Healthy living awareness among health sciences students in Turkey: a cross-sectional study

Abstract

Background

Health sciences students need strong health awareness to promote healthy lifestyles.

Objectives

This descriptive cross-sectional study aimed to assess the level of awareness about healthy living among students enrolled in health sciences programs in Turkey. It also examines the differences according to demographic and academic variables.

Methods

The research was conducted with 493 students from health sciences departments at various universities in Turkey between January and March 2023. Data were collected through an online survey consisting of a demographic information form and the Healthy Living Awareness Scale (HLAS), which consists of a 15-item, 5-point Likert scale with four sub-dimensions. The normality of numerical data was calculated using the Shapiro–Wilk test. We also used independent samples t-test and one-way analysis of variance (ANOVA) to compare group differences. A p-value of < 0.05 was considered statistically significant.

Results

The mean total HLAS score was 56.43 ± 10.84, representing a moderate level of awareness about healthy living among participants. Significant differences were found in HLAS scores across age groups (p = 0.003) and academic departments (p = 0.014). Also, higher grade levels were associated with significantly increased scores in total HLAS and its sub-dimensions, including change, socialization, and responsibility (p < 0.05). Among the sub-dimensions, the highest scores were observed in the change domain, which was followed by socialization, responsibility, and nutrition.

Conclusion

Awareness levels were moderate, and increased with academic progression. Research indicates that increasing the strength of undergraduate curriculum has potential for improving future health care providers’ understanding of how to live a healthy lifestyle.

Introduction

Research has investigated health-protecting behaviours among university students; however, limited research has explored the various dimensions that impact the health of individuals as a whole and, related to those dimensions, investigates the level of beliefs of Turkish health sciences students’ perceptions of healthy living (the multidimensional construct) with established awareness-based instruments [1]. The balance between the physical, mental, and social aspects focusing on the holistic perception of health is known as optimal health [2]. Also this is mainly through guarding the health of individuals and building up health awareness [3, 4]. The wellbeing of the society requires people who constitute the society to be conscious of their health, and make an effort to safeguard their own health [5, 6].

The term “healthy living awareness” means the cognitive awareness, perception, and understanding that an individual has with regard to the concept of healthy living. Health promoting behaviours are the actual behaviours that a person performs in order to maintain or improve their health. Healthy living awareness is considered a necessary precursor to a person’s behaviour, but is not to be confused with their behaviour [7].

A healthy lifestyle refers to the actions that people take to live healthy and enhance their health such as healthy eating, physical exercise, coping with stress, and health accountability [8]. Preventing and or avoiding diseases is closely associated with improving and maintaining health which is also associated with the adoption of healthy lifestyle awareness [9]. Numerous studies have concluded that the risk of morbidity or mortality associated with chronic diseases is much lower in individuals who achieve their highest healthy lifestyle behaviocyle behavior [10].

In the Health Promotion Model established by Pender, the accomplishment of optimal health is specified as the establishment of optimal physical and mental health by emphasizing on cognitive aspects and enhancing health [11]. High degree of awareness is deemed to be crucial as far as giving individuals the feedback they need to arrange themselves and their world and guide their lives. The more the awareness one has, the more the consciousness he/she develops towards oneself, his/her surroundings and the universe [12, 13].

Those students who obtained education in the sphere of health will be able to train health-enhancing self-care situations, understanding a healthy lifestyle, and acquire knowledge about their health, and they will gain the skills that can be applied in various aspects of their life [14]. The trust they have in the personal skills acquired allows them to achieve a healthier state in their personal lives [15, 16]. As it is mentioned in the literature, it will help students to improve their own health due to the knowledge and skills that they will obtain during the education, and the students who will learn to take care of themselves will help to understand better how to take care of other people [17, 18]. As health students’ adoption of the healthy lifestyle behaviours is a critical part of building a healthy society, our objective was to determine the level of awareness of midwifery, nursing, and nutrition and dietetics students [19].

