International Journal of Nursing Practice 2010; 16: 3542

RESEARCH PAPER

The influence of a health education programme

on healthy lifestyles and practices among
university students
ijn_1801

35..42

Fathieh A Abu-Moghli PhD RN

Associate Professor, Clinical Nursing Department, Director of Studies Department, University of Jordan, Amman, Jordan

Inaam A Khalaf PhD RN

Professor, Maternal Child Nursing Department, Director of Community Service Office, University of Jordan, Amman, Jordan

Farihan F Barghoti MD
Associate Professor, Family and Community Medicine Department, University of Jordan, Amman, Jordan

Accepted for publication May 2007

Abu-Moghli FA, Khalaf IA, Barghoti FF. International Journal of Nursing Practice 2010; 16: 3542
The influence of a health education programme on healthy lifestyles and practices among
university students
This study aimed at exploring the lifestyles of university students, the relationship between specific demographical
variables and health practices and the role of training in improving these practices. An experimental and a comparison
group were selected using the convenient sampling method. Two 5-day training programmes on healthy lifestyles were
conducted. Self-reported behaviours of both groups were assessed before and after the programme. The results reflected
slightly positive health practices related to the three behavioural categories with the type of diet being the highest and
physical activity being the lowest. No significant differences were reflected in relation to the selected variables. A positive
influence of training on improving health behaviours of university students related to the three behavioural categories was
observed. Results suggest a similar course to be included as a university elective and students involvement in available
extra curricular activities be encouraged.
Key words: lifestyle, Jordan, nutritional habits, physical activity, university students.

INTRODUCTION
Health is a dynamic process, which changes constantly
throughout life. Health denotes the quality of life involving physical, social, emotional, intellectual and spiritual
well-being.1 One of the major potential challenges to

Correspondence: Fathieh A. Abu-Moghli, University of Jordan, Amman,

Jordan. Email: fathieh@ju.edu.jo
doi:10.1111/j.1440-172X.2009.01801.x

health is the rapid rise of non-communicable diseases

linked by common preventable risk factors related to
lifestyles.2
Health promotion continues to be sanctioned as the
long-term most cost-effective approach to the reduction
of preventable health problems. Promoting healthy lifestyles is a central element in attaining the goals
and objectives of Healthy People by the year 2010.3
Health-promoting lifestyles include many dimensions
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FA Abu-Moghli et al.

such as physical activity, nutrition, stress management, health responsibility, interpersonal support and
self-actualization.4
Improving physical activity and nutrition prevents
deadly chronic diseases and helps control their consequences in those who become ill. Nutrition and physical
activity are key elements to reducing harm caused by heart
diseases, stroke and cancer, as well as diabetes. On the
other hand, unhealthy behaviours are associated with
costly health consequences. Besides the detrimental
impacts for individuals, families and communities is the
financial burden of escalating health-care costs for chronic
illnesses.5
Studies have indicated that health-related curricula
have led to significant changes in knowledge, attitudes and
behaviours of students in the middle and high school.610
At the university level, the importance of health courses in
promoting students health has been acknowledged,
although the impact of such courses on students knowledge, attitudes and behaviours is still unclear.1114 Consequently, the present study explores the healthy lifestyles
of university students and the role of an educational programme in improving the students health practices. The
results will provide information on how to best help
adults achieve and maintain healthy lifestyles and promote
their health status.

Objectives
This study aims to:
1. Assess university students current health practices
related to nutrition (type of diet, nutritional habits) and
physical activity.
2. Identify the relationship between health practices and
certain demographic variables among university students.
3. Evaluate the influence of an educational programme on
improving university students health practices.

Operational definitions
Nutritional practices: the type of diet and nutritional
habits indicated by the students as reflected by the scores
obtained on the study instrument.
Physical activity: the physical practices reported by
students as reflected by the scores obtained on the study
instrument.

