THE HEALTH BEHAVIOURS OF THEIR PEERS
The research evaluated the perceptions of students in health related undergraduate programs towards the activities of their peers like smoking and alcohol use that risk health. Studies have shown that students in health-related subject areas observe the risky behaviors of their peers and those observations affect the perceptions they have about their own health (Zhang, 2011; Ridder et al., 2010). The purpose of this qualitative research was to examine emerging themes and develop a deep knowledge about the health related practices and the perceptions (Seidman 2013).
A phenomenological methodology was used in order to identify and evaluate the experience of participants. In depth interviews were carried out with four Flinders University undergraduate students enrolled in health related programmes. Each interview lasted about 45 minutes and was made of thirteen open ended questions. The questions on the perceptions of their peers’ health behaviours were developed from information offered in the literature review. Peer influence was found to be a high influence on same-age people to the point that similar behaviours were adopted. All four of the interviewees clearly pointed out that students will take part in activities simply because they see their friends and peers doing the same things. The health habits and social life activities were highly liked to peer influences and led to risky behaviors like smoking, drinking alcohol and eating poorly.
(Key words: peer influence, health student perceptions, risky health behaviours, student social life behaviours, qualitative research, interviews)
The perceptions of students in health-related undergraduate programs of the health behaviours of their peers
1.0 Chapter 1 LITERATURE REVIEW
1.1 Perception of Peer Behaviour
Undergraduate students taking courses related to human health have various perceptions of the behaviour that may affect their health, if this behaviour is exhibited by their peers (Zhang, 2011). Other researchers argue that there is a relationship between the actual behaviours reported about students and perceived behaviour by the medical students in Netherlands (Ridder et al., 2010). The authors used a sample of 1608 students issued with questionnaires regarding the number of students engaged in alcohol consumption. Ridder et al. (2010) found that the perceptions of medical students tend to overestimate the levels of consumptions for cigarettes and alcohol. Jones and Rossiter (2008) agree with the authors. They argue that medical students overestimate the indulgence of the behaviour of their peers in unhealthy practices. For instance, Jones and Rossiter found that medical students think that 90 per cent of their peers drink over a period of two weeks. In reality, only 80 per cent who reach this level, so their estimations were inaccurate (Jones & Rossiter, 2008, p. 12).
1.2 Peer influence
Shafiq et al. (2006) examined the perceptions of undergraduate medical students on the causes of indulgence in the supposed unhealthy behaviour. Peer influence was the major cause for indulgence in unhealthy behaviours, such as heroin, charas, benzodiazepines and alcohol consumption, according to medical research. The proposal is in agreement with the perspective of Duperly et al. (2009) who argued that indulgence in perceived wrongful behaviour suffers is rampant when people share similar attributes such as age, gender, and institutional other institutional frameworks. It is easier to indulge in similar behaviour when the parties have an element in common that connects them. In this context, it is elementary to explore the sociological aspects involved in this setting. Papinczak, Young, Groves, & Haynes (2008) discuss the nature versus nurture framework, which triggers the behaviour in individuals. Essentially, Papinczak et al. (2008) focus on nature and its influence on the behaviour of individuals such that the students’ peers drink and indulge in other behaviour because of the influence of the environment. Papinczak et al. (2008) conducted his study on first year medical students, by applying a pre-test, post-test design together with intervention and control. The argument is similar to the quantitative study of Cegolon et al. (2010) in Italy, which suggests that 65 per cent of the indulgence in seemingly unhealthy habits emanates from the interaction with people around students.
1.3 Social group
Valaitis, Sword, Jones, and Hodges (2005) evaluated the risk factors associated with indulgence in unhealthy behaviour. Medical students think that their peers are not adverse to the risk involved when engaging in the risky behaviour. Since they are many, they tend to have a feeling of security such that the effects of the risk involved will be mitigated by the fact that their friends are also involved in the behaviour. Abahussain and Abahussain (2010) also touch on the issue of group mentality and the perceptions held by medical students about their peers. Abahussain and Abahussain (2010) assert that medical students think that indulgence in unhealthy behaviour happens when their peers are in social groups associated with the behaviour.
Abahussain and Abahussain (2010) cite Cape, Hannah, & Sellman, (2006) who propose that more than 50 per cent of people who engage in wrong behaviour perceived to be morally wrong and detrimental to health because of the social group. Such a practice is dangerous, but students still engage in it in because they feel that it is right to act in the same manner as their friends. Engaging in behaviour that is dangerous to mental and physical health affects both the group and the individual (Levinthal, 2014, p. 13).
2.1. Research Question
What are the perceptions of students in health-related undergraduate programs of the health behaviours of their peers?
