Mixed methods needs assessment of student health and wellness to inform university health promotion programming at Abu Dhabi University

Mixed methods needs assessment of student health and wellness to inform university health promotion programming at Abu Dhabi University | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Mixed methods needs assessment of student health and wellness to inform university health promotion programming at Abu Dhabi University Maria Aamir, Omar Friehat, Noura Al Hashmi, Zaineb Bennani This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8892778/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 17 You are reading this latest preprint version Abstract Universities are increasingly recognized as critical settings for promoting student health and well-being through whole-system, evidence-based approaches. Abu Dhabi University (ADU) initiated a Health and Wellness Initiative; however, a comprehensive needs assessment was required to inform the development of a structured, culturally responsive program. This study aimed to assess students’ health behaviours, perceived stress, wellness priorities, and program preferences, and to integrate quantitative and qualitative findings to guide institutional program development. A convergent mixed-methods design was employed. Quantitative data were collected via an online survey completed by 188 undergraduate and postgraduate students across ADU campuses, assessing physical activity, perceived stress, satisfaction with campus food options, barriers to healthy behaviours, and preferences for wellness services and delivery formats. Descriptive statistics and chi-square tests examined patterns by gender and campus. Qualitative data were gathered through six focus group discussions and analysed using reflexive thematic analysis to explore lived experiences, contextual barriers, and student-generated recommendations. Integration occurred at the interpretation stage. Overall, 42.6% of students reported high or very high stress, 29.3% reported low physical activity, and 26.6% were dissatisfied with healthy food options on campus. Students expressed strong interest in stress management, time-management, mindfulness-based activities, and group-based physical activity, with a preference for in-person or hybrid delivery outside academic hours. Qualitative findings revealed that stress was chronic and structurally driven by academic and institutional factors, while engagement in healthy behaviours was constrained by time, fatigue, cost, and campus environments. Students emphasized the need for accessible, low-stigma, integrated wellness programming embedded into campus life. These findings provide a robust empirical foundation for developing a holistic, student-centred Health and Wellness Program and support the advancement of ADU as a health-promoting university. Health-promoting university Student well-being Mixed-methods research Stress Physical activity Nutrition Campus health Needs assessment Abu Dhabi University Contribution to Health Promotion Identifies key health and well-being challenges faced by university students in the UAE. Highlights student priorities for stress management, physical activity, and healthy lifestyle support. Provides evidence to guide the design of student-centred campus wellness programs. Supports the development of universities as health-promoting environments. Introduction Background University students represent a population undergoing rapid and intersecting academic, psychological, and social transitions (Romeo, et. al., 2024; Lipson et al., 2022; McLafferty, et. al., 2017; Conley, et. al., 2014; Arnett, 2000;). This developmental stage is associated with heightened vulnerability to mental distress, sleep disruption, suboptimal dietary patterns, and insufficient physical activity, all of which may have enduring consequences for health and academic success (Altaf, et al., 2024; American College Health Association, 2023; McLafferty, et. al., 2017). Compared with their non-student peers, university students consistently report higher levels of perceived stress and psychological burden, driven by academic workload, performance expectations, increased autonomy, lifestyle disruption, and financial or career-related uncertainty (Al-Sharari, 2024; Auerbach, et al., 2016; McLafferty et al., 2017; Lipson et al., 2022; Eisenberg, et. al., 2021; Bruffaerts et al., 2018; Stallman, 2010). These psychosocial stressors frequently coexist with health-risk behaviours, including sedentary lifestyles, irregular eating patterns, poor sleep hygiene, and limited engagement in physical activity (McLafferty et al., 2017; Lipson et al., 2022; Pengpid, et. al., 2015). Such patterns not only undermine immediate well-being but also increase long-term risk for non-communicable diseases, reduced academic engagement, and poorer life satisfaction (Altaf, et. al., 2024; McLafferty et al., 2017; Bruffaerts, et al., 2018). Universities are therefore increasingly recognized as critical settings for population-level health promotion. The Health-Promoting University framework emphasizes a whole-system approach in which health and well-being are embedded across academic structures, campus environments, institutional policies, and student support services (Cruz, et. al., 2024; Dooris, et. al., 2019; Okanagan, 2015; Barry, et. al., 2013; Tsouros, et. al., 1998; World Health Organization, 1998). Within this framework, effective programming must be grounded in context-specific evidence that reflects students’ lived experiences, priorities, and barriers rather than relying solely on generic or externally developed interventions (Çol, et. al., 2024; Cooper, et. al., 2023; World Health Organization, 1998). Literature Review A substantial body of international literature documents the high prevalence of mental health concerns among university students. Data from the WHO World Mental Health Surveys across 19 countries indicate that a significant proportion of tertiary students experience depression, anxiety, and suicidal ideation during their academic careers (Bruffaerts et al., 2018). Concurrently, global studies report declining physical activity levels and increasing sedentary behaviour among students, particularly during periods of academic intensity and transition (Pengpid, et. al., 2015). Evidence from the Middle East and Gulf Cooperation Council (GCC) region mirrors these trends. University students in Gulf countries report elevated perceived stress, poor sleep quality, academic burnout, and challenges balancing academic and personal demands (Alalalmeh, et. al., 2024; Salama, et. al., 2024; Gosadi, & Shnaimer, 2025; Alotaibi, et. al., 2020; Siddiqui, et. al., 2017). Studies conducted in the United Arab Emirates further highlight concerns related to mental well-being, dietary imbalance, and inconsistent engagement in physical activity among young adults (Diab, et. al., 2025; Dabou, et. al., 2025; Alnaqbi, et. al., 2025; Cheikh Ismail, et al., 2022; Takshe, et. al., 2022). However, much of this literature remains descriptive, focusing on symptom prevalence rather than translating findings into institution-specific, actionable program design. Importantly, international evidence suggests that many university wellness initiatives fail to achieve sustained engagement because they do not adequately align with students’ preferences, cultural context, time constraints, or perceived barriers (Fang, et. al., 2025; Jara, et. al., 2023; Boulton, et. al., 2019; Moore, et. al., 2019). Structured needs assessments have been shown to enhance the relevance, efficiency, and impact of campus health promotion efforts by informing program priorities, delivery formats, and resource allocation (Al-Jayyousi, et. al., 2024; Dooris, et. al., 2019; Newton, et. al., 2016). Despite this evidence, no published, comprehensive wellness needs assessment has been conducted at Abu Dhabi University (ADU), representing a clear empirical and practical gap. Rationale for the Needs Assessment Abu Dhabi University recently initiated a Health and Wellness Initiative aimed at promoting physical, mental, and emotional well-being among its student population. While planned activities encompass physical activity, mental health awareness, lifestyle education, and peer engagement, the effectiveness and sustainability of such initiatives depend on their alignment with students’ actual needs, constraints, and cultural context. Needs assessments serve a foundational role in campus health promotion by: Identifying priority health and wellness challenges (e.g., stress, inactivity, lifestyle imbalance). Clarifying perceived barriers to healthy behaviours (e.g., time constraints, motivation, access). Mapping student preferences for program content, timing, and delivery format. Ensuring cultural and contextual relevance within the UAE higher-education setting; and Guiding strategic allocation of institutional resources toward interventions with the greatest potential impact. Without such evidence, wellness programs risk low participation, limited effectiveness, and poor sustainability. Accordingly, a structured mixed-methods needs assessment was undertaken to inform the design of a comprehensive, evidence-based Health and Wellness Program at ADU. Study Aim and Objectives Aim The primary aim of this study was to conduct a student-centred, campus-wide mixed-methods needs assessment to inform the development of Abu Dhabi University’s Health and Wellness Program. This study focused exclusively on students and did not include faculty or administrative staff. Objectives The specific objectives were to: Quantify levels of physical activity, perceived stress, satisfaction with healthy food options, and interest in wellness services among ADU students. Identify perceived barriers to engaging in healthy lifestyle behaviours, including physical activity and stress management. Examine student preferences regarding wellness program timing, delivery format, and thematic focus. Integrate quantitative and qualitative findings to generate evidence-based, contextually relevant recommendations for program development. Establish a baseline to support future evaluation of institutional wellness initiatives. Methods Study Design A cross-sectional, convergent mixed-methods design was employed to assess student health and wellness needs at Abu Dhabi University. Quantitative data were collected through an online survey administered to the student population, while qualitative data were obtained through focus group discussions to provide contextual depth and explanatory insight. Quantitative and qualitative data were analysed independently and integrated at the interpretation stage to enhance understanding of observed patterns. Setting The study was conducted at Abu Dhabi University, a multi-campus higher education institution in the United Arab Emirates, with campuses in Abu Dhabi and Al Ain. ADU enrols undergraduate and postgraduate students across a wide range of academic disciplines. The study was embedded within the institutional context of ADU’s Health and Wellness Initiative and served as the foundational needs assessment for program planning. Participants and Sampling Eligibility Criteria Participants were eligible if they: Were currently enrolled as undergraduate or postgraduate students at ADU. Were aged 18 years or older. Were able to read and understand English; and Provided informed consent electronically. Faculty and administrative staff were excluded in accordance with the study’s student-focused scope. Quantitative Sample and Sampling Strategy Sampling Approach A convenience sampling strategy was used for the quantitative phase to maximize reach across campuses. The online survey was disseminated through institutional student email lists, internal learning platforms, and campus communication channels. Participation was voluntary, and no incentives were offered. Sample Size A total of 188 students completed the quantitative survey. Given the exploratory, needs-assessment nature of the study, a formal power calculation was not required. The achieved sample size was sufficient to: Generate stable descriptive statistics. Identify priority wellness needs; and Conduct exploratory subgroup comparisons by gender and campus, consistent with similar campus health needs assessments reported in the literature. Qualitative Sample and Sampling Strategy Sampling Approach A purposive sampling strategy was employed for the qualitative phase to ensure diversity across: Campus (Abu Dhabi and Al Ain), Academic level (undergraduate and postgraduate), Gender, and Self-reported engagement in health behaviours. Students who completed the quantitative survey were invited to participate in focus groups via a short recruitment form. Sample Size A total of six focus group discussions were conducted, each comprising 6–8 participants, consistent with recommended qualitative research practice. Data collection continued until thematic saturation was achieved, defined as the point at which no new themes emerged across successive focus groups. Data Collection Procedures Quantitative Data Collection Quantitative data were collected using a structured online survey administered via a secure, web-based platform. The survey required approximately ten minutes to complete and was open for a defined data collection period in 2025. Before accessing the survey, participants reviewed an IRB-approved information sheet (Appendix 6) outlining the study purpose, voluntary nature of participation, confidentiality protections, and researcher contact details. Electronic informed consent was required to proceed. Qualitative Data Collection Qualitative data were collected through six focus group discussions, facilitated by trained members of the research team. A semi-structured discussion guide (Appendix 7) was developed directly from quantitative survey findings and informed by the Health-Promoting University framework. Focus group discussions explored four domains: Mental well-being and stress; Physical activity behaviours and barriers; Nutrition and lifestyle habits; and Preferences for Health and Wellness Program design. Sessions lasted 50–60 minutes, were conducted in teams meeting and were audio-recorded with participant consent both written and verbal. A second researcher documented meeting notes capturing group dynamics and non-verbal cues. Measures Quantitative Measures The survey included close-ended and open-ended items assessing the following domains: (Appendix 5). Sociodemographic Characteristics Gender (female, male, prefer not to say), Campus (Abu Dhabi, Al Ain), Academic level (undergraduate, postgraduate). Health and Wellness Indicators Physical activity: self-rated activity level (very active to not active at all); Stress: self-rated perceived stress (very low to very high); Food environment: satisfaction with healthy food options on campus (5-point Likert scale); Barriers to physical activity: multi-response item; Interest in wellness services: multi-response item; Program preferences: timing and delivery format. To enhance interpretability and support subgroup comparisons, three binary outcome variables were created (appendix 1): Low physical activity: not very active or not active at all; High stress: high or very high; Food dissatisfaction: dissatisfied or very dissatisfied. Qualitative Measures The focus group guide included open-ended questions and probes designed to elicit students’ lived experiences, perceived barriers and facilitators, cultural considerations, and actionable recommendations for wellness programming. Questions were flexible to allow exploration of emergent topics raised by participants. Data Management and Confidentiality All quantitative survey responses were anonymized automatically, and no identifying information was retained in the analytic dataset. Qualitative transcripts were de-identified prior to analysis. Data were stored on password-protected institutional devices accessible only to the research team. Data management procedures complied with Abu Dhabi University Institutional Review Board (IRB) requirements and institutional data protection policies. Data Analysis Quantitative Analysis Quantitative analyses were conducted accordance with the IRB-approved analytic plan in Python using Pandas for data cleaning, variable recoding, and descriptive summaries; NumPy for numeric calculations and percentage generation; and SciPy for inferential analyses. Frequencies and percentages were computed for all categorical variables. Multi-response items (e.g., preferred activities and barriers) were transformed into binary indicator variables (selected vs not selected). Key outcomes were recoded into binary variables (high stress, low physical activity, and food dissatisfaction), and chi-square tests of independence were used to examine associations with gender and campus with statistical significance set at p < .05.; Fisher’s exact tests were planned where expected cell counts were small. Figures were produced using Microsoft excel. Qualitative Analysis A qualitative focus group design was employed to contextualize survey findings and explore students’ experiences, barriers, and program preferences. Six focus groups were conducted using a semi-structured guide informed by survey results and organized around four domains: mental well-being, physical activity, nutrition and lifestyle, and program design. Data were analysed using Braun and Clarke’s reflexive thematic analysis, following a six-step process of familiarization, coding, theme development, review, definition, and integration. Deductive and inductive approaches were combined, and themes were mapped back to quantitative findings to support mixed-methods integration. Rigor was enhanced through audit trails, analytic memos, and cross-group comparison. Coding was conducted manually using Microsoft Excel, with analytic memos and audit trails maintained to enhance rigor. Both deductive codes (guided by the discussion domains) and inductive codes (emerging from the data) were applied. Thematic saturation was confirmed across focus groups (appendix 8). Mixed-Methods Integration Integration occurred at the interpretation and reporting stage using triangulation. Quantitative findings identified priority wellness needs and prevalence patterns, while qualitative findings explained underlying mechanisms, contextual factors, and implementation considerations. integrated and narrative weaving were used to align qualitative themes with quantitative outcomes, strengthening the credibility and applicability of the findings (Appendix 9). Ethical Considerations Ethical approval was obtained from the Abu Dhabi University Institutional Review Board. Participation was voluntary, informed written consent was obtained from all participants, and students could withdraw at any time without penalty. No incentives were provided. All procedures adhered to institutional and national ethical guidelines for research involving human participants (Appendix 10). Results Overview Results are presented in four sections: (1) Quantitative results, (2) Qualitative results, (3) Integrated mixed-methods results, and (4) Results appendices 1. Quantitative Results 1.1 Participant Characteristics (Appendix 3) A total of 188 students completed the survey. Participants were predominantly undergraduate students (96.3%), female (83.5%), and enrolled at the Abu Dhabi campus (70.7%). Postgraduate students comprised 3.7% of the sample. These characteristics indicate strong representation of the undergraduate student population across the two main campuses. 1.2 Physical Activity 1.2.1 Self-Rated Physical Activity Levels (Table 2a, figure 1) Self-reported physical activity levels indicated that while a majority of students perceived themselves as at least somewhat active, a substantial proportion reported insufficient activity. Specifically: Very active: 18.6% Somewhat active: 52.1% Not very active: 26.1% Not active at all: 3.2% Using a binary classification aligned with campus health indicators, 29.3% of students were classified as having low physical activity (not very active or not active at all). Interpretation: Nearly one in three students may not be meeting recommended physical activity levels, identifying physical inactivity as a significant population-level concern. 1.2.2 Preferred Physical Activities (Table 2b). Students selected multiple preferred activity types. The most frequently endorsed were: Walking clubs ( 44.1% ) Strength training/weightlifting ( 41.5% ) Group fitness classes (e.g., yoga, Zumba) ( 40.4% ) Team sports (e.g., football, basketball) ( 37.8% ) Interpretation: Preferences favoured accessible, group-based, and flexible activities, suggesting that students are interested in physical activity when it is socially engaging and logistically feasible. 1.2.3 Barriers to Physical Activity (Table 2c) The most commonly reported barriers were: Lack of time ( 48.4% ) Low motivation ( 28.7% ) Lack of facilities ( 11.7% ) Uncertainty about how to start ( 8.0% ) Interpretation: Barriers were predominantly structural and psychological, rather than related to lack of interest, indicating modifiable determinants at the institutional level. 1.3 Stress and Psychological Well-Being (Table 2d), figure 2 Stress was highly prevalent among students: Very high: 14.4% High: 28.2% Moderate: 44.1% Low: 12.2% Very low: 1.1% Using the predefined binary variable, 42.6% of students reported high or very high stress. Interpretation: The concentration of responses in the moderate-to-high range indicates that psychological stress is widespread rather than isolated, reinforcing its prioritization within wellness programming. 