The Effect of COVID-19 Pandemic on the Lifestyle Behaviors of Individuals

Abstract

The study was planned and administered as a descriptive study to determine how COVID-19 pandemic affected the lifestyle behaviors of individuals. The study was administered from 30 June to 30 September by including 615 adult individuals who had been exposed to the COVID-19 pandemic. Of the healthy lifestyle behaviors scale II, the total mean score was found to be 126.37 ± 18.58. The health responsibility (p = .032) and nutrition (p = .004) subscale mean scores of women were found to be significantly higher than men, while the spiritual development subscale mean scores of men (p = .047) were found to be significantly higher than that of women. It was found in this study that individuals did not regularly maintain healthy lifestyle behaviors in general during the pandemic period according to the subscales of health responsibility, physical activity, nutrition, spiritual development, interpersonal relationships, and stress management.

Keywords

COVID-19 virus infection health life style pandemics physical activity

Introduction

The COVID-19 disease is causing a global epidemic with large numbers of deaths and infected individuals. In order to control the spread of the COVID-19 virus, public space restrictions and quarantine practices must be implemented. These restrictions and quarantine practices cause short- and long-term negative effects on cardiovascular health, mainly related to unhealthy lifestyle and anxiety (Mattioli et al., 2020). Since individuals have to be in a limited space in the household, this also prepares the ground for many health problems. It is thought that conditions such as inactivity and malnutrition may pave the way for cardiovascular diseases (CVD) and worsen the disease process in those with existing cardiovascular disease (Mattioli & Ballerini, 2020).

In the guideline on primary prevention of cardiovascular disease, it is stated that “In order to reduce the risk of cardiovascular disease, adults should perform at least 150 minutes of moderate intensity activity per week, or 75 minutes of vigorous aerobic physical activity per week (or an equivalent combination of moderate and vigorous activity)” (Arnett et al., 2019; Mattioli & Ballerini, 2020; World Health Organization, 2020a). Many guidelines recommend that individuals do exercises that can be done at home during the quarantine, maintain a healthy diet, abstain from smoking, and get enough sleep. In this context, there is a change in the habits of individuals to cope with the pandemic such as an increase in alcohol consumption or drug use (World Health Organization, 2020b).

Cardiovascular diseases, which have an important place among chronic diseases, are the most important causes of morbidity and mortality in the world and our country. The increase in the average age of societies, unhealthy diet, sedentary lifestyle, and the widespread smoking habit are among the main causes of CVD. Moderate weight gain and excessive obesity increase the risk of CVD and all-cause mortality. Smoking is an independent risk factor for CVD and this risk depends on the number of cigarettes smoked (Yeşil & Altıok, 2012). There are reports stating that COVID-19 causes worse effects in smokers (Reddy et al., 2020). It is important to reveal how individuals change their smoking habit during this pandemic, because smoking has an important effect on the development of CVD and worsening of the disease. It is clear that a healthy diet, non-smoking and physical activity have positive effects in preventing and controlling cardiovascular risk factors (Yeşil & Altıok, 2012).

A healthy lifestyle change is important for ensuring and maintaining heart health. A global action promoting healthy diet and physical activity following quarantine is imperative to encourage people to return to a healthy lifestyle (Mattioli et al., 2020). During the pandemic, physical activity and nutritional habits change due to the limited space the individuals have (Tural, 2020). In order to prevent the cardiovascular and pulmonary complications that COVID-19 may cause on individuals, it will be important to determine the behavioral changes in the lifestyle of individuals.

Methods

Purpose

The research was planned and implemented as a descriptive study to determine how the COVID-19 pandemic affected the lifestyle behaviors of individuals. In this study, an answer was sought to the question of how the COVID-19 pandemic affects the lifestyle behavior of individuals.

Design and Setting

The universe of the research consisted of individuals over 18 years of age between June 30 and September 30, 2020, who had been exposed to the COVID-19 pandemic and informed about the aim and expectations from the research and who gave their consent to participate in the study.

Participants

In the study, the number of subjects to be included in the study to obtain 80% power at the level of α = .05 was determined as 385, taking into account the 3-month research period by simple random sampling. However, considering the losses, it was calculated to include at least 500 adults in the study. Individuals who agreed to participate in the study, who had been exposed to the COVID-19 pandemic, aged 18 and over, were included in the study. Individuals under the age of 18, and those who were not willing to participate in the study were excluded. In this context, 615 individuals were included in the study.

Data collection and measures: In the study, the data were collected using an “online survey on the internet” by the researchers between June 30 and September 30, 2020 due to implementation of social distance and contact restrictions across the country within the scope of the COVID-19 pandemic. The data in the study were collected using the “Sociodemographic characteristics and change in lifestyle behavior research form” created by the researchers and the “Healthy Lifestyle Behaviors Scale-II.”

Sociodemographic characteristics and change in lifestyle behavior research form

This form, prepared by the researchers in line with the literature (Akgün Şahin, & Biçer, 2015; Aksoy & Uçar, 2014; Bostan & Beşer, 2016; Kolaç et al., 2018; Yalçınkaya et al., 2007), consists of 39 items and 2 parts. In the first part, there are 13 items comprising sociodemographic characteristics questions such as age, gender, and the marital status. In the second part, there are 26 items questioning if there is a change in the lifestyle behavior due to the COVID-19 pandemic.