Although there is a large body of literature on health-promoting lifestyle behaviours and their effects on health status, research on healthy living awareness among healthcare students in Turkey remains limited. Most past research has addressed a generalised view of health and specific components such as nutrition and physical activity, but very few studies have looked at awareness as a multidimensional construct [20]. Additionally, there is variability in results related to how student demographics and academics impact awareness (e.g., age, department, grade level), indicating further investigation is warranted. Understanding this variation can help identify deficiencies in health education and improve health sciences curriculum design. As such, an in-depth exploration of awareness of healthy living in healthcare students or trainee health professionals is required for the development of targeted health promotion strategies.

This study aimed to examine healthy living awareness and assess its association with demographic and academic factors. In contrast to previous research which has investigated healthy living awareness primarily, the present research attempts to assess awareness of healthy living as a multi-dimensional construct with the use of the Healthy Living Awareness Scale; furthermore, this study examines any potential demographic or academic differences.

Materials and methods

Study design

This is a descriptive cross-sectional study.

Population and sample

The sample of the study included 493 active enrolled students in health sciences departments (midwifery, nursing, and nutrition or dietetics) in other parts of Turkey [21, 22]. A non-probability snowball sampling method was used. The study sample included 493 participants voluntary university students who agreed to take part in the study during the period of January to March 2023 [23].

A power analysis done with G*Power (3.1) determined the sample size required to conduct the research. Using a medium effect size (f = 0.25), a two-tailed significance (α = 0.05) and a statistical power = 0.80 in the analysis of variance among groups, the minimum sample size required was 159. According to conventions within the area of Behavioural Science Research as well as other studies conducted in relation to healthy lifestyle awareness amongst undergraduates, a moderate level of effect size (f = 0.25) was chosen. The final sample size was 493 students, which was greater than the required sample size, thus providing sufficient statistical power to detect significant group differences.

Inclusion and exclusion criteria

Undergraduate students in health sciences programs at universities throughout Turkey (including midwifery, nursing and nutrition & dietetics) were recruited for this study. Students were selected from universities located in Mardin, Diyarbakır, Gaziantep, Şanlıurfa, Van and Ankara. Eligible participants were aged 18 years or older, currently enrolled in one of the earlier mentioned programs during the timeframe of this study (January-March 2023) and had an internet-connectable device that allowed them to respond to the online survey. Participation was completely voluntary, and informed consent was obtained from all participants electronically prior to data collection. The introductory questionnaire included.

• Age

• Gender

• Department

• Academic year

• University

• Province

• Consent

Participants were excluded if they submitted questionnaires with more than 10% missing responses, duplicate submissions, inconsistent response patterns, or questionnaires from individuals who did not meet the study eligibility criteria. All incomplete or invalid questionnaires were excluded before the final statistical analysis to ensure data quality and reliability.

Participants were recruited through snowball sampling methodology using online platforms. Initial participants were recruited from among the eligible population of health science students enrolled during the period of study. Once enrolled, they encouraged other potential participants from their networks to participate in completing the survey.

Due to the absence of a national sampling frame for students in health sciences being available, and the need to recruit subjects from multiple universities located in several different regions of Turkey, a snowball sampling technique was utilized.

Data collection tools

The questionnaire form was a 19-question questionnaire which was prepared by the researcher following a literature review [24]. The survey would consist of Introductory information Form and Healthy Living Awareness Scale (HLAS) [25]. HLAS is a 5-point Likert scale with 15 items and 4 sub-dimensions, change (1–5), socialization (6–9), responsibility (10–12), and nutrition (13–15). The minimum score that can be attained in the scale is 15 and the maximum score is 75. A high score on the scale indicates that there is high awareness on healthy life [13].

Assessing validity and reliability of survey instrument

The Healthy Living Awareness Scale (HLAS) is a 15-item, 5-point Likert scale with four dimensions of change, socialization, responsibility, and nutrition. Original scale showed adequate levels of construct validity with a four-factor structure supported by results from both exploratory and confirmatory analyses.

