Health Literacy, Health-Related Behaviors, and Stress Management as Modifiable Factors of Stress among University Students

Articles in Press

Document Type : Original Article

Authors

Public Health Program, Faculty of Science and Technology, Nakhon Si Thammarat Rajabhat University

Abstract

Background and Objective: Mental health among students in higher education remains a major public health concern, affecting well-being and academic performance. This survey research, conducted between December 2023 and January 2024, aimed to determine the academic stress and its related factors among 415 students in 1st  to 4th study years at Nakhon Si Thammarat Rajabhat University, Thailand.

Materials and Methods: Participants were recruited using proportionate convenience sampling across faculties. The data were gathered through a structured questionnaire that consisted of five parts, including health literacy, health-related behaviors, stress management behaviors, and stress tests. Mean differences were compared using independent samples t-tests and one-way analyses of variance. Associations between variables were tested using Pearson correlation analysis. Multiple linear regression and structural equation modeling were used to examine factors associated with stress.  

Result: The results revealed that about 70% students showed stress levels above the normal range. Furthermore, 13.73% of the students had stress at the highest severity level. Female students had significantly higher stress than males (p-value<.05), and fourth-year students exhibited significantly higher stress levels than first- and second-year students (p-value<.001). In addition, Science and Technology students experienced significantly less stress than other students (p-value=.004). Health literacy, health-related behavior, and stress management behavior were found to be significantly negatively correlated with stress.  The findings were consistent with a potential mediating role of stress management in the association between health literacy and stress  with health literacy showing significant indirect association with stress through stress management behaviors (p-value<.001).

Conclusion: These results revealed the importance of health literacy, health-related behavior, and stress management promotions among academic students to reduce stress. Interventions should be considered for specific student subgroups, including by sex, academic year, and faculty, to address those who might be at greater risk of stress.

Keywords

Acknowledgements: We would like to thank Nakhon Si Thammarat Rajabhat University students for participating in this study.


Availability of data and materials: The datasets analyzed and materials in this study can be obtained from the corresponding authors upon reasonable request.


Conflicts of interest: The authors declare no conflict of interest.


Consent for publication: Not applicable. 


Ethics approval and consent to participate: This study was approved by the Human Research Ethics Committee of Nakhon Si Thammarat Rajabhat University (COA No. 042/2566), granted on July 11, 2023, and was conducted in accordance with the principles of the Declaration of Helsinki. All participants were fully informed of the study’s objectives, anticipated benefits, and data collection procedures prior to providing written informed consent. They were also guaranteed that their responses would be kept confidential of and only be used for the study.


Funding: This research received partial financial support from the Public Health Program, Faculty of Science and Technology, Nakhon Si Thammarat Rajabhat University, specifically for expenses related to questionnaire reproduction and ethical review processes.


Author contributions: Conceptualization, Methodology, Formal analysis, Writing - Original Draft: SP, Investigation: KP, PY, WB, Writing- Reviewing and Editing: SP, NT, KC.


Declaration of generative AI and AI-assisted technologies: During the preparation of this manuscript, the authors utilized Sidekicker.ai to assist in refining the academic writing style of the initial draft and to check plagiarism. Following its use, the authors critically reviewed, revised, and edited the content to ensure accuracy and appropriateness. The authors take full responsibility for the content and conclusions presented in the published article.

 

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this license, visit https://creativecommons.org/licenses/by/4.0/

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Journal of Health Literacy

Articles in Press, Accepted Manuscript
Available Online from 23 May 2026

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