Healthy Lifestyle Behaviors Scale II

This scale was developed by Walker et al. (1987), revised again in 1996, and named as “Healthy Lifestyle Behaviors Scale II” (Walker & Hill-Polerecky, 1996; Walker et al., 1987). The validity and reliability of the scale was confirmed by Bahar et al. (2008). The scale measures the health-enhancing behaviors in relation to an individual’s healthy lifestyle. The scale consists of 52 items and has 6 sub-factors. The subgroups include spiritual development, health responsibility, physical activity, nutrition, interpersonal relationships, and stress management. The subscales include health responsibility (Bostan & Beşer, 2016; Chen et al., 2020; Sungur et al., 2019; World Health Organization, 2020b; World Health Organization, 2020c), physical activity (Aksoy & Uçar, 2014; Muslu & Özçelik Ersü, 2020; Peksoy Kaya & Kaplan, 2020; Uncu & Üstündağ, 2018; Yeşil & Altıok, 2012), nutrition (Akgün Şahin, & Biçer, 2015; Bahar et al., 2008; Bozhüyük et al., 2012; Mattioli & Ballerini, 2020; Şen et al., 2017; Türk Nöroloji Derneği Yönetim Kurulu Üyeleri, 2020), spiritual development (Duran, et al., 2018; Küçükberber et al., 2011; Küçükcankurtaran & Özdoğan, 2020; Tural, 2020; Walker et al., 1987), interpersonal relationships (Dilber & Dilber, 2020; Göger et al., 2019; Kolaç et al., 2018; Mattioli et al., 2020; Walker & Hill-Polerecky, 1996), and stress management (Kılınç et al., 2016; Macit, 2020; Reddy et al., 2020; World Health Organization, 2020c; Yalçınkaya et al., 2007). The overall score of the scale gives the score for the healthy lifestyle behaviors. All items of the scale are positive. The scale is a 4-point Likert rating. The answers are accepted as never (1), sometimes (2), often (3), and regularly (4). For the whole scale, the lowest score is 52 and the highest score is 208. The Alpha reliability coefficient of the scale is .94. The Alpha coefficient reliability value of the sub-factors of the scale varies between .79 and .87 (Bahar et al., 2008; Walker & Hill-Polerecky, 1996; Walker et al., 1987).

Ethical Considerations

Permission was obtained from ethics committee application of the study. Individuals who were willing to participate in the study were informed about the purpose and expectations of the study in line with the Declaration of Helsinki and written consents were obtained by voluntary participation.

Statistical Analysis

The statistics of the study were analyzed with the IBM SPSS Windows 21.0 package program (IBM Corp. Armonk, N.Y. USA). In the statistical evaluation of the study, for the numerical and percentage distributions was used to assess the sociodemographic characteristics and the change in lifestyle behavior due to the COVID-19 pandemic. In addition, the Student t test for the two group evaluations of variables and the Oneway ANOVA test for comparisons of three groups and above were used to compare sociodemographic characteristics and scale scores. The results were evaluated at 95% confidence interval and the significance level of p was accepted as <.05.

Results

In this study, 68.6% of participants were women (Table 1). It was evaluated whether the individuals participating in the study had changes in their lifestyle behaviors due to the COVID-19 pandemic. During the pandemic period, 23.6% of the participants were found to have gained more than 3 kg, 50.9% had less than three meals a day, the daily consumption of fruit and vegetables of the majority did not increase compared to the previous times (54.6%), and the majority of the participants (73.8%) did not consume red meat more than three times a week; however, the rate of those who consumed chicken or fish at least twice a week was found to be 52.7% (Table 2). It was determined that the majority of consumers (56.3%) consumed four or more slices of white bread and pita a day, and those who consumed a maximum of three slices of whole wheat and rye bread a day were at a lower rate (43.4%) (Table 2). In the research, the rate of those who did medium-intensity physical activity in the form of speed walking or straight running at least 5 days a week/30 to 60 minutes a day was found as 47.6%, while the rate of those who did medium-high-intensity physical activity was 19.2% (Table 2). In the study, it was determined that 18.2% had started smoking, 15.9% increased their smoking rates, 6.8% started to consume alcohol, 47.3% lost their temper more quickly, and 25.7% thought that their general health status had worsened (Table 2). The total mean score for the Healthy Lifestyle Behaviors Scale-II was 126.37 ± 18.58, and the sub-dimension mean score was between 16.36 and 25.98 (Table 3). While the total scale internal consistency (Cronbach’s alpha value) was .916, the sub-dimension internal consistency was between .639 and .868 (Table 3).

Table 1.

Distribution of Sociodemographic Characteristics of Individuals (N = 615).

Characteristics	n (%)
Age
18–36	305 (49.6)
37–51	245 (39.8)
52–90	65 (10.6)
Body mass index (Mean ± SD) (Minimum-Maximum)
25.15 ± 4.69 (11.48–47.75)
18.5 and below (Weak)	16 (2.6)
18.51–25 (Normal)	311 (50.6)
25.1–30 (Overweight)	205 (33.3)
30.1–40 (Obese)	77 (12.5)
40.1 and above (Morbid obese)	6 (1.0)
Gender
Female	422 (68.6)
Male	193 (31.4)
Marital status
Married	322 (52.4)
Single	293 (47.6)
Education status
Primary and middle school	31 (5.0)
High-school	114 (18.5)
University/postgraduate	470 (76.4)
Income status
My income is lower than my expenses	87 (14.1)
My income is proportional to my expenses	433 (70.4)
My income is higher than my expenses	95 (15.4)
COVID-19 test status
Yes	96 (15.6)
No	519 (84.4)
COVID-19 test result
Negative	85 (13.8)
Positive	12 (2.0)
Working status before the COVID-19 outbreak
I was working full time (8–12 hours)	372 (60.5)
I was working half-day or part-time	64 (10.4)
I was not working	105 (17.1)
Working status after the COVID-19 outbreak
I work full time (8–12 hours)	265 (43.1)
I work half-day or part-time	112 (18.2)
I’m not working	238 (38.7)
Employment status/occupation
Trainer	123 (20.0)
Healthcare employee	178 (28.9)
Safety/Security officer	11 (1.8)
Service industry (cargo/food/cleaning/transportation)	89 (14.5)
Housewife	62 (10.1)
Retired/not working	152 (24.7)
Presence of chronic illness
Yes	145 (23.6)
No	470 (76.4)
If the answer is “Yes,” the chronic disease
Coronary artery disease	9 (1.5)
Diabetes	10 (1.6)
Hypertension	25 (4.1)
Chronic lung disease, Asthma, COPD, etc.	35 (5.7)
Other diseases such as epilepsy, osteoporosis, depression	65 (10.6)

Table 2.

