Promoting Wellness Online: Assessing the Health Needs of U.S. Fully Online College Students to Develop Healthy (Virtual) Campus Initiatives

Concurrent Session 2
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Brief Abstract

The demand for online education paves incredible opportunities for Healthy Virtual (v-)Campus 2020 initiatives, but the results from our study found that most online universities are not providing interactive student health services needed for the fully, online student, based on their most common health and behavior risks affecting academic performances.

Presenters

Dr. Burcin, Academic Program Director for the School of Health Sciences Undergraduate programs, received the 2016 Presidential Award for Faculty Excellence. Prior to joining Walden in 2012, she served as Director of Healthy Carolina at the University of South Carolina where she was responsible for the collaborative development, promotion and assessment of a wide-ranging array of wellness programs. Under Dr. Burcin’s leadership, Healthy Carolina became a nationally recognized initiative developed to enhance student learning, improve recruitment, retention and productivity of faculty and staff, and be a catalyst for health research. Dr. Burcin has served in numerous professional leadership roles including the Chair of the National Healthy Campus Coalition from 2008 until 2013. This multi-disciplinary coalition was responsible for developing Healthy Campus 2020 (the sister document to Healthy People 2020). Dr. Burcin is also a Fellow with the American College Health Association and has implemented more than 100 presentations, workshops and trainings on college campus, business, and conference across the country.

Extended Abstract

Description: It is well documented that health impacts a student’s academic achievement. Although wellness data is collected yearly across college campuses in the U.S., there is very little known about online students’ health needs and behaviors, or how college health services are evolving, to address the needs of this population- who are quickly becoming the majority in higher education. This demographic shift provides incredible opportunities for developing Healthy Virtual (v-)Campus initiatives that leverage technology in innovative ways to improve and promote student wellness.

Research Questions:  The first aim of this study was to determine health status, health behaviors, and risk factors of fully online learners in order to determine priority areas for health promotion for this population. A second aim was to identify health-related factors perceived to impact online students’ academic performance. Finally, the third aim was to assess strategies used by universities to provide health-related services to online students. Therefore, the learning outcomes of this presentation are to:

  1. Describe health behaviors and risk factors, perceived health status, and priority areas for health promotion reported by college students enrolled in fully online academic programs in the U.S.
  2. Identify health-related factors perceived by college students enrolled in fully online programs that impact their academic performance.
  3. Determine virtual health services currently offered by universities to fully online students.
  4. Recommend ways in which technology can be leveraged to develop and deliver virtual Healthy Campus 2020 initiatives that address the needs of online college students.     

Methods:  

This first phase of this study used an online survey to collect data on perceived health status, risk factors, health behaviors and preferred health education among a volunteer sample of 961 fully online college students in the U.S. Students 18 years and older, enrolled in two, large, accredited online universities, were recruited to participate in the research. Students were invited by way of an electronic announcement through various campus communication channels to complete the online health survey. Survey items were based on questions included in the American College Health Association’s (ACHA) National College Health Assessment II (ACHA-NCHA II). The NCHA II is a national, validated and reliable research survey which assists college health service providers, health educators, counselors, and administrators in collecting data about their students' habits, behaviors, and perceptions on the most prevalent health topics. The ACHA-NCHA provides the largest known comprehensive data set on the health of college students, providing the college health and higher education fields with a vast spectrum of information on student health. The researchers leading this study were given permission to use specific subsets (36-items) of the ACHA-NCHA II most relative to virtual, non-traditional students in order to assess health and to benchmark the variables under study.

In the second phase of the study, the researchers also used an online survey to collect data about strategies used by U.S. colleges and universities to deliver health services and health promotion to online students. A volunteer sample of 63 college health professionals from a national sample of accredited colleges completed the survey. Since relevant instrumentation on this topic was lacking, a 19-item survey was created by the study researchers. An expert panel from the executive board of ACHA’s Healthy Campus Coalition reviewed the instrument and assessed the face validity and construct validity by cross-walking survey items to the primary focal areas of Healthy Campus 2020. Recruitment emails were sent through the Student Health Services (SHS) and National Intramural-Recreational Sports Association (NIRSA) listservs, and personalized emails to all institutions that had taken the National Healthy Campus Pledge through ACHA and the top 20 online degree offering universities. Participants were asked to volunteer and complete a brief online survey using Survey Monkey to determine current health-related programs and services offered to fully online students on their campuses.

The primary institution’s Institutional Review Board approved both phases of the research and participants completed an electronic informed consent form regulated by the Uniform Electronic Transactions Act.

