Knowledge, Attitude and Practice of Medical Students Towards Role of Physical Activity in Prevention of Non-communicable Diseases

doi:10.21203/rs.3.rs-3246893/v1

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Knowledge, Attitude and Practice of Medical Students Towards Role of Physical Activity in Prevention of Non-communicable Diseases

https://doi.org/10.21203/rs.3.rs-3246893/v1

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Background

Non-communicable diseases are the leading cause of death and the main issue in modern and future public health worldwide. Non-communicable diseases are amenable to health promotion, prevention and medical interventions. Improved social conditions, quality of diet, body weight, smoking cessation, and increased physical activity can greatly reduce the burden of NCDs.

Methods

This study aims to assess the attitude and practice of medical students towards the role of physical activity in non- communicable diseases prevention in Nile University as perceived by students. An Observational-based analytical, cross-sectional study design. Data analysis was done using the SPSS software.

Result

The study included 81 males(43.1%) and 107 females(56.9%). Out of total number of students, 51% do not engage in physical activities and 49% participate in planned physical activities. The frequency of participation in physical activities are; Students who engage in physical activities daily (14, 7.4%) and weekly (37, 19.7%), while 40 students (21.3%) engage in physical activity monthly. Students that participate in planned physical activities for health benefits were 86(45.7%), and 4 students (2.1%) practice physical activities for social reasons, while a single student practices due to doctor’s advice 1 (5%). The majority of students had good background knowledge (83%) and most provde advice to their friends (38.3%) and family (51.1&).

Conclusion

Maority of the students had an acceptable background knowledge about the role of physical activities in prevention of major NCDs. However, they had low frequency of participation in planned physical activities despite having positive advocating attitude.

Non communicable disease

physical activity

medical students

prevention

excercise

Non-communicable diseases are chronic illnesses that ae not transmissible[1]. In general, the main non-communicable diseases, in terms of mortality and morbidity are main: cardiovascular diseases, diabetes, cancer and chronic respiratory diseases[2]. They are considered the most common cause of death. Non-communicable diseases kill more than 36 million every year, mostly in under developed countries[3]. Risk factors to acquire NCDs include increasing age, exposure to certain environments, smoking, unhealthy diet and lack of physical activity, all of which increase the risk of many NCDS. NCDs may be prevented by focusing of specific risk factors that can be modified, these could include smoking, unhealthy diet and physical inactivity[4].

In order to prevent NCDS it is important to address the risk factors associated with these diseases. Monitoring NCDS progress and trends and associated risks help to guide policy and priorities. Furthermore, Major NCD intervention is possible through primary care for early detection and management may be implement to ease the burden[5]. Evidence suggests that such interventions are appropriate investments because, if provided to patients early, they can reduce the need for more expensive resourses[6].

Non-communicable diseases are usually long lasting and may not be curable. However, current evidence suggests that they can be prevented by effective interventions that address their shared risk factors and underlying social factors. In addition, early detection and appropriate treatment of such diseases can reduce morbidity and premature death and improve quality of life[7]

Assessment of individual's knowledge, attitudes and practice of physical activity and its relationship to the prevention of non-communicable diseases may be useful. There are many modifiable risk factors that can be easily prevented[8]. Therefore, Assessing student behaviour and attitude toward planned physical activity can support student awareness of physical activity as one of the means to improve NCD prevention. Moreover, is important to participate in physical activity as part of treating modifiable risk factors to help with early intervention and disease prevention[9].

Objectives of the study:

To determine the proportion of students who practice planned physical activities.
To assess basic knpwledge of student about the relation between physical activity and non communicable diseases.
To assess the attitude of students towards physical activity.

Literature review:

A study was done in Silesia, Poland, from Medical University of Silesia about “Evaluation of physical activity level in students of Medical University of Silesia in Poland and to focus on the role of physical therapist students in promoting physical activity” the result of which are; The final analysis included 300 students from the schools of physical therapy, midwifery, nursing, pharmacy, cosmetology, and medicine. The short form of the International Physical Activity Questionnaire (IPAQ) was used to evaluate physical activity level. Physical therapist students demonstrated the highest level of physical activity, with (46%) demonstrating a high level of physical activity, (54%) a moderate level of physical activity, and none a low level of physical activity. The largest group of students with a low level of physical activity comprised students from the school of medicine (26%). The number of respondents was relatively small. There was a large group of medical students who, despite being aware of the benefits of physical activity, did not meet the recommended level of physical activity. Physical therapist students are well trained and qualified to promote healthy habits and encourage individuals to undertake regular physical activity[10].