Change in Lifestyle Behaviors Over the Past 2 Months Due to COVID-19 (N = 615).

Lifestyle situations	Yes	No
Lifestyle situations	n (%)	n (%)
1. Have you lost weight over the past 2 months?	150 (24.4)	465 (75.6)
2. Have you gained weight over the past 2 months?	282 (45.9)	333 (54.1)
3. When you think of the last 2 months, did you gain more than 3 kg?	145 (23.6)	470 (76.4)
4. Have you eaten at least three meals a day for the past 2 months?	307 (49.9)	308 (50.1)
5. When you think about the past 2 months, was the number of your meals more than 3?	118 (19.2)	497 (80.8)
6. When you think about the past 2 months, were your meals less than three in number?	313 (50.9)	302 (49.1)
7. Considering the past 2 months, did your daily fruit and vegetable consumption increase compared to the previous times?	279 (45.4)	336 (54.6)
8. Considering the past 2 months, have you consumed red meat at least two times a week?	372 (60.5)	243 (39.5)
9. Considering the past 2 months, have you consumed red meat more than three times a week?	161 (26.2)	454 (73.8)
10. Considering the past 2 months, have you ever consumed chicken or fish at least two times a week?	324 (52.7)	291 (47.3)
11. Considering the past 2 months, have you consumed four or more slices of white bread or pita a day?	346 (56.3)	269 (43.7)
12. When you think of the past 2 months, have you consumed at most three slices of whole wheat and rye bread a day?	267 (43.4)	348 (56.6)
13. When you think of the past 2 months, have you consumed cream and butter for breakfast three or more days a week?	210 (34.1)	405 (65.9)
14. For the past 2 months, have you ever done physical activity of moderate-intensity in the form of speed walking, straight running at least 5 days a week/30 to 60 minutes a day?	293 (47.6)	322 (52.4)
15. For the past 2 months, have you ever done medium-to-high intensity physical activity such as brisk walking, straight jogging, or cycling at least 5 days a week/30 to 60 minutes a day?	118 (19.2)	497 (80.8)
16. Have you started smoking in the past 2 months?	112 (18.2)	503 (81.8)
17. Have you increased your smoking rate over the past 2 months?	98 (15.9)	473 (76.9)
18. Have you reduced your smoking rate over the past 2 months?	89 (14.5)	394 (64.1)
19. Have you quit smoking in the past 2 months?	75 (12.2)	383 (62.3)
20. Have you started drinking alcohol in the past 2 months?	42 (6.8)	546 (88.8)
21. Over the past 2 months, have you increased your alcohol consumption?	33 (5.4)	475 (77.2)
22. Have you reduced your alcohol consumption over the past 2 months?	93 (15.1)	336 (54.6)
23. Have you stopped drinking alcohol in the past 2 months?	91 (14.8)	323 (52.5)
24. When you think of the past 2 months do you think you lose your temper more quickly?	291 (47.3)	324 (52.7)
25. When you think of the past 2 months, do you think your general health has worsened?	158 (25.7)	457 (74.3)

Table 3.

Distribution of Frequency Values and Mean Scores of Healthy Lifestyle Behaviors Scale-II (N = 615).

