Health-Promoting Lifestyle in Iranian Dormitory-Resident Students

Authors
S.H. Hosseini 1
R. Rajabzadeh 1
H. Namdar Ahmadabad 2
M. Afshin 3
F. Hosseini 4
M. Hasanzadeh 4
1 Non-Communicable Diseases Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
2 Vector-borne Diseases Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran
3 “Student Research Committee” and “Department of Pathobiology, Faculty of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran
4 “Student Research Committee” and “Department of Health Education and Health Promotion, Faculty of Health”, North Khorasan University of Medical Sciences, Bojnurd, Iran
10.58209/hehp.13.3.571
Abstract
Aims: Promoting healthy lifestyles among students is crucial, as they can facilitate health education within families and communities. This study aimed to assess health-promoting lifestyles among dormitory-residing students at North Khorasan University of Medical Sciences.

Instrument & Methods: This cross-sectional study was conducted in 2024 among 348 dormitory-resident students at North Khorasan University of Medical Sciences, Iran, selected via multistage sampling. Data on demographics and health-promoting behaviors were collected using a validated 49-item Persian HPLP-II questionnaire. Data were analyzed using SPSS 22, which included descriptive statistics, t-tests, and ANOVA.

Findings: Of the 348 dormitory-residing students (mean age 22.42±2.32 years; 34.8% male), the mean health-promoting lifestyle score was 135.82±19.35. Females exhibited significantly higher total and subscale scores than males (p<0.05). Employed students scored higher in total, health responsibility, physical activity, and nutrition (p<0.05). Significant differences were observed based on educational level, mother’s education, father’s occupation, and family income (p<0.05), with lower scores generally associated with lower socioeconomic factors. No differences were found by marital status (except for health responsibility), semester, field of study, or mother’s occupation.

Conclusion: Sociodemographic factors, including gender, employment, educational level, mother’s education, father’s occupation, and family income play a significant role in health-promoting lifestyles.

Keywords

Subjects

Introduction
Health-promoting lifestyles, which involve actions and beliefs aimed at maintaining health and preventing disease, significantly influence mortality, morbidity, and the mitigation of chronic diseases. Over the past two decades, noncommunicable diseases, such as diabetes, cancer, hypertension, and obesity have emerged as major global threats, increasingly affecting younger populations due to poor habits, sedentary behaviors, and unhealthy diets [1, 2]. Promoting such lifestyles is essential to reduce the incidence of noncommunicable diseases and disability across all ages [3, 4]. Evidence suggests that behavior and lifestyle choices determine 60% of an individual’s health status and quality of life [5]. The World Health Organization (WHO) estimates that lifestyle-related diseases account for 70-80% of deaths in developed countries and 40-50% in developing countries [6].
A health-promoting lifestyle, defined as a multidimensional pattern of actions that enhance well-being, is a crucial determinant of health status and a key strategy for preventing chronic diseases. Based on Pender’s model, a health-promoting lifestyle encompasses six behaviors, namely health responsibility, physical activity, nutrition, spiritual growth, interpersonal relationships, and stress management [7, 8]. These behaviors are often established during youth, a critical period exemplified by the university years, when students make independent lifestyle choices. However, global research indicates that many students engage in risky behaviors, such as physical inactivity and poor nutrition [9, 10]. While students often exhibit strengths in self-actualization and interpersonal support, areas such as stress management, exercise, nutrition, and health responsibility require improvement, highlighting the need for targeted health interventions in this population [2, 3, 10].
University dormitory living constitutes a transitional phase that can substantially influence students’ lifestyles and health-promoting behaviors due to its unique conditions [7]. International research demonstrates that individuals aged 15-24, including most university students, are more prone to high-risk behaviors such as smoking, alcohol consumption, risky sexual practices, and unhealthy eating habits [11]. Dormitory living may heighten this vulnerability, thereby endangering the health of this critical demographic and elevating disability and mortality rates. Nevertheless, many adverse health determinants in youth are modifiable if risk factors are identified and addressed early [12, 13].
Studies from various countries indicate that only a minority of students exhibit desirable health-promoting lifestyles. Similarly, research in Iran shows that university students’ health-promoting behaviors are suboptimal [3, 14]. As students represent a substantial portion of the nation’s youth and act as role models due to their age and educational status, their lifestyle choices affect not only their own well-being but also influence behaviors in broader populations [15]. Thus, promoting healthy lifestyles among students is crucial, as they can facilitate health education within families and communities. Accordingly, this study aimed to evaluate health-promoting lifestyles among dormitory-residing students at North Khorasan University of Medical Sciences.

