Qualitative Study on University Town’s Health Education among Undergraduate in Chongqing University Town, China

College students are in a critical period of physiological and psychological development, and they are highly prone to be exposed to many physical and mental health problems. Research shows that in China, the incidence of college students having physical and mental health disorders is as high as 34.7%, and this rate is increasing annually [1]. Presently, in response to the increasing need for higher education, some “university town”, that meaning several universities and campuses are concentrated in a certain area of the city, have been invested in the construction by the governments of developing countries. They are called in different names, including “college town” in some countries such as Germany, France, Italy, Japan, and Canada. In the 1990s, university towns were built in the main cities of China to provide additional venues for university students. Compared with the developmental speed of university towns in other countries, the formation of Chinese university towns is rapid [2]. Chinese university towns are a product of accelerated urbanization and a consolidation and enlargement of colleges and universities [3]. In contrast to traditional education, education in university towns is characterized by community management, sharing of educational resources, socialization, and strengthening of operational mechanisms between teachers and students. The construction of university towns promotes economic development and the urbanization process.

the health status of college students and how well their health needs are being met by various services, or the perceived value of particular service types.
Mental disorders are prevalent among college students, and the extent and number of these disorders appear to be increasing [8]. The physical and mental health problems of college students in university towns are more severe [9,10]. The most effective way to solve this problem is to provide the platforms that student can get the supports of health counseling and education. School departments can create corresponding services that students can rely on for both their health problems by establishing a compulsory course, utilizing the campus propaganda and so on. However, little attention has been given to their needs. Moreover, few studies had been conducted about the topic. Qualitative methods had been adopted in this research to obtain more detailed information [11].

Method Study design
This study was conducted in Chongqing University town, China in 2011, and employed a qualitative research design in the form of focus group discussions [12] and in-depth interviews [13]. Three different type universities, namely, Chongqing Science and Technology University, Chongqing Normal University, Chongqing Medical University were random chosen from the total of 14 universities.

Setting and sample
As is common in qualitative research designs, we used purposive sampling to select a sample balanced across age, gender, and profession, major and grade [14]. Five aspects of people may relate to students' health both mental and physical directly, and considered the objects we invested are from three schools, we decided the sample size is fifteen.
Fifteen key figures were chosen to participate in the individual in-depth interviews. The key figures included managers, teachers of the youth corps committee, regular teachers, school doctors, and psychological consultants, among others. The key figures were eligible to participate if they were on the establishment, aged 25-60 years and [1] work in this school for more than two years [2] were familiar with the course of the school, places and facilities of the students activities, the work about students mental health, the situation of the university hospital. And the numbers of each school key people with different professions relative equilibrium. Meanwhile, 15 students were selected for the individual face-to-face interviews and focus group discussions, respectively. Forty students (5 to 7 students per group) participated in the discussions, with the gender ratio of 1:1 and ages ranging from 17 to 24 years old.

Data collection
Trained and qualified in simulation interview interviewers conducted in-depth interviews. We used semi-structured interviews conducted in person and each interview lasted from 30 minutes to 1 hour. For the convenience of the respondents, the interviews were conducted in their respective offices or dormitories. Six investigators participated in the investigation. Two had related experience, while the other four only had standardized training. Data were collected by interviews. The specific interview questions are listed in Table 1 and  Table 2. A tape recorder and a combination of site records and notes from the registrar were used during the data collection. Aside from the transcription of the recordings and the notes from the registrar, personnel records were also obtained.

Data analysis
Interviews were audio-recorded, transcribed, re-identified, checked for accuracy, and then analyzed carefully. Field notes during the interviews were kept and used as reference during the data analysis. We used qualitative analysis software MAXqda 11 to manage data. According to the characters of the state of being contented with the needs, the category of needs distinguished and the ways of needs available, we divided the data into three parts of content, forms and sources. The thematic framework analysis, which combines the qualitative interview outline and the interview data, described the phenomenon and revealed the problems that would theoretically identify the reasons for the said problems.

Ethical consideration
All participants provided written consents as evidence of their willingness to participate in the study. Ethical approval for this study was obtained from the Ethics Committee of the Chongqing Medical University.

Participant characteristics
A total of 15 key figures, 8 males and 7 females, from 31 to 57 years old, were interviewed. All key figures were affiliated with a university health system. 8 male and 7 female undergraduates with ages ranging from 17 to 24 years were also interviewed. The undergraduates were from the normal, medical, and science universities ( Table 1).

The content of students' health education needs
University students had diverse needs for health education. These needs were arranged according to level of need, that is, normal university students: physical health, mental health, nutrition, sports care, knowledge of diseases, and drugs; science and engineering university students: mental health, sports care, nutrition, physical health, and knowledge of rehabilitation; medical university students: nutrition, mental health, physical health, knowledge of reproductive medicine disease, and Chinese Medicine Health.