1.4 Campus Food Environment and Nutrition (Table 2e, figure 3) Satisfaction with healthy food options on campus was mixed: Very satisfied: 8.0% Satisfied: 29.3% Neutral: 36.2% Dissatisfied: 18.6% Very dissatisfied: 8.0% Overall, 26.6% of students reported dissatisfaction, while more than one-third expressed neutral satisfaction. Interpretation: The large neutral category suggests acceptance rather than endorsement of the food environment, highlighting an opportunity for targeted improvement. 1.5 Mental Health and Wellness Service Needs (Table 3) Students expressed strong interest in preventive and skill-based wellness services: Stress management workshops ( 56.4% ) Time-management workshops ( 41.0% ) Mindfulness/meditation sessions ( 38.8% ) Counselling services ( 32.4% ) Peer support groups ( 20.2% ) Interpretation: Interest in preventive and educational services exceeded interest in counselling alone, indicating a preference for early, non-stigmatizing interventions. 1.6 Preferred Wellness Topics (Table 4) Students identified priority topics for wellness education: Work/study-life balance ( 58.0% ) Healthy sleeping habits ( 50.0% ) Building healthy lifestyle habits ( 46.3% ) Sleep hygiene ( 36.2% ) 1.7 Program Delivery Preferences (Table 5 & 6) Timing After class/work: 29.8% Evenings (after 4 p.m.): 26.1% Lunch breaks: 15.4% Weekends: 14.9% Before class/work: 13.8% Format In-person: 60.1% Hybrid: 31.9% Fully online: 8.0% Interpretation: Students strongly favoured face-to-face or blended programming scheduled outside academic hours. 1.8 Subgroup Comparisons (Table 7) Chi-square analyses revealed no statistically significant associations between gender or campus and: High stress Low physical activity Food dissatisfaction (all p > .05) A borderline trend suggested higher stress among Abu Dhabi campus students ( p = .056), though this did not reach statistical significance. Interpretation: Wellness challenges were shared broadly across subgroups, supporting the need for campus-wide rather than targeted interventions. 2. Qualitative Results Overview Six focus group discussions (FG1–FG6) were conducted to explore students’ lived experiences of health and wellness, contextualize quantitative survey findings, and identify priorities for program design. Analysis followed Braun and Clarke’s reflexive thematic analysis, combining deductive coding aligned with the four discussion domains (mental well-being, physical activity, nutrition, and program design) and inductive coding to capture emergent patterns across groups. Across all focus groups, a highly consistent and saturated thematic structure emerged, indicating strong convergence of experiences across academic levels and campuses. Five overarching themes were identified (Appendix 8). Theme 1: Student Stress Is High, Chronic, and Structurally Driven (Appendix 8a) Across all focus groups, students described stress as persistent and expected, rather than episodic. While academic workload (examinations, dense course content, deadlines, and group projects) was consistently identified as the primary stressor, participants emphasized that stress was amplified by institutional and structural factors. Students reported that unclear academic guidance, delayed administrative responses, difficulty identifying appropriate support contacts, and compressed assessment schedules intensified stress beyond academic demands alone. Group-based assessments were repeatedly described as emotionally taxing, particularly when workload distribution was perceived as inequitable or grades depended on collective performance. Early-year students were viewed as especially vulnerable due to limited time-management skills and unfamiliarity with institutional systems. Importantly, several groups expanded the stress narrative beyond academics, highlighting future uncertainty, scholarship and GPA maintenance, financial pressure, career anxiety, and self-imposed productivity expectations. Students described a cumulative stress experience in which academic, institutional, and personal pressures interacted to create sustained psychological strain. Theme 1 – Analytic Summary Stress among ADU students is not merely an individual coping issue but reflects structural characteristics of academic design, institutional responsiveness, and performance culture, aligning with a systems-level understanding of student well-being. Across all six focus groups, students consistently described stress as chronic, cumulative, and structurally embedded within their academic experience. Academic workload, clustered deadlines, examination pressure, and performance expectations emerged as dominant stressors, with stress intensifying during peak assessment periods and accumulating over the semester. Importantly, academic stress was frequently intertwined with financial obligations, scholarship requirements, family expectations, and concerns about future employability, amplifying its psychological impact. Students also highlighted structural contributors, including inflexible scheduling, group-based assessments, unclear expectations, and administrative demands, which compounded academic pressure. For postgraduate and working students, stress was further intensified by role overload arising from the need to balance studies with employment and family responsibilities. Collectively, these findings indicate that student stress at Abu Dhabi University is systemic rather than individual, providing strong qualitative corroboration for the high prevalence of stress observed in the quantitative survey and underscoring the need for institutional-level as well as individual-level interventions. Theme 2: Coping Is Predominantly Informal and Self-Managed, with a Persistent Knowledge–Behaviour Gap (Appendix 8b) Students across all focus groups demonstrated high awareness of effective coping strategies, including time management, advance planning, physical activity, breaks, social support, spiritual practices, and self-motivation techniques. However, participants consistently acknowledged a gap between knowing what supports well-being and being able to sustain these behaviours, particularly during peak academic periods. Coping strategies were largely informal and self-managed, relying on friends, family, peers, alumni, and personal routines. While these strategies were perceived as accessible and culturally acceptable, they were often described as reactive rather than preventive, breaking down under prolonged academic pressure. Several groups explicitly articulated an “awareness-action gap”, noting that fatigue, time scarcity, and mental overload frequently undermined intentions to exercise, eat well, sleep adequately, or seek support. Theme 2 – Analytic Summary Students possess substantial wellness literacy and resilience, but structural demands and environmental constraints limit their ability to translate knowledge into sustained health behaviours. Across all six focus groups, students consistently reported relying on informal and self-directed coping strategies to manage academic stress. The most prevalent strategies included social and peer support, physical activity, and personal time-management practices, reflecting a strong emphasis on individual agency and trusted interpersonal networks. Planning ahead, using digital tools, and engaging in low-barrier activities such as walking or brief breaks were frequently described as effective ways to manage stress within constrained schedules. Notably, coping strategies were often reactive and short-term, shaped by workload intensity and time pressure. Several students described sacrificing sleep, postponing rest, or using avoidance behaviours during peak academic periods, indicating that while coping efforts are active, they are not always sustainable. Cultural coping mechanisms, such as spirituality, emerged in some groups, highlighting the contextual nature of stress management practices. When integrated with the quantitative findings, Theme 2 explains students’ strong preference for stress-management, time-management, and mindfulness-based programming, as these align closely with students’ existing coping approaches. The findings suggest that wellness interventions at Abu Dhabi University should build upon students’ preferred informal strategies while strengthening skills for sustainable self-regulation and creating supportive pathways toward formal support when stress exceeds individual coping capacity. Theme 3: Stigma, Fear of Judgment, and Trust Concerns Constrain Formal Help-Seeking Despite recognizing the importance of mental health, participants across all focus groups reported low utilization of formal mental health services. Help-seeking was constrained by stigma, fear of judgment, cultural norms emphasizing self-reliance, concerns about confidentiality, and uncertainty about how services operate. Students expressed discomfort with being perceived as “weak,” concerns about mental health records affecting future opportunities or family perceptions, and scepticism about counsellor fit or effectiveness. Counselling was often viewed as a last resort for crisis situations, rather than a routine or preventive resource. At the same time, participants emphasized that support would be more acceptable if it were normalized, confidential, choice-based, culturally sensitive, and easily accessible, with clear pathways and visibility. Theme 3 – Analytic Summary Barriers to help-seeking are not due to lack of need or awareness, but to social, cultural, and trust-related factors, underscoring the importance of normalization and system-level design rather than solely expanding services. Across all six focus groups, students consistently reported substantial barriers to engaging with formal mental health and counselling services, despite acknowledging high levels of academic and psychological stress. Stigma and fear of judgment emerged as the most pervasive and recurrent barrier, with students expressing concern about being labelled, perceived as weak, or socially judged. These concerns were frequently reinforced by cultural and societal norms, which discourage open discussion of mental health difficulties and normalize emotional suppression. Concerns regarding confidentiality and privacy were also prominent across groups, with students reporting uncertainty about who might access their information and how help-seeking might affect their academic or social standing. In parallel, many students described a strong preference for informal support systems, such as friends, family members, or peers, which were perceived as safer, more relatable, and less stigmatizing than institutional services. Limited awareness and visibility of available services, alongside accessibility constraints related to time and scheduling, further reduced engagement with formal support. Importantly, students across focus groups emphasized greater comfort with low-threshold alternatives, including workshops, peer-led initiatives, and anonymous or online formats, which were viewed as less intimidating entry points into mental health support. When triangulated with quantitative findings, this theme provides a clear explanation for why interest in counselling services was lower than interest in stress-management, mindfulness, and skills-based workshops. Together, the mixed-methods findings highlight the need for low-stigma, culturally sensitive, confidential, and flexible mental health provision, alongside stepped-care models that allow students to engage with support gradually and safely. Theme 4: Health Behaviours Are Valued but Constrained by Time, Fatigue, Cost, and Campus Environment Physical Activity Physical activity was widely viewed as beneficial for stress relief and overall well-being; however, participation was inconsistent. Students cited time constraints, fatigue, academic prioritization, environmental heat, distance to facilities, self-consciousness, and lack of enjoyment as barriers. Across groups, walking and low-effort, embedded movement emerged as the most feasible and acceptable forms of activity. Motivation was consistently higher for social, group-based, non-competitive activities, with additional emphasis on culturally comfortable environments (e.g., female-only spaces), flexible scheduling, incentives, and short “micro-activities” integrated into the academic day. Nutrition and Lifestyle Nutrition was described as a daily, high-impact challenge. Students reported irregular eating patterns, frequent meal skipping (especially breakfast), reliance on fast food, and heavy caffeine consumption, particularly during exam periods. Healthy food options were perceived as limited, repetitive, expensive, insufficiently filling, or poorly visible, while supportive infrastructure (e.g., microwaves, healthy side options, clear labelling) was often lacking. Students consistently linked nutrition to sleep deprivation, screen overuse, hydration issues, and stress, describing a reinforcing cycle of lifestyle strain. Theme 4 –Analytic Summary Health behaviours are shaped less by motivation or knowledge and more by structural constraints, affordability, convenience, and campus design, highlighting the need for environmental and policy-level interventions. Across all six focus groups, students expressed strong interest in physical activity and healthy lifestyle behaviours, yet consistently identified time constraints, academic workload, fatigue, and scheduling conflicts as primary barriers to engagement. Motivation to engage in physical activity was often undermined during peak academic periods, particularly when stress and burnout were high. Students emphasized a preference for low-intensity, flexible, and socially engaging activities, such as walking clubs, group fitness, and team sports, which were perceived as more sustainable and enjoyable. Nutrition-related challenges were closely tied to food affordability, availability, and convenience, with students reporting difficulty accessing healthy options on campus, particularly during busy academic days. Sleep disruption and irregular routines were widely described across groups, highlighting the interconnected nature of academic stress, lifestyle behaviours, and overall well-being. In terms of program design, students consistently favoured in-person or hybrid wellness initiatives, scheduled after classes or in the evening, and integrated into the academic environment where possible. Preferences for culturally responsive options, flexible delivery, incentives, and practical relevance were repeatedly emphasized. When triangulated with quantitative findings, Theme 4 reinforces the need for accessible, student-centred, and structurally supportive wellness programming that addresses environmental barriers while promoting sustainable health behaviours. Theme 5: Students Call for an Integrated, Visible, and Student-centred Wellness Ecosystem Across all focus groups, students rejected fragmented, one-off wellness activities in favour of a holistic, integrated Health and Wellness Program embedded into daily campus life. Participants emphasized the need for: A centralized wellness hub (preferably a mobile application) integrating mental health resources, physical activity opportunities, nutrition information, and event schedules; Clear, proactive communication through trusted channels (lectures, orientation, social media, learning platforms); Flexible timing aligned with academic schedules and avoidance of peak assessment periods; Inclusive, non-judgmental, and culturally responsive programming; Incentives, recognition, and social engagement to sustain participation; Visible institutional commitment and leadership support; and Continuous student involvement and feedback in program design and improvement. Students repeatedly emphasized that wellness should be experienced as part of the campus culture, not as an optional add-on. Theme 5 – Analytic Summary Effective wellness programming requires a systems-level, student-centred approach consistent with the Health-Promoting University framework, integrating policy, environment, services, and student voice. Across all six focus groups, students articulated clear and consistent expectations for a Health & Wellness Program that is integrated, flexible, and student-centred. Participants emphasized the importance of practical, skills-based programming that directly addresses real student challenges, rather than abstract or one-off initiatives. Flexibility in timing and delivery particularly in-person and hybrid formats were repeatedly highlighted as essential to accommodate diverse academic schedules, work commitments, and personal responsibilities. Students strongly emphasized the need for program sustainability, advocating for ongoing initiatives embedded throughout the academic semester rather than isolated events. Peer involvement, including student ambassadors and peer-led activities, was viewed as a key strategy for enhancing relatability, trust, and engagement. Cultural sensitivity, inclusivity, and institutional commitment through leadership support and integration into academic structures were also identified as critical components of a successful program. When integrated with quantitative findings, Theme 5 reinforces students’ preference for accessible, interactive, and well-promoted wellness initiatives, and underscores the importance of embedding health promotion within the broader university ecosystem. Together, these findings provide clear, actionable guidance for the development of a comprehensive, sustainable Health & Wellness Program at Abu Dhabi University. Qualitative–Quantitative Integration This study employed a convergent mixed-methods design, integrating quantitative survey findings with qualitative focus group data to provide a comprehensive understanding of student health and wellness needs at Abu Dhabi University. Quantitative data identified the prevalence and distribution of key wellness indicators, while qualitative findings explained the underlying experiences, contextual factors, and student-driven recommendations. Integration occurred at the interpretation stage through triangulation of results across datasets (Appendix 9). Mental Well-Being and Stress Quantitative findings indicated that 42.6% of students reported high or very high stress, highlighting mental well-being as a major concern. Interest in stress management workshops (56.4%), time-management programs (41.0%), and mindfulness activities (38.8%) further underscored the salience of stress-related needs. Qualitative findings strongly confirmed and contextualized these results. Across all six focus groups, students described stress as chronic, cumulative, and structurally embedded within academic life rather than situational or episodic (Theme 1). Stress was attributed to heavy coursework, clustered deadlines, high GPA expectations, scholarship and financial pressures, family expectations, and uncertainty regarding future careers. Students emphasized that stress accumulated over the semester and intensified during peak assessment periods, directly affecting sleep, motivation, and emotional well-being. Coping Strategies and Help-Seeking Behaviours While quantitative results demonstrated substantial interest in wellness programming, fewer students expressed interest in formal counselling services (32.4%), suggesting a gap between stress prevalence and professional help-seeking. Qualitative findings (Theme 2 and Theme 3) explained this discrepancy. Students primarily relied on informal, self-directed coping strategies, including peer and family support, physical activity, planning, and short restorative breaks. Formal mental health services were often viewed as a last resort, with students preferring low-stigma, skills-based, or group-oriented approaches. Multiple barriers to formal help-seeking were consistently identified (Theme 3), including stigma, fear of judgment, confidentiality concerns, cultural norms, limited awareness of services, and accessibility constraints. Students expressed greater comfort with workshops, peer-led initiatives, and anonymous or online options, which they perceived as safer and more acceptable entry points to support. Physical Activity, Nutrition, and Lifestyle Behaviours Quantitative data showed that 29.3% of students reported low physical activity, despite high interest in walking clubs, strength training, group fitness, and team sports. The most common barriers were lack of time (48.4%) and low motivation (28.7%). Additionally, 26.6% of students were dissatisfied with healthy food options on campus, and many reported sleep difficulties. Qualitative findings (Theme 4) provided depth to these patterns. Students consistently described time pressure, academic workload, fatigue, and scheduling conflicts as primary barriers to physical activity and healthy routines. Nutrition challenges were linked to affordability, limited healthy options, and convenience-driven food choices. Sleep disruption was frequently reported as a consequence of academic stress and poor time balance, reinforcing the interconnected nature of wellness behaviours. Program Design Preferences and Expectations Quantitative findings revealed strong preferences for in-person (60.1%) or hybrid (31.9%) wellness programs, particularly scheduled after classes or in the evening. Preferred topics included work–study-life balance, healthy sleep, and sustainable lifestyle habits. Qualitative findings (Theme 5) strongly reinforced these preferences and translated them into concrete design recommendations. Students emphasized the importance of practical, flexible, culturally sensitive, and sustainable programming embedded within campus life rather than one-time events. Peer involvement, incentives, clear promotion, and institutional commitment were viewed as essential for long-term