JOURNAL OF AMERICAN COLLEGE HEALTH, VOL. 56, NO.

Health Value, Perceived Social Support,

and Health Self-Efficacy as Factors
in a Health-Promoting Lifestyle
Erin S. Jackson, PhD; Carolyn M. Tucker, PhD; Keith C. Herman, PhD

Abstract. During their college years, students may adopt healthpromoting lifestyles that bring about long-term benefits. Objective and Participants: The purpose of this study was to explore
the roles of health value, family/friend social support, and health
self-efficacy in the health-promoting lifestyles of a diverse sample
of 162 college students. Methods: Participants completed an
Assessment Battery consisting of the following instruments: (1)
a demographic questionnaire, (2) the Multi-Dimensional Support,
(3) the Value on Health Scale, (4) the Self-Rated Abilities for
Health Practices, (5) the Health-Promoting Lifestyle Profile II,
and (6) the Marlowe-Crowne Social Desirability Scale. Results:
Correlational analyses indicated that health value, perceived family/friend social support, and health self-efficacy were significantly
associated with engagement in a health-promoting lifestyle. An
analysis of covariance (ANCOVA) revealed that health value and
health self-efficacy significantly predicted the level of engagement
in a health-promoting lifestyle. Perceived family/friend social
support was not significant in the model. As age increased, level
of perceived family/friend social support decreased. Conclusion:
Present findings suggest that health interventions programs focus
on assessing and increasing health self-efficacy and health value of
these youth. College health professionals can design and evaluate
the effectiveness of such health-promoting interventions.

ing these challenges may become parts of their lifestyle into

adulthood. These behaviors can promote health or increase
the frequency of risk behaviors that lead to poor health.3 The
promotion and maintenance of health-promoting lifestyles
for college students are critical to prevent the development
of chronic diseases.4 In addition, health-promoting behaviors
make it more likely that students will be successful in school,
by reducing absenteeism and fostering positive mental health.4
Research aimed at identifying the health-promoting needs of
college students may assist in the adoption of healthy lifestyle
behaviors throughout their life spans.
To improve the health of college students, it is imperative
to reduce the frequency, delay the onset, and aim for the
prevention of health-risk behaviors. Therefore, an important goal of researchers investigating college student health
must be to identify factors that influence health-promoting
behaviors, such as exercising frequently, eating healthy
foods, and getting sufficient rest.
Pender5 proposed the Health Promotion Model to explain
the multidimensional pattern of a health-promoting lifestyle and to guide future research. According to this model,
performing health-promoting behaviors can be achieved
through the direct and indirect effects of a combination of
individual cognitive-perceptual factors, modifying factors,
and cues to action.6 Cognitive-perceptual factors are motivational mechanisms that directly influence the maintenance
of health-promoting behaviors. These factors may include
definitions of health, health value, perceived health status,
perceived control, perceived self-efficacy, perceived benefits,
and perceived barriers. We used 2 key cognitive-perceptual terms: health value and self-efficacy. Health value is an
enduring belief that a specific health-promoting behavior is
preferred to an alternative behavior. Self-efficacy is the belief
that one can successfully engage in an expected health behavior. Modifying factors are variables that impact the decision-

Keywords: health-promoting lifestyle, health self-efficacy, health

value, social support

any college students are living away from home

for the first time and are challenged with the
responsibility of their personal health.1 They are
also challenged with greater autonomy, new demands, and
stressors associated with a different structure to daily life.2 The
behaviors that college students develop in the process of meetDrs Jackson and Tucker are with the Psychology Department
at the University of Florida, Gainesville. Dr Herman is with
Johns Hopkins Universitys Department of Child and Adolescent
Psychiatry, Baltimore, MD.
Copyright 2007 Heldref Publications
69

