state that is either challenging or reflecting the grief. But those who have optimistic personalities they have more positive mix of feelings and they anticipate good results (Benyamini & Raz, 2007).

Dispositional optimism and self- efficacy have different core features but they are alike in their purpose, meaning and content. They differ in two core features that optimism is a global expectancy. However, the self-efficacy believes might be having specific domains. Second main difference between them is that their central features differ due to the locus of estimated optimistic activities. In self-efficacy, the individual’s own actions are important (Bandura, 1997)

Perceived self-efficacy is regarded as one is enough competent that he can achieve the goal competently. It is an obvious acknowledgment of anticipated goal mastery to one’s capability. While dispositional optimism take account of skill attribution as only one likelihood among several others, such as good fortune or celestial powers, and hence is the wider paradigm (Schwarzer&Luszsynska, 2007).

• 1.2.3 Health beliefs and health promoting lifestyle

There are many prominent and effective factors that may become problematic for the individual to take on the standard way of living. In order to design the intervention, the health workers should use the all relevant factors (Kaewthummanukul & Brown, 2006). In a Health Belief Model, predictors of healthy behaviors are included that are perceived risk (i.e. perceived vulnerability and perceived severity), perceived achievement profits and perceived act hurdles.

Various studies point out that the perceived risk of a disease has a positive relationship with healthy behavior (Norman & Brain, 2005).Though, further researches indicate the perceived threat of an ailment has a negative correlation with healthy behavior (Petrovici & Ritson, 2006). Thus, the changed results of the studies showed that causes of health promoting behaviors are still uncertain. So, before promoting health behaviors to change the way of living in order to avert diseases, beliefs of persons about the health must recognize such persuasive aspects as perceived act value, perceived action barricade and perceived danger.

1.2.4 Demographic variables as predictors of health promoting lifestyle:

• 1.2.4.1 Gender and marital status role in adoption of health behaviors

There are many other variables that are forecaster of health promoting behaviors like demographic variables. Among them is the gender-role orientation. Both men and women move into the society, they meet with the people and accept, take on the different patterns of behaviors. They also acquire different roles in the society that we called social roles. As a result of this they are more likely to grow into different personalities. They acquire different personality traits and their health related behaviors differ from each other (Helgeson, 1994).

One’s marital status also seems to be affecting his/her involvement into health behaviors. According to existing literature, in various culture such as in western cultures, married women tend to indulge more into health promoting lifestyle as compared to men and similarly, young unmarried women adopt more healthier behaviors but this needs to be more intensive investigation because many studies has found no significant differences (Spence & Buckner, 2000).

• 1.2.4.2 Age & socio-economic status relation to health behavior

Socio-economic discrimination and health behaviors are linked. Regardless of societal and health strategies that strive for lessen the gap between socioeconomic groups. In Europe the socioeconomic discrimination in heart impermanence are highest and discrepancies in life probability in Finland have even developed in the last years (Martikainen, Blomgren, &Valkonen, 2007). Low education, lesser income level or having not significant employment is regarded as low socioeconomic status (SES). It has long been recognized as related to the poor well-being (Adler et al., 1994).

The individuals having low socio economic status are more likely to undergo and pass away from non-communicable diseases for example diabetes, cardiac illnesses and various types of tumor (Huisman et al., 2005).

The incidence of Type II Diabetes is 50% higher in 30 years above less educated Finish women than highly educated. Moreover, among both genders, less educated individuals more suffer from at least one chronic condition and proportion is high (Koskinen et al., 2007). Many theoretic explanations are given to explain the association between socio economic status and health. In the studied mechanisms, the cultural and material factors are included. Low economic status people are more likely to stick to healthy behaviors (Laaksonen, Prattala, Helasoja, Uutela, &Lahelma, 2003). Also, it has been claimed that public health interventions and programmers at the population level reach high-SES groups first and only later affect those with low socio economic status inverse (Victoria, Vaughan, Barros, Silva, &Tomasi, 2000). This could be one of the reasons of differences between the two social classes in adoption of health promoting lifestyle.

The role of age gradient in health has long been recognized (Winkleby, Fortmann, & Barrett, 1990), but how do individuals change their health behavior over time. An observational study over four years reported that although physical activity and dietary habits varied over time, there were no socioeconomic differences with regard to changes (Mulder, Ranchor, Sanderman, Bouma, & van den Heuvel, 1998), however, another study reported that, over seven years, adoption and maintenance of healthy eating and exercise was related to higher SES (Boniface, Cottee, Neal, & Skinner, 2001) and another that over two years, adoption and maintenance of physical activity was related to educational level among women but not among men (Sallis, Hovell, &Hofstetter, 1992).

•  1.2.4.3 Role of educational background

In large part, education level difference in health and impermanence is attributable to unhealthy way of living (Laaksonen et al., 2007). Though, it has also been found out that educated people more implement health practices in their daily routines by consuming daily fruit, vegetables and low fat food. These lifestyles were more common among the higher educated (Helakorpi et al., 2010). Likewise, it is evident from the research that percentage of individuals increase who report that they do leisure-time physical activity of at least 30 minutes twice a week or more the difference between educational groups among men increase (Helakorpi et al., 2010). Subsequently, risk factors more likely to develop more in people with low education  such as weight gain and become overweight (Law, Power, Graham, & Merrick, 2007).

According to a meta-analysis, students who study the courses which are related to health are more likely to adopt healthy behaviors, although these behaviors vary across in a wide range from intake of healthy nutrition to daily exercise. Also, they take more preventive measures to remain healthy (Ward, Thorn, Clements, Dixon, & Sanford, 2006).  But, there are also studies which found no relationship of study course being studied with health promoting lifestyle so it needs to be explored.

• 1.2.4.4 Role of student-teacher relationship

Intervention studies in which analyses regarding STR have been conducted show that the intervention effects on adoption of health promoting behaviors being thought in an institute are not modified by STR however, a review of nutrition interventions found a mixed pattern (Oldroyd, Burns, Lucas, Haikerwal, & Waters, 2008). The mixed efficacy in preventive and health promotion interventions may be linked to another proposed mechanism explaining the nature of relationship poor or healthy with the source person who delivers the intervention and adoption of health related behaviors. Those with poor relation tend to less practicing what is being taught (Acheson, 1998).

According to literature, students tend to practice that knowledge more in real life which is being taught by a teacher with whom they have good relationship as compared to the teacher they do not like (Wikstrom et al., 2009) So, in adoption of health behaviors of those students who study health related courses, their relationship with the teachers can be an important factor.

