This descriptive cross-sectional study was conducted from November 2016 to February 2017 at King Saud University (KSU) in Saudi Arabia. KSU is the largest and oldest university in the Kingdom of Saudi Arabia, located in the capital city Riyadh. To conduct this study, ethical approval was provided by the Ethics Committee at the College of Applied Medical Science at KSU (CAMS 003–37/38).A sample of 1656 students participated in this study; they were enrolled at either the health or non-health colleges of KSU. In this study, health colleges included disciplines such as medicine, nursing, and applied medical sciences, whereas non-health colleges are comprised of the business, computer, and science schools. Convenience sampling was used to recruit students. In addition, the formula by Krejcie & Morgan was used to estimate the sample size of the present study.

University professors were asked to distribute a self-administered questionnaire among their students. In order to control for duplicated studies, the survey questionnaire was distributed in each department by one doctor or researcher assigned to that college. Additionally, an online version of the questionnaire was developed via Google Forms and the link was sent to all students enrolled at KSU in this college. The online survey was available for 12 weeks to allow enough time for students to respond. Participation in the study was voluntary and students agreeing to participate were asked to sign a consent form. Moreover, students were assured of the confidentiality and anonymity of the collected data and were informed of their right to both withdraw from the study and skip answering any specific question.A self-administered questionnaire was used for data collection. It consisted of two sections: the first section was about demographic characteristics including age, gender, type of college, year in school, family structure, residence status, and body height and weight which were transformed into a body mass index score (BMI) (kg/m2). BMI scores have been categorized into four groups: underweight (≤18.5); normal weight (18.6–24.9); being overweight (25–29.9); and being obese (≥30) [26].

The second section of the questionnaire included  The Web Druid questions from the Health Promotion Lifestyle Profile II (HPLP-II), which consists of a total of 52 items along six subscales [6, 27]. However, in order to encourage the participation of students in this study, to ensure that all questions are being properly answered, and most importantly to ascertain that posed questions are culturally appropriate, the researchers decided to stream it down to three subscales consisting of 26 items. The chosen subscales are the ones known to have the most direct effect on health status, including health responsibility [9 items], physical exercise [8 items] and nutrition [9 items].

The overall score on the scale reflects the level of healthy lifestyle behaviors. All items on the scale were presented positively. Participants responded to each item on a 4-point Likert-type scale (1 = never, 2 = sometimes, 3 = often, and 4 = always). The lowest possible score for the entire scale is 26, and the highest possible score is 104, higher scores on the scale indicated a higher level of health promoting behaviors. Before we started the process of data gathering, the questionnaire was translated into Arabic language by a professional language translator. Also the questionnaire was pilot tested to ensure the reliability, validity, and its appropriateness with respect to cultural relevance here in Saudi Arabia. The Arabic translated HPLP questionnaire had an acceptable Cronbach’s alpha of 0.94. The chosen subscales are the ones known to have the most direct effect on health status, including health responsibility [9 items], physical exercise [8 items] and nutrition [9 items]. The Cronbach’s alpha coefficients of the three subscales that have been used varied between .79 and .87.Because smoking among female students in Saudi Arabia is a sensitive issue and based from the literature mentioned above the researchers decided to exclude this factor in this study. Moreover, the investigators who were bilingual speakers translated the questionnaire into Arabic and then back translated it into English. The back-translated copy was compared to the original English version and adjustments were made as necessary. The Arabic version was piloted on a sample of students (N = 50) to ensure the clarity, understandability and cultural relevanceof the items.

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