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Year : 2017  |  Volume : 6  |  Issue : 3  |  Page : 169-175

Assessing healthy lifestyles in female university students: Eastern province, Saudi Arabia

Department of Health Information Management and Technology, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia

Date of Web Publication6-Feb-2018

Correspondence Address:
Dr. Mona Faisal Al-Qahtani
Department of Health Information Management and Technology, College of Public Health, Imam Abdulrahman Bin Faisal University, P.O. Box 2435, Dammam 31441
Kingdom of Saudi Arabia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/sjhs.sjhs_102_17

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Aims: This study aim to explore female undergraduates' healthy behaviors, to explore significant differences in their healthy behaviors, and to discover potential correlations between students' healthy behaviors and their demographic variables. Subjects and Methods: This cross-sectional study was conducted during the academic year 2015–2016. The Health-Promotion Lifestyle Profile scale (HPLP-II) was distributed to all 2nd, 3rd, and 4th year undergraduate female students in 6 health professions at Imam AbdulRahman Bin Faisal University, Saudi Arabia. Descriptive and inferential statistics were conducted. Results: A total of 324 participants out of 375 completed the questionnaire with 86.4% response rate. The mean age was 20.69 ± 1.082. The overall/total score for the HPLP-II was 2.46 ± 0.42. There were significant differences in students' healthy behaviors and associations between HPLP-II scores and demographic characteristics. Conclusions: The overall score for HPLP-II was low. The spiritual growth subscale had the highest mean, and physical activity had the lowest mean. The mean scores for HPLP-II of juniors and younger students were higher compared with those of senior and older students. As students progressed through their academic years, their stress management declined. Students in the clinical nutrition profession scored higher on the nutrition subscale than students in the other professions. Therefore, considering female students' low scores in the dimensions of healthy behaviors, it is recommended that educators in charge of decision-making introduce physical and health education to the general curriculum for female university-level students. Facilities should also be provided to encourage healthy lifestyles in female students.

Keywords: Female students, health-promoting lifestyle behavior, Saudi Arabia, undergraduate

How to cite this article:
Al-Qahtani MF. Assessing healthy lifestyles in female university students: Eastern province, Saudi Arabia. Saudi J Health Sci 2017;6:169-75

How to cite this URL:
Al-Qahtani MF. Assessing healthy lifestyles in female university students: Eastern province, Saudi Arabia. Saudi J Health Sci [serial online] 2017 [cited 2022 May 23];6:169-75. Available from: https://www.saudijhealthsci.org/text.asp?2017/6/3/169/224743

  Introduction Top

Health is considered a sophisticated, dynamic, and constantly changing process.[1] Lifestyle affects health,[2] and the maintenance of health-promoting lifestyle behaviors is an important strategy to sustain health.[3] Health-promoting lifestyle behaviors are defined as a “multidimensional pattern of self-initiated actions and perceptions that serve to maintain or enhance the level of wellness, self-actualization, and fulfillment of the individual” (Walker et al.,[4] P = 0.77). These behaviors encompass six dimensions (6D): interpersonal relations (IPR), nutrition, physical activity (PA), stress management (SM), health responsibility, and spiritual growth (SpG).[5] Although healthy lifestyle behaviors are stressed by international organizations, such as the World Health Organization, as a “goal of health” for all age groups,[6] the younger generation worldwide does not seem very interested in health-promotion activities because they perceive themselves as being in a healthy phase of life.[7] The literature emphasizes that the university age is a critical phase for young adults.[8],[9] It is considered a dynamic transitional stage from childhood to adulthood.[8],[9] It is assumed that at this stage of life, university students have greater autonomy, more responsibility for their own health, and more control over their lifestyles compared to adolescents and that this is the period to start adopting a healthy lifestyle.[10]

Previous studies have indicated that many students in this stage of life adopt unhealthy behaviors, such as smoking,[11] the consumption of unhealthy foods, poor PA, and insufficient sleep, all of which might influence both their current and their long-term health.[12],[13]

