Attitudes Towards Stress And Lifestyle Of University Students In Health Education

Health and lifestyle

According to the modern holistic concept of health, overall health of an individual is a sum of mutual relations and influences concerning not only physical, mental, social and spiritual health, but also healthy relationships with the community and the world, i.e. the society and nature. The factors that modify health can be classified from different perspectives. The basic classification distinguishes between uncontrollable factors (personal or family medical history, gender, age, genetics), and controllable factors, which are significantly associated with lifestyle, socio-economic status and social position reflecting the person’s material security (Kastnerová, 2012). The most urgent trend in the development of the society in the 21st century is the quickly deteriorating health of the global population. As a result, new plans and strategies of lifelong health promotion are developed. The greatest threat to the health of future generations is the prevalence of chronic diseases, which usually occur in industrial societies marked by considerable economic and industrial progress. These are usually non-communicable diseases known as lifestyle diseases (obesity, diabetes, cancer, coronary artery disease, etc.), which can be considered degenerative diseases caused by lifestyle and regimen (Lieskovská et al., 2013).

According to Kastnerová (2012), the onset and subsequent development of a number of acute and chronic diseases may be influenced in the sense of prevention or mitigation of their consequences by observing behavioural factors that have an effect on health and lifestyle.

Lifestyle in university students

University study is a period of intellectual growth and development, a transition from young adulthood to adulthood. For optimum return on this investment later in life, students need to maximize their academic effort and personal growth (Hershner & Chervin, 2014). The results of a number of research studies confirmed that health in university students is worse compared with their peers not enrolled in university. One of the reasons is the fact that university students face specific situations and adaptation problems, often accompanied by distress. The greatest source of stress in these students is the academic environment (Josífková, 2013).

This can be illustrated on a specific research study focusing on the correlation between stress and increased food consumption among university students in the first year. As suggested by Papier et al. (2015), the results show that 52.9% of participating students felt distressed and that both girls and boys consumed larger quantities of ‘unhealthy’ food (with higher fat and sugar) as a result. The preventive measure recommended to university students is an active lifestyle, the importance of which is acknowledged by most students; they are also aware of relevant health risks (consequences of smoking, alcohol, poor dietary habits and lack of physical activity). Many of them try to change their lifestyle to avoid these negative consequences. Yet, there are many students who try to enjoy university life (parties, dating, social events, summer jobs, sports and other events and entertainment) and do not worry about possible consequences. Despite the hectic nature and hastiness of university life, everybody should find time and space for observing appropriate regimen in order to prevent later problems (Hegedüšová, 2014).

The experience that students gain in universities (i.e. structured environments) has priceless value and generally includes the acquisition of knowledge, skills and a certain degree of independence, which they may use later to become valuable members of the society (Hershner & Chervin, 2014). For this reason, universities are an ideal location for inducing changes in the area of lifestyle and improving students’ behaviour to support their health. During their study at university, students are surrounded by a vast amount of research-based knowledge and multidisciplinary professionals, and have access to world-class information, technologies and resources, which makes universities a potentially ideal health promoting environment. The age of university students still enables positive changes in their behaviour and adoption of better habits and attitudes which will affect their health in the future (Plotnikoff et al., 2015).

Stress in university students

Nowadays an increased emphasis is on acquiring a university degree as a key to life satisfaction and success (Thurber & Walton, 2012). University students need to observe specific requirements concerning preparation for study, examination and assessment. This often causes overloading and health problems. They also need to achieve higher standards concerning their abilities, skills and knowledge compared with secondary school students or their peers not enrolled in university who already found a job. Another stressful circumstance is their economic dependence on parents. What frequently happens is that students devote most of their free time to earning money. This reduces space for their own study and academic preparation, but also for hobbies and relaxation, or entertaining student life. All of these circumstances including many others place a considerable mental stress on university students, which often leads to various psychosomatic diseases (Josífková, 2013).