Jackson, Tucker, & Herman

making process by influencing individual perceptions. These

variables involve demographic factors (eg, age, gender, race,
ethnicity, education, and income), biologic characteristics
(eg, body weight, height, and body fat), interpersonal influences (eg, social support), situational factors (eg, access to
alternatives), and behavioral factors (eg, past experiences).
A key modifying factor term used in this article is perceived
social support, which is a perceived sense of social belonging or social connection influenced by the preferred versus
desired frequency of social interaction and level of intimacy
in those interactions. This modifying factor can serve as a
cue to action. Cues to action are variables that may move
the individual from the decision-making phase to the action
phase. These cues may be personal awareness, advice from
others, the impact of mass media, and social and political
movements.
Penders Health Promotion Model5 can be viewed as
an extension and elaboration of the more familiar Health
Belief Model.4 Penders model is more comprehensive
because it delineates multiple cognitive-perceptual variables
and modifying variables that lead to health decisions and
behaviors. For instance, one of the primary criticisms of the
Health Belief Model has been its failure to account for selfefficacy and social support,4 2 central variables in Penders
Model. Penders Model has been successfully applied to
understanding the health-promoting lifestyles of several
populations, such as older women,7 blue collar workers,8
ambulatory cancer patients,9 adolescent girls,10 and college
students.11
Although the health behaviors of college students have
been frequently studied,1217 few studies have used Penders
Health Promotion Model to guide such research.18 Penders
Model may be particularly applicable to college students
because of its emphasis on modifiable self variables, health
value, and self-efficacy. Recent studies have supported its
applicability to adolescents and diverse samples.19,20 We
based our study on Penders Model and designed it to explore
the factors associated with the health-promoting lifestyles
of college students. Health value and perceived health selfefficacy were the cognitive-perceptual factors from Penders
Model that we examined as motivational tools that may
directly influence the adoption and upholding of positive
health behavior. We examined social support as a modifying
factor that may affect the decision-making process involved
with engagement in positive health behavior. Aspects of
social support, such as advice from others, serve as cues to
action that may guide the college students from the decision-making stage to the action phase of engaging in health
promoting behaviors. In sum, we explored the roles of health
value, self-efficacy, and social support in the engagement in
health-promoting behaviors of college students.
METHODS
Participants
Following Institutional Review Board approval, the first
author recruited students from 2 introductory psychology
classes at a large university located in the southeastern part of
70

the United States. We selected these classes because students

from a wide range of majors and of varying backgrounds typically enroll in these courses and because they provided easy
access to a large pool of students. We distributed questionnaires to 180 interested students and collected them during
subsequent classes. We informed participants that participation
was voluntary and anonymous. The response rate was 90%.
The sample included 162 participants; 49 were men
and 113 were women. The median age of the participants
was 20 years (standard deviation [SD] = 0.85). The ethnic
backgrounds of the students comprised 3% Latino/Hispanic
black, 7% Asian American/Pacific Islander, 8% Latino/Hispanic white, 11% African American/black, 68% Caucasian/
white American, and 4% other. Table 1 shows additional
descriptive data obtained from these participants.

TABLE 1. Descriptive Statistics for Research

Participants
Demographic variable
Age (y)
18
19
20
21
22
23 and older
Gender
Female
Male
Race/ethnicity
African American/black
Asian American/Pacific Islander
Caucasian/white American
Latino/Hispanic black
Latino/Hispanic white
Other
Class
Freshman
Sophomore
Junior
Senior
Post-baccalaureate
Family income
Less than $20,000
$20,001$40,000
$40,001$60,000
$60,001$80,000
$80,001$100,000
More than $100,001
Primary caregiver in home
Mother/mother figure
Father/father figure
Other relative
Other
Adults mostly present in home
Mother/mother figure
Father/father figure
Mother and father
Other