1.3 Theoretical Frame Work:

• 1.3.1 Health belief model by Rosenstock (1966) Beker &Collegues (1970 – 80’s)

Health Belief Model is a model that describes the details of behavior of people. The Health belief model gives details of the motives of people to engage in health related behavior, make use of health care, or trail medical endorsements. It is argued that various psychological procedures are important in making the decisions regarding the health choices. These various psychological processes are general health worry, vulnerability, severity, welfares, and hurdles. The general health concern is regarded as individuals’ concern, prevailing inclination, keenness, or propensity about making healthy selections. Susceptibility is defined as the extent to which an individual perceives and identifies the risks of acquiring disease and danger of suffering from the ill effects of the prevailing illness. The verdict of an individual concerning the effect of ailment once, or if acquired on the health is regarded as severity. By taking into account of the worth and costs of different health choices is refereed as benefits and barriers. The model assumes that the beliefs of people about health may mediate the effects of other variables on the health choices people make (Ogden, 2004).

In the present study, according to the health belief model it has been assumed that individuals health promoting behaviors develop on the basis of their health beliefs. When students study health related courses they become more concern about their health, studying various diseases and those ill effects on health make them perceive themselves as susceptible and they get continuous cues to action to adopt healthy lifestyle. So, by using this model in the research, students’ health beliefs as a predictor were assessed affecting their choices to adopt healthy lifestyle.

1.4 Health Promotion Model:

• 1.4.1 Health promotion model by Pender (1982; revised, 1996)

The model suggested by Pender (1982; 1996) a “complementary counterpart to models of health protection. In this model, the health is regarded as positive lively state not only the absence of illness. The model is focused on enhancing the well being of the clients. The model explains the multi-dimensional nature of individuals regarding their interaction with their surroundings. Three following areas are more focused:

• • Individualities and Experiences
  • Perceptions/Cognitions Specific to Behavior and Emotions
  • Behavioral Effects

The model describes that every individual possess distinctive personal features and experiences that have impact on the succeeding results. The knowledge specific to behavior is described by set of variables. These variables are important for motivation and can be revised through giving attention to the actions. End point in the model is the health promoting behavior. That is the anticipated behavioral result. End result of health promoting behaviors should be better-quality health, improved functional capability and healthier life at all steps of progress. Immediate challenging response and predilections swayed the final behavioral demands; it can also ruin the planned health promoting activities (Pender, 1996).

In the present study, health promotion model is being used to explain the process of adopting a healthy behavior. The personal factors, (demographics such as educational back ground, role of gender, socio economic status, student teacher relationship etc& personality) have been studied to understand their role in adopting a health behavior. Moreover, individuals’ specific cognition (health beliefs) and their behavioral outcome (health promoting lifestyle) have been examined.

1.4.1 Assumptions of the health promotion model

There are the following assumptions of the health belief mode:

1. The individuals pursue to keenly regulate their behaviours.
2. In all the bio psychosocial intricacy, the individuals interact with their surroundings, gradually changing the environs and being changed over time.
3. Health specialists set up a part of the relational environs, which produce influence on the individual through their life.
4. In order to change the behaviour, interactions that happen between individual and the environment, these interactive patterns of self-initiated reconfiguration are necessary (Pender, 1996).

1.4.2 Theoretical propositions of the HPM

The model is grounded on the hypothetical assumptions. Beliefs, emotions, and acting out of health-promoting behaviors are influenced by past behavior and innate and learned features. The behaviors which anticipate the stemming valued profits are more likely by the individuals to be engaged in these kinds of behaviors. The commitment that is made to action can be limited by perceived barriers that play a role of mediator in all the kinds of behavior, perceived and actual behavior. The perceived competence or self-efficacy to perform a specific behavior increases the probability that the individual is obliged to action and actual performance of the behavior.

Less perceived barriers to a specific health behaviors resulted from the large perceived self-efficacy. Higher perceived self-efficacy will be produced by positive affect orientation which in turn produced the bigger positive affect. By producing link between positive emotions and behavior, there are more chances that the individual is more committed to action (Pender, 1996).

When significant persons in the society carry out the behaviour, assume the behaviour to happen, and provide provision and support to facilitate the behaviour, the probability of engaging the persons in these health-promoting behaviours will increased. The more committed the individuals are to the actions, there are more chances that the persons will maintain the health promoting behaviour over time. There are a number of influential factors that influence that commitment to action among them are the family, peers, health investigators and situational factors like external atmosphere also have an impact to be engaged in the health-promoting behaviour. When other actions or behaviours are more striking and there are challenging demands on the persons which need the instant attention of the individual than there are less chances that the individual will commit to action. Thoughts, perceptions, emotions and interpersonal and surrounding scan be adjust by the individual in order to generate inducements for health actions (Pender, 1996).

1.4.3. Major concepts and definitions

• Individual Characteristics and Knowledge
• Preceding Associated Behaviour
• Frequency of the similar behaviour in the past
• Direct and indirect effects on the likelihood of engaging in health promoting behaviours (Pender, 1996).
  • Personal factors. Biological, psychological and socio-cultural factors are recognized as personal factors. These are the predictors of a given behavior and formed by the nature of the target behavior being measured. Age, gender, body mass index, puberty, strength, quickness or balance is personal biological factors.

Self-assurance, self-motivation, personal competency, perceived well-being eminence and race, culture, society, acculturation, education and socioeconomic status are personal psychological factors and cultural factors respectively (Pender, 1996).

• 1.4.3.2 Perceived benefits of action

Expected positive results that results by implementing the health behavior in their daily life.

• 1.4.3.3 Perceived barriers to action

Predicted made-up or real barriers and personal costs of accepting a given behavior.

• 1.4.3.4 Perceived self-efficacy

Perceived self-efficacy is referred as person’s competency that he/she can organize and perform the health promoting behavior successfully. Higher self-efficacy results in the lower perceived barriers to the actions.

• Activity related affect. It refers to the subjective feelings either positive or negative related to the behavior that occurs before, during and following the behavior. It influences the perceived self-efficacy which induces the positive feelings and in turn enhances the self-efficacy and result in the positive affect.
• Interpersonal influences. Interpersonal influences comprises of beliefs, thoughts, behaviors that involve cognition and attitude of others. Learned behavior by observing others that engaged in a particular behavior, encouragement from others and norms are interpersonal influences. The main sources of interpersonal influences are family members, peers.
• Situational influences. Personal insights and understandings of any specified condition or environment that can assist or inhibit behavior. It may have direct or indirect impacts on health behavior (Pender, 1996).

 

1.4.4 Behavioral Outcome:

• 1.4.4.1 Commitment to plan of action.

Commitment to action plan is referred as the recognition of a strategy that is planned in order to carrying out the health behavior.

• Immediate competing demands and preferences. Competing demands are that alternative behavior over which individuals have low control because there are environmental contingencies such as work or family care responsibilities. Competing preferences are alternative behavior over which individuals exert relatively high control, such as choice of ice cream or apple for a snack
• Health promoting behavior. The behavior that results in healthy, well-being and useful living (Pender, 1996).