The Turkish version of the Healthy Living Awareness Scale has been previously validated as well and also showed good psychometric characteristics, including good internal reliability, acceptable model fit indices (based on confirmatory factor analysis), and good internal consistency. In this study, Internal Consistency of the total scale was high (Cronbach’s α = 0.904) with sub scale coefficients ranging between.793 and.875, which is evidence of strong reliability of HLAS [13].

Data collection

A survey questionnaire (Google Form) was prepared to be used in data collection [26]. The students studying in other provinces in universities were accessed using the snowball technique. The questionnaires were sent out in the period between January and March 2023 [27].

Statistical analysis

The normal distribution of the numerical data was used to check the distribution through the Shapiro–Wilk test [28]. The assumptions of normality were evaluated using the Shapiro–Wilk test, and homogeneity of variances was assessed using Levene's test before applying parametric statistical analyses. Independent-samples t-tests and one-way analysis of variance (ANOVA) were subsequently performed where assumptions were satisfied. Effect sizes (Cohen's d for t-tests and eta squared [η2] for ANOVA) were calculated to quantify the magnitude of group differences. Non-normally distributed variables were tested using the nonparametric Mann–Whitney U test or Kruskal–Wallis ANOVA. The Cronbach’s alpha coefficient was calculated in order to determine the reliability of the scale. A p-value < 0.05 was considered statistically significant. The SPSS windows version 23.0 [29, 30] was used to conduct statistical analysis. Table 1 shows Demographic Characteristics of Participants.

Table 1.

Demographic characteristics of participants

Characteristic	Category	N	%
Age	≤ 19	109	22.1
	20–21	195	39.6
	≥ 22	189	38.3
Gender	Male	107	21.7
	Female	386	78.3
Department	Nutrition/Dietetics	56	11.4
	Midwifery	166	33.7
	Nursing	271	55.0
Academic Year	1	167	33.9
	2	89	18.1
	3	103	20.9
	4	134	27.2

Ethical considerations

The institutional ethics committee approved the study, and all the participants gave informed consent.

Results

The research question was to test the level of awareness of healthy living among health sciences students, and the sample size of the research was 493 students. In line with the earlier studies in the health-promoting behavior, this research study conducted an analysis of various facets of health awareness.

Cronbach’s is the measure of the reliability of the scale at large with a value of 0.70 and above showing the reliability of the scale. The average score of the total HLAS was 56.43, with the standard deviation of 10.84, which means that the health behaviors of students are either above the moderate level, and this is in accordance with the principle of health promotion as shown in Table 2.

Table 2.

Descriptive statistics and reliability analysis of HLAS scores

Scale/Subscale	Mean ± SD	Min–Max	Cronbach’s Alpha
HLAS Total	56.43 ± 10.84	16–75	0.904
Change	20.06 ± 4.23	5–25	0.875
Socialization	14.61 ± 3.81	4–20	0.832
Responsibility	11.82 ± 2.60	3–15	0.809
Nutrition	9.96 ± 3.10	3–15	0.793

Table 2 showed that the average total HLAS score was 56.43 + 10.84, which depicts the above-moderate standard of healthy living awareness among health sciences students. The Change subscale had the maximum mean score (20.06 ± 4.23), and the next subscale scores are Socialization (14.61 ± 3.81), Responsibility (11.82 ± 2.60), and Nutrition (9.96 ± 3.10), which proves that the students demonstrate higher ability to recognise bodily changes. These results indicate that health education is effective in building the self-monitoring skills of students that are vital in health promotion behaviors. Table 3 shown Distribution of Responses to HLAS Items.

Table 3.

