HEALTH PROMOTING BEHAVIOUR

AND ITS BARRIERS AMONG NURSING

STUDENTS OF AIIMS, JODHPUR
A Thesis submitted to the

All India Institute of Medical Sciences, Jodhpur

In partial fulfillment of the requirement for the degree

Master of Science in Nursing

(Paediatric Nursing)

By
PRATIBHA SHARMA

GUIDE
Mrs. Remiya Mohan
Assistant Professor
College of Nursing
AIIMS, Jodhpur

College of Nursing
All India Institute of Medical Sciences, Jodhpur
[2021]
 DECLARATION BY THE CANDIDATE

I hereby declare that the thesis entitled “Health promoting behaviour and

its barriers among nursing students of AIIMS, Jodhpur” is a bonafide work

carried out by me under the guidance of Mrs. Remiya Mohan, Assistant

Professor, Department of Paediatrics, College of Nursing, All India Institute of

Medical Sciences (AIIMS), Jodhpur (Rajasthan). No part of this thesis has

formed the basis for the award of any degree previously.

Pratibha Sharma

Enrolment number- AIIMS/JDH/PG/NUR/011/2019

Roll number- 20190011

[Link]. (Nursing) final year

College of Nursing

AIIMS, Jodhpur (Rajasthan)

DATE:

I
 CERTIFICATE BY THE GUIDE

This is to certify that the thesis entitled “Health promoting behaviour and its

barriers among nursing students of AIIMS, Jodhpur” is a bonafide work

done by Ms. Pratibha Sharma in partial fulfilment of requirement for the award

of [Link]. (Nursing) degree of the All India Institute of Medical Sciences,

Jodhpur under the guidance of undersigned. She has carried out the work at

College of Nursing, All India Institute of Medical Sciences, Jodhpur.

Guide

Mrs. Remiya Mohan

Assistant Professor

Department of Paediatric Nursing

College of Nursing, AIIMS, Jodhpur

Date:

Co-guide Co-guide

Dr. Mukesh Chandra Sharma Dr. Daisy Khera

Associate Professor Additional Professor

Department of Paediatric Nursing Department of Paediatrics

College of Nursing AIIMS, Jodhpur

AIIMS, Jodhpur

Date: Date:

II
 ENDORSEMENT BY THE PRINCIPAL

This is to certify that the thesis entitled “Health promoting behaviour and its

barriers among nursing students of AIIMS, Jodhpur” is a bonafide

research work done by Ms. Pratibha Sharma under the guidance of Mrs.

Remiya Mohan, Assistant Professor, Department of Paediatrics, College of

Nursing, AIIMS, Jodhpur.

Signature

Dr. (Prof) Suresh K. Sharma

Principal

College of Nursing

AIIMS, Jodhpur

DATE:

III
 ACKNOWLEDGEMENT

Above all, firstly I thank the Almighty for the abundant grace he showed on me

and provided me strength and hope throughout the journey of my life. Words

are not enough to thank and it is my proud privilege to express my deepest

regards and heartfelt gratitude to Prof. Dr. Sanjeev Mishra, Director, AIIMS,

Jodhpur and Prof. (Dr.) Raj Rani, Principal, College of Nursing, AIIMS, Jodhpur

for providing constant support and guidance during the course of study.

I would like to thank my supervisor Mrs. Remiya Mohan under whose valuable

suggestions and comments, this endeavour could become possible. She has

been my source of inspiration and also provided her constant support during

the entire two years. I am also highly indebted to her for providing timely

guidance and meticulous supervision for my dissertation and inculcating my

interest in research. Working under her was truly a great learning and

unforgettable experience.

I would like to express my deep and sincere gratitude to my co-supervisor Dr.

Daisy Khera, Additional Professor, Department of Paediatrics, AIIMS, Jodhpur,

and Dr. Mukesh Chandra Sharma, Associate Professor, College of Nursing,

AIIMS, Jodhpur for their guidance and valuable suggestions. My deepest

heartfelt appreciation also goes to them for providing support throughout the

completion of this dissertation.

I would like to thank Mrs. Mohana Sundari, Tutor, College of Nursing, AIIMS,

Jodhpur for providing me constant support with their valuable suggestions.

I would like to thank the Institutional Ethical Committee of AIIMS, for granting

the approval of my study.

IV
I wish to thank all the faculty of College of Nursing for their constructive

criticism in various stages of this study.

I am grateful towards all the study subjects for willingly participating in the

study.

This endeavour will remain incomplete if I fail to acknowledge the unconditional

love and support of my parents (Mr. Pawan Kumar Sharma and Mrs. Geeta

Devi) and brothers (Gaurav Sharma and Yash Sharma). A word of thanks for

the constant support and suggestions received from my colleagues. I would

like to thank my friend Chiku for being part of my research.

Ms. Pratibha Sharma

[Link]. Nursing (Paediatric Nursing)

College of Nursing, AIIMS, Jodhpur

DATE:

V
 LIST OF ABBREVIATIONS

ABBREVIATION EXPANSION

AIIMS All India Institute of Medical

Sciences

CON College of Nursing

df Degree of freedom

NCD Non communicable diseases

NS Non significant

HPBS Health Promoting Behaviour Scale

HTN Hypertension

SD Standard Deviation

N Sample size

> Greater than

< Less than

% Percentage

X2 Chi-Square

VI
 ABSTRACT

Introduction- Non communicable diseases (NCD’s) are increasing all over the

world and accounts for major problems in developing countries like India. Due

to unhealthy lifestyle, there is happened a great increase in the prevalence and

incidence of many chronic conditions, including obesity, atherosclerosis, and

coronary heart disease (CHD).

Method- A descriptive study was conducted on a sample of 160 students of

CON, AIIMS, Jodhpur. Sampling method was total enumerative sampling and

data collection method was structured telephonic interview.

Result- The study findings reveal a significant association Health Promoting

Behaviour using the Chi-Square (p≤0.05). 120 (75%) were have excellent

Health Promoting Behaviour score and 40 (25%) were good category. The total

mean score and standard deviation of health promoting behaviour score was

84.18±5.81. The highest mean score and S.D. in the subscale was 5.21±0.59

for safety; lowest was 10.49±0.65 for physical activity. 121 (75.6%) and 89

(55.6%) reported time management problems due to college timings and

spending of more time on mobile phones as barriers in promoting healthy

lifestyle respectively.

Conclusion- The present study concluded that the nursing students shows

positive attitude towards health promoting behaviours. Poor health behaviour

practices were noted for physical activity. Time is an important factor which

needs to be addressed. Work and college timings should also be favourable.

Keywords- Barriers, Behavior; College; Health; Nursing students.

VII
 TABLE OF CONTENTS

CHAPTER NO. CONTENT PAGE NO.

I INTRODUCTION
 Background 1-4
 Need of the study 4-7
 Aim of study 7
 Statement of Problem 7
 Objectives 7-8
 Hypothesis 8
 Operational definitions 8-9
 Assumptions 9
 Delimitation 9

II REVIEW OF LITERATURE 10-15

III RESEARCH METHODOLOGY

 Methodology Flow chart 16
 Research Approach 17
 Research Design 17
 Variable under study 17-18
 Setting of the study 18
 Population 18-19
 Sample and sampling technique 19
 Sample size 19-20
 Sample criteria 20
 Description of data collection tools 20-22
 Ethical considerations 22
 Validity 23
 Reliability 24
 Pilot study 24-25
 Data collection procedure 25-26
 Data analysis and interpretation 26
 Summary 27

IV ANALYSIS, INTERPRETATION AND

DISCUSSION
Other findings and major findings 28-44

V SUMMARY, CONCLUSION AND

RECOMMENDATION
 Summary of major findings 45
 Strength of the study 46
 Limitations of the study 46
 Implications in Nursing 46-48
 Recommendations 48
 Conclusion 49

REFERENCES 50-62
63-92
APPENDICES

VIII
 LIST OF TABLES

Table Title Page No.

1. Table showing Health Promoting Behaviour 22

Subscales

2. Content Validity Index of data collection tool. 23

3. Reliability of data collection tool. 24

4. Frequency and percentage distribution of 29

demographic variables.

5. Frequency and percentage distribution of Health 31

promoting behaviour score among nursing students.

6. Mean and rank of Health Promoting Behaviour Scale 32-33

among nursing students.

7. Domain wise mean and rank of Health Promoting 35

Behaviour Score among nursing students.

8. Frequency and percentage distribution of Health 36

Promoting Barriers among the nursing students.

9. Association between the Health Promoting 38-39

Behaviour of nursing students with the selected

demographic variables.

IX
 LIST OF FIGURES

Fig. No. Figure Legend Page No.

1. Flow chart of research methodology 16

2. Health Promoting Behaviour score among 31

nursing students.

3. Graphical representation of distribution of 37

Health Promoting Barriers among nursing

students

X
 LIST OF APPENDICES

Appendix I Ethical permission letter

Appendix II Informed consent form (English and Hindi)

Appendix III Demographic variables (English and Hindi)

Appendix IV Structured Health promoting behaviour scale (English

and Hindi)

Appendix V Structured Health promoting barrier questionnaire

(English and Hindi)

Appendix VI Letter requesting opinion and suggestion from experts

for content validity of tool

Appendix VII List of tool validation expert

Appendix VIII Master sheet

XI
 CHAPTER I
INTRODUCTION
 INTRODUCTION

BACKGROUND

Now a days, there is increase in the emergence of non-communicable

diseases such as cancer, diabetes, hypertension and coronary heart disease

which is becoming a universal health concern. It has been expected with the

help of several studies that by 2020, these diseases will be accountable for

seven out of every 10 deaths in the developing countries like India. 1 Also, an

international report stated that instead of only being limited to adult population,

these chronic diseases are affecting youths too. 2 Obesity is increasing

internationally at distressing rate and is estimated to be the fifth leading cause

of death worldwide.3 Overweight is also considered a remarkable predisposing

factor for other chronic diseases.4 Unhealthy eating habits and sedentary

lifestyles are considered as the main reasons that leads to obesity in the

person.5,6 By enhancing the health promoting lifestyles, we can control the

chronic conditions prevalence across all the people of all age groups that

would ultimately decrease the rate of development of disease among them.6

A lifestyle can be defined as the way of living of life which can be both terms,

like healthy as well as unhealthy that depends on the personal behaviour

choices. Health promoting behaviours include health responsibilities, physical

activity, nutrition, spiritual growth, interpersonal relations, and stress

management.7 A health promoting lifestyle is an important factor that is

responsible for health status and is considered as a major determinant for the

maintenance and improvement of health.8 Some of the modifiable factors of

1
health behaviour that are responsible for the development of chronic

conditions are physical activities, eating habits, and smoking. 9

College time is a challenging period when students come up with a number of

challenges that includes changes in developing new social relationships, social

environment, having more behavioural independence, and reconcile to new

time tables.10 College students used to engage more in risky health behaviours

which has negative affect on the well-being such as poor dietary habits, stress

and physical activity.11,13 Health promoting behaviours plays an important role

in the well-being of an individual; exercises are known to show potential

physical and psychological benefits and exercise habits in the child known to

have positive association with his/her academic achievement.12,14,15.

Noncommunicable diseases (NCDs) are increasing all over the world and

results in the development of various problems in the developing countries like

India. Internationally, NCDs are responsible for 63% of all the deaths that

accounts for 80% of the global burden of diseases.16 Statistics indicate that

53% of the causes of death are related to human lifestyle. Due to sedentary

lifestyle, there is great increase in the prevalence and incidence of many

chronic conditions like hypertension, coronary heart disease (CHD),

atherosclerosis and obesity.17,18 Due to sedentary lifestyle like unhealthy

eating and reduced physical activities, there is increase in the prevalence of

obesity among the people in both developing as well as developed countries

that leads to the emergence of chronic conditions. 19,20 Obesity is the fifth

leading cause of mortality globally and is considered as a predisposing factor

for many diseases such as hypertension, cancers, metabolic syndrome, CHD

and Type 2 diabetes21 in a way that 23% of ischemic heart diseases, 7-41% of

2
cancers and 44% of Type 2 diabetes are corresponding to overweight and

obesity.22 It is possible to tackle these predisposing factors by modifying the

lifestyle that would decrease the rate of chronic diseases' mortality and

morbidity.23,24

Health is one of the basic human right. In order to improve the concept of

health, it is important for each individual in society to take responsibility and

make the healthy life model as a part of daily routine.25 Whole actions and

beliefs which individuals adopt in order to stay healthy and thus preventing

themselves from development of diseases is defined as health promoting

behaviours. Along with that, the health promoting behaviour is based on the

ability to express one’s personality in social environments, support between

individuals, nutritional values, stress management, exercising and taking the

responsibility of one’s own health.26 The tremendously growing incidence of

non-communicable diseases is responsible for 60% of world’s deaths. 26 In

India also, the condition of life diseases is quite distressing. There is rapid

change in the disease profile. The World Health Organization (WHO) has

considered India as one the nation that has most of the lifestyle disorders in

the coming future. Nowadays, these lifestyle disorders are becoming more

common and also affecting the youths. Therefore, the at-risk population shifts

from 40+ to may be 30+ or even younger. 27,28 Healthy lifestyle and health

promoting activities are main factors in facilitating and preserving health.25

Nursing students are responsible for providing health education to clients.

They are important to the success of this paradigm shift from a disease model

to health promotion.29 Most of the nursing activities involve healthcare

education, that’s why health promoting behaviour is an important aspect

3
concept in nursing. Nurses are often expected as role models of health

promoting lifestyles and as leaders to adopt health promoting behaviour in the

communities.30 Today’s nursing students will become tomorrow’s health care

providers. Nurse’s role modelling healthy lifestyles encourage people to adopt

the health promoting behaviours.25

In spite of the busy schedule of the nursing students, if they are able to develop

the health promoting lifestyles and function as role models as per the

expectation of the client is the main purpose of this study. However, there are

limited research studies conducting in assessing the health promoting lifestyle

of nursing students in India. Therefore, this study was undertaken to determine

the health promoting behaviours of nursing students of College of Nursing, All

India Institute of Medical Sciences, Jodhpur.

NEED OF THE STUDY

A health promoting lifestyle contributes a person towards the maintenance and

improvement of health.31,34 Lifestyle is basically defined as the way of living of

individuals, families, and societies that can be healthy or unhealthy in terms of

personal behaviours such as stress management, physical activity and

nutrition. A healthy lifestyle may lead to better health and happiness whereas

an unhealthy lifestyle may lead to illness and morbidity. 35,36 Pender et al.

indicated that health promoting behaviours like self-initiated behaviours,

actions and health perceptions may have an impact on individual happiness

and well-being.37 Health promoting behaviours comprise of six components

including stress management, nutrition, spiritual growth, health responsibility,

physical activity and interpersonal relations. Increasing evidence indicate that

4
if individuals practice properly and routinely, it would result in better health and

lifestyle.38 32,33

Physical as well as mental health promoting are considered in the terms of

holistic health. There is tremendous overgrowth in the prevalence of non-

communicable as well as mental problems in India.39,40 This can be reduced

by engaging individual towards the adoption of health promoting behaviours

and being accountable for their own health. 41

Healthy behaviours help individual to be healthy as well as not to have

diseases as said by the WHO (World Health Organization).42 Health promotion

is considered to be an important concept in nursing. Nursing students are

future health professionals who will motivate the common people towards

health promotion.39 So, it is important for nursing students to maintain the

healthy lifestyle. Many of the studies conducted in US and European countries,

found that students were not interested in adopting healthy behaviours. 43,44,45

Out of the various domains, healthy diet and physical activity were the most

least scored domains among all the domains of health promoting behaviours.