Chapter II

Literature Review:

A research was carried out to see the relationship between health promoting activities/lifestyle and of students their relationship with teachers at school of health. Results indicated a positive relationship between stress management, spiritual growth and implementing health promoting lifestyle with good students-teacher relationship. This study has also examined if student-teacher relationship predicts health promoting lifestyle in university students (Tavassoli, Shariferad & Shojaeezadeh, 2013).

A research was done to find out the relationship between selective demographic variables, health beliefs and health promoting behaviors like nutrition and physical activity in old age people No significant relationship was found between internal and powerful others health beliefs where as positive relationship was discovered in the adoption of the health promoting behaviors of physical activity and nutrition (Wallace, 2000).

A cross sectional research study was done in the rural areas of Hungary on factors of health promoting lifestyle behavior. The results revealed significant relations between health-promoting behavior and demographic, (social and economic characteristics) of the individuals and their dwelling place. The prevalence of healthy lifestyle activities was lower among lower educated, lower income and aged people (Paulik, Boka, Kertesz, Blaogh, & Nagymajteny, 2010).

A research study was done to study the link between type of personality inclinations and health promoting and risk-taking behaviors. The study was carried out to find to predictors in college students. Moreover, various demographic variables that mediate the relationship were also studied to determine the predictive relationship. The outcome of the study was that personality preferences and types both are predictors of health promoting and risk taking behaviors. There exist analytical relationship with diet, interpersonal relations, and spiritual development, and physical activity, cumulative health-promoting way of living, alcohol use, binge drinking, and heavy drinking. The present study also examined the role of personality traits in predicting health promoting lifestyle among university students. (Martin, 2011)

Another study was conducted to examine the predicting factors of health-promoting lifestyles. A qualitative approach was used to explore the predicting factors. The results showed that towards the health promoting lifestyles the individuals showed highest score who showed highest scores in self-actualization and showed lowest scores toward the health responsibility. So it was proved that the self-actualization is necessary for the individuals to achieve in life. The present study also explored the predicting value of various factors towards health promoting lifestyle (Janssenen, 2010).

The present study investigated gender differences towards adopting health promoting lifestyle as a cross-sectional study was done to assess the health promoting behaviors of 287 medical students in Bhopal using HPLP II questionnaire. The result showed that the female students were low in physical activity and high in spiritual growth whereas were high in physical activity and low in spiritual growth and health responsibility respectively (Chouchan, 2016).

A study was conducted by in which the health- promoting behaviors were explored and their relationship with demographics was examined. Findings suggest that the health promoted behaviors differ by age, gender, employment status, marital status, and acculturation. Perceived health status, demographics, and acculturation explained almost 12% of the variance in overall health-promoting lifestyle .The present study also examined the demographics role in adopting health promoting lifestyle (Bukey, 2011).

Health beliefs influence in health promoting lifestyle of students with background of health courses was examined in this study as in Pakistan health promotion perceptions were examined of healthcare stakeholders’ about health promoting hospitals, potential benefits and need in Pakistan a qualitative exploratory study was conducted. According to results health promotion was perceived as health education and participants with public health education were better able to relate their perceptions to a more holistic view of health promotion; than those without public health background. Participants largely revealed Health Promoting Hospitals to benefit not only patients, but also community, hospital staff and hospitals at large. Health Promoting Hospitals transition was also perceived as ‘opportunistic step’ for controlling triple burden of diseases, curtailing morbidity and mortality toll, and ‘sole answer’ to promote population health, and wellbeing. Given the view, Health Promoting Hospitals was strongly recommended as “Need of the hour” for Pakistan (Khowaja, Mistry, Agha, &Karmalian, 2007).

A comparative research study was conducted in Pakistan, in which the predictors of health promoting behaviors or lifestyles among medical and non-medical students were examined and the sample was gathered through seven different universities. The result showed that medical students were more indulged into health behaviors including physical activity and health responsibility. The result showed that the majority of students had a moderate score of HPL. Similarly, The present study has examined the health promoting lifestyle of the students who study health related courses (Khawaja, 2011).

In Pakistan across-sectional study wasconductedto empirically found out that either medical or non-medical students differ in awareness and practices with respect to healthy life style. The study was also carried out to find out the any perceived barriers in students age ranges form 17-24 years. On general and clinical knowledge about nutrition, the difference was statistically significant and average score of knowledge was different. In the study, there was no difference in medical and non-medical students in perception of work related stress in daily life. The most important reason for missing meals and hurdle to exercise daily was lack of time (Sajwani, 2009).

2.1 Rationale of the Study

Pender (1996) theorizes that early stage of chronic health conditions can be prevented by engaging in lifestyle that promotes the well-being. Healthy lifestyle can enhance the well-being and general mental health of the adults and individuals. Physical degeneration that happened due to the chronic health problems can be reduced or slow down by adopting healthy lifestyle (Speake, Cowart, & Pellet, 2008).

Health promoting activities are very beneficial. Their benefits can’t be overlooked. It is vital to recognize the other factors that may influence the decisions of the individuals regarding implementing the healthy daily life practices. So there is utmost need of present time to identify and recognize the certain predictors which predict the likely hood of engaging in health promoting behaviors among students, so these can be achieved then. So, the present study examined the relationship of various psychosocial predictors relating to health promoting lifestyle.

According to a research study the most important part of the population is university students and they are very influential for any kind of lifestyle to be adopted. Because of their age and social conditions and educated group of the society can turn them into a symbol in the society. University students are very persuasive as their selection of certain kind of lifestyle not only affects their lives but also the way of living and actions of other groups in the society (Omar, 2014). The present study tried to find out the level of engagement of university students in health promoting lifestyles. It also examined the predictors of practicing health promoting lifestyle among students including their personality, health beliefs, life orientation and role of demographical variables.  This study assessed the predictors thus enlightened that the   promotion of healthy lifestyle is of central importance for this group; as a channel, this group can be health agents in the matters related to themselves, their relations and, subsequently, the society.

2.2 Objectives

The objectives of the study are as follow

• To examine the psycho social factors such as personality, life orientation and health beliefs facilitating health promoting lifestyle in university students with an academic background in health related programs.
• To investigate the extent of influence of academic background and learning of health related course on health promoting lifestyles.

2.3 Research Questions

• Do individual’s personality, life orientation and health belief affect health promoting lifestyles?
• Which personality traits can be facilitators and which ones can be barriers to health promoting lifestyles?
• Is studying health related courses affect students’ health promoting lifestyle?
• Does student-teacher relationship of students affect their involvement into health promoting lifestyle?

2.4 Hypotheses of the Research

Following hypotheses were investigated in the current research;

H1: There is likely to be a relationship between personality, health beliefs and life orientation health promoting lifestyle in students.

H2: Health promoting lifestyle is likely to be predicted by personality, life orientation and Health beliefs of students by controlling demographic variables.

H3: Students studying health related courses are tend to indulge into health promoting lifestyle

H4: Students’ relationship with their current teachers is likely to affect their adoption of health promoting lifestyle

H5: Demographic factors are likely to affect health promoting lifestyle in students.