engagement. Together, the integrated findings indicate that student wellness needs at Abu Dhabi University are systemic, interconnected, and context-specific, requiring a comprehensive, student-centred Health & Wellness Program grounded in both empirical evidence and lived experience. Summary of Integration The mixed-methods integration demonstrates strong convergence between quantitative and qualitative findings, with qualitative data consistently explaining and contextualizing survey results. No major contradictions were identified. Qualitative insights clarified the drivers of high stress, coping behaviours, and the program features most likely to be effective and sustainable. High stress levels were linked to academic and institutional pressures, while low physical activity and nutrition dissatisfaction were explained by time, cost, and environmental constraints. Preferences for in-person or hybrid programming were translated into clear implementation principles. Together, the findings provide robust explanatory depth and actionable guidance, revealing that student well-being challenges are systemic, predictable, and modifiable through institutional design. These insights strengthen the validity of the study and directly inform the development of an evidence-based, culturally responsive Health and Wellness Program at Abu Dhabi University. Discussion This mixed-methods needs assessment offers important insights for the development of an evidence-based Health and Wellness Program. It provides a comprehensive and context-specific understanding of student health and wellness needs at Abu Dhabi University, integrating quantitative prevalence data with qualitative explanations of lived experience. The findings demonstrate that student well-being challenges at ADU are systemic, multifactorial, and deeply embedded within academic, social, and institutional contexts, rather than isolated individual issues. The Quantitative findings revealed high levels of perceived stress, suboptimal physical activity engagement, and moderate dissatisfaction with the campus food environment, alongside strong interest in wellness services and in-person or hybrid programming. Qualitative findings deepened understanding of these patterns by demonstrating that student wellness challenges are not merely individual-level issues but are embedded within academic structures, institutional processes, cultural norms, and campus environments. The convergence of quantitative and qualitative results strengthens confidence in the findings and offers a robust empirical foundation for evidence-based program design. Mental Well-Being and Academic Stress Consistent with global trends, a substantial proportion of ADU students reported high or very high stress levels (42.6%). More than two-fifths of surveyed students reported high or very high stress, a prevalence consistent with or exceeding estimates reported in international studies of university populations (Roy, et. al., 2025 ; Alalalmeh, et. al., 2024 ; Salgado, et al., 2024 ; Bruffaerts et al., 2018 ; ACHA, 2023). Qualitative findings extend this evidence by illustrating that stress is experienced as chronic and cumulative, driven by academic workload, clustered deadlines, performance expectations, scholarship requirements, family pressure, and uncertainty about future careers. This aligns with recent international studies showing that student mental distress is increasingly shaped by systemic and organizational factors rather than isolated academic pressure alone (Azizova, et. al., 2025 ; Asghar, at. al., 2023; Campbell, 2022). It further suggests that university stress increasingly reflects structural academic pressures rather than transient stressors (Zhang, et al., 2024 ; Córdova, et. al., 2023; Browning et al., 2021 ; Lipson et al., 2022 ). Importantly, students emphasized anticipatory stress experienced before assessments suggesting that anxiety is not limited to examination periods but persists throughout the academic cycle (Alshareef, et. al., 2025 ; Jerrim, 2023 ; Liu, et. al., 2019 ). Recent longitudinal research supports this pattern, demonstrating that persistent academic stress predicts sleep disruption, emotional exhaustion, and reduced academic engagement over time (Zhang, et. al., 2025 ; Pramesti, et. al., 2025 ; Alotaibi, et. al., 2020 ). These findings reinforce calls for universities to address stress at the curricular and assessment design level, rather than relying solely on downstream coping interventions. Coping Strategies and the Informal Support Preference Despite high stress prevalence, students primarily relied on informal, self-directed coping strategies, including peer and family support, time management, physical activity, and brief self-care practices. This pattern mirrors recent evidence suggesting that students often view formal mental health services as supplementary rather than primary resources (Batmanov, et. al., 2026 ; Osborn, et. al., 2024 ; Osborn, et. al., 2022 ; Quinn, et. al., 2009 ). While many of these coping strategies are adaptive, qualitative findings revealed that they are frequently short-term and compensatory, with students reporting sleep sacrifice, guilt around rest, and reliance on distraction during peak stress periods. Emerging evidence indicates that such coping trade-offs may sustain academic functioning in the short term but increase long-term risk of burnout and mental health deterioration (Shi, et. al., 2023 ; Biaigo, et. al., 2025 ) Stallman, et. al., 2020 ). This underscores the importance of programs that strengthen sustainable self-regulation skills, rather than reinforcing productivity-focused coping alone. Barriers to Formal Mental Health Support One of the most critical contributions of this study is the clear explanation of the gap between high stress and relatively lower interest in counselling services. Qualitative findings identified stigma, confidentiality concerns, cultural norms, limited awareness, and accessibility constraints as persistent barriers to formal help-seeking. These findings are consistent with recent cross-cultural research indicating that stigma and privacy concerns remain dominant deterrents in university populations, particularly in collectivist or family-oriented cultures (AthinarayananRao, et. al., 2025 ; Knettel, et al., 2005; Chen, et al., 2025 ; Hyseni, et. al., 2024). Students’ preference for anonymous, online, peer-led, or workshop-based formats reflects global shifts toward stepped-care and low-threshold mental health models in higher education (Ali, et. al., 2025 ; Duraku, et. al., 2025 ; Vomhof, 2024). Evidence increasingly suggests that offering multiple entry points rather than a single counselling pathway improves engagement and early intervention (Appleton, et. al., 2025 ; Casley, et. al., 2025 ; Polillo, et. al., 2023 ). For ADU, these findings highlight the need for culturally responsive, confidential, and flexible mental health ecosystems, rather than reliance on traditional counselling alone. Physical Activity, Nutrition, and Lifestyle Behaviours Physical activity findings revealed a notable discrepancy between interest and engagement. While students expressed strong preferences for walking, group fitness, and strength training, nearly one-third reported low physical activity levels. Qualitative insights clarified that this gap is largely explained by time constraints, fatigue, academic prioritization, environmental heat, and concerns related to comfort and social judgment. This pattern is consistent with global research showing that environmental and structural determinants rather than motivation or knowledge are the primary barriers to physical activity among university students (Radebe, et. al., 2025 ; Akil, 2025 ; Prieto-González & Alkouatli., 2025). The strong preference for walking and low-effort movement suggests that interventions embedded into daily routines may be particularly effective in this context. Nutrition emerged as a daily and cumulative challenge for students. Although only one-quarter of students reported dissatisfaction with healthy food options, a large proportion reported neutral satisfaction, suggesting tolerance rather than endorsement. Qualitative findings revealed that food choices are shaped by affordability, convenience, portion adequacy, and limited variety, alongside insufficient campus infrastructure to support healthy eating. These findings are consistent with studies demonstrating that campus food environments significantly influence dietary behaviours, and that cost and accessibility are critical determinants of food choice among university students (Almoraie, et. al., 2025 ; Li, et. al., 2022 ; Tam, et. al., 2017 ; Roy, et. al., 2016 ). Sleep disruption emerged as a cross-cutting issue, linking academic stress, physical inactivity, and dietary choices. Recent evidence identifies sleep as a critical mediator between academic stress and both mental and physical health outcomes in students (Fabio, et. al., 2026 ; Yuting, & Rashid, 2025 ; Alotaibi, et. al., 2020 ). These findings support integrated wellness approaches that address sleep, stress, physical activity, and nutrition simultaneously, rather than as isolated behaviours. Despite high stress prevalence, qualitative findings indicated limited engagement with formal mental health services. Students described stigma, fear of judgment, confidentiality concerns, and cultural norms emphasizing self-reliance as key barriers to help-seeking. Counselling was often perceived as a service reserved for crisis situations rather than preventive care. This pattern mirrors international evidence indicating that stigma and trust-related concerns remain central obstacles to mental health service utilization among students, even in settings where services are available (Rahmi, et. al., 2025 ; Pimenta, et. al., 2023 ; Lipson et al., 2022 ). These findings underscore the need for normalization, visibility, and culturally responsive delivery models. Program Design and the Health-Promoting University Framework Across all focus groups, students articulated a clear vision for wellness programming that is practical, flexible, inclusive, culturally sensitive, and embedded within university life aligned closely with the Health-Promoting University framework. Participants consistently emphasized the need for an integrated, visible, and student-centred wellness ecosystem embedded into campus life, rather than fragmented or one-off initiatives. Preferences for in-person or hybrid delivery, flexible scheduling aligned with academic demands, centralized communication platforms, and student involvement in program design highlight the importance of institutional commitment and systems-level change. This aligns with contemporary HPU literature emphasizing whole-university approaches that integrate health into policies, environments, services, and campus culture (Bannigan, et. al., 2025 ; ACHA., 2023, 2017; Dooris, et. al., 2016 ; World Health Organization, 1998 ). Importantly, students emphasized sustainability and institutional commitment, cautioning against one-time initiatives. Recent evaluations of university wellness programs demonstrate that integration into governance, curriculum, and campus culture is essential for long-term impact (Han, et. al., 2025 ; Li, 2025 ; Cowley, et. al., 2024 ; Venkatasubramanian, 2022 ; Young, et. al., 2020 ). The findings from ADU therefore provide actionable guidance for operationalizing the HPU framework in a Middle Eastern context. Strengths and Limitations A major strength of this study is its convergent mixed-methods design, which integrated quantitative prevalence data with in-depth qualitative insights to provide a comprehensive understanding of student wellness needs. The inclusion of six focus groups enabled thematic saturation and strengthened the credibility of qualitative findings. Focusing exclusively on students ensured direct relevance to wellness program development, while the institutional context enhanced practical applicability. Limitations include the cross-sectional design, which limits causal inference, and reliance on self-reported data, which may introduce recall or social desirability bias. Convenience sampling and the predominance of female respondents may affect representativeness, and findings from a single institution may limit generalizability. Nonetheless, the results offer transferable insights for similar higher education settings in the region. Policy and Practice Implications Student well-being should be embedded within academic and administrative systems, including assessment scheduling, workload management, and academic support. Mental health services must be framed as preventive, confidential, and culturally responsive, with multiple low-stigma access points. Physical activity initiatives should prioritize low-barrier, socially embedded options, while improvements to the campus food environment should focus on affordable and accessible healthy choices. Centralized wellness platforms and active student co-design are essential for relevance, engagement, and sustainability, supporting the Health-Promoting University approach. Conclusion This mixed-methods needs assessment shows that student health and wellness challenges at Abu Dhabi University are substantial, interconnected, and shaped by institutional, environmental, and cultural factors. Although students demonstrate resilience and strong interest in wellness initiatives, structural barriers limit sustained engagement in healthy behaviours. The integration of quantitative and qualitative evidence provides a strong foundation for developing a holistic, culturally responsive, and student-centred Health and Wellness Program, while contributing actionable insights to the health-promoting university literature. Declarations Disclosure Statement The authors have no conflicts of interest to report. Ethics Statement Ethical approval was obtained from the Abu Dhabi University Institutional Review Board. Participation was voluntary, written informed consent was obtained from all participants, and students could withdraw at any time without penalty. No incentives were provided. All procedures adhered to institutional and national ethical guidelines for research involving human participants. Data Availability Statement De-identified data are available from the corresponding author upon reasonable request, subject to institutional and ethical approval. Acknowledgements The authors thank the participating students for their time and contributions to this study. Funding This research received Consent to Publish Not Applicable. Author Contributions Maria Aamir conceptualized the study, led data collection, analysis, and manuscript drafting. Omar Friehat contributed to study design and interpretation. Noura AlHashmi and Zaineb Bennani supported data collection and qualitative analysis. Asiya Nazir and Hajira Jukaku supported with identifying the participants. All authors reviewed and approved the final manuscript. References Akil, Mustafa. (2025). Barriers to physical activity among university students in the light of psychosocial and body composition determinants. BMC Psychology. 13. 10.1186/s40359-025-03789-4. Alalalmeh, S. O., Hegazi, O. E., Shahwan, M., Hassan, N., Humaid Alnuaimi, G. R., Alaila, R. F., Jairoun, A., Tariq Hamdi, Y., Abdullah, M. T., Abdullah, R. M., & Zyoud, S. H. (2024). Assessing mental health among students in the UAE: A cross-sectional study utilizing the DASS-21 scale. Saudi pharmaceutical journal : SPJ : the official publication of the Saudi Pharmaceutical Society , 32 (4), 101987. https://doi.org/10.1016/j.jsps.2024.101987 Al-Jayyousi, G. F., Alsayed Hassan, D., Abdul Rahim, H., E Abdel-Rahman, M., Ferreira, I., Mukhalalati, B., O'Hara, L., Khalil, H., Tayyem, R., S Abu Alhaija, E., Abidia, R., Zolezzi, M., El-Awaisi, A., Al-Wattary, N., Mahmood Al Saady, R., Saffouh El Hajj, M., Shraim, M., K Abouhanian, A., Saeb, H., Mohammed, M., … QU Health Youth Wellbeing Research Network Group (2024). Health and Well-Being in the Context of Health-Promoting University Initiatives: Protocol for a Mixed Methods Needs Assessment Study at Qatar University. JMIR research protocols , 13 , e58860. https://doi.org/10.2196/58860 Alnaqbi, Shaikha Eisa; Sohail, Rahab; Radwan, Hadia M.; Mohamad, Maysm N.; Zeb, Falak; Hasan, Haydar; Hashim, Mona; Osaili, Tareq; AlBlooshi, Sharifa; Al Dhaheri, Ayesha S.; Stojanovska, Lily; and Ismail, Leila Cheikh, (2025). "Physical activity, screen time, dietary habits, and health outcomes among children and adolescents in the Middle East and North Africa region: a narrative review" (2025). All Works. 7553. https://zuscholars.zu.ac.ae/works/7553 Alotaibi, A. D., Alosaimi, F. M., Alajlan, A. A., & Bin Abdulrahman, K. A. (2020). The relationship between sleep quality, stress, and academic performance among medical students. Journal of family & community medicine , 27 (1), 23–28. https://doi.org/10.4103/jfcm.JFCM_132_19 Almoraie, N. M., Alothmani, N. M., Alomari, W. D., Al-amoudi, A. H., (2025). Addressing nutritional issues and eating behaviours among university students: a narrative review. Nutrition Research Reviews . 2025;38(1):53-68. doi:10.1017/S0954422424000088 Alshareef, N., Giga, S., & Fletcher, I. (2025). Test anxiety, emotional regulation and academic performance among medical students: a qualitative study. Medical education online , 30 (1), 2505177. https://doi.org/10.1080/10872981.2025.2505177 Arnett J. J. (2000). Emerging adulthood. A theory of development from the late teens through the twenties. The American psychologist , 55 (5), 469–480. AthinarayananRao, Kesantini & C Ah Gang, Getrude & E. Ading, Carmella. (2025). Mental Health Stigma among International University Students in Malaysia. International Journal of Academic Research in Business and Social Sciences. 15. 10.6007/IJARBSS/v15-i4/25213 . Auerbach, R. P., Alonso, J., Axinn, W. G., Cuijpers, P., Ebert, D. D., Green, J. G., Hwang, I., Kessler, R. C., Liu, H., Mortier, P., Nock, M. K., Pinder-Amaker, S., Sampson, N. A., Aguilar-Gaxiola, S., Al-Hamzawi, A., Andrade, L. H., Benjet, C., Caldas-de-Almeida, J. M., Demyttenaere, K., Florescu, S., … Bruffaerts, R. (2016). Mental disorders among college students in the World Health Organization World Mental Health Surveys. Psychological medicine , 46 (14), 2955–2970. https://doi.org/10.1017/S0033291716001665 Ali, M., van Berkel, N., Tag, B., Paananen, V., Oppenlaender, J., Yatani, K., & Hosio, S. (2025). Investigating mental wellbeing self-care in higher education using BERTopic modeling. Discover mental health , 5 (1), 204. https://doi.org/10.1007/s44192-025-00323-1 Al-Sharari, H. (2024). Psychological Stress and Its Relationship to Academic Adjustment among Female University College Students at Al-Taif University. International Journal of Advanced Humanities Research, 4(2), 41-71. doi: 10.21608/ijahr.2024.335233.1048 Altaf, S., Malmir, K., Mir, S. M., Olyaei, G., R., Omar, A., Syed, J., 2024 . Associations between Mental Health, Academic Performance, and Sleep Quality in Physical Therapy Students: A Cross-Sectional Study. Journal of Health and Rehabilitation Research. 4(1): DOI: https://doi.org/10.61919/jhllman, H., 2025rr.v4i1.615 American College Health Association (ACHA); 2023. National College Health Assessment III: Undergraduate student reference group executive summary . https://www.acha.org/wp-content/uploads/2024/06/NCHA-IIIb_FALL_2023_UNDERGRADUATE_REFERENCE_GROUP_EXECUTIVE_SUMMARY.pdf Appleton, R., Barnett, P., Clarke, C., Yang, J., Begum, S., Edbrooke-Childs, J., Emptage, I., Foye, U., Griffiths, J. L., Hanson, I., Hunt, N. C., Jarvis, R., McAuliffe, M., Maynard, E., Mitchell, L., Mostafa, I., Pemovska, T., Saunders, R., Trevillion, K., Waite, P., … Johnson, S. (2025). Approaches to early intervention for common mental health problems in young people: a systematic review. BMC medicine , 23 (1), 651. https://doi.org/10.1186/s12916-025-04438-8 Asghar, Muhammad & Minichiello, Angela & Iqbal, Assad. (2023). Institutional Role in the Mental Health and Well-being of Undergraduate Engineering Students: Student and Faculty Perspectives Students: Student and Faculty Perspectives. 10.18260/1-2--43963 . Azizova, A.F. & Baimoldina, L.O. & Rakhimzhanova, G.A.. (2025). Structural and practical aspects of supporting the psychological health of students in higher education institutions. Psychology and Cognitive Sciences. 153. 98-116. 10.32523/3080-1893-2025-153-4-98-116. Bannigan, Gráinne & McGrath, Denise & Matthews, James. (2025). Whole-university approaches to embedding well-being in the curriculum: a scoping review. Frontiers in Education. 10. 10.3389/feduc.2025.1534244. Barry, M. M., Clarke, A. M., Jenkins, R., & Patel, V. (2013). A systematic review of the effectiveness of mental health promotion interventions for young people in low and middle income countries. BMC public health , 13 , 835. https://doi.org/10.1186/1471-2458-13-835 Batmanov, A., Grigoryeva, I., Calderón-Hernández, B., Roberto González-Téllez, Ramírez, A. G., 2026. Beliefs, information sharing, and mental health care use among university students, Journal of Development Economics, Volume 180, 2026, https://doi.org/10.1016/j.jdeveco.2025.103646. Biaigo, K., Ray, S., & Ahmed, S. I. (2025). Academic burnout and coping strategies in healthcare students: a scoping review. Medical education online , 30 (1), 2579392. https://doi.org/10.1080/10872981.2025.2579392 Boulton, Chris & Hughes, Emily & Kent, Carmel & Smith, Joanne & Williams, Hywel. (2019). Student engagement and wellbeing over time at a higher education institution. PLOS ONE. 14. e0225770. 