Health promotion and risk behaviors among adolescents in Turkey

Alruwaili K, Alanezi YSA, Abdulhadi Alruwaili A. Assessment of health promotion behavior and associated factors among the northern Saudi adolescent population: a cross-sectional study

Background and Aim

Health promotions among the adolescent population have a significant role in achieving the 2030 sustainable development goals of the World Health Organization. The COVID-19 pandemic has led to several devastating impacts on the health, economic, social, and healthcare systems, and adolescents' health promotions are no exception. We assessed health promotion behaviors and associated factors among the adolescent population of northern Saudi Arabia (KSA).

Methods

We used the Arabic version of the adolescent health promotion scale (AHPS-40) among the 400-adolescent population. The AHPS-40 assessed six domains of adolescent health behavior: nutrition, social support, health responsibility, life appreciation, exercise, and stress management. We applied the Chi-square test to identify the associated factors of adolescent health promotion activities and the logistic regression test to find the predictors for overall health promotion categories.

Results

Of the studied participants, the mean ± SD of the total AHPS-40 was 103.31 ± 18.78. The nutrition domain of the AHPS-40 was significantly associated with the age group (p = 0.002), and the social support domain was significantly related to fathers' (p = 0.022) and mothers' education (p = 0.006). The exercise domain of AHPS-40 was significantly associated with age group (p = 0.018) and school level (p = 0.026). Gender was significantly associated with most of the six domains. Furthermore, more than half (52.7%) of them had a low health promotion behavior, which was significantly associated with gender (adjusted odds ratio = 1.59, 95% CI of AOR = 1.04 -2.45, p = 0.032).

Conclusion

Our study results suggest improving health promotion behaviors by instituting awareness-raising and health promotion intervention programs for adolescent groups. Furthermore, we recommend a focused, exploratory, mixed-method survey among the adolescents of other regions of KSA to identify the region-specific adolescent's health promotion behaviors.

Health-promoting domains and lifestyle of a sample of Brazilian adolescents

BACKGROUND

Reports indicate that the health habits of adults are strongly linked to the behaviors incorporated in adolescence. Therefore, it is essential to monitor the lifestyle of adolescents to promote their present and future health. This study aimed to identify differences in health-promoting domains according to demographic data and lifestyle behaviors, including physical activity, sedentary behavior, sleep duration, and food intake, in a sample of Brazilian adolescents.

MATERIALS AND METHODS

Cross-sectional school-based study, with the participation of 306 adolescents aged 14 to 18 years. A questionnaire was applied with structured questions to collect demographic data and lifestyle behaviors. To examine the health-promoting domains the Adolescent Health Promotion Scale (AHPS) was used. Data were analyzed using multivariate analysis.

RESULTS

Scores attributed to each of the health-promoting domains showed substantial variations according to sex, age, year of study, parents' schooling, and family economic class. After adjustment for covariables, the adolescent who presented significantly higher scores equivalent to the overall index of health promotion reported being more physically active (F = 4.848; P = 0.009), sleeping 6-8 hours/night (F = 2.328; P = 0.046), consuming fruit/vegetable more frequently (F = 3.168; P = 0.024), while sedentary behavior and intake of sweetened products/soft drinks have not shown any significant effect.

CONCLUSION

The findings confirmed the consistent positive influence of health-promoting domains assessed by AHPS on healthy lifestyle behaviors, suggesting in the intervention programs aimed at adopting healthy lifestyle approaches it is important enough to contemplate actions aimed at all the areas of health promotion with characteristics aimed at nutrition behavior, social support, health responsibility, life appreciation, exercise behavior, and stress management.

Development and validation of the Health Promoting Behaviour for Bloating (HPB-Bloat) scale

Background

Health management strategies may help patients with abdominal bloating (AB), but there are currently no tools that measure behaviour and awareness. This study aimed to validate and verify the dimensionality of the newly-developed Health Promoting Behaviour for Bloating (HPB-Bloat) scale.

Methods

Based on previous literature, expert input, and in-depth interviews, we generated new items for the HPB-Bloat. Its content validity was assessed by experts and pre-tested across 30 individuals with AB. Construct validity and dimensionality were first determined using exploratory factor analysis (EFA) and Promax rotation analysis, and then using confirmatory factor analysis (CFA).