 

Chapter III

Method:

In this chapter the research design of the current study, sample description, measures, and procedure of conducting the research, ethical consideration are briefed.

3.1 Research Design

A correlation research design was used in this research study to examine the psychosocial factors of health promoting lifestyle in students studying health related courses.

3.2 Sample

Sample was comprised of 150 students (estimated through using G- power) studying health related courses. 50 students studying in M. Phil Public Health, 50 students studying in Masters in Physical health &sports sciences and 50 students studying Health Psychology from the departments of University of The Punjab were recruited.

3.3 Sampling Technique

Convenient Sampling technique was used to select sample (150) for the current research.

3.4 Inclusion Criteria

• Students studying health related courses since a period of a year were included.
• Students without a chronic medical condition were included.
• Students with an academic background in related discipline were included.

3.5 Exclusion Criteria

• Those with an apparent physical disability were excluded.
• Pregnant students were excluded.
• Those who work in health related settings were excluded.
• Those who study in another course along with health related course were excluded.

3.6 Participants Recruitment Procedure

The required formalities for the approval of research project were fulfilled. First of all a list of all educational institutes was made that offered health psychology, public health and sport sciences then  after seeking permission from the concerned departments  of University of The Punjab data was collected.

3.7 Demographic Characteristics of Sample

Demographic information of the sample is provided in the following table;

Above mentioned table defines the demographic characteristics of the sample. The mean age of respondents was 23.93. There were 49 male and 101 female respondents. 98% of them were day scholars and 52% were hostelites. Birth order frequencies were 46% first born, 49% middle born and 55% were last born. Current academic levels of respondents were 9% BS (Hons), 107% MSC/M.A and 34% MPhil. The participants were asked to rate their relationship with teacher. 34% reported poor, 67% reported 5-7 (good) and 49% reported excellent/healthy relationship with their teacher. 60% participants had employment record and 90% did not report any employment record. 63% respondents belong to the urban family back ground and 87% were from the rural family back ground. 51% participants reported chronic illness in family. The current data revealed that 13% father of the participants had chronic illness. 19% participants report that their mother had chronic illness. 1% report that brother had chronic illness and only 4% report that their grand-parents had illness. 99% report that no one had chronic illness. Participants report their perceived health status before last 6 months. 8% report themselves unhealthy, 70% average healthy and 72% report themselves healthy.

Their perceived health status since last 6 months was, 6% unhealthy, 79% unhealthy and 65% unhealthy. 15% participants reported to have any physical condition. When they asked to repot which physical condition they had, 5% had blood pressure, 2% back pain, 1% H-pylori, 1% joint pain, 4% stomach problem and 135% report no physical condition. From when they were having this condition, 1% from 10 years, 1% from 1years and 1% from 6 years having the physical condition. 1% use dialysis treatment, 3% medication/medicine, 1% open heart surgery, 1% self-medication and 1% use surgical treatment. Participants were asked to report their family history of chronic illness 42% respond to yes that they had chronic history in their family. 1% had back pain, 4% blood pressure, 5% cancer, 5% cardiac, hypertension, 1% diabetes, 1% Diabetes/Renal failure, 1% DM, 1% IHD, 1% Paralysis and 3% participants has heart disease illness history in their family. The relationship of participants with those family members whom had chronic condition 13% participants reported relationship with person having chronic conditions were father, 14% reported mothers, 2% reported brothers, 1% reported sister, 2% reported grandparents and 4% reported as son..

Most common health issues the participants tend to have 3% participants report Back ache, 10% hypertension, 1% Diabetes, 2% Cough. 10% participants report flue, 14% headache, 2% heart disease, 3% kidney disease, 12% gastric problem, 2% arthritis and 24% respondents reported other health issues. On being asked last baseline medical test were done, 1% participants reported basic medical tests were done, 18% blood group test, 1% Bones Scan test, 14% participants reported Complete Blood Count. 2%, 1%, 2%, 3%, 3% participants reported Hemo globin, (Hepatitis B & C, Complete Blood Count) (Hepatitis B & C, Human immunodeficiency Virus) respectively. 1% reported Muscle breast test, 2% Liver Functioning Test, 4% Urine Analysis and 1% Urine Analysis & Liver Functioning Test. 11% reported other medical tests. 53% respondents reported normal range test results. 12% reported negative test results. 2% participants reported their test results positive.

3.8 Operational Definitions

Operational definitions of the variables are as following;

• 3.8.1 Life orientation

“Optimism is viewed as generalized positive expectations about future events” (Scheier& Carver, 1985; Scheier, Carver & Bridges, 1994).

• 3.8.2 Personality

“Personality is a notion that is defined as steady variation in effect, behavior or thought of the individuals” (Williams, Smith, & Cribbet, 2008).Widespread personality characters are relatively constant over time and related to many areas of daily life (Boyle, Matthews, & Saklofske, 2008).

• 3.8.3 Health beliefs

“Motives of people to engage in health related behavior, make use of health care, or trail medical endorsements are health beliefs” (Rosenstock, 1966).

• 3.8.4 Health promoting lifestyle

“Promoting those activities that are focused on developing resources that sustain or heighten the health of an individual” (Pender, 1996).

3.9 Assessment Measures

1. Demographic Information Sheet
2. Health Belief Model Questionnaire (Weissfeld, Kirscht,& Brock,1990)
3. Health-Promoting Lifestyle Profile (HPLP II) (Walker, 1995)
4. Life Orientation Scale (Carver, Scheier, &Segerstrom, 2010)
5. Ten Item Personality Inventory (Gosling et al, 2003)

 

• 3.9.1 Demographic Information Sheet.

Demographic factors included gender, age, ethnic origin, hostile or day scholar status, marital status, education, reporting the current health status either it is good, fair, or poor.

• 3.9.2 Health Belief Model Questionnaire.

Health Belief Model Questionnaire was used to measure subjects ‘Health Beliefs. The questionnaire is consisted of 32 items. The instrument has Cronbach’s alpha .89. The reliability of all the sub scales were following: general health concern has Cronbach alpha .74, susceptibility, severity, medical benefits and self-help benefit has internal consistency .77, .89, .72 and .84 respectively (Weissfeld, Kirscht, & Brock, 1990).

• 3.9.3 Life Orientation Scale (LOT-R)

The Life Orientation Test Revised (LOT-R) was used to evaluate the individual’s in general life orientation. The measure consists of ten items. It is a five point Liker scale. The reliability of the scale is .89.

• 3.9.4 Ten Item Personality Inventory (TIPI)

Ten item personality inventory developed by gosling and colleagues. It is consisted of 5 sub scales i.e conscientiousness, extroversion/introversion, agreeableness, emotional stability, and openness to new experiences. It’s a 7 point liker scale strongly agree to strongly disagree with reliability of .99.