A study that was conducted on 500 students in Iran reported that nutrition and

the physical activities were the most least scored domains. 43 Likewise, another

study from Jordan conducted among 167 nursing students reported that

students were more lacking behind in terms of physical activity. 45 A study from

Kuwait noted higher scores in spiritual growth and stress management for

students.46 In few Indian studies also it was found that there are lowest scores

for diet and physical activity and also found that there was age and gender

differences in terms of health promoting behaviour. 39,47

5
For nursing students who are hostelers, it may be exciting for the first time

being away from home and taking on the independent roles but for many it

brings new challenges for them. That’s why their focus may not be on the

healthier diet. As a result, they prefer for fast food, packed food and immediate

preparation of food. Time management is also one of the challenges that can

lead to adopt unhealthy lifestyle.48,65 These conditions may force them internet

addict or being online and available in social media. Their procrastination,

stress and laziness may lead them to choose unhealthy lifestyle in terms of

reduced physical activity or health responsibility. Also, they thought that their

young age will not have that much problems which is the reason why they

neglect the health promoting lifestyle.49,51

Most of the researches indicate that many of the health problems are

underlying in the people’s lifestyles and health behaviours. Implementation of

these health promoting behaviours is one of the best with the help of which

people can maintain their health.50,52 Also, health promotion and disease

prevention are directly related to these behaviours. 53,54

Implementing these behaviours are very important, and it has been researched

that 70% of illnesses are associated with the individual’s lifestyle. 55,56 Some

musculoskeletal and cardio-pulmonary disorders and other disorders are

directly or indirectly related with the individual’s lifestyle. 57 According to WHO

(World Health Organization), around 60% of quality of life and health of

individuals depends on their personal behaviours 58 and 53% of mortality is due

to lifestyle behaviours59,60

6
Despite the fact that youths play a major role in shaping the future generation

and promoting health in the society, they are not considered at priority rather

they are considered to be in a relatively health stage of life. 61,62

During student life, individuals are at risk of developing mental health problems

in certain situations, that affects their academics and may result in subsequent

outcomes54,63 Therefore, students must be aware of health promoting

behaviours so that they can maintain a healthy lifestyle. 64,66

Considering the importance of this issue, there is need to identify the reasons

why students are not accepting the health promoting behaviours 67,68 and also

considering the fact that limited studies have been carried out on nursing

students, this study was conducted with an aim to investigate the health

promoting behaviour and its barriers among the undergraduate students of

College of Nursing, All India Institute of Medical Sciences, Jodhpur.

It is hoped that appropriate interventions must be taken for promoting health

among the group by using the result findings of this study.

AIM OF THE STUDY

The aim of the study is to explore the health promoting behaviour and its

barriers among nursing students of AIIMS, Jodhpur.

STATEMENT OF PROBLEM

Health promoting behaviour and its barriers among nursing students of AIIMS,

Jodhpur.

OBJECTIVES

1. To assess the health promoting behaviour among nursing students of

AIIMS, Jodhpur.

7
 2. To determine the barriers in health promoting behaviour among nursing

students.

3. To find the association between health promoting behaviour of nursing

students with selected demographical variables.

HYPOTHESIS

Null Hypothesis (H0): - There will be no significant association between the

health promoting behaviour of nursing students with the selected demographic

variable.

Research Hypothesis (H1): - There will be significant association between

the health promoting behaviour of nursing students with the selected

demographic variable.

OPERATIONAL DEFINITIONS

In present research, a descriptive study is being done to explore the health

promoting behaviours, and barriers in health promotion among nursing

students of AIIMS, Jodhpur.

1. Nursing students: - Students of nursing college who are studying at

AIIMS, Jodhpur. All the students are females.

2. Health promoting behaviour: - These are the behaviour implemented

by the Undergraduates to maintain the positive health outcome and as

measured by self-structured tool for Health Promoting Behaviour Scale

(3-point Likert Scale).

3. Health promoting barriers: - In this context, it refers to the real blocks

experienced by the undergraduates in implementing the health

promoting lifestyle behaviours, based on physical activity, nutrition,

8
 sleep, lacking in availing of health facilities) as measured by self-

structured questionnaire.

ASSUMPTIONS

It is assumed that: -

1. Nursing students might be adopting some of the unhealthy lifestyle.

2. Demographic variables may influence the health promoting behaviour

score of the nursing students.

3. Health promoting barriers might be influencing the health promoting

behaviour of the nursing students.

4. The tools employed for the study might be adequate to collect

information about assessing the health promoting behaviour and health

promoting barriers of nursing students.

DELIMITATION

1. Study had not included the sexual health behaviour of the nursing

students.

2. Research study was delimited to undergraduates of College of Nursing,

AIIMS, Jodhpur.

3. The study was delimited to age group between 17-24 years of age.

9
 CHAPTER II
REVIEW OF LITERATURE
 REVIEW OF LITERATURE

Review of literature is an important step in the development of a research

project. It helps in understanding the problem and developing the conceptual

context and methodology for data collection and analysis. The review of

literature refers to both the activities involved in searching for the information

on a given topic as well as actual written report that summaries the states of

existing knowledge research problem.

The review of literature of the study is divided under the following headings: -

 Studies related to the Health promoting behaviour among nursing students.

 Studies related to the barriers in promoting healthy lifestyle among nursing

students.

Studies related to the health promoting behaviour among nursing

students

Borle et al69 carried out a study on 124 pupils to investigate their health

promoting behaviours in a tertiary care institute. Self-structured tool was

developed that consists of demographical variables of the students and

contain some information about the Health promoting behaviour of the

respondents and the Health-promoting lifestyle information, a converted

version of Health Promoting Lifestyle Profile II (HPLP II). The results of the

study reported that out of 124 pupil, 29 pupils were found in excellent category

whereas 89 pupil belongs to good category. The overall mean score of Health

Promoting Lifestyle Profile score came to be 62.27±9.66 (ranging from 33 to

87). Out of the domains of Health Promoting Lifestyle, spiritual growth and self-

10
concept has highest mean score. The lowest score was found for exercises

and food practices. Also, highly significant difference (p<0.0001) was found

between the total mean HPLP values among the different age groups.

Sahu et al70 carried out study on 125 students from different nursing

universities of India to investigate the use of internet and the health promoting

behaviour. Out of 125 students, 89 students were undergraduate and 36

students were postgraduate. Researcher used a Berger Social Media

Addiction Scale (a standardized tool) in assessing in dependence of students

on social media and another tool was Health Promoting Lifestyle Profile (HPLP

II) for investigating their health promoting lifestyle. 52 students reported that

they delay their sleep because of influence of social media addiction, 11

students reported that they had habit of excessive use of social network. Total

health promoting lifestyle profile score was found more in males as compared

to females. Male students were found more to be involved in excessive use of

social networking communication.

Raj et al. 71 carried out a pilot study which was conducted in 2009 among the

undergraduate nursing students in Chandigarh university between age 17-20

years of age. A tool was developed that was semi structured which includes

28 items that was used for investigating the health promoting lifestyle

behaviour like physical activity, nutrition, spiritual growth, healthy relationships.

In the result, the total mean score of the students was 67.34±19.99 (Max.

score-106). Also, it was found that students were adopting moderate health

promoting lifestyle. It was found that students were having frequent intake of

junk food and they consume less fruits and vegetables.

11
Salem et. Al72 carried out a cross-sectional study on 262 students in 2014 to

investigate the health promoting lifestyle among the medical students of

Rafsanian University of Medical Sciences, Iran. Voluntary participation of the

students was there. Semi-structured tool was developed that included the

demographic variables questionnaire for obtain the baseline information of the

respondents and the Health Promoting Lifestyle Profile II (HPLP II) was used

to assess the health promoting lifestyle of the students. Out of 262 students,

154 students were female. The mean age of the students was 22.50 ± 2.16

years. The mean and the standard deviation of health promoting lifestyle profile

was 109.74 ± 18.65. It was found that there was a significant relationship

between the health promoting lifestyle and age group, entrance year,

education level of mother and father. Whereas, no relationship was found

between the health promoting lifestyle and parents’ occupation. It can be

concluded that the students of this university were adopting moderate level of

health promoting lifestyle.

Damu et.al73 carried out a cross-sectional study to explore the health

promoting lifestyle of undergraduate first year students of Sri Venkateshwara

Institute of Medical Sciences with an aim to compare the health promoting

lifestyles of different first year under graduate students of different courses of

the university. A self-structured questionnaire tool was developed and

administered to assess the health promoting lifestyle of the students. 354

students participated in the study. Out of these students, 149 students were

form MBBS, 99 were from Bachelor of Physiotherapy, 56 were from B. Sc

Nursing and 50 were from B. Sc Paramedical course. Results of the study

revealed that Study findings revealed that students scored higher in

12
Interpersonal relations (i.e. 2.98 ± 0.45) whereas lower score was found for

physical exercises (i.e. 2.08±0.6) and nutrition (i.e. 2.4 ± 0.44) had highest

score in Interpersonal relations (i.e. 2.98 ± 0.45). It can be concluded that there

was no significant difference between different courses in terms of Health

Promoting lifestyle.

Studies related to the barriers in promoting healthy life-style among

nursing students.

Lee75 (2013) carried out a mixed-method study among 236 nursing pupils in

the urban area of Delhi to investigate the barriers and promoting factors

involved in health promoting behaviour among nurses. Aim of the study was to

assess the prevalence of health promoting behaviour among nursing students

with the investigation of the barriers. Shift work and work-related stress were

found as the barriers in health promotion whereas self-efficacy, social support

and individual attributes were reported as facilitators in health promotion as

measured by the application of conceptual framework i.e. Health Action Plan

Approach. Two thirty-six nurses were involved in the study. Findings of the

study revealed that there was a significant positive association with some of

the variables and health promoting lifestyle. With the help of focussed group

interviews, two subthemes were found i.e. 12 hour shift duty and stress related

to the working condition are the reasons why nurses are unable to adopt the

health promoting lifestyle.

Mc. Gill et al76 carried out a study to find out the physical activity levels of

nursing and medicine students of UK medical school and investigate the

facilitators of physical exercise. Researcher conducted study on 361 students.

Among them, 193 students were form nursing and 168 students were from

13
medicine. Survey was done including measures like benefits and barriers to

exercise, social support, physical activity level, self-efficacy and perceived

stress for exercise. Findings revealed that 48% of nursing students and 38%

of medical students were found less active in the involvement of physical

activities and unable to achieve the levels of physical activity. Perceived

benefits of exercise were health related for nurses and for medicine students

it was concerned with stress relief. Lack of time, lack of motivation and

inconvenient schedules were most noted barriers to exercise. Nursing

students were found less active as compared to medicine students in terms of

physical activities. Nursing students perceived more barriers and fewer

benefits to exercise and reported lower social support for exercise.

Thwaite [Link]. 77 carried out a qualitative study on Australian nursing students

with an aim to assess the barriers to healthy lifestyle behaviours. In 7 focus

groups, 54 nursing students were present during the interview. Researcher

find out psychological, environmental, individuals’ barriers that prevents in

adopting healthy lifestyle. Respondents recommended several individual plans

of action to overcome barriers.

Sanjay [Link].78 carried out a cross-sectional study to assess the barriers in

health promotion among medical students. Study was conducted between 1st

year and final year medical students. In this study, all medical students were

asked to fill the self-structured questionnaire about perceived barriers to health

promoting behaviour. Time management issues, lack of motivation as well as

pressure of studies were the most common barriers among students.

Guler [Link].79 carried out a cross-sectional study among nurses of military

hospital with an aim to assess their exercise/benefit beliefs. Exercise

14
Benefits/Barriers Scale questionnaire was used for collecting the data from the

subjects and was analyzed with the help of sample mean, ANOVA, Kruskal-

Wallis analysis and t-test. Study findings revealed that nurses appreciated

importance of physical exercises for health promotion and disease prevention.

Providing easily accessible sport facilities and providing enough time to them

for performing physical fitness can lead them to adopt health promoting

behaviour.

Thomas et.al80 carried out a study to find out the barriers to healthy eating in

a nurse's working environment. Sampling technique used by the researcher is

convenience sampling. Research design included the following things i.e.

photo collection, a self-report survey, and individual semi-structured

interviews. Subjects used Photo Voice to take pictures of their experiences

and environment. The self-report survey included demographics, physical

health, eating habits as well as mental and emotional health. Sample size

included 6 subjects. Lack of availability and food quality were the reasons for

adopting unhealthy lifestyle. Subjects included various ways of adopting

healthy lifestyle like easier availability of healthy food.

Allan et.al81 carried out a qualitative study to assess the perceived factors

found for nurses’ eating and physical activity behavior. Semi-structured

qualitative interviews were conducted by researcher with 16 nurses to

investigate the factors based on the TDF (Theoretical Domains Framework).

Result findings revealed that the important health promoting barriers in

engaging healthy eating and physical activity behaviour were stress, lack of

planning, family and friend’s behaviour, fatigue.

15
 CHAPTER III
RESEARCH
METHODOLOGY
 RESEARCH APPROACH
Quantitative Research Approach

RESEARCH DESIGN
Descriptive Research Design

VARIABLES
Research variables – Health promoting Behaviour, and Demographic variables-
barriers among nursing students . Including Demographic Data

SETTING
College of Nursing, AIIMS Jodhpur

POPULATION
Nursing Students

SAMPLE
Undergraduates of CON, AIIMS, Jodhpur

SAMPLE SIZE
160 Students

SAMPLING TECHNIQUE
Total enumerative sampling technique

TOOLS FOR DATA COLLECTION

Tool 1- Demographic Tool 2- Structured Health Tool3- Structured Health
Promoting Barrier
Variables Promoting Behaviour Scale Questionnaire

DATA COLLECTION METHOD

Structured Telephonic Interview

DATA ANALYSIS AND INTERPRETATION

Descriptive and inferential statistics

FIGURE 1: Flow chart of research methodology

16
 RESEARCH METHODOLOGY

Research methodology is a systematic procedure, which the researcher starts

from the initial identification of the problem to its final conclusions. The role of

methodology consists of procedures and techniques for conducting a study. 82

RESEARCH APPROACH

A research approach tells the researcher, from whom the idea is to be

collected, what to collect, how to collect and analyze them. It also suggests

possible conclusions and helps the researcher in answering specific research

questions in the most accurate and efficient way possible. 83 The research

approach adopted for this study was descriptive, as it aimed to assess the

health promoting behaviour and its barriers in nursing students.

RESEARCH DESIGN

The research design is explicit blue- print for research activities to be carried

out. Research design helps the researcher to determine what data to collect

and how to analyze it. It also suggests possible conclusions to be drawn from

the data. In the present study the researcher adopted descriptive research

design as there was a need to assess the health promoting behaviour and its

barriers among the nursing students.

VARIABLES

Variables are the characteristics that may vary among the subjects being

studied. It is the focus of the study and reflects the empirical aspects of the
84
concepts being studied, the investigator measures the variables.

17
Research variable: - The research variable is the variable used by the

researcher in the study85 In this study, the health promoting behaviour and its

barriers in undergraduates were the research variables.

Demographic variables: it includes selected parents demographic data

include like education, occupation, religion, family income, type of family

whereas child profile include age, sex, dietary pattern, BMI of the child, any

history of abuse and chronic illness.

SETTINGS OF THE STUDY

Selection of an appropriate place for conducting the study is an important

aspect because there is effect of setting in a way how the person behaves or

feel and as well as in the way of responding. Setting is defined as physical

place where the data collection takes place. The study was conducted at

College of Nursing, All India Institute of Medical Sciences, Jodhpur.

The College of Nursing, All India Institute of Medical Sciences, Jodhpur has

been established to become a benchmark in field of Nursing Education in India.

The first batch of B. Sc (Hons) Nursing started on 2 nd September, 2013 with

an intake of 60 students.

The selection of study setting was on the basis of: -

 Feasibility of the study

 Availability of the samples

POPULATION

A population is a complete set of people with a specialized set of

characteristics.87. There is need to define the population in the research study

so as to mention the group to which the results of the study findings can be

applied.87. In this study, the study population comprises the nursing students.

18
Target population: - Undergraduate nursing students (between 17-24 years

of age).

Accessible population: - Undergraduate students of College of Nursing, All

India Institute of Medical Sciences, Jodhpur (between 17-24 years of age).

SAMPLE AND SAMPLING TECHNIQUE

Sample is defined as a group of people, objects or items that are taken from a

larger population for measurement. 86 Sample was conducted on 160

undergraduate nursing students between 17-24 years of age selected by Non

probability i.e. Total enumerative sampling technique. Complete list of

undergraduate nursing students was taken from office and those who fulfilled

the criteria were approached and selected as sample for the research study.

SAMPLE SIZE

The sample size was determined based on a previous similar study with 95%

confidence interval.

Sample size was calculated through Cochran formula-

n0=Z2pq/e2

n0 is the sample size; Z is 1.96 from the Z-table

e is the margin of error i.e. 5% (0.05)

p is the estimated proportion which has the attribute in question; q is 1-p

So, in the present study, p is prevalence (prevalence of 47% of students

showing health promoting behaviour according to Journal of Lifestyle

Medicine).1

Therefore, sample size came to be 382.72

~383 (approximately)

19
To reduce sample size,

𝐧𝟎
𝒏 = 𝟏+(𝐧𝟎−𝟏/𝐍)

n0 is sample size recommended by Cochran’s sample size i.e. 383

N is the population size, i.e. 240 and

N is new sample size.

