Iranian Journal of Sociology, 2008, 2 (1): 190-227
Gender Differences in Health-related Knowledge and Beliefs and their
Relationships with Health-related Behaviors
Mohammad Esmaeil Riahi: Assistant Professor- University of Mazandaran
Abstract
Objectives: The main objectives of this study are to describe and explain gender & national differences
in health related knowledge & beliefs, and their impacts on health behaviors of university students in Iran
(Mazandaran University) and India (Panjab University), with special emphasis on psychosocial factors.
Methods: Survey method is been used for conducting the present study. By means of multi– stage
sampling procedure, 504 students from both the universities have been selected randomly, to fill up the
self- administered questionnaire consists of two scales regarding health related knowledge & beliefs ,and
some questions about health-related behaviors such as personal hygiene , physical exercise , dietary
habits , preventive medical checkups, alcohol consumption, and smoking.
Results: The main findings of the present study can be summarized as follows: 1) The university
students in India compared with their counterparts in Iran were more aware of risk factors involved in
certain diseases (higher rates of health knowledge), while men and women students did not differ in this
respect. 2) The university students in both countries were not different in terms of health beliefs, while
women compared with men students were more conscious of the importance of certain behaviors for
health maintenance (higher rates of health beliefs). 3) Association between health knowledge and healthrelated behaviors was found to be weak and non significant; while a very strong and significant
association between health beliefs and health related behaviors was observed.
Discussion: Improving health beliefs of students rather than their health knowledge, is an essential step
in order to increase their positive health-related behaviors.
Keywords: Gender, Gender differences, health knowledge, health beliefs, health behaviors, University
students, Iran, India
1) Introduction
Health is one of the most vital but taken-for granted qualities of everyday life.
There is good evidence that health is a major basis of human progress and that lack of
it, is one of the predisposing factors of national decay. As Cockerham (1989: 2) rightly
points out: while a person’s social class, income, and access to goods and services are
highly important, the quality of one’s life, ultimately depends upon one’s level of health.”
In light of the role of health in happiness, efficiency, and well-being, it seems that every
social group and society strive for the betterment of health of its members.
1
Overall, the most important determinants of the health status can be summarized as
follows: heredity and genetic composition; socio-demographic characteristics (such as
age, marital status, place of residence, etc.); socio-economic status (such as education,
income, and employment); Socio-cultural factors (gender, religion, ethnicity); gender
inequality; health knowledge and health beliefs; health-related behaviors (such as
smoking, alcohol consumption, physical exercise, and dietary habits); political economy;
poverty and malnutrition; access to health services and facilities; and physical
environment. A combination of factors than just one of them determines the health
status of individuals and societies. Among the above mentioned factors, this study
focuses on health knowledge and beliefs and their impacts on the health behaviors.
The literature on associated factors with health beliefs and knowledge identified some
psychosocial factors. For instance, Weissfeld and colleagues (1990) found that sociodemographic markers of social disadvantage (e.g., black race, or low SES) appeared to
associate with favorable health beliefs, that is, with health beliefs often associated with
health promoting behaviors. They, specifically, found that blacks expressed greater
concern about health (health concern). Significant gender, ethnic, and acculturation
differences were found among beliefs related to frequency of condom use in the past
year by Norris and others (1994) in Midwest (USA). A cross-cultural study of beliefs
about smoking among teenaged females by Hanson (1999) also showed that beliefs
related to attitudes about smoking differed among three ethnic groups. The findings of
this study suggested that specific beliefs distinguish between smokers and nonsmokers
and that some beliefs differ by ethnicity. Jobanputra and Furnham (2005) studying the
cultural differences in beliefs about health and illness found that Gujarati Indian
immigrants agreed with items reflecting supernatural explanations of ill health more than
indigenous British Caucasian participants. Awasthi and colleagues (2006) conducted a
study on health beliefs of cervix cancer patients and found that individual and
psychosocial causes were more strongly represented in the belief system of patients
than environmental or supernatural causes. Additionally, Munro and others (2007) in
assessing the impact of training on mental health nurses’ therapeutic knowledge found
a significant group effect on knowledge about co-morbidity. The training programme
was effective in improving participants’ knowledge of alcohol, drugs, and co-morbidity.
Likewise, Bassey et. al (2007) found gender differences in health knowledge about HIV.
2
Accordingly, they identified a great disparity between male (73.7%) and female (28.9%)
respondents on knowledge about HIV.
On the other hand, many studies have been conducted to find out associations
between health knowledge and beliefs with health-related behaviours. A brief review of
literature in this respect shows that findings of studies conducted on health knowledge
in relation to health-related behaviours (HRBs) were not consistent and stable, but
health beliefs had a strong and consistent relationship with health-related behaviors. For
example, a few studies highlighted how health knowledge is related to decrease in
health risk behaviors (Dittmar et al. 1980), and an increase in health-promoting
behaviors (Fleetwood and Packa, 1991). It also influences dietary behavior (Harnack et
al., 1997); and or brings about reduction in alcohol consumption, improvement of
physical activity (Wardle and Steptoe, 1991), and treatment-seeking behaviour by
women reported depression symptoms (Simmons et. Al, 2007). Despite of these
supportive evidences regarding influence of health knowledge on HRBs, however, some
research findings point out that mere information of the hazards of health risk behaviors
is not a sufficient condition for the avoidance of risk-taking behaviors. For example, no
relationship could be found between health knowledge and reduction in smoking
(Wardle, 1992; Jones et. al., 1992; Small, 1994; Steptoe & Wardle, 1992; Kapoor et al.,
1995; Yassin et al., 1998; Kurtz et al, 1972); or alcohol consumption (Steptoe and
Wardle, 1992). Further, according to Lopez et al. (1992) there exist many contradictions
between the theoretical acquisition of health knowledge and the observed frequency of
high-risk behaviors. Similarly, Avis et al. (1990) concluded that knowledge does not lead
to risk reducing behavior in cardiovascular diseases as well as sun-protective
behaviors.
However, majority of the studies on health beliefs confirmed the positive relationship
between health beliefs and health behaviors. Rather, it has been observed that unlike
health knowledge, there has been a constant relationship between health beliefs and
health behaviors. According to Monneuse et al. (1997) knowledge of the significance of
behaviour seems to be closely associated with health related behaviors. Similarly,
Steptoe and Wardle (1992) come to the conclusion that health beliefs consistently
showed a positive association with health practices. Cody and Lee (1990) consider
health beliefs as a significant variable in predicting health behaviors. Calan
3
and Rutter (1988) also show that a change in the health beliefs could result in the
improvement of health behaviors. Thus, the above studies show that people’s beliefs on
health matters have an important effect on what they do about health, namely; their
health behavior. Abroms and colleagues (2003) also concluded that males and females
differed in their beliefs that motivated their sunscreen use. Holt and others (2003) in the
studying association between spirituality, breast cancer beliefs and mammography
utilization among African American found that the belief dimension of spirituality played
a more important role in adaptive breast cancer beliefs and mammography utilization
that did the behavioural dimension. A research done by Riley-Doucet (2005) showed
that family dyads with beliefs that pain was controllable had less symptom distress than
dyads with beliefs that pain was not controllable. Moreover, Lee and colleagues (2007)
revealed that the fear-avoidance beliefs factor is an important biopsychosocial variable
in predicting future disability level and return to complete work capacity in patients with
neck pain.
