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ABSTRACT The Healthy Lifestyle Scale for University Students: development and psychometric testing

In recent decades, lifestyle has been recognised as an important determinant of health status and has become a focus of increasing research interest worldwide. The World Health Organization (WHO) has stated that 60% of an individual’s health-related quality of life depends on his or her lifestyle (WHO 2004). Numerous publications (Nöthlings et al. 2010; Hu et al. 2011; Reddy et al. 2011) have shown that healthy lifestyle practices reduce disease occurrence and mortality rates. Healthy lifestyles depend on the early adoption of healthy living habits; unhealthy lifestyles among youths are strongly linked to unhealthy habits in adulthood (Lowry Et al.2000; Landsberg Et al.2010). Although it is difficult to change unhealthy habits that adults have adopted in their youth, many effects of health risk factors among adults are avoidable if these behaviours are identified and changed at an early stage (Megel et al. 1994; Lee et al. 1997; Gall et al. 2009). Thus, young people are the primary target population for education about the importance of healthy lifestyles (Phongsavan et al. 2005).

University students typically enter a dynamic transitional period of new independence from their parents that is characterised by rapid, interrelated changes in body, mind and social relationships (Pullman et al. 2009). Although the university years are often viewed as a key phase for personal growth and development, they also represent a period of increased risk for injury, morbidity and mortality associated with multiple health behaviours (Binkowska-Bury and Januszewicz 2010). Moreover, many university students fail to meet recommended nutritional and physical activity guidelines (Lowry et al. 2000; Huang et al. 2003). In Australia, adolescents are becoming less physically active and have increasingly adopted a sedentary lifestyle centred on computer use and television viewing (Ericsson et al. 2008). A national survey of substance use in the United States (Southern Illinois University Carbondale 2006) found that 84.5% of undergraduate students had consumed alcohol in the previous year, 41.0% used tobacco products and 30.1% used marijuana. Extensive evidence has indicated that university students in China engage in health risk behaviours such as smoking, drinking alcohol, lack of exercise, lack of sleep and poor eating habits (Tao et al. 1999; Zhang et al. 2002; Lin and Xu 2005; Ji 2007; Zhang and Su 2007; Wang et al. 2009). The transition from high school to university is a period of increased stress for this age cohort that may increase their engagement in such health risk behaviours (Rosset al.1999; Pullman Et al.2009) and lead to a variety of adverse health outcomes, including major morbidities (Sells and Blum 1996; Lynn et al. 2004). These behaviour patterns and their consequences typically persist into adulthood, jeopardising individuals’ health status in later life (Pender and Barkaskas 1992).

Because university students are in a unique stage of knowledge absorption and personality shaping, health education in the university environment is an ideal and cost-effective means of developing healthy lifestyles. Thus, the understanding and evaluation of healthy lifestyles among university students are essential for the promotion of their healthy growth.

Physical examinations can be standardised and laboratory testing methods can be quality-controlled to ensure maximum precision. However, lifestyle is an imprecise, difficult to quantify and highly variable factor with many diverse components.

Several instruments have been developed to objectively evaluate healthy lifestyles and examine associated factors, including the Health-Promoting Lifestyle Profile (HPLP), the Adolescent Lifestyle Questionnaire (ALQ), the Adolescent Lifestyle Profile (ALP) and the Adolescent Health-Promoting (AHP) scale. The HPLP (Walker et al. 1995) was developed to test Pender’s health promotion model. This Model is a paradigm for explaining health promoting behaviour, an expression of the human actualising tendency that is directed towards sustaining or increasing the individual’s level of well-being, self-actualisation and personal fulfilment (Pender 1987). The HPLP is perhaps the most frequently used measure of personal health management in nursing studies. However, this instrument does not include items related to disease prevention or undesirable health practices, such as smoking. Furthermore, the HPLP was developed for and tested on adult populations, and its developers indicated the need for additional lifestyle assessment tools that are appropriate for children and adolescents.

The ALQ (Gillis 1997) was tested on a sample of 292 students aged 12–19 years from a rural school district in eastern Canada.

The ALP (Hendricks et al. 2006) was tested using a convenience sample of 207 students aged 10–15 years from five middle schools in a single district in the United States. Because these two instruments were developed and tested on small and relatively young samples of students, they have not been used widely due to their poor applicability and representativeness. The AHP scale (Chen et al. 2003), which is based on Pender’s health promotion model, was developed to evaluate health-promoting lifestyles among adolescents and is widely used in Taiwan (Yang et al. 2006; Chen et al. 2007). However, like the HPLP, the AHP scale is limited by its sole focus on health promotion and is not a suitable tool for the assessment or identification of risk behaviours among youths.

Recent economic, scientific and technological developments, such as the rapid spread of the Internet, have markedly increased the emphasis on competition, and lifestyles have changed dramatically in response. The content of the above-mentioned instruments, which were developed in the 20th century, is thus no longer compatible with current lifestyles.

In recent years, the number of individuals enrolled in higher education has increased dramatically worldwide. For example, China had 5.56 million university students in 2000; this number had tripled (to 15.62 million) in 2005 and is expected to increase to 33.5 million by 2015 (Ministry of Education of the People’s Republic of China 2010). Increasing numbers of students tend to practise health risk behaviours, such as smoking, drinking alcohol, practising a sedentary lifestyle and irregular breakfasting. Research on the lifestyles of university students has focussed primarily on these health risk behaviours; few studies have quantified healthy lifestyles among these students, and no study to date has developed a standardised scale for the examination of healthy behaviours in this population. In addition because healthy behaviours are sensitive to temporal trends, culture, ethnicity and socioeconomic status, the instruments mentioned above cannot represent actual conditions.

Our aim in the present study was to describe the development and psychometric evaluation of the Healthy Lifestyle Scale for University Students (HLSUS), and to propose its use as a research and evaluation tool by health care providers.