Results

During the development stage, 35 items were generated for the HPB-Bloat, and were maintained following content validity assessment and pre-testing. One hundred and fifty-two participants (mean age of 31.27 years, 68.3% female) and 323 participants (mean age of 27.69 years, 59.4% male) completed the scale for EFA and CFA, respectively. Using EFA, we identified 20 items that we divided into five factors: diet (five items), health awareness (four items), physical activity (three items), stress management (four items), and treatment (four items). The total variance explained by the EFA model was 56.7%. The Cronbach alpha values of the five factors ranged between 0.52 and 0.81. In the CFA model, one problematic latent variable (treatment) was identified and three items were removed. In the final measurement model, four factors and 17 items fit the data well based on several fit indices (root mean square error of approximation (RMSEA) = 0.044 and standardized root mean squared residual (SRMR) = 0.052). The composite reliability of all factors in the final measurement model was above 0.60, indicating acceptable construct reliability.

Conclusion

The newly developed HPB-Bloat scale is valid and reliable when assessing the awareness of health-promoting behaviours across patients with AB. Further validation is needed across different languages and populations.

Reliability, Validity, and Gender Invariance of the Exercise Benefits/Barriers Scale: An Emerging Evidence for a More Concise Research Tool

The Exercise Benefits/Barriers Scale (EBBS) research instrument has been extensively used to investigate the perceived benefits and barriers of exercise in a range of settings. In order to examine theoretical contentions and translate the findings, it is imperative to implement measurement tools that operationalize the constructs in an accurate and reliable way. The original validation of the EBBS proposed a nine-factor structure for the research tool, examined the EBBS factor structure, and suggested that various factors are important for the testing of the perception of exercise benefits and barriers, whereas a few items and factors may not be vital. The current study conducted a confirmatory factor analysis (CFA) using hierarchical testing in 565 participants from the northwest region of the United Kingdom, the results of which provided evidence for a four-factor structure of the benefits measure, with the Comparative Fit Index (CFI) = 0.943, Tucker–Lewis Index (TLI) = 0.933, and root means square error of approximation (RMSEA) = 0.051, namely life enhancement, physical performance, psychological outlook, and social interaction, as well as a two-factor structure of the barrier measures, with the CFI = 0.953, TLI = 0.931, and RMSEA = 0.063, including exercise milieu and time expenditure. Our findings showed that for a six-factor correlated model, the CFI = 0.930, TLI = 0.919, and RMSEA = 0.046. The multi-group CFA provided support for gender invariance. The results indicated that after three decades of the original validation of the EBBS, many of the core factors and items are still relevant for the assessment of higher-order factors; however, the 26-item concise tool proposed in the current study displays a better parsimony in comparison with the original 43-item questionnaire. Overall, the current study provides support for a reliable, cross-culturally valid EBBS within the UK adult population, however, it proposes a shorter and more concise version compared with the original tool, and gives direction for future research to focus on the content validity for assessing the perception of the barriers to physical activity.

Association of electronic health literacy with health-promoting behaviours in adolescents

AIM

This study aimed to determine the electronic health (e-health) literacy level of high school students and its relationship with their health-promoting behaviours.

METHODS

This was a cross-sectional study conducted between April and May 2018. The study sample consisted of 409 students, who were aged between 14 and 19 years old, in three high schools located in the city centre of Denizli. Multiple regression analyses were performed to examine the predictive variables for six dimensions of health-promoting behaviours.

RESULTS

In this study, the mean (SD) e-health literacy score of 27.89 (6.19) was slightly above moderate level. e-Health literacy was found to significantly predict all six dimensions of health-promoting behaviours positively, that is, e-health literacy was determined to predict the dimensions of nutritional behaviours (β = 0.64, P < 0.001), life appreciation (β = 0.55, P < 0.001), social support (β = 0.72, P < 0.001), exercise (β = 0.36, P < 0.001), stress management (β = -0.22, P < 0.001) and health responsibility (β = 0.68, P < 0.001).

CONCLUSION

With e-health literacy significantly predictive of health-promoting behaviours, nurses are recommended to consider the e-health literacy levels of adolescents in the health-promoting programs they design.