Instrument and Methods
Study design and sample
This cross-sectional study was conducted in 2024 among dormitory-residing students at North Khorasan University of Medical Sciences, Iran. The population consisted of all students living in the university dormitories. Inclusion criteria included active enrollment at the university and willingness to participate. Incomplete or inaccurate questionnaires were excluded from analysis.
The sample size was calculated to be 348 participants using a standard deviation of 20 from Maheri et al. [16], a margin of error of 2 (10% of the standard deviation), and a 95% confidence level. Participants were selected via multistage sampling. First, the population was stratified by faculty (n=6), with proportional allocation based on the number of students per stratum. Second, simple random sampling was employed within each stratum to select participants from the dormitory resident lists.
Data collection tools
Data were collected using a two-part questionnaire. The first part assessed demographic characteristics, including age, gender, field of study, marital status, educational level, parents’ education, and family income. The second part comprised the 49-item Persian-validated Health-Promoting Lifestyle Profile II (HPLP-II) questionnaire, adapted by Mohammadi Zeidi et al. [17] from the original 52-item version [18]. Based on Pender’s health promotion model, it evaluates health-promoting behaviors. Validity and reliability assessments, including factor analysis, led to the removal of three items. In Mohammadi Zeidi et al.'s study, Cronbach’s alpha was 0.82 overall (0.79-0.91 for subscales), with item-total correlations ranging from 0.21 to 0.72 [17].
The questionnaire assesses six domains: health responsibility, which consists of 8 items (1-8), physical activity, comprising 8 items (9-16), nutrition, including 9 items (17-25), self-actualization and spiritual growth, with 8 items (26-33), social support and interpersonal relations, containing 9 items (34-42), and stress management, featuring 7 items (43-49). Items were scored on a 4-point Likert scale (1=never; 4=always). Total scores ranged from 49 to 196 and were calculated as the mean of responses; higher scores indicated healthier lifestyles.
Procedure
Institutional approvals were obtained prior to data collection. Trained researchers visited the dormitories, explained the study objectives, assured data confidentiality, and obtained written informed consent. Questionnaires were self-administered. The study was approved by the Research Ethics Committee of North Khorasan University of Medical Sciences and adhered to ethical guidelines. Participation was voluntary, and data were handled anonymously.
Data analysis
Data were analyzed using SPSS 22. Inferential analyses, assuming normality of scores, included independent t-tests and one-way ANOVA to examine associations between health-promoting lifestyle scores and categorical parameters (dichotomous or polytomous). Post hoc analyses were conducted following significant ANOVA results to determine specific pairwise differences between groups.

Findings
A total of 348 dormitory-residing students participated; the mean age was 22.42±2.32 years (Table 1).  

Table 1. Demographic characteristics of dormitory-resident students at North Khorasan University of Medical Sciences (n=348)



The mean total health-promoting lifestyle score was 135.82±19.35 (range: 57-194; Table 2).

Table 2. Mean scores of health-promoting lifestyle subscales among dormitory-resident students


Total health-promoting lifestyle scores and all subscale scores were significantly higher in females than in males (all p<0.001; Table 3).

Table 3. Health-promoting lifestyle scores by gender among dormitory-resident students


No significant differences were observed in total health-promoting lifestyle scores or subscales between married and single students, except for health responsibility (Table 4).

Table 4. Health-promoting lifestyle scores by marital status among dormitory-resident students


Total health-promoting lifestyle scores, as well as health responsibility, physical activity, and nutrition scores, were significantly higher in employed than in unemployed students (p<0.05). No differences were found for spiritual growth, interpersonal relations, or stress management (p>0.05; Table 5).

Table 5. Health-promoting lifestyle scores by employment status among dormitory-resident students


Significant differences were observed in total health-promoting lifestyle scores and all subscales, except for spiritual growth, across educational levels (p<0.05). Tukey’s post hoc test results, including specific intergroup comparisons, are detailed in Table 6.