6
38
43
35
22
18

3.7
23.5
26.5
21.6
13.6
11.0

113
49

69.8
30.2

17
11
110
4
13
7

10.5
6.8
67.9
2.5
8.0
4.3

1
30
73
56
2

.6
18.5
45.1
34.6
1.2

8
21
39
26
22
40

4.9
13.0
24.1
16.0
13.6
24.7

82
54
3
11

50.6
33.3
1.9
6.8

32
2
124
4

19.8
1.2
76.5
2.5

JOURNAL OF AMERICAN COLLEGE HEALTH

Health-Promoting Lifestyle

Instruments
We used an Assessment Battery consisting of the following instruments: (1) a demographic questionnaire to obtain
information including age, gender, race, current academic
level, and family income; (2) the Multi-Dimensional Support Scale21 to assess the frequency/availability and adequacy of perceived social support from family and friends
(previously reported internal reliability coefficient alphas for
the scale range from .81 to .9021); (3) the Value on Health
Scale22 to assess the value placed on or the importance of
different aspects of health, including fitness or good physical
state, energy or vigor, endurance or stamina, maintaining an
appropriate weight, and opposition to disease (the Value on
Health Scale has good internal consistency [ = .77])22; (4)
the Self-Rated Abilities for Health Practices Scale23 to assess
health self-efficacy regarding exercise, well-being, nutrition,
and general health practices (the internal consistency of the
Self-Rated Abilities for Health Practices Scale is .92)23; (5)
the Health-Promoting Lifestyle Profile II (HPL II)24,25 to
measure the degree of engagement in a health-promoting
lifestyle along 6 dimensions: spiritual growth, health responsibility, physical activity, nutrition, interpersonal relations,
and stress management (the Cronbach alpha for the total
scale is .94 and ranges from .79 to .87 for subscales24); and
(6) the Marlowe-Crowne Social Desirability Scale, short
form (M-C SDS [20],26 to measure the amount of variance
in the data caused by the participants desire to present self
in a socially desirable manner. (Reliability coefficients for
the 20-item instrument range from .78 to .83.26) Researchers
in prior studies with college students used all the scales that
we used.
Procedure
We recruited participants from 2 introductory psychology classes. Extra course credit was provided for each study
participant. We informed students that their participation was
voluntary and anonymous and that at any time they could
withdraw from the study or refuse to answer any question.
We told students that the purpose of the study was to investigate the relationships between beliefs and health behaviors.
We asked those students interested in participating to demonstrate their interest by collecting a packet after class.
We distributed an Informed Consent Form and an Assessment Battery in an envelope to students who approached
the investigator for a packet. We instructed participants
to complete the assessments in the packets at home and
return them at 1 of the following 2 class meetings, which
were held 2 days and 4 days after the initial distribution of
Assessment Batteries. We also informed participants of the
contents of the packet. We then gave participants instructions for completing the contents of the package. First,
we instructed participants to read and sign the Informed
Consent Form. Second, we told them to complete the
Assessment Battery, which included the 5 assessments
described above that totaled 113 items. Third, we instructed
participants to complete the Demographic Questionnaire.
To ensure confidentiality, we told participants to place the
VOL 56, JULY/AUGUST 2007

completed Assessment Battery and Demographic Questionnaire, which were stapled together, into the provided
envelope and to seal the envelope. We told participants to
drop the Informed Consent Form in a box that was separate
from the box in which the envelopes with their completed
questionnaires were collected to guarantee that their questionnaire responses were kept confidential.
Upon submission of the completed Assessment Battery,
we gave each participant a Debriefing Form to read and
sign that was kept separate from the completed packets.
The Debriefing Form outlined the nature and purpose of the
study. We asked participants to return the signed Debriefing
Form to the Principal Investigator immediately after reading it over carefully and having any questions addressed.
Finally, to obtain extra course credit, participants signed
a roster upon submission of their signed Debriefing Form.
We gave this roster directly to the class instructors or their
teaching assistants to insure each student received extra
credit for research participation.
RESULTS
Preliminary Analysis
We performed preliminary Pearson product-moment correlation analyses to examine the relationship between social
desirability and the other studied variables. The analyses
revealed that social desirability significantly correlated with
health-promoting lifestyle (r = .28, n = 144, p < .01), perceived family/friend social support (r = .17, n = 153, p <
.05), and health self-efficacy (r = .17, n = 153, p < .05).
Therefore, we used social desirability as a covariate in the
analyses used to test the proposed hypotheses and research
question.
Results Regarding the Hypotheses and
Research Question
Correlation analyses revealed significant positive relations between the health-promoting lifestyle variable and
levels of health value (r = .51, n = 141, p < .01), perceived
family/friend social support (r = .35, n = 141, p < .01), and
health self-efficacy (r = .61, n = 141, p < .01). Table 2 presents the correlational matrix from these analyses.
We conducted an analysis of covariance (ANCOVA) to
determine the unique contribution of 3 independent variableshealth value, perceived family/friend social support,
and health self-efficacyin predicting health-promoting
lifestyle when controlling for social desirability. The overall model was significant, F(4,132) = 36.35, r2adj = .51, p
< .01, and accounted for 51% of the variance in level of
engagement in a health-promoting lifestyle. Significant
main effects included health self-efficacy, t(1) = 7.03, p <
.001, and health value, t(1) = 5.18, p < .001 (see Table 3).
We also performed a multivariate ANCOVA (MANCOVA) to determine whether there was a significant difference in the level of value of health, level of perceived
family/friend social support, level of health self-efficacy,
or level of engagement in a health-promoting lifestyle in
association with gender, age, family income, or ethnicity
71

Jackson, Tucker, & Herman

TABLE 2. Intercorrelations of Major Investigated Variables
Variable
1.
2.
3.
4.