The forms of students' health education needs
University students had different forms of health education preferences, that means how they would like to receive health education: in the aspect of seminar or a report for students, 76% the normal university students willing to accept a psychological counseling outpatient service, with only 7.6% the science and engineering university students choosing psychological consulting, and 51% the medical university students suggested compulsory courses, seminars or reports, while 65% were keen on choosing elective courses. 31% the medical university students also favored the use of a psychological counseling clinic, while 3.4% students proposed to employ network propagandas.

Health education resources
Normal Students urgent need physical health, mental health and nutrition knowledge. Medical students want to get more knowledge of nutrition, mental health and physical health and other aspects of science. And science students hope to satisfy the need of mental health, sports health, and nutrition knowledge.

Health education curriculum
Normal, science and medical students affirmed that the school has carried out the corresponding compulsory courses about health ( Table  2). Key figures represented elective course about health education can be carried out, but some schools did not carry out compulsory health education curriculum (citations A-M1). They were not sure the differences and connect between physical health and mental health (Citation P-M7). Moreover, some schools have carried out corresponding compulsory and elective courses (citation P-M2).

Health counseling or guidance
84% students tend to accept the form of seminars or lectures of the report, but they do not know clearly the function of psychological counseling center (this means a department that pay attention to mental health, provide students with psychological counseling, and help them to solve the problem of emotional and life) ( Table 2). Key figures said all of the schools have psychological counseling center. The operation of the counseling center exists the problem that insufficient staff resources, not clear the focus of work and not be fully established the mental health system (citation D-F1). Counseling center of some schools were still under construction (Y-F2). In addition, they believed that the creation of health education seminars and report are meaningful (citations A-F4).

School campus propaganda media on health education
78% students from normal and medical university did not admire the campus propaganda media(this means a medium used to disseminate information on campus, such as radio, newspaper ,windows and so on) because they rarely contribute to health education, but the student from science university believed campus propaganda media play a positive role on mental health education ( Table 2). Key figures considered schools publicized physical and mental health knowledge by the school newspaper, windows, radio, mental health activities (citation Y-M6, T-M4, Y-F7), but the network publicity(this means a way of promoting health information via Network) were imperfect (citations Y-M6 ).

Sports facilities are related to health education
Each school also had their own related social organizations, which were fully affirmed by the students from different school in the aspect of mental health. Normal students had sports-related clubs such as basketball, badminton and so on, and sports facilities have met the needs of only 14% students, except sports venues. Science students had the organizations about basketball, badminton and psychological association, and both sports facilities and venues could satisfy the need of 74% students. Medicine students have sexual medical association, A psychological center exists. The concrete is not clear.
Have opened, but the concrete is not certain.
The campus propaganda media on health promotion Have school magazines, newspapers, posters, etc. 77% said the effect is not ideal.
Have campus radio, television, posters; mainly through the schools radio. The effect is fair.
Blackboard newspapers and campus radio. 79% said the effect is poor Related to physical and mental health education of students association Community: relevant to the movement of basketball, badminton, etc.; Most believe the effect is good.
Associations including basketball, the psychological association, etc. The effects are good.
Sexual medicine, Nutrition association, sport club, etc. The effect is good.
School doctors or hospital 82% students are not familiar with them; some believe that the effect is not very ideal.
67% students said that the service attitude is good; 52% students believe that there should be more staff members 70% believe that there should be more staff members and that the size should be larger.

The school sports facilities
Only 14% students believe that sports facilities are OK and that they can meet the needs. 47% the students believe that the resources are insufficient.
74% of the students said that the accessibility of sports facilities is very good.
34% said the sports facilities are fair; 65% considered them not perfect and that the sports facilities must be improved. the nutrition society, football clubs and other student organizations, but 65% students believed that sports facilities and venues are limited ( Table 2). Key figures felt that the schools should have the appropriate mental health and psychological counseling associations (citations T-M5, T-F6, Y-M8).

School doctor and clinic
The evaluation of science and engineering students on the school doctor and clinic is higher than that of normal and medical students, as presented in Table 3. Key figures were in the great differences of opinion. The key figure of normal university believed that although provided technical support, the school doctor clinic staff, outpatient are unknown (citation P-M3).The key figure of science university thought we should increase the professional guidance to school doctors(citation D-F3), while the key figure of medical university believed the school doctors are worthy of mental health (citations A-F5).