The phenomenological approach was adopted in this research aiming to develop an accurate and clear identification and description of the participant’s experience. This approach allows me to investigate the emerging themes and develop deep understanding about the perception of health related practices among participants (Aspers, 2009).
2.3 Data Collection
Four undergraduate students from Flinders University were recruited to participate in this research; all of them were studying health related programs. Data were collected during the interview with participants. All participants were involved in an in-depth interview aiming to explore their ideas and perceptions of the phenomena. In depth interview is a qualitative research technique that allows the researcher to collect ideas and observations from the participants (Seidman, 2013). The interview took place in a place chosen by the participants and lasted for approximately 45 minutes.
All participants were asked to answer a set of open-ended questions (13 Questions) designed to allow the opportunity for the participants to explain more about the subject and include any specific words or opinion in their answers (Creswell, 2012). Questions were divided into 3 sections, the first section aimed to understand the participant’s profile and personal information. The second section aimed to investigate the main issues observed in the literature review and related to their perception of their peers’ health behaviour. Finally the last section was designed to conclude the interview and all the participants a chance to add other ideas or opinion relating to the research question that had not been discussed during the interview.
Four undergraduate students from Flinders University were recruited to participate in this research. All of them were studying health related programs. The recruitment process was based on meeting with potential participants to explain to them the purpose of the research and how the results will be generated. The researcher also answered all the questions asked by potential participants and explained how ethics and data privacy will be maintained. The researcher asked the participant to sign a consent form.
The strategy used for sampling was the snowball strategy (Babbie, 2011). According to Babbie (2011) snowballing strategy is a very useful strategy to be implemented when the research wants to rely on participants to locate other potential participants to his/her research by asking selected members of the target population to nominate participants.
2.5 Ethical Implications
Ethical implications were mainly related to data privacy and personal bias. The researcher has ensured to inform the participants about the procedure applied for data privacy. The researcher’s personal bias was avoided by allowing the participants the time needed to answer the questions; the use of a structured interview format, avoiding interruption when participants were answering the questions and reporting only what has been said in an interview (Taylor 2005).
The research results could not be generalized because of the sample size of only four students.
2.7 Reliability, Validity and Reflexivity
3.1 Peer influence
This theme is prominent as throughout the interviews, all respondents make it clear that most students will do things simply because their friends and peers are doing them.
3.2 Health habits
Health habit is a prominent them because there is eating, drinking smoking and different other forms of lifestyle like dieting and so forth.
3.3 Social life
Everything happening based on the responses by the interviewees reflects social life within the institution. Parties, recreation and general relationships feature prominently through the interview.
3.4 Peer influence-Results
Peer influence appears to be a major factor that prompts people in the same age to adopt similar behaviours. Notably, for students, it is clear that from the interview responses, that students influence one another so that their behaviours (drinking, eating habits and smoking) tend to be the same almost across the entire institution. The interviewee (1) notes, “Well, I think it has something to do with “do as other are doing”. When you are a student, in a party with a group of friends, you wouldn’t want to look different or less bold and daring.” This is a clear indication that the students always want to do what others are doing so that they can participate and feel to belong to their group. Interviewee (2) says, “Nothing specific. To enjoy their time and share with others.” None of those who attend the parties wants to be identified as different from the others. As such, they are willing to share common habits, dislikes and likes in order to identify themselves. Therefore, they end up adopting new behaviours in order to fit in their environment.
3.5 Health habits-Results
Health is also another theme which was clearly identified in the interviews. Notably, students normally consider taking fast foods and ready-made meals. This is due to the convenience that such foods offer. Most students drink alcohol during parties. This also reflects on their leisure time when they may choose to drink. Besides drinking, they also smoke. These have developed as common habits during parties as well as a lifestyle for others. These have a health impact upon them. Essentially, being protein rich foods, they are likely to lead to increase in weight. As a result, some of the students opt to follow nutrition programs which help them address overweight or unnecessary weight issues.
As interviewee (3) notes, students rarely seek medical help “They will not, unless they feel the need to. I mean, physically.” Health habits therefore pose as a theme in this analysis since health programs organized present a platform on which to address health issues that arise. For instance, it is clear that some students will seek medical assistance when they experience unhealthy conditions while others will not interviewee (4), when asked whether students seek medical assistance notes, “Not quite much, unless they have a specific condition.” This clearly shows that they have the space to make choices and decisions regarding their health status and condition.