Literature review
In one of the reviewed studies, the lifestyles were assessed
among culturally varied students.15 The East European
2010 Blackwell Publishing Asia Pty Ltd

students lifestyles were found to be less healthy than

Western Europeans. East European students were less
likely to be aware of the relationship between lifestyle
practices and risk of developing cardiovascular diseases. In
another study, gender differences in students health
habits and motivation for a healthy lifestyle were investigated.16 The study results showed that female students had
healthier habits related to alcohol consumption and nutrition but were more stressed. Male students showed a high
level of overweight and obesity and were less interested in
nutrition advice and health-enhancing activities.
However, a study conducted in Hong Kong indicated that
health-promoting behaviours and psychosocial well-being
of university students did not differ significantly by
gender, but male students scored better than female students on the physical exercise subscale.17
A study of the association between health-related
behaviours, social relationship and health status in late
childhood and adolescence indicated that in both genders,
smoking, irregular breakfast eating and poor perceived
current health were associated with persistent inactivity.18
The association between the practice of regular physical
exercise, the anthropometrical and physiological characteristics, and the dietary habits and the type of study
(nursing vs. other disciplines) was also investigated.19
Regular physical exercise in nursing students was found to
be positively correlated with higher absolute and relative
maximal volume of oxygen and with lower diastolic blood
pressure. However, statistically significant differences
between the two groups in anthropometric indices were
not observed. Similarly, a descriptive cross-sectional
study was conducted to assess current awareness and practice of health risk behaviours among Egyptian university
students.20 The main determinants of risky behaviour
reported were being a male, of older age, having a high
allowance and having no attention to danger.
The effect of health education on health-related behaviours has been studied worldwide. At the school level, a
study was conducted to investigate the effect of a health
education programme on healthy lifestyles on promoting
child health in schools.21 A significant increase in students
knowledge of nutrition and healthy lifestyles as determined by the scores obtained on a prepost-test was
reported. At the university, the results of a pilot study to
evaluate the effects of a healthy-lifestyle-promoting programme, taught as part of an undergraduate community
health nursing course, indicated a positive change in physical fitness, exercise and nutrition among students.22

Healthy lifestyles

37

Similarly, a study conducted in Taiwan indicated that a

course on health promotion for nursing students significantly increased students intent to adopt healthy
lifestyles.23 In Lebanon, a positive impact of a universitylevel Health Awareness course on attitudes and behaviours of undergraduates enrolled in the course was
reported. In addition, movement in a health promotion
direction along the stages of change was evident for
smoking, type of diet and exercise.24
The literature reviewed has confirmed the relationship
between the lifestyles and the health status of individuals.
Moreover, it reflected that nurse educators are in an ideal
position to develop and provide health promotion and
illness prevention programmes, both for their own
nursing students and for a broader campus-wide student
population. Yet, the degree of the impact of health education on university students knowledge, attitudes and
behaviours still needs to be clarified.

METHOD
Design
This quasi-experimental study is designed to evaluate
the extent to which the participation in a health education programme influences students health-related
behaviours.

Setting and sample

The target population of the study was undergraduate
students enrolled in the various faculties at the University
of Jordan. The University of Jordan is the oldest institution of higher education in Jordan. The university population is mainly youth as the students age ranges from 18
to 25 years.
The convenient sampling method was used to select the
sample. An experimental group was formed through
posting announcements in all 18 faculties inviting students
to participate in a workshop on healthy lifestyles. Registration of students was performed at the Community
Service Office at the university. Students consent for
participation in the study was solicited during registration
time. The number of students who registered, attended
the workshop and accepted to participate in the study was
60 students. However, 46 of them (76.6%) completed
the questionnaire before and 2 months after the workshop. For the comparison group, the students attending
another educational programme offered by the Community Service Office (civic education) were approached
(n = 100), of whom only 84 (84%) accepted to partici-

pate and completed the questionnaire before and 2

months after the programme.

Instrument
A self-administered questionnaire to assess the attitude
and self-reported behaviours of students was developed
by the researchers based on an extensive review of the
literature and an items pool prepared by the six health
professionals who conducted the programme. The questionnaire is composed of two parts; part one includes
selected demographic information and questions related
to smoking habits, illnesses, regular medications taken
and habits related to sports. Part two includes 25 descriptive statements of behaviours related to lifestyles grouped
under three categories: type of diet (nine items), nutritional habits (eight items) and physical activity (eight
items). A four-point scalealways, most of the time,
rarely and never with values 4, 3, 2 and 1, respectively, is
used to assess students responses to the statements in
each behavioural category.
The questionnaire was submitted to a jury of three
nurse educators and two family physicians to assess validity. A pilot study was conducted on a sample of students
(n = 20), who were not included in the study; accordingly
modifications of the instrument and method were done.
Internal consistency reliability (Cronbach alpha) estimates
were 0.71 for the type of diet, 0.70 for nutritional habits
and 0.79 for physical activity. The overall internal consistency reliability was 0.77.