Sub-dimensions and items	Never	Sometimes	Often	Regularly	Mean score	Cronbach α
Sub-dimensions and items	n (%)	n (%)	n (%)	n (%)	Mean ± SD (Minimum -Maximum)	Cronbach α
Health responsibility
3. I’d tell the doctor or a healthcare professional about any unusual signs and symptoms in my body.	35 (5.7)	362 (58.9)	131 (21.3)	87 (14.1)	19.97 ± 4.22 (9.00–36.00)	.776
9. I watch health promotion programs on TV and read books on these topics.	140 (22.8)	339 (55.1)	99 (16.1)	37 (6.0)
15. I ask questions to the healthcare staff to understand their suggestions.	41 (6.7)	329 (53.5)	198 (32.2)	47 (7.6)
21. I always consult another healthcare staff when I have questions about the recommendations of the healthcare staff I regularly go to.	107 (17.4)	375 (61.0)	112 (8.2)	21 (3.4)
27. I consult the health personnel about my health problems.	19 (3.1)	291 (47.3)	203 (33.0)	102 (16.6)
33. I check my body for physical changes and dangerous signs at least once a month.	162 (26.3)	295 (48.0)	115 (18.7)	43 (7.0)
39. I consult the healthcare staff about how I can take better care of myself.	145 (23.6)	339 (55.1)	98 (15.9)	33 (5.4)
45. I participate in individual healthcare training programs.	278 (45.2)	260 (42.3)	59 (9.6)	18 (2.9)
51. I get counseling and guidance from others when I need it.	43 (7.0)	281 (45.7)	191 (31.1)	100 (16.3)
Physical activity
4. I do a regular exercise program.	188 (30.6)	297 (48.3)	72 (11.7)	58 (9.4)	16.36 ± 5.06 (8.00–32.00)	.868
10. I exercise for 20 minutes and/or longer at least three times a week (such as brisk walking, cycling, aerobics, dancing).	163 (26.5)	281 (45.7)	98 (15.9)	73 (11.9)
16. I exercise at light to moderate intensity (e.g. I walk five times a week or more).	146 (23.7)	286 (46.5)	120 (19.5)	63 (10.2)
22. In my spare time, I do entertain physical activities such as swimming, dancing, and cycling.	194 (31.5)	314 (51.1)	73 (11.9)	34 (5.5)
28. I do muscle strengthening exercises at least three times a week.	283 (46.0)	252 (41.0)	54 (8.8)	26 (4.2)
34. I exercise during daily work (for example, I walk to eat, use the stairs instead of the elevator, park my car away).	77 (12.5)	256 (41.6)	179 (29.1)	103 (16.7)
40. I check my pulse and heart rate while exercising.	191 (31.1)	239 (38.9)	120 (20.7)	58 (9.4)
46. I exercise until my heart rate goes up.	229 (37.2)	272 (44.2)	86 (14.0)	28 (4.6)
Nutrition
2. I prefer a diet low in oil and fat, cholesterol.	99 (16.1)	300 (48.8)	134 (21.8)	82 (13.3)	20.48 ± 3.89 (10.00–34.00)	.639
8. I restrict sugar and sweet.	118 (19.2)	289 (47.0)	130 (21.1)	78 (12.7)
14. I eat 6 to 11 meals a day of bread, cereal, rice, and pasta.	380 (61.8)	198 (32.2)	27 (4.4)	10 (1.6)
20. I eat two to four meals a day comprising fruit.	134 (21.8)	350 (56.9)	82 (13.3)	49 (8.0)
Sub-dimensions and items	Never	Sometimes	Often	Regularly	Mean score	Cronbach α
Sub-dimensions and items	n (%)	n (%)	n (%)	n (%)	Mean ± SD (Minimum -Maximum)	Cronbach α
26. I eat three to five meals a day comprising vegetables.	148 (24.1)	315 (51.2)	122 (19.8)	30 (4.9)
32. I eat milk, yogurt, or cheese three to four times a day.	65 (10.6)	267 (43.4)	175 (28.5)	108 (17.6)
38. I eat three to four portions of meat, chicken, fish, legumes, eggs, nuts every day.	121 (19.7)	334 (54.3)	122 (19.8)	38 (6.2)
44. I read the labels on the food packages determining the nutrient, fat, and sodium contents.	125 (20.3)	252 (41.0)	138 (22.4)	100 (16.3)
50. I have breakfast.	16 (2.6)	127 (20.7)	130 (21.1)	342 (55.6)
Spiritual development
6. I feel like I’m changing and improving in a positive way.	25 (4.1)	335 (54.5)	180 (29.3)	75 (12.2)	25.98 ± 4.38 (12.00–36.00)	.771
12. I believe my life has a purpose.	23 (3.7)	119 (19.3)	247 (40.2)	226 (36.7)
18. I look to the future with hope.	31 (5.0)	196 (31.9)	236 (38.4)	152 (24.7)
24. I feel at peace and self-sufficient.	28 (4.6)	182 (29.6)	274 (44.6)	131 (21.3)
30. I work for long term purposes in my life.	37 (6.0)	193 (31.4)	239 (38.9)	146 (23.7)
36. Every day I find different and interesting things to do.	72 (11.7)	357 (58.0)	139 (22.6)	47 (7.6)
42. I am aware of the things that are important to me in my life.	13 (2.1)	127 (20.7)	251 (40.8)	224 (36.4)
48. I believe in the existence of a divine power.	33 (5.4)	68 (11.1)	138 (22.4)	376 (61.1)
52. I am open to new experiences and situations.	9 (1.5)	119 (19.3)	248 (40.3)	239 (38.9)
Interpersonal relationships
1. I discuss my worries and problems with people close to me.	19 (3.1)	371 (60.3)	160 (26.0)	65 (10.6)	24.73 ± 3.92 (12.00–36.00)	.737
7. I appreciate people for their success.	3 (0.5)	67 (10.9)	343 (55.8)	202 (32.8)
13. I maintain meaningful and fulfilling relationships with people.	10 (1.6)	125 (20.3)	297 (48.3)	183 (29.8)
19. I spare time for my close friends.	4 (0.7)	214 (34.8)	283 (46.0)	114 (18.5)
25. It is easy for me to show interest, love, and closeness to others.	24 (3.9)	143 (23.3)	302 (49.1)	146 (23.7)
31. I hug the people I love.	39 (6.3)	176 (28.6)	245 (39.8)	155 (25.2)
37. I make an effort to have close friends.	132 (21.5)	301 (48.9)	140 (22.8)	42 (6.8)
43. I get support from people with similar problems.	74 (12.0)	340 (55.3)	150 (24.4)	51 (8.3)
49. I solve conflicts by talking and compromising.	14 (2.3)	141 (22.9)	292 (47.5)	168 (27.3)
Stress management
5. I get enough sleep.	45 (7.3)	235 (38.2)	157 (25.5)	178 (28.9)	18.82 ± 3.65 (8.00–32.00)	.663
11. Every day I take time to relax.	96 (15.6)	319 (51.9)	134 (21.8)	66 (10.7)
17. I accept the things I can’t change in my life.	49 (8.0)	281 (45.7)	196 (31.9)	89 (14.5)
23. I think of good things before I go to sleep.	36 (5.9)	332 (54.0)	170 (27.6)	77 (12.5)
29. I use proper methods to control my stress.	62 (10.1)	353 (57.4)	156 (25.4)	44 (7.2)
35. I balance my work and leisure time.	58 (9.4)	274 (44.6)	199 (32.4)	84 (13.7)
41. I practice relaxing for 15 to 20 minutes a day.	189 (30.7)	306 (49.8)	76 (12.4)	44 (7.2)
47. I protect myself from getting tired.	152 (24.7)	340 (55.3)	76 (12.4)	47 (7.6)
Total scale					126.37 ± 18.58 (64.00–206.00)	.916