Therefore, reduced sample size came to be 148.

SAMPLE CRITERIA

 Inclusion Criteria:

Undergraduate nursing students studying in AIIMS, Jodhpur within age group

17-24 years of age who were: -

 Present at the time of data collection.

 Willing to participate in the research study.

 Able to speak and understand English/Hindi.

 Exclusion Criteria:

 Diagnosed with any chronic disease condition (like HTN, Cancer,

Diabetes, etc.)

DESCRIPTION OF DATA COLLECTION TOOLS

Data collection tool refers to the instruments which were constructed by the

researcher to obtain relevant data.

Section A: - Demographic variables (APPENDIX III)

Section B: - Self-structured Health Promoting Behaviour Scale (APPENDIX IV)

Section C: - Self-structured Health Promoting Barrier Questionnaire

(APPENDIX V)

20
Section A: Demographic variables

This section collects the information regarding the demographic profile of the

sample. It includes Age, Academic year, Residence, Accommodation,

Religion, Dietary pattern, Socio-economic status, Type of family, Any Health

campaign attended, If the student is diagnosed with any chronic disease

condition, Any history of substance abuse, BMI of the student.

Section B: Self-Structured Health Promoting Behaviour Scale

 A self-structured 3-point Likert scale was developed that measures

health promoting behaviour of the students which helps to maintain or

preserve the health of a person.

 This tool focuses on the actions taken by the person itself in order to

maintain or preserve their own health.

 It is a 3-point response scale consisting of: -

i. 1 representing ‘‘never’’

ii. 2 representing ‘‘sometimes’’

iii. 3 representing ‘‘Routinely’’

 This scale comprises of 35 items which are health promoting

behaviours categorised into 6 health promoting behaviour subscales i.e.

physical activity, nutrition, stress management, healthy relationships,

health responsibility and safety as shown in Table 1.

Section C: Self- structured Health Promoting Barrier Questionnaire

This section includes various aspects of health promoting barriers i.e. physical

activity, nutrition, sleep, lack of support system. The questionnaire is based on

the yes/no response. It includes total 13 questions.

21
Interpretation

Among the listed barrier in the questionnaire, the maximum percentage of

barrier reported by the student will be considered as the main barrier in their

health promoting behaviour.

TABLE 1: Table showing Health Promoting Behaviour Subscales

DOMAINS ITEM NUMBER

Physical Activity 1,3, 21,25, 31

HEALTH Nutrition 2,4,8,10,12,14,15,18,19,28,33

PROMOTING
Stress management 5,7,11,26, 32, 35
BEHAVIOUR
Healthy Relationships 6,13,17,24,34
SUBSCALES
Health Responsibility 9,16,20,22,27,29

Safety 23,30

ETHICAL CONSIDERATIONS

1) Ethical Clearance had been obtained from the Institute Ethics

committee, AIIMS, Jodhpur. Certificate Reference Number:

AIIMS/IEC/2020-21/3002. (APPENDIX I)

2) Prior permission to conduct the study was taken from Principal, College

of Nursing, AIIMS, Jodhpur.

3) Informed verbal consent had been taken from the subjects and they

were assured of confidentiality with autonomy to withdraw self from the

study at the time of data collection. (APPENDIX II)

22
VALIDITY OF TOOL

Content validity has a special relevance to individuals designing a test to

measure knowledge in specific content area 88. Validation of the self-structured

tools was done in the following way: first, it was prepared using the reliable

books and sources (the WHO standard questionnaire of life quality); then, it

was examined by consultation with the guide and experts in the field of

Paediatric Nursing and their suggestions were applied to the questionnaire;

finally, its validity was approved after correcting some problems and

ambiguities. (APPENDIX VII)

1) Self-structured Health Promoting Behaviour Scale tool’s content validity

was determined by scale content validity index (SCVI). Validity (SCVI)

value was 0.88 which means tool was valid as validity (SCVI) range

from 0.83 to 1. (Table 2)

2) Self-structured Health Promoting Barrier Questionnaire tool’s content

validity was determined by scale content validity index (SCVI). Validity

(SCVI) value was 0.96 which means tool was valid as validity (SCVI)

range from 0.83 to 1. (Table 2)

TABLE 2: Content Validity Index of data collection tool

TOOLS VALIDITY CVI

Self-structured Health Promoting Content 0.88

Behaviour Rating Scale validity

Self-structured Health Promoting Content 0.96

Barriers questionnaire validity

23
RELIABILITY OF TOOL

1. Self-structured Health Promoting Behaviour tool’s internal consistency was

checked by Cronbach’s alpha. Reliability of the tool was 0.80 which means tool

was reliable as reliability acceptability range is 0.70 to 1.0. (Table 3)

2. Self-structured Health Promoting Barriers questionnaire tool’s internal

consistency was determined by Split-half method. Reliability of the tool was

0.766 which means tool was reliable as reliability acceptability range is 0.70 to

1.0. (Table 3)

TABLE 3: Reliability of data collection tool

TOOLS RELIABILITY STATISTICS VALUE

Self-structured Health Internal Cronbach’s 0.801

Promoting Behaviour consistency alpha

Rating Scale

Self-structured Health Internal Split half 0.766

Promoting Barriers consistency method

questionnaire

PILOT STUDY

The pilot study was conducted from 15 October to 22 October at College of

Nursing, All India Institute of Medical Sciences, Jodhpur on 10% of the total

sample size of main study i.e. 18 undergraduates of age group between 17 to

24 years of age selected by Non-probability (Convenient) sampling technique.

Data was collected using self-structured tools.

The main objectives were: -

24
  To assess the feasibility of the study.

 To assess the practicability of the study.

 To determine the reliability of data collection tool.

 To determine the understanding and language clarity of the tool.

Result of the pilot study indicated that study was found feasible, practical and

language of data collection tool was clear and understandable to students.

Average time taken in interviewing each student was 15-20 min.

DATA COLLECTION PROCEDURE

After obtaining permission from Institute Ethics committee and Principal of

College of Nursing, AIIMS, Jodhpur, data collection was initiated. Data

collection was done from 5 Nov 2020 to 7 Dec 2020. Steps of data collection

were as follows:

 Undergraduate nursing students were approached.

 Introduced myself to the students and aim and purpose of the study was

explained to them before the data collection.

 Confidentiality of their responses was assured and their informed verbal

consent was taken from them prior to the study.

 Data collection was through structured telephonic interview method.

 Undergraduate students were asked to be comfortable and be relaxed

and instructions related to the tool were given to facilitate co-operation.

 Students were instructed to respond to each and every question asked

and not to skip any question.

 General information was asked related to demographic data as per the

interview schedule.

25
  Structured questionnaire to assess the health promoting behaviour with

35 items and barriers with 13 items was interviewed one by one.

 Responses were recorded on the rating scale during the telephonic

interview.

 Clarifications of the questions were provided wherever necessary.

 Approx. 15-20 min. were taken to collect data from each student.

 After that the collected data was coded one by one and it was entered

into the master sheet for the analysis.

DATA ANALYSES AND INTERPRETATION

Collected data was coded and entered into master sheet and analysed with

help of SPSS 20 version. Descriptive and inferential statistics were used.

 Descriptive statistics: Frequency, mean, percentage, mean

percentage and Standard Deviation had been used to assess the

demographic profile, Health promoting behaviour and its barriers

among undergraduate nursing students of College of Nursing, All India

Institute of Medical Sciences, Jodhpur.

 Inferential statistics: Inferential statistics was done with the

application of Chi-square test. This test was used to discover the

association of Health promoting behaviour of undergraduate nursing

students with selected demographic variables.

Analyzed data are interpreted and depicted with the help of tables, graphs and

charts, etc.

26
SUMMARY

This chapter deals with the research methodology. Quantitative research

approach and descriptive research design were used in the study. Study was

conducted at College of Nursing, All India Institute of Medical Sciences,

Jodhpur (Rajasthan). Data was collected by structured telephonic interview

from 160 undergraduate students using total enumerative sampling technique.

Self-structured health promoting behaviour scale was administered and along

with it another self-structured health promoting barrier questionnaire tool was

used to assess the barriers which they face in implementing healthy lifestyle.

Collected data was entered into master sheet and SPSS 20 version was used

for the descriptive and inferential statistical analysis.

27
 CHAPTER IV
ANALYSIS
AND
INTERPRETATION
ANALYSIS AND INTERPRETATION

The term analysis refers to the computation of certain measures along with

searching for patterns of relationship that exits among data groups. (Kottari C.R.

1990).

Kerlinger (1995) defines analyses as the categorizing, ordering, manipulating

and summarizing of data into intelligible and interpretation form so that the

relations of research problem can be studied and tested.

This chapter deals with the analysis and interpretation of data collected 160

undergraduate students of College of Nursing, All India Institute of Medical

Sciences, Jodhpur. The collected data were coded, calculated, organised &

interpreted by using descriptive and inferential statistics as per the objectives of

the study.

The findings are presented under the following sections.

SECTION A: - Analysis of demographic variables of nursing students.

SECTION B: - Analysis of Health Promoting Behaviour Score among nursing

students.

SECTION C: - Analysis of Item-wise Mean and Rank of Health Promoting

Behaviour Scale among nursing students.

SECTION D: - Analysis of Domain-wise Mean and Rank of Health Promoting

Behaviour Scale among nursing students.

SECTION E: - Analysis of the Health Promoting Barriers among the nursing

students.

SECTION F: Analysis of association between the Health Promoting Behaviour

of nursing students with the selected demographical variables.

28
SECTION A: Analysis of demographic variables of nursing students.

TABLE 4: Frequency and percentage distribution of demographic

variables.

N=160

S. No Demographic variables Frequency (%)

1. Age (years of age)

17-19 43 (26.9)
19-21 62 (38.7)
>21 55 (34.4)
2. Academic year
I 0
II 54 (33.8)
III 59 (36.9)
IV 47 (29.3)
3. Residence
Urban 87 (54.4)
Rural 73 (45.6)
4. Accommodation
Hosteler 127(79.4)
Day Scholar 33 (20.6)
5. Religion
Hindu 154 (96.2)
Muslim and other 6 (3.8)

6. Dietary pattern
Vegetarian 87 (54.4)
Non-vegetarian 30 (18.7)
Eggetarian 43(26.9)
7. Socio-economic status of the family
Class I (Upper) 0
Class II (Upper Middle) 0
Class III (Lower Middle) 87 (54.4)
Class IV (Upper Lower) 73(45.6)
Class V (Lower) 0
8. Type of family
Nuclear family 120 (75)
Joint family 40 (25)
Extended family 0
9. Any health campaign attended?
Yes 23 (14.4)
No 137 (85.6)
10. Do you have any history of addiction?
Yes 2 (1.3)
No 158 (98.7)
11. BMI (Body mass index)
<18.5 (underweight) 39 (24.4)
18.5-24.99 (normal) 103 (64.3)
25-29.99 (pre-obese) 9 (5.6)
30.0-34.9 (Obesity class I) 2 (1.3)
35.0-39.9 (Obesity class II) 0
Above 40 (Obesity class III) 7 (4.4)

29
The data presented in Table 4 illustrates the demographic characteristics of

the students of 160 participants. More than one-third i.e. 62 students were

between 19-21 years and mean age of students was 20.5±1.2 years (range

from 17 to 24 years). Majority of students were Hindus (96.2%). More than half

of the students i.e. 54.4% were from urban area and majority of the students

were hosteler (79.4%). Out of 160 students, 54.4% belong to Socio-economic

Class III as per the Kuppuswamy socio-economic scale. 54.4% students were

vegetarians and majority i.e. 120 of the students belong to nuclear family.

Among all of them, 23 students had not attended health campaign. Only 2

students reported the history of addiction. Body Mass Index was calculated for

all students and it showed that 39 students were underweight and 9 were in

pre- obese stage, while more than half i.e. 64.3% students had normal BMI.

30
SECTION B: Analysis of Health Promoting Behaviour Score among
nursing students.
TABLE 5: Frequency and percentage distribution of Health Promoting
Behaviour Score among nursing students.
N=160
Level of Health Promoting Frequency Percentage (%)
Behaviour

Poor (≤51) 0 0

Average (52-79) 30 18.75%

Good (≥80) 130 81.25%

Table 5 and Figure 2 illustrates that among 160 undergraduate students, 130

had good health promoting behaviour. Only 30 students had 30 had average

health promoting behaviour and none of the students has poor health

promoting behaviour.

30

Average
Good

130

FIGURE 2: - Health Promoting Behaviour score among nursing students.

31
SECTION C: Analysis of Item-wise Mean and Rank of Health Promoting
Behaviour Scale among nursing students.
Table 6: Mean and rank of Health Promoting Behaviour Scale among
nursing students.
Items Mean ± S.D. Rank

1. Exercise for 30 minutes or more at least three times a 2.07±0.16 29

week (such as brisk walking, bicycling, aerobic dancing,

use stairs).

2. Eat poultry/fish/dried beans/eggs/nuts group each day. 1.90±0.67 31

3. Takes part in the games/sports events. 2.15±0.66 27

4. Limited intake of sugars and food containing sugars 2.48±0.56 13

(sweets).

5. Sleep for at least 8 hours daily. 2.77±0.43 1

6. Cooperate with others. 2.63±0.53 6

7. Do yoga for at least 30 minutes for relaxation each day. 2.24±0.73 25

8. Have regular breakfast. 2.65±0.51 4

9. Maintain adequate personal hygiene. 2.70±0.48 3

10. Drink 6-8 glasses of water daily. 2.71±0.53 2

11. Think of something good I had done during the daytime. 2.39±0.51 17

12. Have salad with each meal. 2.31±0.56 22

13. Discuss my problems with others. 2.31±0.52 22

14. Read the labels on the packed food items to identify 2.51±0.54 12

nutrients, fat and sodium content in it.

15. Eat fruits daily. 2.37±0.52 19

16. Seek medical help, in case of illness. 2.60±0.51 7

32
17. Praise and feel happy in others achievements. 2.64±0.55 5

18. Have milk/yogurt or cheese each day. 2.58±0.57 9

19. Have balanced diet. 2.56±0.59 10

20. Brush before going to bed daily. 2.53±0.62 11

21. Include muscle and bone strengthening activities, at 2.08±0.67 28

least 3 times per week.

22. Use internet sources for health maintenance (like 2.33±0.58 21

MedlinePlus, Health finder govt. app etc).

23. Use seat belts and helmets every time while travelling. 2.64±0.56 5

24. Handle the conflicts through discussion with others. 2.26±0.57 24

25. Take part in free-time physical activities (like 2.21±0.64 26

swimming/dancing/bicycling/gardening).

26. Accept the things in my life which I cannot change. 2.41±0.53 15

27. Perform necessary examination every month (i.e. 2.16±0.71 26

Breast self-examination for girls).

28. Eat less salt and salty items (<5gm i.e. just under a 2.38±0.55 18

teaspoon).

29. Go for regular health check-ups. 2.27±0.62 23

30. Follow the traffic rules. 2.59±0.61 8

31. Spend more than 60 minutes a day on physical activities 1.98±0.64 30

such as fast walking.

32. Able to deal with stressful situation. 2.40±0.51 16

33. Avoid using saturated fats and fatty foods. 2.43±0.54 14

34. Spend time with my close friends. 2.36±0.58 20

35. Able to control the stresses of my life. 2.31±0.78 22

33
Table 6 depicts the item wise rank of Health Promoting Behaviour Scale in

nursing students by calculating the mean and the standard deviation in which

item 5 from stress management domain has the highest mean 2.77, which

signifies that most of the students have 8 hours of sleep daily. Item 10 from

nutrition domain has the second highest mean i.e. 2.71 which reflects to be the

second most practiced health promoting behaviour among the 35 items listed.

Item 9 from health responsibility has the third highest mean i.e. 2.70. Whereas

Item no. 1 is third lowest mean i.e. 2.07 from physical activity domain which

signifies that students are not doing exercises for promoting healthy lifestyle.

Item 31from physical activity domain is the second lowest mean 1.98 which

signifies that students are less interested towards adopting additional health

benefits. Item 2 from nutrition domain has the lowest mean among total of 35

items, i.e. 1.90 which signifies that students are not in the habit of eating

nutritious things daily.

34
SECTION D: Analysis of Domain wise mean and rank of Health Promoting
Behaviour Score among nursing students.
TABLE 7: Domain wise mean and rank of Health Promoting Behaviour
Score among nursing students.