• 3.9.5 Health-Promoting Lifestyle Profile (HPLP- II)

The Health-Promoting Lifestyle Profile II established by Walker, (1995) was used to measure the health promoting lifestyle of sample. The instrument comprises of 52-items having six sub-scales. The sub-scales measure the six domains related to healthy life style. The six main domains are physical activity, nutrition, health responsibility, stress management, interpersonal relations and spiritual growth. It is a 4 point Liker scale (1 = never, 2 = sometimes, 3 = often, and 4 = routinely). The score ranges from 52-208 and measure the frequency in the practice of health-promoting behaviors. The overall reliability of the instrument was .94. The Cronbach alpha for all the six sub-scales was following: Physical Activity (.85), Nutrition (.80), Health Responsibility (.86), Interpersonal Relations (.87), Stress Management (.79), and Spiritual Growth (.86).

3.10 Procedure

Before conducting the research, permission was taken from the concerned authorities. In order to collect the data, permission was obtained from the University of Punjab, Institute of Applied Psychology. Informed consent was filled by the participants. The participants were informed that their all information will be kept confidential and anonymity of the data would be maintained. The subjects were informed that they could be quit at any time. The introduction of research was reviewed and explained to all subjects. The data was collected by considering the students comfort and feasibility.  Each participant was allowed to continue according to his/her own pace. The fatigue element was minimized in the present research, because being students they have busy schedule to follow. Any possible stress or pressure was lessened by communicating that there were no ‘right’ or ‘wrong’ answers. The participants were assured that their responses were kept confidential. They were asked if they want results of the study, they can have the summary report of the findings and asked to provide email id for that.

3.11 Statistical Analysis

Hierarchical regression was run to examine the predicting value of predictors of health promoting life style and as Independent sample ANOVA and Pearson Product Moment was run as additional analysis.

3.12 Ethical Considerations

1. Institutional approval was obtained from the Director of Institute of Applied Psychology.
2. Prior permission of the tools to be used in the research was taken from the authors through email.
3. Permission was taken from all the concerned authorities for data collection.
4. Research purpose was explained to the research participants and their right to withdraw was entertained.
5. Written consent from participants was taken.
6. Confidentiality and privacy of participants was maintained.

Chapter IV

Results

The research aimed to investigate the predictors of health promoting life style in students who study health related courses. The students reported their involvement in Health Promoting Lifestyle on 6 subscales of Health Promoting Profile II which are Health Responsibility, Physical Activity, Nutrition, and Spiritual Growth & Interpersonal Relations &Stress Management. Health Promoting Lifestyle is likely to be predicted by psycho social factors such as demographics, Personality of students, Life orientation and health beliefs. So, these predictors were evaluated to examine if they predict health promoting life style or not. Descriptive analysis was done to outline the sample and to analyze individual differences of sample. The data analytic strategies involved performing; (i) Descriptive analysis for study variables (ii) Pearson product moment correlational analysis to find out relationship between study variables (ii) Hierarchical regression to check for predictors of health promoting life style and  (iv) Independent sample ANOVA  to compare the health promoting life style in three groups of students studying health related courses.

Table 4.1

Descriptive Statistics and Reliability Analysis of ten items personality inventory subscales, Life Orientation Test-R, subscales of Health Belief questionnaire and subscales of Health Promoting Life style.

Note: N=150; k = no. of items, M = Mean, SD = Standard Deviation, α = reliability

Table 4.1 indicates the reliability coefficients, Mean and SD of Ten Item Personality Inventory, Life Orientation Test, Health Belief Modal Questionnaire and Health Promoting Life Style Profile II. Ten Item Personality Inventory and life orientation scale showed medium psychometric property α = .56.  Therefore the results should be generalized carefully. Whereas all other scales Health Belief Modal Questionnaire and Health Promoting Life Style Profile II showed higher psychometric properties of α = .89 and α = .94 respectively. All of these reliability values of assessment measures were significant enough to done for further analysis in accordance with the present research hypotheses.

To investigate the relationships between variables Pearson product moment co relational analysis was carried out.

Results revealed positive correlation of age with conscientiousness and medical benefits whereas negative relationship with general health threat. It means that as the people grew older they started acknowledging medical benefits and they are like to develop a higher conscientiousness level with age growth. Student teacher relationship showed a significant positive correlation with extroversion, nutrition, spiritual growth, interpersonal relations and stress management. It showed that the students, who had healthy relationship with their teachers were extrovert, were more conscious about their nutrition, spiritual growth, interpersonal relations and stress management.

Current academic level showed significant positive relationship with life orientation. It indicates that students with higher academic level had optimistic life orientation. Extraversion had a positive significant relationship with conscientiousness, emotional stability, and openness to new experiences, life orientation, general health concerns, health responsibility, physical activity, nutrition, spiritual growth, interpersonal relations and stress management. Agreeableness had significant positive relationship with conscientiousness, emotional stability, openness to new experiences, life orientation and stress management whereas negative relationship with susceptibility to illness. It indicates that students higher in agreeableness are more likely to indulge in new life experiences and have positive life orientation but do not feel the risk of getting ill.

Conscientiousness showed a significant positive relationship with openness to experiences, life orientation, and general health concern, severity to illness, physical activity, spiritual growth, interpersonal relationship and stress management. It means students higher in conscientiousness are more optimists, more likely to indulge in new experiences, more involved in physical activity.

Emotional stability had a significant positive relationship with life orientation, general health concerns, self-help benefits, nutrition, spiritual growth, interpersonal relations and stress management. It indicates that students are emotionally stable are more likely to have positive general health concerns. Greater emotional stability has greater interpersonal relationships. Higher emotional stability indicates the higher stress management.

Openness to experiences had a significant positive relationship with life orientation, general health concerns and spiritual growth whereas significant negative relationship with general health threat. Significant positive relationship was found between life orientation and medical benefits, self-help benefits, spiritual growth, interpersonal relations and stress management. It indicates that students who are higher on openness to experience, they had higher spiritual growth, positive general health concerns whereas, higher openness to experience leads to lower general health threat.

General health concern showed a significant positive relationship with general health threats, severity, medical benefits, self-help benefits, health responsibilities, physical activities, nutrition, spiritual growth, interpersonal relations and stress management. It shows that those students who had greater health concerns, they had greater medical benefits, health responsibilities. They are more likely to had better interpersonal relationships. Their stress management is also high when general health concerns are high.

General health threats are found to be significantly positively related only with susceptibility to illness. It indicates that if general health threats are more than susceptibility to illness will be high.

Susceptibility was only positively related to severity to threat. It means higher perceived susceptibility contributes to the higher perceived severity to health threat.

Severity to threat was positively related to medical benefits, self-help benefits, interpersonal relations and stress management. It describes that students who had high severity to threat, they are more likely to involve in medical benefits, indulge more in self-help benefits, had better relationships and they manage their stress more effectively.

