Introduction:

Physical inactivity is the leading cause of morbidity and mortality worldwide (Morgan,

Young, Smith, & Lubins, 2016.) In fact, the World Health Organization (WHO) has estimated

that in 2000, two million deaths worldwide were attributable to physical inactivity ( WHO,

2002.) Lack of physical activity greatly increases an individual’s risk of developing numerous

diseases, such as coronary heart disease, hypertension, diabetes, various cancers, and obesity

(U.S. Department of Health and Human Service [USDHHS], 1996.) Despite this risk, however,

numerous studies have indicated that the majority of Americans do not engage in the

recommended amount of physical activity required for optimum health (Downes, 2015.) Physical

activity can be described as a complex behavior that encompasses any sort of activity, such as

activity arising at work, household tasks, self care, transportation and discretionary leisure

time, including exercise and sports (Casperson, Powell, & Christenson, 1985.) The World

Health Organization (WHO) recommends a total of 150 minutes per week of leisure time

activities for adults aged 18-64. Despite these recommendations, a total of 8 in 10 adults do not

meet the recommended levels and even worse, a quarter of the United States population does not

engage in any leisure-time activity whatsoever (Hutchinson & Barfield, 2016.) College students

are included within these statistics and are considered to be at a particular risk for decreases in

physical activity levels (Calfas, Sallis, Lovato, & Campbell, 1994.) College students report more

barriers to exercise than any other age group (Johnston, Massey, & Marker-Hoffman, 2012.) It

has also been reported that health and physical activity professionals are unable to decrease the

number of college students who choose to remain sedentary (Keating, Guan, Piñero, & Bridges,

2005). According to a recent report, only 15% of 30% of college students meet the recommended

amount of physical activity (Blanchard et al., 2008,) and less than 20% engage in moderate
intensity at recommended levels (Centers for Disease Control and Prevention [CDC], 1997.)

Sedentary individuals not only fail to realize their increased risk of developing diseases, but also

the numerous benefits of engaging in regular physical activity. Regular physical activity

increases one’s quality of life and helps to prevent the onset of diseases (Tung & Hsu, 2009.) The

World Health Organization (WHO) states that individuals that engage in regular physical

activity have a decreased rate of all diseases, have less risk of a hip or vertebral fracture, exhibit

a higher level of cardiorespiratory and muscular fitness, and are more likely to achieve weight

maintenance, and have a healthier body mass (World Health Organization, 2016.) Regular

physical activity also provides many psychological benefits, such as an increase in self-esteem

and reductions in stress, depression, and anxiety (Nguyen-Michel, Unger, Hamilton, & Spruijt-

Metz, 2006; Ploughman, 2008; Youngstedt, 2005.) Despite the numerous benefits, however,

physical activity levels continue to decline in most societies (Patterson, Mcgeough, Cannon,

Hagstromer, Bergman, Kearney, and Sjostrom, 2006.) I will conduct an intervention study using

the Health Belief model to work towards increasing the physical activity levels of college

students.

Behavioral Intervention Theories:

The Health Belief Model (HBM), developed by Irwin Rosenstock in 1966, is a cognitive

model that appeals to an individual’s fear and examines the predictors and precursors to a health

behavior (Janz & Becker, 1984) (Marks, Murray, Evans, & Estacio (2015.) It is composed of 4

constructs: perceived susceptibility, perceived severity, perceived barriers, and perceived

benefits. Perceived susceptibility is an individual’s assessment of their risk of obtaining a disease

(Marks et al. 2015). If an individual feels as though he or she is more susceptible, the more likely

he or she is to increase physical activity levels in order to combat the increased risk of obtaining
disease. Perceived severity is an individual’s assessment of the seriousness of the health problem

and its potential consequences (Marks et al. 2015). The health belief model proposes that

individuals who view a given health problem as more serious are more likely to engage in

behaviors to prevent the health problem from occurring or reducing its severity. Perceived

barriers are an individual’s assessment of the influences that facilitate or discourage adoption of

the promoted behavior (Marks et al 2015.) Perceived benefits are an individual’s assessment of

the positive consequences of adopting the behavioral change (Marks et al. 2015.) The individual

must perceive more benefits than barriers to even consider engaging in regular physical activity.