Health-promoting lifestyle and its association with the academic achievements of medical students in Saudi Arabia

Objective:

This study aimed to assess health-promoting lifestyles among university medical students and to investigate whether such lifestyles are associated with students’ academic achievement.

Methods:

A cross-sectional descriptive investigative study was performed on 576 medical college students of King Saud University (KSU) in March 2019. Data were collected using the Health-Promoting Lifestyle Profile II (HPLP II) scale, which includes six dimensions (health responsibility, spiritual growth, physical activity, interpersonal relationships, nutrition, and stress management). The data were analyzed using descriptive and inferential statistics at a significance level of P < 0.05.

Results:

A mean score of 3.39 for total health-promoting behaviors was reported. The highest mean score was reported for spiritual growth (3.75) and the lowest was reported for health responsibility (3.23). The mean body mass index (BMI) of the students was 24.9 ± 6.4 kg/m². An analysis of variance identified an association between a student’s GPA and the spiritual growth dimension (P = 0.014). Based on the Pearson matrix correlation coefficient, there was a statistically significant and positive relationship between the HPLP II dimensions (P < 0.05).

Conclusion:

Since the HPLP scores were good, there is a need to enhance and promote healthy behaviors in students. The BMI data indicated that one-third of male students were overweight or obese; thus, health program planning, particularly involving physical activity and nutrition, is recommended.

Health Literacy and Health Promotion Behaviors of Adolescents in Turkey

PURPOSE

This study was conducted to determine the health literacy and health promotion behaviors of adolescents.

DESIGN AND METHODS

This study used cross sectional and correlational design. The population of the study consisted of 6th, 7th, and 8th grade students from three different secondary schools selected from high, middle, and low income levels. The sample consisted of 2498 students.

RESULTS

The mean score of the health literacy scale of the students was 30.26. The mean score of the adolescent health promotion scale was 143.75. The mean scores of health literacy and adolescent health promotion scores of the students in high income level, sixth grade, and have parents with a baccalaureate or graduate degree were significantly higher (p < 0.005). A moderate positive correlation was found between the school age health literacy scale and the adolescent health promotion scale (p < 0.001).

CONCLUSIONS

Adolescents' health literacy, and their health promotion behaviors were at moderate level. By integrating a basic health knowledge and healthy lifestyle behaviors course into the student curriculum, health literacy of the students could be increased.

PRACTICE IMPLICATIONS

The determination of health literacy and health promotion behaviors in adolescents by nurses in the schools will be a guide for the promotion of enhanced adolescent health.

Propriedades Psicométricas da Versão Brasileira da Adolescent Health Promotion Scale (AHPS)

Resumo Os objetivos do estudo foram traduzir para o idioma português, realizar adaptação transcultural e verificar propriedades psicométricas da Adolescent Health Promotion Scale (AHPS) para uso em adolescentes brasileiros. Versão original foi traduzida de acordo com recomendações internacionais. Versão final da escala traduzida foi administrada em uma amostra de 1.949 adolescentes de ambos os sexos com idade entre 12 e 18 anos. Para identificar as propriedades psicométricas iniciais foi realizada análise fatorial exploratória e, na sequência, análise fatorial confirmatória. Após discretas modificações apontadas no processo de tradução, comitê de juízes considerou que a versão para o idioma português da AHPS apresentou equivalências semântica, idiomática, cultural e conceitual. Análise fatorial confirmou estrutura de seis subescalas originalmente proposta, mediante indicadores estatísticos equivalentes a χ2 /gl=1,83, CFI=0,948, GFI=0,969, AGFI=0,956 e RMSR=0,052. Validade fatorial e confiabilidade foram confirmadas mediante adequadas cargas fatoriais e desejáveis dimensões de confiabilidade composta (>0,7) e variância média extraída (>0,5). Concluindo, tradução, adaptação transcultural e propriedades psicométricas da AHPS foram satisfatórias, o que viabiliza sua aplicação em futuros estudos no Brasil.

Experiences of school health nurses regarding the provision of the school health service delivery in the Tshwane district

Background

Irrespective of the provision of an integrated school health policy, the school health nurses continue to experience multiple challenges regarding the provisioning of school health service delivery.

Aim

The aim of this paper was to explore and describe the experiences of school health nurses regarding school health service delivery in the Tshwane district.

