Changed lifestyles during the COVID-19 pandemic: the need for health education in the curriculum of pedagogical students

Abstract

The health education in schools became the focus of public attention during the global pandemic of COVID-19. Teaching practice changed to meet the increased demand for pupils’ health, triggering a reevaluation of higher education curricula for pedagogical students. Therefore, this mixed methods study aimed to investigate the lifestyle of university students of pedagogy in Slovenia during the COVID-19 pandemic. One hundred and four students (87.4% females and 12.6% males) met the criteria and participated in an online survey in which they self-assessed their physical activity, eating habits, mental well-being, and sleep quality. The convergent parallel mixed methods design was used to obtain qualitative descriptions of student experiences with lifestyle domains and quantitative data on their attitudes towards the impact of lifestyle on physical and mental well-being during the pandemic. The results suggest that the pandemic did significantly impact student lifestyles, especially their mental well-being. Although most students maintained a healthy lifestyle during the pandemic, they also reported a deterioration in other measured domains of health-related behaviour. Particular attention should, therefore, be paid to the curriculum of pedagogical students to develop their competences in health education and readiness to assume an active role as educators for their future pupils’ health.

Keywords:

• Health education
• university students
• curriculum development
• education professions
• mixed methods research

Reviewing Editor:

• Lawrence Jun Zhang, Curriculum and Pedagogy, University of Auckland Faculty of Education and Social Work, Auckland, New Zealand

Subjects:

• Psychological Methods & Statistics
• Qualitative and Mixed Methods
• Education Policy
• Curriculum
• Behaviour
• Teacher Education & Training
• Health Education and Promotion
• Mental Health

Introduction

One of the highest goals of education is the development of students’ universal values, including the encouragement of moral thinking and socially acceptable action. This goal is usually unrelated to any particular school subject but is implemented through inter-curricular content (Peček Čuk & Lesar, 2021). However, from the earliest history of schooling, there has been a question about which values should be developed in schools, and which are universal and extend across the curriculum, history, and regions to provide judicious guidance for the educational process.

The cognitive part of learning is still dominant in today’s school practice, but it matters that every pedagogical experience should equally embrace the emotional aspect of a student’s experience. Even purely scientific and logical learning content includes some values that can be recognised only through emotions such as joy and pleasure, and in conjunction with beauty, aesthetics, ethics, sociality, grace, compassion and expectations, along with feelings of wonder, disappointment, sadness, excitement, etc. Therefore, school should not be oriented towards knowledge alone but should focus on the individual and their authentic personal values by increasing awareness of humanity (Gogala, 1933).

A student’s physical and mental well-being enables the learning process, academic achievement, and school grade progression. Student’s mental health issues have been a major cause of dropping out, particularly in higher grades (Ekornes, 2017). Students who are more contented and have better physical and mental well-being are more motivated and have higher levels of concentration and greater willingness to study. Consequently, their mental state is closely related to a better classroom climate and fewer problems with discipline and conflict in the school community (Gogala, 1933).

For example, regular, moderate and aerobic physical activity has proven to be a significant factor in academic achievement (Fedewa & Ahn, 2011; Donnelly & Lambourne, 2011; Zurc & Planinšec, 2022). Studies showed that having an adequate amount of aerobic physical activity, with the right frequency and intensity in preadolescence could improve a pupil’s concentration and memory (Ruiz-Ariza et al., 2022; Trudeau & Shephard, 2008), attention, mood and task-oriented behaviour (Centers for Disease Control & Prevention, 2010; Ruiz-Ariza et al., 2022), aerobic ability (Castelli et al., 2007), body mass index (Castelli et al., 2007; Donnelly & Lambourne, 2011), cognitive and brain function (Hillman et al., 2008), working memory and speed of cognitive processing (Hillman et al., 2005). Moreover, an active student lifestyle contributes positively to classroom behaviour (Trudeau & Shephard, 2008). Daily short active breaks at moderate-high intensity showed an effect on cognitive functioning in adolescent students (Ruiz-Ariza et al., 2022).

Based on the importance of students’ and pupils’ mental and physical health for learning and school achievement, it is not surprising that along with intellectual, moral and aesthetic education, health education is one of the traditional areas that have emerged throughout the history of pedagogy. Health education promotes the individuals’ growth, development, and physical and mental well-being, along with a healthy lifestyle and responsible attitudes towards health (Peček Čuk & Lesar, 2021). Health education thus represents one of the universal values that should guide education across multiple curriculums, times, and regions. On the other hand, contemporary health education has been criticised for equivocal value positions that fail to acknowledge the socio‐economic determinants and structural inequalities in society, which significantly determine the health and illness of individuals (Hyland, 1988).

Our study was motivated by the dynamic development and increased importance of health education in schools during the COVID-19 pandemic. This new situation prompted reflection on the higher education of pedagogical students to meet the increased demands on their own health and the health of their future pupils. Using an innovative mixed methods approach, our study aimed to explore the experiences of pedagogical students with health-related behaviours during the three waves of the COVID-19 pandemic, and to identify possible factors that should be considered in promoting healthy lifestyles and health education competences among prospective educational professionals in the post-pandemic period.