Discussion
To our knowledge, this is the first known article to explore health education needs of undergraduates in University Town. In spite of special environment of the university town, students in the rural area, for example, lack continuous quality care and knowledge regarding health system access [14]. Thus, they are more vulnerable to physical and mental problems and in special need of health educators. The most effective way to solve this problem is to make the communication between students and the supportive people convenient. School departments can create corresponding services that students can rely on for both their health problems. In the future, mental health promotion interventions will be delivered at three levels: universal level, which is an intervention that affects the entire school or community, selective level, which is an intervention focusing on a certain group of students, and indicated level, which is an individually focused intervention [15].
The survey showed that more than 80% of the respondents have significant needs on nutrition knowledge. College students, in the latter period of their youth, are encountering heavy study tasks and additional work pressure, and nutritional disorders among college students can disturb their overall physiological and health status [16]. Moreover, previous studies had found many students (especially female) were in pursuit of figure satisfaction leading nutritional disorder [17][18][19]. In general, attitudes and behaviors about nutrition are positively related to knowledge. Elevating the level of nutrition knowledge can affect their attitude and reflected on their eating behavior [20]. In the future, to raise the level of nutrition knowledge among college students, favorable support for healthy habits should be provided. First, health education design should be based on school types and their existing health problems. Although schools have carried out the corresponding  compulsory course about physical and mental health, situations about elective courses were different; some even were not clear about the character about courses. Second, the characteristic of university towns to share educational resource should be utilized and the cooperation between schools on health education should be strengthened, such as the elective courses at the university town. School can hire or invite experts majoring in health and psychological counselors to guide the development of curriculum.
And the work based on a positive psychology framework in study has been confirmed to motivate positive development of college students [21]. On the other hand, the work of psychological counseling center is not clear. It is necessary to strengthen the publicity of psychological consulting center and improve students' understanding of it to attract more students to seek professional psychological help.
Most students do not like the dreary campus propaganda. College students are willing to accept the more creative and fresh health education method. The present study has concluded that seminars or lectures are acceptable by majority of the students, the students' associations play a positive role in health education and with the development of network, social network has become one of the most popular informal channels for students [22], but key figures considered network publicity of health knowledge were imperfect, so that school may consider using its potential social influence to assist students in their life adjustments and positive development in physical and psychological health [23,24]. Our results found that the sports facilities and venues don't fully meet the need of most students. Key figures felt that the schools should have the appropriate mental health and psychological counseling associations. More attention and economic investment should be paid to the support the sports and activities and encourage establishment of the associations about mental health and psychological counseling.
The present study found that only a few students know about their school doctors but these doctors have poor evaluations. Although provided technical support, the school doctor clinic staffs, outpatients are unknown. School doctors [25] and clinics have a responsibility to maintain the health of students [26]. School physicians must address medical and social needs. In the future, the responsibility of school doctors should be strengthened in such a way that attention is given not only to the problem of body diseases, but also the mental health of their patients. School doctors and clinics are advised to work with health education teachers and provide guidance to students in need during and after class.
The study also has certain limitations. First, with the employment of the purposive sampling method, the sample obtained comprises only a small part of a typical observation sample. Second, the interview sample size is not large, resulting in definite limits on stability and representation. Third, the study uses qualitative methodology with semi-structured interview questions for in-depth interviewing purposes, but the questions may be more open-ended. In future studies, the sample size should be increased, and a combination of quantitative and qualitative research should be administered to guarantee the reliability of the results [27]. What's more, the interview questions were self-design.

Implications for future health education in university towns
In order to do undergraduates' health education well in university towns, we give these following suggestions: First, to establish a harmonious health education system and carry out health education for students in all aspects, psychological health education, ideological and political education, and the college sports curriculum should be implemented. Second, to popularize physical and mental health knowledge, special reports and other multiple approaches can be used.
Third, to establish a smooth physical and mental health care network, the following can be conducted: (a) establishing and improving the l health education leadership system for college students, along with deepening the reform of the courses system, (b) regularly testing physical quality of college students and having their physical and mental health files installed, and (c) emphasizing on the positive role of counselors and teachers in strengthening mutual cooperation and jointly promoting the development of mental health of college students. These efforts to integrate mental health care into the general health care system can enhance the provision of psychiatric care to students with physical illnesses [11]. What's more, to highlight the university sports education function and constantly improve the quality and efficiency of sports teaching, various forms and interesting sports teaching methods can be adopted and university sports education courses should be promoted to students.

Conclusions
In-depth interviews can provide extensive information about the health education needs of university towns. The findings of this study provide a better understanding of the needs characteristics of the health of students in university town. The results of this study can aid other countries or regions in implementing health education in university towns, as well as provide a reference for further investigations on health education.

Funding
This study received support of Education Science "Eleventh Five-Year Plan" project of Chongqing Municipal (10-GJ-0414).
This study was also supported by China Ministry of Education of Humanities and Social Science research of 2015 fund projects. This study received support of Education Science "Eleventh Five-Year Plan" project of Chongqing Municipal (10-GJ-0414).