The transition from home to a foreign environment alone might present an excessive burden for students. This change may cause stress or even depression, lack of appetite and concentration problems (Thurber & Walton, 2012). Leaving home and being outside parental control and supervision is an unprecedented challenge (Mahmoud, Staten, Hall & Lennie, 2012; Moreno, Jelenchick, Koff & Eickhoff, 2012; Wright et al., 2012). According to current research studies, a higher degree of load can also be caused by social networks and the content of shared posts from friends (Chou & Edge, 2012; Jelenchick, Eickhoff, & Moreno, 2013). University students are pressured to meet various requirements, achieve adequate classification, pass tests and examinations, absorb a large amount of knowledge during a short period of time, and, without their own academic objective, university is the most significant stressor (Kumaraswamy, 2013).

University students are constantly confronted with high pressure, which can result in sleep disorders. As suggested by relevant research studies, 68% university students indicated stress as the greatest barrier to good sleep; this usually includes academic stress (39% of students) or emotional stress (25%). Poor falling asleep due to stress causes even more stress. Long sleepless nights can lead to extreme fatigue the next day, which most students deal with by taking stimulants, for example caffeine. Many students thus find themselves in the vicious circle and try to eliminate daily fatigue by taking stimulants and then use other sleep induction means (White, Buboltz & Igou, 2013). In this context, university students for the first time experience more serious problems concerning their health and lifestyle, which they usually resolve by taking ‘lighter’ stimulants, such as the previously mentioned caffeine, energy drinks, alcohol, and later may resort to habit-forming substances, or some hidden mental disorders such as schizophrenia may evolve (Pedrelli et al., 2015). For these reasons it is important to understand the aspects that cause an elevated degree of anxiety and stress, and that may cause a significant disruption of their social, professional and academic functioning (Goswami et al., 2012).

Negative side effects of anxiety and stress show how important it is to work with these aspects in university students. Stress is associated with harmful behaviours such as smoking, poor eating habits, lack of physical activity, poor sleep habits, and non-observance of healthy lifestyle recommendations (Doom & Haeffel, 2013).

Attitudes

Attitudes express specific feelings in relation to an object (Hewstone & Stroebe, 2006). Knowledge is influenced by emotions; therefore, this is a subjective type of evaluation. Evaluation expressed through words is an opinion. If such evaluation is solid and fixed, it is referred to as a conviction; in a negative sense it is considered a prejudice. Emotions affect the intensity of the attitude from extremely positive (the subject is strongly for) through neutral (neither - nor) to extremely negative (strongly against). The neutral attitude relates to an object that is unknown or unimportant to the subject.

As reported by Kohoutek (2008), attitudes are not innate but develop through learning from an early age during the process of socialization. Attitudes are formed within multiple groups, to which an individual belongs. To a limited extent, they are influenced by mass media. Attitudes are learned from other people and groups. For the purposes of being included in a group or accepted by someone else, a person adapts, changes behaviour and expresses an attitude, which is considered socially desirable. Children’s attitudes are of a general nature; later they are differentiated and at the same time clustered in specific groups of attitudes. This grouping of attitudes is called attitude integration. Attitudes have a certain direction (positive, negative), certain intensity (stable, unstable), and impact on human behaviour (significant, insignificant).

ATER two-factor semantic differential

The main research method to measure the attitudes of Czech university students was a simplified version of the ATER two-factor semantic differential (Chráska sr., 2016). This measurement tool was developed on the basis of analyses of the scales of the original semantic differential designed by C. Osgood. The tool contains 10 scales, of which 5 measure the evaluation (ev) factor and 5 measure the energy (en) factor, * indicates a reverse scale – see Fig. 1 .

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The first factor of the ATER measuring tool was in accordance with C. Osgood (Osgood, 1964) identified as the evaluation factor, the other factor is a combination of the original factors of potency and activity and is called the energy factor. The scales that are saturated by this energy factor indicate the degree to which the selected concepts are perceived by the respondents as something that is associated with exertion, difficulty, transformation or activity.

According to Chráska sr. (2016), the evaluation of the concepts according to all three factors is too detailed and does not produce a significantly large amount of information. Moreover, the activity (a) and potency (p) factors might be subject to misinterpretation. Therefore, in an educational context a two-factor semantic differential can be used. However, it is always necessary to test this measurement tool for its factor structure (Chráska jr. & Chrásková, 2016) and select appropriate scales.