Another research was conducted in the University of Malaysia Sabah in accordance with the National Health and Morbidity Survey 3 in 2008, about “Physical inactivity among Medical and Non-medical Students” the result of which are; a cross sectional study with a total participation of 300 University Malaysia Sabah’s undergraduate students (100 medical students and 200 non-medical students) was done. 49% of medical students were physically inactive compared to 35% non-medical students, OR 1.79(95% CI 1.10,2.91) which was statistically significant. 44% and 30% of female and male students were physically inactive respectively. After adjusted for socio- demographic confounders, gender and year of study were found to be confounders that associated with physical inactivity. The prevalence of physical inactivity among medical students was higher compared to non-medical students and physical inactivity was found higher in female students[11].

A mixed method study was conducted in the Grampian area of North-East of Scotland, by Amudha S Poobalan, in 2012 about “Physical activity attitudes, intentions and behaviors among 18- 25year olds” the result of which are; only 28% of 18-25year olds achieved recommended levels of physical activity which decreased with age. Self-reported overweight/obesity prevalence was 22%, increasing with age, particularly in males. Based on the statistical modeling, positive attitudes toward physical activity were strong predictors of physical activity associated with being physically active and less sedentary. However, strong intentions of exercise, was not associated with actual behavior. Interactive discussions through focus groups unraveled attitude and barriers influencing physical activity behavior. Doing physical activity to feel good and to enjoy themselves was more important for young people than the common assumptions of ‘winning’ and ‘pleasing others’. Further this age group saw traditional health promotion message as ‘empty’ and ‘fear of future health’ was not a motivating factor to change current behavior[12].

A study was done in South Africa, from the University of the Western Cape, Cape Town, about “Physical Activity and Non- communicable Disease Risk Factors: Knowledge and Perceptions of Youth in a Low Resourced Community in the Western Cape” the result of which in the total of 22 female youth participated in the study. The majority of the participants were single (86%), unemployed (63.6%) and secondary schooling (72.7%) of the highest level of education. Results indicated that the participants had little knowledge about physical activity, but lacked sufficient knowledge with regards to NCDs. Time constraints, lack of interest, low self-esteem, lack of awareness, safety, and financial constraints, knowledge deficit, parental influence, peer pressure, and poverty were seen as a barrier to the physical activity and NCDs risk factor[13].

Furthermore, another research was done in Eastern Uganda, by Temitope Tabitha Ojo, et al to “Explore the knowledge and attitudes toward non-communicable diseases among village health teams in Eastern Uganda”. The study suggested that the participants ranged from 28 to 66(mean 43.6) years of age. Approximately two-thirds were female and received secondary school education. Participants had worked as Village health teams for an average of 6.4 years and spent 19 hours per week doing village health team work. Nearly all participants (94.1%) knew that NCDs are not transmissible, and (82.4%) agreed/strongly agreed that NCDs are common in Uganda. The majority of participants claimed to know ‘a little’ about high blood pressure (70.6%), heart disease(61.8%), stroke (52.9%) and type II diabetes mellitus (63.2%) and nearly 90% thought that CVD is becoming more in Uganda. In addition, 77.9% responded that diabetes is caused by high blood sugar levels, and over half reported that diabetes can cause complications. Thirty-two participants (47.1%) thought diabetes was preventable. All participants thought smoking affected one’s health and was harmful to the lungs. Approximately 80% thought smoking was harmful to the heart and reported talking to community members about the harms of smoking. Similar numbers of participants reported having advised community members about the harms of excessive alcohol use[14].

A study was conducted in Khartoum, Sudan, by Marwa Mohammed Yousif, Lamis Kaddam and Humeda Suekit Humeda, about the “Correlation between physical activity, eating behavior and obesity among Sudanese medical students”. The total number of subjects who participated in this study was 216 students, 42% of them were males, and 58% were females. Their age ranged between 18 to 25 years and average was 19.99 ± 1.86 years. The participants were from first to fifth level. The prevalence of obesity among students was 6.5% and overweight was 22.2%. The study showed that 44.9% of medical students had low activity while 32% of students had moderate activity level and 23.1% had high physical activity level. There was no significant relationship between physical activity and body mass index (BMI) in this study. The common eating pattern among students was controlled eating (45.8%). There was significant relationship between eating behaviors and BMI (p = 0.01) [15].

Study design:

This is an observational-based analytical, cross sectional study.

Study population:

Medical students studying at Nile university, Khartoum state, Sudan. Medical students have more insight about the relationship between lack of physical activities and outcomes ( namely major non communicable diseases), and would have an expected attitude towards advocation.