3.5 Social life-Results
Social life is another prominent theme which commands significant influence on the routine life of students. The lifestyle within the college institutions is common and shared among the students. They have a similar code of doing things for most of them like in different events such as sports, parties among others. Aspects of social life are handed down so that it becomes a form of culture within the institution which is propagated by the incoming students after borrowing from the outgoing. The environment, or to put is precisely, the society within which the students exists dictates how they grow and develop in the course of their learning both in class and in social affairs.
The participants share common ideas and observations concerning routine life for instance, one observes that, “Oh, most of them. Being at parties encourages habits like drinking or smoking, and I think of the students at this age would do both.” This is a clear signal that social life usually assimilates people so that they share common habits. The other participants have similarly responded to the same question in like manner which shows commonality among the entire institution spectrum.
4.1 Peer Pressure
The results showed that students wanted to engage in the same behaviour as the other students. Generally, students do not want to be seen as different, but instead prefer to blend in. Peer influence was found to be greatly influential to the participants after evaluating the interview results. Roditis and Halpern-Felsher (2015, p. 6) concluded from their research that “perceptions of risk are not formed in a vacuum” but from the dynamics of an individual’s own experiences, intrapersonal communications, and cultural practice. This reflects the findings of Papinczak et al. (2008) and the influence of their environment in terms of nature versus nurture. The two largest sources of impacts identified in the Roditis and Halpern-Felsher (2015) study were peer pressure and the perception that everyone else is doing the same activities (Roditis & Halpern-Felsher, 2015). Research discussed above demonstrated that an important dynamic is that individuals are more highly influenced by peers with whom they feel a connection (Safiq et al., 2006; Valiatis et al., 2005).
4.2 Social Behaviour
The interviews showed that the students are highly connected to other students because of the college environment. The results demonstrated that social life highly influences similar behaviours even when the behaviours are unhealthy. Internet use is a different kind of social behaviour than parties but common to students. Tzavela, Karkaitsou, Dreier et al. (2015) used questionnaires and about the same age of participants to learn about influences affecting online use. Their research showed that participants’ peers online and offline were reported as influential as well as ‘significant others’ such as parents (Tzavela et al., 2015). The behaviour normalization and identified it as a cognitive strategy that was common among the participants (Tzavela et al., 2015). An example was a fifteen year old female participant who shared “My mum is just like me, always on the net just doing nothing” (Tzavela et al., 2015, p. 42). Interestingly whether the social environment was parties or the Internet the behaviour is highly influenced by peers, significant others and their environment (Cegolon et al., 2010; Papinczak et al., 2008).
4.3 Nurture and Nature
Papinczak et al. (2008) noted the sociological dynamics of nature versus nurture framework as mentioned above is part of the influence of students’ environment. The participants in the interviews all noted that students are often reluctant to seek medical help. One of the participants talked about how awareness programs can significantly change students’ resistance to see medical support. Peer pressure and peer influences were found to highly impact health behaviours. Research from an opposite point of view was carried out by Smorti, Guarnieri, and Ingoglia (2013) who studied the resistance to peer influence. They also studied the mediating dynamic between the parental bond (the nurturing element) using risky driving as the independent variable. Earlier research concentrates on either peer influence or the bond between youths and their parents, but this research looked at both (Smorti et al., 2013). The researchers did not using a specially designed survey but instead the Parental Bonding Instrument was used (Smorti et al., 2013). Care and Overprotection are the two dimensions measured with the instrument (Smorti et al., 2013).
Generally the way peer influences are mediated by parental bonds is not clear and more research is needed, but perceptions of whether or not to take risky activities was highly associated with the two variables of “mother care” and “overprotection” and in terms of risky driving the influence is significant (Smorti et al., 2013, p. 190). Gender, overprotection and mother care were significant and positive predictors of resistance to peer pressure (Smorti et al., 2013). Therefore the health related students perceptions in terms of nature versus nurture framework is an important element of the topic.
Interviews were carried out in this phenomenological study in order to learn about health field students’ perceptions of their peers’ risky behaviour. Interviews were carried out with four Flinders University students who are enrolled in health related programmes. Evaluation of the results demonstrated that several prominent themes are part of the dynamics influencing the perceptions of their peers’ behaviours such as, almost all students will undertake an activity if their friends and peers are involved in the activity. The observation was made that student’s want to fit into the activities around them. The interviewees all mentioned health habits, social life, and peer influence demonstrating a commonality in the themes perceived and observed. Social activities and peer influence were observed to be linked. The risky health habits like cigarettes, bad eating habits and alcohol are learned from peers in the context of social events shared by the students. The interview results coincided with the research conclusions from similar research. The results increase the understanding of health students’ perceptions about the high impact of environment on health behaviours. Although more research is needed, the interviews showed that the students’ environment was perceived as highly influential due to other students, parents, and other people in their environment.
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