An Ecological Perspective on Healthy Nutrition as a Component of

Health Attitude

Marietta Karamyan

National University of Uzbekistan, Tashkent, Uzbekistan

Keywords: Health, Biopsychosocial Model, Ecological Model, Environment, Environmental Conditions, Health Attitude,

Cognitive and Emotional Components of Health Attitude, Health Behaviour, Healthy Nutrition, Health Locus

of Control, Self-Efficacy, Self-Regulation, Constructive Self-Assertiveness, Psychological Well-Being.

Abstract: The aim of the present paper is to analyse an ecological perspective of health attitude in personality on the

example of healthy nutrition. The significance of biopsychosocial and ecological approaches for

comprehensive understanding of health and health attitude is emphasized. These approaches holistically

explain health and health attitude as a result of complex interaction of biological, psychological and social

factors at multiple levels and as an integral part of individual’s physical, natural, social and cultural

environment. The component structure of health attitude is briefly described in the frames of V. Myasishev’s

theory of attitudes. The relationship of health attitude and psychosocial characteristics in personality on the

example of healthy nutrition is discussed. The research findings are considered in the course of general idea

that the relationships between psychosocial characteristics and healthy nutrition as component of health

attitude are complex. It is shown that high indicators of internal health locus of control, self-efficacy, self-

regulation, constructive self-assertiveness, psychological well-being correlate to healthy nutrition in adults

and teenagers.

1 INTRODUCTION

Health as a value has one of the important positions

in the individual and social hierarchy of values. Even

though there are more than hundred definitions of

‘health’ and ‘illness’ in the modern literature, the

definition given by World Health Organization

(WHO) in 1948 is still among popular: ‘health is a

state of complete physical, mental and social well-

being, and not merely the absence of disease or

infirmity’ - Babicz-Zielińsk, E (2006) - Barzegari, A,

& et. al. (2012) - Bennet, P., & et. al. (1997) -

Berezovskaya, R.A, & et. al. (2006). This definition

underlines that health has not only biological

peculiarities, but psychosocial, that health status is

dependent on biological, psychological and social

determinants. One of the main contributing factors for

health state is attitude towards health in personality.

The present paper addresses the following

objectives: 1) to give a general overview on

biopsychosocial and ecological understanding of

health as fundamentals for analysis of attitude

towards health; 2) to discuss research data on the

relationship of health attitude and psychosocial

characteristics in personality on the example of

healthy nutrition.

2 LITERATURE REVIEW

Component encompasses person’s feelings, emotions

and emotional resources related to his/her health

status. Behavioural component is defined by presence

or absence of actions directed to support of one’s own

health or coping with illness conditions.

The modern understanding of health attitude is

based on biopsychosocial model of health and illness

and ecological paradigm towards health. The

mentioned above WHO's definition of health is one

of the examples of this model. The biomedical model

of health and illness has been the dominant model for

several centuries. Although this model has proven to

be very effective in treating disease, it is limited

because it disregards the fact that health and illness

are the outcomes of an interaction of social,

psychological and biological factors.

The biopsychosocial model holistically explains

health as a result of complex interaction of biological,

Karamyan, M.

An Ecological Perspective on Healthy Nutrition as a Component of Health Attitude.

DOI: 10.5220/0012956100003882

Paper published under CC license (CC BY-NC-ND 4.0)

In Proceedings of the 2nd Pamir Transboundary Conference for Sustainable Societies (PAMIR-2 2023), pages 1171-1175

ISBN: 978-989-758-723-8

1171

psychological and social factors at multiple levels. It

shows ecological-systemic understanding of health.

In modern publications, scientists prove the need to

consider health as a dynamic system. The use of the

concept of ‘dynamics’ emphasizes that the influence

of biological, psychological, interpersonal and

contextual factors on human health is not strictly

fixed. For example, it is possible to investigate the

mechanisms of influence of a teenager's peer group

and his/her close friendships on the development of

healthy habits.