Increasing attention has been paid over the last two or three decades to the
contribution of behaviors to health. Today, many of the major health problems, such as
heart disease and cancer, are seen as attributable to individual behavior patterns
(Macintyre, 1986: 407). The prevalence of chronic diseases is showing an upward trend
almost all over the world, including the developing countries, because of shifting of
patterns of disease in these countries. People in the developing countries, especially
the middle and high social classes, are exposed to chronic, non-communicable
diseases attributable to health related behaviors. Therefore, it is the right time that the
developing countries increase the awareness of their population about health risk
behaviors (to increase health knowledge and to improve health beliefs) and take
appropriate steps; to avoid the onset of epidemic form of non-communicable diseases
that are likely to emerge in a big way as the status of these societies improves.
Although different social and cultural factors such as income, employment, education,
age, ethnicity, and class have been found to play an important role in the construction of
differences in terms of health-related knowledge, beliefs, and behaviors, but it can be
presumed that gender is one of the most important factors influencing health related
behaviors in each social group as well as society. Accordingly, in the past three
decades, the issue of gender differences in health and illness has gained popularity as
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a subject of research among social scientists. The survey of literature on gender
differences on health status of different societies reveals that women suffer more from
disease in their lifetime, but men die early; women live longer, yet they seem to be
sicker. Further, many research studies found that in general, women are more likely
than men to adopt healthier habits and perform positive health behaviors.
Overall, the main problem that this study is trying to focus on is to understand the nature
of variations in health related knowledge and beliefs of university students and their
associations with health related behaviors. This study has attempted a twofold
comparison in health related knowledge, beliefs and behaviors, that is, by gender and
nationality at the same time. It tries to find out how far health related knowledge and
beliefs of male and female university students in Mazandaran University (Iran) and
Panjab University (India) differ and which factors affect these differences? In the other
words, in this study, gender differences in health related knowledge and beliefs of
university students in Iran and India were described and explained by means of several
socio-psychological and cultural factors. Therefore, the main questions which this study
tries to answer are:
- Are there any gender differences in health-related knowledge and beliefs of university
students in the total sample as well as within each university context?
- What are the associated factors, which influence these differences?
- And how far health knowledge and beliefs act as positive predictors of health related
behaviors?
2) Theoretical Framework
The study of gender differences in health/illness has been approached from a
number of perspectives. In general, these perspectives can be broadly put into two,
namely: Biomedical and Socio-medical. According to the Biomedical perspective it is
hypothesized that observed gender differences in health are the product of biologically
based inherited risks (Kandrack, 1991: 579). In the biomedical model state of health is a
biological fact (immutable, real, independent) and ill health is caused by biological
calamities (Moon and Gillespie, 1996: 83). The Socio-medical perspective on the other
hand, hypothesizes that gender differences in health can be explained in terms of social
and cultural factors (Kandrack, 1991, 579). The Socio-medical model looks at state of
5
health as socially constructed, varied, uncertain, and diverse. It considers social factors
as the causes of ill health, which can be identified through beliefs, and interpretations
built upon custom and social constraints (Moon and Gillespie, 1996: 183).
The present study makes use of the socio-medical perspective to explain gender
differences in health related knowledge, beliefs and behaviors of university students in
Iran and India. Within the broad framework of the socio-medical approach, there are
several approaches such as socialization theory, social role theory, and social position
and socio-economic status.
2-1) Socialization Theories
Socialization is the complex learning process through which individuals develop
selfhood and acquire the knowledge, skills, and motivation required for participation in
social life (Mackie, 1990: 61). In socialization theory, some social groups or
organizations such as family, peer groups, school, and mass media are considered as
agents of socialization. Family socialization forms the basis of many of our health beliefs
and behaviors. Many parents attempt to provide a healthy role model. This may lead to
health enhancing behavioral change by parents. Maintenance of health damaging
behavior may also result from the pressure of parenthood, particularly where material
circumstances are poor and resources are low. Even family related life events may
contribute more positively to lifestyle change (Penny et al., 1994: 113-4). Overall, the
family system plays a major role in children’s learning of health related knowledge,
beliefs, and behaviors. From amongst the different socialization theories, two most
important ones have been explained briefly below:
2-1-1) Social Learning theory
Social learning theory, which has been most substantially articulated by Bandura
(1977, 1986), emphasizes the notion that behaviors are gradually acquired and shaped
as a response to the positive and negative consequences of those behaviors. In
summary, social learning theorists argue that gender role behaviors, are learned by
reinforcement (rewards and punishments) and observational learning. Children are
rewarded or punished by their parents and society for exhibition behaviors appropriate
to their gender role. As a result, gender-appropriate behaviors take on greater value for
the child and are exhibited with greater frequency (Eccles, 2000: 455). Social learning
6
theory places more emphasis on environmental influences. Accordingly, health
promotion or risk behaviors are socially learned and purposeful behavior, results from
interplay of social–environmental and personal perceptions and influences. For example,
this theory conceptualizes that alcohol use as a socially learned, purposive, and
functional behavior results from the interplay between socio-environmental factors and
personal perceptions (Gonzalez, 2000: 4). In this regard, parents may influence their
children’s drinking through both direct modeling of alcohol use and the transmission of
parental values about drinking (Jung, 2001: 164). In the study of health related
behaviors, social learning theory as a cognitive view emphasizes expectancies that we
form about the positive/negative effects of each health related behavior. For example, to
have a belief in medical check up, one has to first learn the social norms regarding the
beliefs of others about it. Thereafter, one looks at the situation in which the check up
affects the health of the individual. Thus, one learns the effects of regular medical check
up through his/her health status.
2-1-2) Health Locus of Control
The construction of health locus of control was derived from the social learning
theory developed by Rotter in 1966. From this theory, Rotter developed the locus of
control construct, consisting of internal-external rating scale (www.med.usf.edu). The
locus of control construct refers to the degree to which an individual believes the
occurrence of reinforcements is contingent on his/her own behavior. Theoretical basis of
locus of control relies on individual differences between how people perceive events as
a result of their own behavior or endurance characteristics (internal), or as being
controlled by some other variables like chance, luck, fate, or authority (external).
Health locus of control is “a concept that refers to an individual’s views regarding the
relative control he/she has over his/her health condition (Pacther et al, 2000:716).
Externals refer to the belief that one’s health condition is under the control of powerful
others, or is determined by fate, luck, or chance, but internals refer to the belief that
one’s health condition is directly the result of one’s behavior. Internals are prone to
obtain
proper
nutrition,
exercise,
rest,
stress
reduction,
and
to
adopt
prevention/enhancement strategies to maintain/improve the state of their health.
External individuals are liable to exhibit behaviors, which are less action-oriented, and
appropriate response to the state of their health may not occur (www. members. tripod. com).