In the study, the women’s health responsibility (p = .032), nutrition (p = .004) sub-dimension mean scores were found to be significantly higher than those of men, while the men’s spiritual development sub-dimension mean scores (p = .047) were significantly higher than those of women, and the physical activity subscale mean score (p < .000) of single individuals was significantly higher than that of married ones. Nutrition (p < .000), spiritual development (p = .028), stress management (p = .012), and the total scale subscale mean scores (p = .003) of those with university-undergraduate and graduate education were significantly higher than those with primary-middle and high school graduates. Physical activity (p = .031), spiritual development (p < .000), interpersonal relations (p = .025), stress management (p = .001), and the general scale mean scores (p = .001) of those whose income was higher than their expenses were found to be significantly higher than those whose income was lower and proportionate. Those who tested negative for COVID-19 had significantly higher health responsibility (p = .011), physical activity (p = .001), stress management (p < .000), and general scale mean scores (p = .002) than those with positive test results, while the subdimension mean scores for physical activity (p = .014), spiritual development (p = .033), and the interpersonal relationships (p = .027) of those with no chronic diseases were significantly higher than those with chronic diseases (Table 4).

Table 4.

Healthy Lifestyle Behaviors Scale-II Score Distribution According to Sociodemographic Characteristics of Individuals (N = 615).