Study area:

Nile university is an academic institution located in khartoum state, Sudan. The university usually engages in physical activities and organize annual competitions in which both students and staffs participate. The university is open for both national and international student.

Sampling technique:

A stratified sampling method was used, focusing on third, fourth and fifth year studrnts who are generally exposed to basic sciences, and would expected to have backgroud information.The total sample size was 02, and was calculated using standard statistical formula with a 95% confidence level, a 50% population proportion, a 5% margin of error, and a population size of 350.

Data management:

Data were collected via structured questionnaire after obtaining proper consent. Data analysis was perfoed using the SPSS software.

Demographic distribution

43.1% of participants were male and 56.9% female (Figure 1). Majority (72.3%) of students were between 21-25 years who were 136 in number, while the minority (4.3%) were between 26 and above and were 8 in number. However (23.4%) of students were between 18-20 years who were 44 (Figure 2). The participants were from 3^rd, 4th and 5^th year. Students from 3^rd year were 44(23.4%), and 82 students (43.6%) were from 4^th year, while 62 students (33%) were from 5^th year students (Table 1).

Students' practice of planned physical activity:

51% of student do not engage in physical activity and only (49%) of students participate in physical activities (Figure 3). Students that were found to participate in sporting activities were 54 (28.7%), while 37 students (19.7%) participate in physical exercise (Table 2). Students who engage in physical activities daily were 14(7.4%) and 37 of the students (19.7%) engage weekly, while 40 students (21.3%) engage in physical activity monthly (Table 3). 14% of total students practice for less than 30 min each session, 45% practice for one hour, where 26% of them practice for more than one hour (Figure 4). Students that participate in planned physical activies for health benefits were 86(45.7%), and 4 students (2.1%) practice physical activities for social reasons, while a single student practice physical activities due to doctor’s advice (5%) (Table 4). Moreover, Students who often plan a free time or date to engage in physical activities regularly were 51(27.1%), in which 40 students (21.3%) plan rarely (Table 5). More than half of students (68%) responded that their academic activities do not interfere with engagement of planed physical activities. 20% had clear interference and 12% were affected sometimes (Figure 5).

Stidents' background knowledge and attitude:

Students who think physical activities help in prevention of major NCDs were (83%), while the rest of the students (17%), do not think that engaging in physical activities helps in the preventing major NCDs (Figire 6). Moreover, students who usually advice colleague/friends to participate in planned physical activities were 72(38.3%), while 96 students (51.1%) advice their family members (Table 6).

Table (1): Frequency of students according to level of study.

Frequen cy			Percen t	Valid Percent	Cumulativ e Percent
Valid	3rd year	44	23.4	23.4	23.4
	4th year	82	43.6	43.6	67.0
	5th year	62	33.0	33.0	100.0
	Total	188	100.0	100.0

The participants were from 3^rd, 4th and 5^th year. Students from 3^rd year were 44(23.4%), and 82 students (43.6%) were from 4^th year, while 62 students (33%) were from 5^th year students.

Table (2): Type of planned physical activities performed by students.

Frequen cy			Percen t		Valid Percent		Cumulativ e Percent
Sports (Football, Basketball, Volleyball, swimming).	54	28.7		28.7		28.7
Physical exercise (jogging, gym etc.)	37	19.7		19.7		48.4
None	97	51.6		51.6		100.0
Total	188	100.0		100.0

Students that were found to participate in sporting activities were 54(28.7%), while 37 students (19.7%) participate in physical exercise.

Table (3): Frequency of participation in physical activities.

Freque ncy			Percen t	Valid Percent	Cumulativ e Percent
Valid	Daily	14	7.4	7.4	7.4
	Weekl y	37	19.7	19.7	27.1
	Month ly	40	21.3	21.3	48.4
	None	97	51.6	51.6	100.0
	Total	188	100.0	100.0

Students who engage in physical activities daily were 14(7.4%) and 37 of the students (19.7%) engage weekly, while 40 students (21.3%) engage in physical activity monthly

Table (4): Frequency of Primary motivation for participation in physical activities among students.

Frequen cy			Percen t	Valid Percent	Cumulativ e Percent
Vali d	For health benefit	86	45.7	45.7	45.7
	For social reasons	4	2.1	2.1	47.9
	Doctor’s advice	1	.5	.5	48.4
	I do not participate in any physical activity.	97	51.6	51.6	100.0
	Total	188	100.0	100.0

Students that participate in planned physical activies for health benefits were 86(45.7%), and 4 students (2.1%) practice physical activities for social reasons, while a single student practice physical activities due to doctor’s advice 1 (5%).