Self-efficacy is a key component of the health belief model. Self-efficacy is an

individuals’ perception of his or her ability to successfully perform a behavior. An individual

must believe he or she is capable of performing regular physical activity. If an individual

believes he or she is able to control exercise behavior, then it is likely he or she will implement

the behavior change. Cues to action are also an important part of the health belief model. Cues

to action influence the likelihood of engaging in the behavioral change; they are reminders or

prompts to take action consistent with the intention and can be either internal (feeling a certain

way) or external (seeing posters) (Marks et al. 2015.)

Previous Physical Activity Interventions:

In a study conducted in 2012, Barfield and Hutchinson indicated that the transition from

adolescence to young adulthood serves as a critical juncture for continued participation in

physical activity, as physical activity levels decline from middle school to high school with

further decreases from high school to college graduation (Barfield & Hutchinson, 2012.) Bray

and Born (2004), examined this transitional period and found that the duration and frequency of

vigorous physical activity greatly decreased, with 50% of students who had been vigorously
active (i.e. [greater than or equal to] 20 minutes on [greater than or equal to] three days a week)

in high school becoming insufficiently active during their first college year. This supports the

fact that physical activity levels greatly decline an individual ages. Barfield and Hutchinson also

noted that college students perceive many barriers to engaging in physical activity (Barfield &

Hutchinson, 2012); for example, students may experience too much stress from an overload of

homework, exams, and other obligations.

The results of a study conducted in 2014 by Salahshuri, Sharifirad, Hassanzadeh, &

Mostafavi support the findings that young adults may perceive too many barriers to engaging in

physical activity. The researchers identified several health belief model components, in particular

the roles of self-efficacy, the benefits of and barriers to physical activity and its relationship with

physical activity in male and female high school students in the city of Izeh, Iran. The

participants of the study, which were obtained through a multi-stage random sampling method,

were 500 students (200 boys, 300 girls) from high schools of Izeh city during 2011 and 2012.

The data of the study was acquired through questionnaires that requested information about

demographic characteristics, self-efficacy, and perceived benefits and barriers. Once the data was

gathered, it was analyzed through the use of statistical tests, such as independent t-tests,

Spearman's correlation, Pearson's correlation coefficient and linear regression. This study

indicated that many factors influence students’ physical activity levels, such as long working

hours, family obligations, poor weather, lack of facilities, daily activities, no encouragement

from family, friends, etc., bad finances, bad mood, fear of injury, physical constraints, mild body

aches, physical exhaustion, lack of knowledge and guidance, lack of interest, devoting time to

study, lack of support from others (Salahshuri, Sharifirad, Hassanzadeh, , & Mostafavi (2014.)

The results of the study verified that self-efficacy and perceived benefits and barriers are crucial
in predicting the level of physical activity. Another study, conducted by Patterson, Mcgeough,

Cannon, Hagströmer, Bergman, Kearney, and Sjöström in 2006, also indicated that self-efficacy

may serve as an important determinant of physical activity (Patterson et. al, 2006.) Self-efficacy,

as stated previously, is a key component of the health belief model. It is an individuals’

perception of his or her ability to successfully perform a behavior. If an individual believes he or

she is capable of successful performing a behavior then the likelihood of them engaging in the

behavior increases.

As a result of physical inactivity, a study conducted by Downes (2015) indicated that lack

of adequate physical activity has greatly contributed to the obesity epidemic throughout the last

decade. Obesity is a risk factor for numerous chronic diseases, such as heart disease, diabetes

mellitus, and hypertension (Downes, 2015.) The study discovered that the majority of college

students’ physical activity levels were less than the recommended guidelines (Downes, 2015.)

The purpose of the study was to describe the health behaviors of a cohort of college students and

to assess the relationship between motivators and barriers to health behaviors, BMI, and

demographic variables. The researchers utilized a cross-sectional descriptive correlational survey

design to collect data from students at the University of Florida. The participants were 106

students at the university that attended an annual community health fair. The study included

much inclusion criteria: (a) being a student at the university; (b) age ≥ 18 years; and (c) ability to

read and speak English. The results of the study, which were obtained through surveys, indicated

that participants who were more likely to engage in physical activity reported high motivation

and perceived a low amount of barriers.