Placement of health education in schools

Schools offer a primary agent for implementing health education for the large population of children and youth (Brunette, 2017; Rossi et al., 2016). For some, ‘…schools are perhaps the ‘only’ place where some children get any health care’ (Rossi et al., 2016, 272). Therefore, health education in schools may have beneficial effects in reducing health inequalities among pupils with low socio-economic status (Hillier-Brown et al., 2014) or ethnic minority groups.

The importance of health education in schools became the focus of public attention during the global pandemic of COVID-19. Teachers, with a minimum of preparation and training, were required to deliver and oversee health work as part of the school’s responsibility to protect overall societal health. The rapid challenge to teaching practice in meeting the increased health needs of pupils triggered a rethinking of higher education curricula for prospective educational professionals (Brunette, 2017; Ekornes, 2017; Rossi et al., 2016).

However, health education was a significant part of the regular school curriculum long before the COVID-19 pandemic (Sinkinson & Burrows, 2011). From the perspective of the importance of preventive health, schoolteachers were seen as vital partners in the health system, building links between education and health. Historically, medical and healthcare staff have a dominant role in delivering school-based, health-related content and activities. Nevertheless, schools are now primarily responsible for implementing health education for a broader population of children and youth (Hoekstra et al., 2016). A survey across Australia’s teaching profession showed that teachers spent a quarter of their contracted time each week undertaking various health-related tasks in their classrooms. These tasks involved a wide range of health-related activities, such as providing support for mental health, encouraging personal growth and life skills development, overseeing mandatory health policy programs (e.g. traffic safety) and addressing urgent conditions (e.g. self-harm, neglect and abuse, high-risk behaviours). Although teachers took on these tasks, they had concerns that they were neither knowledgeable about nor trained to do this work (Rossi et al., 2016). Similarly, a study among teachers in the USA found that teachers may not consider health education as part of their teaching job (Brunette, 2017). Moreover, parents of primary school pupils (aged 9 to 11 years) in a French survey perceived the competence of teachers to be low regarding teaching health issues to their pupils (Jourdan et al., 2018). A systematic review of qualitative findings by Hung et al. (2014) showed that teachers perceive a lack of confidence in health-related teaching. Similarly, a mixed methods study with a sequential exploratory design in Norway found that teachers experienced stress from a mismatch between perceived demands and the perceived competences to cope with them when delivering health education in mental health (Ekornes, 2017).

Teachers’ lifestyle as a factor in well-implemented health education in schools

Only well-implemented, school-based health education can promote pupils’ health (Lima-Serrano & Lima-Rodríguez, 2014). Successful school-based health education and health promotion programs depend on many distinct factors. Alongside the content and teaching approach (e.g. interactive lessons), multiple target groups, follow-up strategies, and the multidisciplinary collaborative approach (Hung et al., 2014; Lima-Serrano & Lima-Rodríguez, 2014; Zurc & Laaksonen, 2023a), the education and training of teachers is one of the most crucial elements in providing high-quality health-related education in schools (Hung et al., 2014; Jourdan et al., 2018; Peters et al., 2009; Singh et al., 2017).

Furthermore, research evidence has revealed that the success of health education in schools is strongly related to teachers’ personal health beliefs and interest in their own health. Favourable personal beliefs among teachers and an interest in their own health exert a positive influence on students’ and pupils’ health-related outcomes and learning outcomes (Brunette, 2017). Brunette’s study showed that teachers’ interest in health was a significant factor in the construction of their role as health educators, even more than perceived competences for teaching health-related content. Therefore, teachers should be physically and emotionally prepared to teach, while communicating positively with students and encouraging their academic achievement. This is because students absorb the fundamental tone of the teacher’s mental mood, and even more, they become naturally influenced by these feelings (Gogala, 1933). Particularly during higher education, students are most sensitive to learning how to deal with stress and mental issues. Therefore, it is crucial to support young adults in self-awareness of their psychological functioning, in learning effective approaches to deal with workloads and in developing strategies for maintaining a healthy lifestyle during their studies and throughout their lifespan (Tekavc, 2021).

Study purpose

Understanding teachers’ attitudes towards their health and lifestyle as potential factors in their pupils’ health is vital for providing high-quality health education in schools (Brunette, 2017). Therefore, collecting and studying the evidence on health and lifestyle among teaching professionals and pedagogical students is imperative.

However, the health-related behaviour of prospective educational professionals has rarely been the subject of investigation. Given this gap, the present study aimed to investigate the lifestyle of university students of pedagogy in the North-Eastern region of Slovenia during the COVID-19 pandemic. We were interested in their personal experiences and opinions on the lifestyle domains of physical activity, eating habits, quality of sleep, and mental well-being to qualitatively identify how they were affected by change during the pandemic, and that may require interventions and improvements in health education within the curriculum of university pedagogical study programs. In addition, we were interested in establishing whether there were any quantitative differences in lifestyle experiences during the COVID-19 pandemic among groups of pedagogical students depending on a range of characteristics: age, level in the study program, part-time employment status, type and size of home town, and residence type.