Characteristics/scale sub-dimensions		Health responsibility	Physical activity	Nutrition	Spiritual development	Interpersonal relationships	Stress management	Total scale mean score
Characteristics/scale sub-dimensions		Mean ± SD	Mean ± SD	Mean ± SD	Mean ± SD	Mean ± SD	Mean ± SD	Mean ± SD
Gender
Female	n = 422	20.21 ± 3.99	16.12 ± 4.87	20.78 ± 3.73	25.75 ± 4.23	24.74 ± 3.86	18.74 ± 3.54	126.37 ± 17.39
Male	n = 193	19.43 ± 4.65	16.88 ± 5.43	19.82 ± 4.17	26.50 ± 4.66	24.73 ± 4.06	18.98 ± 3.88	126.37 ± 21.00
		*t = 2.152 bp = .032	t = −1.729 p = .084	t = 2.859 bp = .004	t = −1.990 bp = .047	t = 0.040 p = .968	t = −0.772 p = .440	t = 0.001 p = .999
Marital status
Married	n = 322	19.99 ± 4.28	15.62 ± 4.85	20.60 ± 3.98	26.14 ± 4.40	24.87 ± 4.04	18.78 ± 3.73	126.04 ± 19.24
Single	n = 293	19.94 ± 4.16	17.17 ± 5.18	20.35 ± 3.79	25.81 ± 4.35	24.59 ± 3.79	18.85 ± 3.57	126.73 ± 17.86
		*t = 0.161 p = .872	t = −3.821 b p < .000	t = 0.807 p = .420	t = 0.933 p = .351	t = 0.879 p = .380	t = −0.230 p = .819	t = −0.464 p = .643
Education status
Primary-middle school	n = 31	19.54 ± 4.26	13.48 ± 3.96	19.41 ± 3.46	23.96 ± 5.21	23.12 ± 4.24	17.38 ± 3.75	116.94 ± 18.43
High-school	n = 114	19.72 ± 4.76	15.36 ± 5.15	20.02 ± 3.65	25.92 ± 4.70	24.82 ± 4.38	18.29 ± 4.09	124.18 ± 19.80
University-undergraduate and above	n = 470	20.05 ± 4.08	16.79 ± 5.02	20.66 ± 3.96	26.13 ± 4.22	24.82 ± 3.76	19.04 ± 3.50	127.52 ± 18.10
		**F = 0.441 p = .644	F = 9.144 b p < .000	F = 2.466 p = .086	F = 3.598 bp = .028	F = 2.763 p = .064	F = 4.458 bp = .012	F = 5.780 bp = .003
Income status
My income is lower than my expenses	n = 87	19.88 ± 4.38	15.49 ± 5.38	19.74 ± 3.87	24.93 ± 3.80	24.01 ± 3.63	17.57 ± 3.25	121.64 ± 17.10
My income is proportional to my expenses	n = 433	19.81 ± 4.05	16.30 ± 4.80	20.56 ± 3.78	25.82 ± 4.45	24.70 ± 3.90	18.92 ± 3.60	126.13 ± 18.29
My income is higher than my expenses	n = 95	20.76 ± 4.77	17.44 ± 5.76	20.81 ± 4.35	27.69 ± 4.14	25.57 ± 4.16	19.50 ± 3.99	131.80 ± 20.02
		**F = 2.019 p = .134	F = 3.489 bp = .031	F = 1.979 p = .139	F = 10.317 b p < .000	F = 3.719 bp = .025	F = 7.011 b p < .001	F = 7.037 b p < .001
COVID-19 test result
Negative	n = 85	20.96 ± 3.88	16.56 ± 4.81	20.50 ± 4.16	25.94 ± 4.46	24.41 ± 3.94	18.85 ± 3.64	127.25 ± 18.87
Positive	n = 12	17.91 ± 3.31	11.83 ± 3.29	18.16 ± 3.66	23.91 ± 5.40	22.16 ± 3.12	14.83 ± 2.82	108.83 ± 16.95
		*t = 2.586 bp = .011	t = 3.291 bp = .001	t = 1.846 p = .068	t = 1.432 p = .155	t = 1.884 p = .063	t = 3.667 b p < .000	t = 3.200 bp = .002
Presence of chronic disease
Yes	n = 145	20.33 ± 4.45	15.46 ± 4.95	20.35 ± 3.85	25.31 ± 4.59	24.11 ± 3.94	18.49 ± 3.76	124.08 ± 19.37
No	n = 470	19.85 ± 4.15	16.64 ± 5.07	20.52 ± 3.91	26.19 ± 4.30	24.93 ± 3.90	18.92 ± 3.62	127.08 ± 18.30
		*t = 1.197 p = .232	t = −2.462 bp = .014	t = −0.445 p = .657	t = −2.137 bp = .033	t = −2.216 bp = .027	t = −1.223 p = .222	t = −1.702 p = .089
Age
18–36 years	n = 305	19.81 ± 4.43	16.43 ± 5.19	20.00 ± 3.77	25.62 ± 4.74	24.51 ± 4.24	18.62 ± 3.77	125.03 ± 19.88
37–51 years	n = 245	20.27 ± 4.04	16.36 ± 5.10	20.96 ± 3.97	26.36 ± 3.90	24.93 ± 3.62	18.98 ± 3.46	127.90 ± 17.02
52–90 years	n = 65	19.53 ± 3.83	16.00 ± 4.34	20.90 ± 3.95	26.27 ± 4.27	25.09 ± 3.42	19.09 ± 3.78	126.91 ± 17.73
		**F = 1.190 p = .305	F = 0.201 p = .818	F = 4.609 bp = .010	F = 2.122 p = .121	F = 1.067 p = .345	F = 0.851 p = .427	F = 1.655 p = .192
Working status before the COVID-19 outbreak
I was working full time (8–12 hours)	n = 372	19.84 ± 4.19	16.30 ± 5.04	20.17 ± 4.01	26.01 ± 4.57	24.57 ± 3.89	18.38 ± 3.51	125.30 ± 18.83
I was working half-day or part-time	n = 64	19.71 ± 3.51	17.56 ± 4.98	20.90 ± 3.24	26.00 ± 3.78	24.67 ± 3.42	19.06 ± 3.53	127.92 ± 15.70
I was not working	n = 179	20.31 ± 4.50	16.05 ± 5.10	20.97 ± 3.81	25.93 ± 4.19	25.10 ± 4.14	19.64 ± 3.85	128.03 ± 18.96
		**F = 0.853 p = .427	F = 2.152 p = .117	F = 3.001 bp = .05	F = 0.017 p = .984	F = 1.082 p = .34	F = 7.458 bp = .001	F = 1.550 p = .213
Working status after the COVID-19 outbreak
I work full time (8–12 hours)	n = 265	19.55 ± 4.34	16.18 ± 5.27	19.96 ± 4.10	25.96 ± 4.74	24.35 ± 4.05	18.31 ± 3.63	124.35 ± 19.77
I work half-day or part-time	n = 112	20.26 ± 3.70	17.15 ± 4.93	20.63 ± 3.79	26.29 ± 4.07	24.88 ± 3.33	18.94 ± 3.40	128.18 ± 16.90
I am not working	n = 238	20.29 ± 4.29	16.19 ± 4.87	20.99 ± 3.65	25.86 ± 4.11	25.09 ± 4.01	19.32 ± 3.73	127.77 ± 17.82
		**F = 2.267 p = .104	F = 1.657 p = .192	F = 4.491 bp = .012	F = 0.368 p = .692	F = 2.318 p = .099	F = 4.967 bp = .007	F = 2.789 p = .062
Body mass index
18.5 kg/m² and below (Weak)	n = 16	21.12 ± 6.14	18.06 ± 6.85	21.06 ± 3.97	26.81 ± 4.49	26.18 ± 4.56	19.18 ± 3.56	132.44 ± 23.05
18.5–24.9 kg/m² (Normal)	n = 320	19.83 ± 4.15	16.90 ± 5.15	20.19 ± 3.85	25.88 ± 4.20	24.52 ± 3.96	18.93 ± 3.59	126.29 ± 17.75
25–29.9 kg/m² (Overweight)	n = 196	20.25 ± 4.10	16.42 ± 4.89	21.02 ± 4.05	26.27 ± 4.52	25.12 ± 3.86	19.00 ± 3.76	128.11 ± 19.54
30–39.9 kg/m² (Obese)	n = 77	19.50 ± 4.30	13.97 ± 4.01	20.10 ± 3.47	25.49 ± 4.69	24.29 ± 3.64	17.85 ± 3.56	121.23 ± 17.25
40 kg/m² and above (Morbid obese)	n = 6	20.00 ± 5.09	12.66 ± 3.55	20.16 ± 4.66	25.50 ± 4.84	24.33 ± 5.08	18.16 ± 3.92	120.83 ± 22.38
		**F = 0.835 p = .503	F = 6.639 b p < .000	F = 1.716 p = .145	F = 0.668 p = .614	F = 1.534 p = .191	F = 1.631 p = .165	F = 2.505 bp = .041

Student t test.

One way ANOVA.

bp < 0.05.

It was found that the nutritional sub-dimension mean score (p = .010) of the 37 to 51 age group was significantly higher than the other age groups. When the healthy lifestyle behavior was evaluated according to the working status after the COVID-19 epidemic, it was found that the nutrition (p = .012) and stress management (p = .007) sub-dimensions mean scores of the non-working group were significantly higher than those of the working groups. It was found that the physical activity (p < .000) sub-dimension and general scale mean scores (p = .041) of the individuals in the underweight category according to the body mass index (BMI) were significantly higher than those in the other BMI categories (Table 4).

Discussion

The aim of this study was to determine how the COVID-19 pandemic affected the lifestyle behaviors of individuals. The World Health Organization (WHO) emphasizes the importance of attempts to prevent the spread of COVID-19 and the protection of healthy lifestyle behaviors in breaking the chain of infection during the pandemic process (Peksoy Kaya & Kaplan, 2020; Sliwa, et al., 2021).