Setting

Schools in the Tshwane district in Pretoria were used in the study.

Methods

A qualitative and descriptive phenomenological design was used to conduct the study. Purposive sampling techniques were used to select a sample from the population of school health nurses employed in the Tshwane district and conduct the enquiry because of their knowledge and experience of school health services. The researchers collected data by means of unstructured, one-on-one in-depth interviews. The Tesch data analysis method was used by the researcher and co-coder. The researcher identified categories, subcategories and themes and these were reduced into grouping topics that were related to one another.

Results

Positive and negative experiences of school health nurses emerged. It was evident from the findings of the study that the factors affecting the quality of the integrated school health programme (ISHP) provided were interrelated. Most of these factors negatively affected service delivery.

Conclusion

It was recommended that the partnership between the National Department of Health and National Department of Basic Education as the main role players should be sustained at all times to ensure the successful implementation of the ISHP.

Parents' and teachers' expectations of school nurse roles: A scale development study

OBJECTIVES

Many studies concerning the roles and functions of school nurses exist, however, such studies are very limited in Turkey and there is any research on a comprehensive measuring tool that can evaluate teachers' and parents' perceptions and expectations of school nurses roles. The purpose of this study is to develop a valid and reliable assessment tool that can be used to determine parents' and teachers' expectations of school nurse's roles.

METHODS

For the methodological research "Parents' and Teachers' Expectations of School Nurse's Roles" scale was designed and administered at primary and high schools in Turkey. To assess the data, assessment of item variability, internal consistency, factor analysis, correlations between the scale and subscales, and test-retest reliability were utilized.

RESULTS

The content validity index for the scale was 0.94. As a result of core components analysis varimax rotation, 7 factors were obtained from 54 items. Cronbach's α coefficient for the factors ranged from 0.82 to 0.92. The intra-class correlation coefficient for the test-retest reliability was 0.859, P < 0.001.

CONCLUSIONS

The scale was a rather valid and reliable assessment tool in determining the parents' and teachers' expectations of school nurses' roles.

Health behaviors in high school students in İzmir, Turkey

AIM

The aim of this cross-sectional study was to determine the prevalence of the self reported health behaviors and differences in these behaviors by gender and grades in high school adolescents in İzmir, Turkey.

MATERIAL AND METHODS

A stratified cluster sampling procedure was used for this cross-sectional study. The study sample included 2 296 students attending 22 high schools in Izmir. As a data collection instrument, some questions from the Health Behavior in School-aged Children Study 2009/2010 questionnnaire and questions which were developed by the researchers to understand behaviors of internet use in adolescents were used. Chi-square tests and Cramer's V statistics were used for statistical analyses.

RESULTS

Among the high school students, 33.8% experimented smoking, 26.3% smoked cigarette during the 30 days before the survey, 14.9% smoked cigarette regularly during the 30 days before the survey, 54.1% experimented drinking alcohol, 38.4% drunk alcohol during the 30 days before the survey, 31.6% got drunk, 10.9% were adequately physically active, 59.9% watched TV for a long period of time, 72.8% used internet for a long period of time, 48.1% ate breakfast regularly, 36.2% ate adequate amount of fruit, 14.1% ate adequate amount of vegetable, 31.3% ate candies and chocolate very often, 18% drunk soft drink very often, 30.3% were bullied, 29.9% bullied others and 41% involved in a physical fight.

CONCLUSIONS

These results showed that "Adolescent friendly health services" should be generalized all over Turkey, physicians should evaluate each adolescent for his/her health behaviors in each visit and implementation of prevention programs which adopt a health promotion perspective is necessary begining from the elementary school.

Factors Associated With Healthy Lifestyle Behaviors in a Sample of Turkish Adolescents: A School-Based Study

PURPOSE

This was a descriptive-correlational study designed to determine factors associated with the healthy lifestyle behaviors of high school students in Turkey.

DESIGN

The study sample consisted of 812 high school adolescents. The Adolescent Lifestyle Profile scale was used to identify the healthy lifestyle behaviors of adolescents.

RESULTS

The total Adolescent Lifestyle Profile mean score of 2.75 ± 0.33 and the mean score on the Interpersonal relations subscale were found to be the highest scores while the mean score on the Health responsibility subscale was found to be the lowest. Significant predictors of healthy lifestyle behaviors of adolescents were good relationships with family and friends, having a father who was a college graduate, and good health perception.

