The Effect of Health Promotion Program Applied to University Students on Improving Healthy Nutrition and Physical Activity Behaviors
Phase: NA
Conditions: Obesity, Students
Sponsor: Istanbul Medipol University Hospital

 
 
 
 
THE EFFECT OF HEALTH PROMOTION PROGRAM APPLIED TO UNIVERSITY 
STUDENTS ON IMPROVING HEALTHY NUTRITION AND PHYSICAL ACTIVITY 
BEHAVIORS 
 
 
 
STUDY PROTOCOL 
 
 
 
 
 
 
 
 
Primary Investigator: Ayse Dost, Lecturer 
Istanbul Medipol University 
Faculy of Health Sciencies 
Nursing Department 
Adress: Unkapanı Mah. Atatürk Bulvarı No: 27, 34083 Fatih, İstanbul 
Phone: 4448544 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Sponsor: İstanbul Medipol Üniversitesi Hastanesi 
Phone:  444 85 44 
Fax :0212 521 23 77 
Adress: Unkapanı Mah. Atatürk Bulvarı No: 27, 34083 Fatih, İstanbul 
 
Date of the Document: January 1, 2019 
 
 

 
Purpose: This study will be conducted to determine the Effect of Health Promotion Program 
Applied  to  University  Students  on  Improving  Healthy  Nutrition  And  Physical  Activity 
Behaviors. 
 
Type  of  Study:  This  study  was  planned  as  a  randomized  controlled  experimental  study 
to determine  the  effect  of  health  promotion  program  applied  to  university students  on  
healthy eating and physical activity behaviors. 
 
The  Universe  and  the  Place  of  the  Study:  The  general  population  of  the  study  will  
be composed   of   students   enrolled   in   the   formal   education   program   at   Istanbul   
Medipol University  between  January  and  September  2019.  The  study  population  will  
consist  of students with a body mass index of 25-35 kg / m², a mean score of 2 and below, no 
regular physical activity, and no problems with the musculoskeletal system, cardiopulmonary 
system, metabolic system and other systems that prevent exercise. 
 
Sample: The sample size was  calculated by power  analysis.  In the  calculation, 0,80 power 
value, 0,05 error level, 0,60 'relationship is predicted, sampling 45 students to the experiment 
and 45 students to the control group was found to be appropriate. 
In the study process, 10 substitutes were selected considering that there could be subjects who 
could leave the research. After all; 55 people in the experimental group and 55 people in the 
control group were selected by sampling. The sample consisted of 110 employees. 
 
Variables of the research: 
 
Independent Variables: Web-based health promotion program, individual counseling and 
reminders for university students according to the Health Promotion Model 
Dependent Variables: 
- Variables related to physical activity and nutrition behaviors 
• Frequency of physical activity-International Physical Activity Questionnaire score 
• Number of steps 
• Body Mass Index 
• Healthy Lifestyle Behaviors scale nutrition and exercise subscales average score 
• Meal frequency, energy, macro and micro nutrient intake of individuals 
 
Variables related to cognitive risk behaviors 
• Multi-Dimensional Health Control Scale score average 
• Meaning of Health Importance Scale 
• Health Status Perception Scale score average 
• Self-efficacy Scale average score in regular exercise 
• Self-efficacy Scale score average in the regulation of nutrition habits 
 
Research Steps: 
1. In order to identify the risky students in the study universe, a stand will be opened in the 
most crowded area of the campus and the most frequently used area of the campus. 
2. As a result of the screening, body mass indexes are between 25-35 kg / m², the average 
score of nutritional behavior is 2 or less, do not perform regular physical activity and prevent 
exercise, musculoskeletal system, cardiopulmonary system, metabolic system and other 
systems without problems Students will be admitted to the study universe.

3. Assignment will be made to the experimental and control groups by making probable 
selection from the study population. 
4. Measurements of physical and cognitive variables of experimental and control groups will 
be made. 
5. Health Promotion Modeled Health Promotion Program (Annex-1) will be applied to the 
experimental group. Health promotion program; The Web-based Health Promotion Program 
includes individual counseling and reminder practices. The content of the Web Based Health 
Promotion Program is given in Annex-2. The control group will be given educational 
brochures to develop healthy eating and physical activity behaviors. 
6. Measurements of physical and cognitive variables of experimental and control groups at 
1st, 3rd and 6th months will be made. 
7. The data will be analyzed and evaluated statistically. 
8. Report will be written. 
 
Study Timeline 
 
Year 
2018 
2019 
2020 
Month 
7 
8 
10 
11 
12 
01 
02 
04 
06 
07 
10 
11 
12 
1 
2 
3 
4 
Topic 
Choose 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Literature 
Review 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Topic 
Decide 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Planning  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Consents 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
project 
accept 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Pilot study 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Intervention 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Data collect 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Data input 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Data 
Analysis 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Report 
Writing 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
         
                                                           
 
 
 

Data Collection Tools 
 
•     Socio-demographic characteristics data sheet 
•     Multidimensional Health Check Scale 
•     Health Importance Scale 
•     Healthy Lifestyle Behavior Scale 
•     Health Perception Scale 
•     Food Consumption Frequency Determination Form 
•     Self-Efficacy Scale for Regulation of Nutritional Habits 
•     Self-efficacy Scale for Regular Exercise 
•     International Physical Activity Survey (IPAQ) short for 

Biophysiological measurements: Height and weight measurements will be done to determine 
the body mass index of the students. Tape measure and scale will be used for these 
measurements. 
 