Recent studies show that the COVID-19 pandemic causes negative changes in individuals’ diet, sleep, and physical activity patterns (Dilber & Dilber, 2020; Küçükcankurtaran, & Özdoğan, 2020; Macit, 2020).

Smoking is a common risk factor for coronavirus disease infection. Smoking damages, the immune system and the individual’s susceptibility to infections, making smokers more vulnerable to infectious diseases (Türk Nöroloji Derneği Yönetim Kurulu Üyeleri, 2020). In the study, it was determined that 18.2% of the individuals had started smoking, 15.9% had increased their rate of smoking, 6.8% had started using alcohol, 47.3% lost their temper more quickly, and 25.7% thought that their general health status had worsened (Table 2).

In a study, it was found that individuals skipped lunch more frequently during the pandemic period than before the pandemic (p < .001). On the contrary, it was determined that there was a significant increase in consumption of three or more meals per day (p < .001). In the same study, the frequency of consumption of meat, eggs, legumes, nuts, milk and its products, fruits, cooked vegetables, cereal products, chocolate and sweets, junk food, and herbal tea had increased significantly (p < .05) (Küçükcankurtaran, & Özdoğan, 2020).

With the prolongation of the lockdown period at home due to the pandemic, an increase in activities such as sitting and lying, and a decrease in regular physical activity and sports activities have been observed. Physical activity has a positive effect on reducing depression and anxiety as well as maintaining the energy balance (Chen et al., 2020; Macit, 2020). In a study conducted to determine the physical activity levels of adults in the COVID-19 pandemic, it was found that individuals’ moderate physical activity levels decreased during the pandemic period (p < .001) (Küçükcankurtaran, & Özdoğan, 2020). In this study, it was determined that the rate of those who did medium-intensity physical activity in the form of fast walking and straight running at least 5 days a week/30 to 60 minutes a day was 47.6%, while the rate of those who did medium-high-intensity physical activity was 19.2% (Table 2).

In Macit (2020)’s study, it was found that individuals experienced 1.0 ± 1.5 kg body weight gain in a total of 17.30 ± 13.9 days, and 80.9% (n = 276) showed a decrease in physical activity (Macit, 2020). In this research, it was determined that the rate of those who gained more than 3 kg during the past 2 months of the pandemic was 23.6% (Table 2). Adequate and balanced nutrition is important in order to be healthy before or in the presence of infectious diseases. Therefore, it is important to maintain a healthy diet during the COVID-19 pandemic. A healthy diet is extremely effective in strengthening the immune system. Energy and nutrients obtained with adequate and balanced nutrition support the immune system (Muslu & Özçelik Ersü, 2020). The World Health Organization’s healthy eating recommendations for adults during the COVID-19 pandemic are stated as follows: Consuming fresh and unprocessed foods every day (fruits, vegetables, legumes, whole grain products, oilseeds, and foods of animal origin), preferring raw vegetables and fresh fruits for snacks instead of foods with high sugar, fat or salt content, consuming less salt and sugar, choosing healthy fats, consuming oils containing unsaturated fatty acids instead of saturated fatty acids, white meat instead of red meat and consuming low-fat dairy products are recommended (Muslu & Özçelik Ersü, 2020; World Health Organization, 2020b). In the study, it was determined that 50.9% had less than three meals a day during the pandemic period, and the majority of the participants (73.8%) did not consume red meat more than three times a week. In addition, it was determined that the majority (56.3%) consumed four or more slices of white bread and pita a day (Table 2).

In the study, it was aimed to evaluate the individuals’ lifestyle behaviors to be physically active and to make healthy dietary choices, and to be aware of the physiological and psychological resources in order to control stress and to activate them during the pandemic, with the use of the HLBS-II scale. When the literature was examined, it was seen that studies were carried out in different groups to determine healthy lifestyle behaviors. However, in the only study conducted in our country during the pandemic, students with a mean age of 20.89 ± 1.95 years had a mean HLBS-II total score of 55.76 ± 12.05, and the mean score from the nutrition sub-dimension was 20.34 ± 4.29, the physical activity sub-dimension score was 16.84 ± 5.14 and the stress management sub-dimension score was 18.58 ± 4.29 (Peksoy Kaya & Kaplan, 2020). It was seen that the rate of students showing healthy lifestyle behaviors was at a very low level compared to the studies before the pandemic. When other studies conducted before the pandemic were examined, in a study conducted with healthcare workers, the total score of the Healthy Lifestyle Behaviors Scale-II was determined as 121.18 ± 18.40 (24). In a study conducted with factory workers, the total score was found to be 130.70 ± 21.98 (Kolaç et al., 2018). Şen et al. (2017) determined the mean score of health vocational school students as 118.01 ± 21.0. In this study, it was determined that individuals did not regularly maintain healthy lifestyle behaviors during the pandemic period according to the sub-dimensions of health responsibility, physical activity, nutrition, spiritual development, interpersonal relationships, and stress management (Table 3).

In the study, the women’s health responsibility (p = .032) and nutrition (p = .004) sub-dimension mean scores were found to be significantly higher than men, while the men’s spiritual development sub-dimension mean scores (p = .047) were found to be significantly higher than those of women (Table 4). It was observed that men had higher spiritual feelings during the pandemic period, but they did not cope well enough in nutrition and health responsibility issues, and they were inadequate in acquiring or maintaining healthy living habits. Health responsibility is when the individual feels an active role in being informed about their own health problems and seeking medical help when necessary (Şen et al., 2017). In the study, it was determined that the health responsibility of women was more developed than men (Table 4). Sungur et al. (2019) found that the only statistically significant difference between men and women was in the spiritual development dimension. Similar to our study, the authors found that men’s spiritual development sub-dimension scores were higher than those of women’s. However, the authors stated that the other subscale scores were similar between men and women (Şen et al., 2017). In the study of Uncu and Üstündağ (2018), it was found that there was no statistically significant difference between the mean scores of the healthy lifestyle behaviors sub-dimension by gender. In the study of Şen et al. (2017), although there was no statistically significant difference, it was found that the healthy lifestyle behavior scores of male students were higher than that of female students. Kılıç et al. (2016) found that men displayed higher healthy lifestyle behaviors than women.