CONCLUSIONS

The study revealed similar results among adolescents of different cultures.

IMPLICATIONS FOR PRACTICE

These findings can be used as a guide in developing an adolescent health promotion program for school nurses.

Health-promoting behaviors: psychometric properties of an assessment tool

Aiming to evaluate the psychometric properties of an instrument to assess the levels of health promoting behaviors, as well as to encounter those same levels related to their age, sex and graduation in a sample of 1213 Portuguese adolescents, the study was conducted of a quantitative, descriptive, correlational, retrospective and cross-sectional. The instrument has good internal consistency (Cronbach's Alpha de 0,889) and reasonable correlations between items (entre -0,009 e 0,788), confirming the six factors defined by the authors of the scale. Levels of health-promoting behaviors in the sample are good (x=3,70), being higher in girls than boys, and youth to the detriment of younger older. Thus demonstrates the reliability of the instrument in the assessment of healthy behavior in portuguese adolescents, as well as the need for an health intervention in this population.

Health promoting Behaviors Among Adolescents: A Cross-sectional Study

Background:

Health maintenance and promotion are the fundamental prerequisites to community development. The best time for establishing healthy lifestyle habits is during adolescence.

Objectives:

Due to importance of health promotion behaviors in adolescents, this study was conducted to investigate health-promoting behaviors and its associated factors among high school students in Rasht, Iran.

Materials and Methods:

A cross-sectional descriptive study was conducted on 424 students during the first semester of the year 2012. We employed the multistage sampling design to recruit from private and public high schools in Rasht, Iran. The data collection instrument was a self-report questionnaire consisting of two parts. The first part of instrument was consisted of demographic questionnaire and the second part was adolescent health promotion scale (AHPS) questionnaire. AHPS questionnaire was consisted of six dimensions (nutrition, social support, health responsibility, life appreciation, physical activity, and stress management) to measure health promoting lifestyles. Statistical analysis was performed by SPSS 16 software employing ANOVA (analysis of variance) test, t-test, Mann-Whitney, and the Kruskal-Wallis.

Results:

The score of total Adolescent Health Promotion Scale were 3.58 ± 0.52 (possible range was 1-5). The highest score was in life appreciation dimension (3.99 ± 0.068) and the lowest score was in health responsibility dimension. Moreover, Significant associations were found between the adolescent health promotion Scale with age (P < 0.001), gender (P < 0.003), school grade (P < 0.011), father’s educational level (P < 0.045), mother’s educational level (P < 0.021), and mother’s occupation (P < 0.008).

Conclusions:

Female and older students are at higher risk of developing unhealthy lifestyle. Consequently, healthcare providers, health instructors, schoolteachers, and families must pay more attention to these students. Moreover, as most of lifelong healthy and unhealthy lifestyle habits are established during adolescence, developing effective health promotion and disease prevention strategies for adolescents seems crucial.

Health behaviors of a sample of adolescents in bandar abbas, iran

BACKGROUND

Health promotion for adolescents has become a research priority worldwide and life at school offers a good opportunity to establish health promoting behavior among this age group.

OBJECTIVES

This study aimed to investigate health behaviors of a sample of adolescents in Bandar Abbas, Iran.

MATERIALS AND METHODS

Totally, 410 students including 204 males and 206 females studying in grades 9 to 12 and aged between 15-18 years old were studied. The instruments used to collect data were a self administered demographic questionnaire and the scale of Adolescent Health Promotion (AHP).

RESULTS

The mean age of participants was 16.5 (SD = 1.34) years. The mean score of Adolescent Health Promotion (AHP) scale was 64.8 (SD = 8.9) ranging from 34.3 to 89.9. Female students scored significantly higher for health-responsibility, life-appreciation, and stress-management than male students (P < 0.05). In contrast, male students scored higher scores on exercise behavior than female (P < 0.05). All dimensions of AHP scale except for nutrition behavior and social support was associated with gender and nutrition behavior was associated with age (P < 0.05).

CONCLUSIONS

This study indicated that sedentary life style and physical inactivity is a common and serious problem among high school students of Bandar Abbas.