Medical benefits showed positive relationship between self-help benefits, nutrition, spiritual growth, interpersonal relations and stress management. It indicates that those students who involve more in medical benefits, they are more likely to involve in self-help benefits, better in interpersonal relationships, grew better spiritually and manage stress better.

A significant positive relationship was found between self-help benefits and physical activities, nutrition, spiritual growth, interpersonal relations and stress management. It indicates that students who indulge more in self-help benefits get more involved in physical activities, follow healthy nutrition patterns, grew better spiritually, are better in interpersonal relations and manage stress better. Physical activity showed a positive relationship only with nutrition whereas nutrition and all other three subscale of Health Promoting Lifestyles i.e. self-help benefits, interpersonal relations and stress management had a positive relationship with each other. It describes that, students who are more physically active follow healthier nutrition patterns and who follow more healthy diet patterns indulge more in self-help benefits, develop more healthy interpersonal relations and manage stress better.

To examine predictors of health responsibility subscale of Health Promoting Life Style Profile; age, gender, student teacher relationship and current academic level were entered in first block, Ten Item Personality Inventory(extraversion, agreeableness, conscientiousness, emotional stability and openness to experience)in second block, Life Orientation Test-R was entered in third block, and Health Belief Model (general health concerns, general health threat, susceptibility, severity, medical help, self-help benefits)  was entered in the fourth block hierarchical regression was carried out (see table 4.3).

Table 4.3

Hierarchical Regression Analysis for demographics, Personality, Life Orientation and Health Beliefs predicting Health Responsibility

In step I, the covariates (age, gender, student teacher relationship and current academic level) entered as control variable to assess the predictive significance on health responsibilities 3.8 % variance came in the overall model at stage 1 that is F(4, 144) = 4.36, p< .05 . It revealed that only student teacher relationship was the predictor of health responsibility but overall, the model was not significant which indicates that age, gender, and current academic level is not predicting health responsibility. Education was only predictor of health responsibility. In step 2, the effect of personality type (extravert, conscientiousness) on health responsibilities was seen after controlling the effect of covariates with 7.9% variance, F (5,139) = 4.96, p >.05. Result revealed that student teacher relationship is the strongest predictor of health responsibility as it is predicting health responsibilities despite of controlling other variables. With the addition of another variable of life orientation at stage 3 again only student teacher relationship was predicting health responsibility with variance of 0.1 and F (1,138) = 2.28, p< .05 at stage 4 with the addition of Health Belief Model it was found that self-help benefits were predicting health responsibilities with variance of 10.2% and F (6, 132) = 4.34, p<.01.  Overall, variance was 21%.

To examine predictors of physical activity subscale of health promoting life style; age, gender, student teacher relationship and current academic level was entered in first block, Ten Item Personality Inventory in second block, Life orientation Test-Revised was entered in third block, and health belief modal (general health concerns, general health threat, susceptibility, severity, medical help, self-help benefits)  was entered in the fourth block hierarchical regression was carried out (see table 4.4).

The hierarchical multiple regression revealed that at Stage one, gender negatively predicted the physical activity, F (4,144) = 3.03, p< .05) and accounted for 7.8% of the variation in physical activity. Introducing the personality type variables explained an additional 9.3% of variation in physical activity and this change in R² was significant, F (5, 139) = 3.18, p < .01. Adding life orientation to the regression model explained an additional 0.1% of the variation in Satisfaction and this change in R² was significant, F (1,138) = 2.86, p < .01. Finally, the addition physical activity and this change in R² square was also significant, F (6,132) = 2.30, p < .01. When all four independent variables were included in stage four of the regression models, neither personality type, nor life orientation was significant predictors of physical activity. The most important predictor of physical activity was health beliefs. Together the four independent variables accounted for 21% of the variance in Physical activity.

To examine predictors of nutrition subscale of health promoting life style; age, gender, student teacher relationship and current academic level was entered in first block, Ten Item Personality Inventory(extraversion, agreeableness, conscientiousness, emotional stability and openness to experience)in second block, Life orientation Test-R was entered in third block, and health belief modal (general health concerns, general health threat, susceptibility, severity, medical help, self-help benefits)  was entered in the fourth block hierarchical regression was carried out (see table 4.5).

The hierarchical multiple regression revealed that at Stage one, student teacher relationship contributed significantly to the regression model, F (4,144) = 2.64, p < .05 and accounted for 6.8% of the variation in nutrition. Introducing the personality type variables conscientiousness and emotional stability explained an additional 13% of variation in nutrition and this change in R² was significant, F (5,139) = 3.81, p < .001. It indicates that student teacher relationship, conscientiousness and emotional stability are strong predictors of student’s nutrition patterns.  Adding life orientation F (1,138) = 3.43, p < .001with the variance of 0.1% and health beliefs F (6,132) = 4.06, p < .001 with the variation of 13.1% in third and four stages respectively to the regression model but none of the variable predicted nutrition significantly overall significance was 33%. This shows that life orientation, and health beliefs are not predicting nutrition of students.

To examine predictors of health responsibility subscale of health promoting life style; age, gender, student teacher relationship and current academic level was entered in first block, Ten Item Personality Inventory(extraversion, agreeableness, conscientiousness, emotional stability and openness to experience)in second block, Life Orientation Test-Revised was entered in third block, and health belief modal (general health concerns, general health threat, susceptibility, severity, medical help, self-help benefits)  was entered in the fourth block hierarchical regression was carried out (see table 4.6).

In step I, again the covariates (age, gender, student and current academic level) entered as control variable to assess the predictive significance on spiritual growth. Results revealed 5.9% variance and F(4,144) = 2.24 p> .05, . Only student teacher relationship was the predictor of spiritual growth but overall, the model was not significant. In step 2, the effect of personality type (extraversion, emotional stability and conscientiousness etc.) on spiritual growth was seen after controlling the effect of covariates 21.7% variance came in the overall model at stage II,  F (5, 139) = 5.88, p=>.001. Results revealed that student teacher relationship is the strongest predictor of spiritual growth as it is predicting spiritual growth despite of controlling other variables. This indicates that student teacher relationship with the addition of another variable of life orientation at stage 3,  student teacher relationship, extraversion, emotional stability, conscientiousness and life orientation was predicting spiritual growth with variance of 2.2% and F (1, 138) = 5.85, p >.001. At stage 4, with the addition of Health Belief Model it was found that self-help benefits were predicting spiritual growth with variance of 13.9% delta F (6, 132) = 6.39, p=>.001. Overall, the model was strongly predicting spiritual growth. Overall variance in the model was 43.7%.

To examine predictors of interpersonal relations subscale of health promoting life style; age, gender, student teacher relationship and current academic level was entered in first block, Ten Item Personality Inventory(extraversion, agreeableness, conscientiousness, emotional stability and openness to experience)in second block, Life orientation Test-R was entered in third block, and health belief modal  was entered in the fourth block hierarchical regression was carried out (see table 4.7).