Description of the research sample

The research sample included 65 Czech university students who will become teachers of subjects in the category of Health education – see Tab. 1 . During the teaching process (In the Czech Republic, the graduates from the Bachelor’s teacher training degree (after three years of study) can only become assistant teachers. To be qualified for the teaching profession, students must take the follow-up Master’s degree, i.e. after a total of five years of study.) they will provide their students with information about an optimum lifestyle. Specifically, the research sample included all students of the Faculty of Education, Palacký University in Olomouc in the third year of the Bachelor’s degree programme Health education with a focus on teaching, and the first and second year of the follow-up Master’s degree programme Teaching of Health education. Despite the small size of the research sample, the sample was representative concerning all students of this field of study in the third to fifth year.

Optimization and description of the ATER questionnaire

Prior to the processing of the results, a control factor analysis of the scales of the ATER semantic differential (Chráska jr., 2014) was performed using the STATISTICA 12 programme. The analysis was used to select those scales that showed the best agreement with the anticipated factor structure. For the calculation of the evaluation of the concept, only scales 3 and 7 were used. For the calculation of the energy of the concept, only scales 2 and 8 were used.

The STATISTICA 12 programme was also used to determine measurement reliability by means of the internal consistency method. The calculated value (Cronbach’s alpha = 0.76) suggests that the measurement of the attitudes using the semantic differential was sufficiently reliable.

Attitudes of students of Health education by year of study

To determine whether the attitudes of students of Health education at the Faculty of Education differ by year of study, the data were compared by means of the ANOVA analysis of variance in the STATISTICA 12 programme. The comparison of the differences in evaluation and energy of the concepts is shown in Table 2 . In overall terms, there are almost no differences in the perception of all concepts by year of study (p=0.45). Statistically significant differences in evaluation or energy were observed only in some concepts – indicated in Table 2 in bold.

Statistically significant differences were not observed in concepts included in the content of Health education, such as Drugs, Alcohol, Smoking, Physical health, Mental health, Risky sexual behaviour, Physical activity, Balanced diet, Disease, Healthy lifestyle, Lifestyle diseases, and Obesity. Significant differences in the changes in attitudes during the course of study were identified in relation to the following concepts: University I study at (ev), Personal computer (ev + en), I (en), Love (en), Mental stress (en). This statistically significant shift in time is illustrated by the semantic space in Fig. 2 .

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Students’ attitudes by gender

A comparison of the concepts by the respondents’ gender was made by means of the t-test in the STATISTICA 12 programme. Precise values of the comparison of evaluation and energy of the concepts are shown in Table 2 .

Statistically significant differences between the perception by men and women were observed only in some concepts (again indicated in bold in Table 2 ). The comparison of these concepts is shown in semantic spaces for the area of healthy lifestyle and social area – see Fig. 3 and 4. The figures clearly show that the most difficult concepts in the area of healthy lifestyle for both men and women are Disease and Stress, but for women these concepts are more energy demanding. Moreover, in the case of the concept Stress, a statistically significant difference was observed between the attitudes of men and women, both in energy and evaluation.

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As is shown in Fig. 4 , the concepts from the social area, where statistically significant differences were observed in their perception and which are considered most difficult by both men and women, include education and money. In overall terms however, for men the following concepts are most difficult: Future, Love, Money and Education. For women the following concepts are most difficult: Education, Money, My professional preparation and Future.

The results of the study suggest that students of Health education have positive attitudes to the concepts relating to optimum lifestyle, such as: Healthy lifestyle, Physical health, Balanced diet, Physical activity. These concepts received the best evaluation, which corresponds with the fact that they know the concepts from classes, use them and analyse them in terms of didactic approaches. A similar situation was observed in the area of concepts that have a negative effect on lifestyle. Students of Health education indicated the worst evaluation for the following concepts: Disease, Mental stress, Lifestyle diseases, Obesity, Drugs and Smoking. These concepts are also associated with a high degree of energy expenditure. Regarding the specific field of study, such negative evaluation of these concepts was expected. The high degree of energy expenditure may be associated with the students’ effort to get to the heart of the associations concerning negative effects on lifestyle.

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