Table of Contents  
Year : 2018  |  Volume : 1  |  Issue : 1  |  Page : 22-25

On-campus promoting health literacy and behavior in adolescent athletes: A pilot study

Department of Pediatrics, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan

Date of Web Publication24-Jul-2018

Correspondence Address:
Dr. Meng-Che Tsai
Department of Pediatrics, Division of Genetics, Endocrinology, and Metabolism, College of Medicine, National Cheng-Kung University Hospital, National Cheng Kung University, 138 Sheng-Li Road, Tainan 704
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/SHB.SHB_11_18

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Introduction: Little is known about the profile of health-promoting behaviors in Taiwanese adolescent athletes. We codesigned a school-based extracurricular club with the adolescent athletes and aimed to examine the effect of program on the health-promoting behaviors among the participants. Methods: We recruited a sample of 40 athlete students: 20 participants from the health promotion club (intervention group) and 20 comparisons from other extracurricular clubs (control group). The content of health promotion program contained a wide array of health issues, such as growth, nutrition, sport injury, and life resuscitation. Certified physicians and physiotherapists provided lectures, workshops of experimentation, and forums of group discussion. We compared the health-promoting behaviors based on the Adolescent Health Promotion (AHP) scale before and after the program and between the intervention and control groups. Results: Athlete students scored higher in exercise (20.9 ± 3.6 vs. 16.3 ± 3.7, P < 0.01) but lower in nutrition (19.7 ± 3.4 vs. 22.1 ± 3.9, P < 0.01) among the AHP scale items than general students referenced in the literature. Athletes who participated in health promotion club showed improvement in AHP scores, particularly in the domain of health responsibility that was persistent up to 6 months after the intervention. Conclusion: We identified a general lack of healthy nutrition practices in these athlete youth. After 20 weeks' training, the participants adopted healthier behaviors that persisted even longer. Further research of larger participation is needed to evaluate the effectiveness of the scheme.

Keywords: Adolescent, athlete, health behavior, health literacy, health promotion

How to cite this article:
Tsai MC. On-campus promoting health literacy and behavior in adolescent athletes: A pilot study. Soc Health Behav 2018;1:22-5

How to cite this URL:
Tsai MC. On-campus promoting health literacy and behavior in adolescent athletes: A pilot study. Soc Health Behav [serial online] 2018 [cited 2023 Oct 1];1:22-5. Available from:

  Introduction Top

Healthy lifestyles during adolescence contribute greatly to lifelong health and well-being. Engagement in regular physical activities reduces the risk for obesity, cardiovascular diseases, emotional distress, and osteoporosis.[1] Unlike general students, athlete students receive extraordinary intense training in the daily life. They are physically healthier than sedentary individuals but prone to sports injuries and relevant psychopathological consequences.[2] Higher demand for nutritional support and mental toughness against stress are also required for multiple competitions.[3],[4] However, they share many developmental and behavioral risks with other teenagers. The unhealthy practices, such as binge eating, illicit drug abuse, or violent behaviors, are likely to be overlooked by parents or coaches and subsequently hinge their health.[5] Over the last decade, public health institutions have shift emphasis on passive prevention of disease to active promotion of health in adolescent health care.[6] Cultivating healthy lifestyles and enhancing self-care ability empower adolescents to safely navigate the transition into the adulthood. This pilot study aimed to investigate the health behaviors of adolescent athletes and evaluate the effectiveness of extracurricular health-promoting activities.

  Methods Top


This pilot study was a quasi-experiment taking place in a private senior high school of approximately 5000 students in Tainan city. Taiwanese senior high school students are required to participate 2 h every week in extracurricular clubs of their interest, such as chess playing, street dancing, and roller skating. To promote adolescent health, we developed a school-based model containing a series of educational speeches, counseling services, and integrated extracurricular activities. As a part of participatory action research (PAR), we created a health promotion club in cooperation with school authorities. Its main purpose was to enhance participants' health literacy and self-efficacy. Participants included athlete students specifically trained for competitive sports at least for 3 years. The intervention group consisted of 20 athlete students enrolling voluntarily in the club. For the comparison group, other 20 athlete students were recruited from the other extracurricular clubs. Selection of health issues was initiated by the students and focused on puberty, nutrition, reproductive health, and sports medicine. A 20-week educational program was subsequently developed according to their health interests, such as growth, nutrition, sport injury, and life resuscitation, and they were provided by certified physicians and physiotherapists. The contents of the program were diverse, including lectures (8 weeks), workshops of experimentation (8 weeks), and forums of group discussion (4 weeks). A 20-item questionnaire of health knowledge designed according to the provided courses was used to assess their learning in these activities. We scored their health knowledge based on the number of correct answers to the multiple-choice questions. At the end of the program, all the participants were requested to give their feedback on the course content and teacher performance, and program recommendability was assessed using a 5-point scale with a higher score representing better satisfaction. The participants and their parents were informed about the content of this study and gave their written consents. The entire procedure of study was approved by the Institutional Review Board of National Cheng Kung University Hospital.