Possibilities to be used in the thesis study: 
 
Web-based health promotion program will be implemented by using Istanbul Medipol 
University Distance Education Center system. 
• File costs of the research will be covered by the researcher. 
 
Units and Persons to Cooperate in the Execution of the Thesis if Required: 
 
Istanbul Medipol University Non-Interventional Clinical Research Ethics Committee, Istanbul 
Medipol University Faculty of Health Sciences Dean, Istanbul Medipol University School of 
Health Sciences, Directorate of Health Services Vocational School, Istanbul Medipol 
University Vocational School, Istanbul Medipol University Health Culture and Sports 
Department 
 
 
 
 
 
 
Importance of the Subject, Purpose and Scientific Basis of the Study 
 
The university period is a period in which important changes such as the first separation from 
the family, the new education environment and the transition to life are experienced for young 
people.  Adaptation  difficulties  in  this  process  also  lead  to  changes  in  individual  life, 
vocational  education  and  health  behaviors.  The  youth's  attitudes  and  behaviors  related  to 
health affect him / herself in particular, his / her family and society in general. Reaching the 
young population, which constitutes a large part of the society and is an important group that 
can easily adopt health behaviors, gains more importance for these reasons (Tuğut and Bekar, 
2008; Straker et al., 2014). 
University  period  is  among  the  most  risky  periods  in  gaining  negative  health  behaviors. 
Unhealthy eating behaviors, dieting and sedentary life, crime, smoking, alcohol or substance 
use,  energy  drink  use,  self-harm  behavior,  suicide  attempt,  risky  (alcoholic,  unarmed,  
fast, unskilled) driving, having sexuality at an early age , having unprotected sexual intercourse, 
escaping  from  home  or  school,  dropping  out  of  school,  disinterest  in  classes,  and  risky 
behaviors are considered as (Atlam et al., 2017). Decreasing physical activity of young people 
is becoming increasingly important in developing countries. Obesity is becoming widespread 
especially among young people and has negative consequences in terms of nutrition problems 
and other diseases related to obesity. It was found that students generally do not pay attention 
to  meals,  they  eat  only  one  meal,  economic  difficulties  are  effective  in  the  problems  of 
inadequate and unbalanced nutrition, students staying in dormitories are not good at feeding, 
they only feed to feed their bellies and make unhealthy choices. 
According to the World Health Organization, 23% of adults and 81% of school-age children are 
not active enough. In Australia, 2729 university students with an average age of 20; 53% of girls 
and 68% of boys do physical activity. In the study conducted in the USA, 51% of the students 
were found to have low physical activity levels. In the study conducted by Oğuz et al., 18.81% 
of the students had regular physical activity, 14.98% of the girls and 28% of the boys had regular 
physical activity. (Oğuz et al., 2018). Decreasing physical activity as well as increasing passive 
activities are an important problem. In 2011, it was stated that in 2011, one

third  of  the  students  between  the  ages  of  10  and  24  played  an  average  of  3  hours  or  
more computer  games  on  school  days  or  watched  television,  and  the  average  time  spent  
on computer and television passed 2 hours in our country (Gözüm, 2012). 
Existing studies show that young adults have poor eating habits such as high consumption of 
fast  food,  low  intake  of  fruits  and  vegetables,  and  skipping  breakfast  (Hilger  et  al.,  2016; 
Çakır, 2017). In a study conducted by Özdoğan et al., It was reported that 50.1% of university 
students  did  not  eat  three  meals  during  the  day,  84.5%  skipped  main  meals,  and  the  
most skipped meal was breakfast (Özdoğan et al., 2012). In a study conducted in nursing 
students, it  was  reported  that  62.0%  of  the  students  ate  2  meals  a  day  and  55.0%  skipped  
breakfast meals (Onay, 2011). 
As a result of health promotion programs in which positive health behaviors related to healthy 
lifestyle   behaviors   nutrition,   physical   activity   and   non-smoking   were   gained,   it   was 
determined that individuals lost weight, regular physical activity and smoking cessation rates 
increased (Esin & Aktaş, 2012). 
One  of  the  most  widely  used  models  in  gaining  health  behaviors  is  the  Health  Promotion 
Model (SGM). The health promotion model developed by Pender stems from social learning 
theory and explains the importance of cognitive processes that affect an individual's health- 
promoting behaviors. The health promotion model, which has been tested and validated on many 
community groups, is a model used to increase the individual's well-being (Zaybak and 
Fadıloğlu, 2004). The model points out the importance of  cognitive processes affecting the 
individual's behaviors that improve health (Pender et  al., 2002). The main components that 
affect  behavior  are  defined  as  1)  Individual  Characteristics  and  Experiences,  2)  Behavior- 
Specific Cognitive Processes and Effects, and 3) Behavior Results. In the behavioral change 
process, interventions using effective methods such as strengthening the cognitive capacity of 
the  individual,  stimulus  control,  modeling,  operant  conditioning,  individual  counseling  and 
group discussions are applied. 
There are many descriptive studies in the literature on health behaviors of university youth. 
However,  there  are  a  limited  number  of  model-based  interventional  studies  explaining  
the development of positive health behaviors of students in the university period. 
 