Aspects of health Mean ± S.D. Mean Rank

promoting behaviours percentage

Physical activity (5) 10.49±0.65 69.93% 6

Nutrition (11) 26.92±0.62 81.57% 3

Stress management (6) 14.64±0.59 81.33% 4

Healthy relationships (5) 12.34±0.58 82.26% 2

Health responsibilities (6) 14.63±0.62 81.27% 5

Safety (2) 5.21±0.59 86.83% 1

TOTAL SCORE 84.18±5.81

Table 7 illustrates that the overall mean score of Health promoting scale came

out as 84.18±5.81 which signifies that students were having reasonably good

orientation towards health promoting behaviour. The highest mean score in the

subscale was for safety i.e., 5.21±0.59 which signifies that the students were

more engaged towards adopting safety measures; and next to safety, highest

score was found for healthy relationships i.e.,12.34±0.58 which signifies that

students were more engaging themselves towards maintaining healthier

relationships and lowest was 10.49±0.65 for physical activity which signifies

that students were reluctant in performing physical activities as depicted by the

table.

35
SECTION E: Analysis of the Health Promoting Barriers among the
nursing students.
TABLE 8: Frequency and percentage distribution of Health Promoting
Barriers among the nursing students.
N-160

HEALTH PROMOTING BARRIERS Frequency (%)

YES

1. Lack of appropriate place of physical activity. 30 (18.8)

2. Time management problems due to academic hours. 121 (75.6)
3. Low self-esteem due to poor physical activity. 37 (23.1)
4. Intake of less nutritious diet, due to poor economic status. 39 (24.4)
5. Parents more focus towards academic achievement. 39 (24.4)
6. Lack of motivation to consume healthy nutrition. 43 (26.9)
7. Lack of information on healthy eating. 21 (13.1)
8. Easy accessibility of outside food nearby college. 83 (51.9)
9. Lack of knowledge towards maintaining healthy lifestyle. 13 (8.1)
10. Lack of will-power. 32 (20.0)
11. Irregular sleeping pattern due to late sleep time of 15 (9.4)
roommate/family members.
12. Spending more time on mobile phone. 89 (55.6)
13. Negative influence of peer group. 47 (29.4)

Table 8 illustrates that most of the students i.e., 121 students reported time

management problems due to college timings which signifies that they were

unable to perform health promoting activities due to their busy schedule

whereas 89 students reported that they spend more time on mobile phones.

The second least barrier reported is irregular sleep pattern due to late sleep

time of roommate/family members by 15 students. Only few students reported

lack of knowledge towards maintaining healthy lifestyle.

36
 Lack of appropriate place of physical activity 18.80%

Time management problems due to academic

75.60%
hours.

Low self-esteem due to poor physical activity. 23.10%

Intake of less nutritious diet, due to poor

24.40%
economic status.

Parents more focus towards academic

24.40%
achievement.

Lack of motivation to consume healthy nutrition. 26.90%

Lack of information on healthy eating. 13.10%

Easy accessibility of outside food nearby college. 51.90%

Lack of knowledge towards maintaining healthy

8.10%
lifestyle.

Lack of will-power. 20.00%

Irregular sleeping pattern due to late sleep time of

9.40%
roomate/family members.

Spending more time on mobile phone. 55.60%

Negative influence of peer group. 29.40%

0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8

PERCENTAGE

FIGURE 3: Graphical representation of Health Promoting Barriers among

nursing students.

37
SECTION F: Analysis of association between the Health Promoting
Behaviour of nursing students with the selected demographic variables.
TABLE 9: Association between the Health Promoting Behaviour of
nursing students with the selected demographic variables.

Demographic variables Health Promoting Behaviour df X2 P

Score

Average Good

1. Age (years)
17-19 11 32 2 0.084 0.959 NS
19-21 16 46
>21 13 42

2. Academic year
II 12 42 2 1.525 0.467 NS
III 18 41
IV 10 37

3. Residence
Urban 24 63 1 0.680 0.410 NS
Rural 16 57

4. Accommodation
Hosteller 29 98 1 1.54 0.215 NS
Day Scholar 11 22

5. Religion
Hindu 39 115 1 0.231 0.631 NS
Muslim and other 1 5

6. Dietary pattern
Vegetarian 24 63 1 0.735 0.693 NS
Non-vegetarian 7 23
Eggetarian 9 34

7. Socio-economic status
Class I - -
Class II 25 62 1 1.419 0.234 NS
Class III 15 58
Class IV - -
Class V - -

38
8. Type of family
Nuclear family 24 96 1 6.40 0.01*
Joint family 16 24
Extended family - -

9. Any health campaign

attended?
Yes 2 21 1 3.808 0.05*
No 38 99

10. Do you have any history

of addiction?
Yes 2 0 1 6.076 0.01*
No 38 120

11. BMI (Body Mass Index)

<18.5 12 27 4 4.390 0.356 NS
18.5-24.99 21 82
25.0-29.99 4 5
30.0-34.9 1 1
35.0-39.99 - -
Above 40 2 5

Note: Chi-Square test, level of significance ≤0.05, *Significant, NS- Non

significant
Table 9 depicted the association between the Health Promoting Behaviour and

selected demographic variables using the Chi-Square. The health promoting

behaviour was found significant with the type of family, any health campaign

and history of addiction. There was no association with age group, academic

year, residence, accommodation, religion, dietary pattern, socio-economic

status and BMI.

39
MAJOR FINDINGS OF THE STUDY

Summary of major findings of the study:

 More than one-third i.e. 62 (38.7%) students were between 19-21 years

with mean age of the students was 20.5±1.2 years (range from 17 to 24

years).

 Majority of students were Hindus (96.2%).

 More than half of the students were from urban area and majority 79.4%

students were hosteller.

 Out of 160 students, 54.4% of students belong to Socio-economic Class

III as per the Kuppuswamy socio-economic scale.

 54.4% of the students were vegetarians.

 3/4th (i. e.120) of the students were belonging from nuclear family.

 Among all of them, 23 (14.4%) students that are very huge in number

had attended health campaign.

 2 students reported the history of addiction.

 BMI (Body Mass Index) was calculated for all students and it showed

that 39 (24.4%) students were underweight and 9 (5.6%) were in pre-

obese stage, while more than half (i. e. 64.3%) students were in normal

BMI.

 The mean overall (Total) Health Promoting Behaviour Scale score was

84.18±5.81. The highest mean score in the subscale was 5.21±0.59 for

safety; and 12.34±0.58 for healthy relationships and lowest was

10.49±0.65 for physical activity.

 Most of the students 121 (75.6%) and 89 (55.6%) reported time

management problems due to college timings and spending of more

40
 time on mobile phones as barriers in promoting healthy lifestyle

respectively.

 A significant association was found between the Health Promoting

Behaviour and the selected demographic variables using the Chi-

Square (p≤0.05).

41
DISCUSSION

In developing countries like India, health promotion and health education are

two main pillars that are achieving an increased level of attention as it plays an

important role in health maintenance. One of the factors that positively

contributes to the quality of life is the Health promoting lifestyle of an individual.

Today’s worldwide research topic is focusing on the Health promoting lifestyle

among the students. College time is a transitional period in the life of the

students that offers good opportunities in a number of ways that helps them in

maintaining health promoting lifestyles. Many of the research studies conducted

in US and European countries, found that students were not interested in adopting

healthy behaviours in terms of physical activity and health eating 89. However, very

few studies are conducted in India regarding the assessment of health

promoting among the students. A person has a great potential to be healthy

and live a healthy life without any disease condition, when he/she engages in

health promoting lifestyle. The Health promoting behaviour score reflect the

nursing student’s commitment of health maintaining act, so better is the score,

better will be the health profile of a student.

Only Females were there in the study. In this study, overall mean Health

Promoting Behaviour Scale score was 84.18±5.81 and majority i.e. 130

students shows good level of health promoting behaviour (≥80).

It can be concluded that students were practicing moderate level of health

promoting behaviours. Previous studies also showed similar type of result

findings90 With regard to the health promoting behaviour subscales, the

students in this study scored highest in safety. In safety, 109 (65.12%)

42
students, use seat belts every time while travelling and 84 (52.5%) were

following the traffic rules.

The second highest score among the health promoting behaviour subscale

achieved by the students was healthy relationships. In healthy relationships,

these students were having a good score for interpersonal relations. Hindu is

the primary religion in India. Hossein et al91 reported that out of the domains

of Health promoting behaviour, the second highest score was found in

interpersonal relations which corresponds to our findings.

The next lowest score was for nutrition. The present study findings showed

that only 69 (43.12%) students ate fruits daily and 47 (29.37%) had their

breakfast daily. About 56.87% of our sample were not taking the fruits and

vegetables in their diet. This might be because majority students were hostelite

and they had to rely on mess food which only sometimes had vegetables and

usually not contains the fruits. Fast food consumption is said to be the barrier

of fruit and vegetable intake as well.92

The lowest score among the health promoting behaviour subscale achieved

by the students was physical activity which was consistent with other studies.93

The description of the findings could be that the nursing students have both

theoretical and clinical hours in the curriculum that makes their schedule busy

that makes them tired or exhausted to practice health promoting behaviours.

This could be due to the younger age students were new comers for this

course and were might not be aware of the health promoting behaviours.

Consistent result was not founded with the findings of other studies. 94

Similarly, while assessing the Health Promoting Barriers in the students, most

of the students i.e. 121 reported time management problems due to college

43
timings and 89 students reported spending of more time on mobile phones as

barriers in promoting healthy lifestyle. Sanjay et al.78 study findings reported

time management issues and lack of motivation were reported by the students

as the barriers in promoting healthy lifestyle which corresponds to our findings

of research study.

44
 CHAPTER V
SUMMARY, CONCLUSION
AND RECOMMENDATION
 SUMMARY, CONCLUSION AND RECOMMENDATION

This chapter gives a brief account of the present study including summary of

major findings, limitations, implications of the study and recommendations for

future research. A descriptive study was conducted among nursing students of

All India Institute of Medical Sciences, Jodhpur to assess their health promoting

behaviour and its barriers. The objectives of the study were:

1. To assess the health promoting behaviour among nursing students of

AIIMS, Jodhpur.

2. To determine the barriers in health promoting behaviour among nursing

students.

3. To find the association between health promoting behaviour of nursing

students with selected socio-demographic variables.

Sample of the study were undergraduate students of College of Nursing, All

India Institute of Medical Sciences, Jodhpur, Rajasthan. Tools for collecting data

included Demographical information, self-structured Health promoting

behaviour scale to assess the health promoting behaviour of students. Another

tool was used to assess the health promoting barrier of the students. A total of

160 students participated in the study by total enumerative sampling technique.

The students who were willing to participate were approached and all the

instructions were given to them verbally. Data was collected through structured

telephonic interview method. Informed verbal consent was taken prior to the

study. After interview, students were thanked for participating in the study. Data

was collected from 5 Nov 2020 to 7 Dec 2020 and analyzed with descriptive and

inferential statistics.

45
Strength of the study

 Extensive ROL (Review of Literature) has been done while conducting

the research.

 Sample was calculated with the help of sample size calculation formula.

 Emphasis was laid down on the barriers which results in adoption of their

unhealthy lifestyle.

Limitations of the study

 It is a single-centred study.

 The samples were limited to 160 students.

 Only females were taken into consideration.

IMPLICATIONS IN NURSING
Nursing is an art and science. It is based upon the current knowledge, i.e.,

frequently changing the discoveries, ideas, techniques, methodologies and

motivations. When nurses collaborate the science and art of nursing in their

practice then the quality of care provided to the clients it at maximum level that

profits innumerable persons. The findings of the study have implications on

nursing education, nursing practice, nursing administrators, nursing research

and general public.

a) Nursing Education

The student nurses of today will be the staff nurses, educators,

administrators, supervisors of future; this study has nursing implications

as well. As nurses are often expected as role models of health promoting

lifestyles and as leaders to activate communities for health promotion.

So, their beliefs, attitudes and behaviours may affect the lifestyle of

46
 general population. Nursing educators should conduct continuing nursing

education programmes and quality improvement programmes to nursing

officers to provide methods for interventions to be adopted to maintain

healthy lifestyle.

b) Nursing Practice

Educate the nursing students to overcome the barriers faced in

implementing the health promoting behaviour. There should be

promotion of physical activities in the students. Interventions must lay

down efforts in building self-efficacy for physical activities among

students. Interventions should be developed that specifically target to

reduce time-management related barriers to physical activities as well as

motivating the students towards less addiction of mobile phone use by

them.

c) Nursing Administration

The concept of extended and expanded role of the nurse offers many

opportunities for a nurse administrator to improve the quality of life of

students. The nurse administrator should co-ordinate her work along with

the preventive, creative and rehabilitative aspect of care.

 Formation of rules and regulations in mess department to ensure

the quality of food supplied to students for health promoting

behaviour of nursing students.

 Helping the nursing students in providing them less burden of

assignments, clinicals, etc.

47
 d) Nursing Research

Main focus of the nursing research is on the expansion of the scientific

base of knowledge in nursing profession and broad the scope of nursing.

Nursing research helps in the evidence-based practice. It will be

advantageous only if nurses are taking initiatives to conduct research in

future. Several many studies must be conducted in different settings with

the use of various innovative methods so as to improve the health

promoting behaviour practices among nursing students.

RECOMMENDATIONS

On the basis of the findings of the study, it is recommended that: -

 A similar study can be replicated with large sample size to strengthen

the study findings.

 Multi-centre study can be done along with the involvement of male

gender also in the study.

 Comparative study can be done between health and non-health

colleges.

PROBLEM FACED DURING STUDY

1. There were some network connection issues in connecting through

students at the time of data collection.

2. First year students were not available at the time of data collection.

3. Some of the students refused to participate in the study.

48
CONCLUSION

Poor health behaviour practices were noted for physical activity. Simply

knowing about the benefits of physical activity is not sufficient to translate it to

practice. Sedentary life-style among the students was distressing. Health

promotion planning is necessarily needed to motivate the students for regular

physical activities with an aim to preserve and maintain health along with the

disease prevention. An enabling environment could be provided for the

students. Physical activation promotion in the form of sports/exercise at the

college, should be supported with adequate infrastructure and its

maintenance. Time is an important factor which needs to be addressed. Work

and college timings should also be favourable. At a personal level, motivation

needs to come from within and needs to be persistent. Therefore, it is

recommended that attention need to be promoting for physical activities for the

students to have healthy lifestyle. Nursing educators should raise the concern

regarding the health promoting lifestyles.

49
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93. Nassar OS, Shaheen AM. Health-Promoting Behaviours of University

Nursing Students in Jordan. Health. 2014 November 28;6(19):2756-63.

94. Raj S, Senjam SS, Singh A. Assessment of Health Promoting Behaviour

and Lifestyle of Adolescents of a North Indian City. Int J Prev Med. 2013

October;4(10):1189–93.