7
2-2) Social Role Theory (SRT)
Social role theory focuses on studies of learned behavior of men and women in
society by means of their social and gender roles. Gender role theory derives from the
general concept of social role. It refers to the shared expectations that apply to persons
who occupy a certain social position as members of a particular social category. In this
manner, gender roles are those shared expectations that apply to individuals on the
basis of their socially identified sex. Accordingly, people hold expectations about the
behaviors that are appropriate to an individual because they identify the person as a
member of the social category that consists of either females or males (Eagly, 2000:
448). In the area of health and illness, social role theory attempts to understand how the
multifaceted nature of men and women’s lifestyle affects their health and well being
(Pavalko and Woodbury, 2000). According to Nathanson (1975) women report more
illness than men because it is culturally more acceptable from them to be ill; and the
sick role is relatively compatible with women’s other role responsibilities, and
incompatible with those of men, and also women’s assigned social roles are more
stressful than those of men; consequently women experience more illness. Gove (1984)
develops the ‘fixed role’ hypothesis and its relationship to men’s health. According to
this idea the roles of men tend to be more structured or fixed than the roles of women. It
is argued that highly structured or fixed roles tend to be causally related to good mental
health and low rates of morbidity. Gender differences in health knowledge, beliefs, and
behaviors can be attributed to gender role socialization, gendered expectations and
obligations that determine appropriate or misappropriate behaviors for men and women,
and influence health status of individuals. A common explanation of the decline in sex
differences in smoking in western societies focuses on the consequences of gender
equality. Narrowing sex differences in smoking in times of increasing gender equality
and strengthening values of female independence, leads to the inference that the new
found freedom and higher status of women have prompted the undesirable behavior of
smoking (Pampel, 2001: 388).
2-3) Social position and socio-economic status
The influence of socio-economic status on health related knowledge, beliefs, and
behaviors have been well documented. Lower socio-economic status individuals have
lower level of knowledge about risk factors of diseases, they are not deeply believed to
8
importance of healthy lifestyle on health status, and they participate in fewer positive
health behaviors; for example, exercise, maintaining healthy body weight and change
their negative health behavior such as smoking at a slower rate than higher socioeconomic status individuals. Recent research indicates that social location in status
hierarchies is an important conditioning factor for the allocation of resources,
opportunities, and constraints that influence knowledge, beliefs and behaviors related to
health (Crzywacz and Marks, 2001; 203). People in lower socio-economic strata tend to
be disadvantaged in a broad array of biomedical, environmental, behavioral, and
psychosocial risk factors for health, which mediates the relationship between socioeconomic position and health. House (2001: 134) also points out that socio-economic
status determines and shapes individual’s exposure to and experience of virtually all
known psychosocial, and many biomedical risk factors for health. Thus socio-economic
positions are originally fundamental causes that shape exposure to and experience of
most diseases and risk factors for health.
Overall, several social, psychological, and biological mechanisms have been
hypothesized to underlie the socio-economic status–health relationship. One set of
hypotheses centers on the ways that socio-economic status may influence health status
through its effect on shaping the individual’s day-to-day lifestyle and health-affecting
behaviors, such as diet, sleep, exercise, smoking, drinking, and drug use. Another
pathway through which socio-economic status and health are hypothesized to influence
each other is by way of socio-economic status differences in exposure to psychological
stress and distress. Another obvious way is through differences in occupational
conditions (Mulatu and Schooler, 2002: 23).
The present study, proposes to test the efficacy of all these approaches in explaining
gender related differences in health knowledge, beliefs, and behaviors of university
students in Iran and India.
3) Data and Methods
3-1) Survey Design
The universe of this study relates to formally enrolled university students in Iran and
India. For the present study, which is incidentally cross-national study, separate
9
samples of university students were obtained from Mazandaran University (in north of
Iran, Babolsar) and Panjab University (in north of India, Chandigarh).
The ultimate nature of the sampling procedure resembles the multi-stage sampling
procedure. At the first stage, Mazandaran University in Iran and Panjab University in
India were selected. Then, various and as much as possible similar departments in
each university (Law, Sociology, Economics, Commerce and Management, Physical
Education, Languages, Humanities, History, Political Sciences, Psychology, Botany,
Mathematics, Physics, Chemistry, Biology, Geology, and Chemical Engineering) were
selected in the second stage, and at the final stage, the samples of study were chosen
randomly from the students of each department who were present in the classroom
when sampling was in operation. For the purpose of sampling, rough estimates of the
total student population in these universities were obtained. These estimates showed
that nearly 27915 students in all were enrolled in both the universities. Thereafter, it was
decided to limit the size of the sample to roughly 500 respondents from both the
universities and around 250 from each of them. In Mazandaran University the total size
of the sample was 263 representing 7.2% of the total population; and in Punjab
University the total size of the sample came to 241, after eliminating the incomplete
questionnaires, representing 7.6% of the total population of students.
3-2) Data Collection
Data collection was done when the classes were going on and all those students
who were attending the classes on those particular days were distributed the
questionnaires with the presumption that all students enrolled would be present in the
classroom. Thus, ensuring the randomness of the sample, classroom setting was also
considered ideal for approaching the students because the students could be explained
the purpose of the study, given instructions about filling the questionnaires, and since
the questionnaires were distributed after seeking the cooperation of the teachers and
the authorities, a good response rate was expected.
The main instrument of data collection used in this study was the self-administered
questionnaire, which was developed using a combination of questions derived from
previous research studies, particularly Wardle & Steptoe (1991), Steptoe & Wardle
(1992), Callaghan (1996), Ross & Wu (1995), Douglas et al (1997), Patrick et al (1997),
10
Pietila et al (1995), and Fennell (1997). Then every effort was made to adopt these
questions within the cultural contexts of Iran and India. A total of 43 question items were
included, among which 16 items referred to socio-demographic characteristics; 19 items
related to health behaviors, and 6 items related to psychosocial variables (such as
health locus of control, health concern, etc.). Further, the health knowledge questions
were in a multiple choice format, with one correct answer for each question; while the
health beliefs index consisted of five-point Likert type items. Finally, this study used one
questionnaire in two languages due to the nature of the study population: a Persian
version was used in Iran, and an English version in India.
3-3) Methods of Data Analysis
Data were analysed by using the statistical package for social sciences (SPSS).
Reliability analysis was conducted for testing the reliability of scales and indices.
Internal consistency of these sections of the questionnaire was calculated by using
cronbach alpha techniques. Descriptive statistics was applied to portray the current
status of subjects in demographic and socio-cultural characteristics, as well as socioeconomic status of their families. Analytical statistics (Student’s t-test and one-way
analysis of variance, ANOVA) were used to assess gender and national differences in
health related knowledge and beliefs, and also to determine significant factors
associated with each health related knowledge and beliefs.
3-4) Operationalization of Variables
3-4-1) Health Knowledge
Researcher developed an index of health knowledge or risk awareness by
presenting a matrix of six health problems (heart diseases, lung cancer, breast cancer,
high blood pressure, hepatitis, and tuberculosis) and nine health related risk factors
(smoking, alcohol consumption, stress, adding extra salt to meals, consumption of extra
fat, drinking excess coffee, physical inactivity, consumption of polluted water, and
receiving blood). Subjects were asked to tick the appropriate box if they were of the
opinion that the health problem was influenced by the factor in question. The overall
reliability coefficient for knowledge test in the overall sample was .9116 suggesting very
high internal consistency of the test.