Health value
Family/friend social support
Health self-efficacy
Health-promoting lifestyle

.23
.29
.51

.34
.35

.61

Note. All variables are significant at p < .01. N = 141.

TABLE 3. Analyses Predicting Health-Promoting Lifestyle, Controlling

for Social Desirability
Variable
Health value
Perceived social support
Health self-efficacy

SE

2.32
.52
.60

.33
.35
.09

5.18
1.49
7.03

.00*
.14
.00*

Note. F(4,132) = 36.35, r2adj = .51, p < .01.

*
p < .01.

TABLE 4. Analyses of Significant Variables in Multivariate Analyses

Significant relationship
Race and health-promoting lifestyle*
African American
Asian American
Caucasian
Latino/Hispanic black
Latino/Hispanic white
Age and family/friend social support
*

13.72
17.66
3.58
11.97
8.89
.46

1.13
1.39
.32
.81
.71
2.54

.26
.17
.75
.42
.48
.01

F(5, 123) = 4.22, p < .01.

F(1, 123) = 6.46, p < .05.

(see Table 4). The dependent variables in the MANCOVA

were health value, perceived family/friend social support,
health self-efficacy, and health-promoting lifestyle. The
independent variables included gender, age, family income,
and ethnicity. We once again entered social desirability as a
covariate. The multivariate tests revealed that race, Wilkss
lambda () = .675, F(20, 398) = 2.512, p < .05, and age,
= .924, F(4,120) = 2.468, p < .05, had statistically significant main effects. Univariate results indicated that race
was significantly associated with level of engagement in a
health-promoting lifestyle, F(5, 123)= 4.22, p < .01; however, follow-up tests to determine the nature of these associations revealed no significant racial differences in level of
engagement in health-promoting lifestyle. Univariate tests
also revealed that age was significantly associated with
level of perceived family/friend social support, F(1, 123) =
6.46, p < .05. Inspection of relationship direction indicated
72

that as participants age increased, level of perceived family/friend social support tended to decrease.
COMMENT
Our research affirmed the importance of health value and
health self-efficacy as variables in health-promoting lifestyles among college students. Intervention programs that
empower students to make positive health decisions and
to engage in health-promoting behaviors may counter the
influences to engage in health risk behaviors such as substance abuse that are common in college environments.3,4
Health value and health self-efficacy significantly contributed to participants engagement in a health-promoting
lifestyle. Participants who placed a higher value on health
and on health self-efficacy tended to also have a greater
involvement in a health-promoting lifestyle. This finding lends support for Penders Health Promotion Model
JOURNAL OF AMERICAN COLLEGE HEALTH