62
APPENDICES
APPENDIX I (ETHICAL CLEARANCE CERTIFICATE)

63
 APPENDIX II
All India Institute of Medical Science Jodhpur, Rajasthan
Informed Assent Form

Title of Thesis/dissertation: - Health promoting behaviour and its barriers among

nursing students of AIIMS, Jodhpur.
Name of PG Student: Ms. Pratibha Sharma ([Link]. Nursing 1st Year)
Tel. No. 8396020776
Patient/Volunteer Identification No:
I,_______________________S/o or D/o______________________________
R/o __________________________________ give my full, free, voluntary
consent to be a part of the study “Health promoting behaviour and its barriers
among nursing students of AIIMS, Jodhpur.” The information and nature of
which has been explained to me in my own language to my full satisfaction. I
confirm that I have had the opportunity to ask questions.
I understand that my participation is voluntary and I am aware of my right to
option out of the study at any time without giving any reason.
I understand that the information collected about my child may be looked at by
responsible individual from AIIMS, Jodhpur or from regulatory authorities. I give
permission for these individuals.
Date: -_______________ __________________________
Place: _____________ Signature/Left thumb
impression
This to certify that the above consent has been obtained in my presence
Date: -________________ _________________________
Place: ________________ Signature of PG Student
1. Witness 1 2. Witness 2
____________________________ __________________________
Signature Signature
Name: _______________________ Name: _____________________
Address: _____________________ Address: ___________________

64
 परिशिष्ट - II
अखिल भारतीय आयु र्विज्ञान संस्थान

जोधपु र, राजस्थान
सूर्ित प्रपत्र
थीर्सस / शोध प्रबं ध का शीर्िक: - “स्वास्थ्य को बढावा दे ने वाले व्यवहार और एम्स, जोधपु र के नर्सिंग
छात्रों के बीि इसकी बाधाएं ”

पीजी छात्र का नाम: सुश्री प्रर्तभा शमाि ([Link] नर्सिंग प्रथम वर्ि)
दू रभार् क्रमांक- 8396020776

रोगी / स्वयं सेवक पहिान संख्या:

मैं,_________________________________पु त्र/बे टी___________________________
पता__________________________________ मेरी पू र्ि, मुक्त, स्वै खिक सहमर्त "स्वास्थ्य को

बढावा दे ने वाले व्यवहार और एम्स, जोधपु र के नर्सिंग छात्रों के बीि इसकी बाधाएं " का र्हस्सा बनने के
र्लए सहमर्त दें । र्जसकी जानकारी और स्वरूप मुझे अपनी भार्ा में अपनी पू र्ि संतुर्ि के र्लए समझाया
गया है । मैं पु र्ि करता हं र्क मुझे प्रश्न पू छने का अवसर र्मला है ।
मैं समझता हं र्क मेरी भागीदारी स्वैखिक है और मुझे र्बना र्कसी कारर् के र्कसी भी समय अध्ययन से

बाहर र्नकलने के अपने अर्धकार के बारे में पता है ।

मैं समझता हं र्क मेरे बच्चे के बारे में एकर्त्रत जानकारी को एम्स, जोधपु र के र्जम्मेदार व्यखक्त या
र्नयामक अर्धकाररयों द्वारा दे िा जा सकता है । मैं इन व्यखक्तयों को अनुमर्त दे ता हं ।
र्दनां क:_______________ ___________________________
स्थान: _______________ हस्ताक्षर / बाएं अं गूठे का र्नशान
यह प्रमार्र्त करने के र्लए र्क मेरी उपखस्थर्त में उपरोक्त सहमर्त प्राप्त हुई है ।
र्दनां क________________ ___________________________
जगह: ________________ पीजी छात्र के हस्ताक्षर
1. साक्षी 1 2. गवाह 2
____________________________ __________________________
हस्ताक्षर हस्ताक्षर
नाम: __________________________ नाम: _____________________

पता: __________________________ पता: _____________________

65
 APPENDIX III
DEMOGRAPHIC VARIABLES

INSTRUCTIONS: Following are the items related to personal data. You are requested
to provide some information about you.

DATE: -

ID NUMBER: -

1. Age (in years): -

a. 17-19
b. 19-21
c. >21

2. Class: -

3. Residence: -

a. Urban
b. Rural
c. Semi-urban

4. Accommodation: -

a. Hosteler
b. Day scholar

5. Religion: -

a. Hindu
b. Muslim and other

6. Dietary pattern: -

a. Vegetarian
b. Non-vegetarian
c. Eggetarian

7. Socio-economic status of the family: -

66
[Link] Education of Score Occupation of Score Updated Score
head head monthly
family
income in
rupees
(2020)
1. Postgraduate or 7 Professional 10 >199,862 12
professional
2. Graduate 6 Semi-professional 6 99,931- 10
degree 199,861
3. Higher 5 Arithmetic skill 5 74,755- 6
secondary Job 99,930
Certificate
4. Higher school 4 Skilled worker 4 49,962- 4
certificate 74,755
5. Middle school 3 Semi-skilled 3 29,973- 3
certificate worker 49,961
6. Literate, less 2 Unskilled worker 2 10,002- 2
than middle 29,972
school
certificate
7. Illiterate 1 Unemployed 1 ≤ 10, 001 1

Socio-economic class of the family: -

a. 26-29 Upper (I)

b. 16-25 Upper Middle (II)

c. 11-15 Lower Middle (III)

d. 5-10 Upper Lower (IV)

e. <5 Lower (V)

8. Type of family: -

a. Nuclear family
b. Joint family
c. Extended family

9. Any health campaign attended?

a. Yes
b. No

67
10. Do you have any history of addiction?

a. Yes
b. No

11. BMI of the student: -

a. Height (in cm): - _______

b. Weight (kg): - _________

BMI Nutritional status

a. Below 18.5 Underweight

b. 18.5-24.9 Normal weight

c. 25.0-29.9 Pre-obesity

d. 30.0-34.9 Obesity class I

e. 35.0-39.9 Obesity class II

f. Above 40 Obesity class III

68
 परिशिष्ट – III
जनस ांख्यिकीय प्रश्न
शनर्दे ि: र्नम्नर्लखित व्यखक्तगत डे टा से संबंर्धत आइटम हैं। आपसे अनुरोध है र्क आप अपने बारे में
कुछ जानकारी प्रदान करें ।

र्दनां क: आईडी नं बर:

1. आयु (वर्ों में): -

क. 17-19
ि. 19-21
ग. .21

2. कक्षा: -

3. र्नवास: -

क. शहरी

ि. ग्रामीर्

ग. अधि शहरी

4. आवास: -

क. छात्रावासी

ि. र्दन का र्वद्वान

5. धमि: -

क. र्हंदू

ि. मुखिम और अन्य

6. आहार पैटनि : -

क. शाकाहारी

ि. मां साहारी

ग. अण्डे का सेवन करने वाले

7. पररवार की सामार्जक-आर्थिक खस्थर्त : -

स्कोर सामार्जक आर्थिक वगि

क. 26-29 अपर (I)

ि. 16-25 अपर र्मर्डल (II)

ग. 11-15 लोअर र्मर्डल (III)

घ. 5-10 ऊपरी र्निला (IV)

ड. <5 लोअर (V)

69
 क्रमसंख्या पररवार के मुखिया की स्कोर पररवार के स्कोर रुपीज़ (2020) में स्कोर
र्शक्षा मुखिया का र्नधाि ररत मार्सक
व्यवसाय पाररवाररक आय
1. स्नातकोत्तर या पेशेवर 7 पेशेवर 10 > 199,862 12
2. स्नातक उपार्ध 6 अधि पेशेवर 6 99,931-199,861 10
3. उच्च माध्यर्मक 5 अंकगर्र्त 5 74,755-99,930 6
प्रमार्पत्र कौशल नौकरी
4. उच्च र्वद्यालय का 4 कुशल 4 49,962-74,755 4
प्रमार् पत्र कामगार
5. मध्य र्वद्यालय का 3 अर्द्ि कुशल 3 29,973-49,961 3
प्रमार् पत्र श्रर्मक
6. सार्हत्य, मध्य 2 अर्नपुर् 2 10,002-29,972 2
र्वद्यालय के प्रमार् कामगार
पत्र से कम
7. र्नरक्षर 1 बेरोज़गार 1 1 10, 001 1

8. पररवार का प्रकार: -

क. एकल पररवार
ि. संयुक्त पररवार
ग. र्वस्तृत पररवार

9. र्कसी भी स्वास्थ्य अर्भयान में भाग र्लया?

क. हााँ

ि. नहीं

10. क्या आपका कोई इर्तहास है? नशे की लत ?

क. हााँ

ि. नहीं

11. छात्र का बीएमआई: -

क. ऊाँिाई ( cm में): - _______ ि. वजन (र्कग्रा): - _________

बीएमआई पोषण ख्यथिशि

क. 18.5 से नीिे वजन
ि. 18.5-24.9 सामान्य वज़न
ग. 25.0-29.9 पूवि मोटापा
घ. 30.0-34.9 मोटापा वगि I
ड. 35.0-39.9 मोटापा वगि II
ि. 40 से ऊपर मोटापा वगि III

70
 APPENDIX IV
STRUCTURED HEALTH PROMOTING BEHAVIOUR SCALE

INSTRUCTIONS: This questionnaire contains statements about your present way of life or

personal habits. Please respond to each item as accurately as possible and try not skip any

item. Indicate the frequency with which you engage in each behaviour by circling: N for never,

S for sometimes, R for routinely. (N-1, S-2, R-3)

ITEMS SCORING

1 2 3

1. Exercise for 30 minutes or more at least three times a week (such

as brisk walking, bicycling, aerobic dancing, use stairs).

2. Eat poultry/fish/dried beans/eggs/and nuts group each day.

3. Takes part in the games/sports events.

4. Limited intake of sugars and food containing sugars (sweets).

5. Sleep for at least 8 hours daily.

6. Cooperate with others.

7. Do yoga for at least 30 minutes for relaxation each day.

8. Have regular breakfast.

9. Maintain adequate personal hygiene.

10. Drink 6-8 glasses of water daily.

11. Think of something good I had done during the daytime.

12. Have salad with each meal.

13. Discuss my problems with others.

14. Read the labels on the packed food items to identify nutrients, fat

and sodium content in it.

15. Eat fruits daily.

16. Seek medical help, in case of illness.

17. Praise and feel happy in others achievements.

18. Have milk/yogurt or cheese each day.

19. Have balanced diet.

71
20. Brush before going to bed daily.

21. Include muscle and bone strengthening activities, at least 3 times

per week.

22. Use internet sources for health maintenance (like MedlinePlus,

Health finder govt. app etc).

23. Use seat belts and helmets every time while travelling.

24. Handle the conflicts through discussion with others.

25. Take part in free-time physical activities (like

swimming/dancing/bicycling/gardening).

26. Accept the things in my life which I cannot change.

27. Perform necessary examination every month (i.e. Breast self-

examination for girls).

28. Eat less salt and salty items (<5gm i.e. just under a teaspoon)

29. Go for regular health check-ups.

30. Follow the traffic rules.

31. Spend more than 60 minutes a day on physical activities such as

fast walking.

32. Able to deal with stressful situation.

33. Avoid using saturated fats and fatty foods.

34. Spend time with my close friends.

35. Able to control the stresses of my life.

72
 परिशिष्ट - IV
हेल्थ प्रोमोश ां ग बीहीशियि स्केल

शनर्दे ि: इस प्रश्नावली में आपके वतिमान जीवन या व्यखक्तगत आदतों के बारे में कथन हैं। कृपया प्रत्ये क आइटम

का यथासंभव सटीक उत्तर दें , और र्कसी भी आइटम को छोड़ने का प्रयास न करें । उस आवृर्त्त को इं र्गत करें

र्जसके साथ आप िक्कर लगाकर प्रत्ये क व्यवहार में संलग्न हैं: कभी नहीं के र्लए एन, कभी-कभी एस के र्लए,

र्नयर्मत रूप से आर के र्लए। (एन -1, एस -2, आि -3)

प्रश्न स्कोररं ग

1 2 3

1. मैं सप्ताह में कम से कम तीन बार 30 र्मनट या इससे अर्धक व्यायाम करती हं (जैसे तेज

िलना, साइर्कल िलाना, एरोर्बक डांर्संग, सीर्ढयों का उपयोग करना)।

2. मैं प्रत्ये क र्दन पोल्ट्र ी / मछली / सूिे बीन्स / अंडे / और नट् स िाती हं।

3. िेल में भाग लेती हं।

4. शक्कर और शक्कर युक्त भोजन (र्मठाई) का सीर्मत में सेवन करती हं।

5. रोजाना कम से कम 8 घंटे की नींद लेती हं।

6. दू सरों के साथ सहयोग करती हं।

7. प्रत्ये क र्दन र्वश्राम के र्लए कम से कम 30 र्मनट तक योग करती हं।

8. र्नयर्मत नाश्ता करती हं।

9. पयाि प्त व्यखक्तगत स्विता बनाए रिती हं।

10. रोज 6-8 र्गलास पानी पीती हं।

11. कुछ अिा सोिती हं जो मैंने र्दन के समय र्कया होता है।

12. प्रत्ये क भोजन के साथ सलाद लेती हं।

13. मैं अपनी समस्याओं पर दू सरों के साथ ििाि करती हं।

14. पोर्क तत्ों, वसा और सोर्डयम सामग्री की पहिान करने के र्लए पैक्ड िाद्य पदाथों पर

लेबल पढती हं।

73
15. रोजाना फलों का सेवन करती हं ।

16. बीमारी की खस्थर्त में र्िर्कत्सकीय सहायता लेती हं।

17. प्रशंसा और दू सरों की उपलखियों में िुशी महसूस करती हं।

18. प्रत्ये क र्दन दू ध / दही या पनीर का सेवन करती हं।

19. संतुर्लत आहार लेती हं।

20. रोजाना र्बस्तर पर जाने से पहले ब्रश करती हं।

21. मां सपेर्शयों और हर्ियों को मजबूत करने वाली गर्तर्वर्धयों को प्रर्त सप्ताह कम से कम

3 बार शार्मल करती हं।

22. स्वास्थ्य रिरिाव के र्लए इं टरनेट स्रोतों का उपयोग करती हं। (जैसे मेडलाइनप्लस,

स्वास्थ्य िोजक सरकारी ऐप)

23. यात्रा करते समय हर बार सीट बेल्ट् और हेलमेट का प्रयोग करती हं।

24. दू सरों के साथ ििाि के माध्यम से संघर्ि को संभालती हं।

25. िाली समय में, शारीररक गर्तर्वर्धयों में (जैसे तैराकी / नृ त्य / साइर्कल िलाना / बागवानी)

भाग लेती हं।

26. मैं अपने जीवन में उन िीजों को स्वीकार करती हं र्जन्हें मैं बदल नहीं सकती।

27. हर महीने शरीर से जुड़ी आवश्यक परीक्षा करती हं। (यानी लड़की के र्लए स्तन की स्व-

परीक्षा )

28. कम नमक और नमकीन िीजें िाती हं। (<5g m यानी र्सफि एक िम्मि से कम कम)

29. र्नयर्मत स्वास्थ्य जां ि के र्लए जाती हं।

31. र्दन में 60 र्मनट से अर्धक समय शारीररक गर्तर्वर्धयों जैसे तेज िलना पर ििि करती हं।

32. तनावपूर्ि खस्थर्त से र्नपटने में सक्षम रहती हं।

33. संतृप्त वसा और वसायुक्त िाद्य पदाथों के उपयोग से बिती हं।

34. अपने करीबी दोस्तों के साथ समय र्बताती हं।

35. मेरे जीवन के तनावों को र्नयंर्त्रत करने में सक्षम रहती हं।

74
 APPENDIX V

STRUCTURED HEALTH PROMOTING BARRIERS QUESTIONAIRE

INSTRUCTIONS: Tick mark the health promoting barriers that you face in implementing

Health Promoting Behaviour.

HEALTH PROMOTING BARRIERS Yes No

1. Lack of appropriate place of physical activity.

2. Time management problems due to academic hours.

3. Low self-esteem due to poor physical activity.

4. Intake of less nutritious diet, due to poor economic

status.
5. Parents more focus towards academic achievement.

6. Lack of motivation to consume healthy nutrition.

7. Lack of information on healthy eating.

8. Easy accessibility of outside food nearby college.

9. Lack of knowledge towards maintaining healthy

lifestyle.
10. Lack of will-power.

11. Irregular sleeping pattern due to late sleep time of

roommate/family members.
12. Spending more time on mobile phone.