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3-4-2) Health Beliefs
It can be defined as the given importance of a series of behaviors for health
maintenance by in individuals. Subjects were asked to rate the importance of 16
behaviors for health maintenance on the index. Some of these 16 items were; brushing
teeth regularly, regular physical exercise, consuming fruit and green vegetables,
avoidance of extra salt, sugar, animal fat, alcohol, and smoking. Beliefs concerning the
importance of behaviors for health were assessed by summated scores obtained on
belief items for each subject. The overall reliability coefficient for the belief index for the
overall sample was .8640, indicating very high internal consistency of the index.
3-4-3) Health-related behaviors (HRBs)
HRBs are those activities, which perform by individual for maintenance and/or
improvement of his/her health status as well as prevent from onset of disease. An
important point is that HRBs are those performed at an asymptomatic stage. In the
present study, we focused on six health-related behaviors, namely; personal hygiene,
dietary habits, physical exercise, preventive medical checkup, smoking, and alcohol
consumption.
3-4-4) Health Related Behaviors (HRBs) of Family
In order to find out how far HRBs of respondents were influenced by current patterns of
HRBs in their families, respondents were asked to identify how many persons in their
families observe HRBs in the study, such as: exercising, healthy dietary habits, personal
hygiene, regular medical checkups, smoking, drinking, etc.
3-4-5) Multidimensional Health Locus of Control (MHLC)
The Multidimensional Health Locus of Control (MHLC) belief scale was used in this
study to measure beliefs about health behavior. Respondents were presented with a list
of statements designed to gauge their views about an individual’s ability to control
health matters. Health locus of control was assessed using the multidimensional health
locus of control scales devised by Wallston, Wallston, and De Vellis (1978), which
modified on 1998 by Wallston (www.Vanderbit.edu/nursing /kwallston/ mhlcscales .htm ).
The MHLC have shown adequate internal consistency in the previous studies (Steptoe
and Wardle, 2001). In this study it shows the internal consistency of .6592
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3-4-6) Health Concern
Health concern or value for health is the value that individuals place on health as a
priority in their lives. Research shows positive association between the value for health
with health related behaviors (Steptoe & Wardle, 2001), and tendency in quitting
smoking (Greenlund et al., 1997). This index was constructed by two items, including;
‘all things considered, good health is the most important thing to have’, and ‘I always
think about my health.
3-4-7) Socio-economic Status of Family
Socio-economic status was used here to refer to inequality in ranking regarding
education, income, and job positions of parents. In each country a three-item scale was
used for the qualification of the individual respondents on different levels of socioeconomic status. The scores allocated to educational status of parents, job position of
parents, and total monthly income of the family.
3-4-8) Socio-demographic Variables
These variables are measured on a nominal or categorical basis, simply by dividing
them into two or three groups, such as gender (0=male, 1=female), university
(0=Mazandaran University, 1= Panjab University), nativity (0=urban areas, 1=rural
areas), type of residence (0=with family, 1= far away from family), level of study
(0=undergraduate, 1= postgraduate).
3-5) Hypotheses
- There is a significant association between level of education and health knowledge.
- There is a significant association between type of residence and health knowledge.
- There is a significant association between socioeconomic status of family and health knowledge.
- There is a significant association between nationality and health knowledge.
- There is a significant association between nativity and health knowledge.
- There is a significant association between gender and health knowledge.
- There is a significant association between nativity and health beliefs.
- There is a significant association between gender and health beliefs.
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- There is a significant association between health concern and health beliefs.
- There is a significant association between health locus of control and health beliefs.
- There is a significant association between health behaviors of family and health beliefs.
- There is not significant association between health knowledge and health-related behaviors.
- There is significant association between health beliefs and health-related behaviors.
3-6) Theoretical Model
Level of Education (Undergraduate/Postgraduate)
Type of Residence (Staying or far away from Family)
Socioeconomic Status of Family
Health Knowledge
Nationality (Iranian/Indian)
Nativity (Urban/Rural)
Health Related Behaviors
Gender (Male/Female)
Health Concern
Health Beliefs
Health Locus of Control
Health behaviors of Family
4) Results
4-1) Health Knowledge
4-1-1) University Level Differences in Health Knowledge
The analysis of inter-university data shows some differences as can be seen from
table one. These differences have been calculated only for the correct answers. On the
whole, students of PU were more aware of risk factors involved in all six diseases listed
in table one than their counterparts in MU, particularly in relation to hepatitis,
tuberculosis, high blood pressure, and lung cancer. In fact, on all the diseases
mentioned in the table, PU students endorsed the right risk factors more often than the
MU students.
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Table 1) Distribution of Health Knowledge among the Students at Mazandaran
University (MU) and Panjab University (PU)(Percentage of correct answers)
Diseases (%)
Risk
Factors
Heart
Lung
Breast
High blood
disease
cancer
cancer
pressure
Average
Hepatitis
Knowledge
TB
MU
PU
MU
PU
MU
PU
MU
PU
MU
PU
MU
PU
MU
PU
Smoking
92.0
75.9
96.0
93.3
59.1
36.7
53.2
60.0
9.4
56.6
29.7
47.1
56.6
61.6
Alcohol
consumption
60.4
78.6
17.9
27.8
14.6
18.9
51.5
84.8
10.4
50.9
6.8
22.5
26.9
47.2
Stress
92.2
87.9
33.5
63.3
41.4
35.6
85.5
96.1
17.5
60.0
23.9
49.5
49.0
65.4
Extra salt
48.9
49.0
32.9
54.1
30.8
56.1
78.1
88.2
16.3
52.3
23.5
49.6
38.4
58.2
Excessive
coffee
37.2
44.2
20.2
35.3
21.6
33.3
16.0
69.4
13.1
43.4
18.7
42.1
16.4
44.6
Animal fat
67.9
79.4
26.5
40.8
11.2
12.3
54.4
65.5
16.6
31.7
22.2
41.4
33.1
45.2
Polluted water
26.2
36.5
18.4
28.3
19.9
42.1
24.1
40.0
31.7
70.2
5.8
15.6
21.0
39.7
Receiving
blood
25.5
36.2
25.1
40.2
21.6
40.5
16.8
33.0
37.3
57.1
24.5
27.9
25.1
39.1
Physical
inactivity
87.3
71.8
25.1
40.5
24.9
40.2
64.2
55.2
20.1
39.7
23.9
31.5
40.9
46.5
Average
knowledge
59.7
62.1
32.8
47.1
30.6
35.1
49.3
65.7
19.2
51.4
19.9
36.3
35.3
49.6
To find out how far these university level differences in health knowledge were
significant, ‘Student’s t-test’ was applied.
Table2) University Level Differences in Health Knowledge
Awareness
of risk
factors for
illness
Mazandaran University
Panjab University
TN
Mean
value
Std.
Deviation
N
Mean
value
1.7907
90
5.27
4.98
Std.
Deviation
value
df
1.8904
.364
284
.716
5.59
255
.000
.010
Sig.
Heart disease
196
5.36
Lung cancer
180
3.06
2.4118
77
Breast cancer
170
2.75
1.5416
71
3.36
1.7091
2.61
239
High blood
pressure
178
4.42
1.8374
75
5.73
1.7268
5.25
251
.000
Hepatitis
175
1.81
2.2871
75
5.09
3.0632
8.32
248
.000
Tuberculosis
178
1.92
1.9223
78
3.51
2.4428
5.08
254
.000
Total
Health
Knowledge
156
20.0
9.2676
68
28.8
9.9079
6.24
222
.000
15
2.7553
Results of t-test show that students of PU compared to students of MU were more
aware of risk factors related to lung cancer, breast cancer, high blood pressure,
hepatitis, and tuberculosis. The only non-significant difference was observed in case of
heart disease. Overall, the mean values of MU and PU students on the total health
knowledge indicates that PU students had more knowledge of risk factors for all the six
diseases listed in table as compared to MU students (Figure 1).