Materials and methods

This is an empirical study with a mixed methods research design. The mixed methods approach was applied as one of the most useful methodologies in health promotion and health education research (Zurc, 2013). The convergent parallel mixed methods design was carried out, enabling us to collect qualitative and quantitative data simultaneously and with the same priority (Creswell & Plano Clark, 2017).

Participants

Two hundred and ninety-three students from the North-Eastern region of Slovenia were invited to participate in a mixed methods study, and of these, one hundred and four met the criteria. One hundred and eighty-nine responses were dropped because of non-participation in the study, missing data, or failure to meet the criteria concerning the field of the pedagogy study program. The resulting sample (87.4% females and 12.6% males) provided self-assessments of their physical activity, eating habits, mental well-being, and sleep quality.

Measures and study procedures

A questionnaire with twenty-seven closed-ended and open-ended questions was used for data collection. The questionnaire was designed based on previous studies of physical activity in primary school children (Zurc, 2012), university students (Majerič & Zurc, 2016) and adults (Škrbina & Zurc, 2016). The measurement tool was tested for content validity and reliability. Content validity was established using the principles of a comprehensive literature review and a panel of experts in the field, who reviewed several versions of the questionnaire in progress and made suggestions for improvement (Almanasreh et al., 2019). A Cronbach alpha with a value of 0.846 showed the strong reliability of the definitive version of the questionnaire.

In this study, we present findings based on the collected qualitative data of questions related to the open-ended qualitative descriptions of pedagogical students’ experiences with physical activity, eating habits, quality of sleep, and mental well-being during the COVID-19 pandemic. In the quantitative analysis we used closed-ended questions on characteristics of study participants (e.g. gender, age, level in the study program, student status, type of home town, size of home town, place of residence), students’ self-assessment of everyday lifestyle during the COVID-19 pandemic measured with five variables on a 4-point scale (1 = really bad, 2 = quite bad, 3 = quite good, 4 = very good), and students’ attitudes towards the impact of an active lifestyle on physical and mental well-being during the COVID-19 pandemic measured with ten statements on a 5-point Likert scale (1 = strongly disagree, 2 = disagree, 3 = neither agree nor disagree, 4 = agree, 5 = strongly agree).

The online survey platform 1KA was used for data collection during the three waves of the COVID-19 pandemic in Slovenia, as follows: 1) May 19, 2020 – August 12, 2020 (n = 83) (1st wave); 2) October 15, 2020 – December 22, 2020 (2nd wave); and 3) March 1 − 18, 2021 (3rd wave).

Consideration of ethical principles

This study is based on the ethical principles for research involving human subjects, as set out in the Declaration of Helsinki (World Medical Association, 2013). Personal data were collected and protected under the provisions of the Personal Data Protection Act (Official Gazette of the Republic of Slovenia, 2022). Following this ethical guidance, prior to the survey, participants were given project information, the informed consent form, and the opportunity to ask questions. All students participated voluntarily and anonymously in this study, with the opportunity to withdraw without consequences at any time. This study was ethically approved by the Commission for Research Ethics at the Faculty of Arts, University of Maribor, Slovenia (approval number: 038-12-102/2021/6/FFUM).

Quantitative and qualitative data analysis

Quantitative data analysis was implemented in the IBM SPSS Statistics (version 28.0) package with descriptive statistics (frequency, percentage, mean, and standard deviation). The distribution of all dependent variables tested by the Kolmogorov-Smirnov test showed a non-normal, unimodal, left-side negative asymmetric probability distribution of data (P < 0.001). Therefore, the non-parametric Mann-Whitney U test (comparison of two groups) and Kruskal-Wallis H test (comparison of three groups) were used to find any statistically significant differences in lifestyle experiences during the COVID-19 pandemic among the university students with different demographic characteristics. During this process, some independent variables were recorded and transformed into two groups to meet the analysis criteria (e.g. age, place of residence, size of home town). All results of P ≤ .05 were considered statistically significant.

The qualitative data in this study were analysed by conducting inductive qualitative thematic analysis with a six-phase iterative and reflective methodology process by Nowell et al. (2017). The qualitative data obtained through open-ended questions in the online survey were analysed by the qualitative inductive approach of generating initial codes first and subsequently merging these codes into categories and defining themes with common features.

Results

Table 1 shows that student participants were mostly female (87.4%), with an average age of 21.2 years, from rural regions (52.9%), living in towns with less than two thousand inhabitants (52.0%), and living in an apartment (66.0%). Most students were studying full-time (59.6%), although 40.4% worked part-time. Moreover, 60.6% of participants were undergraduates, while 39.4% were enrolled in the Master’s study program in pedagogy.

Table 1. Characteristics of study participants.