Table (5): Frequency of students that plan a free time or date to engage in physical exercise.

Frequen cy			Percen t	Valid Percent	Cumulativ e Percent
Valid	Regula rly	51	27.1	27.1	27.1
	Rarely	40	21.3	21.3	48.4
	Never	97	51.6	51.6	100.0
	Total	188	100.0	100.0

Students who often plan a free time or date to engage in physical activities regularly were 51(27.1%), in which 40 students (21.3%) plan rarely.

Table (6): Frequency of students who actively advice others to engage more in planned physical activity.

Frequency			Percent	Valid Percent	Cumulative Percent
Valid	Family members	96	51.1	51.1	51.1
	Colleagues and friends	72	38.3	38.3	89.4
	No one	20	10.6	10.6	100.0
	Total	188	100.0	100.0

Students who usually advice colleague/friends to participate in planned physical activities were 72(38.3%), while 96 students (51.1%) advice their family members.

Table (7): Gender * Students that practice planed physical activity cross tabulation

Do you practice any planed physical activity in job or school?				Total
Yes			No	Total
Gender	Male	52	29	81
Gender	Femal e	40	67	107
Total		92	96	188

P value= 0.000

There is significant relationship.

Table (8): Students that practice planed physical activity * planned physical activities that student engage in Cross tabulation.

Count

Which planned physical activity do you practice?					Total
Sports (Football , Basketbal l, Volleybal l, swimming) .			Physical exercise (jogging, gym etc.)	None	Total
Do you practice any planed physical activity in job or school?	Yes	54	37	1	92
	No	0	0	96	96
Total		54	37	97	188

P value=0.000

There is significant relationship.

Table (9): Students that practice planed physical activity * how often they participate in physical activity cross tabulation.

Count

How often do you participate in physical activity ?						Total
Daily			Weekly	Monthl y	None	Total
Do you practice any planed physical activity in job or school?	Yes	14	37	40	1	92
	No	0	0	0	96	96
Total		14	37	40	97	188

P value = 0.00

There is significant relationship

Table (10): Students that practice planed physical activity * average time which students use to participate in physical activity cross tabulation

Count

How many hours on average do you participate in physical activity?						Total
Less than 30 min			One hour	More than one hour	None	Total
Do you practice any planed physical activity in job or school?	Yes	26	41	24	1	92
	No	0	0	0	96	96
Total		26	41	24	97	188

P value =0 .00

There is significant relationship

Table (11): Students that practice planed physical activity * Reason students participate in planned physical activity cross tabulation

Count

Why do you participate in planned physical activity?						Total
For health benefit			For social reasons	Doctor’s advice	I do not participa te in any physical activity.	Total
Do you practice any planed physical activity in job or school?	Yes	86	4	1	1	92
	No	0	0	0	96	96
Total		86	4	1	97	188

P value=0.00

There is significant relationship

Table (12): Students that practice planed physical activity * interference of students’ academic activities with their involvement in physical activity cross tabulation.

Count

Do academic activities interfere with your involvement in physical activity?					Total
Yes			No	Sometimes	Total
Do you practice any planed physical activity in job or school?	Yes	37	32	23	92
	No	0	96	0	96
Total		37	128	23	188

P value=0.063

There is no significant relationship

Table (13): Students that practice planed physical activity * students who advice people to engage more in planned physical activity Cross tabulation.

Count

Who do you usually advice to engage more in planned physical activity?					Total
Family members			Colleague s and friends	No one	Total
Do you practice any planed physical activity in job or school?	Yes	50	35	7	92
	No	46	37	13	96
Total		96	72	20	188

P value = 0.210

There is no significant relationship

Table (14): Students that practice planed physical activity * knowledge of student about prevention of non-communicable diseases Cross tabulation.

Count

Do you think engaging in planned physical activities helps in preventing major chronic diseases (especially non communicable diseases)?				Total
Yes			No	Total
Do you practice any planed physical activity in job or school?	Yes	82	10	92
	No	74	22	96
Total		156	32	188

P value=0.028

There is significant relationship

Table (15): Students that practice planed physical activity * the barriers that prevent students from participating in physical activity Cross tabulation.

Count

What are the barriers that prevent you from participating in physical activity?						Total
Healthy related barriers			Academic load	Environme ntal barriers	No barriers	Total
Do you practice any planed physical activity in job or school?	Yes	0	7	3	82	92
	No	10	50	36	0	96
Total		10	57	39	82	188

Findings of this study showed that majority of participants were female comprising of 107(57%), most of the student’s age (72%) were between 21–25 years old. Most of students that participated in this study were from 4th year (Table 1). Overall, the study showed that medical students had a relatively lower engagement in planned physical activities similar to a study conducted in the University of Malaysia Sabah in accordance with national health and morbidity survey 3 in 2008[11].