In step I, when the covariates (age, gender, student teacher relationship and current academic level) entered as control variable to assess the predictive significance on interpersonal relationships 7.9% variance came in the model at stage I, F(4,144) = 3.10 ,p<.05 . Only student teacher relationship was the predictor of interpersonal relationships. In step 2, the effect of personality type on interpersonal relationship was seen after controlling the effect of covariates. Extraversion, emotional stability with one of the control variable student teacher relationship was strongly predicting interpersonal relationships. 18% variance F (5, 139) = 5.39, p>.001 was reported. Result revealed that student teacher relationship is the strongest predictor of interpersonal relationships as it is predicting interpersonal relationships despite of controlling other variables. With the addition of another variable of life orientation at stage 3,  student teacher relationship and extraversion was predicting interpersonal relationships with variance of .9% and F (1, 138) = 5.05, p= .001. At stage 4, with the addition of Health Belief Model it was found that student teacher relationship, extraversion, self-help benefits and general health concerns were predicting interpersonal relationships with variance of 16.1% delta F (6, 132)= 6.18, p= .001. All the models were strongly predicting interpersonal relationships. Overall, 42.8 variance was reported.

To examine predictors of stress management subscale of health promoting life style; age, gender, student teacher relationship and current academic level was entered in first block, Ten Item Personality Inventory(extraversion, agreeableness, conscientiousness, emotional stability and openness to experience)in second block, Life orientation Test-R was entered in third block, and health belief modal (general health concerns, general health threat, susceptibility, severity, medical help, self-help benefits)  was entered in the fourth block hierarchical regression was carried out (see table 4.8).

Table 4.8

Hierarchical Regression Analysis for demographics, Personality, Life Orientation and Health Beliefs predicting Stress Management

In step I, again, the covariates (age, gender, student and current academic level) entered as control variable to assess the predictive significance on stress management 6.7% variance came in the model that is  F(4,144) = 2.56, p> .05. Only student teacher relationship was the predictor of stress management and overall, the model was significant. In step 2, the effect of personality type (age, student teacher relationship, emotional stability and conscientiousness etc.) on stress management was seen after controlling the effect of covariates. Age was negatively predicting stress management whereas all other were positively predicting stress management. 16.4 % variance was seen in the model that is F (5, 139) = 4.63, p=>.001. With the addition of another variable of life orientation at stage 3, age,  student teacher relationship, extraversion, emotional stability, and conscientiousness was predicting stress management with variance of 1.1% and delta F (1, 138) = 4.39, p=>.001. Age was negatively predicting whereas other mentioned variables were significantly positively predicting stress management. At stage 4, with the addition of Health Belief Model it was found that age, student teacher relationship, emotional stability and self-help benefits were predicting stress management with variance of 16.2%, F (6, 132) = 5.59, p=>.001. All the models were strongly predicting stress management. Overall variance of the model was 44.4%.

One way ANOVA was carried out to see the differences in Personality Type, Life Orientation, Health Belief and Health Promoting Life Style in three groups of students studying Health Psychology, Sports science and Public Health and following are the findings.

Table

• The findings revealed significant differences between the personality type “conscientiousness”, and health promoting life stylee. physical activity, nutrition and stress management. Which means students with increased conscientiousness were tend to indulge more in health promoting life style.

To find out that which group is better post-hoc was run.

Table 4.10

Post hoc Analysis of three groups of students studying health related courses (N=150)

The post hoc analysis is revealed that there was increased conscientiousness and physical activity in students studying health psychology as compared to those studying sports science and public health. Whereas, stress management was better in students of sports sciences.

4.6 Summary of Findings

• It was found out that students with increased conscientiousness, extraversion and emotional stability follow healthy  nutrition, were spiritually groomed and appeared to experience healthy interpersonal relationships as well they also reported healthy student teacher relationship and get involved more  in  self-help benefits in line with the previous researches done by Farsani, Arofzad, and Hosaini in 2013 found that conscientiousness and emotionally stable individuals follow healthy nutrition and live longer.
• The results revealed that conscientious students indulge more into health promoting lifestyle. i.e. physical activity, nutrition and stress management as found in another study done by Bogg & Roberts in 2013 and they found that conscientious individuals were more physically active.
• It was found out that emotional stable students appeared to follow healthy nutrition patterns as it was found in another study done by Kern & Friedman, 2008 that emotionally stable people follow healthy nutrition patterns.
• Health beliefs of students appeared to contribute into their health promoting lifestyle i.e physical activity in line with the findings of the research done by Petrovici & Ritson in 2006 as they found that health beliefs predict healthy behavior.
• Optimist students appeared to be more spiritually groomed similar to the findings of a study done by Lahey in 2013 who found that optimist individuals were more spiritually groomed and their psychological well being was better.
• It was found that students studying health psychology were more conscientious and more physically active as compared to students of sports sciences and public health, whereas students, studying sports sciences appeared to manage stress more effectively. So it can be concluded that students’ current educational program relates with their health promoting life style. These findings were in line with the findings of a study done by Turiano, Spiro, & Mroczek in 2012 and found that the study course of students effect the lifestyle they adopt.
• Results revealed Student teacher relationship strongly influence health promoting lifestyle  of students which means students who reported healthy relationship with their respective teachers appeared to be more extraverts, followed more healthy nutrition patterns, manage stress more effectively and were more spiritually groomed. It was also found that they also had healthy interpersonal relations. They tend to be involved in self help benefits more and were optimists. These findings are proved by literature and other researches done by various researchers such as a research study done by Hill, Turiano, Hurd, Mroczek, & Roberts in 2011 and they revealed that student who had healthy relationships with their teachers used the knowledge in their practical life more as compared to those who had poor relationship .
• Results revealed students older in age appeared to be more conscientious and showed increased involvement in medical benefits. Whereas the students with increase in age appeared to be less afraid of health threats proved by the results of a research study done by Costa & McCrae, 2009 who found that older adults get involved into medical services more frequently.
• Students studying in higher academic level i.e MS, M.Phil showed increased conscientious and seemed to be more involved in self help benefits and were more responsible towards their health. These findings are similar to those of a study done by Barckley, Lichtenstein, & Lee in 2000 and they found that highly educated people get more involved in healthy lifestyle .

Chapter V

Discussion

The main objective of this research was to examine the extent of influence an individual’s personality, life orientation and health beliefs predict their health promoting lifestyle of students who study health related courses. The study also focused to evaluate the role of socio demographic variables such as current age, academic level, study course, student teacher relationship in predicting health promoting lifestyle of students.

In the study results revealed that conscientiousness; extraversion and emotional stability were the predictors of nutrition, spiritual growth, interpersonal relationship, student teacher relationship and self-help benefits. Several explanations may account for the association between Conscientiousness and health. Individuals high in Conscientiousness are more likely to engage in active lifestyles and maintain healthy diets (Bogg & Roberts, 2004). They tend to be more future-oriented in their thinking, so are more likely to weigh the consequences of their actions for future health (Strathman, Gleicher, Boninger, & Edwards, 1994). They also tend to exert higher levels of self-control, and so are less likely to smoke, abuse drugs or alcohol, or engage in health risk behaviors), and are more likely to have successful careers and stable marriages, which are associated with positive health (Bogg & Roberts, 2004).