	Characteristics	N (%)
Gender
	Female	90 (87.4)
	Male	13 (12.6)
Age
	Up to 20 years	55 (52.9)
	21-25 years	43 (41.3)
	26 years and over	6 (5.8)
Level in the study program
	Undergraduate	63 (60.6)
	Graduate, Masters	41 (39.4)
Student status
	Full-time student	62 (59.6)
	Student in a part-time job	42 (40.4)
	Student in a full-time job	0 (.0)
Type of home town
	Village, countryside	55 (52.9)
	Suburb	17 (16.3)
	City	32 (30.8)
Size of home town
	Less than 2000 inhabitants (countryside)	52 (50.0)
	Up to 10,000 inhabitants	19 (18.3)
	Centre of the region or capital	33 (31.7)
Place of residence
	Apartment	66 (66.0)
	Shared house with two or more households	16 (16.0)
	House with one family	18 (18.0)
		$\overline{\mathit{x}}$ (σ)
Participants’ age		21.19 (2.60)

Legend: $\overline{\mathit{x}}$ – mean, σ – standard deviation.

Lifestyle of pedagogical students during the COVID-19 pandemic

On average, pedagogical students self-assessed their daily lifestyle during the COVID-19 pandemic as quite good (Table 2). Slightly higher scores were given to the quality of eating habits ($\overline{\mathit{x}}$ = 2.73), immediately followed by equal average scores for physical activity, mental well-being, and overall lifestyle ($\overline{\mathit{x}}$ = 2.70). Among the lifestyle domains, sleep quality was assessed as slightly lower ($\overline{\mathit{x}}$ = 2.68) but still indicating a healthy lifestyle during the COVID-19 pandemic.

Table 2. Self-assessment of everyday lifestyle during the COVID-19 pandemic.

	$\overline{\mathit{x}}$ (σ)^1	Mann-Whitney U test (P)
		Age	Level in the study program	Size of home town	Place of residence
Physical activity during the pandemic	2.70 (.90)	.920	.966	.314	.772
Eating habits during the pandemic	2.73 (.80)	.032	.033	.028	.048
Quality of sleep during the pandemic	2.68 (.85)	.724	.948	.980	.854
Mental well-being during the pandemic	2.70 (.85)	.378	.541	.853	.347
Quality of the whole lifestyle during the pandemic	2.70 (.75)	.437	.204	.399	.944

Legend: ¹Measured on a 4-point scale: 1 = really bad, 2 = quite bad, 3 = quite good, 4 = very good, $\overline{\mathit{x}}$ – mean, σ – standard deviation.

In addition, the Mann-Whitney test showed statistically significant differences in the quality of eating habits during the COVID-19 pandemic among students. Students in Master’s study programs (R̅ = 52.93) assessed themselves as having better eating habits than undergraduates (R̅ = 43.08). This finding was confirmed with statistically significant differences between age groups. Students aged 21 or above (R̅ = 52.11) claimed better eating habits than students aged 20 years or below (R̅ = 42.41). The type of residence also differentiates students by eating habits during the pandemic. Students who live in an apartment (R̅ = 48.13) have a better opinion of their eating habits than students living in a house (R̅ = 38.85). Students living in small towns or villages with no more than 2000 inhabitants (R̅ = 51.81) claimed a higher level of nutrition than students living in bigger towns, cities or regional centres (R̅ = 41.87). No statistically significant differences were found by the type of living environment (village, suburb, or city) or by student status (full-time or part-time studies).

Qualitative findings on pedagogical students’ lifestyle changes

Additionally, we were interested in the everyday lifestyle characteristics among pedagogical students from a qualitative perspective to look more closely at which lifestyle domains were most modified during the COVID-19 pandemic and might need particular attention in the post-pandemic period. In the following, Tables 3–6 present qualitative data findings on the health-related behaviour of pedagogical students during the COVID-19 pandemic regarding physical activity, eating habits, quality of sleep and mental well-being.

Table 3. Physical activity among pedagogical students during the COVID-19 pandemic.

Theme	Categories	Codes
Characteristics of physical activity	Frequency	daily, at least four times per week, twice per week, regular, permanent, frequent, several times a week, once a week, several times a month, fairly regular, quite often
	Amount	every day for at least half an hour, try to be as physically active as possible
	Intensity	moderate, moderately active, low, slow
	Type	cycling, walking, walking in nature, running, exercising, gymnastics, sports, dancing, various activities
	Organized	training, physiotherapy
	Nonorganized	walks with family and boyfriend, recreation, walking alone
Place of physical activity	Natural environment	in nature, many walks in nature, usually go for a walk
	Home	online exercise at home
Quality of physical activity	High quality	excellent, very good, good, active, disciplined, solid, diverse, striving, I enjoy it, I think it is good
	Insufficient physical activity or inactivity	almost non-existent, sitting, laziness, passivity, inadequate, infrequent, several times a month, occasional, irregular, less regular than I would like
Compared to the pre-pandemic period	Reduced	poor, worse, less than usual, limited, uncharacteristic
	No change	similar to before
	Increased	making time for 12 km walks every day

Table 4. Eating habits among pedagogical students during the COVID-19 pandemic.