10.1371/journal.pone.0225770. Browning, M. H. E. M., Larson, L. R., Sharaievska, I., Rigolon, A., McAnirlin, O., Mullenbach, L., Cloutier, S., Vu, T. M., Thomsen, J., Reigner, N., Metcalf, E. C., D'Antonio, A., Helbich, M., Bratman, G. N., & Alvarez, H. O. (2021). Psychological impacts from COVID-19 among university students: Risk factors across seven states in the United States. PloS one , 16 (1), e0245327. https://doi.org/10.1371/journal.pone.0245327 Bruffaerts, R., Mortier, P., Kiekens, G., Auerbach, R. P., Cuijpers, P., Demyttenaere, K., Green, J. G., Nock, M. K., & Kessler, R. C. (2018). Mental health problems in college freshmen: Prevalence and academic functioning. Journal of affective disorders , 225 , 97–103. https://doi.org/10.1016/j.jad.2017.07.044 Campbell, F., Blank, L., Cantrell, A. et al. (2022). Factors that influence mental health of university and college students in the UK: a systematic review. BMC Public Health 22, 1778 (2022). https://doi.org/10.1186/s12889-022-13943-x Casley, M., Bateson, M., Harris, P., Brookes, D., Allen, V., & McDonald, K. (2025). “Going the extra mile”: A mixed-methods evaluation of an early-intervention youth coaching and diversion programme. Journal of Criminology , 0 (0). https://doi.org/10.1177/26338076251378938 Cheikh Ismail, L., Osaili, T. M., Mohamad, M. N., Hashim, M., Stojanovska, L., Al Daour, R., Nader, D., Alrayis, H., Alzaabi, N. S., Elbarag, L., Binkhadim, S., Jarrar, A. H., Al Dhaheri, A. S., & Hasan, H. (2022). Psychosocial factors affecting dietary habits of university students: A cross-sectional study. Heliyon , 8 (6), Article e09768. https://doi.org/10.1016/j.heliyon.2022.e09768 Chen, D., Wu, Y., Qian, L., & Zhou, Y., (2025). The impact of self-stigma on college students' attitudes toward professional psychological help-seeking: serial-mediated effects of discrimination perceptions and core self-evaluations. Front. Psychol. 16:1630323. doi: 10.3389/fpsyg.2025.1630323 Cruz, J., Llodio, I., Iturricastillo, A., Yanci, J., Sánchez-Díaz, S., & Romaratezabala, E. (2024). Association of Physical Activity and/or Diet with Sleep Quality and Duration in Adolescents: A Scoping Review. Nutrients , 16 (19), 3345. https://doi.org/10.3390/nu16193345 Çol, B. K., Başaran, A. G., Köse, B. G., 2024. The impact of health promotion training on university students’ health perceptions, healthy lifestyle behaviors, and risky behaviors. Health Psychology. Volume 15 - 2024 | https://doi.org/10.3389/fpsyg.2024.1407233 Córdova Olivera, P., Gasser Gordillo, P., Naranjo Mejía, H., La Fuente Taborga, I., Grajeda Chacón, A., & Sanjinés Unzueta, A. (2023). Academic stress as a predictor of mental health in university students. Cogent Education , 10 (2). https://doi.org/10.1080/2331186X.2023.2232686 Conley, C. S., Kirsch, A. C., Dickson, D. A., & Bryant, F. B. (2014). Negotiating the transition to college: Developmental trajectories and psychosocial outcomes. Journal of American College Health, 62 (2), 110–120. https://doi.org/10.1080/07448481.2013.850698 Cooper, B., Border, N., & Couperthwait, F., 2023. Co-Creating a Health and Wellbeing Strategy for Students and Staff. A Practice Report. DOI: https://doi.org/10.5204/ssj.2781 Cowley, E. S., Goss, H. R., Mahon, C., Dunne, C., Belton, S., (2024). Exploring the health and wellbeing landscape at a third level institution, Wellbeing, Space and Society, Volume 7, 2024,100221,ISSN 2666-5581,https://doi.org/10.1016/j.wss.2024.100221. Dabou, E. A. A., Adam, S., Mohamed, M. G., Carezon Bedolido, M. G., & Militar, K. A. (2025). Investigating Physical Activity as a Predictor of Psychological Distress in UAE Nursing Students. Healthcare (Basel, Switzerland) , 13 (17), 2112. https://doi.org/10.3390/healthcare13172112 Diab, F. M., Al-Sharbatti, S., Eltanbadawy, A. T., Alfahad, R. A., & Elgarawany, G. E. (2025). The mental health impact of physical inactivity: A study on UAE adolescents. PloS one , 20 (9), e0333346. https://doi.org/10.1371/journal.pone.0333346 Dooris, M., Doherty, S., & Orme, J. (2016). The Application of Salutogenesis in Universities. In M. B. Mittelmark (Eds.) et. al., The Handbook of Salutogenesis . (pp. 237–245). Springer. https://doi.org/10.1007/978-3-319-04600-6_23 Dooris, Mark & Farrier, Alan & Powell, Susan & Holt, Maxine. (2019). Whole system approaches to health in higher education: An evaluation of the UK Healthy Universities Network. Health Education. 119. 10.1108/HE-02-2019-0010. Duraku, Z. H., Ng, S. K-Y., Greiçevci, V., et al., (2025). Outcomes of a CBT-based anxiety workshop on higher education students’ mental health, stigma, learning, and career certainty. Journal of Public Health Research . 2025;14(4). doi:10.1177/22799036251381227 Eisenberg, D., Lipson, S. K., & Posselt, J. (2021). Promoting resilience, retention, and mental health. Journal of Adolescent Health, 68 (3), 87-93. https://rossierapps.usc.edu/facultydirectory/publications/219/Eisenberg%20Lipson%20Posselt_2016_Promoting.pdf Fabio, R. A., Di Pietro, A., & Suriano, R. (2026). Sleep Quality, Stress, and Mental Health in College Students: The Protective Role of Optimism and Critical Thinking. Psychiatry International , 7 (1), 5. https://doi.org/10.3390/psychiatryint7010005 Fang, J., Ren, X., & Sotardi, V. A. (2025). Rethinking Student Wellbeing in Higher Education: A Multifaceted Approach to Stress Management. Education Sciences , 15 (7), 872. https://doi.org/10.3390/educsci15070872 Gosadi, I. M., & Shnaimer, J. A. (2025). Association Between Depression, Anxiety, and Stress and Sleep Quality Among University Students from Saudi Arabia: A Cross-Sectional Study. Psychology research and behavior management , 18 , 2287–2298. https://doi.org/10.2147/PRBM.S562798 Han, F., Regalia, M. R., Carisma, R. D. L., (2025). The Impact Of Campus Culture To Student Well – Being In Chinese Secondary Vocational Schools: Basis For The Development Of Management Model. 2025 IJCSPUB, Volume 15, Issue 1 February 2025 | ISSN: 2250-1770. IJCSPTH00050 International Journal of Current Science (IJCSPUB) www.ijcspub.org 126. https://rjpn.org/ijcspub/papers/IJCSPTH00050.pdf Hyseni Duraku, Z., Davis, H., Blakaj, A., Ahmedi Seferi, A., Mullaj, K., & Greiçevci, V. (2024). Mental health awareness, stigma, and help-seeking attitudes among Albanian university students in the Western Balkans: a qualitative study. Frontiers in public health , 12 , 1434389. https://doi.org/10.3389/fpubh.2024.1434389 Jara, Verónica & Pereira, Náyade & Monsalve, Rodrigo. (2023). Barriers perceived to assume promoting health conduct in university students. International Journal of Family & Community Medicine. 7. 151-155. 10.15406/ijfcm.2023.07.00330. Jerrim, J. (2023). Test anxiety: Is it associated with performance in high-stakes examinations? Oxford Review of Education , 49 (3), 321–341. https://doi.org/10.1080/03054985.2022.2079616 Knettel, B. A,. Ganapathy, P., Rougier-Chapman, C., (2024) Examining factors associated with mental health stigma and attitudes toward help-seeking among international college students during the COVID-19 pandemic. PLOS Ment Health 1(1): e0000063. https://doi.org/10.1371/journal.pmen.0000063 Lipson, S. K., Zhou, S., Abelson, S., Heinze, J., Jirsa, M., Morigney, J., Patterson, A., Singh, M., & Eisenberg, D. (2022). Trends in college student mental health and help-seeking by race/ethnicity: Findings from the national healthy minds study, 2013-2021. Journal of affective disorders , 306 , 138–147. https://doi.org/10.1016/j.jad.2022.03.038 Li, X., Braakhuis, A., Li, Z., & Roy, R. (2022). How Does the University Food Environment Impact Student Dietary Behaviors? A Systematic Review. Frontiers in nutrition , 9 , 840818. https://doi.org/10.3389/fnut.2022.840818 Li, H., (2025). Students’ wellbeing in positive higher education: conceptual frameworks and influencing factors. Front. Educ. 10:1607364. doi: 10.3389/feduc.2025.1607364 Liu, Xinqiao & Ping, Siqing & Gao, Wenjuan. (2019). Changes in Undergraduate Students’ Psychological Well-Being as They Experience University Life. International Journal of Environmental Research and Public Health. 16. 2864. 10.3390/ijerph16162864. McLafferty, M., Lapsley, C. R., Ennis, E., Armour, C., Murphy, S., Bunting, B. P., Bjourson, A. J., Murray, E. K., & O'Neill, S. M. (2017). Mental health, behavioural problems and treatment seeking among students commencing university in Northern Ireland. PloS one , 12 (12), e0188785. https://doi.org/10.1371/journal.pone.0188785 Moore, G. F., Evans, R. E., Hawkins, J., Littlecott, H., Melendez-Torres, G. J., Bonell, C., & Murphy, S. (2019). From complex social interventions to interventions in complex social systems: Future directions and unresolved questions for intervention development and evaluation. Evaluation (London, England : 1995) , 25 (1), 23–45. https://doi.org/10.1177/1356389018803219 Newton, Joanne & Dooris, Mark & Wills, Jane. (2016). Healthy universities: an example of a whole-system health-promoting setting. Global Health Promotion. 23. 57-65. 10.1177/1757975915601037. Okanagan Charter for Health Promoting Universities and Colleges. (2015); reaffirmed 2023). An international charter for health-promoting universities and colleges . https://president.media.uconn.edu/wp-content/uploads/sites/3778/2024/04/Okanagan_Charter_Oct_6_2015.pdf Osborn, T.G., Li, S., Saunders, R. et al., (2022). University students’ use of mental health services: a systematic review and meta-analysis. Int J Ment Health Syst 16, 57 (2022). https://doi.org/10.1186/s13033-022-00569-0 Osborn, T. G., Town, R., Bawendi, M., Stapley, E., Saunders, R., Fonagy, P., (2024). University students’ access to mental health services: A qualitative study of the experiences of health service professionals through the lens of candidacy in England. Journal of Health Services Research & Policy. 2024;29(4):230-239. doi:10.1177/13558196241235877 Pimenta, S. M., Hunter, S. C. & Rasmussen, S ., (2023)The Influence of Stigma and Trust in Young People Seeking Support for Their Own or a Friend’s Symptoms: The Role of Threat Appraisals. Child Youth Care Forum 52, 559–581 (2023). https://doi.org/10.1007/s10566-022-09698-6 Pramesti, Getut & Rohman, Rifki & Cahyarani, Sanggita. (2025). How sleep deprivation and academic stress shape statistical achievement: Evidence of academic resilience in undergraduate learners. Jurnal Elemen. 11. 980-995. 10.29408/jel.v11i4.32075. Pengpid, S., Peltzer, K., Kassean, H. K., Tsala Tsala, J. P., Sychareun, V., & Müller-Riemenschneider, F. (2015). Physical inactivity and associated factors among university students in 23 low-, middle- and high-income countries. International journal of public health , 60 (5), 539–549. https://doi.org/10.1007/s00038-015-0680-0 Polillo. A., Foussias. G., Wang, W, et. al., (2023). Care Pathways and Initial Engagement in Early Psychosis Intervention Services Among Youths and Young Adults. JAMA Netw Open. 2023;6(9):e2333526. doi:10.1001/jamanetworkopen.2023.33526 Prieto-González, P., & Alkouatli, C. (2025). Identifying barriers to physical activity participation and engagement among college students in Riyadh (Saudi Arabia): gender differences in perceived barriers. Frontiers in sports and active living , 7 , 1657854. https://doi.org/10.3389/fspor.2025.1657854 Quinn, Neil & Wilson, Alistair & Macintyre, Gillian & Tinklin, Teresa. (2009). ‘ People look at you differently’: students’ experience of mental health support within Higher Education. British Journal of Guidance & Counselling. 37. 405-418. 10.1080/03069880903161385. Radebe, S. S., Breukelman, G. J., Joubert, A. S., & Millard, L. (2025). Primary Motives and Barriers to Physical Activity Participation Among Students Registered at a Semi-Rural University: A Mixed-Methods Study. International Journal of Environmental Research and Public Health , 22 (3), 344. https://doi.org/10.3390/ijerph22030344 Rahmi, Kus & Jamaluddin, Zakiyah & Yahaya, Mahathir & Chik, Azlini & Subardhini, Meiti & Huripah, Enung & Fahrudin, Adi. (2025 ). Barriers to accessing mental health services among university students: A systematic review. Environment and Social Psychology. 10. 10.59429/esp.v10i9.3936. Romeo I, Stanislaw H, McCreary J, Hawley M (2024) . The importance of belonging for well-being in college students. PLOS Ment Health 1(1): e0000057. https://doi.org/10.1371/journal. pmen.000005 Roy, R., Hebden, L., Kelly, B., De Gois, T., Ferrone, E. M., Samrout, M., Vermont, S., & Allman-Farinelli, M. (2016). Description, measurement and evaluation of tertiary-education food environments. The British journal of nutrition , 115 (9), 1598–1606. https://doi.org/10.1017/S0007114516000568 Roy, S., Biswas, A. K., & Sharma, M. (2025). Stres s , Anxiety, and Depression as Psychological Distress Among College and Undergraduate Students: A Scoping Review of Reviews Guided by the Socio-Ecological Model. Healthcare , 13 (16), 1948. https://doi.org/10.3390/healthcare13161948 Salgado, Arnel & Salgado, Jan & Razak, Aqsa & Hussain, Shimna & Fatima, Wafeeqa. (2024). Mental Health and Resilience of University Students in the United Arab Emirates: A Study on Migrant Students at RAK Medical and Health Sciences University. 10.21203/rs.3.rs-4257679/v2. Salama, Rasha & Javaid, Saima & Mohsin, Mariam & Mohsin, Aisha & Wadid, Nihal. (2024). Assessment of academic burnout among undergraduate medical and health sciences students: a survey study from the United Arab Emirates. Journal of Public Mental Health. 23. 10.1108/JPMH-04-2024-0050. Shi, H., Zhao, H., He, M., Ren, Z., Wang, S., Cui, L., Zhao, J., Li, W., Wei, Y., Zhang, W., Chen, Z., Liu, H., & Zhang, X. (2023). The mediating roles of coping styles and academic burnout in the relationship between stressors and depressive symptoms among Chinese postgraduates. PeerJ , 11 , e16064. https://doi.org/10.7717/peerj.16064 Siddiqui, Aesha & AlAmri, Saad & AlKatheri, Assaf & AlHassani, Khalid. (2017). Perceived stress in Saudi undergraduate medical students. Journal of Medical and Allied Sciences. 7. 41. 10.5455/jmas.252925. Stallman, H., (2010) . Psychological distress in university students: A comparison with general population data. DOI: 10.1080/00050067.2010.482109 Stallman, Helen & Lipson, Sarah & Zhou, Sasha & Eisenberg, Daniel. (2020). How do university students cope? An exploration of the health theory of coping in a US sample. Journal of American College Health. 70. 1-7. 10.1080/07448481.2020.1789149. Tam, R., Yassa, B., Parker, H., O'Connor, H., & Allman-Farinelli, M. (2017). University students' on-campus food purchasing behaviors, preferences, and opinions on food availability. Nutrition (Burbank, Los Angeles County, Calif.) , 37 , 7–13. https://doi.org/10.1016/j.nut.2016.07.007 Takshe A. A, Khatib R. E, Contu D, Shehaiber S. N, Alkaabi M. (2022). UAE University Students’ Dietary Practices and Lifestyles at times of COVID-19: A Cross Sectional Study. Curr Res Nutr Food Sci 2022; 10(2). doi : http://dx.doi.org/10.12944/CRNFSJ.10.2.20 Tsouros, A. D., Dowding, G., Thompson, J., & Dooris, M. (1998/updated framework applied). (2021). Health-promoting universities: Concept, experience and framework for action . World Health Organization Regional Office for Europe Venkatasubramanian P. (2022). University Wellness Program-A Pedagogic Innovation to Nudge Wellness and Sustainability Among Students. Frontiers in public health , 10 , 844024. https://doi.org/10.3389/fpubh.2022.844024 Vomhof, M., Bau, J., Hüter, P., Stehl, S., Haastert, B., Loerbroks, A., Icks, A., Calo, S., Schuster, L., Pischke, C., Kairies-Schwarz, N., Angerer, P., Apolinário-Hagen, J., (2024). Preferences Regarding Information Strategies for Digital Mental Health Interventions Among Medical Students: Discrete Choice Experiment. JMIR Form Res 2024;8:e55921. URL: https://formative.jmir.org/2024/1/e55921. DOI: 10.2196/55921 World Health Organization. (1998). Health-promoting universities and colleges: A framework for action . https://iris.who.int/server/api/core/bitstreams/b90c3808-b480-431c-b650-ac344c3e4b6b/content Young, Tarli & MacInnes, Sarah & Aaron, Jarden & Colla, Rachel. (2020). The impact of a wellbeing program imbedded in university classes: the importance of valuing happiness, baseline wellbeing and practice frequency. Studies in Higher Education. 47. 1-20. 10.1080/03075079.2020.1793932. Yuting, L., & Rashid,R. B. A., (2025). Beyond the books: How sleep, school belonging, and physical activity affect the mental health of students under academic stress, Acta Psychologica, Volume 258, 2025, 105213, ISSN 0001-6918, https://doi.org/10.1016/j.actpsy.2025.105213. Zhang, J.,Peng, C.,Chen, C., (2024). Mental health and academic performance of college students: Knowledge in the field of mental health, self-control, and learning in college, Acta Psychologica,Volume 248, 2024, https://doi.org/10.1016/j.actpsy.2024.104351. Zhang, J., Meng, J., & Wen, X., (2025) The relationship between stress and academic burnout in college students: evidence from longitudinal data on indirect effects. Front. Psychol. 16:1517920. doi: 10.3389/fpsyg.2025.1517920 Tables Tables 1 to 7 are available in the Supplementary Files section. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8892778","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":601529769,"identity":"64cf1542-5c8d-4987-8e3f-8eac1feb816c","order_by":0,"name":"Maria Aamir","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6klEQVRIie3PsWrCQBzH8d9xcF0irkokPkHgsgSkVF+lEohzFxEc6mSWPIBPkvnCH+oSdb1u7ZIpg26BWmgilG5X3RzuO/y55cP//oDNdqepy+RgHxA3Ei6vJr+J3lXET3afqsZ46CedclHPCd1EsePRQMJiJvMUUZDRQ/ie7gm94pn3NyaiYigHnGUkhO6sCdCA65jIoUR+xuukJS/fDRlq8K+ziegY5ICmLeHtFqkhXNP5oS5BA7mNGsLdwX7mBMV0PUqNH4v5qVosn7LDGztV80fP2xLp2rTmkvx7Noez1b/AZrPZbOZ+APbjSwH+csaeAAAAAElFTkSuQmCC","orcid":"","institution":"Abu Dhabi University","correspondingAuthor":true,"prefix":"","firstName":"Maria","middleName":"","lastName":"Aamir","suffix":""},{"id":601529770,"identity":"ab781174-b5c9-4c79-af31-7c202b1bef0f","order_by":1,"name":"Omar Friehat","email":"","orcid":"","institution":"Abu Dhabi University","correspondingAuthor":false,"prefix":"","firstName":"Omar","middleName":"","lastName":"Friehat","suffix":""},{"id":601529771,"identity":"a748e484-ef1e-4475-b2c5-3d7585e5a358","order_by":2,"name":"Noura Al Hashmi","email":"","orcid":"","institution":"Abu Dhabi University","correspondingAuthor":false,"prefix":"","firstName":"Noura","middleName":"Al","lastName":"Hashmi","suffix":""},{"id":601529772,"identity":"b57816dc-44fc-476a-aae8-5a8d7b22a1c2","order_by":3,"name":"Zaineb Bennani","email":"","orcid":"","institution":"Abu Dhabi University","correspondingAuthor":false,"prefix":"","firstName":"Zaineb","middleName":"","lastName":"Bennani","suffix":""}],"badges":[],"createdAt":"2026-02-16 11:38:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8892778/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8892778/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104060063,"identity":"f77bf9fb-e4ff-4877-961c-1b0c1905e7b2","added_by":"auto","created_at":"2026-03-06 09:27:56","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":4205373,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8892778/v1/31585838-c7f4-49ec-b352-fdfedc7cade1.pdf"},{"id":104060032,"identity":"47b42db8-9deb-4809-acbd-81c9ceb726c1","added_by":"auto","created_at":"2026-03-06 09:27:47","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":81579,"visible":true,"origin":"","legend":"","description":"","filename":"AppendicesQualitative.docx","url":"https://assets-eu.researchsquare.com/files/rs-8892778/v1/efc5e1ab1936f8a62298ff95.docx"},{"id":104059992,"identity":"bae92da2-7886-465f-ac6c-684a1b8b7706","added_by":"auto","created_at":"2026-03-06 09:27:38","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":44374,"visible":true,"origin":"","legend":"","description":"","filename":"AppendicesQuantitative.docx","url":"https://assets-eu.researchsquare.com/files/rs-8892778/v1/286ecd7430b18709a9a3b01c.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Mixed methods needs assessment of student health and wellness to inform university health promotion programming at Abu Dhabi University","fulltext":[{"header":"Contribution to Health Promotion","content":"\u003cul type=\"disc\"\u003e\n \u003cli\u003eIdentifies key health and well-being challenges faced by university students in the UAE.\u003c/li\u003e\n \u003cli\u003eHighlights student priorities for stress management, physical activity, and healthy lifestyle support.\u003c/li\u003e\n \u003cli\u003eProvides evidence to guide the design of student-centred campus wellness programs.\u003c/li\u003e\n \u003cli\u003eSupports the development of universities as health-promoting environments.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Introduction","content":"\u003ch2\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eUniversity students represent a population undergoing rapid and intersecting academic, psychological, and social transitions (Romeo, et. al., 2024; Lipson et al., 2022; McLafferty, et. al., 2017; Conley, et. al., 2014; Arnett, 2000;). This developmental stage is associated with heightened vulnerability to mental distress, sleep disruption, suboptimal dietary patterns, and insufficient physical activity, all of which may have enduring consequences for health and academic success (Altaf, et al., 2024; American College Health Association, 2023; McLafferty, et. al., 2017). Compared with their non-student peers, university students consistently report higher levels of perceived stress and psychological burden, driven by academic workload, performance expectations, increased autonomy, lifestyle disruption, and financial or career-related uncertainty (Al-Sharari, 2024; Auerbach, et al., 2016; McLafferty et al., 2017; Lipson et al., 2022; Eisenberg, et. al., 2021; Bruffaerts et al., 2018; Stallman, 2010).