Regarding students who participate in planned P.A, 56% were males and 44% were females (Table 7). P value (0.000), Moreover, more than half of the students that participate in physical activities engage in sporting activities (football, basketball, volleyball, swimming rather than traditional physical excersises (p-value 0.00) (Table 8). 43% of those who practice do so only once per month, and 40% practice weekly (p-value 0.00) (Table 9).

Despite the fact that the students are adequately and well informed about the benefits of physical exercise, a significant proportion of the students (51.6%) do not participate in any planned physical activity (Table 3). This is similar to the research that was done in Silesia, Poland, from Medical University of Silesia[10]. Medical students are usually burdined with a relatively higher academic load when compared to other specialties.. However, further analysis revealed that most of the students(68.1%) reported that physical activities do not interfere with their academic performance (Fig. 5).

Majority of participants (45.7%) engage in physical activities mainly for health benefit (Table 4) in contrast to a study done in Grampian area of North-East of Scotland which they found their research participants practice

P.A to feel good and to enjoy themselves[12].

Out of those who practice planned physical activity, 28% practice for less than 30 min, 45% practice for one hour, where 26% of them practice for more than one hour (Table 10).P value (0.00), which was statistically significant.

Furthermore, out of those who practice planned P.A, the majority (86, 93%) mentioned that they practice to become more healthy (Table 11). This may be in line with their background knowledge. However, 40% of those who practice faced significant interference due to academic load, 35% faced no none while 25% reported occasional interference (p-value 0.063) (Table 12), which was not statistically significant. Further analysis also revealed that students who actually practice planned physical activoty tend to have a slightly more positive attitude towards providing advice to others than those who do not. However, these findings had statistically insignificant assocoation (p-value 0.210) (Table 13).

Regarding knowledge of the students about role of P.A in prevention of major NCDs (Fig. 6), almost all the students (83%) were aware that participating in P.A helps in prevention of major NCDs which is similar to a study done in Uganda[14]. However, out of those who agree (156), only 52% of them participate in physical activities (Table 14). P value (0.028), which is statistically significant. Moreover, most students reported no barriers. Andout of those who had barriers, most of them refered to academic load (Table 15).

Medical students have good background knowledge about the role of deferent physical activities in prevention of major NCDs, however, there is significant lack of actual practice despite being aware of the benefits and lack of significant barriers. The positive advocating attiude does not significantly impact engagent in planned physical activity.

Limitations:

The limited sample size, alongside more detailed correlation with different emvironmental backgrounds, ethnicity and cpmparison with other undergraduate healthcare professions would provide more in depth understanding of the disproportionate relation between knowledge and practice that seem to appear in different studies.

Recommendations:

Arrangement of sport days by learning institutions would help improve student’s participation in physical activities, as well as provision of facilities and adequate environment. Moreover, organization of education programs to help students organize and coordinate their participation in physical activities with any potential barriers including academic load.

BMI

Body Mass Index

CDC

Centers for Disease Control

CVD

Cardiovascular Disease

IPAQ

International physical Activity Questionnaire

Doctor of Medicine

MPH

Master of Public Health

NCDs

Non-Communicable Disease

Physical activity

PHD

Doctor of Philosophy

SPSS

Statistical Package of Social Science

WHO

World Health Organization

Ethical Approval:

Ethical clearance was obtained from relevant authorities, namely the Research Project In Public Health ethical commitee, community medicine department, Nile University. The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Consent to participate:

An informed verbal consent was obtained from each participant before data collection while ensuring clear confidentiality and anonymity during data collection from both participant and collectors, as approved by the Research Project In Public Health ethical commitee, community medicine department, Nile University.

Consent for publication:

Not aplicable.

Availability of data and materials:

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

Competing interests:

The authors declare that they have no competing interests.

Funding:

There were no funding nor grants.

Authors' contributions:

SM. contributions: project administration, supervision, manuscript writing, editing, visualization, literature review, investigation, manuscript validation and review.

A.S.M, A.A.M, A.E, AA and AB contributions: literature search, data collection, data analysis, manuscript preparation, editing and revision.

Acknowledgments:

Apprecoations to Nile university, colleagues and students who participated in this study. Gratitude to both departments of community medicine and internal medicine for providing grounds, support and supervision.

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No competing interests reported.

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Knowledge, Attitude and Practice of Medical Students Towards Role of Physical Activity in Prevention of Non-communicable Diseases

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