Optimizing college health promotion in the digital age: Comparing perceived well-being, health behaviors, health education needs and preferences between college students enrolled in fully online versus campus-based programs
Abstract
Background: There is little published about non-traditional and online college students’ health and well-being. College health services must evolve to address the needs of this growing population. The purpose of this study was to explore risk factors, perceived well-being, health behaviors, and health education preferences of US college students enrolled in a fully online academic programs compared to a national sample of college students enrolled in campus based programs.
Methods: This cross-sectional study included a volunteer sample of 961 college students enrolled in two large, U.S. accredited online universities. Participants completed an online survey that included questions and sub scales from the National College Health Assessment (NCHA, IIb). Responses on survey items from student learning online were compared to an equal sample of college students enrolled in non-online programs, randomly drawn from the NCHA IIb national data set (n = 961). Frequencies on survey items were calculated and mean scores of subset measures for online students were compared against those from the NCHA data set using two tailed z-test scores and independent sample t-tests with alpha at 0.05.
Results: Online students reported significantly (P ≤ 0.05) higher percentages of chronic illnesses, psychiatric conditions, mobility disabilities, deafness/hearing loss, speech/language disorders,cigarette use, obesity, sedentary activity, and depression than the NCHA national sample.
Implication for Practice: Health professionals and leaders who work in higher education must consider the shifting landscape and demographics in higher education in order to develop more tailored, innovative digital health promotion approaches that effectively reach the growing population of online, commuter, and older learners.
*Significant differences between online students and NCHA sample (P < 0.0001).
*Significant differences between online students and NCHA sample (P < 0.0001). There were statistically significant differences between the two groups on weight status (Table 4). Over 66% of online students classified themselves as overweight (z = 8.73, Pvalue < 0.0001) to very overweight (z = 22.67, Pvalue < 0.0001) with 69.4% currently trying to lose weight (z = 10.47, Pvalue < 0.0001), compared to the NCHA sample with 36.4% classifying themselves as overweight to very overweight and 52% trying to lose weight. The percentage of online students who consumed three or more servings of fruits and vegetables per day was higher (40.2%) compared to the NCHA sample (33.1%), although more than half in both samples reported consuming two or fewer servings per day. Regarding exercise, online students had a higher percent of zero days per week of: moderate-intensity cardio (30.5%), vigorous intensity (53.5%) and strength training (56.5%). Only 15.5% reported engaging in five or more days each week. A greater percentage of online students (53.5%) reported no days of vigorous-intensity cardio per week, compared to 41.1% of the NCHA sample. Only 8.6% of online students reported engaging in five or more days each week of vigorous cardio. Additionally, 56.6% of online students reported no (0 days) of strength training per week. Finally, 61.3% of online students reported sitting more than 6 hours each day.*Significant differences between online students and NCHA sample (P < 0.0001).
*Significant differences between online students and NCHA sample (P < 0.0001). Regarding mental health, the survey inquired about students’ feelings in the previous two weeks. The NCHA sample had statistically significant higher proportions for: “Overwhelmed by all I have to do” (z = -9.12, Pvalue < 0.0001); “felt very lonely” (z = -7.98, Pvalue < 0.0001); “felt very sad” (z = -6.53, Pvalue < 0.0001); “felt so depressed it was difficult to function” (z = -3.27, Pvalue < 0.0001); and “felt overwhelming anxiety” (z = -2.51, Pvalue < 0.0001) (Table 5). However, a higher percentage of online students (29.3%) reported having been diagnosed with depression (z = 7.85, Pvalue < 0.0001) compared to the NCHA sample (19.1%). For both samples, more than half reported experiencing “more than average” to “tremendous levels” of stress over the previous 12 months (online= 51.9%, NCHA= 53.2%). Regarding sleep, the NCHA sample had a statistically significant higher percent of students who reported not getting enough rest to feel sleepy during the day (41.5%) for “more than a little problem” to a “very big problem” (z = -6.39, Pvalue < 0.0001) compared to 31.1% of the online student sample.*Significant differences between online students and NCHA sample (P < 0.0001).