Results:

Phase 1: Student Survey

In the first phase of the research, a total of 961 fully online students completed the health assessment survey. Results indicated that 15.77% of the respondents have been diagnosed with a chronic illness (e.g. cancer, diabetes, auto-immune disorders) and 11.10% have been diagnosed with a psychiatric condition. In terms of physical health, 10.9% reported using tobacco (cigarettes, cigars, cloves, smokeless) daily, 65.52% reported being slightly-very overweight with 67.23% currently trying to lose weight. Sixty-one percent (61.26%) reported eating only zero-two servings of fruits and vegetables per day, 45.58% engage in no physical activity (moderate-vigorous aerobic or strength training zero days per week), and 60.99% sit more than six hours each day.

Regarding mental health, 20.43% have felt “overwhelmed by all they had to do” and 17.78% felt “exhausted (not from physical activity)” in the last 30 days. Twenty-nine percent (28.74%) have been diagnosed with depression and 29.92% have felt “down, depressed or hopeless” over the last two weeks. Thirty-six percent (35.59%) have felt “more than average stress” and 13.56% have felt “tremendous stress”. Forty-six percent (46.47%) self-reported feeling “rested” after sleeping only 0-2 days per week.

The top five health impediments to academic performance reported by the participants were:  stress, work, anxiety, sleep difficulties, and finances. A large majority (71%) believed that health and well-being impacted their academic standing, and 70.49% indicated “yes” they would participate in virtual health services and use electronic health promotion resources or programs if they were offered at their university.

Phase II: Survey of College Health Professionals

A total of 63 college health professionals working in student health services at U.S. accredited colleges completed the online survey. With regard to university health services offerings to fully online students, 15% of the institutions represented charged online students a health fee, 33% offered university sponsored health insurance, 36% provided primary care services, and 52% provided mental health services. Mental health and stress management were the most common types of services offered, but the most common modality was through text-based materials on a website. After mental health, the most common type of health services offered to fully online students were resources or programs relating to 2) stress management (n = 37); 3) physical activity/fitness (n = 33); 4) relationship violence/sexual assault (n = 32); 5) weight management tied with substance abuse (n = 31); 6) nutrition (n = 29); 7) tobacco cessation (n = 26); 8) STI/HIV/AIDS (n = 21); 9) injury prevention (n = 20); 10) family planning (n = 15). The most common modalities to offer the health services were: 1) written material/website (39%); 2) individual health coaching (18.2%); 3) online modules (12.9%); 4) lecture/live Q&A session (10.9%); 5) webinars (7.6%); 6) group health coaching (5.9%); 7) telehealth/eHealth (4.4%); 8) mobile app/text messaging (1.8%); 9) discussion board coaching (0.3%). 

Discussion/Interpretation: Our study findings underscored the need for U.S. colleges and universities to increase virtual health promotion resources, programs and strategies tailored for the growing number of online college students. The demand is there; the large majority (70%; n = 580) of online students in this study indicated they would use health promotion resources and services if they were offered at their institution. However, few universities are doing more than providing written material online. Handouts and websites provide a good starting point but they do not offer behavior change techniques or support for real health actualization. Strategies might include online health coaching, self-paced online modules, videos, pod casts, wellness blogs, mobile apps, or social media campaigns.

Most of the health issues reported by students in this survey are addressed by Healthy Campus (e.g. mental health issues such as stress; nutrition; sleep, physical activity). However, online students identified financial health as an area for health education as well as sedentary behaviors. Fifteen percent of participants completing the survey were dealing with some form of a chronic illness, so more tailored education around certain chronic diseases most commonly reported by university students.  

Leveraging technology to improve college health promotion will not only cater to the preferences of more “digitally native” Millennial students, but will also address a resource gap, especially for those enrolled in fully online programs. Furthermore, as the results of the student survey confirmed, health and well-being are connected to academic success. By providing services and programs that address some of the most pressing health challenges, including mental, physical and financial health, academic performance and retention may also improve.

Conclusion: With so many digital tools and platforms available like never before, now is the perfect time for health educators and others involved with college wellness to collaborate, develop, and test the effectiveness and potential of virtual health innovations. Likewise, the field of college health and the guidelines in Healthy Campus 2020 must also evolve to account for more eHealth and Healthy v-Campus approaches which support and sustain a culture of wellness.

Engagement: The audience will be engaged with Turning Point technology and able to respond to polls throughout the presentation simultaneously. In addition the audience will participate in round table, brainstorming discussions regarding ways to incorporate wellness into online learning platforms.