According to the ecological paradigm of health a

human being is understood as an integral part of

his/her physical, natural, social and cultural

environment. There are several key characteristics of

health in ecological approach: 1) health is

multidimensional phenomenon; 2) health is seen via

dynamic balance and interaction of an individual with

environment, which are holistic and integrated; 3)

health is both a process of active adaptation of

individual to changing conditions of environment and

its result; 4) health is related to spiritual and

emotional individual well-being as well with cultural

lifestyles.

I. Kickbusch shows that ecological model is

comprehensive because it is concerned with the

whole individual in its environment. It considers all

range of health determinants, takes into account

cultural and personal meanings of health, aims to

understand emotional and behavioural sides of health.

This model allows to discuss primary health care,

disease prevention and health promotion. For

example, the ecological approach to health promotion

includes both the need to conserve natural resources

and to respond to the environmental factors (e.g.,

urbanization, technology) changing people’s lives. In

other words, the ecological understanding of health

underlines the individual’s position at the centre of

complex interaction of social, cultural and physical

environment.

The biopsychosocial and ecological models frame

the social psychological theories of health attitude,

health behaviour and their studies, health promotion

programs and design for behaviour change

interventions. According to these models health

attitude is determined by various sets of factors such

as socio-demographic (sex, age, education and social

status), socio-economic and legislative (e.g.

socioeconomic status, laws restricting the

advertisement of alcohol), socio-cultural (e.g. dietary

culture), socio-medical (e.g. health care provision,

access to health care), psychosocial (e.g. social

support, motivational factors).

In a broader context it is shown that the

psychosocial impacts associated with environmental

conditions. For example, the research by Crighton et

al (2003) was devoted to the impact of environmental

conditions on health in Karakalpakstan. It was found

that residents of three Karalpak districts (Kungrad,

Shumanay, Muynak) were more likely to report

environmental concern if they had trouble keeping

employment, perceived their health as fair or poor,

were involved in more local activities; and the

respondents were less likely to have environmental

concerns if they had more close relatives and friends.

This study indicated the positive relationship between

psychosocial impacts and negative environmental

perceptions (i.e. environmental awareness, perceived

health impacts).

The research on gender factors is another good

example of ecological understanding of health

attitude and health behaviour. The idea that the

differences between men and women in their health

outcomes are the consequences of behaviours had

been raised in the mid-1970s. Many studies

demonstrate strong evidence that fewer health-

promoting practices and greater risk taking among

men contribute to their increased risk of serious

chronic disease, injury and death. They show that

women are more likely than men to engage in a

variety of health-enhancing practices and to have

healthier lifestyle patterns. Men, in contrast, are more

likely than women to engage in health-impairing

behaviour. Men are also less likely than women to

engage in a variety of preventive and self-care

techniques and the failure to do so is a major

contributor to men’s shorter lives and increased

health risks.

It is shown that beliefs about manhood are

associated with increased risk for health. Men who

adopt stereotypic beliefs about masculinity have

greater health risks than their peers with less

traditional beliefs. More prominent masculine

features in individuals are associated with better self-

assessed health status for both women and men.

Psychosocial factors also play an important role in

understanding person’s healthy nutrition in the

frames of the ecological paradigm. The literature

review shows that the considerable body of studies on

the psychosocial correlates of healthy nutrition can be

divided into several research directions:

▪ the first research direction focuses on knowledge

of what constitutes a healthy diet, i.e. on beliefs about

nutrition and food;

▪ the second research direction primarily

investigates an influence of psychological factors on

food choice;

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▪ the third research direction pays attention to

possible relationship of eating habits and

psychosocial mediators such as social and family

influence, age, gender;

▪ the fourth research direction attempts to find

associations between eating and dietary habits and

self-attitudes, including self-esteem, ‘self-silencing’,

self-regulation;

▪ the fifth research direction analyses how

different motivational and emotional characteristics

such as perceived behavioural control, locus of

control, self-efficacy may possibly influence person’s

eating behaviours and dietary habits.

Based on the mentioned above the article presents

some empirical data on the relationship between

psychosocial factors (health locus of control, self-

efficacy, self-regulation, psychological well-being)

and nutrition.