Table 6. Health-promoting lifestyle scores by educational level among dormitory-resident students


No significant differences were found in health responsibility, physical activity, or stress management scores by academic semester (p>0.05), nor in total health-promoting lifestyle scores or health responsibility, physical activity, or nutrition subscales by field of study (p>0.05).
No significant differences occurred in total health-promoting lifestyle scores or any subscales based on fathers’ education (p>0.05). For mothers’ education, significant differences were noted in health responsibility, nutrition, spiritual growth, and stress management subscales (p<0.05), but not in physical activity or interpersonal relations (p>0.05). Students with mothers who had primary education had lower physical activity scores than all groups except those with mothers holding master’s degrees or higher (p<0.05). They also had lower interpersonal relations scores than those with mothers holding bachelor’s degrees or higher (p<0.05), and lower total health-promoting lifestyle scores than those with mothers holding master’s degrees (p<0.05).
Significant differences were observed in total health-promoting lifestyle scores and all subscales based on fathers’ occupation (p<0.05). Students with laborer fathers had lower health responsibility scores compared to those with self-employed, farmer, or livestock breeder fathers. They also had lower physical activity scores than those with self-employed, farmer, or livestock breeder fathers. Additionally, their nutrition scores were lower than those of students with self-employed or farmer/livestock breeder fathers. Furthermore, they had lower spiritual growth scores than those with self-employed fathers, as well as lower interpersonal relations and stress management scores than all other groups. Students with employee fathers had lower health responsibility and physical activity scores than those with farmer or livestock breeder fathers, lower nutrition scores than those with self-employed or farmer/livestock breeder fathers, and lower total scores than those with self-employed, farmer, or livestock breeder fathers. No differences were found based on mothers’ occupation (p>0.05).
Significant differences occurred in total health-promoting lifestyle scores and all subscales based on family income (p<0.05). Students from low-income families had lower health responsibility scores than all other groups; lower physical activity scores than those from good- or excellent-income families; and lower nutrition, spiritual growth, interpersonal relations, stress management, and total scores than all other groups.