The processes through which Conscientiousness contributes to health take shape across the life course and are intertwined with individuals’ daily decisions to engage in activities that promote good health and mitigate health risks (Hampson, Andrews, Shanahan, Hill, Roberts, Eccles, & Friedman, 2012).

Conrad and Patry (2012) research proved the finding of the current research as they found that conscientiousness is the personality type that enhances student teacher relationship and students who are extravert by their personality experienced healthy student teacher relationship and practice what is being learned. In the current study it was also found that students higher on conscientiousness and extravert showed healthy student teacher relationship and this healthy student teacher relationship further predicted their health promoting life style.”

Many studies also lend support to the involvement of Extraversion, Agreeableness, and Neuroticism in health processes (Chapman, Roberts, & Duberstein, 2011; Sutin et al., 2010). Less is known about Openness to Experience, although here too there is suggestive evidence that openness to experience is not significantly predicting health promoting lifestyle (Ferguson & Bibby, 2012;).”

Sutin, Ferrucci, Zonderman, & Terracciano ( 2011) support the result of the current research that emotional stability has a strong significant relationship with spiritual growth. They found that as the person grows older he/she become more emotional stable and that further leads to spiritual growth. Consistent with the previous literature this study found that emotional stability has a significant relationship with spiritual growth (O’Connor &Paunonen, 2007).

Neuroticism did not predict health promoting lifestyle, a finding that appears to counter psychosomatic theories suggesting aspects of neuroticism such as stress reactivity and anxiety may translate to increased susceptibility to ill health resulting into increased involvement in health related behaviors (H. S. Friedman & Booth-Kewley, 1987). One hypothesis is that Neuroticism is less strongly related to objective health (Watson & Pennebaker, 1989). In line, the finding of the research study showed a non significant relationship of neuroticism with health promoting lifestyle.

According to the findings of the study those who were optimists were indulged in health promoting lifestyle i.e spiritual growth. These findings are inline of the findings of a research study by Rahimian (2013) who found out the significant positive correlation between happiness, optimism and socioeconomic status, and engagement in health-related behaviors. Similarly, Steptoe et al, (2006) found that optimism was correlated with healthy behaviors such as abstaining from smoking, moderate consumption of alcohol, the habit of walking briskly, high in spiritually growth and regular physical activity, regardless of demographical factors, current psycho-physical conditions and body mass.

According to the health belief model, predictors of health-promoting behaviour include perceived threat (i.e. perceived susceptibility and perceived severity), perceived action benefits and perceived action barriers (Von Ah et al. 2004). Some research indicates that the health beliefs positively correlates with healthy behavior (Lo et al. 2001). According to the findings of the study, health beliefs are related to health promoting lifestyle i.e physical activity. Those students who perceived themselves at risk of being obese, and those obese who suspect themselves getting any disease related to obesity appeared to be more physical active, thus consistent with the findings of previous literature.

Results revealed that student studying health related courses were indulged more in health promoting activities like indulging into more physical activities, stress management and nutrition care but the study carried by Sajwani, (2009) found that the knowledge, attitudes and practices of medical students in Karachi suggest that superior knowledge about healthy lifestyle does not necessarily result into better practices(Sajwani,2009). The reason of this inconsistency could be possible only in the case of medical related fields.

Lazarus (1999) found the positive relationship between student teacher relationship and stress management. He found that good student teacher relationship reduces stress level in students and enhance their academic efficacy and student perform in more better way when they experience good relationship with their teachers (Lazarus, 1999). Similarly in current research this relationship has also been found as students having healthy relationship with their teachers appeared to manage stress more effectively.

Dongre, Deshmukh, Boratne, Thaware, and Garg (2007) found that those students performed better and used their knowledge practically in life in terms of adapting what is being learned who experienced good school environment, facilities and comfortable relationship with their teachers. Moreover, teacher’s harsh attitude leaded to the decline in academics as well less practicing behaviors learned through education. These findings are consistent with the current findings as students studying health related courses and having healthy student teacher relationship predicts more use of knowledge in terms adapting healthy behaviors such as good nutrition, stress management and spiritual growth of the students (Dongre, Deshmukh, Boratne, Thaware, & Garg, 2007).

Research literature proves that with growing age beliefs in medicines and health care responsibilities enhances as proven by the research carried by Chapman, Petrilla, Benner, Schwartz, and Tang (2008). They proved that as people grew older they started taking care of their health and started taking medicines regularly although adherence with diet is poor in older age. In current research it was found out that students older in age were more responsible towards their health thus confirming the findings of the previous literature.

Conclusion

The study examined if students who are enrolled in health related courses i.e health psychology, public health and sports sciences practice health promoting life style or not and if they do, then what are the predictors of their health promoting lifestyle. This study examined the predicting role of personality, life orientation, their health beliefs towards students health promoting life style. Role of demographical variables in adoption of health promoting life was also assessed. The results revealed that student who study health related courses follow health promoting lifestyle to some extent. Personality traits particularly conscientiousness predicted health promoting lifestyle of students.  Students who reported healthy relationship with their teachers were engaged more in health promoting lifestyle. These results obtained here provide relevant information for future actions. To more effectively reduce chronic illnesses and improve population health, health promoting lifestyle should be ensured and for that health related education programs should be planned to stimulate the interests of different students according to their socio-demographic characteristics.

5.2 Limitations and Suggestions of the Study

Some limitations of the current research are as follow;

• First of all, a co-relational research design was used and in order to evaluate accurate relationship between variables a longitudinal design is needed and suggested for further studies. The pre and post health promoting lifestyle of students needed to be assessed for the comparison of health promoting lifestyle before and after their enrollment in the health related courses.
• In the study only those’ students health promoting lifestyle have been examined who were studying health related courses. A comparison of health promoting lifestyle between students from other than health related courses and students studying health related courses would be beneficial to examine the exact influence of study course in adaptation of health promoting lifestyle.
• Not all the variables described in the model of health promotion have been studied in the study including, prior related behavior, Activity related affect and competing demands which are important factors in adoption of health promoting behaviors and in further studies their effect is also needed to be examined.

 5.3 Implications

In spite of all these limitations following are the implications of study

• The present research provides a ground for further investigations examining the predictors of health promoting lifestyle. The findings point to the need for more research into health promotion behaviors, study style, degree programs, social environment or activities, and recreational activities during students’ university and daily lives. Future studies of other life stages, such as the populations of junior high school students, senior high school students, graduate students, young adults, and adults will be needed to clearly show how changing the life conditions or environment of university students influences their health-related behaviors.
• This Research will be helpful to plan interventions to promote health promoting life styles among students.

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