Health-promoting behaviors

The Adolescent Health Promotion (AHP) scale that has been previously developed and validated in Taiwanese adolescent population was applied to assess the health-promoting behaviors in our sample of students.[7] The items contained in this scale are divided into six subdomains, which are (1) nutrition (eating three regular meals, selecting food without too much oil, including dietary fibers in meals, drinking at least 1500 ml of water, including five food groups in meals, and eating breakfast daily); (2) social support (expressing warmth and caring to others, concerning about and keeping in touch with others, smiling every day, discussing concerns with others, keeping in touch with relatives, maintaining good interpersonal relationship, and talking about troubles to others); (3) health responsibility (reading food labels at every purchase, observing bodily abnormality at least monthly, searching for health information, choosing foods without additives, discussing health concerns with health professionals, brushing teeth and using dental floss after meals, moderating body weight, and washing hands before meals); (4) life appreciation (feeling happy and content, feeling change in positive direction, liking himself, understanding and accepting his/her own strengths and weakness, believing in purposeful life, knowing the importance of life, feeling interesting and challenging every day, and auditing and correcting his/her own defects); (5) exercise (exercising rigorously 20–30 min at least 3 times per week, participating in activities of physical fitness every week, warming up before rigorous exercises, performing stretching daily, and standing or sitting straight); and (6) stress management (monitor emotional changes, determining sources of stressors, practicing relaxation every day, making schedules and setting priorities, and using appropriate responses to unreasonable issues). The scores on these items in this questionnaire were reported on a 5-point scale with a higher score representing a more positive health-promoting behavior.

Demographic variates

Demographic variables of the athletes were included in the initial assessment. The items included age, parent education levels, family bonding, health service utilization within 3 months, and perceived health status. Bonding with family was self-rated into three categories including “distant,” “neutral,” and “close,”[8] while perceived health status divided into “good,” “intermediate,” and “poor.”[6]

Statistical analysis

Effectiveness of the health promotion club, which included perceived health status, health knowledge, and health behaviors, took place at the pre- and post-intervention time points. The students in the intervention group were further invited to repeat the AHP scale and health knowledge test 6 months after the club. Initially, we compared the profile of health-promoting behaviors using unpaired Student's t-test between athlete students and general students, who were drawn from a subsample of male adolescents with a similar age range in a published study.[9] Further, comparison between the intervention and control groups was made with paired and unpaired Student's t-test, Mann–Whitney U-test, and Wilcoxon signed-rank test as appropriate.

All of the statistical analyses were conducted with SPSS 17.0 software (SPSS Inc., Chicago, IL, USA).

  Results Top

The demographic characteristics of participants are summarized in [Table 1]. The mean age of total athlete students was 16.5 years. They showed different health behaviors from that of general adolescents by higher scores in exercise but lower scores in nutrition among the AHP scale items [Table 2]. After participating in the health promotion club, the intervention group had significantly higher scores on health knowledge than that of the control group. However, the difference was not persistent up to 6 months [Figure 1]. Perception of health status and scores on the AHP scale were not significantly different between the two groups in the pre- and post-test. Noteworthy was that scores on the AHP scale in the intervention group remarkably increased 6 months later. Improvement of health responsibility, such as searching for health information and choosing foods without additives, was noted across intervention group and even pronounced 6 months later. Their healthy lifestyles related to social support, such as maintaining good interpersonal relationship and talking about troubles to others, were also reinforced 6 months later [Table 3]. All the students in the health promotion club were satisfied (mean score = 4.9 ± 0.31) with the course and strongly recommended to their schoolmates (mean score = 4.95 ± 0.22).
Table 1: Demographic data of participants (n=40)