Health-Promoting Lifestyle

because it is consistent with the Penders tenet that engagement in health behavior is a function of the value attached to
the outcome of good health and of personal beliefs, such as
self-efficacy. However, family/friend social support was not
a significant predictor of engagement in a health-promoting
lifestyle. This unexpected finding suggests that, for this college student sample, personal variables, such as health value
and health self-efficacy, are stronger influences on engagement in a health-promoting lifestyle than are the external
influence of general family/friend social support. Because
college students typically spend more time away from home
and their families, family support may be less influential in
their engagement in health-promoting lifestyles. Independent exploration of family versus friend social support may
provide clarity regarding the role of external social support
in the health-promoting activities of college students.
Implications for College Student Personnel
Health professionals working on college campuses can
facilitate the adoption and maintenance of health-promoting lifestyles among college students.13 By providing outreach education on health issues, the self-efficacy beliefs
of college students may be increased. As students are
informed and instructed on how to perform certain positive health behaviors, confidence in their ability to perform
those actions may also be enhanced. Planners of outreach
education programs can address breast self-examining,
constructing healthy meal plans, balancing salt and sugar
intake, proper exercise techniques, stress management, and
relaxation. Administrators can also address these self-care
practices at campus health fairs or in health classes.
Health professionals can also develop and implement
programs aimed at increasing the health value of college
students. Furthermore, they can offer seminars addressing self-management strategies for engaging in health
behaviors that decrease the likelihood of cancer, diabetes,
hypertension, obesity, arthritis, substance addiction, and
unplanned pregnancy. By explicitly describing the link
between current health behavior and long-term health quality of life, students value of health may be enhanced. At the
same time, college students may desire healthier lifestyles
and, therefore, increase levels of engagement in health-promoting behaviors. In addition, changing perceived social
norms about health behaviors is an established way to alter
health value valences.4 For instance, most students who
engage in harmful behaviors, such as smoking or excessive
alcohol use, significantly overestimate the percentage of
their peers that engage in the same behaviors. Measuring
social norms on campus and then advertising them can
significantly alter student health value beliefs.
College and university administrators must aid college
students in the adoption and maintenance of health-promoting lifestyles. By creating campuses in which students feel
empowered to make healthy choices, college students can
adopt healthy lifestyles as they enter the workforce. Health
researchers, health educators, and mental health providers
can facilitate this empowerment.
VOL 56, JULY/AUGUST 2007

Our findings that 2 self variables, health self-efficacy and

health value, were significant predictors of engagement in a
health-promoting lifestyle among college students provides
support for health-promoting interventions that empower
college students to make positive health decisions. College
health professionals possess the necessary skills to promote
this empowerment of college students through teaching
self-management strategies and using cognitive interventions designed for the adoption and maintenance of healthpromoting lifestyles.
Implications for Future Research
Our study has several implications for advancing
research. First, researchers should explore the healthpromoting lifestyles of college students of different ethnic backgrounds. Different ethnic populations must be
researched independently to better grasp the motivating
factors for each population. Possible contributing variables include family value of health, family and close
friend support for positive health behavior, family health
practices, locus of control, and perceived barriers to
health-promoting lifestyles.
Second, future studies are needed in which researchers
further examine the role of health value in the healthpromoting lifestyles of college students. It would also be
beneficial to conduct this research with larger samples that
include a representative number of male college students.
Third, researchers also should investigate the roles of
family support and friend support separately as external
social support influences on health-promoting lifestyles
among college students. Because college students have
limited interaction with their families during the college
years, the support of friends may have been what accounted
for the weak association between family/friend support and
engagement in a health-promoting lifestyle in the present
study.
Fourth, future research in which investigators explore the
role of health self-efficacy in health-promoting lifestyles
is clearly indicated. Such research would benefit from the
inclusion of a general self-efficacy measure so that the
relative influence of general self-efficacy and health selfefficacy can be assessed within the same study.
Limitations
Although our findings generally supported the hypotheses,
some limitations must be considered when interpreting the
results. The first major limitation of this study concerns the
small sample size; 162 students participated in the study, and
68% were Caucasian Americans. Furthermore, the sample
was predominantly female (70%). Because the sample was
drawn from 2 classes on a single university, it is not known
how well the findings generalize to students in other schools
in other parts of the country or even to students at the same
school. Additional research is needed to augment the present
findings.
A second limitation of the study is the use of a crosssectional design. This design does not allow for the infer73

Jackson, Tucker, & Herman

ence of causality. Therefore, research using longitudinal

data may assist in determining a specific relationship
between the investigated factors and engagement in a
health-promoting lifestyle among college students.
Conclusion
Colleges and universities are environments where health
professionals can establish intervention programs to promote the adoption and maintenance of healthy lifestyles
among college students. These programs are particularly
meaningful, given that college students are challenged
with the responsibility for their personal health.1 New life
experiences in college may lead college students to engage
in unhealthy behaviors, such as unprotected sex, substance
abuse, or smoking. Research in which investigators aim
to identify factors that contribute to health-promoting lifestyles among college students can provide information that
would aid in establishing effective health-promotion programs on college campuses.
NOTE
For comments and further information, address correspondence to Dr Keith C. Herman, Johns Hopkins University, 600 N. Wolfe St., CMSC 394, Baltimore, MD 21287
(e-mail: kherman6@jhmi.edu).
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