Theme	Categories	Codes
High-quality diet	Balanced	healthy eating, balanced, excellent, good, try to live healthy
	Varied	very diverse, vegetables, fruits, lots of fruit and vegetables, pasta, various, different, eat everything, satisfying food, mixed, light
	Regular	2-3 meals a day, three times a day, regular diet
	Meal size	smaller meals, light meals
	Fluid intake	adequate fluid intake, drinking a lot of water
	Home-made	home-made products, home-cooked, frequent cooking
Special diet	Solid, mostly healthy	adequate, acceptable, average, stable, relatively healthy, reasonably healthy, harmless
	Diet	vegetarian diet, vegan diet, fasting, not eating bread
Unhealthy diet	Unbalanced diet	unhealthy, partly healthy, unbalanced, sometimes everything − sometimes nothing, so-so
	Monotonous	not enough fruit and vegetables, few vegetables, not varied food, occasionally monotonous, satisfying nutrition, poor
	Disorganized	irregular, disorganized, inconsistent meals
	Junk food	too much sugar
Compared to the pre-pandemic period	Positive impact	started eating vegetables
	No change	the same as before the pandemic, the same as usual
	Negative impact	eating more than usual

Table 5. Quality of sleep among pedagogical students during the COVID-19 pandemic.

Theme	Categories	Codes
Characteristics of sleep	Amount	8-9 hours every day, 8-10 hours, minimum 8 hours, 7 hours a day, optimal, sufficient, long, long enough, enough sleep
	Place	home bed
Sleep quality	Good quality	excellent, very well, good sleep, quality sleep, firm sleep, sound sleep, peaceful sleep, light sleep, deep sleep, comfortable sleep, enough sleep, regular sleep, adequate, optimal, long enough
	Solid, but it could be better	acceptable, solid, diverse, occasionally disturbed, not bad, not the best, no problems
	Low quality	currently weak, weak, restless sleep, sleeping in intervals
Sleep problems	Waking up and interrupted sleep	difficulty falling asleep, a lot of dreams, interruptions, waking up, falling asleep late, shallow sleep, depending on my child’s waking up, frequent waking
	Inadequate amount of sleep	too little sleep, too little, short sleep, usually very little sleep, night bird, lack of sleep, too much sleep
	Fluctuating	sometimes well, depending on my child’s sleep, depending on the day
Compared to the pre-pandemic period	Increased amount of sleep	more sleep, longer sleep, sleep time increased
	Decline in sleep quality	worse than usual

Table 6. The mental well-being of pedagogical students during the COVID-19 pandemic.

Theme	Categories	Codes
Well-being	Excellent	top, super, happy, great
	Positive	satisfied with mental state, happy, optimistic, feel good, good
	Calmness	calmness, stable, relaxed, peaceful, not stressful, phlegmatic view of events
	Neutral	feeling fine, O.K., average, I usually feel fine
Poor mental well-being	Sadness	sadness, broken heart, bad, very bad, tired, depressed, no socializing
	Anxiety	cramped, anxiety, anxious, slightly restless, feeling trapped, addicted, occasional anxiety, slightly anxious
	Stress and workload	stressful, mentally exhausted, occasionally very tired, under pressure, burdened, heavy workload from studying
	Mood swings	bad and great, half-half, unstable, mood swings, fluctuating, unbalanced, mixed
	Body pain	frequent headaches
Compared to the pre-pandemic period	Worse	worse than before the pandemic, it could be better, on hold, unusual panic attacks, anxiety during isolation, uncomfortable because of regional restrictions, unstable, oscillations

Physical activity

Pedagogical students characterized their physical activity based on its frequency, amount, intensity, type, way of performing (organized, nonorganized) and place of performing. Some students evaluated their physical activity as high quality, which increased during the pandemic, while others reported insufficient physical activity or inactivity. Various physical and sports activities in the natural environment, such as walking, cycling, running with moderate intensity, and participating most days a week with family members or alone, seem to have been the preferable physical activities among pedagogical students during the COVID-19 pandemic. However, we should not overlook the group of students who reported a sedentary lifestyle with limited, insufficient or poor-quality physical activity, performed irregularly and occasionally, and declining during the pandemic (Table 3).

Eating habits

The COVID-19 pandemic had three different impacts on the eating habits of pedagogical students: positive, neutral, and negative. Students reported that the pandemic had the positive effect of increasing their vegetable intake, while others claimed that it negatively increased their meal sizes and the amount of food consumed. In most cases, students reported no change in their nutrition during the pandemic.