\u003c/p\u003e\n\u003cp\u003eThese psychosocial stressors frequently coexist with health-risk behaviours, including sedentary lifestyles, irregular eating patterns, poor sleep hygiene, and limited engagement in physical activity (McLafferty et al., 2017; Lipson et al., 2022; Pengpid, et. al., 2015). Such patterns not only undermine immediate well-being but also increase long-term risk for non-communicable diseases, reduced academic engagement, and poorer life satisfaction (Altaf, et. al., 2024; McLafferty et al., 2017; Bruffaerts, et al., 2018).\u003c/p\u003e\n\u003cp\u003eUniversities are therefore increasingly recognized as critical settings for population-level health promotion. The Health-Promoting University framework emphasizes a whole-system approach in which health and well-being are embedded across academic structures, campus environments, institutional policies, and student support services (Cruz, et. al., 2024; Dooris, et. al., 2019; Okanagan, 2015; Barry, et. al., 2013; Tsouros, et. al., 1998; World Health Organization, 1998). Within this framework, effective programming must be grounded in context-specific evidence that reflects students\u0026rsquo; lived experiences, priorities, and barriers rather than relying solely on generic or externally developed interventions (\u0026Ccedil;ol, et. al., 2024; Cooper, et. al., 2023; World Health Organization, 1998).\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eLiterature Review\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eA substantial body of international literature documents the high prevalence of mental health concerns among university students. Data from the WHO World Mental Health Surveys across 19 countries indicate that a significant proportion of tertiary students experience depression, anxiety, and suicidal ideation during their academic careers (Bruffaerts et al., 2018). Concurrently, global studies report declining physical activity levels and increasing sedentary behaviour among students, particularly during periods of academic intensity and transition (Pengpid, et. al., 2015).\u003c/p\u003e\n\u003cp\u003eEvidence from the Middle East and Gulf Cooperation Council (GCC) region mirrors these trends. University students in Gulf countries report elevated perceived stress, poor sleep quality, academic burnout, and challenges balancing academic and personal demands (Alalalmeh, et. al., 2024; Salama, et. al., 2024; Gosadi, \u0026amp; Shnaimer, 2025; Alotaibi, et. al., 2020; Siddiqui, et. al., 2017). Studies conducted in the United Arab Emirates further highlight concerns related to mental well-being, dietary imbalance, and inconsistent engagement in physical activity among young adults (Diab, et. al., 2025; Dabou, et. al., 2025; Alnaqbi, et. al., 2025; Cheikh Ismail, et al., 2022; Takshe, et. al., 2022). However, much of this literature remains descriptive, focusing on symptom prevalence rather than translating findings into institution-specific, actionable program design.\u003c/p\u003e\n\u003cp\u003eImportantly, international evidence suggests that many university wellness initiatives fail to achieve sustained engagement because they do not adequately align with students\u0026rsquo; preferences, cultural context, time constraints, or perceived barriers (Fang, et. al., 2025; Jara, et. al., 2023; Boulton, et. al., 2019; Moore, et. al., 2019). Structured needs assessments have been shown to enhance the relevance, efficiency, and impact of campus health promotion efforts by informing program priorities, delivery formats, and resource allocation (Al-Jayyousi, et. al., 2024; Dooris, et. al., 2019; Newton, et. al., 2016). Despite this evidence, no published, comprehensive wellness needs assessment has been conducted at Abu Dhabi University (ADU), representing a clear empirical and practical gap.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eRationale for the Needs Assessment\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eAbu Dhabi University recently initiated a Health and Wellness Initiative aimed at promoting physical, mental, and emotional well-being among its student population. While planned activities encompass physical activity, mental health awareness, lifestyle education, and peer engagement, the effectiveness and sustainability of such initiatives depend on their alignment with students\u0026rsquo; actual needs, constraints, and cultural context.\u003c/p\u003e\n\u003cp\u003eNeeds assessments serve a foundational role in campus health promotion by:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eIdentifying priority health and wellness challenges (e.g., stress, inactivity, lifestyle imbalance).\u003c/li\u003e\n \u003cli\u003eClarifying perceived barriers to healthy behaviours (e.g., time constraints, motivation, access).\u003c/li\u003e\n \u003cli\u003eMapping student preferences for program content, timing, and delivery format.\u003c/li\u003e\n \u003cli\u003eEnsuring cultural and contextual relevance within the UAE higher-education setting; and\u003c/li\u003e\n \u003cli\u003eGuiding strategic allocation of institutional resources toward interventions with the greatest potential impact.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eWithout such evidence, wellness programs risk low participation, limited effectiveness, and poor sustainability. Accordingly, a structured mixed-methods needs assessment was undertaken to inform the design of a comprehensive, evidence-based Health and Wellness Program at ADU.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eStudy Aim and Objectives\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003e\u003cstrong\u003eAim\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe primary aim of this study was to conduct a student-centred, campus-wide mixed-methods needs assessment to inform the development of Abu Dhabi University\u0026rsquo;s Health and Wellness Program.\u003c/p\u003e\n\u003cp\u003eThis study focused exclusively on students and did not include faculty or administrative staff.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjectives\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe specific objectives were to:\u003c/p\u003e\n\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eQuantify levels of physical activity, perceived stress, satisfaction with healthy food options, and interest in wellness services among ADU students.\u003c/li\u003e\n \u003cli\u003eIdentify perceived barriers to engaging in healthy lifestyle behaviours, including physical activity and stress management.\u003c/li\u003e\n \u003cli\u003eExamine student preferences regarding wellness program timing, delivery format, and thematic focus.\u003c/li\u003e\n \u003cli\u003eIntegrate quantitative and qualitative findings to generate evidence-based, contextually relevant recommendations for program development.\u003c/li\u003e\n \u003cli\u003eEstablish a baseline to support future evaluation of institutional wellness initiatives.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Methods","content":"\u003ch3\u003eStudy Design\u003c/h3\u003e\n\u003cp\u003eA cross-sectional, convergent mixed-methods design was employed to assess student health and wellness needs at Abu Dhabi University. Quantitative data were collected through an online survey administered to the student population, while qualitative data were obtained through focus group discussions to provide contextual depth and explanatory insight. Quantitative and qualitative data were analysed independently and integrated at the interpretation stage to enhance understanding of observed patterns.\u003c/p\u003e\n\u003ch3\u003eSetting\u003c/h3\u003e\n\u003cp\u003eThe study was conducted at Abu Dhabi University, a multi-campus higher education institution in the United Arab Emirates, with campuses in Abu Dhabi and Al Ain. ADU enrols undergraduate and postgraduate students across a wide range of academic disciplines. The study was embedded within the institutional context of ADU\u0026rsquo;s Health and Wellness Initiative and served as the foundational needs assessment for program planning.\u003c/p\u003e\n\u003ch3\u003eParticipants and Sampling\u003c/h3\u003e\n\u003cp\u003e\u003cstrong\u003eEligibility Criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants were eligible if they:\u003c/p\u003e\n\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eWere currently enrolled as undergraduate or postgraduate students at ADU.\u003c/li\u003e\n \u003cli\u003eWere aged 18 years or older.\u003c/li\u003e\n \u003cli\u003eWere able to read and understand English; and\u003c/li\u003e\n \u003cli\u003eProvided informed consent electronically.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eFaculty and administrative staff were excluded in accordance with the study\u0026rsquo;s student-focused scope.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQuantitative Sample and Sampling Strategy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSampling Approach\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA convenience sampling strategy was used for the quantitative phase to maximize reach across campuses. The online survey was disseminated through institutional student email lists, internal learning platforms, and campus communication channels. Participation was voluntary, and no incentives were offered.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample Size\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 188 students completed the quantitative survey. Given the exploratory, needs-assessment nature of the study, a formal power calculation was not required. The achieved sample size was sufficient to:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eGenerate stable descriptive statistics.\u003c/li\u003e\n \u003cli\u003eIdentify priority wellness needs; and\u003c/li\u003e\n \u003cli\u003eConduct exploratory subgroup comparisons by gender and campus, consistent with similar campus health needs assessments reported in the literature.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eQualitative Sample and Sampling Strategy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSampling Approach\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA purposive sampling strategy was employed for the qualitative phase to ensure diversity across:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eCampus (Abu Dhabi and Al Ain),\u003c/li\u003e\n \u003cli\u003eAcademic level (undergraduate and postgraduate),\u003c/li\u003e\n \u003cli\u003eGender, and\u003c/li\u003e\n \u003cli\u003eSelf-reported engagement in health behaviours.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eStudents who completed the quantitative survey were invited to participate in focus groups via a short recruitment form.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample Size\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of six focus group discussions were conducted, each comprising 6\u0026ndash;8 participants, consistent with recommended qualitative research practice. Data collection continued until thematic saturation was achieved, defined as the point at which no new themes emerged across successive focus groups.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eData Collection Procedures\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003e\u003cstrong\u003eQuantitative Data Collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eQuantitative data were collected using a structured online survey administered via a secure, web-based platform. The survey required approximately ten minutes to complete and was open for a defined data collection period in 2025.\u003c/p\u003e\n\u003cp\u003eBefore accessing the survey, participants reviewed an IRB-approved information sheet (Appendix 6) outlining the study purpose, voluntary nature of participation, confidentiality protections, and researcher contact details. Electronic informed consent was required to proceed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQualitative Data Collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eQualitative data were collected through six focus group discussions, facilitated by trained members of the research team. A semi-structured discussion guide (Appendix 7) was developed directly from quantitative survey findings and informed by the Health-Promoting University framework.\u003c/p\u003e\n\u003cp\u003eFocus group discussions explored four domains:\u003c/p\u003e\n\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eMental well-being and stress;\u003c/li\u003e\n \u003cli\u003ePhysical activity behaviours and barriers;\u003c/li\u003e\n \u003cli\u003eNutrition and lifestyle habits; and\u003c/li\u003e\n \u003cli\u003ePreferences for Health and Wellness Program design.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eSessions lasted 50\u0026ndash;60 minutes, were conducted in teams meeting and were audio-recorded with participant consent both written and verbal. A second researcher documented meeting notes capturing group dynamics and non-verbal cues.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eMeasures\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003e\u003cstrong\u003eQuantitative Measures\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe survey included close-ended and open-ended items assessing the following domains: (Appendix 5).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSociodemographic Characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eGender (female, male, prefer not to say),\u003c/li\u003e\n \u003cli\u003eCampus (Abu Dhabi, Al Ain),\u003c/li\u003e\n \u003cli\u003eAcademic level (undergraduate, postgraduate).\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eHealth and Wellness Indicators\u003c/strong\u003e\u003c/p\u003e\n\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003e\u003cstrong\u003ePhysical activity:\u003c/strong\u003e self-rated activity level (very active to not active at all);\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eStress:\u003c/strong\u003e self-rated perceived stress (very low to very high);\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eFood environment:\u003c/strong\u003e satisfaction with healthy food options on campus (5-point Likert scale);\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eBarriers to physical activity:\u003c/strong\u003e multi-response item;\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eInterest in wellness services:\u003c/strong\u003e multi-response item;\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eProgram preferences:\u003c/strong\u003e timing and delivery format.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eTo enhance interpretability and support subgroup comparisons, three binary outcome variables were created (appendix 1):\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eLow physical activity:\u003c/strong\u003e not very active or not active at all;\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eHigh stress:\u003c/strong\u003e high or very high;\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eFood dissatisfaction:\u003c/strong\u003e dissatisfied or very dissatisfied.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eQualitative Measures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe focus group guide included open-ended questions and probes designed to elicit students\u0026rsquo; lived experiences, perceived barriers and facilitators, cultural considerations, and actionable recommendations for wellness programming. Questions were flexible to allow exploration of emergent topics raised by participants.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eData Management and Confidentiality\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eAll quantitative survey responses were anonymized automatically, and no identifying information was retained in the analytic dataset. Qualitative transcripts were de-identified prior to analysis. Data were stored on password-protected institutional devices accessible only to the research team.\u003c/p\u003e\n\u003cp\u003eData management procedures complied with Abu Dhabi University Institutional Review Board (IRB) requirements and institutional data protection policies.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eData Analysis\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003e\u003cstrong\u003eQuantitative Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eQuantitative analyses were conducted accordance with the IRB-approved analytic plan in Python using Pandas for data cleaning, variable recoding, and descriptive summaries; NumPy for numeric calculations and percentage generation; and SciPy for inferential analyses. Frequencies and percentages were computed for all categorical variables. Multi-response items (e.g., preferred activities and barriers) were transformed into binary indicator variables (selected vs not selected). Key outcomes were recoded into binary variables (high stress, low physical activity, and food dissatisfaction), and chi-square tests of independence were used to examine associations with gender and campus with statistical significance set at p \u0026lt; .05.; Fisher\u0026rsquo;s exact tests were planned where expected cell counts were small. Figures were produced using Microsoft excel.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQualitative Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA qualitative focus group design was employed to contextualize survey findings and explore students\u0026rsquo; experiences, barriers, and program preferences. Six focus groups were conducted using a semi-structured guide informed by survey results and organized around four domains: mental well-being, physical activity, nutrition and lifestyle, and program design. Data were analysed using Braun and Clarke\u0026rsquo;s reflexive thematic analysis, following a six-step process of familiarization, coding, theme development, review, definition, and integration. Deductive and inductive approaches were combined, and themes were mapped back to quantitative findings to support mixed-methods integration. Rigor was enhanced through audit trails, analytic memos, and cross-group comparison. Coding was conducted manually using Microsoft Excel, with analytic memos and audit trails maintained to enhance rigor. Both deductive codes (guided by the discussion domains) and inductive codes (emerging from the data) were applied. Thematic saturation was confirmed across focus groups (appendix 8).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMixed-Methods Integration\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIntegration occurred at the interpretation and reporting stage using triangulation. Quantitative findings identified priority wellness needs and prevalence patterns, while qualitative findings explained underlying mechanisms, contextual factors, and implementation considerations. integrated and narrative weaving were used to align qualitative themes with quantitative outcomes, strengthening the credibility and applicability of the findings (Appendix 9).\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eEthical Considerations\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eEthical approval was obtained from the Abu Dhabi University Institutional Review Board. Participation was voluntary, informed written consent was obtained from all participants, and students could withdraw at any time without penalty. No incentives were provided. All procedures adhered to institutional and national ethical guidelines for research involving human participants (Appendix 10).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eOverview\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eResults are presented in four sections:\u003cbr\u003e\u0026nbsp;(1) Quantitative results,\u003cbr\u003e\u0026nbsp;(2) Qualitative results,\u003cbr\u003e\u0026nbsp;(3) Integrated mixed-methods results, and\u003cbr\u003e\u0026nbsp;(4) Results appendices\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1. Quantitative Results\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.1 Participant Characteristics (Appendix 3)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 188 students completed the survey. Participants were predominantly undergraduate students (96.3%), female (83.5%), and enrolled at the Abu Dhabi campus (70.7%). Postgraduate students comprised 3.7% of the sample. These characteristics indicate strong representation of the undergraduate student population across the two main campuses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.2 Physical Activity\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.2.1 Self-Rated Physical Activity Levels (Table 2a, figure 1)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSelf-reported physical activity levels indicated that while a majority of students perceived themselves as at least somewhat active, a substantial proportion reported insufficient activity.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSpecifically:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eVery active: \u003cstrong\u003e18.6%\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003eSomewhat active: \u003cstrong\u003e52.1%\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003eNot very active: \u003cstrong\u003e26.1%\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003eNot active at all: \u003cstrong\u003e3.2%\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eUsing a binary classification aligned with campus health indicators, 29.3% of students were classified as having low physical activity (not very active or not active at all).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInterpretation:\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Nearly one in three students may not be meeting recommended physical activity levels, identifying physical inactivity as a significant population-level concern.