Studies in Saudi Arabia (SA) have revealed that smoking is on the rise, particularly among young people.[14] In 2009, Bassiony [15] reviewed papers published between 1987 and 2008 on smoking among secondary school and university students in SA. He estimated that at that time, the incidence of smoking ranged from 2.4% to 52.3%. In 2011, Mandil et al.[14] found the prevalence of tobacco use among university students at SA's King Saud University to be 14.5%. Research conducted by Al-Kaabba et al.[16] in King Fahad Medical City, SA, indicated that nearly 40% of medical students had smoked in the past and that approximately 18% were current smokers. In 1999, the overall prevalence of smoking among Saudi female university students was 5.6%.[17] By 2011, the percentage of female university students who smoked had increased to 8.6%,[18] and recent estimates indicated that women constitute 22% of smokers in SA.[19] The incidence of smoking addiction in female students in SA varies by academic specialty. For example, the prevalence was lower among female medical students (0.32%) than among female nonmedical students (4.2%).[20] According to Abdulghani et al.,[21] the incidence of current smoking in female students in SA was highest in the College of Business and Administration (10.81%) and lowest in the College of Medicine (0.86%).

Studies on health-promoting behaviors in SA are scarce. To the best of this author's knowledge, no authorized studies have been conducted to examine this issue in Imam AbdulRahman Bin Faisal University (IAFU), SA. It is expected that this study will be useful in the quest to promote healthy behaviors in students. This study has three objectives. First, it seeks to assess healthy lifestyles in female students in undergraduate health profession programs at IAFU, SA. Second, it seeks to explore any significant differences in their healthy lifestyles in relation to their demographic characteristics. Third, it seeks to explore any correlations between healthy lifestyles and female students' demographic variables.

  Subjects and Methods Top


All 2nd, 3rd, and 4th year undergraduate female students in the different health faculties/professions cardiac technology (CT), clinical nutrition (CN), health information management and technology (HIMT), clinical laboratory sciences (CLS), respiratory care (RC), and physical therapy (PT) – at IAFU-Female section were eligible to participate. Overall, 324 participants of a possible 375 completed the questionnaires, resulting in a total response rate of 86.4%. Response rates by program were as follows: CT, 78% (n = 52); CN, 83% (n = 57); HIMT, 98% (n = 44); CLS, 81% (n = 56); RC, 97% (n = 66); and PT, 86% (n = 49).

Ethical approval and consent to participate

This cross-sectional study received the ethical sanctions of the institutional review board (IRB-2016-03-016) of IAFU, SA. All the participants gave their informed written consent after being assured that the study information was classified and that participation was anonymous and voluntary.


The Arabic version of the Health-Promotion Lifestyle Profile (HPLP-II) questionnaire [22],[23] was adapted for use in measuring health-promoting lifestyles. It contained 52 statements covering the following 6D/subscales: (1) IPR, (2) nutrition, (3) PA, (4) health responsibility, (5) SM, and (6) SpG. The statements asked participants to indicate on a 4-point Likert scale (ranging from 4 = routinely, 3 = often, 2 = sometimes, to 1 = never) how often they engaged in various healthy behaviors. For each dimension, the sum of the scores for all items was divided by the total number of statements in the dimension to obtain the subscale scores. The overall/total HPLP-II score was obtained by an aggregate of all the scores and the division of the product by the total number of statements. The resulting scores were used as an index of health-promoting lifestyles. The higher the overall/total HPLP-II score, the higher the level of health promotion. A personal information form was also included and required the following sociodemographic variables: age, grade level/year of study, and faculty specialty/profession. A paper-based questionnaire was used to collect the data. The first page of each questionnaire contained an explanation of this study's purpose. It took approximately 10–15 min to complete the questionnaire.

Five students were used in a pilot study to test the questionnaire's feasibility and applicability. The result of this study showed that the questionnaire was clear and unambiguous and did not require any changes to its content.

Statistical analysis

The data were analyzed using the Statistical Package for Social Sciences (SPSS, IBM, Chicago, Illinois, USA), version 19. Continuous data were reported as the mean, standard deviation, median, and interquartile range, whereas categorical data were reported as the number and percentage. The Kolmogorov–Smirnov test was used to assess the normality of the data distribution. The results of this test indicated that nonparametric tests were more appropriate for use. A comparative analysis of students' scores on the HPLP-II scale and its six subscales by age groups, grade level/year of study, and faculty specialty/profession was conducted utilizing both the Kruskal–Wallis test and the Mann–Whitney U-test. Cronbach's alpha coefficient was calculated to assess the internal consistency of the items. Spearman's rho coefficient was computed to evaluate correlations among the variables under study. A 0.05 level of significance was used as a cutoff point for statistical significance.

