<b>Objectives</b>: This descriptive study of 219 undergraduate medical students at Patan Academy of Health Sciences in Nepal was conducted to evaluate the relationships of their demographic variables with a health-promoting lifestyle profile. <b>Methods</b>: The Health Promoting Lifestyle Profile (HPLP) questionnaire was used to study students’ lifestyles. We compared the HPLP scores according to gender, residence type, school background and year of study. One-way analysis of variance (ANOVA) and multiple comparison test were conducted to identify significant differences among university year (first, second, third and fourth) groups. Multiple regression analysis was used to analyze the effects of various demographics on the overall HPLP score and the six health-promoting lifestyle subscales. <b>Results</b>: The overall HPLP mean score of participants was 2.60 ± 0.29, with the highest mean scores being for spiritual growth (2.99 ± 0.42) and interpersonal relations (2.90 ± 0.35), and the lowest mean scores being for health responsibility (2.39 ± 0.39) and physical activity (2.25 ± 0.54), respectively. The overall HPLP score of the students was the highest for the first year students at 2.65 ± 0.26. The male students had a better overall HPLP score, although female students obtained better score in some subscales such as health responsibility, interpersonal relations and nutrition. The students from a public school background had significantly higher scores for health responsibility, physical activity and stress management than those who graduated school level education from a private school. <b>Conclusions</b>: The results of this study reveal that the status of health promoting behaviors among the students was acceptable with ample room for improvement. Implementation of health education and promotion programs with an emphasis on the different dimensions of health lifestyle behaviors is recommended.
Health-Promoting Lifestyle Profile Medical Student Nepal1. Introduction
Health lifestyle behavior is considered as the science and art which helps people to change their lifestyle in order to gain optimal health [1] . Lifestyle is a planned effort made by a person. It gives a person the ability to correct and control his/her own health, so as to enjoy one’s full health potential and continue to have a healthy lifestyle [2] . It is greatly influenced by culture, family, reference groups, and social class. Lifestyle comprises of the decisions on diet selection, exercise, health responsibility, stress management and the actions that one takes to achieve those decisions [3] . One’s health is affected by one’s lifestyle, and health promoting behaviors and healthy lifestyles are an important feature to facilitate and maintain one’s health [4] [5] .
Health promoting behavior is an important factor in the avoidance of many illnesses, and health promotion and disease prevention are directly associated with this behavior [6] . One of the most important associations of chronic diseases such as cancer, high blood pressure, diabetes and heart diseases is healthy lifestyle and hence building healthy lifestyle is one of the best ways to restore or maintain health [7] . Research has established genetic links for disease and discovered relationships between behaviors and disease whereas environmental influences also contribute to the onset and progression of diseases [8] .
People are responsible for their own personal health promotion and disease prevention. Therefore, studies that concentrate on young people are important because they are considered as change agent for healthy lifestyle. Students form a large proportion of young adults. Students progressively take the responsibility for their health in line with their physical, psychological, social and sexual developments [9] [10] [11] [12] [13] . The transitional period during the university years is the best time to establish healthy behaviors and it is also the period when habits formed will be carried out for the rest of life [10] . Because of their influence on society as they progress to become responsible adults, students function as a channel to spread matters of self-health promotion. Therefore, the lifestyle they choose also affects the lifestyle of others [14] [15] [16] .
Medical students encounter multiple socio-psychological adaptations as they change from self-indulgent young people to responsible physicians. Doctors, in turn, are role models of society, and their lifestyle and health conditions are highly valued by the general public in the country. As they are such a valuable part of society, it is important to know the Health Promoting Lifestyle Profile of Medical Students. A detailed survey of health promoting lifestyles has not been done in Nepali college students or medical students. The demographic factors that affect the HPLP are also not known. Knowledge of those factors could help to design effective interventions to improve the HPLP of medical students.
This study aimed to examine the health-promoting lifestyles of undergraduate medical students to determine the relationships between demographic parameters and their year level with their overall score on the Health Promoting Lifestyle Profile (HPLP) consisting of the six parameters which encompassed health responsibility, spiritual growth, physical activity, interpersonal relations, nutrition, and stress management.
2. Methods
This study utilized the Health-Promoting Lifestyle Profile (HPLP) survey developed by Walker et al. [17] . The HPLP has been used by many researchers for assessing health promoting lifestyle and is reported to have high validity and reliability for use in different populations. The English version of this overall scale, which was administered for data collection in this research, reported a Cronbach alpha of 0.877. The questionnaire that was used had two sections, namely, demographic variables and health promotion lifestyle profile questionnaires.
The HPLP survey consists of 52 questions. These questions are divided into six subscales, namely, spiritual growth-9 questions, interpersonal relations-9 questions, nutrition-9 questions, physical activity-8 questions, health responsibility-9 questions and stress management-8 questions. Each question is answered based on a 4-point Likert scale with a scoring range of 1 to 4 for never, sometimes, often, and routinely, respectively. The lowest possible individual overall score of the HPLP is 52 (1 × 52) and the highest possible is 208 (4 × 52). For each subscale, the scores for the questions were added and divided by the number of items in the subscale for obtaining the subscale scores. The overall score is obtained by adding the scores for all the items and dividing by the total number of items. The lowest possible overall or mean score is 1 and the highest possible overall or mean score is 4. The higher the mean score obtained, higher is the index of a health-promoting lifestyle.
In this study the questionnaire-based HPLP survey was done on MBBS students, aged between 17 and 32 (average age 21) years and studying in the first to fourth year of their medical course (Bachelor of Medicine and Bachelor of Surgery, MBBS) at Patan Academy of Health Sciences, Nepal. The research questionnaires (N = 240) were distributed to the students. To ensure anonymity, the questionnaire was self-administered, no name was required on the questionnaire and it was returned to a designated box.
The analysis was performed using Statistical Package for the Social Sciences (SPSS) v16.0. Distribution of socio-demographic characteristics, and characteristics of lifestyle of the students who participated in the study were evaluated and difference between mean score in the HPLP overall and in the subscales was analyzed. The statistical differences between the groups are in terms of socio-demographics and HPLP. The HPLP scores were compared according to gender, residence type, school background and year of study. Scores were analyzed using independent t-test and analysis of variance (ANOVA) test. Multiple comparison test were conducted to identify significant differences among university year (first, second, third and fourth) groups. The post-hoc test was performed to determine the direction and significance of differences between the groups. A p-value of 0.05 was considered to be statistically significant.
All the students were eligible to participate and participation in the study was voluntary. Consent was taken from them before filling the questionnaire.
3. Results
The survey was completed by 219 (121 males, 98 females) students (91%) amongst 240 students who were handed the questionnaires (Table 1). All four academic years, years one through four, participated. The average age of first-year students
Demographic data of the participants
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