Researchers have also discovered that an individual’s health beliefs also play a crucial

role in understanding the importance of engaging in physical activity. Haas, Steptoe, Sallis, and
Wardle (2004) examined the leisure time activity in university students from 23 countries and

found that prevalence of leisure time inactivity varied with cultural and economic developmental

factors, averaging 23% (North-Western Europe and the United States), 30% (Central and Eastern

Europe), 39% (Mediterranean), 42% (Pacific Asian), and 44% (developing countries) (Haas,

Steptoe, Sallis, & Wardle, 2004.) The researchers indicated that the likelihood of leisure time

activity was associated with the individuals’ strength of beliefs in the health benefits of activity

and with national economic development. The individuals knowledge of activity and health was

rather disappointing, considering only 40-60% were aware that physical activity was linked to

disease (Haas et al., 2004.) Therefore, physical inactivity may a result of a lack of health

knowledge.

Physical Activity Intervention Components

The health belief model will be utilized to implement the importance of engaging in

regular physical activity. The basic components of the model are perceived susceptibility,

perceived severity, perceived barriers, and perceived benefits. The model also includes self-

efficacy, an individuals’ belief in his or her ability to successfully perform or implement a

behavior, and cues to action. Cues to action are the reminders or prompts to take action

consistent with the intention and can be either internal or external (Marks et al. 2015.) Perceived

self-efficacy will be improved by showing the participant’s how to self motivate in order to

continue their physical activity regimen, organize their time, and successfully engage in various

exercises. The participant’s attitudes about engaging in exercise will be assessed before and after

the intervention. Perceived behavioral control and behavioral intentions will also be assessed to

determine if the participants are able to successfully implement what they learned during the

educational sessions.
 Methods

Participants

The participants of the study will be a minimum of 100 Oakland university college

students, aged 18-24, who are enrolled in either HS 201 (Health in Personal or Occupational

Environments) or PSY 338 (Health Psychology.) The duration of the study will be a month. The

study is open to students of all class standings, however, the maximum amount of participants

accepted will be 150. The goal is to obtain as much data as possible. The participants will be

notified of the study through email, as well as through posters containing information about the

study posted throughout the Human Health Building. The teachers will also be requested to

notify the students of the study during class, considering many students do not check their

Oakland University email regularly. The participants will be offered either 5 extra credit points

or $25 as an incentive to participate and but must fully complete the study in order to obtain the

incentives.

Procedure

The participants will be required to first sign a consent form that informs them of all the

information pertaining to the study, including the purpose, the reason they are chosen as

participants, the risks, benefits, as well as the alternatives that are associated with the study, and

the rights they have as participants. The participants will be notified that they have the option of

withdrawing from the study at any time, however they will not receive incentive if they do so.

The participants that sign the informed consent form will then be administered a survey that

inquires if they feel remaining physically active is important and why, if they currently have any

exercise habits and how often they engage in them if so, and any barriers to exercise they may

perceive.
 After the participants complete the survey, they will then be required to attend 30- minute

sessions twice a week that incorporates the health belief model. They will be informed of the

many dangers of remaining sedentary, as well as the numerous benefits of engaging in regular

physical activity. They will learn about the numerous diseases they are at a higher risk for if they

choose to continue to remain sedentary and also the numerous benefits they will experience if

they choose to develop a regular exercise regimen. The sessions will also teach the participants

various exercises, how often they should be engaging in physical activity, and tips about how to

incorporate an exercise regimen into their daily lifestyle. They will also be made aware that they

are welcome to utilize the recreation center on campus, considering they are all Oakland

University students.

The participants will also have the opportunity to form exercise groups in order to

promote physical activity and increase self-efficacy. The groups will be composed of other

participants and the exercise sessions will occur at the recreation center. This will help the

participants to stay motivated to continue to exercise and change their exercise habits. The

participants will be required to track any forms of physical activity they engage in. The

participants’ fitness logs will be turned into me each week. This will hopefully discourage any

false data from being submitted. If a participant fails to submit their fitness log, they will be

dismissed from the study.