Distribution of responses to HLAS items (selected items)

No	Statements	Strongly Disagree n(%)	Disagree n(%)	Neutral n(%)	Agree n(%)	Strongly Agree n(%)
1	I notice physical changes in my body	18 (3.7)	33 (6.7)	77 (15.7)	151 (30.8)	211 (43.1)
2	When I experience a change in my health, I can describe it	12 (2.4)	29 (5.9)	114 (23.2)	153 (31.1)	184 (37.4)
3	When I have thoughts/feelings that cause distress, I recognize them	8 (1.6)	24 (4.9)	112 (22.8)	156 (31.7)	192 (39.0)
4	I recognize the effect of stress on my body	18 (3.7)	20 (4.1)	78 (15.8)	139 (28.2)	238 (48.3)
5	I recognize the signs of illness that appear in my body	9 (1.8)	40 (8.1)	120 (24.3)	153 (31.0)	171 (34.7)

Table 4 shows that there was the greatest amount of agreement in the character of statement- I notice physical changes in my body, with the highest percentage of 43.1 completely agreeing and 30.8 agreeing. The data shows the scores of HLAS differed significantly statistically (p = 0.003) between age categories. The young students at age 22 years and above showed a high level of awareness (58.48) which was significantly higher than the young students of 19 years and below (54.3) and even more so using the students of 20–21 years (55.64) and that maturity and higher education levels may lead to an increase in health consciousness. This is a gradual increase in age which is in agreement with developmental theories and exposure to health concepts in education.

Table 4.

Distribution of HLAS and subscale scores by socio-demographic characteristics

Variable	Category	HLAS Total	Change	Socialization	Responsibility	Nutrition
Age	≤ 19	54.3 ± 11.04	19.22 ± 4.35	13.78 ± 4.14	11.43 ± 2.6	9.87 ± 3.37
	20–21	55.64 ± 11.28	19.77 ± 4.27	14.47 ± 3.85	11.77 ± 2.7	9.64 ± 3.2
	≥ 22	58.48 ± 9.99	20.9 ± 3.85	15.2 ± 3.47	12.14 ± 2.42	10.34 ± 2.81
Department	Nutrition	60.35 ± 10.06	21.02 ± 3.8	15.26 ± 3.71	12.33 ± 2.59	11.65 ± 2.67
	Midwifery	56.34 ± 10.44	20.17 ± 4.1	15.13 ± 3.65	11.9 ± 2.65	9.23 ± 3.01
	Nursing	55.69 ± 11.11	19.85 ± 4.29	14.15 ± 3.88	11.67 ± 2.56	10.07 ± 3.09
Year	1	53.67 ± 12.16	18.92 ± 4.78	13.88 ± 4.27	11.25 ± 2.95	9.68 ± 3.35
	2	55.12 ± 10.87	19.68 ± 4.12	14.24 ± 3.78	11.6 ± 2.53	9.66 ± 3.27
	3	58.24 ± 9.37	20.72 ± 3.62	15.26 ± 3.43	12.32 ± 2.35	9.94 ± 2.8
	4	59.34 ± 9.13	21.33 ± 3.34	15.25 ± 3.31	12.29 ± 2.18	10.53 ± 2.82

Figure 1 shows the change subscale there was progressive age improvement (p = 0.002), the scores of both the older students (≥ 22 years) and the youngest one (19.22 ± 4.35) were 20.9 ± 3.85. Change subscale scores increased across the age groups, with students aged ≥ 22 years demonstrating the highest mean score. These findings indicate higher awareness among older students; however, the implications of this observation are discussed in the Discussion section.

Fig. 1.

Change subscale scores by age group

Significant differences existed between departments (p = 0.014) with nutrition/dietetics students having the highest mean score (60.35 ± 10.06), midwifery (56.34 ± 10.44) and nursing (55.69 ± 11.11). Nutrition and Dietetics students demonstrated significantly higher healthy living awareness scores than students from the other departments. The Nutrition and Dietetics department recorded the highest mean HLAS score among the three departments.

The Nutrition subscale recorded the strongest differences in the departments (p = 0.001). The highest score was observed among the nutrition/dietetics students (11.65 ± 2.67), then the nursing (10.07 ± 3.09) and midwifery (9.23 ± 3.01) showing expected knowledge translation into the curriculum and demonstrating curriculum specificity. Nutrition subscale scores differed significantly among the departments.