13. Negative influence of peer group.

75
 परिशिष्ट – V

स्व स्थ्य को बढ ि र्दे ने ि ले अििोध प्रश्न िली

शनर्दे ि: स्व स्थ्य को बढ ि र्दे ने ि ले व्यिह ि को ल गू किने में आने ि ली ब ध ओां को िोकने ि ले स्व स्थ्य

को शिशिि किें ।

स्व स्थ्य को बढ ि र्दे ने ि ले अििोध ह ाँ नही ां

1. शारीररक गर्तर्वर्ध के उपयुक्त स्थान का अभाव।

2. शैक्षर्र्क समय के कारर् समय प्रबंधन की समस्याएं ।

3. कम शारीररक गर्तर्वर्ध के कारर् कम आत्मसम्मान ।

4. कम पौर्िक आहार का सेवन, िराब आर्थिक खस्थर्त के कारर्।

5. माता-र्पता शैक्षर्र्क उपलखि की ओर अर्धक ध्यान केंर्ित करते हैं।

6. स्वस्थ पोर्र् का उपभोग करने के र्लए प्रेरर्ा का अभाव।

7. स्वस्थ भोजन पर जानकारी का अभाव।

8. पास के कॉलेज के बाहर के भोजन की आसान पहुाँि ।

9. स्वस्थ जीवन शैली को बनाए रिने के र्लए ज्ञान की कमी ।

10. इिा-शखक्त का अभाव।

11. रूममेट / पररवार के सदस्यों के दे र से सोने के कारर् अर्नयर्मत नींद का पैटनि ।

12. मोबाइल फोन पर अर्धक समय र्बताना।

13. सहकमी समूह का नकारात्मक प्रभाव ।

यर्द कोई अन्य है, तो उल्लेि करें ____________

76
 APPENDIX VI

LETTER REQUESTING OPINION AND SUGGESTION FROM EXPERTS

FOR CONTENT VALIDITY OF TOOL

77
 APPENDIX VII

LIST OF EXPERTS OF TOOL VALIDATION

S. No Name of experts

1 Dr. Siyaram Didel

Assistant Professor
Department of Pediatric
AIIMS, Jodhpur

2 Mrs. Gomathi Arumugam

Associate Professor
College of Nursing
AIIMS, Jodhpur

3 Dr. Mrs. Rupinder Deol

Assistant Professor
Pediatric Nursing
AIIMS, Rishikesh

4 Mr. Hansmukh Jain

Associate Professor
College of Nursing
AIIMS, Patna

5. Dr. Theresa Leonda Mendoca

Laxmi memorial College of Nursing
Mangalore Karnataka

6. Mrs. Malar Kodi

Assistant Professor
College of Nursing
AIIMS, Rishikesh

7. Ms. Poonam Joshi

Lecturer
College of Nursing
AIIMS, New Delhi

78
 APPENDIX VIII

MASTER SHEET

A. Demographical variables of subjects

1 2 3 4 5 6 7 8 9 10 11
1 1 3 1 1 1 3 3 1 2 2 2
2 1 4 2 1 1 1 3 1 2 2 1
3 2 3 1 1 1 1 3 1 1 2 2
4 1 4 2 1 1 1 3 1 1 2 2
5 2 4 2 1 2 1 3 1 1 2 2
6 1 3 1 2 1 1 3 1 2 2 2
7 2 3 1 1 1 2 3 2 2 2 2
8 3 4 2 1 1 2 3 1 2 2 1
9 2 4 2 1 1 3 3 2 2 2 2
10 1 3 1 1 1 1 4 2 2 2 2
11 1 4 2 1 1 1 3 1 1 2 2
12 2 4 1 2 1 2 3 1 2 2 2
13 2 3 1 1 1 3 3 2 2 2 2
14 2 4 2 1 1 1 3 1 2 2 1
15 1 4 1 1 1 1 3 1 2 2 2
16 1 3 1 1 1 3 3 1 1 2 2
17 3 4 1 1 1 1 4 1 2 2 1
18 1 4 1 1 1 1 3 1 2 2 2
19 3 2 1 2 1 1 3 2 1 2 1
20 2 4 1 1 1 2 3 1 2 2 2
21 2 3 1 1 1 1 4 2 2 2 2
22 1 4 2 1 1 3 4 1 2 1 3
23 1 4 2 1 1 1 3 1 2 2 2
24 2 4 1 2 1 1 3 1 2 2 2
25 3 3 2 1 1 1 3 1 1 2 2
26 3 3 2 2 1 3 3 1 2 2 6
27 3 3 1 1 1 2 4 1 2 2 1
28 1 3 2 1 1 1 3 1 1 2 2
29 1 2 2 1 1 3 3 2 1 2 2
30 2 3 1 1 1 1 3 1 2 2 1
31 3 3 1 1 1 1 4 1 2 2 2
32 2 3 1 1 1 1 3 1 2 2 3
33 3 3 1 1 1 1 3 1 2 2 2
34 3 3 2 2 1 1 3 1 2 2 1
35 1 3 2 2 1 3 3 1 2 2 2
36 3 3 1 2 1 1 3 2 2 2 2
37 1 2 1 2 1 3 4 1 2 2 6
38 2 2 2 1 1 3 3 1 2 2 1
39 3 2 1 1 1 3 3 1 2 2 3
40 1 2 1 1 1 1 4 1 2 2 2
41 2 2 1 1 1 2 4 1 2 2 2
42 2 2 1 1 1 1 4 1 2 2 2
43 3 2 1 1 1 3 4 1 2 2 2
44 2 2 2 1 1 1 4 1 2 2 1
45 2 2 1 1 1 1 4 1 2 2 1
46 1 2 2 1 1 1 4 1 2 2 2
47 2 2 2 1 1 1 4 2 2 2 2
48 1 2 1 1 1 1 4 1 2 2 2
49 3 2 1 1 1 1 3 2 2 2 4
50 1 3 2 1 1 3 3 2 2 2 2
51 2 3 1 1 1 2 3 1 2 2 2
52 3 3 1 2 1 3 4 1 1 2 2
53 2 3 2 2 1 1 4 2 2 2 2

79
 54 1 3 2 1 1 3 4 2 2 2 1
55 1 3 2 1 1 3 4 1 2 2 2
56 3 3 1 1 1 1 3 2 2 2 2
57 3 3 2 1 1 1 3 2 2 2 2
58 2 3 1 2 1 1 4 1 1 2 1
59 3 3 2 2 1 1 4 1 2 1 3
60 2 3 2 1 1 1 4 2 2 2 2
61 2 3 1 1 1 1 4 1 2 2 2
62 2 3 1 2 1 3 4 2 2 2 2
63 2 2 1 1 1 1 4 1 2 2 2
64 3 2 2 1 1 1 4 1 2 2 2
65 2 2 2 1 1 2 4 1 2 2 2
66 2 2 1 1 1 2 4 2 2 2 1
67 1 2 1 1 1 1 3 1 2 2 2
68 3 2 1 1 1 3 3 1 2 2 2
69 2 2 2 1 1 1 3 2 2 2 2
70 2 2 2 2 1 1 3 1 2 2 1
71 3 2 2 2 1 1 3 1 2 2 3
72 2 2 1 1 1 3 4 2 2 2 2
73 2 2 2 1 1 1 4 1 2 2 6
74 1 3 2 1 2 2 4 1 2 2 2
75 2 2 2 1 1 2 4 1 2 2 1
76 2 2 2 1 1 3 4 2 2 2 1
77 2 2 1 2 1 3 3 1 2 2 1
78 3 4 1 1 1 1 3 1 2 2 2
79 3 3 2 1 2 2 3 1 1 2 1
80 3 4 2 1 1 1 3 1 2 2 2
81 3 3 1 1 1 1 3 1 2 2 2
82 3 4 2 1 1 1 3 1 2 2 2
83 3 4 2 2 1 3 4 1 2 2 2
84 3 4 1 1 1 1 4 1 1 2 2
85 3 4 1 1 1 1 4 1 1 2 2
86 3 4 2 1 1 1 4 2 2 2 1
87 3 4 2 1 1 2 4 1 2 2 2
88 3 3 1 1 1 2 3 1 2 2 1
89 3 4 1 2 1 1 3 1 2 2 1
90 3 4 1 1 1 2 3 1 2 2 3
91 3 4 1 1 1 1 3 1 2 2 1
92 3 2 2 1 2 2 3 1 2 2 3
93 1 3 1 1 1 1 3 2 2 2 2
94 1 4 2 1 1 1 4 1 2 2 6
95 2 4 1 2 1 3 4 1 2 2 2
96 3 3 2 1 1 1 3 1 1 2 2
97 3 3 2 2 1 1 3 1 2 2 6
98 3 3 1 1 1 2 4 1 2 2 1
99 2 3 2 1 1 3 3 1 1 2 2
100 2 2 2 1 1 3 3 2 1 2 2
101 2 3 1 1 1 1 3 1 2 2 1
102 1 4 1 1 1 3 3 1 2 2 2
103 1 4 1 1 1 3 3 1 2 2 2
104 1 4 1 1 1 1 4 1 2 2 2
105 1 2 1 1 1 1 3 1 1 2 2
106 2 3 1 2 1 3 3 2 1 2 2
107 1 4 1 1 1 2 3 1 2 2 3
108 2 4 1 1 1 1 4 2 2 2 2
109 2 3 2 1 1 1 4 1 2 2 6
110 1 4 2 1 1 3 3 1 2 2 2
111 2 4 1 2 1 3 3 1 2 2 1
112 3 3 2 1 1 1 3 1 2 2 1
113 2 2 2 1 1 2 3 1 1 2 2
114 2 2 1 1 1 2 3 1 2 2 6
115 1 2 1 1 1 1 3 2 2 2 1
116 3 2 1 1 1 3 3 1 2 2 2

80
117 2 3 2 1 1 3 3 1 2 2 2
118 2 3 1 1 1 2 4 2 2 2 2
119 2 4 1 1 1 1 4 1 2 2 2
120 1 3 2 1 1 1 4 1 2 2 2
121 2 4 2 1 2 1 4 1 2 2 2
122 1 3 1 2 1 3 3 1 2 2 2
123 2 2 1 1 1 2 3 2 2 2 2
124 3 4 2 1 1 2 3 1 2 2 1
125 2 4 2 1 1 3 3 2 2 2 2
126 1 3 1 1 1 3 4 2 2 2 2
127 1 4 2 1 1 1 3 1 1 2 2
128 3 3 2 2 1 1 3 1 1 2 2
129 2 3 2 2 1 3 3 1 2 2 2
130 3 3 1 2 1 1 3 2 2 2 2
131 1 2 1 2 1 3 4 1 2 2 1
132 2 2 2 1 1 1 3 1 2 2 3
133 3 2 1 1 1 3 3 1 2 2 2
134 1 2 1 1 1 1 4 1 2 2 2
135 2 2 1 1 1 2 4 1 2 2 2
136 2 2 1 1 1 1 4 1 2 2 2
137 2 2 1 1 1 1 4 1 2 2 1
138 2 3 1 2 1 3 4 1 2 2 1
139 1 2 1 1 1 1 4 1 2 2 2
140 3 2 2 1 1 1 4 2 2 2 2
141 2 2 2 1 1 2 4 1 2 2 2
142 2 2 1 1 1 2 4 2 2 2 4
143 3 4 2 2 1 3 4 2 2 2 2
144 3 4 1 1 1 1 4 1 2 2 2
145 3 4 1 1 1 3 4 1 1 2 2
146 3 4 2 1 1 1 4 2 2 2 2
147 3 4 2 1 1 2 4 2 2 2 2
148 3 4 1 1 1 2 3 1 2 2 2
149 1 4 2 1 1 1 4 1 2 2 1
150 2 3 1 2 1 1 4 2 2 2 1
151 3 3 2 1 1 1 3 1 2 2 2
152 3 3 2 2 1 1 3 1 2 2 2
153 3 3 2 1 2 2 4 1 2 2 2
154 2 2 2 1 1 2 4 2 2 2 1
155 2 2 2 1 1 1 4 2 2 2 1
156 2 2 1 2 1 3 3 1 2 2 1
157 3 3 1 1 1 1 3 1 2 2 2
158 1 2 2 1 1 3 4 1 2 2 1
159 1 2 1 1 1 1 4 1 2 2 1
160 1 2 2 1 1 1 4 1 2 2 2

81
B. Health promoting behaviour score of nursing students

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35

1 3 2 3 3 1 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

2 2 1 3 2 2 2 2 3 3 3 3 3 2 2 3 2 2 3 3 1 2 1 2 2 2 3 2 2 1 3 3 3 2 2 2

3 2 1 2 2 3 3 2 3 3 3 2 3 2 3 2 3 3 2 3 3 2 3 3 2 2 2 2 2 3 3 2 2 2 2 3

4 2 2 1 3 3 3 3 3 3 3 2 2 3 3 3 2 3 3 1 1 2 2 3 2 2 2 3 2 3 3 3 3 2 3 3

5 2 1 3 2 3 2 3 3 3 3 2 2 2 2 2 3 2 2 3 3 2 3 3 2 2 3 3 3 2 3 2 2 3 3 2

6 2 2 2 3 3 3 2 3 3 3 3 3 2 2 3 3 3 3 3 3 2 2 3 2 2 2 3 3 2 3 1 2 3 2 3

7 2 2 1 3 3 3 2 2 2 3 3 2 2 2 2 3 3 3 3 1 1 2 1 3 2 3 1 3 2 3 1 2 3 2 3

8 3 2 2 2 3 3 1 3 3 2 3 2 3 2 3 3 3 3 2 1 2 2 3 3 3 3 2 3 2 3 1 2 3 3 3

9 2 2 2 2 2 3 2 3 3 3 3 2 2 2 2 3 2 2 2 3 2 2 3 2 2 2 2 2 3 3 2 2 2 1 2

10 2 2 2 3 2 2 3 2 2 3 3 3 2 3 2 3 3 2 3 2 2 1 2 2 2 2 3 2 1 3 1 2 2 2 2

11 3 2 3 3 2 3 2 3 3 3 2 3 1 3 2 2 3 3 3 3 2 2 3 2 2 1 3 3 3 3 2 1 3 2 2

12 1 3 3 2 3 3 1 3 3 3 2 2 2 2 3 3 2 3 2 1 1 3 3 3 2 2 3 2 1 3 2 2 2 3 2

13 2 2 2 3 3 2 2 3 3 3 2 2 3 3 2 2 2 2 3 3 2 2 3 2 2 2 3 3 2 3 2 2 2 3 3

14 2 1 1 2 3 3 2 3 3 3 2 3 3 2 2 3 3 2 2 3 2 3 3 3 2 2 3 2 2 3 2 2 2 3 2

15 2 1 2 3 3 3 2 1 3 3 2 2 3 2 2 3 3 3 2 3 2 3 3 3 2 2 3 3 2 3 1 3 3 2 3

16 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 2 2 3 2 2 2 3 3 2 3 2 2 3 3 2