Table 1. Means and Standard Deviations in Groups with External and Internal Locus of Control (N=122, adults)

Components of

Health Behaviour

Participants with

External Locus of

Control (N=53)

Participants with Internal Locus of

Control (N=69)

Student’s test, p<0.05

M SD M

Nutrition 1.16 1.10 1.84

Table 2: Bivariate Correlations of Healthy Nutrition, Self-Efficacy and Indicators of Self-Regulation (N=200, teenagers)

Variables Self-

Efficacy

Constructive Self-

Assertiveness

Self-

Regulation:

Planning

Self-

Regulation:

Modelling

Self-

Regulation:

Programming

Self-

Regulation

: Results'

Evaluation

Nutrition

Correlation

Coefficient

.306** .215** .142* .182** .127 .144* .206**

p<0.05 (*), p<0.01 ()**

Table 3. Bivariate Correlations of Healthy Nutrition and Personality’s Psychological Well-Being (N=122, adults)

Variables Positive

Relations

Autonomy Environmental

Mastery

Self-

acceptance

General

Psychological

Well-Being

Nutrition

Bivariate

Correlations

with

Nutrition

.248** .128 .266** .238** .188*

Note: *p < 0.05, **p < 0.01

3 METHODOLOGY

The participants (adults’ sample of 122 females and

males, teenagers’ sample of 200 girls and boys) were

asked to indicate how well the specific health actions

described his/her typical behaviour and to answer

psychological questionnaires. Also, they were asked

to define the notion of ‘healthy life style’ which

allowed to conduct a content analysis of social

representations of respondents.

Health practices in the sphere of nutrition were

studied with the help of list of items which compose

healthy nutrition (e.g. ‘Eat sensibly’, ‘Avoid eating

fast food’, ‘Have a balanced diet’). Motivational

characteristics of adults were evaluated using

Multidimensional Health Locus of Control (by

Wallston et al, 1978), Self-Efficacy Scale

(R.Schwarzer, M. Jerusalem), psychological well-

being – The Ryff Scale of Psychological Well-Being.

Motivational features of teenagers were studied using

Self-Efficacy Scale (R.Schwarzer, M. Jerusalem),

Self-Regulation Style Questionnaire

(V.I.Morosanova), Self-assertion Scale for

Teenagers.

Data analysis was performed by the SPSS 23.0

software. Descriptive, inferential statistics

(Independent Samples Student’s Test or Mann-

Whitney Test depending on normality of distribution)

and correlation analysis (Spearman's Rank

Correlation Coefficient) were used.

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4 RESULTS AND DISCUSSIONS

Cognitive component of health attitude

The idea of importance of healthy nutrition for health

state is reflected in people’s social representations of

‘healthy life style’. In other words, cognitive

component of health attitude encompasses people’s

understanding of their health and life style. The

content-analysis of adult’s and teenagers’

(Karamyan, M. 2018) social representations was

conducted in the frames of final year research

projects. It was found that ‘nutrition’ takes the third

place among actions which adults (16,3%) and

teenagers (12%) consider to be health practices.

‘Healthy food’, ‘right nutrition’, ‘useful food’, ‘eat

what it is useful for you’, ‘fresh products’, ‘diet’,

‘regular eating’, ‘you are what you eat’ are the

examples of answers related to healthy nutrition. The

results of these studies show that adults and teenagers

relate healthy life style with healthy nutrition

including choice and intake of safe food, appropriate

eating behaviour and dietary habits.

Behavioural component of health attitude and

motivational correlates

Healthy nutrition as health-related behaviour can be

governed by specific characteristics of human being

motivational sphere such as locus of control and self-

efficacy.

The locus of control concept could be defined as

person’s belief that he/she has control over their

health, including healthy nutrition. It was shown that

people with internal health locus of control more

likely find information on health, follow healthy diet

and physical activity. Self-efficacy is seen as sense

which concerned with perceived capabilities to

produce effects and personal influence. It has been

found that self-confident people more often that non-

confident ones perform health practices, e.g. people

with high self-efficacy were less likely to relapse to

their previous unhealthy diet.