Table 4 shows that three main diet classifications were revealed by the qualitative analysis: healthy diet, special diet and unhealthy or risky diet. A high-quality diet was defined as a balanced diet consisting of regular meals (three per day, approximately) of modest size, home-cooked dishes, and variety in food consumption. In a positive direction, students’ healthy diest also included fluid intake, especially tap water. Vegetarian diets, vegan diets and fasting were mentioned within the special diet classification. However, these diets were not considered the healthiest, but as reasonably healthy or merely harmless.

On the other hand, some pedagogical students reported an unhealthy diet. Unbalanced eating, monotonous foods, inconsistent meals, and consumption of junk food were the most commonly mentioned unhealthy eating practices. Students reported over-consumption of sugar, a lack of fruit and vegetables in their nutrition, consuming monotonous foods, alternating between taking care of their eating and unhealthy dietary habits, and having a disorganised eating schedule. In these cases, the students evaluated their diet as only partly healthy.

Quality of sleep

The pedagogical students reported sleeping for approximately seven hours per day during the last month (σ = 1.35), with a minimum of 3 hours and a maximum of 11 hours per day. Table 5 shows their sleep quality could be excellent, acceptable, or low. During the COVID-19 pandemic, students reported an increased amount of sleep. On the other hand, participating pedagogical students expressed a decline in sleep quality during the COVID-19 pandemic.

The most commonly reported sleeping issues among pedagogical students during the pandemic were waking up, interrupted sleep and inadequate sleep. Furthermore, students reported difficulty falling asleep and frequent waking during the night, which led to sleeping in intervals and resulted in shallow, weak, and restless sleep. Inadequate sleep, in most cases, was used to indicate shortened hours of sleep. Nevertheless, some students reported that they slept too much. On the other hand, good quality of sleep during the pandemic was characterized by firm, peaceful, deep, and comfortable sleep, which was regular and sufficiently long.

Mental well-being

Mental well-being was one of the most salient lifestyle domains during the COVID-19 pandemic. These pedagogical students reported more extensively on their mental issues rather than on mental well-being (Table 6). It is of great concern that the mental well-being of pedagogical students was self-assessed as worse compared to the pre-pandemic period. Participants reported unusual panic attacks during pandemic isolation, of a type that had rarely happened before. Moreover, they complained about regional restrictions on movement, which caused discomfort and unstable moods. One of the participants declared: ‘The longer I spend by myself, the more I find that I am extremely unstable or there are oscillations’.

Mood swings, anxiety, sadness, stress and workload, and body pain were among pedagogical students’ most often reported mental issues during the COVID-19 pandemic. Students reported mild signs of poor mental well-being, such as lack of socializing, tiredness, restlessness, mood swings, feelings of stress, and severe mental issues such as depression, anxiety, addiction, and burnout. Besides the lack of social contact, study loads were among the most significant stress triggers. In some cases, poor mental well-being was manifested in body pain, particularly in frequent headaches.

However, pedagogical students also experienced positive mental functioning during the pandemic, such as happiness, satisfaction, positive feelings, and calmness. Calmness was recognised as an emotional state defined by feeling relaxed, stable, and peaceful, with a phlegmatic perspective on the pandemic.

Impact of active lifestyle on the physical and mental well-being of pedagogical students during the COVID-19 pandemic

Students evaluated the impact of a physically active lifestyle on their physical and mental health and well-being during the COVID-19 pandemic and agreed with almost all the measured benefits (Table 7). Notably, they highly valued the positive effects of a healthy lifestyle on general mental and physical condition ($\overline{\mathit{x}}$ = 4.20), body strength ($\overline{\mathit{x}}$ = 4.17), better mood ($\overline{\mathit{x}}$ = 4.17), confidence ($\overline{\mathit{x}}$ = 4.12), calmness ($\overline{\mathit{x}}$ = 3.91) and effectiveness in daily activities ($\overline{\mathit{x}}$ = 3.90). Moreover, pedagogical students reported having better sleep quality ($\overline{\mathit{x}}$ = 3.78) and experiencing less tiredness ($\overline{\mathit{x}}$ = 3.48). Only the study discipline seems to be influenced by factors other than a healthy lifestyle.

Table 7. Students’ attitudes towards the impact of an active lifestyle on physical and mental well-being during the COVID-19 pandemic.

	$\overline{\mathit{x}}$ (σ)^1	Mann-Whitney U test (P)
		Age	Level in the study program	Size of home town
Physically I feel good and more vital.	4.20 (0.82)	.134	.121	.341
I have more endurance and strength.	4.17 (0.90)	.457	.485	.494
I am in a better mood.	4.17 (0.82)	.338	.419	.750
I am more confident.	4.12 (0.92)	.288	.127	.033
I am healthier.	4.10 (0.84)	.827	.780	.434
I am calmer and more relaxed.	3.91 (0.89)	.101	.186	.272
In daily activities and tasks, I am more effective.	3.90 (1.00)	.097	.077	.159
I get better sleep.	3.78 (1.02)	.626	.742	.466
I am less tired.	3.48 (1.04)	.019	.012	.052
I have better study discipline.	3.38 (1.08)	.044	.103	.301

Legend: ¹Measured on a 5-point Likert scale: 1 = strongly disagree, 2 = disagree, 3 = neither agree nor disagree, 4 = agree, 5 = strongly agree; $\overline{\mathit{x}}$ – mean, σ – standard deviation.