17 2 1 1 2 3 3 2 3 3 3 2 3 3 2 2 3 3 2 2 3 2 3 3 3 2 2 3 2 2 3 2 2 2 3 2

18 2 2 2 2 3 3 2 2 3 2 2 2 2 2 2 3 2 2 3 2 2 2 3 2 2 2 3 2 2 3 2 2 2 2 2

19 2 1 2 3 3 3 1 3 3 3 3 3 2 3 2 3 3 3 3 2 2 2 3 2 2 3 3 3 2 3 2 3 2 3 3

20 2 2 2 2 3 3 2 3 3 3 3 2 2 2 3 3 3 3 3 2 2 2 2 3 2 3 3 2 2 3 2 3 1 3 3

21 1 1 2 3 3 3 1 3 3 3 2 2 2 2 2 3 2 3 3 2 2 2 3 2 2 2 3 3 2 2 1 2 2 3 3

82
22 1 1 2 2 3 3 2 3 3 2 2 2 1 3 2 2 3 3 3 1 1 2 3 2 1 3 3 2 1 3 2 2 3 2 2

23 2 2 2 3 3 2 2 2 3 3 2 3 2 3 3 3 2 3 3 2 2 2 3 2 2 2 3 3 3 3 2 2 3 2 2

24 2 2 3 3 3 1 3 2 2 2 2 2 3 2 3 2 3 3 3 3 2 2 3 3 3 2 3 2 3 3 1 2 2 3 3

25 2 2 3 2 3 3 2 3 3 3 3 2 2 2 2 3 3 2 2 3 2 3 3 2 2 3 2 2 2 3 2 3 2 2 3

26 2 2 2 3 3 2 1 3 3 3 3 2 3 3 2 2 2 2 3 3 1 2 3 2 2 2 3 2 3 3 2 2 2 2 2

27 2 2 2 3 3 3 2 3 3 3 2 2 2 3 2 3 3 3 3 2 3 3 3 2 2 3 2 3 2 3 2 2 3 3 3

28 2 1 2 3 2 2 1 3 3 2 3 3 2 2 2 3 3 2 2 2 2 2 2 2 2 2 2 2 2 3 1 2 2 2 2

29 2 2 2 2 3 3 3 3 3 3 2 3 3 3 3 3 3 3 3 3 2 2 3 3 2 3 3 2 2 3 2 3 3 3 3

30 1 1 2 3 2 2 1 2 3 3 2 2 2 3 2 2 3 3 2 3 2 2 3 2 1 2 3 3 2 3 3 2 3 2 2

31 2 1 2 2 2 2 1 2 3 3 2 2 2 2 2 2 2 3 2 3 2 2 3 2 1 2 1 3 3 3 1 2 2 2 1

32 2 2 2 2 3 3 2 3 3 3 3 3 2 2 3 3 3 3 3 3 2 2 3 2 2 2 1 2 1 3 1 2 3 2 3

33 2 2 1 3 3 3 2 3 3 2 2 2 3 3 2 3 3 2 3 3 2 2 3 3 2 2 1 3 2 3 2 2 3 3 3

34 1 1 1 2 3 3 2 2 3 3 2 2 2 3 2 2 3 2 3 3 1 2 2 2 2 2 3 3 2 3 2 2 3 3 2

35 2 2 2 2 3 3 2 3 3 3 3 2 2 3 2 3 3 3 3 3 2 3 3 2 2 3 2 2 2 3 2 3 2 2 3

36 2 2 3 2 3 3 2 3 3 3 2 2 2 2 2 3 3 3 3 2 3 3 2 2 2 2 3 2 2 3 2 2 2 2 3

37 2 2 2 3 3 3 2 3 3 3 2 3 2 2 2 3 3 3 3 3 2 2 3 2 2 2 2 3 2 3 2 2 2 2 2

38 1 1 2 3 2 3 1 3 3 3 2 2 2 3 2 3 3 3 3 3 2 1 3 2 2 3 1 2 2 3 1 3 3 2 2

39 1 2 1 3 3 3 1 3 3 3 2 3 2 2 3 2 3 2 3 3 2 3 3 2 2 2 2 2 2 3 2 2 3 3 2

40 2 2 2 3 3 3 3 3 3 3 3 3 2 3 2 2 2 3 3 3 2 3 3 3 2 3 2 2 2 3 2 3 3 2 2

41 2 3 2 2 3 3 1 3 3 3 3 3 2 3 3 3 3 3 3 2 3 2 3 3 2 2 2 2 2 3 2 3 2 2 3

42 2 2 1 2 2 3 2 3 3 3 3 2 2 3 2 3 3 3 3 1 1 2 3 2 2 3 2 2 2 3 2 3 2 3 2

43 2 1 1 2 3 3 2 3 3 3 3 2 3 3 2 3 3 3 3 3 1 2 3 3 2 2 3 3 2 3 2 3 3 3 3

44 1 2 2 2 3 3 3 3 3 3 2 2 2 2 2 3 3 3 3 3 1 2 3 2 1 2 1 3 3 3 2 2 2 3 2

45 2 2 2 2 3 3 2 3 2 3 3 2 3 2 2 2 3 1 3 3 1 3 3 2 2 2 3 3 3 3 2 3 3 2 3

83
46 2 1 2 2 3 3 2 3 3 3 3 3 2 2 2 3 3 3 3 3 2 3 3 2 2 3 3 3 2 3 1 3 3 3 2

47 2 1 1 3 3 3 1 3 3 3 3 3 3 3 2 3 3 3 3 2 1 2 3 2 2 2 1 3 2 3 1 2 3 3 3

48 3 1 3 2 3 2 3 3 3 3 2 3 2 3 3 2 3 3 3 3 2 2 3 2 2 2 1 3 3 3 2 2 2 3 2

49 2 1 2 2 3 3 1 3 3 3 3 2 3 2 2 2 3 3 2 1 2 3 2 3 2 2 2 1 1 3 2 3 2 3 2

50 2 2 2 3 3 2 2 3 2 2 2 2 2 3 2 2 2 2 3 2 2 2 3 2 2 2 2 3 3 3 2 2 2 2 2

51 2 3 2 1 3 3 3 3 3 3 2 2 2 2 3 3 3 2 3 2 2 2 3 2 2 2 2 2 1 3 2 3 2 3 2

52 3 2 2 3 3 2 3 3 3 3 3 3 2 3 3 3 3 3 3 3 2 3 3 3 2 3 3 2 3 3 3 2 3 3 2

53 1 1 1 2 2 3 3 3 3 3 3 2 3 1 3 2 2 3 3 1 3 2 3 1 2 3 2 2 1 3 3 2 2 2 2

54 2 1 2 3 3 3 2 3 3 3 3 3 2 2 3 3 3 3 3 2 2 2 3 2 2 3 2 2 3 3 2 2 3 2 3

55 3 2 3 1 3 2 2 3 3 3 2 2 2 3 2 3 2 3 3 2 3 3 3 2 3 3 1 2 2 3 2 3 2 3 3

56 1 1 1 2 3 3 1 2 3 3 2 2 2 2 2 3 3 3 3 2 1 2 3 2 1 2 2 1 2 3 1 2 2 2 2

57 2 1 2 2 2 2 2 3 3 3 2 2 2 3 3 2 3 1 3 2 2 2 3 2 2 2 2 3 3 2 1 3 2 3 2

58 2 2 2 3 2 3 3 3 3 3 2 2 2 2 3 2 3 3 3 3 3 2 3 3 2 2 2 2 2 3 2 2 3 2 2

59 2 1 2 2 3 3 1 2 3 3 2 2 1 2 2 2 3 3 2 2 1 2 3 1 2 2 2 2 2 3 2 2 2 1 2

60 2 2 2 2 3 2 2 3 3 3 2 3 2 3 2 3 2 3 2 3 2 3 2 2 2 2 2 3 3 3 2 2 3 2 2

61 2 2 2 3 3 3 2 3 3 3 2 2 2 3 2 2 3 2 3 2 2 3 3 3 2 2 2 3 2 3 2 3 3 3 2

62 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 1 2 2 2 2 2 1 2 2 2 2

63 1 1 1 3 3 3 2 3 3 3 3 2 2 2 3 2 3 3 3 3 3 2 3 2 1 2 1 3 2 3 3 3 2 1 3

64 2 1 2 2 3 3 2 3 3 3 3 2 3 2 2 2 3 2 3 2 2 2 3 3 2 3 1 2 1 3 2 3 2 2 2

65 2 3 2 3 3 3 3 3 3 3 3 3 2 3 3 3 3 3 3 3 3 2 3 3 2 2 2 3 2 3 3 3 3 3 2

66 2 2 2 2 3 3 1 3 3 3 2 2 3 2 2 3 3 2 3 2 1 1 2 3 2 2 1 2 2 3 3 2 2 3 3

67 3 2 1 3 3 3 2 2 3 3 2 2 2 3 2 2 3 3 3 1 2 3 2 3 3 3 2 3 1 3 2 3 2 3 3

68 3 2 2 3 3 2 2 3 3 3 2 2 2 3 3 3 3 2 2 3 3 3 3 2 3 3 1 3 3 3 2 2 2 2 3

69 1 1 2 2 3 2 2 3 3 3 2 2 2 3 2 1 3 3 3 3 1 1 3 1 2 2 1 2 2 3 1 2 1 3 2

84
70 2 2 3 2 3 3 3 3 3 3 2 3 2 3 2 2 3 3 3 2 3 2 2 2 2 2 3 2 2 3 3 2 3 2 2

71 1 1 2 3 3 3 2 3 3 3 3 2 2 3 2 2 3 1 3 3 1 2 3 3 1 2 1 3 2 3 1 2 2 2 3

72 3 1 3 3 3 3 2 3 3 3 3 2 2 3 2 3 3 3 3 2 2 2 2 2 3 3 2 3 2 3 2 3 2 2 3

73 1 1 1 2 2 3 1 2 3 2 2 2 1 2 2 2 3 3 3 2 1 2 3 2 1 3 1 3 1 3 1 3 2 2 2

74 2 3 3 1 2 3 2 3 3 2 2 2 2 2 3 3 3 2 3 2 2 2 2 3 3 3 1 2 2 3 2 3 2 3 2

75 2 2 2 2 2 3 1 3 3 3 3 2 2 3 3 2 2 3 3 3 1 2 3 1 2 2 3 3 2 3 2 2 2 2 2

76 2 1 2 3 3 3 2 3 3 3 3 2 3 3 2 3 3 2 2 2 2 2 3 2 2 2 2 3 3 3 2 2 2 3 3

77 2 1 1 2 2 3 1 2 3 3 1 2 2 3 2 1 3 1 2 3 1 2 3 2 2 1 1 3 1 3 1 1 2 2 1

78 3 1 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 1 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

79 2 2 2 3 3 3 2 2 3 2 3 2 3 2 2 3 3 2 3 2 2 3 2 3 2 3 3 3 2 2 3 3 2 3 3

80 2 3 3 2 3 3 2 3 3 3 2 3 2 3 2 2 3 2 3 1 2 3 3 2 2 2 2 2 1 3 3 2 3 3 2

81 1 1 1 2 3 3 1 3 3 3 3 2 3 2 3 3 3 2 3 2 1 3 3 3 1 2 3 2 2 3 1 3 3 3 3

82 2 1 2 3 3 3 2 3 3 3 3 3 2 3 2 3 3 3 3 2 2 3 3 2 2 2 3 3 2 3 2 3 3 3 3

83 3 2 1 3 3 3 2 3 3 3 3 3 3 3 3 3 3 3 3 3 2 3 3 3 3 3 3 2 2 3 2 3 3 3 3

84 2 3 2 2 3 3 2 3 3 3 3 2 2 3 2 3 2 3 3 3 2 3 3 2 2 2 3 2 2 3 2 3 3 3 3

85 2 3 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 2 3 3 3 3

86 2 2 1 3 2 3 2 3 3 3 3 2 2 3 3 2 3 2 3 3 2 2 3 2 3 3 2 3 1 3 2 3 3 2 2

87 1 1 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 2 3 3 3 1 3 3 3 3 3 1 2 3 3 3