4-1-2) Gender Differences in Health Knowledge
Table 3) Gender Distribution of Respondents’ Health Knowledge (Percentage of correct answers)
Diseases
Lung
Breast
cancer
cancer
Average
High blood
pressure
Hepatitis
Knowledge
TB
Men
Women
Men
Women
Men
Women
Men
Women
Men
Women
Men
Women
Men
Women
Risk
Factors
Heart
disease
Smoking
84.3
86.7
93.4
95.9
57.9
44.4
54.5
57.1
26.8
23.8
32.0
40.4
58.1
58.0
Alcohol
consumption
59.4
76.7
28.2
15.6
13.0
18.7
64.1
66.0
24.5
22.4
7.5
16.1
32.8
35.9
Stress
87.4
93.1
46.9
40.3
52.9
66.4
91.7
88.3
32.9
29.4
35.0
29.7
57.8
57.9
Extra salt
43.6
54.9
43.4
36.8
42.7
35.8
76.3
88.7
31.3
25.3
36.6
28.4
45.7
45.0
Excessive
coffee
36.8
43.2
29.6
21.5
30.6
20.4
36.9
43.2
23.4
23.9
26.9
26.7
30.7
29.8
Animal fat
68.8
77.2
33.5
29.7
9.0
14.2
58.0
59.6
26.1
17.7
33.9
23.2
38.2
36.9
Polluted water
30.0
29.8
24.6
19.3
28.4
16.0
26.9
32.1
42.8
52.2
11.9
7.1
27.9
26.1
Receiving
blood
30.7
21.8
33.3
27.7
29.3
27.2
21.7
23.2
40.0
51.1
27.4
24.1
30.4
29.2
Physical
inactivity
80.7
81.0
34.5
26.8
33.1
27.1
65.4
55.5
25.3
28.7
28.8
24.7
44.6
40.7
Average
Knowledge
57.9
62.7
40.8
34.8
33.0
31.1
55.1
57.1
30.3
30.5
26.6
24.5
40.6
40.2
A number of gender differences were found in relation to; alcohol consumption
and adding extra salt to meals for heart disease (59.4% and 43.6% men as against 76.7%
and 54.9% women respectively); smoking and animal fat for breast cancer (57.9% and
9.0% men as against 44.4% and 14.2% women respectively); adding extra salt to meal
and physical inactivity for high blood pressure (76.3% and 65.4% men as against 88.7%
and 55.5% women respectively); consumption of polluted water and receiving blood for
16
hepatitis (42.8% and
nd 40.0% men
m
as against 52.2% and 51.1% wom
women respectively);
and finally smoking and alcohol
alco
consumption for tuberculosis (32.0%
.0% and 7.5% men as
against 40.4% and 16.1%
% women respectively). Overall, women were
w
more aware of
risk factors involved in hea
eart disease and high blood pressure than
th
men, while men
were more aware of risk fa
factors involved in lung cancer, breast cancer,
ca
hepatitis, and
tuberculosis.
erences in Health Knowledge (Awareness of risk factors for diseases)
Table 4) Gender Differe
Awareness
of risk
factors for
illness
Men
Women
N
Mean
M
v
value
Deviation
Heart disease
145
5
5.05
Lung cancer
130
3
3.95
Breast cancer
126
High blood
pressure
T
T-
N
Mean
value
Deviation
1.7511
141
5.62
1.8499
2.6468
127
3.32
2.6544
3
3.08
1.6877
115
2.76
126
4
4.69
1.6794
127
Hepatitis
126
2
2.84
2.7744
Tuberculosis
128
2
2.47
Total
Health
Knowledge
116
2
22.75
Std.
Std.
Val
alue
N
Sig.
2.67
2.6
284
.008
1.90
1.9
255
.057
1.5179
1.55
1.5
239
.122
4.92
2.0938
.966
.96
251
.335
124
2.75
3.1303
.265
.26
248
.791
2.1662
128
2.34
2.2673
.479
.47
254
.632
9.5094
108
22.86
11.0178
.075
.07
222
.941
However, the apparent ge
gender differences in knowledge of disea
ease inducing factors
were statistically non-signifi
nificant (see table 4). Gendered awareness
ess of risk factors was
significant only for heartt d
disease. Thus, women students were
e more
m
aware of risk
factors involved in heart dis
isease as compared to men students.
Figure 1)) Gender and National Differences
in Health Knowledge
30
Mean value
25
20
15
10
5
0
MU
PU
Men
17
Women
Overall, it is clear that there were no significant differences between men and
women students as regards their knowledge of risk factors in the selected diseases, as
evident from t-value (.075) not significant even at 0.05 level (Figure 1).
4-1-3) Links between Health Knowledge and Health Behavior
An effort was also made to find out the linkages between health knowledge and health
related behaviors of individuals on selected diseases. The data in table 5 shows nonsignificant relationship between health knowledge and health behaviors of respondents.
Table 5) Association between Health Knowledge and Health Related Behaviors
Mean
Knowledge
about
Physical
activity
Smoking
Alcohol
Consumption
Excessive
coffee
Extra salt
Extra
Animal fat
Frequency of Health-related Behaviors
No
exercise
2.63٭
Less active
Nonsmoker
Light
smoker
3.31
Nondrinker
3.26
Light
drinker
1.95
1-3 cups
3.75
Always
2.23
Always
2.50
1.90
Moderately
active
2.70
Highly
active
Moderate
smoker
3.40
2.64
Strong
Smoker
2.75
Moderate
drinker
1.80
Heavy
drinker
2.16
1.72
Less than
Rarely
one cup
2.20
1.59
Mostly Sometimes
Rarely
2.45
2.52
2.57
Mostly Sometimes
Rarely
2.61
2.26
1.91
Never
1.69
Never
3.18
Never
2.33
F
N
Sig.
2.39
296
.068
.359
317
.783
.315
293
.814
289
.122
1.41
298
.228
1.67
294
.156
1.95
٭Mean values of health knowledge about relationship between physical activity and some diseases
For example, there were no significant differences between the knowledge of smoking
as a contributory factor in lung cancer and its influence in making a person give up
smoking. In other words, there were no significant differences between smokers and
non-smokers in terms of knowledge of harmful effects of smoking. Similarly, drinking or
non-drinking was not significantly associated with awareness of the influence of alcohol
on illness. It is interesting to note that heavy drinkers were more aware of alcohol
hazards (mean knowledge=2.16) than non-drinkers (1.95), though the F-ratio was not
significant. This suggests that drinkers are more aware of the possible harmful
consequences of alcohol than non-drinkers, and that knowledge did not function as a
deterrent. The same association holds for every item concerning adding salt to meals,
consumption of extra fat, frequency of drinking excessive coffee, and physical activity.