Kolaç et al. (2018) stated in their study that the HLBS II mean total score and physical activity mean scores of single individuals were higher than those of married individuals. Similarly, Uncu and Üstündağ (2018) found that the health responsibility, physical activity, and stress management scores of single individuals were statistically significantly higher than those who were married. It is thought that the high stress management scores of the married people may be due to the economic and social negative effects of the pandemic as a source of stress. Kılınç et al. (2016) also stated in their study that married people showed higher healthy lifestyle behaviors than single ones. On the contrary, physical activity levels of single individuals were found to be better than those who were married in this study (Table 4).

Küçükberber et al. (2011) found that married, undergraduate, and post-graduates, those with a good socio-economic status and those without any additional disease exhibited better healthy living behaviors. Göger et al. (2019) found that there was no relationship between the individuals’ educational status and healthy lifestyle behaviors. Kılınç et al. (2016) also stated that individuals with a high level of education showed better healthy lifestyle behaviors than those with a low level of education. Similarly, in this study, it was found that those with university-undergraduate and postgraduate education, those with higher income than their expenses and those without chronic diseases led a healthier lifestyle. In addition, in this study found that those who were negative for COVID-19 test exhibited significantly better healthy lifestyle behaviors than those who tested positive (Table 4).

Infections increase the body’s energy and nutrient needs. In addition, adequate nutrition is important in order to be healthy in the presence of an infectious disease. Maintaining a healthy diet supports the strong immune system (Muslu & Özçelik Ersü, 2020). In the study, when the healthy lifestyle behavior was evaluated according to the working status after the COVID-19 epidemic, the nutritional (p = .012) and stress management (p = .007) sub-dimension mean scores of the non-working group were significantly higher than those of the working groups, and since they were at home, they were found to have healthy eating habits and methods of coping with stress (Table 4).

Adequate and balanced nutrition is one of the basic conditions for the society and individuals to be healthy and strong, to develop economically and socially, and for increased level of welfare. Proper nutrition is one of the preconditions of prevention from metabolic diseases and a healthy life (Bozhüyük et al., 2012). In the study, it was determined that the nutrition sub-dimension mean score (p = .010) of the individuals in the 37 to 51 age group was significantly higher than those in the other age groups (Table 4). In another study similar to this study, it was found that the health responsibility and interpersonal relations sub-dimensions of individuals in the 18 to 24 age group, the physical activity and mean total score of individuals in the 25 to 31 age group, and the nutritional scores of individuals in the 32 to 33 age group were higher (Uncu & Üstündağ, 2018). Sungur et al. (2019) stated in their study that individuals aged 40 to 65 years were more sensitive than individuals aged 39 and under in terms of showing healthy lifestyle behavior, and individuals aged 39 and younger were more sensitive than those aged 65 years and above. Göger et al. (2019) also found in their study that as age increased, their healthy lifestyle behavior decreased and there was a negative relationship between them.

Being overweight or obese increases the risk of developing health problems such as high blood pressure, high blood cholesterol, cardiovascular diseases, stroke, diabetes, some types of cancer, arthritis, and respiratory failure. On the other hand, being weak is an undesirable situation that negatively affects the immune system and can cause weakness and inefficiency in daily life (Bozhüyük et al., 2012). However, in the study, it was found that underweight individuals displayed higher healthy lifestyle behaviors and performed more physical activity (Table 4). Similarly, Göger et al. (2019) stated that there was a negative relationship between the BMI variable and health responsibility, physical activity, stress management and HPL II total scores, and that as the BMI decreased, they displayed higher healthy lifestyle behaviors.

Conclusion and Recommendations

As a result, it was determined in the study that individuals did not regularly maintain healthy lifestyle behaviors during the pandemic period in terms of the sub-dimensions of health responsibility, physical activity, nutrition, spiritual development, interpersonal relationships and stress management.

It is known that lifestyle significantly affects health. The positive effects of individuals’ proper eating habits and being physically active on the immune system are very important in preventing a disease. It is recommended to explain the effects of COVID-19 disease on individuals who do not have healthy eating habits, do not do physical activity, smoke, and consume alcohol, and do not show healthy lifestyle behaviors, and to explain the importance of the disease by using the media and social media sites, to reach individuals and to take initiatives to raise awareness.

Study Limitations

Data collection was carried out online over the internet due to pandemic restrictions. For this reason, there was a problem in reaching sufficient data in the desired time.

Footnotes

Acknowledgements

The authors would like to thank the person who participated in the study.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Hilal Uysal

Author Biographies

Hilal Uysal, Assistant Professor, PhD,RN, Istanbul, Turkey. I am working at the Istanbul University-Cerrahpaşa Florence Nightingale Faculty of Nursing in Turkey. I am primarily interested about the cardiovascular nursing, coronary intensive care, rehabilitation, educational counselling of cardiovascular.

Esra Argın, Nurse, Istanbul, Turkey. I work as a service nurse in the Adult Emergency Service of Istanbul Marmara University Pendik Training and Research Hospital. I am a member of Turkish Nurses Association, Turkish Intensive Care Nurses Association, Turkish Respiratory Research Association.

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