Figure 2 indicates that A significant upwards trend was evident in HLAS scores as students advanced in academic years (p = 0.001), it rose by 53.67 12.16 in Year 1 to 59.34 9.13 in Year 4. HLAS scores increased progressively from first-year to fourth-year students. A progressive increase in HLAS scores was observed across academic years.

Fig. 2.

HLAS total scores across academic years

Figure 3 indicates that All subscales with exception of Nutrition recorded significant increment in academic years. The Subscales Change, Socialization, and Responsibility have shown the same improvement (p < 0.05) indicating the holistic approach in teaching health sciences in developing a multi-faceted awareness. Nutrition scores showed comparatively smaller differences across academic years than the other HLAS subscales. Table 5 illustrates Correlation Analysis of Scale Scores with Age Variable.

Fig. 3.

HLAS subscale scores across academic years

Table 5.

Correlation analysis of scale scores with age variable

Variable	Age (r)	Age (p)	Age (n)
HLAS Total	0.141	0.002	481
Change	0.131	0.004	483
Socializing	0.126	0.005	487
Responsibility	0.111	0.014	486
Nutrition	0.102	0.024	486

According to Fig. 4, it was revealed that Positive correlations were found between age and HLAS Total scores (r = 0.141, p = 0.002), which confirms the observation that with the increase in age, the level of health awareness also increased. A weak positive correlation was observed between age and total HLAS score (r = 0.141, p = 0.002). Age was positively associated with healthy living awareness; however, the strength of the association was weak.

Fig. 4.

Correlation between age and HLAS total score

Figure 5 suggest the correlation analysis showed that there were weak yet statistically significant positive relations between age and all of the scale components (p < 0.05). Change subscale had the highest correlation (r = 0.131, p = 0.004) and Nutrition was the least correlated (r = 0.102, p = 0.024), which demonstrated that development of awareness was more diverse among various dimensions of a healthy lifestyle. Weak positive correlations were observed between age and each HLAS subscale.

Fig. 5.

Correlation heat map—age vs. HLAS scores

The samples in the study (Fig. 6) indicate that the study population was mainly composed of female students (78.3, n = 386) as opposed to male students (21.7, n = 107) which resembles the normal gender distribution in health sciences programs, especially in the nursing and midwifery field. The only statistic that showed a significant difference between males and females was the Nutrition subscale (p = 0.023), where male students had a high score (10.52 ± 3.20) than the female students (9.81 ± 3.06). Male students demonstrated significantly higher Nutrition subscale scores than female students, whereas no significant differences were observed in the remaining HLAS subscales.

Fig. 6.

Gender distribution of participants (N = 493)

As Fig. 7 demonstrates, The radar chart visualization demonstrates the imbalanced profile of the healthy living awareness with Change and Socialization dimensions constituting the strongest ones, and at the same time a more significant dimension of Responsibility and the most improvement opportunity belonging to Nutrition. The Change and Socialization subscales recorded the highest mean scores, whereas the Nutrition subscale recorded the lowest mean score. The implications of these findings are discussed in the Discussion section.

Fig. 7.

Healthy living awareness profile—HLAS subscale scores

Discussion

This study found that health sciences students showed a moderate level of healthy living awareness, as measured by the HLAS. Awareness levels were significantly higher among older students, those in advanced academic years, and students in nutrition-related programs, indicating the influence of education and demographic factors on health awareness.

This study is grounded on the premise that any given society can be healthy only when individuals that constitute a given society care about their health, take care of their health, and take some steps to ensure that their health is not compromised [5, 6]. In this regard, the degree of knowledge of students pursuing the health sciences regarding the awareness of the health aspects of life is debated based on the concept that health personnel are determinate to the health of the society.

The body awareness study reflects a high level of self-knowledge when it comes to physical modifications and this is central to staying healthy and early detection of diseases in future health practitioners. This result contributes to the idea that health consciousness is a vital element of health promotion behaviors, as promoted in health promotion models.