  Results Top

Demographic characteristics of Female University students

There were 324 female student participants, with a mean age of 20.69 ± 1.082 years. Most participants were between the ages of 19 and 21 (n = 252, 78%), and most were in their 4th year of study (n = 121, 37.3%) and studied in the RC Department (n = 66, 20.4%) [Table 1].
Table 1: Demographic characteristics of female university students in eastern province, Saudi Arabia

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Internal consistency was computed utilizing the Cronbach's alpha coefficient. Cronbach's alpha (α) for the scale and the six subscales of HPLP-II ranged from 0.664–0.818 [Table 2]. The results of the study agree with earlier HPLP-II research that reported the comparable reliability scores deemed to be satisfactory.[1],[24]
Table 2: Descriptive statistics for the health-promoting lifestyle behavior subscales for the whole sample (n=324)

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Healthy behaviors of Female University students

The statistics for the female students' self-reported healthy lifestyle behaviors are presented in [Table 2]. The overall/total mean score for the HPLP-II scale was 2.46 ± 0.40, as shown in the last row of [Table 2]. SpG had the highest mean score (2.93 ± 0.548) and PA the lowest (1.94 ± 0.612). The subscales' mean scores were categorized as high (if > 3), moderate (if between 2.5 and 3), and low (if < 2.5).

[Table 3] presents the overall HPLP-II and subscale scores for the respondents based on their demographic variables. There were significant differences in healthy behaviors by age group (P = 0.029, 0.000, and 0.037 for the overall HPLB-II, SM, and SpG subscales, respectively), department/profession (P = 0.017 for nutrition subscale), and year of study (P = 0.015 for the stress-management subscale).
Table 3: Means, standard deviations, medians, and interquartile ranges of overall/total Health-Promotion Lifestyle Profile scale-ii and subscales for the respondents based on their demographic variables

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The correlation analysis of the HPLP-II scale, as well as its subscales, with demographic characteristics for the entire sample showed that the overall HPLP-II was negatively and significantly associated with age group (r = −0.122, P = 0.028). The IPR subscale was related significantly and negatively to year of study (r = −0.131, P = 0.018). SM and SpG subscales were both associated significantly and negatively with age group (r = −0.213, P = 0.000; r = −0.116, P = 0.037, respectively) and year of study (r = −0.110, P = 0.048, and r = −0.162, P = 0.003, respectively). In addition, the stress-management subscale was significantly related to department/profession (r = 0.116, P = 0.037).

Both the correlation analysis of the HPLP-II scale and its subscale, with demographic characteristics for students by professional program, revealed that for students in the RC profession, health responsibility, SM, SpG, and overall HPLP-II were related negatively and significantly to age group (r ranged from −0.281 to −0.329, 0.007 ≤ P ≤ 0.022). In addition, SM, IPR, SpG, and overall HPLP-II were related negatively and significantly to the year of study (r ranged from −0.264 to −0.367, 0.002 ≤ P ≤ 0.032).

For students in the CLS, the health responsibility subscale was significantly and positively related to the year of study (r = 0.328, P = 0.014). For students in the CN, the subscales of PA, IPR, SM, and overall HPLP-II were significantly and negatively related to the year of study (r ranged from −0.338 to −0.446, 0.001 ≤ P ≤ 0.010). Furthermore, the stress-management subscale was significantly and negatively related to age group (r = −0.285, P = 0.032). For HIMT, the nutrition, SM, and overall HPLP-II scores were significantly and negatively related to age group (r ranged from −0.336 to −0.373, 0.013 ≤ P ≤ 0.026). For students in both PT and CT, no significant association was found between the overall/total HPLP-II scale or its subscale and the year of study and age group.

  Discussion Top

This study explored the healthy lifestyles of female students in six health professions at IAFU, SA. The overall mean score of the HPLP-II (mean = 2.46) corresponded to the overall mean score of the HPLP-II obtained from Japanese university students (mean = 2.50)[25] and was higher than that of Jordanian university students (mean = 2.40).[1],[26] However, it was lower than that of students at Kuwait University (mean = 2.60).[24]

For this study's subscales, the lowest score was for “PA” and the highest score was for “SpG.” This finding is in accordance with the findings of studies by Hosseini et al.[27] in Iran, Al-Qahtani [28] in SA, Al-Khawaldeh [1] in Jordan, Nassar and Shaheen [29] in Jordan, Can et al.[13] in Turkey, and Kirag and Ocaktan [30] in Turkey. In line with the findings of previous studies,[1],[13],[26] SpG was found to have primary importance and had the maximum score. Cultural and religious factors might explain the high scores for SpG.