In addition, we were interested in whether there were any differences in student perspectives on the impact of an active lifestyle on their physical and mental health during the COVID-19 pandemic based on demographic characteristics. The most differences were found in the attitude towards managing fatigue. Higher-grade students aged 21 or above (R̅ = 53.63), students in graduate study programs (R̅ = 55.31) and students living in small towns or villages (R̅ = 52.02) reported stronger belief in the positive impact of an active lifestyle on feeling less tired in comparison with their younger peers (R̅ = 41.05), students in undergraduate study programs (R̅ = 41.51) and students living in bigger towns and cities in the regional centres (R̅ = 41.64). Moreover, students from small towns reported a statistically significantly stronger impact of an active lifestyle on feelings of greater self-confidence (R̅ = 52.35) than students from cities (R̅ = 41.29). In addition, older students (≥21 years of age) expressed greater agreement with the positive impact of an active lifestyle on better study discipline (R̅ = 52.70) than did their younger peers (R̅ = 41.88).

No statistically significant differences were found in the Mann-Whitney U test and the Kruskal-Wallis H test by the type of residence (apartment, house), student status (full-time study, part-time job), or type of home town (village, suburb or city).

Discussion

The findings of this study suggested that the COVID-19 pandemic did have an impact on the lifestyle of pedagogical students. Although most participating students maintained a healthy lifestyle during the pandemic and self-assessed this as quite good, at the same time, they reported deterioration in all observed health-related domains, especially in mental well-being. The students in our study found emergency remote study a heavy burden, which caused stress and mental exhaustion. Anxiety, depression, mood swings, and feelings of stress were the most commonly identified mental issues during the COVID-19 pandemic among the university students participating in our study. Similar findings were reported by Goldstone and Zhang (2022) in a study on a sample of more than 3,000 postgraduate research students in the United Kingdom (UK). In this UK study, many students experienced unfavourable outcomes, while certain groups demonstrated severely negative pandemic experiences with mental well-being. Similar disorientation in mental well-being and increased feelings of loneliness were reported among university students in Germany and Poland (Lippke et al., 2021; Szczepańska & Pietrzyka, 2023). It could be predicted that self-isolation measures and restrictions on social life during the COVID-19 pandemic would severely impact the mental well-being of the student population across Europe (Szczepańska & Pietrzyka, 2023).

Among the highest risk groups for poorer mental well-being were students in arts and humanities study programs, including pedagogical students, who reported a high level of social isolation from peers and low supervisory support, including access to the resources and training provided by universities (Goldstone & Zhang, 2022). Our study draws its major conclusion based on findings among female students (87.4%), who have traditionally constituted a vulnerable group challenged by entrenched structural gender inequalities. School pressure, a competitive culture, parent/family-related pressure, gendered expectations, and the demand for academic success are all related to mental illness and anxiety, which are more likely to be experienced among girls and young women (Stentiford et al., 2021).

Another reason for the increase in mental health issues can be found in the demographic structure of this sample. More than half the students who participated in our study lived in rural areas. Previous systematic reviews found that rural residence has a negative impact on anxiety among students, owing to lower levels of mental health services provision, isolation, and greater social stigma around mental health issues. Moreover, rural students’ anxiety leads to greater absenteeism in school and lower rates of education completion (Harvey & Clark, 2020). During the pandemic lockdowns and border closures, the inequities experienced by rural and remote students even deepened, particularly in relation to their access to financial resources and emotional and practical support (Cook et al., 2022). Increased anxiety and stress levels during the COVID-19 crisis may also have resulted from weak support by student social networks and a lack of formal university support services in well-being and mental health, as reported by non-traditional groups of students (Raaper et al., 2022).

An active lifestyle seems to have been a crucial factor in mitigating the negative consequences of the COVID-19 pandemic (Lippke et al., 2021). Regular physical activity helps students to maintain their physical and mental well-being. According to student self-assessment in our study, the benefit from physical activity shows in general mental condition, better mood, confidence, calmness and relaxation, effectiveness in daily activities, fatigue management, and better sleep quality. However, while some students in our study valued physical activity during the pandemic, others reported mainly sedentary lifestyles. This latter group should not be overlooked. Statistical comparison between groups of students based on demographic factors showed that they were particularly convinced of the positive outcomes of a healthy lifestyle on fatigue management, better self-confidence, and study discipline. A stronger attitude was found among graduate students and students living in smaller rural towns.

Based on our findings, student nutrition did benefit to some extent from the COVID-19 pandemic within the lifestyle areas. Students claimed to be paying more attention to a balanced diet, including food variety, vegetable intake, regular meals of modest size, and home-cooked dishes. However, some students reported an excessively increased amount of food. Although the pandemic had fewer negative impacts on student diets, this remains the most mysterious health-related domain and one that should be carefully examined in future studies, particularly because there are currently many popular extreme eating regimes that could harm student health. Statistically significant differences were found in better eating habits among postgraduate students, students in smaller rural towns, and students living in apartments.