Research Hypotheses: 
 
Hypothesis 1 
Post-intervention  BMI  and  weight  average  of  students  participating  in  health  promotion 
model  based  health  promotion  program  will  be  lower  than  pre-program  and  non-program 
group. 
Hypothesis 2 
The  average  number  of  meals  consumed  by  the  students  who  participated  in  the  health 
promotion model based health promotion program after the initiative will be higher than the pre-
program and non-program group. 
Hypothesis 3 
The  daily  drinking  water  amount  of  students  participating  in  the  health  promotion  model 
based health promotion program will be higher than the pre-program and non-program group. 
Hypothesis 4 
The  average  number  of  weekly  steps  of  the  students  participating  in  the  health  promotion 
model-based health promotion program throughout the initiative will be higher than the pre- 
program and non-program group. 
Hypothesis 5

The  average  carbohydrate  consumption  consumed  by  students  participating  in  the  health 
promotion  model-based  health  promotion  program  will  be  lower  than  the  pre-program  
and non-program group. 
Hypothesis 6 
International Physical Activity Questionnaire (IPAQ) score of students participating in health 
promotion model based health promotion program will be higher than pre-program and non- 
program group. 
Hypothesis 7 
Healthy Lifestyle Behaviors Scale Nutrition subscale score of students participating in health 
promotion model based health promotion program will be higher than pre-program and non- 
program group. 
Hypothesis 8 
Healthy Lifestyle Behaviors Scale Exercise subscale score of students participating in health 
promotion model based health promotion program will be higher than pre-program and non- 
program group. 
Hypothesis 9 
Self-efficacy  Scale  for  Regulation  of  Nutritional  Habits  of  students  participating  in  health 
promotion model based health promotion program will be higher than pre-program and non- 
program group. 
Hypothesis 10 
Self-efficacy  Scale  for  Regular  Exercise  Scale  score  of  students  participating  in  health 
promotion model based health promotion program will be higher than pre-program and non- 
program group.

 
 
STUDY PROTOCOL 
General Universe 
 
N=30.000 students
 
 
 
Working Universe 
 
N=5.451 students 
 
 
 
Sampling 
 
n=110 students 
 
 
Experimental Group (n=55)                                                                                      Control Group (n=55) 
 
 
Physıcal and Cognıtıve 
Measurements 
 
 
Participation in health promotion program 
 
Distribution of 
training brochures
 
 
 
1st month follow- 
up 
 
Physıcal and Cognıtıve 
Measurements 
 
 
1st month follow- 
up
 
 
3rd month follow- 
up 
Physıcal and Cognıtıve 
Measurements 
3rd month follow- 
up
 
 
6th month follow- 
up 
 
Physıcal and Cognıtıve 
Measurements 
6th month follow- 
up
 
 
Experimental 
group 
 
Control group
 
EVALUATİON

VARİABLES OF THE RESEARCH 
 
Independent Variables: Web-based health promotion program, individual counseling and reminders 
for university students according to the Health Promotion Model 
 
Dependent Variables: 
 
Variables related to physical activity and nutrition behaviors 
 
• Frequency of physical activity-International Physical Activity Questionnaire score 
 
• Number of steps 
 
• Body Mass Index 
 
• Healthy Lifestyle Behaviors scale nutrition and exercise subscales average score 
 
• Meal frequency, energy, macro and micro nutrient intake of individuals 
 
Variables related to cognitive risk behaviors 
 
• Multi-Dimensional Health Control Scale score average 
 
• Meaning of Health Importance Scale 
 
• Health Status Perception Scale score average 
 
• Self-efficacy Scale average score in regular exercise 
 
• Self-efficacy Scale score average in the regulation of nutrition habits

ANALYSİS OF DATA 
 
In the evaluation of the data, the data is planned to be realized in a computerized version with SPSS 
22.0 (license obtained by Istanbul Medipol University Information Technologies Department, IP: 
10.201.2.15 connection is provided over the server). 
 
In evaluating the homogeneity of the experimental and control groups: 
 
Descriptive analysis (average, 
 
standard deviation, percentage) 
 
Chi-square test 
 
T test in independent groups 
 
Mann Whitney U test 
 
To compare the findings of cognitive risk behaviors, physical activity and nutritional behaviors 
between experimental and control groups in pre-program, post-program 1st month, 3rd month and 
6th month. 
 
Analysis of variance in repeated measurements 
 
Friedman test 
 
In dependent groups t test will be used. 
 
For the analysis of food consumption, analysis will be performed by using Nutrition Information 
Systems Package Program (BEBİS).