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.2.2 Preferred Physical Activities (Table 2b).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudents selected multiple preferred activity types. The most frequently endorsed were:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eWalking clubs (\u003cstrong\u003e44.1%\u003c/strong\u003e)\u003c/li\u003e\n \u003cli\u003eStrength training/weightlifting (\u003cstrong\u003e41.5%\u003c/strong\u003e)\u003c/li\u003e\n \u003cli\u003eGroup fitness classes (e.g., yoga, Zumba) (\u003cstrong\u003e40.4%\u003c/strong\u003e)\u003c/li\u003e\n \u003cli\u003eTeam sports (e.g., football, basketball) (\u003cstrong\u003e37.8%\u003c/strong\u003e)\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eInterpretation:\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Preferences favoured accessible, group-based, and flexible activities, suggesting that students are interested in physical activity when it is socially engaging and logistically feasible.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.2.3 Barriers to Physical Activity (Table 2c)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe most commonly reported barriers were:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eLack of time (\u003cstrong\u003e48.4%\u003c/strong\u003e)\u003c/li\u003e\n \u003cli\u003eLow motivation (\u003cstrong\u003e28.7%\u003c/strong\u003e)\u003c/li\u003e\n \u003cli\u003eLack of facilities (\u003cstrong\u003e11.7%\u003c/strong\u003e)\u003c/li\u003e\n \u003cli\u003eUncertainty about how to start (\u003cstrong\u003e8.0%\u003c/strong\u003e)\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eInterpretation:\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Barriers were predominantly structural and psychological, rather than related to lack of interest, indicating modifiable determinants at the institutional level.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.3 Stress and Psychological Well-Being \u0026nbsp;(Table 2d), figure 2\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStress was highly prevalent among students:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eVery high: \u003cstrong\u003e14.4%\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003eHigh: \u003cstrong\u003e28.2%\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003eModerate: \u003cstrong\u003e44.1%\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003eLow: \u003cstrong\u003e12.2%\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003eVery low: \u003cstrong\u003e1.1%\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eUsing the predefined binary variable, 42.6% of students reported high or very high stress.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInterpretation:\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;The concentration of responses in the moderate-to-high range indicates that psychological stress is widespread rather than isolated, reinforcing its prioritization within wellness programming.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.4 Campus Food Environment and Nutrition (Table 2e, figure 3)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSatisfaction with healthy food options on campus was mixed:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eVery satisfied: \u003cstrong\u003e8.0%\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003eSatisfied: \u003cstrong\u003e29.3%\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003eNeutral: \u003cstrong\u003e36.2%\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003eDissatisfied: \u003cstrong\u003e18.6%\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003eVery dissatisfied: \u003cstrong\u003e8.0%\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eOverall, 26.6% of students reported dissatisfaction, while more than one-third expressed neutral satisfaction.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInterpretation:\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;The large neutral category suggests acceptance rather than endorsement of the food environment, highlighting an opportunity for targeted improvement.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.5 Mental Health and Wellness Service Needs (Table 3)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudents expressed strong interest in preventive and skill-based wellness services:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eStress management workshops (\u003cstrong\u003e56.4%\u003c/strong\u003e)\u003c/li\u003e\n \u003cli\u003eTime-management workshops (\u003cstrong\u003e41.0%\u003c/strong\u003e)\u003c/li\u003e\n \u003cli\u003eMindfulness/meditation sessions (\u003cstrong\u003e38.8%\u003c/strong\u003e)\u003c/li\u003e\n \u003cli\u003eCounselling services (\u003cstrong\u003e32.4%\u003c/strong\u003e)\u003c/li\u003e\n \u003cli\u003ePeer support groups (\u003cstrong\u003e20.2%\u003c/strong\u003e)\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eInterpretation:\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Interest in preventive and educational services exceeded interest in counselling alone, indicating a preference for early, non-stigmatizing interventions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.6 Preferred Wellness Topics (Table 4)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudents identified priority topics for wellness education:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eWork/study-life balance (\u003cstrong\u003e58.0%\u003c/strong\u003e)\u003c/li\u003e\n \u003cli\u003eHealthy sleeping habits (\u003cstrong\u003e50.0%\u003c/strong\u003e)\u003c/li\u003e\n \u003cli\u003eBuilding healthy lifestyle habits (\u003cstrong\u003e46.3%\u003c/strong\u003e)\u003c/li\u003e\n \u003cli\u003eSleep hygiene (\u003cstrong\u003e36.2%\u003c/strong\u003e)\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e1.7 Program Delivery Preferences (Table 5 \u0026amp; 6)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTiming\u003c/strong\u003e\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eAfter class/work: \u003cstrong\u003e29.8%\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003eEvenings (after 4 p.m.): \u003cstrong\u003e26.1%\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003eLunch breaks: \u003cstrong\u003e15.4%\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003eWeekends: \u003cstrong\u003e14.9%\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003eBefore class/work: \u003cstrong\u003e13.8%\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eFormat\u003c/strong\u003e\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eIn-person: \u003cstrong\u003e60.1%\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003eHybrid: \u003cstrong\u003e31.9%\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003eFully online: \u003cstrong\u003e8.0%\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eInterpretation:\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Students strongly favoured face-to-face or blended programming scheduled outside academic hours.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.8 Subgroup Comparisons (Table 7)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eChi-square analyses revealed no statistically significant associations between gender or campus and:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eHigh stress\u003c/li\u003e\n \u003cli\u003eLow physical activity\u003c/li\u003e\n \u003cli\u003eFood dissatisfaction\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e(all \u003cem\u003ep\u003c/em\u003e \u0026gt; .05)\u003c/p\u003e\n\u003cp\u003eA borderline trend suggested higher stress among Abu Dhabi campus students (\u003cem\u003ep\u003c/em\u003e = .056), though this did not reach statistical significance.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInterpretation:\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Wellness challenges were shared broadly across subgroups, supporting the need for campus-wide rather than targeted interventions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2. Qualitative Results\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOverview\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSix focus group discussions (FG1\u0026ndash;FG6) were conducted to explore students\u0026rsquo; lived experiences of health and wellness, contextualize quantitative survey findings, and identify priorities for program design. Analysis followed Braun and Clarke\u0026rsquo;s reflexive thematic analysis, combining deductive coding aligned with the four discussion domains (mental well-being, physical activity, nutrition, and program design) and inductive coding to capture emergent patterns across groups. Across all focus groups, a highly consistent and saturated thematic structure emerged, indicating strong convergence of experiences across academic levels and campuses. Five overarching themes were identified (Appendix 8).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 1: Student Stress Is High, Chronic, and Structurally Driven (Appendix 8a)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAcross all focus groups, students described stress as persistent and expected, rather than episodic. While academic workload (examinations, dense course content, deadlines, and group projects) was consistently identified as the primary stressor, participants emphasized that stress was amplified by institutional and structural factors.\u003c/p\u003e\n\u003cp\u003eStudents reported that unclear academic guidance, delayed administrative responses, difficulty identifying appropriate support contacts, and compressed assessment schedules intensified stress beyond academic demands alone. Group-based assessments were repeatedly described as emotionally taxing, particularly when workload distribution was perceived as inequitable or grades depended on collective performance. Early-year students were viewed as especially vulnerable due to limited time-management skills and unfamiliarity with institutional systems.\u003c/p\u003e\n\u003cp\u003eImportantly, several groups expanded the stress narrative beyond academics, highlighting future uncertainty, scholarship and GPA maintenance, financial pressure, career anxiety, and self-imposed productivity expectations. Students described a cumulative stress experience in which academic, institutional, and personal pressures interacted to create sustained psychological strain.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 1 \u0026ndash; Analytic Summary\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStress among ADU students is not merely an individual coping issue but reflects structural characteristics of academic design, institutional responsiveness, and performance culture, aligning with a systems-level understanding of student well-being. Across all six focus groups, students consistently described stress as chronic, cumulative, and structurally embedded within their academic experience. Academic workload, clustered deadlines, examination pressure, and performance expectations emerged as dominant stressors, with stress intensifying during peak assessment periods and accumulating over the semester. Importantly, academic stress was frequently intertwined with financial obligations, scholarship requirements, family expectations, and concerns about future employability, amplifying its psychological impact. Students also highlighted structural contributors, including inflexible scheduling, group-based assessments, unclear expectations, and administrative demands, which compounded academic pressure. For postgraduate and working students, stress was further intensified by role overload arising from the need to balance studies with employment and family responsibilities. Collectively, these findings indicate that student stress at Abu Dhabi University is systemic rather than individual, providing strong qualitative corroboration for the high prevalence of stress observed in the quantitative survey and underscoring the need for institutional-level as well as individual-level interventions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 2: Coping Is Predominantly Informal and Self-Managed, with a Persistent Knowledge\u0026ndash;Behaviour Gap (Appendix 8b)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudents across all focus groups demonstrated high awareness of effective coping strategies, including time management, advance planning, physical activity, breaks, social support, spiritual practices, and self-motivation techniques. However, participants consistently acknowledged a gap between knowing what supports well-being and being able to sustain these behaviours, particularly during peak academic periods.\u003c/p\u003e\n\u003cp\u003eCoping strategies were largely informal and self-managed, relying on friends, family, peers, alumni, and personal routines. While these strategies were perceived as accessible and culturally acceptable, they were often described as reactive rather than preventive, breaking down under prolonged academic pressure.\u003c/p\u003e\n\u003cp\u003eSeveral groups explicitly articulated an \u0026ldquo;awareness-action gap\u0026rdquo;, noting that fatigue, time scarcity, and mental overload frequently undermined intentions to exercise, eat well, sleep adequately, or seek support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 2 \u0026ndash; Analytic Summary\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudents possess substantial wellness literacy and resilience, but structural demands and environmental constraints limit their ability to translate knowledge into sustained health behaviours. Across all six focus groups, students consistently reported relying on informal and self-directed coping strategies to manage academic stress. The most prevalent strategies included social and peer support, physical activity, and personal time-management practices, reflecting a strong emphasis on individual agency and trusted interpersonal networks. Planning ahead, using digital tools, and engaging in low-barrier activities such as walking or brief breaks were frequently described as effective ways to manage stress within constrained schedules. Notably, coping strategies were often reactive and short-term, shaped by workload intensity and time pressure. Several students described sacrificing sleep, postponing rest, or using avoidance behaviours during peak academic periods, indicating that while coping efforts are active, they are not always sustainable. Cultural coping mechanisms, such as spirituality, emerged in some groups, highlighting the contextual nature of stress management practices. When integrated with the quantitative findings, Theme 2 explains students\u0026rsquo; strong preference for stress-management, time-management, and mindfulness-based programming, as these align closely with students\u0026rsquo; existing coping approaches. The findings suggest that wellness interventions at Abu Dhabi University should build upon students\u0026rsquo; preferred informal strategies while strengthening skills for sustainable self-regulation and creating supportive pathways toward formal support when stress exceeds individual coping capacity.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 3: Stigma, Fear of Judgment, and Trust Concerns Constrain Formal Help-Seeking\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDespite recognizing the importance of mental health, participants across all focus groups reported low utilization of formal mental health services. Help-seeking was constrained by stigma, fear of judgment, cultural norms emphasizing self-reliance, concerns about confidentiality, and uncertainty about how services operate.\u003c/p\u003e\n\u003cp\u003eStudents expressed discomfort with being perceived as \u0026ldquo;weak,\u0026rdquo; concerns about mental health records affecting future opportunities or family perceptions, and scepticism about counsellor fit or effectiveness. Counselling was often viewed as a last resort for crisis situations, rather than a routine or preventive resource.\u003c/p\u003e\n\u003cp\u003eAt the same time, participants emphasized that support would be more acceptable if it were normalized, confidential, choice-based, culturally sensitive, and easily accessible, with clear pathways and visibility.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 3 \u0026ndash; Analytic Summary\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBarriers to help-seeking are not due to lack of need or awareness, but to social, cultural, and trust-related factors, underscoring the importance of normalization and system-level design rather than solely expanding services. Across all six focus groups, students consistently reported substantial barriers to engaging with formal mental health and counselling services, despite acknowledging high levels of academic and psychological stress. Stigma and fear of judgment emerged as the most pervasive and recurrent barrier, with students expressing concern about being labelled, perceived as weak, or socially judged. These concerns were frequently reinforced by cultural and societal norms, which discourage open discussion of mental health difficulties and normalize emotional suppression. Concerns regarding confidentiality and privacy were also prominent across groups, with students reporting uncertainty about who might access their information and how help-seeking might affect their academic or social standing. In parallel, many students described a strong preference for informal support systems, such as friends, family members, or peers, which were perceived as safer, more relatable, and less stigmatizing than institutional services. Limited awareness and visibility of available services, alongside accessibility constraints related to time and scheduling, further reduced engagement with formal support. Importantly, students across focus groups emphasized greater comfort with low-threshold alternatives, including workshops, peer-led initiatives, and anonymous or online formats, which were viewed as less intimidating entry points into mental health support. When triangulated with quantitative findings, this theme provides a clear explanation for why interest in counselling services was lower than interest in stress-management, mindfulness, and skills-based workshops. Together, the mixed-methods findings highlight the need for low-stigma, culturally sensitive, confidential, and flexible mental health provision, alongside stepped-care models that allow students to engage with support gradually and safely.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 4: Health Behaviours Are Valued but Constrained by Time, Fatigue, Cost, and Campus Environment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePhysical Activity\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePhysical activity was widely viewed as beneficial for stress relief and overall well-being; however, participation was inconsistent. Students cited time constraints, fatigue, academic prioritization, environmental heat, distance to facilities, self-consciousness, and lack of enjoyment as barriers.\u003c/p\u003e\n\u003cp\u003eAcross groups, walking and low-effort, embedded movement emerged as the most feasible and acceptable forms of activity. Motivation was consistently higher for social, group-based, non-competitive activities, with additional emphasis on culturally comfortable environments (e.g., female-only spaces), flexible scheduling, incentives, and short \u0026ldquo;micro-activities\u0026rdquo; integrated into the academic day.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNutrition and Lifestyle\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNutrition was described as a daily, high-impact challenge. Students reported irregular eating patterns, frequent meal skipping (especially breakfast), reliance on fast food, and heavy caffeine consumption, particularly during exam periods. Healthy food options were perceived as limited, repetitive, expensive, insufficiently filling, or poorly visible, while supportive infrastructure (e.g., microwaves, healthy side options, clear labelling) was often lacking.\u003c/p\u003e\n\u003cp\u003eStudents consistently linked nutrition to sleep deprivation, screen overuse, hydration issues, and stress, describing a reinforcing cycle of lifestyle strain.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 4 \u0026ndash;Analytic Summary\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHealth behaviours are shaped less by motivation or knowledge and more by structural constraints, affordability, convenience, and campus design, highlighting the need for environmental and policy-level interventions. Across all six focus groups, students expressed strong interest in physical activity and healthy lifestyle behaviours, yet consistently identified time constraints, academic workload, fatigue, and scheduling conflicts as primary barriers to engagement. Motivation to engage in physical activity was often undermined during peak academic periods, particularly when stress and burnout were high. Students emphasized a preference for low-intensity, flexible, and socially engaging activities, such as walking clubs, group fitness, and team sports, which were perceived as more sustainable and enjoyable. Nutrition-related challenges were closely tied to food affordability, availability, and convenience, with students reporting difficulty accessing healthy options on campus, particularly during busy academic days. Sleep disruption and irregular routines were widely described across groups, highlighting the interconnected nature of academic stress, lifestyle behaviours, and overall well-being. In terms of program design, students consistently favoured in-person or hybrid wellness initiatives, scheduled after classes or in the evening, and integrated into the academic environment where possible. Preferences for culturally responsive options, flexible delivery, incentives, and practical relevance were repeatedly emphasized. When triangulated with quantitative findings, Theme 4 reinforces the need for accessible, student-centred, and structurally supportive wellness programming that addresses environmental barriers while promoting sustainable health behaviours.