All the sub-dimensions of HLAS proved to be reliable in this study. According to the outcomes of the study, the average scores of the students in the Healthy Living Awareness Scale (HLAS) are much higher than the moderate range [31, 32]. The average scores of the students were lower than the moderate level [32] in the research undertaken by Alzahrani et al. [14] among learners in the Saudi Arabian health department. Among other works, in the study of Gül et al. [32], the mean scores of the students in the HLAS were moderate [33]. According to Kılıç and Balta [34], although the scores of the scale of healthy lifestyle behaviors of students of the physical education and sports school were above moderate, in the case of the Faculty of Law students, the scale score was moderate [35]. High levels of health awareness among senior students may stem from their cumulative exposure to both health education and clinical training. Age, personal health experiences, and other unmeasured variables may also influence this link. Therefore, results need to be interpreted as associations instead of proof of cause.

It is observed that the subgroups of the scale have the highest score in changing sub-dimension [36]. The products pertaining to the factor include the identification of physical changes and symptoms. It was noted that 43.1 percent of the respondents agreed with the item completely with the statement "I notice physical changes in my body" which means that they have a high self-monitoring ability.

As they found, there was a statistically significant difference in the mean scores of the HLAS across age groups [36]. It has been noted in previous research that a higher sensitivity to a healthy living was found in the participants of 35–43 years old compared to those of 26–34 years old [37]. Also, it was determined that the health awareness and responsibility of postgraduate graduates was higher than that of high school and below, associate and undergraduate graduates [38].

Current findings align with Pender’s Health Promotion Model, which states that the formation of health-related cognitive beliefs is due to our cumulative knowledge, experience and perception of the benefits of participating in a healthy behaviour [11]. Increased exposure to health promotion principles and clinical practice during their professional educational progression can enhance the student’s experience of becoming aware of leading a healthy lifestyle. Acquiring greater health literacy through undergraduate education may also provide the learner with greater capability to make health-related decisions due to the increased recognition given to the availability and quantity of health-related materials.

Although age showed a statistically significant positive correlation with healthy living awareness (r = 0.141), the magnitude of the relationship was weak, indicating that age alone explains only a small proportion of the variability in awareness. Educational experiences, clinical exposure, and individual motivation are likely to play a more substantial role.

The results on the analysis of the healthy living awareness scale scores by gender showed that there is a considerable difference only in the subgroup of nutrition and dietetics. The results of a study carried out by Zhang et al. involving dietetics, nursing, and physiotherapy students showed that the scores of males were higher than those of females in certain parameters [34, 39]. The literature produced different results regarding genders and this concluded that there are complex interactions between gender socialization and training in professions.

A statistically significant gender difference was observed only for the Nutrition subscale, whereas no significant differences were identified in the total HLAS score or the Change, Socialization, and Responsibility subscales. These findings suggest that healthy living awareness was generally comparable between male and female students. The lack of significant gender differences across most dimensions indicates that academic education and professional training may have a greater influence on healthy living awareness than gender alone.

The results showed that there was a statistically significant difference of the means of the healthy living awareness scale among the departments. Although HLAS of nutrition/dietetics and nursing students were similar, the same was found to be significantly higher than that of midwifery students [40, 41]. Those who showed an increased level of health awareness displayed a higher propensity towards engaging in health promoting behaviours [42]. Consistent with these findings, candidates to health professions are supposed to be role models in health behaviours, so it is important that positive healthy living awareness are internalized by candidates and transferred to their lives [43]. To this end, it should be decided to reach theoretical and practical accruals regarding the behaviour development of the educational process.

Nutrition and Dietetics students attained the highest level of awareness, most likely due to the fact that Nutrition has been substantially emphasized within an educator’s curriculum as it pertains to nutrition and preventive medicine, as well as counselling and modifying behaviours through dietary means. Higher awareness of health promotion concepts may be attributed to the fact that they will have significantly more exposure to these concepts when compared to students from other health-related disciplines [44].

Although Nutrition and Dietetics students achieved the highest nutrition scores, the nutrition subscale demonstrated the lowest internal consistency among the HLAS subscales. This relatively lower Cronbach's alpha may reflect greater variability in participants' responses to nutrition-related items rather than lower awareness. Differences in individual dietary practices, personal eating behaviours, and interpretation of nutrition-related questions may have contributed to this variability. Nevertheless, the internal consistency remained within an acceptable range, supporting the reliability of the nutrition subscale for assessing healthy living awareness.