18
4-1-4) Factors Associated with Health Knowledge
Table 6) Factors Associated with Health Knowledge in the Overall Sample
Associated
Factors
Mean Values of Health Knowledge in Different
Categories
F
N
Sig.
University
Mazandaran University ٭
20.2
Panjab University
28.8
39.0
223
.000
Level of
education
Undergraduate students
21.5
Postgraduate students
26.6
10.9
223
.001
Type of
residence
Far away from family
25.2
Staying with family
21.8
5.25
215
.023
Urban
Rural 19.7
5.48
222
.020
31.2
6.28
208
.000
10.2
211
.000
13.4
210
.000
Nativity
SES
Father’s
education
Mother’s
education
Low
17.3
23.7
Medium
22.4
High
Less than
middle school
Middle & high
school
Graduate &
postgraduate
12.0
21.5
25.6
Less than
middle school
14.2
Middle & high
school
Graduate &
postgraduate
26.5
22.2
٭Mean values of health knowledge rated by each category of students
As can be seen from table 6, there exists a significant association between the level of
health knowledge and the university of respondents, level of education, type of
residence, nativity, subject of study, father’s education, mother’s education, and SES of
respondent’s family.
4-2) Health Beliefs
4-2-1) University Level Differences in Health Beliefs
University-wise data reveals that
55.7 % students of MU as against 54.8%
students of PU gave high importance to health maintenance behaviors. Three health
related behaviors which have been assigned the highest importance for maintenance of
health were regular brushing of teeth (91.1%), abstaining from smoking (81.9%), and
eating fruit (79.0%). The three behaviors, which were given least importance, were
annual dental check-up (49.7%), eating fish and poultry (42.8%), and annual check up
for blood pressure (41.6%).
19
Table 7) Distribution of Health Beliefs among the Students of
Mazandaran University and Panjab University
Level of Health Beliefs (Given importance of
behaviors for health maintenance)
List of Behaviors
Mazandaran University (%)
Panjab University (%)
Low
Medium
High
Low
Medium
High
Brush teeth regularly
0.8
13.7
85.6
----
2.9
97.1
Annual dental checkup
19.8
23.7
56.5
22.6
35.1
42.3
Regular physical exercise
9.7
17.4
73.0
9.7
25.3
64.7
7-8 hours sleep daily
3.1
20.6
76.3
4.6
13.9
81.5
Eating breakfast every day
8.9
17.4
73.6
4.7
13.1
82.2
Eating green vegetables
6.8
21.3
71.9
2.9
10.9
86.2
Eating fruit
2.3
19.5
78.2
2.5
17.6
79.9
Eating milk & dairy products
8.4
18.6
73.0
5.1
18.6
76.3
Eating fish and poultry
6.1
30.4
63.5
54.5
26.0
19.6
Annual blood pressure checkup
31.0
22.0
47.0
42.5
21.9
35.6
Not to smoke
13.0
3.2
83.8
16.3
3.9
79.8
Drink no alcohol
12.0
11.5
76.5
15.0
9.0
76.0
Avoid extra fat
16.7
28.7
54.6
19.9
14.3
65.8
Avoid excess salt
15.8
23.6
60.6
16.3
27.9
55.8
Avoid excess coffee
21.4
23.0
55.6
18.3
26.4
55.3
Avoid excess sugar
18.6
26.7
54.7
14.9
23.4
61.7
Mean
12.1
32.2
55.7
15.6
29.6
54.8
The university-wise data reveals some variations. Students of MU gave the highest
importance to regular brushing of teeth, non-smoking and eating fruit, while the students
of PU believed that regular brushing of teeth ,eating green vegetables, and having
breakfast regularly were the three most important behaviors, respectively. On the other
hand, students of MU gave the least importance to avoiding too much sugar, avoiding
extra fat and annual check up for blood pressure, whereas annual dental checkup,
annual blood pressure checkup, and eating fish and poultry were believed to be the
least important behaviors for maintenance of health by students of PU. The average
20
ratings given by students of MU and PU about the importance of different behaviors for
health are shown in table 8, which are ranked according to their aggregate means.
Table 8) University Level Differences in Health Beliefs
Mazandaran University
(MU)
Panjab University
(PU)
Tvalue
df
Sig.
.4903
6.13
455
.000
4.24
1.4310
.538
478
.591
239
4.31
.8497
1.52
499
.127
.9629
239
4.39
.8427
4.61
500
.000
4.14
.8895
238
4.27
.9133
1.64
498
.102
251
4.20
1.2628
233
4.14
1.3901
.510
482
.610
Eating breakfast daily
258
4.03
1.0204
236
4.29
.8964
2.92
492
.004
Eating milk& dairy
products
263
4.07
.9855
236
4.21
.9763
1.59
497
.112
Regular exercise
259
4.05
1.0806
238
3.86
1.0613
1.91
495
.056
Avoid extra fat
258
3.59
1.1540
231
3.78
1.4252
1.63
487
.103
Avoid excess salt
259
3.68
1.1846
233
3.66
1.2869
.202
490
.840
Avoid excess sugar
258
3.56
1.2083
235
3.77
1.2885
1.85
491
.064
Avoid excess coffee
252
3.52
1.2732
235
3.62
1.2931
.838
485
.403
Annual dental check up
262
3.55
1.2545
239
3.29
1.1979
2.37
499
.018
Eating fish& poultry
263
3.84
.9543
235
2.37
1.2798
14.3
430
.000
Annual blood pressure
check up
255
3.19
1.3313
233
2.87
1.4453
2.51
486
.012
Total Health Beliefs
221
63.3
10.69.8
208
62.2
10.0073
1.07
427
.281
List of Behaviors
N
Mean
value
Std.
deviation
Brush teeth regularly
263
4.41
Not to smoke
247
Eating fruit
N
Mean
value
Std.
deviation
.7516
240
4.76
4.31
1.3020
233
262
4.20
.8448
Eating green
vegetables
263
4.01
7-8 hours sleep daily
262
Drink no alcohol
Significant university level differences were found for six items listed in table, of which
for three items (annual dental checkup, annual checkup for blood pressure, and eating
fish& poultry) students of MU had higher mean values than students of PU; whereas for
three other items, namely eating breakfast every day, eating fruit, and eating green
vegetables, students of PU scored higher mean values as compared to their
counterparts in MU. Also, there were no significant differences for the remaining ten
21
items. However, there were no significant university level differences (T-value= 1.07)
when all the health beliefs were taken together, though the mean values of MU students
were higher (63.3) than that of PU students (62.2).
4-2-2) Gender Differences in Health Beliefs
The data on gender differences in health beliefs shows that on the whole 64.6% men
as against 69.3% women students gave high importance for health related behaviors
listed in table 9. This indicates a higher level of importance given by women to health
related behaviors for maintenance of health as compared to their men counterparts.