Discussion
This study aimed to evaluate health-promoting lifestyles among dormitory-residing students at North Khorasan University of Medical Sciences. Investigating health-promoting lifestyles among college students is essential, as this demographic undergoes a critical transition during which established habits influence long-term health. Studies indicate that students frequently face stress, suboptimal dietary habits, and insufficient physical activity, heightening the risks for adverse outcomes, such as anxiety, depression, and obesity. Identifying these risk factors enables targeted interventions to enhance nutrition, exercise, and mental well-being, thereby boosting academic performance and social engagement. Ultimately, such efforts support public health objectives by fostering healthier generations, reducing healthcare expenditures, and elevating quality of life [19, 20].
We assessed health-promoting lifestyles among dormitory-residing students at North Khorasan University of Medical Sciences using the health-promoting lifestyle profile II questionnaire (possible score range: 52-208). The mean total score was 135.82±19.35, with the highest subscale scores in interpersonal relations and nutrition, and the lowest in stress management and physical activity. Significant differences in total scores were observed by gender (higher in females), employment status (higher in employed), educational level, mother’s education, father’s occupation, and family income. No significant differences emerged by marital status (except for health responsibility), academic semester, field of study, father’s education, or mother’s occupation.
Comparisons with studies from other Iranian universities reveal consistent patterns and variations in health-promoting lifestyles among medical sciences students. Our mean HPLP-II score is comparable to that reported by Pouresmaeil et al. [21] at Qazvin University and higher than those found by Maheri et al. [16] in Tehran, Moghaddam et al. [22] in Zanjan, Azami Gilan et al. [23] in Kermanshah, Karimian et al. [24] in Shiraz (moderate levels, with most subscales above midpoint except exercise), and Rahbar & Yosefi Roshan [15] in Ramsar. This suggests moderate overall scores with regional or methodological variability.
Consistent with our findings, interpersonal relations or spiritual growth emerges as the highest-scoring subscales (e.g., in Azami Gilan et al. [23], Karimian et al. [24], and Pouresmaeil et al. [21]), whereas physical activity ranks lowest across all cited studies, indicating a national challenge for dormitory-residing students. Stress management was also low in our study, aligning with moderate scores in Maheri et al. [16] and Moghaddam et al. [22].
Demographic parallels include higher scores among females in our study and in Azami Gilan et al.’ research [23], although this trend was absent in studies by Maheri et al. [16] and Karimian et al. [24]. Moghaddam et al. [22] and Rahbar & Yosefi Roshan [15] specifically linked gender to physical activity. Employment and family income positively influenced scores in our cohort, as well as in studies by Maheri et al. [16] and Azami Gilan et al. [23]. Marital status showed minimal effects (except for health responsibility), contrasting with broader associations found in studies by Maheri et al. [16] and Azami Gilan et al. [23]. Differences in educational level echoed Karimian et al.'s [24] links to field of study and age. Parental factors (mother’s education, father’s occupation) were unique to our study, meriting further investigation. These patterns highlight the necessity for targeted interventions in physical activity and stress management across Iranian universities, customized to socioeconomic and gender factors.
Comparisons with international studies show consistencies and variations in health-promoting lifestyles among university students. Our mean total HPLP-II score aligns with findings from Gore et al. [25] in India and Musić et al. [26] in Croatia, but exceeds those reported by Alzahrani et al. [27] in Saudi Arabia and Qiu et al. [28] in China. Chao [2] in Taiwan reports higher per-item averages, possibly due to scale differences or contextual factors.
Consistent with our results, these studies identify interpersonal relations and nutrition as strong subscales, while physical activity and stress management are weak, reflecting common challenges among students. Gender differences align with higher female scores in our study and in the research by Gore et al. [25], but differ from the study by Musić et al. [26], reporting lower female scores in spiritual growth and stress management, and Alzahrani et al. [27], finding higher male scores in physical activity. Socioeconomic influences, such as income and parental occupation, parallel those in studies by Alzahrani et al. [27] and Gore et al. [25], while our findings on employment and education align with Chao’s [2] emphasis on physical activity. These variations highlight cultural effects and support tailored interventions to enhance physical activity and stress management worldwide.
This cross-sectional study cannot establish causality between sociodemographic factors and health-promoting lifestyles. Self-reported data collected via the adapted 49-item Persian HPLP-II may introduce social desirability, recall, and misclassification biases, potentially inflating scores, as evidenced in student health surveys. The sample, limited to dormitory-residing students at one Iranian university, restricts generalizability. Voluntary participation and the exclusion of incomplete questionnaires risk non-response and selection biases, while the normality assumptions for parametric tests may not fully hold.
This study underscores the importance of targeted interventions to enhance health-promoting lifestyles among dormitory-residing students at North Khorasan University of Medical Sciences. Although students exhibited strong performance in the interpersonal relations and nutrition subscales, notable deficiencies were evident in stress management and physical activity. Significant variations by gender, employment status, educational level, mother’s education, father’s occupation, and family income highlight the influence of sociodemographic factors. To address these issues, we recommend implementing structured wellness programs, including stress reduction workshops, group physical activities, and peer mentoring initiatives. Educational sessions on time management and self-care, tailored to diverse student profiles, could further promote engagement. A holistic health promotion strategy may thereby improve overall student well-being.

Conclusion
Sociodemographic factors, including gender, employment, educational level, mother’s education, father’s occupation, and family income play a significant role in health-promoting lifestyles.

Acknowledgments: The authors would like to thank the students of North Khorasan University of Medical Sciences, Bojnurd, Iran, for their assistance in this research project.
Ethical Permissions: The study was approved by the Ethics Committee of North Khorasan University of Medical Sciences, Bojnourd, Iran (code: IR.NKUMS.REC.1401.118.).
Conflicts of Interests: All authors declared no conflicts of interests.
Authors' Contribution: Hosseini SH (First Author), Introduction Writer/Methodologist/Main Researcher/Discussion Writer/Statistical Analyst (25%); Rajabzadeh R (Second Author), Methodologist/Researcher/Discussion Writer/Statistical Analyst (20%); Namdar Ahmadabad H (Third Author), Methodologist/Assistant Researcher/Discussion Writer (25%); Afshin M (Fourth Author), Introduction Writer/Assistant Researcher/Discussion Writer/Statistical Analyst (10%); Hosseini F (Fifth Author), Assistant Researcher (10%); Hasanzadeh M (Sixth Author), Assistant Researcher (10%)
Funding/Support: This study was funded by North Khorasan University of Medical Sciences (Grant no. 4010214).
Health Education and Health Promotion
Volume 13, Issue 3
Summer 2025
Pages 571-577