The participants will be required to attend two meetings throughout the intervention. The

first meeting will occur during the middle of the intervention. During this meeting, I will respond

to any questions the participants may have. The second meeting will occur at the end of the

intervention and will finalize the study and discover its effects. The goal is that the participants

have realized the importance of engaging in regular physical activity and have permanently
incorporated it into their lives. The participants will complete a final survey that inquires if they

now feel that remaining active is important, if they have developed any exercise habits, and if the

perceived barriers have significantly decreased, if not diminished. Upon completion of the study,

the goal is that the participants realize the importance of exercise and begin to engage in regular

physical activity.

Measures

Attitudes. Attitudes about physical activity will be assessed through the multiple surveys

that will be administered. It will measure how successfully the participants progressed through

the stages of the transtheoretical model and if the health belief model successfully enabled the

participants to recognize the effects of failing to engage in regular physical activity. The survey

will include statements, such as “I recognize the importance of remaining physically active” and

“I have noticed many changes in my stress levels and mood?” Participants will respond by using

the 7-point Likert scales, ranging from strongly disagree to strongly agree.

Educational sessions. This measures if the sessions, which incorporated the health belief

model and taught the participants the dangers of remaining sedentary, the benefits of regular

physical activity, and tips to incorporate regular physical activity, were effective in encouraging

the participants to engage in regular physical exercise. Participants will answer two questions

through a questionnaire about how successful they felt the educational sessions were, “How

successful do you feel the educational sessions were in implementing the importance of engaging

in physical activity?” Responses will be obtained through the 7- point Likert scale, ranging from

not successful to very successful.

Perceived self-efficacy. Perceived self- efficacy will be assessed using two questions,

“Are you confident enough to continue engaging in regular physical activity” and “During the
last month, did you feel as though you could continue implementing regular physical activity

into your lifestyle?” Responses will be obtained through the Likert 7-point scale, with responses

ranging from yes, very likely (1) to no, not likely at all (2.)

Perceived behavioral control. Perceived behavioral control will be assessed through two

questions, “Do you believe whether or not you exercise is up to you?” and “How confident are

you in your ability to effectively engage in physical activity?” Responses will be obtained

through the Likert 7-point scale, with responses ranging from not at all (1) to extremely (2)

Behavioral intentions. Behavioral intentions will be assessed through two questions,

“How often did you expect to engage in physical activity throughout this intervention?” and

“How often did you consider engaging in physical activity throughout this intervention?”

Responses will be given on a 7-point Likert scale ranging from never (1) to every day (7).

Discussion

There are numerous strengths of this intervention on Oakland University students. It will

educate the students’ about the importance of engaging in regular physical activity, promote

physical activity, and decrease the risk of obtaining disease. The participants’ will also benefit

from the numerous effects of engaging in regular physical activity, such as experiencing

decreases in anxiety and stress levels, obtaining better sleep, and either maintaining weight or

experiencing weight loss. These effects would greatly benefit Oakland University students,

considering it is likely they experience an overload of stress from not only school, but from

various other obligations.

Some weaknesses are also present within this intervention study, however. Numerous

psychosocial influences could influence the changes in the physical activity levels. Cultural or

environmental factors, for example, could be influencing the changes. Another weakness is the
fact that the participants are capable of submitting false data in order to receive an incentive. The

fact that the results are not generalizable to the entire United States population is also a weakness

of the study.

College is an important transitional period during which individuals form habits that will

last a lifetime; therefore, it is absolutely crucial to implement the importance of engaging in

physical activity during this time. The benefits of engaging in regular physical activity are

numerous for college students. College students are able to obtain an increased risk for numerous

diseases, experience better mental health, the strengthening of bones and muscles, the ability to

control weight, and the keeping of the students’ mind clear (Centers for Disease Control and

Prevention [CDC], 2015.) This intervention would educate the students’ about the dangers of

remaining sedentary, the numerous benefits of engaging in physical activity, how to perceive

little to no barriers, and how to successfully implement physical activity into the students’

lifestyles. Considering physical activity seems to be declining in many societies (Patterson,

Mcgeough, Cannon, Hagstromer, Bergman, Kearney, and Sjostrom, 2006.), only half of college

students meet the recommended amount of physical activity (Blanchard et al., 2008), and less

than 20% engage in moderate intensity at recommended levels (Centers for Disease Control and

Prevention [CDC], 2015), it is absolutely crucial to intervene at the college age level to begin the

implementation of these lifestyle changes.

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