Table 9) Gender Distribution of respondents’ health beliefs
Level of Health Beliefs
Men (%)
List of behaviors
Women (%)
Low
Medium
High
Low
Medium
High
Brush teeth regularly
0.8
6.6
92.6
----
10.4
89.6
Annual dental checkup
25.2
31.4
43.4
17.4
27.0
55.6
Regular physical exercise
7.4
19.3
73.3
11.8
23.2
65.0
7-8 hours sleep daily
4.1
19.0
76.9
3.5
15.9
80.6
Eating breakfast every day
3.8
15.1
81.1
9.8
15.6
74.6
Eating green vegetables
5.3
18.1
76.5
4.6
14.7
80.7
Eating fruit
2.9
21.0
76.1
1.9
16.3
81.8
Eating milk & dairy products
4.9
20.2
74.9
8.6
17.2
74.2
Eating fish and poultry
27.5
30.8
41.7
30.2
26.0
43.8
Annual blood pressure checkup
40.6
22.6
36.8
32.5
21.3
46.2
Not to smoke
12.6
3.8
83.7
16.3
3.3
80.1
Drink no alcohol
14.2
14.6
71.3
12.7
6.1
81.1
Avoid extra fat
19.0
25.7
55.3
17.5
18.3
64.3
Avoid too much salt
18.3
32.8
49.0
13.9
18.7
67.3
Avoid excessive coffee
20.4
29.6
50.0
19.4
19.8
60.7
Avoid too much sugar
16.6
31.1
52.3
17.1
19.4
63.5
Total health beliefs
14.1
21.3
64.6
13.6
17.1
69.3
Gender wise data reveals some variations. Overall, women have paid more attention
to eating fruit and avoiding alcohol for health maintenance while men have given more
importance to non smoking and having breakfast regularly in this regard. Both men and
22
women considered brushing teeth regularly as the most important behavior for
maintenance of health.
Table 10) Gender Differences in Health Beliefs
Men
.6530
260
Annual dental checkup
242
3.26
1.2367
259
Regular exercise
243
4.08
1.0171
254
7-8 hours sleep daily
242
4.14
.9228
258
Eating breakfast daily
238
4.27
.8561
256
Eating green vegetables
243
4.13
.9086
259
Eating fruit
243
4.18
.8640
258
Eating milk & dairy
products
243
4.17
.9332
256
Eating fish and poultry
240
3.15
1.3182
258
Annual blood pressure
checkup
239
2.85
1.3377
249
Not to smoke
239
4.33
1.2695
241
Drink no alcohol
240
4.05
1.3418
244
Avoid extra fat
237
3.57
1.2719
252
Avoid too much salt
241
3.48
1.2352
251
Avoid excessive coffee
240
3.45
1.2264
247
Avoid too much sugar
241
3.56
1.2203
252
Total health beliefs
219
61.21
9.8262
210
4.58
Standard
Deviation
Number
4.58
Mean
Value
Standard
Deviation
243
Number
Brush teeth regularly
Behaviors
Mean
Value
List of
Women
.6725
N
Sig.
.074
501
.941
TValue
3.58
1.2117
2.98
499
.003
3.85
1.1169
2.37
495
.018
4.27
.8800
1.62
498
.105
4.05
1.0560
2.60
492
.009
4.25
.9394
1.53
500
.125
4.32
.8291
1.85
499
.064
4.11
1.0284
.676
497
.499
3.15
1.3568
.025
496
.980
3.22
1.4255
2.99
486
.003
4.21
1.4539
.955
478
.340
4.29
1.2995
1.97
482
.049
3.81
1.3043
1.98
487
.048
3.85
1.2059
3.33
490
.001
3.68
1.3273
1.98
485
.048
3.85
1.2720
1.99
491
.046
64.31
10.6976
3.13
427
.002
The data in table 10 shows that on the whole, the highest mean values were for
brushing teeth regularly, followed by non smoking, and eating fruit; while the lowest
mean values were for annual dental check up, followed by eating fish and poultry, and
annual blood pressure checkup. However, significant gender differences were found for
nine items listed in the table, of which for seven items (annual dental checkup, annual
23
blood pressure checkup,, n
non-drinking alcohol, avoidance of anim
imal fat; excess salt;
coffee, and sugar) women
en had higher mean values than men.. In two items that is,
regular exercise and havin
ving breakfast men students scored high
gher mean values as
compared to women stude
dents. There were no significant gender
er differences for the
remaining seven. It implies
es that in general, women students gave
e more importance to
health maintenance behavio
viors than men. It can be inferred from the
he above analysis that
by and large men and wome
men students differ on their ‘health beliefs’
fs’ (Figure 2).
Figure 2)
2 Gender and National Differences
in Health Beliefs
70
Mean value
60
50
40
30
20
10
0
MU
PU
Men
Women
4-2-3) Links between Heal
ealth Beliefs and Health Behaviors
In the present study, the q
question of whether variations in the prevalence
pr
of healthrelated behaviors were ass
ssociated with the level of beliefs aboutt iimportance of those
behaviors for health main
intenance was analysed. Similar to prev
revious studies, clear
associations were observed
ed for almost all items included in this study
udy.
As can be seen from the table,
ta
for all items (except avoidance of excessive coffee) a
significant association could
uld be seen between the frequency or inte
tensity of carrying out
the behavior and the mean
an values of the associated belief. For example,
ex
people who
brush their teeth twice or more
m
times daily believe (mean value was
as 4.74) this behavior
to be more important than
n those who brush their teeth once a day
ay (4.56), who in turn
believe it to be more impo
portant than those who brush their teeth
h less frequently than
once per day (3.88). F-ratio
tio for this association comes out to be sig
significant at .01 level
of confidence (F = 13.0,, N = 500, P <. 01). It implies that there
th
exist significant
24
differences in belief rankings according to frequency of brushing teeth, indicating strong
influence of health beliefs on healthy behavior on this item.
Table 11) Association between Health Beliefs and Health-related Behaviors
Mean Health
Beliefs about
Frequency of Health-related Behaviors
2 times or
more a
day
4.74٭
Always
Once a
day
Once a
week
Rarely or
never
4.56
Once per
every 2-3
days
3.88
4.00
4.12
Mostly
Sometimes
Rarely
Never
4.53
4.24
3.82
3.27
3.65
Once a
day or
more
4.52
Once a
day or
more
4.43
Once a
day or
more
4.37
Regularly
Every 2-3
days
About once
a week
Rarely or
never
3.99
Every 2-3
days
3.90
About once
a week
4.05
Every 2-3
days
4.07
About once
a week
4.16
Mostly
4.08
Sometimes
About
once a
month
3.57
About
once a
month
3.71
About
once a
month
3.84
Rarely
3.37
3.92
3.68
3.38
2.62
Always
3.81
Mostly
3.50
Sometimes
3.66
Rarely
3.88
Never
3.31
Always
Mostly
Sometimes
Rarely
Never
3.35
Always
3.13
Mostly
3.56
Sometimes
3.85
Rarely
3.84
Never
Avoid too much
sugar
3.21
3.47
3.31
3.87
4.01
More than
3 cups
2.33
1-3
Cups
3.30
Less than
one cup
3.37
Rarely
Never
Avoid excessive
coffee
3.57
3.60
Brush teeth
regularly
Eating breakfast
daily
Eating green
vegetables
Eating fruit
Eating milk & dairy
products
Annual blood
pressure checkup
Avoid extra fat
Avoid too much salt
Drink no alcohol
Not to smoke
4.40
Rarely or
never
N
Sig.
