Health Behaviours and Educational Outcomes among Australian University Students

Abstract

Young people may encounter several challenges when transitioning to higher education. Failure to navigate this transition successfully may contribute to the development of poor health behaviours, which in turn can impact university students’ current, and future, health and educational success.

There is a growing body of literature examining relationships between selected health behaviours and educational outcomes (EO) in university students. However, understanding of these relationships is in its infancy, and there are gaps in the existing literature that limit this understanding. These gaps include a lack of knowledge about how health behaviours change over time and during and over academic years, a lack of consideration of confounding factors in analyses, and little attention devoted to qualitative investigations in this area. Other shortcomings of relevant work include lack of consideration of EO other than grade point average (GPA; e.g., graduation rate) and several major methodological issues (e.g., using self-reports measures). To date, no study has examined the relationships between health behaviours and EO qualitatively and few studies have been conducted within the Australian higher education context.

This thesis has been informed by a conceptual framework developed by the World Health Organisation (WHO) that describes the potential causal relationships between health behaviours and EO. Guided by this framework, the overarching aim of this thesis was to explore (a) the relationships between health behaviours and EO, and (b) perceptions of health behaviours and EO, among Australian undergraduate university students.

Study 1 (Chapter 3) involved a systematic review that aimed to synthesise the existing evidence from studies examining quantitative associations between physical activity (PA), sedentary behaviour (SB), and EO. The quality of included studies was assessed and data were synthesised using an approach considering the consistency and strength of reported associations. Among 35 included studies, most were rated as poor quality (63%) and used self-report measures of PA and SB (97%) and EO (68%). Findings indicated mixed results for the associations between PA, SB, and EO, with grades/GPA being the only EO examined.

Studies 2 and 3 (Chapters 4 and 5) aimed to explore cross-sectional and longitudinal associations between PA, SB and EO (Study 2), and dietary intake, alcohol consumption and EO (Study 3), respectively, in first-year Australian university students. Participants (n=80) took part in three data collection points (semesters 1- 3) that included self-reported and device-based PA and SB, and self-reported dietary patterns and intake. Objective EO variables (corresponding semester GPA, overall GPA, graduation status) were extracted from academic records. Multivariate analyses of Study 2 demonstrated that self-reported SB was negatively associated with semester GPA at time point three (β = -0.224, 95%CI: -0.446 ‒ -0.001). Study 3 findings showed a positive association between serves of vegetables and semester GPA at time point two (β = 0.26, 95% CI: 0.034 ‒ 0.481) and over time (β = 0.116, 95% CI: 1.001 ‒ 1.260).

Study 4 (Chapter 6) used a qualitative approach incorporating semi-structured focus groups to explore university students’ perceptions about (1) factors that influence their health behaviours and (2) the relationships between health behaviours and EO. Twelve focus groups were conducted with 37 students, and data were initially analysed using an inductive thematic approach, followed by a deductive approach that involved mapping themes on the abovementioned WHO framework. Research question one findings identified several themes that influence students’ health behaviours at the micro (knowledge and skills; personal attributes; socio-demographic characteristics; time), meso (geographic location; university; social influences), and macro (COVID-19 related policies and restrictions) levels. Research question two findings identified two themes. The first theme related to relationships between health behaviours and short-term EO, where students described links between health behaviours and overall grades and other indicators of academic performance. The second theme related to factors perceived to mediate the relationships between health behaviours and EO, with students describing both positive and negative influences of health behaviours on attendance and concentration, motivation to study, and quality of study.

Overall, informed by a framework situated within an educational context, this thesis contributes towards a better understanding of the relationships between university students’ health behaviours and EO. The unique contributions of this thesis to the existing body of knowledge include examining longitudinal associations, considering a wide range of potential confounding factors and EO indicators, and incorporating qualitative student perspectives of the relationships of interest. The thesis’ findings highlight that some health behaviours (i.e., sleep, SB and healthy eating) may be more important than others when examining associations with EO, and that addressing potential confounding factors is important for accurately understanding relevant associations. Further, findings point to the importance of timely interventions to support students' health behaviours to optimise both health outcomes and EO, which may benefit from tailored multi-level strategies, targeting multiple health behaviours (as health behaviours are interrelated), and addressing modifiable barriers common across health behaviours (e.g., improving time management skills).