The low scores for PA in the study might be partially attributable not only to cultural norms that discourage PA, especially for females but also to the lack of infrastructure necessary for promoting exercise. There are few safe public outdoor places for people to walk in SA's harsh weather. In addition, membership in gyms that are mostly operated by private hospitals or ladies' salons is expensive. Other possible explanations for the low score for PA might be the absence of compulsory or even elective physical education courses in female sections at Saudi universities. This discourages students' PA. Samara et al.[31] indicated that the major barriers to the PA of females in Saudi universities are the shortage of facilities, the lack of support from university authorities, and societal restrictions. Therefore, it is recommended that decision makers in higher education introduce courses such as physical education and intervention programs that encourage students to engage in PA. The results of the current study confirmed the results of Al-Kandari et al.[24] and Nassar and Shaheen [29] that showed a tendency by university students to engage in very little PA.

In general, this study concluded that the scores for female university students are low for overall HPLP-II behaviors. The scores are also poor for SM, PA, nutrition, and health-responsibility behaviors. However, moderate levels of IPR and SpG health-promoting behaviors were displayed (mean = 2.81 and 2.93, respectively).

Comparative analysis of students by level/year of the study showed that the mean score for SM among 2nd year students was significantly higher than that among their counterparts. Likewise, Hosseini et al.[27] found that the mean of 1st year students' SM was greater than that of 4th year students. However, the result of the significant differences found in the students' SM scores with respect to the level/year of study contradicts the findings of Al-Khawaldeh [1] that reflected an absence of significant differences in the total HPLP-II score and its subscales with respect to students' level of study. The results of this study seem to reflect the impact of the stress of university life and the students' ability or inability to adapt to the pressures of that life. It is recommended to convene courses and/or workshops that focus on stress-management skills and how to cope with university life.

In addition, younger students (i.e., 19–21-year-old) scored significantly higher on overall HPLP scale, SpG, and SM than older students.

Interestingly, a higher score for SM was negatively associated with age groups and level/year of the study. The tendency was for older and senior students (i.e., 4th year students) to score lower on SM than younger and junior students.

Comparative analysis of students by profession showed that nutrition scores for students in the CN profession were higher than those for students in other professions. One possible explanation for this result is that these students' specialty makes them more conscious of the significance of a healthy diet, and they are better informed of the risks of eating unhealthy foods than students in other professions.

The correlation analysis by profession revealed that the stress-management subscale score was significantly and negatively related to age group and year of study but only for the RC and CN professions. This negative association between age and SM contradicts the results of the Al-Khawaleh [1] study. However, our result is in accordance with the conclusion of the Can et al.[13] study. This result could be the consequence of cumulative stress over time resulting from students' course load and the demands of academic life. In this study, the negative and significant correlation between the stress-management subscale and age contradicts the findings of Nassar and Shaheen [29] showing that only the interpersonal subscale negatively and significantly correlated with students' age.

In addition, the association between health responsibility and level of study was statistically and positively significant for students in the CLS profession. One possible reason for this finding might be the students' maturity. As these students advanced in their studies, they tended to be more conscious of the significance of a healthy diet and lifestyle and of the role of their health responsibility in sustaining healthy behaviors. Hosseini et al.[27] also found that the score of upper-level students increased in certain dimensions of health-promoting behaviors, such as health responsibility, whereas it decreased in other dimensions, such as SM.

Limitations of the study

The main limitation of this study is that the sample was only taken from undergraduate female students in six health professions. Our recommendation is to conduct studies that investigate the healthy lifestyles of students in other health sectors.

  Conclusions Top

The overall HPLP-II scores of the female students were low. The lowest mean score was for PA and the highest for SpG. The mean scores of HPLP-II of juniors (years 2 and 3) and younger (19–21-year-old) students were higher compared with those of senior (year 4) and older students (22–24-year-old). Moreover, as they progressed through their education, students' SM decreased. Students in the CN profession scored higher on the nutrition subscale than students in other professions.

These study findings can be used by decision makers and top management educators as a basis for allocating resources to develop infrastructure that facilitates and allows females to perform physical exercise and for planning intervention programs that promote positive healthy behaviors in female university students. The findings also provide practical evidence for the need to incorporate health education/promotion courses into the general curriculum to increase students' appreciation of the role of health-promoting behaviors in sustaining health and to foster positive attitudes toward behaviors that contribute to healthy lifestyles.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

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  [Table 1], [Table 2], [Table 3]

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