These data are confirmed by correlational analysis

which revealed statistically significant positive

correlation between healthy nutrition and internality

(rs=0.259, p<0.01) and self-efficacy (rs=0.226,

p<0.05). It allows to conclude that individual’s belief

in his/her own capacities and disposition to rely on

oneself determines high behavioural activity in the

sphere of healthy nutrition and physical activity.

Table 2 shows statistically significant positive

correlations between healthy nutrition scale and self-

efficacy (rs=0.306, p<0.01), constructive self-

assertiveness (rs=0.215, p<0.01), self-regulation

(rs=0.142, p<0.05), planning (rs=0.182, p<0.01),

programming (rs=0.144, p<0.05), results’ evaluation

(rs=0.206, p<0.01) in the teenagers sample. In other

words, those teenagers who are characterized by high

self-efficacy, flexible and adequate reactions to

environment, independence, conscious and realistic

planning of activity, are more confident in their

choice of healthy nutrition and performance of

healthy eating.

Behavioural component of health attitude and

psychological well-being. Psychological well-being

is multidimensional concept consisting of person’s

self-acceptance, skills to establish quality ties to

others, sense of autonomy, ability to manage complex

environments to suit personal values, to develop as a

person. It has been explored that success of weight

loss program and improvement of nutrition

behaviours are related to the development of

psychological well-being in individuals with the help

of Kripalu yoga.

The results of correlational analysis between health

behaviour components and indicators of

psychological well-being are given in Table 3. The

analysis of the relationship between total healthy

nutrition score and psychological well-being

dimensions showed that there are positive

correlations of adequate nutritional practices and

general indicator of psychological well-being

(rs=0.188, p<0.05), positive relations with others

(rs=0.248, p<0.01), environmental mastery

(rs=0.266, p<0.01), self-acceptance (rs=0.238,

p<0.01).

Although these correlations are not strong, they may

reflect the specific dynamics in the personal response

to healthy nutrition as behaviour. They demonstrate

that there is a variety in explanation of relationship

between psychological well-being and healthy

nutrition. For instance, person’s high level of life

satisfaction, his/her positive affective emotions

explain his/her activity in relation to choose and

following to healthy nutrition. If people are

characterized by warm, satisfying, trusting relations

with others, are concerned about their welfare and are

capable of strong empathy and intimacy, then they

have enough power to follow healthy life style in

general and healthy nutrition in particular. Also if one

possesses a positive attitude toward his/herself, feels

positive about past life and acknowledges different

parts of his/her life and personality, then he/she is

more successful in performing healthy nutrition.

The results of these studies demonstrate that there are

different psychosocial factors contributing to

person’s healthy nutrition including choice of safe

food, its intake, eating and dietary habits. These data

show that according to ecological paradigm the

modification of behaviour related to healthy nutrition

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assumes not changing only social, political, economic

conditions but also careful consideration of

individual’s role in producing and performing the

health practices. However, this article does not claim

that one or other of the generalisations made are more

right. The most important point is to look not only at

the statistical significance of results but also at their

practical significance..

5 CONCLUSIONS

There is a growing body of evidence suggesting that

ecological understanding of health attitude and the

healthy nutrition as its part gives many practical

applications for effective development of health care,

health education and health promotion. It is especially

significant because one’s nutrition play a key role in

prevention of food- and life style-related diseases and

improvement of his/her health.

What people eat and how much and how often are

behavioural processes, which lead researchers and

health promotion specialists to consideration of

psychosocial factors as determinants of food choice,

its intake and nutritional habits.

The effective promotion of healthy nutrition among

people is only possible with development of their own

responsibility for health, life style and environment.

In other words, an ecological perspective allows to

consider an individual and his/her psychosocial

peculiarities (including health locus of control, self-

efficacy, self-regulation, constructive self-

assertiveness, psychological well-being) in the

environmental and cultural context..

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