88 3 2 2 2 2 3 1 2 3 2 3 2 2 2 2 2 3 2 2 2 3 2 3 2 3 3 2 2 2 3 2 2 2 2 2

89 2 1 1 3 3 3 1 3 3 2 3 2 3 1 3 2 3 2 3 1 1 2 3 3 2 2 2 1 3 3 1 2 2 3 3

90 2 3 1 2 3 3 1 3 3 2 2 1 2 2 3 1 2 1 3 1 1 2 3 3 2 2 2 2 3 3 1 2 2 3 2

91 1 2 2 3 3 2 2 2 2 2 2 1 3 2 3 3 3 3 3 3 1 2 2 3 2 3 3 3 2 2 1 2 3 3 3

92 2 3 3 3 3 3 2 2 3 3 2 1 2 2 3 3 3 3 2 3 3 2 2 2 2 3 3 3 2 2 3 2 3 3 3

93 1 3 2 3 3 2 1 2 2 3 3 1 3 3 3 2 2 3 2 3 1 2 2 2 1 3 3 2 3 2 1 2 3 3 3

85
 94 3 2 3 3 3 3 2 2 3 3 3 1 3 2 2 3 3 2 2 3 2 3 2 2 3 3 3 2 3 2 2 3 2 3 3

95 1 1 1 2 3 3 2 3 2 2 3 2 3 2 3 2 3 2 2 2 1 2 1 2 1 3 2 2 3 1 1 2 2 2 3

96 2 2 3 3 3 3 3 3 2 3 2 3 2 3 3 3 3 2 2 3 2 2 2 2 3 3 3 2 2 3 2 3 3 2 3

97 3 2 3 2 3 3 2 2 2 2 2 2 2 2 2 2 3 2 2 3 3 3 3 3 3 3 3 2 2 3 3 2 2 2 3

98 3 1 3 3 3 2 1 3 3 3 3 2 2 3 3 3 3 3 3 2 3 1 3 3 3 3 2 3 3 2 2 2 2 2 3

99 3 1 3 2 3 2 2 3 2 3 2 2 2 3 2 3 1 3 3 3 3 2 3 3 3 3 2 2 3 3 1 2 2 2 3

100 2 3 2 3 3 2 2 3 2 3 3 3 3 2 3 2 3 3 3 2 2 2 2 3 2 3 3 3 2 2 2 2 3 2 3

101 1 2 2 2 3 3 1 3 2 3 3 2 3 2 2 3 3 3 3 3 2 2 2 3 1 3 2 2 2 2 1 2 2 3 3

102 1 2 1 3 3 2 2 2 2 3 3 2 3 3 2 2 2 3 3 3 3 2 3 2 1 2 3 3 3 2 3 2 2 3 3

103 2 2 2 3 3 3 3 3 2 3 2 2 3 3 3 3 3 3 2 3 2 3 3 2 2 3 2 3 2 2 2 3 2 3 3

104 2 1 2 2 2 3 3 3 1 3 2 2 3 3 2 3 3 3 3 3 3 1 3 2 2 3 1 2 2 3 3 3 1 2 2

105 2 2 2 2 3 3 2 2 2 3 2 3 2 2 1 2 3 2 2 2 1 2 3 2 2 3 2 2 2 1 3 3 2 2 2

106 3 2 3 3 2 3 2 2 2 3 2 3 2 3 3 3 3 3 3 3 2 3 3 3 2 2 3 3 3 2 3 2 2 2 2

107 2 3 3 2 2 2 3 2 2 3 3 2 2 2 3 2 3 3 3 2 2 2 3 3 2 2 2 2 2 2 2 2 3 2 3

108 2 2 2 3 2 2 3 3 2 3 3 3 2 3 3 3 1 2 3 3 2 2 3 3 3 3 1 2 3 2 1 3 3 2 3

109 3 2 3 3 3 2 2 2 3 1 2 3 3 2 3 3 3 2 2 3 2 3 2 3 3 2 2 3 3 2 2 3 2 2 2

110 2 3 2 3 2 3 3 2 2 3 3 3 3 3 2 3 3 3 2 3 3 3 3 3 1 3 3 2 3 2 2 2 3 3 2

111 2 1 2 2 2 3 2 3 2 2 2 1 3 2 2 3 3 1 2 3 2 3 3 3 1 2 2 2 2 2 3 2 2 2 3

112 3 3 3 3 2 2 3 3 3 2 2 1 2 2 3 2 3 3 3 2 3 2 3 1 2 3 2 3 2 2 3 3 3 2 2

113 2 2 3 3 3 3 3 3 3 2 2 1 2 2 3 2 2 3 2 3 2 2 3 3 2 3 3 3 2 2 2 2 1 3 1

114 2 3 2 3 3 2 3 3 2 2 2 1 2 3 3 2 2 3 3 2 3 3 2 2 2 2 3 2 2 2 2 2 2 1 2

115 2 1 2 3 3 3 3 2 3 2 2 1 3 2 3 3 3 2 2 2 3 2 1 2 2 2 2 2 3 2 2 2 3 3 2

116 2 2 2 2 3 1 3 2 3 1 2 2 2 2 3 3 3 2 2 2 3 3 3 2 2 2 2 2 3 2 3 3 2 2 2

117 3 1 2 3 3 2 3 2 3 3 2 3 3 3 2 3 3 2 3 2 2 3 3 2 1 3 1 2 3 3 2 2 2 3 1

86
118 2 3 2 3 3 3 3 2 2 3 3 3 2 3 3 3 3 3 3 2 1 2 3 2 2 3 2 3 2 3 3 3 3 1 2

119 2 2 2 2 3 2 3 3 2 3 2 2 2 3 2 3 3 2 3 2 1 2 3 1 2 3 3 2 2 2 3 3 2 2 2

120 3 2 3 2 3 3 3 2 2 2 3 2 2 3 2 2 1 3 2 1 1 1 2 3 1 2 2 2 2 2 3 3 2 2 3

121 2 3 2 3 3 2 3 2 2 2 2 3 2 2 3 2 3 3 3 2 2 2 3 2 3 2 1 3 3 3 2 2 3 3 2

122 2 2 3 3 3 2 3 2 3 2 2 2 2 3 3 2 3 3 2 2 3 2 1 1 3 3 2 3 3 1 3 2 2 2 1

123 2 3 3 2 3 3 3 3 2 3 2 2 2 1 2 2 3 3 3 2 2 2 2 3 3 2 2 2 3 3 2 2 3 3 2

124 2 2 3 3 3 3 3 2 3 2 2 3 2 2 3 2 3 3 2 3 3 2 2 2 2 3 2 2 3 1 2 2 2 2 2

125 3 3 3 1 3 2 3 2 2 3 2 2 3 3 2 3 2 3 3 2 3 2 3 2 3 3 3 2 3 3 2 3 3 2 1

126 2 3 3 2 3 3 3 2 2 3 2 2 3 2 2 2 3 3 3 2 2 2 1 3 3 3 2 1 3 1 3 3 2 3 1

127 2 2 3 3 3 2 3 2 2 3 3 2 2 3 3 2 3 3 2 2 3 2 2 2 3 2 2 3 3 3 2 3 3 2 1

128 2 2 3 2 2 3 3 3 3 3 2 2 3 3 2 3 2 3 2 3 2 3 2 2 3 2 1 2 3 2 1 2 3 3 1

129 2 3 3 2 3 2 2 3 3 3 2 3 3 2 1 3 2 2 3 3 2 3 2 3 3 2 2 2 3 2 2 2 3 3 2

130 2 3 3 3 3 3 3 3 3 2 3 3 3 3 3 2 3 3 2 2 3 2 2 2 2 2 1 3 3 3 2 2 3 3 3

131 3 2 3 2 3 2 3 2 2 2 3 2 1 2 3 2 1 3 2 2 3 3 3 2 3 3 2 2 3 2 2 3 3 2 2

132 2 2 3 3 3 2 3 2 2 3 3 3 3 3 3 2 2 2 3 2 2 2 2 2 3 2 2 2 3 2 3 3 2 3 3

133 2 2 3 3 2 3 2 2 3 2 3 3 3 2 3 2 2 2 2 2 3 2 3 1 3 3 3 3 3 3 2 3 3 3 3

134 2 3 3 3 3 3 2 3 3 3 2 3 2 3 2 3 2 3 3 3 2 3 2 1 3 2 3 2 3 2 1 3 2 2 3

135 3 2 3 2 3 3 2 2 3 2 3 1 3 2 2 3 3 1 2 3 2 3 2 3 1 3 2 2 1 2 1 3 3 3 3

136 1 3 1 3 3 3 2 3 2 3 3 3 2 2 3 3 2 2 3 3 1 3 3 2 2 3 2 2 1 2 1 3 3 3 2

137 3 2 3 3 2 3 2 2 2 2 3 3 3 3 2 3 2 2 2 3 3 3 2 2 3 3 2 1 3 1 3 3 2 2 2

138 3 2 3 2 2 3 3 2 2 3 3 2 2 3 2 3 2 2 2 3 3 3 3 2 3 3 2 1 2 2 2 2 2 2 2

139 2 3 2 3 2 3 3 3 2 3 3 3 3 3 3 3 1 3 1 3 2 3 2 1 3 2 2 3 3 2 2 3 3 3 2

140 3 3 2 3 2 3 3 3 3 2 1 2 2 3 2 3 3 2 2 2 3 3 1 3 3 2 2 2 3 1 1 3 2 1 2

141 3 2 2 2 3 1 3 3 2 3 3 3 2 3 2 2 3 2 1 3 3 3 3 3 3 2 3 2 3 3 2 3 3 3 2

87
142 3 3 3 2 3 1 3 2 2 3 3 2 2 3 3 3 3 2 2 3 3 3 3 2 3 3 3 2 3 2 2 3 3 2 3

143 3 2 2 3 3 3 3 2 3 3 2 3 3 3 2 3 3 1 2 3 3 3 2 3 3 1 2 1 2 2 2 3 3 3 3

144 3 2 3 1 3 2 3 3 3 1 2 2 2 3 2 3 3 3 3 3 3 3 3 2 3 3 3 3 2 2 3 2 2 2 1

145 1 3 2 3 3 3 3 3 3 1 2 2 3 1 2 3 2 3 2 3 2 3 2 3 3 2 2 3 2 2 2 2 3 2 2

146 2 2 3 2 3 3 3 2 2 3 2 2 3 1 3 3 2 3 1 3 2 3 2 3 3 2 2 2 2 1 2 2 3 1 2

147 2 3 3 3 3 3 3 3 3 2 2 3 2 3 2 3 2 3 2 3 1 3 2 2 3 2 2 3 2 2 3 3 3 2 2

148 2 2 3 2 3 3 3 2 3 2 2 2 2 2 2 3 2 3 1 3 2 3 3 2 3 3 2 2 3 2 2 2 3 3 1

149 2 3 2 3 3 2 3 3 3 2 3 2 2 2 2 3 1 3 3 3 2 2 2 1 3 3 2 3 2 3 2 3 3 2 2

150 3 2 2 2 3 2 3 2 3 1 2 2 2 3 1 3 2 3 1 3 2 3 3 2 3 3 3 2 2 1 2 3 3 1 2

151 2 2 2 3 3 2 3 1 2 3 3 3 3 3 3 2 2 3 1 3 2 2 3 2 3 2 2 3 3 3 2 3 3 2 3

152 3 2 2 3 3 2 3 3 3 2 2 2 2 2 3 3 2 3 2 3 3 3 2 2 3 2 2 2 2 2 2 2 2 2 2

153 2 2 2 2 3 2 3 3 3 3 2 2 3 2 2 3 3 2 2 3 2 2 1 2 3 3 3 2 2 1 2 2 2 2 1

154 2 2 3 3 3 3 3 3 2 3 2 2 2 3 2 2 2 2 2 2 3 3 2 2 3 2 1 2 3 2 3 2 2 3 2

155 3 3 2 2 3 2 3 3 2 2 2 2 2 3 2 3 2 2 2 3 3 3 2 2 2 3 2 2 2 2 2 2 3 2 2

156 2 2 2 2 3 2 3 3 3 1 2 3 2 2 3 2 2 2 2 3 3 2 3 2 3 3 2 3 2 2 2 3 2 2 1

157 2 2 2 3 3 3 3 2 2 2 2 3 3 2 3 3 3 2 2 3 2 3 3 3 3 3 2 2 3 2 2 3 3 1 1

158 2 3 2 3 3 2 3 2 3 3 3 2 3 3 2 3 2 3 1 3 2 2 3 2 3 2 2 3 2 3 2 3 2 3 1

159 2 1 2 2 2 2 3 1 2 3 2 2 3 2 2 3 2 3 3 3 2 3 3 3 2 2 3 3 2 1 2 2 2 3 1

160 3 3 1 2 3 3 2 3 1 3 2 3 3 2 3 3 2 3 3 3 2 3 3 3 3 2 1 2 3 3 2 2 3 2 2

88
C. Health promoting barriers

1 2 3 4 5 6 7 8 9 10 11 12 13
1 2 1 2 2 2 2 2 2 2 2 2 2 2
2 2 1 2 1 2 1 2 1 2 2 2 1 1
3 2 1 2 2 2 2 2 1 2 2 2 1 1
4 2 1 2 2 2 2 2 2 2 1 2 1 1
5 2 2 2 2 2 2 2 1 2 2 2 2 2
6 2 1 2 2 2 2 2 2 2 2 2 1 1
7 2 1 2 1 2 2 2 1 2 2 2 1 2
8 2 1 2 2 2 2 2 1 2 2 2 1 2
9 2 1 2 2 2 2 2 2 2 2 2 2 2
10 2 1 1 1 2 2 2 2 2 2 2 2 2
11 1 1 1 1 1 1 2 1 2 2 2 1 2
12 2 1 1 1 2 1 2 2 2 2 2 1 2
13 2 1 2 2 2 1 1 2 2 1 2 1 2
14 2 1 2 1 1 2 2 2 2 1 2 1 1
15 2 1 2 2 2 1 1 2 2 1 2 1 2
16 2 1 2 2 2 2 2 2 2 2 2 2 2
17 2 1 2 2 2 1 1 2 2 1 2 1 2
18 1 1 1 1 1 1 2 1 2 2 2 1 1
19 2 1 2 2 2 2 2 1 1 2 2 2 2
20 2 1 2 2 2 2 2 2 2 2 2 1 2
21 2 1 2 2 2 2 2 1 2 2 2 1 2
22 2 1 1 2 1 2 2 2 2 2 2 1 2
23 2 1 2 2 2 1 2 2 2 2 2 2 2
24 2 1 2 2 2 1 2 2 2 2 2 2 2
25 1 1 2 2 2 2 2 1 2 2 2 1 2
26 2 1 2 1 2 2 2 2 2 2 1 2 1
27 2 1 2 2 2 2 2 1 2 2 2 2 2
28 1 2 2 2 2 2 2 2 2 2 2 1 1
29 2 2 2 2 2 2 2 1 2 2 2 1 1
30 1 1 1 2 2 2 2 1 2 2 1 1 1
31 2 1 1 2 2 2 2 2 1 2 2 1 1
32 2 1 2 2 1 2 2 1 2 2 2 1 1
33 2 1 1 2 1 2 2 2 2 2 2 2 2
34 2 2 1 2 2 2 1 1 2 2 2 2 2
35 2 1 2 2 2 2 2 2 2 2 2 1 2
36 1 1 1 2 1 2 2 2 2 2 2 1 1
37 1 1 2 2 2 2 2 1 2 2 2 2 2
38 2 1 1 2 2 2 2 1 2 2 2 1 2
39 1 2 2 2 1 2 1 1 2 2 2 1 2
40 2 1 2 2 1 2 2 1 2 1 2 1 2
41 2 1 2 2 2 1 2 2 2 2 1 1 2
42 2 1 2 2 1 2 2 1 2 2 1 1 2
43 2 1 2 2 2 1 2 1 2 2 2 1 2
44 2 1 2 1 1 1 2 1 2 2 2 2 1
45 2 1 2 2 2 2 1 1 2 2 2 2 2
46 1 1 2 2 2 2 1 1 2 2 2 1 2

89
47 2 1 2 2 2 2 2 2 2 2 2 1 2
48 2 2 2 2 2 2 2 1 2 2 2 2 1
49 1 1 2 1 1 1 2 1 2 2 2 1 1
50 2 2 2 2 2 2 2 1 2 1 1 1 1
51 1 1 2 1 2 1 2 2 2 2 2 1 2
52 2 2 2 2 2 2 2 2 2 2 2 2 2
53 1 1 1 2 2 2 2 1 2 2 2 1 2
54 2 1 2 2 2 2 2 1 2 2 2 2 2
55 2 1 2 1 2 2 2 2 2 2 2 2 2
56 2 1 1 1 2 1 1 1 2 2 2 1 1
57 2 1 1 2 2 2 2 2 2 2 2 1 2
58 1 1 2 2 1 1 2 1 2 2 2 1 2
59 1 1 2 2 1 2 2 1 2 2 2 1 1
60 2 1 2 2 2 2 2 1 2 2 2 1 2
61 2 2 2 2 2 2 2 1 2 2 2 2 2
62 1 1 1 1 1 1 1 1 1 1 1 1 2
63 2 2 2 2 2 2 2 2 2 2 2 1 2
64 1 1 2 1 1 2 2 2 2 2 2 1 1
65 2 2 2 2 2 2 2 1 2 2 2 2 2
66 2 1 2 2 2 2 2 1 2 1 2 1 2
67 2 1 2 2 2 2 2 1 2 1 2 1 2
68 2 1 2 2 2 2 2 1 2 2 2 2 1
69 2 2 2 2 1 1 2 1 2 2 1 2 1
70 2 2 1 1 1 1 2 1 1 1 2 2 1
71 2 2 2 2 2 2 2 1 2 2 2 2 2
72 2 2 2 2 2 2 2 2 2 2 2 2 1
73 1 1 2 2 1 2 2 1 2 2 2 1 2
74 1 1 2 2 1 1 1 2 2 1 1 1 2
75 2 2 2 2 2 2 2 2 2 2 2 2 2
76 2 2 2 2 2 2 2 1 2 2 2 2 1
77 2 2 1 2 2 2 2 1 2 2 2 1 1
78 2 1 2 2 2 2 2 2 2 2 2 2 2
79 2 1 2 2 1 2 2 2 2 1 2 1 2
80 2 1 2 1 1 1 1 1 1 2 2 2 1
81 2 1 2 2 2 2 2 2 2 2 2 1 2
82 2 1 2 2 2 2 2 2 2 2 2 2 2
83 2 1 2 2 2 2 2 1 2 1 2 1 1
84 2 1 2 2 2 2 2 2 2 2 2 2 2
85 2 2 2 2 2 2 2 2 2 2 2 2 2
86 2 1 2 2 2 2 2 1 2 2 2 2 2
87 2 1 2 2 2 2 2 1 2 1 2 1 1
88 1 1 1 1 2 1 2 2 2 2 2 2 1
89 2 1 2 2 2 2 2 1 2 2 2 2 2
90 2 1 2 2 2 2 2 2 2 2 2 1 1
91 2 1 2 2 2 2 2 2 2 2 2 2 2
92 2 1 2 1 2 1 2 1 2 2 2 1 1
93 2 1 2 2 2 2 2 1 2 2 2 1 1
94 2 1 2 2 2 2 2 2 2 1 2 1 1

90
 95 2 2 2 2 2 2 2 1 2 2 2 2 2
96 2 2 1 1 1 1 2 1 1 1 2 2 1
97 2 2 2 2 2 2 2 1 2 2 2 2 2
98 2 2 2 2 2 2 2 2 2 2 2 2 1
99 1 1 2 2 1 2 2 1 2 2 2 1 2
100 1 1 2 2 1 1 1 2 2 1 1 1 2
101 2 2 2 2 2 2 2 2 2 2 2 2 2
102 2 2 2 2 2 2 2 1 2 2 2 2 1
103 2 2 1 2 2 2 2 1 2 2 2 1 1
104 2 1 2 2 2 2 2 2 2 2 2 2 2
105 2 1 2 2 1 2 2 2 2 1 2 1 2
106 1 2 2 2 1 2 1 1 2 2 2 1 2
107 2 1 2 2 1 2 2 1 2 1 2 1 2
108 2 1 2 2 2 1 2 2 2 2 1 1 2
109 2 1 2 2 1 2 2 1 2 2 1 1 2
110 2 1 2 2 2 1 2 1 2 2 2 1 2
111 2 1 2 2 2 1 1 2 2 1 2 1 2
112 1 1 1 1 1 1 2 1 2 2 2 1 1
113 2 1 2 2 2 2 2 1 1 2 2 2 2
114 2 1 2 2 2 2 2 2 2 2 2 1 2
115 2 1 2 2 2 2 2 1 2 2 2 1 2
116 2 1 2 2 2 2 2 2 2 2 2 2 2
117 2 1 1 1 2 2 2 2 2 2 2 2 2
118 1 1 1 1 1 1 2 1 2 2 2 1 2
119 2 1 1 1 2 1 2 2 2 2 2 1 2
120 2 1 2 2 2 1 1 2 2 1 2 1 2
121 2 1 2 2 2 2 2 1 2 2 2 2 2
122 2 1 2 1 2 2 2 2 2 2 2 2 2
123 2 1 2 2 2 2 2 2 2 2 2 2 2
124 2 1 1 1 2 2 2 2 2 2 2 2 2
125 1 1 1 1 1 1 2 1 2 2 2 1 2
126 2 1 1 1 2 1 2 2 2 2 2 1 2
127 2 1 2 2 2 1 1 2 2 1 2 1 2
128 2 1 2 1 2 1 2 1 2 2 2 1 1
129 2 1 2 2 2 2 2 1 2 2 2 1 1
130 2 1 2 2 2 2 2 2 2 1 2 1 1
131 2 2 2 2 2 2 2 1 2 2 2 2 2
132 2 2 1 1 1 1 2 1 1 1 2 2 1
133 2 2 2 2 2 2 2 1 2 2 2 2 2
134 2 1 2 2 2 2 2 2 2 2 2 1 1
135 2 1 2 2 2 2 2 2 2 2 2 2 2
136 2 1 2 1 2 1 2 1 2 2 2 1 1
137 2 1 2 2 2 2 2 1 2 2 2 1 1
138 1 2 1 2 2 2 2 2 2 2 2 2 2
139 2 2 1 1 2 2 2 2 2 2 2 2 2
140 2 2 1 1 1 2 1 2 1 1 2 2 2
141 1 2 1 1 2 2 1 2 1 1 1 1 2
142 2 2 2 2 2 2 2 1 1 1 2 1 2

91
143 1 2 2 1 2 2 2 1 2 2 2 1 1
144 2 2 2 2 2 1 2 1 2 2 2 2 2
145 2 1 2 2 2 2 2 1 2 1 2 2 2
146 2 1 2 2 2 2 2 1 2 2 2 2 2
147 2 1 2 2 1 2 2 1 1 1 2 2 2
148 2 1 2 2 2 2 1 2 2 2 2 2 2
149 2 1 2 2 2 2 2 2 2 2 2 2 2
150 1 1 1 1 1 2 2 2 1 2 1 2 2
151 2 1 2 2 2 2 2 2 2 2 1 2 2
152 2 1 2 2 2 2 2 2 2 2 2 2 2
153 2 2 2 2 2 2 2 1 2 2 2 2 2
154 2 2 1 2 1 2 2 2 2 2 1 2 2
155 2 1 2 2 1 2 2 2 2 2 2 2 2
156 2 1 1 1 2 2 2 2 2 2 2 2 2
157 1 1 1 1 1 1 2 1 2 2 2 1 2
158 2 1 1 1 2 1 2 2 2 2 2 1 2
159 2 1 2 2 2 1 1 2 2 1 2 1 2
160 2 1 2 2 2 1 1 2 2 1 2 1 2

92