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Citation for published item:
Blake, H. and Stanulewicz, N. and Griths, K. (2017) 'Healthy lifestyle behaviors predict health promotion
attitudes in pre-registered nurses: a questionnaire study.', Journal of nursing education., 56 (2). pp. 94-103.
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Blake, Holly and Stanulewicz, Natalia and Griffiths,
Katherine (2016) Healthy lifestyle behaviours predict
health promotion attitudes in pre-registered nurses.
Journal of Nursing Education . ISSN 1938-2421 (In
Press)
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1
HEALTHY LIFESTYLE BEHAVIOURS PREDICT HEALTH PROMOTION
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ATTITUDES IN PRE-REGISTERED NURSES: A QUESTIONNAIRE STUDY
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Holly Blake
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, Natalia Stanulewicz
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, Katherine Griffiths
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School of Health Sciences, University of Nottingham, UK.
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2
School of Psychology, University of Nottingham, UK.
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Nottingham University Hospitals NHS Trust, Nottingham, UK.
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Holly Blake PhD CPsychol
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Associate Professor of Behavioural Science, School of Health Sciences, University
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of Nottingham, Queen's Medical Centre, Nottingham, Nottinghamshire.
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Natalia Stanulewicz MA (corresponding author)
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Doctoral student, School of Psychology, University of Nottingham, Nottingham,
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Nottinghamshire.
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address: Natalia Stanulewicz
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School of Psychology, East Drive, University Park Campus, University of
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Nottingham, Nottingham, Nottinghamshire, NG7 2RD, United Kingdom
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e: lpxnkk@nottingham.ac.uk
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Katherine Griffiths MNursSci
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Staff Nurse, Queen's Medical Centre, Nottingham University Hospitals NHS Trust,
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Nottingham, Nottinghamshire.
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2
HEALTHY LIFESTYLE BEHAVIOURS PREDICT HEALTH PROMOTION ATTITUDES
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IN PRE-REGISTERED NURSES
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Abstract
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Background: Nurses report inadequacies in health promotion practices and recognise their
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own lifestyle choices influence their willingness to give health promotion advice. The aim of
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this study was to investigate attitudes towards being role models for healthy eating, and
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examine predictors of health promotion attitudes in pre-registered nurses as health
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professionals of the future.
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Method: Questionnaire survey with 493 pre-registered nurses. Measures included health
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promotion attitudes, healthy lifestyle index (combining diet and physical activity habits), self-
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esteem and body satisfaction.
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Results: Pre-registered nurses (89.5%) felt that nurses should be role models for health; at the
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same time 37% had rather negative health promotion attitude. Those who disagreed were
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more likely to be dissatisfied with their body and lead less healthy lifestyles. Most pre-
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registered nurses (96%) felt that delivering health promotion would be a key element of their
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job and held positive health promotion attitudes. Healthy lifestyle was the most consistent
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significant predictor of health promotion attitude.
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Conclusion: Pre-registered nurses with unhealthy lifestyle, lower self-esteem (and body
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dissatisfaction among overweight/obese student nurses) held more negative health promotion
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attitude. Intervention is needed to support pre-registered nurses in making healthy lifestyle
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choices, improving self-perception and health promotion attitude.
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Key words: Health promotion, healthy lifestyle, nurses, obesity, self-perception.
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3
HEALTHY LIFESTYLE BEHAVIOURS PREDICT HEALTH PROMOTION ATTITUDES
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IN PRE-REGISTERED NURSES
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Excess weight and obesity are a major population health issue in the United Kingdom
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(NOF, 2014) and worldwide (James, 2004), with devastating effects for individual health,
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healthcare services and the economy. As the advocates for health, nurses play an important
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role in health promotion and the reduction of population obesity (Prime Minister’s
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Commission, 2010). As such, patients view nurses as role models for health (Blake, 2013).
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Nurses generally agree with this view, and recognise that their lifestyle choices can influence
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those of their patients (e.g., poor diet and smoking: Blake & Harrison, 2013). However,
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nurses often do not lead healthy lifestyles themselves (McElligott, Siemers, Thomas, &
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Kohn, 2009), which can negatively impact on care quality (Hebert, Caughy, & Shuval, 2012;
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Lobelo, Duperly, & Frank, 2009) and their credibility (Blake & Harrison, 2013), as healthcare
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professionals who lead healthy lifestyle are more likely to deliver health promotion to
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patients than those who do not (Hebert et al., 2012, Lobelo et al., 2009). Nurses have reported
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previously that being overweight or engaging in unhealthy behaviours would reduce their
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willingness to promote health promotion to their patients (Blake & Patterson, 2015).
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Even though nurses largely agree that it is important for them to make healthy lifestyle
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choices, this view does not necessarily translate into a healthier nursing workforce. In the
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UK, the Department of Health (DH, 2009) reported that 58% of nurses working for the
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National Health Service (NHS) were overweight; with 25% being obese. This is close to the
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amount of people with BMI > 25 in the general UK population – 61.7% (PHE, 2015), which
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is concerning taking into account the health-related education and training that nurses
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receive. Still, overweight and obesity remain prevalent amongst pre-registered (student) and
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registered (qualified) nurses (e.g., DoH, 2009; Blake, Mo, Lee, & Batt, 2012). Dietary habits
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are less than exemplar among nurses (especially among pre-registered nurses), as many of
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