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Table 2: Comparison of adolescent athletes and general students in terms of adolescent health promotion scale

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Figure 1: Comparison of intervention group and control group in terms of health knowledge scores

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Table 3: Comparison of intervention group and control group in terms of adolescent health promotion scale

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  Discussion Top

This is a preliminary study first investigating the profile of health-promoting behaviors among adolescent athlete students in Taiwan. Although limited by a small number of participants, our results clearly showed that athlete students differed in some aspects of health-promoting behaviors. Despite the nutrition planning required for the need of intensive training, a general lack of nutrition knowledge was recognized among these young athletes, let alone their information mostly derived from sources that are varied in reputability.[10] Correspondingly, our results further consolidated that their nutrition behaviors were less healthy and required attention and effort in promotion from different sectors of their health, such as parents, coaches, health-care providers, and school and/or national authorities.

The school-based participant-initiated health promotion program was well appreciated by the athlete students. This program addressed their needs in promoting health behaviors most relevant to their athlete status. Through these educational and instructive activities, participants gained better health knowledge and cultivated healthier behaviors. Although their health knowledge did not persistently remain after 6 months, changes in their health-promoting behaviors continued to be manifested. Our finding was limited in its applicability as this cohort was unisex. Health needs and behaviors are considerably different for male and female adolescents.[8],[9] Furthermore, self-reported health behaviors may be biased because of self-unawareness or social undesirability. Semester effect and other health information that were not controlled in this pilot study should be considered when addressing health behaviors among students. Further studies of larger participation and both gender over an extended period of time are strongly encouraged to evaluate the effectiveness of implementation.

  Conclusion Top

The pilot study identified a general lack of healthy nutrition practices in these athlete youth. Healthier behaviors could be reinforced via the co-development of structured courses. However, further research of larger participation is required to evaluate the effectiveness of the scheme.


This study was funded by Jung-Lin Chen Pediatric Research Foundation. Special thanks to Chang Jung Senior High School and all the students for their enthusiastic participation.

Financial support and sponsorship

This study was funded by Jung-Lin Chen Pediatric Research Foundation.

Conflicts of interest

There are no conflicts of interest.

  References Top

Kruk J. Physical activity in the prevention of the most frequent chronic diseases: An analysis of the recent evidence. Asian Pac J Cancer Prev 2007;8:325-38.  Back to cited text no. 1
O'Connor KL, Baker MM, Dalton SL, Dompier TP, Broglio SP, Kerr ZY, et al. Epidemiology of sport-related concussions in high school athletes: National athletic treatment, injury and outcomes network (NATION), 2011-2012 through 2013-2014. J Athl Train 2017;52:175-85.  Back to cited text no. 2
Vinci DM. Effective nutrition support programs for college athletes. Int J Sport Nutr 1998;8:308-20.  Back to cited text no. 3
Anton NE, Howley LD, Pimentel M, Davis CK, Brown C, Stefanidis D, et al. Effectiveness of a mental skills curriculum to reduce novices' stress. J Surg Res 2016;206:199-205.  Back to cited text no. 4
Johnson KE, McRee AL. Health-risk behaviors among high school athletes and preventive services provided during sports physicals. J Pediatr Health Care 2015;29:17-27.  Back to cited text no. 5
Tsai MC, Lin SH, Chou YY, Lin SJ. Exploration of health status, healthcare utilization, and health service expectations among Taiwanese adolescents. Eur J Pediatr 2014;173:187-96.  Back to cited text no. 6
Chen MY, Wang EK, Yang RJ, Liou YM. Adolescent health promotion scale: Development and psychometric testing. Public Health Nurs 2003;20:104-10.  Back to cited text no. 7
Tsai MC, Chou YY, Lin SJ, Lin SH. Factors associated with adolescents' perspectives on health needs and preference for health information sources in Taiwan. Arch Dis Child 2013;98:9-15.  Back to cited text no. 8
Chen MY, Chou CC, Yang RJ. Considering the factors of gender and body weight in the promotion of healthy behavior among adolescents. J Nurs Res 2005;13:235-43.  Back to cited text no. 9
Zuniga KE, Downey DL, McCluskey R, Rivers C. Need for and interest in a sports nutrition mobile device application among division I collegiate athletes. Int J Sport Nutr Exerc Metab 2017;27:43-9.  Back to cited text no. 10


  [Figure 1]

  [Table 1], [Table 2], [Table 3]


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