13.0
500
.000
2.91
483
.000
15.2
4.28
Heavy
drinker
3.08
Heavy
smoker
4.16
Moderately
active
4.25
Moderate
drinker
3.14
Moderate
smoker
3.16
Less
active
3.89
Light drinker
497
.000
6.98
497
.000
10.3
494
.000
14.1
465
.000
2.47
470
.043
3.55
Never
4.59
Highly active
Physical exercise
3.60
Rarely or
never
F
3.27
Light smoker
No
exercise
3.63
Nondrinker
4.33
Non-smoker
3.68
4.31
7.39
.988
482
483
472
.001
.000
.414
13.2
496
.000
14.4
465
.000
3.03
468
.029
٭Mean values of health beliefs about the importance of brushing teeth regularly for health.
The same association holds for every item concerning having breakfast, regular
exercise, eating green vegetables, fruit, milk & dairy products, annual blood pressure
check up, non smoking, non drinking, avoiding extra fat, salt, and sugar. On the whole,
25
there was a significant association between total health beliefs and health-related
behaviors that is behaviors that were believed to be more important for health
maintenance, carried out by more individuals than behaviors which were believed to be
less important. In other words, those who scored higher on health belief values
positively practiced better health behaviors.
The findings of present study are in line
with those studies conducted by Wardle and Steptoe, 1991; Calnan and Rutter (1988);
Steptoe and Wardle (1992); Courtenay (2002); Cody and Lee (1982); Osaka et al.
(1999); Steptoe et al. (2002); Kurtz et al. (1992); Callaghan (1995); Gorin (1992);
Harnack et al. (1997); and Monneuse et al. (1997).
4-2-4) Factors Associated with Health Beliefs
As can be seen from table, there is significant association between level of health
beliefs with gender, nativity, health behaviors of family, health locus of control, and
health concern. The data shows that health beliefs were higher among women students
and students who were residents of urban areas. Also it was higher for those whose
families observed higher level of positive lifestyle, students who enjoyed a good sense
of control, and those who were more concerned about their health status.
Table 12) Factors Associated with Health Beliefs in the Overall Sample
Associated
Factors
Mean values of health beliefs in different categories
Gender
Men
Nativity
Health locus
of control
Health
concern
Health
behaviors of
family
61.2٭
Urban 63.5
Slightly internal
57.0
Low
59.3
N
Sig.
Women
64.3
9.81
428
.002
Rural
60.4
6.85
422
.009
3.10
399
.046
3.21
422
.023
4.60
371
.001
Moderately internal
62.4
Medium
60.7
F
Strongly internal
63.6
High
63.6
Very high
64.3
Very low
Low
Medium
High
Very high
58.5
61.0
63.4
66.3
65.1
٭Mean values of health beliefs rated by each category of students
5) Discussion
On the basis of the above analysis, it was found that differences in health
knowledge of PU and MU students were quite significant; while the differences in health
beliefs were non significant. In other words, awareness of students of PU and MU about
26
the various health related risk factors was different. It was generally observed that
students of PU were more aware of risk factors involved in certain diseases than the
students of MU. However, in terms of health beliefs, students of MU and PU gave
almost the same importance to health maintenance behaviors. However, significant
differences existed in some items, namely students of PU compared with students of
MU gave more importance to regular brushing of teeth, eating breakfast daily, and
eating green vegetables; while students of MU gave more importance to annual dental
check up, eating fish and poultry, and annual blood pressure check up.
Further, in line with previous studies no significant gender differences in health
knowledge could be observed. In other words, awareness of men and women students
about some risk factors for illness was similar, except about heart disease about which
women students showed more awareness of risk factors for heart disease than men
students. In relation to health beliefs, men students differed significantly from women
who gave more importance to behaviors such as annual dental checkups, annual blood
pressure measurement, avoiding alcohol; animal fat; excess salt; coffee; and sugar as
health enhancing measures. On the other hand, men students believed regular exercise
and eating breakfast daily as more important for their health maintenance. Also, in line
with previous studies association between health knowledge and health related
behaviors was found to be weak and non significant; while a very strong and significant
association between health beliefs and health related behaviors was observed. It
implies that health knowledge does not lead necessarily to risk reducing or healthenhancing behaviors, while health beliefs, to a large extent, improve the health related
behaviors. Finally, it was found that there exist significant associations between health
knowledge and some factors such as, being a student of PU, being postgraduate
students, living in urban areas, living far away from family, having more educated father
and mother, and belonging to higher SES families. Further, some other factors such as
being a woman, living in urban areas, belonging to more healthy families, enjoying a
good sense of control, and being more concerned about personal health were
associated with higher level of health beliefs.
The results in the present study are in line with those reported by Wardle and
Steptoe (1991); Kurtz et al., (1992), Kapoor et al., (1995); and Avis et al., (1996). All
these studies confirmed that both smokers and nonsmokers were well informed about
27
the adverse effects of smoking indicating that mere provision of information on hazards
of smoking may not be enough to reduce the prevalence of smoking. These findings are
also supported by other studies such as those of Kurtz et al., (1992); Naslund and
Fredrikson (1993); Frost (1992); Avis et al., (1990); and Jerkegren et al., (1999). All
these studies indicate a weak and non-significant relationship between health
knowledge and health behaviors, suggesting that health knowledge does not
necessarily lead to risk reducing behaviors.
These findings are consistent with previous studies about gender differences on
health beliefs. For example, Steptoe and Wardle (1992) found that gender differences in
belief ratings were uniform across eight European countries, for instance, in all these
countries; women rated fat avoidance and moderation in alcohol consumption as more
important than men. Similarly Courtney et al. (2002) who conducted a study on
gender/ethnic differences on health beliefs and behaviors found that men students had
significantly riskier beliefs in diet, substance use, medical compliance, and preventive
care than women students. Also, Cody and Lee (1989) found that women scored
significantly higher than men on skin protection knowledge, intension, and behavior.
In the light of the results of this study and also those of other studies, association
between health knowledge and health related behavior is inconsistent and non
significant, while health beliefs have significant and consistent association with health
behaviors of students. This finding strongly suggests that, although knowledge remains
an important factor that must be addressed in health education programmes, in order to
motivate young college students to take appropriate prevention measures when
exposed to unhealthy behaviors, educational efforts must focus primarily on the
formation of attitudes and beliefs towards health related behaviors. Prevention
approaches based on social learning theory have emphasized developing social and
personal skills in youth and young adults to enable them to resist pro-drug and
unhealthy environmental and peer pressures. Therefore, educational efforts directed
toward young college/university students should include strategies that help reduce the
influence of the peer group. Further, all health interventions by the authorities have to
adopt multi-pronged strategies to improve health knowledge, health beliefs, health
concern, and health related behaviors.
28
However, further studies are needed for monitoring progress in enhancing health
knowledge & beliefs, reducing critical health risk behaviors, or improvement in positive
health habits among young students. The periodic research studies in this area and at
the cross-national levels would be necessary to establish priority areas for future
interventions and to monitor their effects. Further, a national study among the university
students of each country on a larger scale, with the cooperation of all institutions for
higher education could make a significant contribution to the literature and the future
health of college/university students in Iran and India. Further studies, of course, can be
conducted on other socio-economic groups of society to compare the results with the
university students and finding out the place of students in health hierarchy. Finally, in
order to clarify which factors best explain cross-national differentials observed in health
related behaviors, future research needs to go beyond the set of determinants available
for the current study and strike into the more subtle aspects of health related behaviors
across settings.
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