Data collection method

An official permission to conduct the study was obtained
from the university administration. Ethical approval was
obtained from two ethical committees: the Research
Committee at the Faculty of Nursing and the Research
Ethical Committee at the Deanship of Academic Research
at the University of Jordan. Both committees confirm to
the provisions of the Declaration of Helsinki in 1995 (as
revised in Edinburgh 2000).
Two 5-day educational programmes on healthy lifestyles were planned and coordinated by the researchers
and conducted by a group of faculty members (four nurse
educators and one community and one family physician).
The daily sessions extended over an 8 h period each. The
programme was designed to help students make selfdirected and autonomous health decisions. The content
was related to the students daily life practices (i.e. eating
breakfast, water intake per day, exercise and relaxation).
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FA Abu-Moghli et al.

An interactive approach was used and students were led

through group discussions and role play to reflect on the
relationship between health behaviour and health status.
Various active teaching strategies and learning resources
were used to enhance students understanding. A manual
including all presented material was prepared by the educators and distributed to all students in the experimental
group.
The questionnaire was distributed to students who
agreed to participate in the study before the beginning of
the first session for both the experimental and comparison
groups. It was re-administered to the students in both
groups during a meeting that was held 2 months after the
end of the educational programme.

Data analysis
Statistical analyses were performed using the statistical
software package spss version 13 (SPSS Inc., Chicago, IL,
USA). Scores of items within the same health style were
added and mean score calculated for each respondent and
then for all respondents in the sample to create one variable measuring each style. Descriptive statistics (frequencies and percentages and SD) and t-test were used to
measure significant differences between the mean scores
for each of the three health styles according to students
gender and faculty type. The pretest and post-test scores
related to the type of diet and nutritional habits passed the
KolmogorovSmirnov normality test (P > 0.05), whereas
pretest and post-test scores related to physical activity did
not pass the KolmogorovSmirnov normality test except
after logarithmic transformation.

Body mass index (BMI) was calculated by determining

the relationship between weight and height. A BMI less
than 20 is considered to be low, a BMI of 2025 is considered to be normal and a BMI of greater than 25 is
considered to be high.
Analysis of variance (anova) was used to test significant
differences in the pretest mean scores of students in the
three BMI categories followed by StudentNewman
Keuls test for multiple comparisons. Analysis of covariance (ancova) was used to test for differences in post-test
scores between the two groups (comparison, experimental) and the pretest scores were used as covariate in the
comparison between the two groups. Paired analysis for
means was conducted for pretest scores as compared with
post-test scores to indicate significant improvement in
behaviours of the experimental group related to the three
categories (type of diet, nutritional habits and physical
activity). In all of the statistical tests, the null hypothesis
was rejected (P 0.05).

RESULTS
Table 1 shows the characteristics of both the experimental
and comparison groups. It shows that 23.8% of the students were male and 76.2% were female. Out of the total
sample, 34.1% were enrolled at humanity faculties and
64.9% were in science faculties. The majority of the students (70.7%) have a normal BMI whereas 11.2% have
less than the normal BMI and 18.1% have a BMI above
than the normal.
Other background information indicates that the two
groups were very similar. No significant differences were

Table 1 Characteristic of the sample illustrated by frequencies and percentages

Variable

Gender
Faculty
Body mass index

Total (n = 8130)
N (%)

Group

Male
Female
Humanity
Science
Lower
Normal
Upper

2010 Blackwell Publishing Asia Pty Ltd

Comparison (n = 84)
N (%)

Experimental (n = 846)
N (%)

18
66
21
62
10
47
16

13
33
24
22
3
35
5

(21.4)
(78.6)
(25.3)
(74.7)
(13.7)
(64.4)
(21.9)

(28.3)
(71.7)
(52.2)
(47.8)
(07.0)
(81.4)
(11.6)

31
99
45
84
13
82
21

(23.8)
(76.2)
(34.1)
(64.9)
(11.2)
(70.7)
(18.1)