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 5: Students Call for an Integrated, Visible, and Student-centred Wellness Ecosystem\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAcross all focus groups, students rejected fragmented, one-off wellness activities in favour of a holistic, integrated Health and Wellness Program embedded into daily campus life. Participants emphasized the need for:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eA centralized wellness hub (preferably a mobile application) integrating mental health resources, physical activity opportunities, nutrition information, and event schedules;\u003c/li\u003e\n \u003cli\u003eClear, proactive communication through trusted channels (lectures, orientation, social media, learning platforms);\u003c/li\u003e\n \u003cli\u003eFlexible timing aligned with academic schedules and avoidance of peak assessment periods;\u003c/li\u003e\n \u003cli\u003eInclusive, non-judgmental, and culturally responsive programming;\u003c/li\u003e\n \u003cli\u003eIncentives, recognition, and social engagement to sustain participation;\u003c/li\u003e\n \u003cli\u003eVisible institutional commitment and leadership support; and\u003c/li\u003e\n \u003cli\u003eContinuous student involvement and feedback in program design and improvement.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eStudents repeatedly emphasized that wellness should be experienced as part of the campus culture, not as an optional add-on.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 5 \u0026ndash; Analytic Summary\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEffective wellness programming requires a systems-level, student-centred approach consistent with the Health-Promoting University framework, integrating policy, environment, services, and student voice. Across all six focus groups, students articulated clear and consistent expectations for a Health \u0026amp; Wellness Program that is integrated, flexible, and student-centred. Participants emphasized the importance of practical, skills-based programming that directly addresses real student challenges, rather than abstract or one-off initiatives. Flexibility in timing and delivery particularly in-person and hybrid formats were repeatedly highlighted as essential to accommodate diverse academic schedules, work commitments, and personal responsibilities. Students strongly emphasized the need for program sustainability, advocating for ongoing initiatives embedded throughout the academic semester rather than isolated events. Peer involvement, including student ambassadors and peer-led activities, was viewed as a key strategy for enhancing relatability, trust, and engagement. Cultural sensitivity, inclusivity, and institutional commitment through leadership support and integration into academic structures were also identified as critical components of a successful program. When integrated with quantitative findings, Theme 5 reinforces students\u0026rsquo; preference for accessible, interactive, and well-promoted wellness initiatives, and underscores the importance of embedding health promotion within the broader university ecosystem. Together, these findings provide clear, actionable guidance for the development of a comprehensive, sustainable Health \u0026amp; Wellness Program at Abu Dhabi University.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQualitative\u0026ndash;Quantitative Integration\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study employed a convergent mixed-methods design, integrating quantitative survey findings with qualitative focus group data to provide a comprehensive understanding of student health and wellness needs at Abu Dhabi University. Quantitative data identified the prevalence and distribution of key wellness indicators, while qualitative findings explained the underlying experiences, contextual factors, and student-driven recommendations. Integration occurred at the interpretation stage through triangulation of results across datasets (Appendix 9).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMental Well-Being and Stress\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eQuantitative findings indicated that 42.6% of students reported high or very high stress, highlighting mental well-being as a major concern. Interest in stress management workshops (56.4%), time-management programs (41.0%), and mindfulness activities (38.8%) further underscored the salience of stress-related needs.\u003c/p\u003e\n\u003cp\u003eQualitative findings strongly confirmed and contextualized these results. Across all six focus groups, students described stress as chronic, cumulative, and structurally embedded within academic life rather than situational or episodic (Theme 1). Stress was attributed to heavy coursework, clustered deadlines, high GPA expectations, scholarship and financial pressures, family expectations, and uncertainty regarding future careers. Students emphasized that stress accumulated over the semester and intensified during peak assessment periods, directly affecting sleep, motivation, and emotional well-being.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCoping Strategies and Help-Seeking Behaviours\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWhile quantitative results demonstrated substantial interest in wellness programming, fewer students expressed interest in formal counselling services (32.4%), suggesting a gap between stress prevalence and professional help-seeking.\u003c/p\u003e\n\u003cp\u003eQualitative findings (Theme 2 and Theme 3) explained this discrepancy. Students primarily relied on informal, self-directed coping strategies, including peer and family support, physical activity, planning, and short restorative breaks. Formal mental health services were often viewed as a last resort, with students preferring low-stigma, skills-based, or group-oriented approaches.\u003c/p\u003e\n\u003cp\u003eMultiple barriers to formal help-seeking were consistently identified (Theme 3), including stigma, fear of judgment, confidentiality concerns, cultural norms, limited awareness of services, and accessibility constraints. Students expressed greater comfort with workshops, peer-led initiatives, and anonymous or online options, which they perceived as safer and more acceptable entry points to support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePhysical Activity, Nutrition, and Lifestyle Behaviours\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eQuantitative data showed that 29.3% of students reported low physical activity, despite high interest in walking clubs, strength training, group fitness, and team sports. The most common barriers were lack of time (48.4%) and low motivation (28.7%). Additionally, 26.6% of students were dissatisfied with healthy food options on campus, and many reported sleep difficulties.\u003c/p\u003e\n\u003cp\u003eQualitative findings (Theme 4) provided depth to these patterns. Students consistently described time pressure, academic workload, fatigue, and scheduling conflicts as primary barriers to physical activity and healthy routines. Nutrition challenges were linked to affordability, limited healthy options, and convenience-driven food choices. Sleep disruption was frequently reported as a consequence of academic stress and poor time balance, reinforcing the interconnected nature of wellness behaviours.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProgram Design Preferences and Expectations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eQuantitative findings revealed strong preferences for in-person (60.1%) or hybrid (31.9%) wellness programs, particularly scheduled after classes or in the evening. Preferred topics included work\u0026ndash;study-life balance, healthy sleep, and sustainable lifestyle habits.\u003c/p\u003e\n\u003cp\u003eQualitative findings (Theme 5) strongly reinforced these preferences and translated them into concrete design recommendations. Students emphasized the importance of practical, flexible, culturally sensitive, and sustainable programming embedded within campus life rather than one-time events. Peer involvement, incentives, clear promotion, and institutional commitment were viewed as essential for long-term engagement.\u003c/p\u003e\n\u003cp\u003eTogether, the integrated findings indicate that student wellness needs at Abu Dhabi University are systemic, interconnected, and context-specific, requiring a comprehensive, student-centred Health \u0026amp; Wellness Program grounded in both empirical evidence and lived experience.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSummary of Integration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe mixed-methods integration demonstrates strong convergence between quantitative and qualitative findings, with qualitative data consistently explaining and contextualizing survey results. No major contradictions were identified. Qualitative insights clarified the drivers of high stress, coping behaviours, and the program features most likely to be effective and sustainable. High stress levels were linked to academic and institutional pressures, while low physical activity and nutrition dissatisfaction were explained by time, cost, and environmental constraints. Preferences for in-person or hybrid programming were translated into clear implementation principles. Together, the findings provide robust explanatory depth and actionable guidance, revealing that student well-being challenges are systemic, predictable, and modifiable through institutional design. These insights strengthen the validity of the study and directly inform the development of an evidence-based, culturally responsive Health and Wellness Program at Abu Dhabi University.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis mixed-methods needs assessment offers important insights for the development of an evidence-based Health and Wellness Program. It provides a comprehensive and context-specific understanding of student health and wellness needs at Abu Dhabi University, integrating quantitative prevalence data with qualitative explanations of lived experience. The findings demonstrate that student well-being challenges at ADU are systemic, multifactorial, and deeply embedded within academic, social, and institutional contexts, rather than isolated individual issues. The Quantitative findings revealed high levels of perceived stress, suboptimal physical activity engagement, and moderate dissatisfaction with the campus food environment, alongside strong interest in wellness services and in-person or hybrid programming. Qualitative findings deepened understanding of these patterns by demonstrating that student wellness challenges are not merely individual-level issues but are embedded within academic structures, institutional processes, cultural norms, and campus environments. The convergence of quantitative and qualitative results strengthens confidence in the findings and offers a robust empirical foundation for evidence-based program design.\u003c/p\u003e \u003cp\u003e \u003cb\u003eMental Well-Being and Academic Stress\u003c/b\u003e \u003c/p\u003e \u003cp\u003eConsistent with global trends, a substantial proportion of ADU students reported high or very high stress levels (42.6%). More than two-fifths of surveyed students reported high or very high stress, a prevalence consistent with or exceeding estimates reported in international studies of university populations (Roy, et. al., \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Alalalmeh, et. al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Salgado, et al., \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Bruffaerts et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; ACHA, 2023). Qualitative findings extend this evidence by illustrating that stress is experienced as chronic and cumulative, driven by academic workload, clustered deadlines, performance expectations, scholarship requirements, family pressure, and uncertainty about future careers. This aligns with recent international studies showing that student mental distress is increasingly shaped by systemic and organizational factors rather than isolated academic pressure alone (Azizova, et. al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Asghar, at. al., 2023; Campbell, 2022). It further suggests that university stress increasingly reflects structural academic pressures rather than transient stressors (Zhang, et al., \u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; C\u0026oacute;rdova, et. al., 2023; Browning et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Lipson et al., \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Importantly, students emphasized anticipatory stress experienced before assessments suggesting that anxiety is not limited to examination periods but persists throughout the academic cycle (Alshareef, et. al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Jerrim, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Liu, et. al., \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Recent longitudinal research supports this pattern, demonstrating that persistent academic stress predicts sleep disruption, emotional exhaustion, and reduced academic engagement over time (Zhang, et. al., \u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Pramesti, et. al., \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Alotaibi, et. al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). These findings reinforce calls for universities to address stress at the curricular and assessment design level, rather than relying solely on downstream coping interventions.\u003c/p\u003e \u003cp\u003e \u003cb\u003eCoping Strategies and the Informal Support Preference\u003c/b\u003e \u003c/p\u003e \u003cp\u003eDespite high stress prevalence, students primarily relied on informal, self-directed coping strategies, including peer and family support, time management, physical activity, and brief self-care practices. This pattern mirrors recent evidence suggesting that students often view formal mental health services as supplementary rather than primary resources (Batmanov, et. al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2026\u003c/span\u003e; Osborn, et. al., \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Osborn, et. al., \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Quinn, et. al., \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e2009\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWhile many of these coping strategies are adaptive, qualitative findings revealed that they are frequently short-term and compensatory, with students reporting sleep sacrifice, guilt around rest, and reliance on distraction during peak stress periods. Emerging evidence indicates that such coping trade-offs may sustain academic functioning in the short term but increase long-term risk of burnout and mental health deterioration (Shi, et. al., \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Biaigo, et. al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) Stallman, et. al., \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). This underscores the importance of programs that strengthen sustainable self-regulation skills, rather than reinforcing productivity-focused coping alone.\u003c/p\u003e \u003cp\u003e \u003cb\u003eBarriers to Formal Mental Health Support\u003c/b\u003e \u003c/p\u003e \u003cp\u003eOne of the most critical contributions of this study is the clear explanation of the gap between high stress and relatively lower interest in counselling services. Qualitative findings identified stigma, confidentiality concerns, cultural norms, limited awareness, and accessibility constraints as persistent barriers to formal help-seeking. These findings are consistent with recent cross-cultural research indicating that stigma and privacy concerns remain dominant deterrents in university populations, particularly in collectivist or family-oriented cultures (AthinarayananRao, et. al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Knettel, et al., 2005; Chen, et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Hyseni, et. al., 2024).\u003c/p\u003e \u003cp\u003eStudents\u0026rsquo; preference for anonymous, online, peer-led, or workshop-based formats reflects global shifts toward stepped-care and low-threshold mental health models in higher education (Ali, et. al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Duraku, et. al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Vomhof, 2024). Evidence increasingly suggests that offering multiple entry points rather than a single counselling pathway improves engagement and early intervention (Appleton, et. al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Casley, et. al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Polillo, et. al., \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). For ADU, these findings highlight the need for culturally responsive, confidential, and flexible mental health ecosystems, rather than reliance on traditional counselling alone.\u003c/p\u003e \u003cp\u003e \u003cb\u003ePhysical Activity, Nutrition, and Lifestyle Behaviours\u003c/b\u003e \u003c/p\u003e \u003cp\u003ePhysical activity findings revealed a notable discrepancy between interest and engagement. While students expressed strong preferences for walking, group fitness, and strength training, nearly one-third reported low physical activity levels. Qualitative insights clarified that this gap is largely explained by time constraints, fatigue, academic prioritization, environmental heat, and concerns related to comfort and social judgment. This pattern is consistent with global research showing that environmental and structural determinants rather than motivation or knowledge are the primary barriers to physical activity among university students (Radebe, et. al., \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Akil, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Prieto-Gonz\u0026aacute;lez \u0026amp; Alkouatli., 2025). The strong preference for walking and low-effort movement suggests that interventions embedded into daily routines may be particularly effective in this context.\u003c/p\u003e \u003cp\u003eNutrition emerged as a daily and cumulative challenge for students. Although only one-quarter of students reported dissatisfaction with healthy food options, a large proportion reported neutral satisfaction, suggesting tolerance rather than endorsement. Qualitative findings revealed that food choices are shaped by affordability, convenience, portion adequacy, and limited variety, alongside insufficient campus infrastructure to support healthy eating. These findings are consistent with studies demonstrating that campus food environments significantly influence dietary behaviours, and that cost and accessibility are critical determinants of food choice among university students (Almoraie, et. al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Li, et. al., \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Tam, et. al., \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Roy, et. al., \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSleep disruption emerged as a cross-cutting issue, linking academic stress, physical inactivity, and dietary choices. Recent evidence identifies sleep as a critical mediator between academic stress and both mental and physical health outcomes in students (Fabio, et. al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2026\u003c/span\u003e; Yuting, \u0026amp; Rashid, \u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Alotaibi, et. al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). These findings support integrated wellness approaches that address sleep, stress, physical activity, and nutrition simultaneously, rather than as isolated behaviours.\u003c/p\u003e \u003cp\u003eDespite high stress prevalence, qualitative findings indicated limited engagement with formal mental health services. Students described stigma, fear of judgment, confidentiality concerns, and cultural norms emphasizing self-reliance as key barriers to help-seeking. Counselling was often perceived as a service reserved for crisis situations rather than preventive care. This pattern mirrors international evidence indicating that stigma and trust-related concerns remain central obstacles to mental health service utilization among students, even in settings where services are available (Rahmi, et. al., \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Pimenta, et. al., \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Lipson et al., \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). These findings underscore the need for normalization, visibility, and culturally responsive delivery models.