*Significant differences between online students and NCHA sample (P < 0.0001). The top five health impediments to academic performance reported by online students were: 1) stress; 2) chronic health problem; 3) work; 4) anxiety; and 5) death of a family/friend (Table 6). The top five health education topics of interest reported by online college students were: 1) stress; 2) nutrition; 3) physical activity; 4) sleep difficulties; 5) how to help others in distress.Stress, anxiety, and work ranked as top academic impediments for both groups, but chronic health problems and death of a family/friend were specific to online students. The majority (71%) of online students believed that health and well-being impacted their academic standing, and 70.1% indicated “yes” they would participate in virtual health services and use electronic health promotion resources or programs if they were offered at their university. There are very few published studies which examine the health of online college students compared to students enrolled in brick-and-mortar academic programs. This study compared health habits, behaviors, and perceptions of online students attending two large, accredited US universities (n = 961) to an equal comparison group of non-online students drawn from the 2015 NCHA IIb dataset. Significant differences in age, race/ethnicity, marital status and hours worked were identified between the two groups. Online students in this study were older (40 years). More participants identified as African American/Black and Hispanic/Latino; more were married or divorced; and the majority worked 40 or more hours per week. The sample characteristics of the study are consistent with the demographic breakdown of a what is characterized in the literature as “non-traditional” student population: 57% female, 34 years being the average age, almost 30% identifying as non-Caucasian, and the majority working full or part-time (60% for undergraduates and 88% for graduate students).8 The demographics are also more consistent with community college students.10 As non-traditional students have become the majority (71%) on college campuses,11 the term “non-traditional” is no longer fitting. This demographic shift should inform the college and university Healthy Campus initiatives as well as health promotion strategies and services. The results of this study also demonstrated that online students had significantly higher percentages of having chronic illnesses, psychiatric conditions, mobility disabilities, deafness/hearing loss, and/or speech or language disorders versus the college students from the NCHA data set. These findings are consistent with the literature that notes online students are vulnerable to challenges affecting their well-being, levels of stress and satisfaction, academic persistence and diploma attainment.11 In addition, online students had statistically significant higher percentages of daily cigarette as well as higher percentages of students classifying themselves as “overweight” to “very overweight” when compared to the college students from the NCHA data set (66.5% versus 36.4%, respectively). Yet 52% of college students from the NCHA data set reported trying to lose weight compared to 69.4% of online students. Therefore, online students may have a more realistic perception of body image when compared to the NCHA sample. This clearly aligns with research studies that have demonstrated that symptoms of eating disorders are pervasive among college students, with a prevalence ranging from 8% to 17%.12-14 This may be due to structural and psychosocial influences, such as stress, lower levels of self-esteem and sense of unity.15 Obesity is a major health problem in the United States, affecting roughly one-third of adults, and is associated with multiple chronic health problems.16 Lack of exercise is the largest contributor to obesity in America. In relation to this, online students had a higher percent of sedentary activity and these findings are consistent with the literature concludingonline students’ are at higher risk of sedentary lifestyles and cigarette smoking.3 Researchers also reported older students having significantly higher body mass index (BMI) scores, and smoking being associated with higher BMI.17 The demographics of this sample of online students (being older, married, employed, more ethnically diverse) are known to negatively influence physical activity behavior.18 Furthermore, screen time (amount of time spent in front of a television, computer, or other electronic devices) has been linked to obesity.19 Several studies have concluded that a higher screen time (more than 21 hours per week) was associated with obesity, regardless of exercise behavior.17,19,20 Online students had statistically significant lower proportions for being overwhelmed, lonely, sad, depressed, and anxiety over the past two weeks, but a statistically significant higher percentage of having been diagnosed with depression. More information and research is needed in this area, but one could speculate that online students are older and therefore have found coping skills and techniques to deal with depressive symptoms. Stress was the top health impediment to academic performance reported by both groups. According to a recent study, mental health and stress management were the most common types of health services offered by universities offering fully online academic programs.21 However, services were offered in the form of written material or website. The results from this study also underscored the need for mental health services promoted to online students to be more interactive and possibly synchronous. For example, support groups and coaching might be offered virtually. Handouts and websites provide a good starting point, but they do not create a healthy campus climate, offer behavior change techniques, or support for real health actualization.21 In terms of health education needs and preferences, the top five health education topics of interest to online college students only slightly differed from those in the non-online group. For the online group, the top issues of need or interest were: 1) stress; 2) nutrition; 3) physical activity; 4) sleep difficulties; 5) how to help others in distress. Topics reported by non-online students included the following: 1) mental health; 2) stress management; 3) physical activity/fitness; 4) relationship violence/sexual assault; and 5) weight management.21 This study, like all research, was not without limitations. The first was that participants in the online group were selected through convenience sampling of two fully online universities and did not reflect all online students in the United States. This may have limited variation in responses and thereby inhibits generalizability of findings. In addition, the NCHA IIb subscales used to collect the data only provide a snapshot of a college student’s health and well-being, as defined by the limitations of the scale and self-reported data. Although it is the most widely used college health instrument, the NCHA has a number of limitations such as item sensitivity, not defining health behaviors, and absence of theory, as recently outlined by researchers Rahn, Pruitt and Goodson.22 Ideally, future iterations of the NCHA would account for the shifting demographics in higher education and the fact that more full-time students are enrolling in fully online academic programs.Notes
Citation: Burcin MM, Armstrong SN, Early JO, Godwin H. Optimizing college health promotion in the digital age: comparing perceived well-being, and health behaviors, health education needs and preferences between college students enrolled in fully online versus campus-based programs. Health Promot Perspect. 2019;9(4):270-278. doi: 10.15171/hpp.2019.37.
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