Healthy lifestyles

39

indicated except for the smoking behaviour as 4.8% of the

comparison group and 15.2% of the experimental group
were smokers (c2 = 4.19). Almost all the study participants (98.8% and 97.5% of the comparison and experimental groups, respectively) believe that practising sports
is healthy. However, 4.8% of the comparison and 8.7% of
the experimental group are members in a sport club. Only
9.5% and 10.9% of the comparison and experimental
groups, respectively, indicated that they complain of
health problems and 11.9% and 6.7% of the comparison
and experimental groups, respectively, take prescribed
medications.
Table 2 shows that the mean scores of the two groups
on the pretest reflect slightly positive health practices
related to the three behavioural categories (Mean = 2.42,
SD = 0.35). The highest score was related to the type of
diet (Mean = 2.61, SD = 0.43) followed by nutritional
habits (Mean = 2.60, SD = 0.47) and the lowest was for
the physical activity (Mean = 2.04, SD = 0.59).
In regard to the relationship between practices in the
three categories (type of diet, nutritional habits and physical activity) and gender and type of faculty (humanities or

scientific), the results of t-test show no significant differences at P = 0.05 level or less for any of the health practices (t-test values ranged between 0.01 and 3.92).
anova test results reflected significant differences
between BMI (low, normal and high) and health practices
related to the type of diet (F = 3.92, P = 0.02). The
StudentNewmanKeuls test shows that students who
have a low BMI have a higher mean scores for practices
related to the type of diet (Mean = 2.93, SD = 0.35)
compared with students who have a normal BMI
(Mean = 2.58, SD = 0.43), and students who have a
higher than normal BMI (Mean = 2.61, SD = 0.4)
(Table 2). Students with low BMI scored higher on nutritional habits than those who have normal and high BMI
(2.64, 2.59, 2.48, respectively); these differences were,
however, not significant. On the other hand, students
BMI did not seem to be related to physical activity as
students with high BMI scored higher on physical activity
followed by students with normal and finally those with
low BMI.
To evaluate the influence of the educational programme on improving health behaviours of university

Table 2 Pretest mean scores, standard deviation (SD) and t-test for both the experimental and comparison groups
Variable

Lifestyle
Physical activity
Mean SD

Gender

Male (n = 31)
Female (n = 99)

t-test
P-value
Faculty Humanities
(n = 45)
Science (n = 84)
t-test
P value
Body
Lower (n = 13)
mass
Normal (n = 82)
index
Upper (n = 21)
F-test
P-value

95% CI

Type of diet
Mean SD

95% CI

Nutritional habit
Mean SD

95% CI

Total
Mean SD

95% CI

2.12
2.02
0.70
0.48
1.95

0.68 1.872.37 2.65

0.55 1.912.13 2.59
0.67
0.5
0.51 1.802.11 2.53

0.38 2.512.79 2.51

0.44 2.502.68 2.62
1.08
0.28
0.42 2.412.66 2.61

0.45 2.342.68 2.44

0.48 2.522.72 2.41
0.29
0.77
0.49 2.462.76 2.37

0.39 2.292.58
0.34 2.352.48

2.09
1.14
0.25
2.03
2.05
2.08
0.01
0.98

0.62 1.962.23 2.64

1.36
0.17
0.6 1.672.40 2.93
0.55 1.932.17 2.58
0.72 1.752.42 2.61
3.92
0.02

0.43 2.552.74 2.58

0.36
0.72
0.35 2.713.14 2.64
0.43 2.482.67 2.59
0.4 2.432.79 2.48
0.59
0.55

0.46 2.482.68 2.45

1.17
0.25
0.62 2.263.02 2.55
0.45 2.492.69 2.41
0.48 2.262.70 2.4
0.9
0.41

0.34 2.372.52

0.36 2.262.48

0.37 2.332.77
0.34 2.342.49
0.4 2.222.58

CI, confidence interval.

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FA Abu-Moghli et al.

Table 3 Means and standard deviation (SD) for pretest and post-test and ancova test between groups
Variable

Physical activity
Type of diet
Nutritional habits
Total

Comparison

Pretest
Post-test
Pretest
Post-test
Pretest
Post-test
Pretest
Post-test

Experimental

Mean

SD

95% CI

Mean

SD

95% CI

2.02
2.02
2.65
2.65
2.57
2.57
2.42
2.42

0.64
0.63
0.42
0.42
0.49
0.49
0.37
0.36

1.882.16
1.882.50
2.562.74
2.562.74
2.472.68
2.462.68
2.352.50
2.342.50

2.08
2.30
2.51
2.82
2.63
2.81
2.41
2.65

0.48
0.59
0.43
0.46
0.44
0.43
0.32
0.38

1.942.23
2.122.48
2.382.64
2.692.96
2.502.76
2.682.94
2.312.51
2.442.57

ancova
F-test

Observed
power

P-value

0.00

0.99

0.05

11.52

0.00

0.92

22.56

0.00

0.99

1.70

0.19

0.25

CI, confidence interval.

students related to the three categories, and to test the

differences between the comparison and experimental
groups, ancova test was applied taking into consideration
the value of pretests results. The results as reflected in
Table 3 show a significant difference in relation to type of
diet (F = 11.52, P = 0.00) as the experimental group had
higher mean score (2.82) than the comparison group
(2.65). A significant difference between the experimental
and the comparison groups was also reflected in relation
to nutritional habits (F = 22.56, P = 0.00) where the
experimental group scored higher (Mean = 2.81) than
the comparison group (Mean = 2.57). No significant differences in health behaviours related to physical activity
were recorded at P = 0.05 level (F = 0.0).