The healthy living awareness level observed in this study is moderate and is similar to levels of awareness found in previous studies with university students in Saudi Arabia, Ireland, and China. In those studies, the level of awareness increased with educational progression; however, awareness varied according to the academic discipline of the participants and the institutional context in which they were studying. These observations suggest that professional education, while creating similar levels of awareness across different healthcare systems, may also have been influenced by the different cultures and curricula of those healthcare systems.

This study expands the current understanding of healthy lifestyle awareness as a multidimensional concept. The next step was using empirical data to examine how healthy living awareness varies across different academic and demographic variables; thus, creating a framework to conceptualize the cognition of health in the context of future health professionals.

Conclusion

This research was aimed at evaluating the degree of healthy living awareness among health science students. It was established that, the healthy living awareness among the health sciences students involved in the research was usually above the average threshold. The findings indicate that healthy living awareness improves with academic progression and varies across health science disciplines, highlighting the important role of undergraduate education in preparing future healthcare professionals to promote healthy lifestyles. Strengthening health promotion education during undergraduate training may contribute to the development of healthcare professionals who serve as effective role models for healthy behaviours in the community.

Based on the findings of this study, the following practical recommendations are proposed to improve healthy living awareness among health sciences students:

1. Introduce a mandatory Healthy Lifestyle Promotion course during the second year of undergraduate health sciences education to strengthen students' awareness and healthy lifestyle practices.

2. Integrate practical health promotion activities, including workshops, simulation-based learning, and community outreach programs, into the curriculum to encourage the application of healthy living principles in daily life.

3. Strengthen nutrition education across all health sciences disciplines by incorporating evidence-based dietary counselling and preventive health strategies throughout undergraduate training.

4. Regularly assess students' healthy living awareness using validated instruments such as the Healthy Living Awareness Scale (HLAS) to monitor educational outcomes and identify areas requiring improvement.

5. Establish university-wide health promotion initiatives that provide supportive environments for healthy behaviours, enabling students to become effective role models for future patients and the wider community.

Study limitations

There are many limitations to be taken into consideration in the interpretation of the results found within this research study. The first limitation is that it is a cross-sectional design, so no conclusions about causality can be made. The second limitation is that the method of sampling, which was snowball sampling, may have created selection bias and not all subjects being sampled were representative of the population from(the) community where they were obtained. The third limitation is that all data collected came from self-report methods, so there is a risk that such data may have been impacted by both recall and social desirability bias. The final limitation is that the Nutrition and Dietetics participants only made up 11.4% of all respondents in the study, so the estimates made using responses from respondents within this area of study are likely to be less precise than estimates made with respondents in other areas of study.

The adoption of snowball sampling may have introduced selection bias due to the recruitment of participants using existing social networks, resulting in the lack of representativeness for all Health Sciences students in Turkey.

Implications for future research

Longitudinal designs should be used to show the evolution (change) of awareness regarding healthy living during the undergraduate degree program. Multicentre studies that utilize probability sampling will allow for better generalization of the findings. Additionally, it would be beneficial to conduct intervention studies to evaluate curriculum-based health promotion programs. Future research should explore variables representing health literacy, self-efficacy, perceived stress, and digital health literacy, which could serve as predictors of healthy living awareness.

Authors’ contributions

Gulcan Ciftcioglu Yalcin conceived and designed the study, conducted data collection, performed statistical analysis, interpreted the data, and prepared the original manuscript. The author critically reviewed, revised, and approved the final version of the manuscript.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Ethics approval and informed consent statements

This study was approved by the Non-Interventional Clinical Research Ethics Committee of Mardin Artuklu University (Approval No. 2023/2–39, dated 13 February 2023). Written informed consent was obtained electronically from all participants before data collection.

Competing interests

The authors declare no competing interests.