Implications for the higher education curriculum of pedagogical students

Based on the findings about pedagogical students’ lifestyles during the COVID-19 pandemic, the question arises: ‘Which health education improvements should be made in the curriculum of pedagogical students?’

First, pedagogical students should be offered health interventions in all affected health domains to overcome the pandemic’s consequences and improve their health-related lifestyles. By implementing school-based interventions, university professors can minimise the negative impact of the pandemic on students’ health, social inequality, and academic outcomes (Goldstone & Zhang, 2022; Harvey & Clark, 2020). Every university professor in every course has an opportunity to include health promotion activities in their lectures and tutorials. These will lead to a better quality of teaching and learning, an improved classroom climate, higher academic achievement and improved health and lifestyle among pedagogical students. However, providing special training for educators on identifying and addressing their students’ emotional needs and mental well-being might be essential for the success of the intervention (Harvey & Clark, 2020; Zurc & Laaksonen, 2023b).

Second, special attention should be given to the pedagogical students’ mental health and well-being. There are many effective strategies for improving the mental health of students. Mindfulness training, with its origin in the Buddhist tradition, is one of the most recognised stress relief practices to have far-reaching implications for all aspects of education by enhancing learning about emotions and providing a foundation for cognitive development (Hyland, 2014). Mindfulness is particularly valuable for prospective educational professionals to acquire awareness of how to perceive and react to other people in stressful circumstances. Therefore, the principles of mindfulness should be systematically included in the higher education curriculum of future educational professionals to enhance their mental health and lower their chances of suffering from occupational burnout (Tarrasch, 2019; Tekavc, 2021).

Third, every education is based on values (Hyland, 1988; Peček Čuk & Lesar, 2021; Zorić et al., 2022). Therefore, the question arises, which universal values should be emphasized in the curriculum of pedagogical students and how health as one of the most critical values in a society should be placed within them? This study’s findings suggested improvements in the curriculum for pedagogical students. Enhancing pedagogical students’ perceptions of their health-related role in education is crucial to encourage them to care for their health, healthy lifestyle, and behaviour.

Finally, future studies are needed to investigate pedagogical students’ and teachers’ views on health education and to identify opportunities to engage them in effective health education training. While traditional training may adequately provide teachers and school counsellors with the knowledge and ability to manage pupils’ health issues, it may not prepare them to take on roles as active educators and promotors of physical and mental health in their classrooms (Brunette, 2017). Particular attention should be placed on teachers who work in the early years of primary schooling.

Study limitations and directions for future studies

The generalization of our findings is limited to populations with demographic characteristics similar to those of the participants in our study, such as female students in pedagogical study programs, in their early twenties, living in rural areas and studying full-time at public universities. Future studies are needed to investigate health-related lifestyles among students from different living environments, social backgrounds, study programmes, study levels and genders, as well as differences between separate waves of the COVID-19 pandemic. As vulnerable groups within the student population, students from rural and remote communities and non-traditional students should be the focus of consideration based on their dissimilarities and inequalities in their social and power position (Cook et al., 2022; Raaper et al., 2022). Furthermore, particular attention should be given to how pedagogical students’ lifestyle relates to their feelings of competence and enjoyment related to their future role as health educators for school children.

Conclusion

This mixed methods study showed that the COVID-19 pandemic did significantly impact the lifestyle of Slovenian pedagogical students across a range of health domains, especially in the deterioration of mental well-being. The negative consequences of the pandemic should be actively addressed through organized health promotion interventions for the student population. These interventions should target students in rural areas and include physical activity as a crucial factor in empowering all areas of a healthy lifestyle. Finally, emphasis should be given to the formal education of pedagogical students in developing their health-related behaviour and competences to empower physical and mental well-being in school children. Overall, the pandemic taught us that implementing health education in every pedagogical curriculum, from kindergarten to university, is crucial to prevent any similar negative consequences of infectious diseases on the physical and mental health of the population in the future.

Ethical approval

The research was approved by the University of Maribor’s Faculty of Arts Commission for Research Ethics [Approval No. 038-12-102/2021/6/FFUM].

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The dataset related to this manuscript can be made available upon reasonable request.

Additional information

Funding

This work was supported by the Slovenian Research Agency − Javna Agencija za Raziskovalno Dejavnost RS under the research program grant ‘Slovene Identity and Cultural Awareness in Linguistic and Ethnic Contact Areas in Past and Present’ [number P6-0372].

Notes on contributors

Joca Zurc

Joca Zurc is an associate professor at the Department of Pedagogy, Faculty of Arts, University of Maribor, Slovenia. She has more than 20 years of experience in empirically-based educational research. Her primary interest involves teachers’ competences in promoting a healthy lifestyle and well-being for school children.