DISCUSSION
This research explores the healthy lifestyles of university
students and the role of education in improving their
health practices. The percentages of male and female students in the sample selected reflect the percentage of both
male and female students enrolled at the university at the
time of the study. Moreover, although the nonprobability sampling procedure was used for selecting the
sample, yet, no significant differences in the background
information (smoking behaviour, beliefs about exercises
and health status) of the two groups were noted, which
indicates that the sample is representative of the university
students.
The results of the present study reflected slightly positive health practices related to the three behavioural cat 2010 Blackwell Publishing Asia Pty Ltd

egories with the type of diet being the highest and physical
activity being the lowest. These results are congruent
with those of a study conducted by Lee and Loke17 who
reported that less than half of the university students ate
fruits and vegetables every day and only a few were
engaged in some form of physical activity or exercised
regularly.
Inconsistency regarding the relationship between
gender and nutritional habits and physical activity was
reflected in the literature. Although, in some studies,
female students were reported to have healthier habits
related to nutrition, male students were found to be more
likely to exercise regularly.16,25 Yet, other studies
reflected that students scores on nutritional habits did not
differ significantly by gender, and that male students
scored better than female students on physical exercise.18
The results of the present study, however, indicated no
significant relationship between students gender or type
of school (sciences or humanities) and the students habits
related to either nutrition or physical activity.
The results of the present study reflected significant
differences between BMI and health practices related to
the type of diet. Students who have low BMI have higher
mean scores for practices related to the type of diet compared with the students who have a normal BMI and
students who have high BMI. Students with lower BMI
scored higher on nutritional habits followed by the normal
and the high BMI. These differences were however not
significant. On the other hand, students BMI did not
seem to be related to physical activity as students with

Healthy lifestyles

high BMI scored higher on physical activity followed by

students with normal BMI and finally students with low
BMI. Steptoe et al. indicated that, in their study, no
simple association between BMI and physical exercise was
observed.15 Among women, BMI was not related to physical exercise. Among men, a curvilinear association
emerged with higher levels of engagement among individuals with a BMI in the average range.
The results of the present study indicated a positive
influence of education on improving health behaviours of
university students related to the three behavioural categories. The difference in the scores of the experimental
and control groups was significant in relation to type of
diet and nutritional habits but was not significant in relation to physical activity. This result supports the results of
many of the reviewed studies2124 and might be attributed
to that it is easier to note the direct influence on behaviours that do not require much effort such as nutrition vs.
behaviours related to physical activity. However, the
results of a study conducted in Beijing reflected contradictory results.26 Interestingly, the Beijing study indicated
a significant decrease in the participation in physical exercise and a significantly greater intake of high-salt foods.
In conclusion, this study provides preliminary support
for the impact of the programme on students knowledge
and behaviour. One of the main factors considered as
contributing to the success of the programme is that students participated voluntarily. However, several factors
limit the generalization of the results. Self-selection to
participate in the programme might indicate that respondents in the experimental group are already sensitized and
interested and might be more receptive to health messages
transmitted than other university students. Moreover, a
causal interpretation of the association between education
and physical activity cannot be made from this study
because of the relatively short period between the preand post-tests. Consequently, a follow up on students
might better predict changes in physical exercise over a
12-month period. Moreover, to confirm the real effect of
health education, it is recommended that a similar course,
taught by health-care professionals specifically nurse educators, be included as a university elective that is subject
to pre- and post-testing of knowledge and self-reported
behaviours. In addition, students should be encouraged to
join the extra curricular activities such as sports and health
awareness campaigns, which are already available at the
university campus on continuous basis to enhance their
attitudes and practices of healthy lifestyles.

41

ACKNOWLEDGEMENTS
We are grateful to the Deanship for Scientific
ResearchUniversity of Jordanand the United
Nations Population Fund (UNFPA) for funding this study.
Our gratitude extends to the university students, whose
participation made this study possible, and to many others
who contributed to this study.

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