\u003c/p\u003e \u003cp\u003e \u003cb\u003eProgram Design and the Health-Promoting University Framework\u003c/b\u003e \u003c/p\u003e \u003cp\u003eAcross all focus groups, students articulated a clear vision for wellness programming that is practical, flexible, inclusive, culturally sensitive, and embedded within university life aligned closely with the Health-Promoting University framework. Participants consistently emphasized the need for an integrated, visible, and student-centred wellness ecosystem embedded into campus life, rather than fragmented or one-off initiatives. Preferences for in-person or hybrid delivery, flexible scheduling aligned with academic demands, centralized communication platforms, and student involvement in program design highlight the importance of institutional commitment and systems-level change. This aligns with contemporary HPU literature emphasizing whole-university approaches that integrate health into policies, environments, services, and campus culture (Bannigan, et. al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; ACHA., 2023, 2017; Dooris, et. al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; World Health Organization, \u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e1998\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eImportantly, students emphasized sustainability and institutional commitment, cautioning against one-time initiatives. Recent evaluations of university wellness programs demonstrate that integration into governance, curriculum, and campus culture is essential for long-term impact (Han, et. al., \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Li, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Cowley, et. al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Venkatasubramanian, \u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Young, et. al., \u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). The findings from ADU therefore provide actionable guidance for operationalizing the HPU framework in a Middle Eastern context.\u003c/p\u003e \u003cp\u003e \u003cb\u003eStrengths and Limitations\u003c/b\u003e \u003c/p\u003e \u003cp\u003eA major strength of this study is its convergent mixed-methods design, which integrated quantitative prevalence data with in-depth qualitative insights to provide a comprehensive understanding of student wellness needs. The inclusion of six focus groups enabled thematic saturation and strengthened the credibility of qualitative findings. Focusing exclusively on students ensured direct relevance to wellness program development, while the institutional context enhanced practical applicability.\u003c/p\u003e \u003cp\u003eLimitations include the cross-sectional design, which limits causal inference, and reliance on self-reported data, which may introduce recall or social desirability bias. Convenience sampling and the predominance of female respondents may affect representativeness, and findings from a single institution may limit generalizability. Nonetheless, the results offer transferable insights for similar higher education settings in the region.\u003c/p\u003e \u003cp\u003e \u003cb\u003ePolicy and Practice Implications\u003c/b\u003e \u003c/p\u003e \u003cp\u003eStudent well-being should be embedded within academic and administrative systems, including assessment scheduling, workload management, and academic support. Mental health services must be framed as preventive, confidential, and culturally responsive, with multiple low-stigma access points. Physical activity initiatives should prioritize low-barrier, socially embedded options, while improvements to the campus food environment should focus on affordable and accessible healthy choices. Centralized wellness platforms and active student co-design are essential for relevance, engagement, and sustainability, supporting the Health-Promoting University approach.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis mixed-methods needs assessment shows that student health and wellness challenges at Abu Dhabi University are substantial, interconnected, and shaped by institutional, environmental, and cultural factors. Although students demonstrate resilience and strong interest in wellness initiatives, structural barriers limit sustained engagement in healthy behaviours. The integration of quantitative and qualitative evidence provides a strong foundation for developing a holistic, culturally responsive, and student-centred Health and Wellness Program, while contributing actionable insights to the health-promoting university literature.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eDisclosure Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no conflicts of interest to report.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Abu Dhabi University Institutional Review Board. Participation was voluntary, written informed consent was obtained from all participants, and students could withdraw at any time without penalty. No incentives were provided. All procedures adhered to institutional and national ethical guidelines for research involving human participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003cbr\u003e\u003c/strong\u003eDe-identified data are available from the corresponding author upon reasonable request, subject to institutional and ethical approval.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003cbr\u003e\u003c/strong\u003eThe authors thank the participating students for their time and contributions to this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003cbr\u003e\u003c/strong\u003eThis research received\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publish\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMaria Aamir conceptualized the study, led data collection, analysis, and manuscript drafting. Omar Friehat contributed to study design and interpretation. Noura AlHashmi and Zaineb Bennani supported data collection and qualitative analysis. Asiya Nazir and Hajira Jukaku supported with identifying the participants. All authors reviewed and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003e\u003cstrong\u003eAkil, Mustafa. (2025). \u003c/strong\u003eBarriers to physical activity among university students in the light of psychosocial and body composition determinants. BMC Psychology. 13. 10.1186/s40359-025-03789-4. \u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eAlalalmeh, S. O., Hegazi, O. E., Shahwan, M., Hassan, N., Humaid Alnuaimi, G. R., Alaila, R. F., Jairoun, A., Tariq Hamdi, Y., Abdullah, M. T., Abdullah, R. M., \u0026amp; Zyoud, S. H. (2024). \u003c/strong\u003eAssessing mental health among students in the UAE: A cross-sectional study utilizing the DASS-21 scale. \u003cem\u003eSaudi pharmaceutical journal : SPJ : the official publication of the Saudi Pharmaceutical Society\u003c/em\u003e, \u003cem\u003e32\u003c/em\u003e(4), 101987. https://doi.org/10.1016/j.jsps.2024.101987 \u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eAl-Jayyousi, G. F., Alsayed Hassan, D., Abdul Rahim, H., E Abdel-Rahman, M., Ferreira, I., Mukhalalati, B., O\u0026apos;Hara, L., Khalil, H., Tayyem, R., S Abu Alhaija, E., Abidia, R., Zolezzi, M., El-Awaisi, A., Al-Wattary, N., Mahmood Al Saady, R., Saffouh El Hajj, M., Shraim, M., K Abouhanian, A., Saeb, H., Mohammed, M., \u0026hellip; QU Health Youth Wellbeing Research Network Group (2024). \u003c/strong\u003eHealth and Well-Being in the Context of Health-Promoting University Initiatives: Protocol for a Mixed Methods Needs Assessment Study at Qatar University. \u003cem\u003eJMIR research protocols\u003c/em\u003e, \u003cem\u003e13\u003c/em\u003e, e58860. https://doi.org/10.2196/58860\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eAlnaqbi, Shaikha Eisa; Sohail, Rahab; Radwan, Hadia M.; Mohamad, Maysm N.; Zeb, Falak; Hasan, Haydar; Hashim, Mona; Osaili, Tareq; AlBlooshi, Sharifa; Al Dhaheri, Ayesha S.; Stojanovska, Lily; and Ismail, Leila Cheikh, (2025). \u003c/strong\u003e\u0026quot;Physical activity, screen time, dietary habits, and health outcomes among children and adolescents in the Middle East and North Africa region: a narrative review\u0026quot; (2025). All Works. 7553. https://zuscholars.zu.ac.ae/works/7553 \u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eAlotaibi, A. D., Alosaimi, F. M., Alajlan, A. A., \u0026amp; Bin Abdulrahman, K. A. (2020). \u003c/strong\u003eThe relationship between sleep quality, stress, and academic performance among medical students. \u003cem\u003eJournal of family \u0026amp; community medicine\u003c/em\u003e, \u003cem\u003e27\u003c/em\u003e(1), 23\u0026ndash;28. https://doi.org/10.4103/jfcm.JFCM_132_19\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eAlmoraie, N. M., Alothmani, N. M., Alomari, W. D., Al-amoudi, A. H., (2025). \u003c/strong\u003eAddressing nutritional issues and eating behaviours among university students: a narrative review. \u003cem\u003eNutrition Research Reviews\u003c/em\u003e. 2025;38(1):53-68. doi:10.1017/S0954422424000088\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eAlshareef, N., Giga, S., \u0026amp; Fletcher, I. (2025). \u003c/strong\u003eTest anxiety, emotional regulation and academic performance among medical students: a qualitative study. \u003cem\u003eMedical education online\u003c/em\u003e, \u003cem\u003e30\u003c/em\u003e(1), 2505177. https://doi.org/10.1080/10872981.2025.2505177\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eArnett J. J. (2000).\u003c/strong\u003e Emerging adulthood. A theory of development from the late teens through the twenties. \u003cem\u003eThe American psychologist\u003c/em\u003e, \u003cem\u003e55\u003c/em\u003e(5), 469\u0026ndash;480.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eAthinarayananRao, Kesantini \u0026amp; C Ah Gang, Getrude \u0026amp; E. Ading, Carmella. (2025). \u003c/strong\u003eMental Health Stigma among International University Students in Malaysia. International Journal of Academic Research in Business and Social Sciences. 15. 10.6007/IJARBSS/v15-i4/25213\u003cstrong\u003e. \u003c/strong\u003e\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eAuerbach, R. P., Alonso, J., Axinn, W. G., Cuijpers, P., Ebert, D. D., Green, J. G., Hwang, I., Kessler, R. C., Liu, H., Mortier, P., Nock, M. K., Pinder-Amaker, S., Sampson, N. A., Aguilar-Gaxiola, S., Al-Hamzawi, A., Andrade, L. H., Benjet, C., Caldas-de-Almeida, J. M., Demyttenaere, K., Florescu, S., \u0026hellip; Bruffaerts, R. (2016).\u003c/strong\u003e Mental disorders among college students in the World Health Organization World Mental Health Surveys. \u003cem\u003ePsychological medicine\u003c/em\u003e, \u003cem\u003e46\u003c/em\u003e(14), 2955\u0026ndash;2970. https://doi.org/10.1017/S0033291716001665\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eAli, M., van Berkel, N., Tag, B., Paananen, V., Oppenlaender, J., Yatani, K., \u0026amp; Hosio, S. (2025). \u003c/strong\u003eInvestigating mental wellbeing self-care in higher education using BERTopic modeling. \u003cem\u003eDiscover mental health\u003c/em\u003e, \u003cem\u003e5\u003c/em\u003e(1), 204. https://doi.org/10.1007/s44192-025-00323-1 \u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eAl-Sharari, H. (2024). \u003c/strong\u003ePsychological Stress and Its Relationship to Academic Adjustment among Female University College Students at Al-Taif University. International Journal of Advanced Humanities Research, 4(2), 41-71. doi: 10.21608/ijahr.2024.335233.1048\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eAltaf, S., Malmir, K., Mir, S. M., Olyaei, G., R., Omar, A., Syed, J., 2024\u003c/strong\u003e. Associations between Mental Health, Academic Performance, and Sleep Quality in Physical Therapy Students: A Cross-Sectional Study. Journal of Health and Rehabilitation Research. 4(1): DOI: https://doi.org/10.61919/jhllman, H., 2025rr.v4i1.615\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eAmerican College Health Association (ACHA); 2023.\u003c/strong\u003e \u003cem\u003eNational College Health Assessment III: Undergraduate student reference group executive summary\u003c/em\u003e.\u003cbr\u003e https://www.acha.org/wp-content/uploads/2024/06/NCHA-IIIb_FALL_2023_UNDERGRADUATE_REFERENCE_GROUP_EXECUTIVE_SUMMARY.pdf\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eAppleton, R., Barnett, P., Clarke, C., Yang, J., Begum, S., Edbrooke-Childs, J., Emptage, I., Foye, U., Griffiths, J. L., Hanson, I., Hunt, N. C., Jarvis, R., McAuliffe, M., Maynard, E., Mitchell, L., Mostafa, I., Pemovska, T., Saunders, R., Trevillion, K., Waite, P., \u0026hellip; Johnson, S. (2025). \u003c/strong\u003eApproaches to early intervention for common mental health problems in young people: a systematic review. \u003cem\u003eBMC medicine\u003c/em\u003e, \u003cem\u003e23\u003c/em\u003e(1), 651. https://doi.org/10.1186/s12916-025-04438-8 \u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eAsghar, Muhammad \u0026amp; Minichiello, Angela \u0026amp; Iqbal, Assad. (2023). \u003c/strong\u003eInstitutional Role in the Mental Health and Well-being of Undergraduate Engineering Students: Student and Faculty Perspectives Students: Student and Faculty Perspectives. 10.18260/1-2--43963\u003cstrong\u003e. \u003c/strong\u003e\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eAzizova, A.F. \u0026amp; Baimoldina, L.O. \u0026amp; Rakhimzhanova, G.A.. (2025). \u003c/strong\u003eStructural and practical aspects of supporting the psychological health of students in higher education institutions. Psychology and Cognitive Sciences. 153. 98-116. 10.32523/3080-1893-2025-153-4-98-116. \u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eBannigan, Gr\u0026aacute;inne \u0026amp; McGrath, Denise \u0026amp; Matthews, James. (2025). \u003c/strong\u003eWhole-university approaches to embedding well-being in the curriculum: a scoping review. Frontiers in Education. 10. 10.3389/feduc.2025.1534244. \u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eBarry, M. M., Clarke, A. M., Jenkins, R., \u0026amp; Patel, V. (2013). \u003c/strong\u003eA systematic review of the effectiveness of mental health promotion interventions for young people in low and middle income countries. \u003cem\u003eBMC public health\u003c/em\u003e, \u003cem\u003e13\u003c/em\u003e, 835. https://doi.org/10.1186/1471-2458-13-835 \u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eBatmanov, A., Grigoryeva, I., Calder\u0026oacute;n-Hern\u0026aacute;ndez, B., Roberto Gonz\u0026aacute;lez-T\u0026eacute;llez, Ram\u0026iacute;rez, A. G., 2026. \u003c/strong\u003eBeliefs, information sharing, and mental health care use among university students, Journal of Development Economics, Volume 180, 2026, https://doi.org/10.1016/j.jdeveco.2025.103646. \u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eBiaigo, K., Ray, S., \u0026amp; Ahmed, S. I. (2025). \u003c/strong\u003eAcademic burnout and coping strategies in healthcare students: a scoping review. \u003cem\u003eMedical education online\u003c/em\u003e, \u003cem\u003e30\u003c/em\u003e(1), 2579392. https://doi.org/10.1080/10872981.2025.2579392 \u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eBoulton, Chris \u0026amp; Hughes, Emily \u0026amp; Kent, Carmel \u0026amp; Smith, Joanne \u0026amp; Williams, Hywel. (2019). \u003c/strong\u003eStudent engagement and wellbeing over time at a higher education institution. PLOS ONE. 14. e0225770. 10.1371/journal.pone.0225770.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eBrowning, M. H. E. M., Larson, L. R., Sharaievska, I., Rigolon, A., McAnirlin, O., Mullenbach, L., Cloutier, S., Vu, T. M., Thomsen, J., Reigner, N., Metcalf, E. C., D\u0026apos;Antonio, A., Helbich, M., Bratman, G. N., \u0026amp; Alvarez, H. O. (2021). \u003c/strong\u003ePsychological impacts from COVID-19 among university students: Risk factors across seven states in the United States. \u003cem\u003ePloS one\u003c/em\u003e, \u003cem\u003e16\u003c/em\u003e(1), e0245327. https://doi.org/10.1371/journal.pone.0245327\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eBruffaerts, R., Mortier, P., Kiekens, G., Auerbach, R. P., Cuijpers, P., Demyttenaere, K., Green, J. G., Nock, M. K., \u0026amp; Kessler, R. C. (2018). \u003c/strong\u003eMental health problems in college freshmen: Prevalence and academic functioning. \u003cem\u003eJournal of affective disorders\u003c/em\u003e, \u003cem\u003e225\u003c/em\u003e, 97\u0026ndash;103. https://doi.org/10.1016/j.jad.2017.07.044\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eCampbell, F., Blank, L., Cantrell, A. \u003cem\u003eet al.\u003c/em\u003e (2022).\u003c/strong\u003eFactors that influence mental health of university and college students in the UK: a systematic review. \u003cem\u003eBMC Public Health\u003c/em\u003e 22, 1778 (2022). https://doi.org/10.1186/s12889-022-13943-x\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eCasley, M., Bateson, M., Harris, P., Brookes, D., Allen, V., \u0026amp; McDonald, K. (2025). \u003c/strong\u003e\u0026ldquo;Going the extra mile\u0026rdquo;: A mixed-methods evaluation of an early-intervention youth coaching and diversion programme. \u003cem\u003eJournal of Criminology\u003c/em\u003e, \u003cem\u003e0\u003c/em\u003e(0). https://doi.org/10.1177/26338076251378938\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eCheikh Ismail, L., Osaili, T. M., Mohamad, M. N., Hashim, M., Stojanovska, L., Al Daour, R., Nader, D., Alrayis, H., Alzaabi, N. S., Elbarag, L., Binkhadim, S., Jarrar, A. H., Al Dhaheri, A. S., \u0026amp; Hasan, H. (2022). \u003c/strong\u003ePsychosocial factors affecting dietary habits of university students: A cross-sectional study. \u003cem\u003eHeliyon\u003c/em\u003e, \u003cem\u003e8\u003c/em\u003e(6), Article e09768. https://doi.org/10.1016/j.heliyon.2022.e09768 \u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eChen, D., Wu, Y., Qian, L., \u0026amp; Zhou, Y., (2025). \u003c/strong\u003eThe impact of self-stigma on college students\u0026apos; attitudes toward professional psychological help-seeking: serial-mediated effects of discrimination perceptions and core self-evaluations. Front. Psychol. 16:1630323. doi: 10.3389/fpsyg.2025.1630323 \u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eCruz, J., Llodio, I., Iturricastillo, A., Yanci, J., S\u0026aacute;nchez-D\u0026iacute;az, S., \u0026amp; Romaratezabala, E. (2024). \u003c/strong\u003eAssociation of Physical Activity and/or Diet with Sleep Quality and Duration in Adolescents: A Scoping Review. \u003cem\u003eNutrients\u003c/em\u003e, \u003cem\u003e16\u003c/em\u003e(19), 3345. https://doi.org/10.3390/nu16193345\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003e\u0026Ccedil;ol, B. K., Başaran, A. G., K\u0026ouml;se, B. G., 2024. \u003c/strong\u003eThe impact of health promotion training on university students\u0026rsquo; health perceptions, healthy lifestyle behaviors, and risky behaviors. Health Psychology. Volume 15 - 2024 | https://doi.org/10.3389/fpsyg.2024.1407233\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eC\u0026oacute;rdova Olivera, P., Gasser Gordillo, P., Naranjo Mej\u0026iacute;a, H., La Fuente Taborga, I., Grajeda Chac\u0026oacute;n, A., \u0026amp; Sanjin\u0026eacute;s Unzueta, A. (2023). \u003c/strong\u003eAcademic stress as a predictor of mental health in university students. \u003cem\u003eCogent Education\u003c/em\u003e, \u003cem\u003e10\u003c/em\u003e(2). https://doi.org/10.1080/2331186X.2023.2232686\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eConley, C. S., Kirsch, A. C., Dickson, D. A., \u0026amp; Bryant, F. B. (2014). \u003c/strong\u003eNegotiating the transition to college: Developmental trajectories and psychosocial outcomes. \u003cem\u003eJournal of American College Health, 62\u003c/em\u003e(2), 110\u0026ndash;120.\u003cbr\u003e https://doi.org/10.1080/07448481.2013.850698\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eCooper, B., Border, N., \u0026amp; Couperthwait, F., 2023. \u003c/strong\u003eCo-Creating a Health and Wellbeing Strategy for Students and Staff. A Practice Report. DOI: https://doi.org/10.5204/ssj.2781\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eCowley, E. S., Goss, H. R., Mahon, C., Dunne, C., Belton, S., (2024). \u003c/strong\u003eExploring the health and wellbeing landscape at a third level institution, Wellbeing, Space and Society, Volume 7, 2024,100221,ISSN 2666-5581,https://doi.org/10.1016/j.wss.2024.100221.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eDabou, E. A. A., Adam, S., Mohamed, M. G., Carezon Bedolido, M. G., \u0026amp; Militar, K. A. (2025). \u003c/strong\u003eInvestigating Physical Activity as a Predictor of Psychological Distress in UAE Nursing Students. \u003cem\u003eHealthcare (Basel, Switzerland)\u003c/em\u003e, \u003cem\u003e13\u003c/em\u003e(17), 2112. https://doi.org/10.3390/healthcare13172112\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eDiab, F. M., Al-Sharbatti, S., Eltanbadawy, A. T., Alfahad, R. A., \u0026amp; Elgarawany, G. E. (2025). The \u003c/strong\u003emental health impact of physical inactivity: A study on UAE adolescents. \u003cem\u003ePloS one\u003c/em\u003e, \u003cem\u003e20\u003c/em\u003e(9), e0333346. https://doi.org/10.1371/journal.pone.0333346 \u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eDooris, M., Doherty, S., \u0026amp; Orme, J. (2016).\u003c/strong\u003e The Application of Salutogenesis in Universities. In M. B. Mittelmark (Eds.) et. al., \u003cem\u003eThe Handbook of Salutogenesis\u003c/em\u003e. (pp. 237\u0026ndash;245). Springer. https://doi.org/10.1007/978-3-319-04600-6_23\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eDooris, Mark \u0026amp; Farrier, Alan \u0026amp; Powell, Susan \u0026amp; Holt, Maxine. (2019).\u003c/strong\u003e Whole system approaches to health in higher education: An evaluation of the UK Healthy Universities Network. Health Education. 119. 10.1108/HE-02-2019-0010.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eDuraku, Z. H., Ng, S. K-Y., Grei\u0026ccedil;evci, V., et al., (2025). \u003c/strong\u003eOutcomes of a CBT-based anxiety workshop on higher education students\u0026rsquo; mental health, stigma, learning, and career certainty. \u003cem\u003eJournal of Public Health Research\u003c/em\u003e. 2025;14(4). doi:10.1177/22799036251381227\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eEisenberg, D., Lipson, S. K., \u0026amp; Posselt, J. (2021).\u003c/strong\u003e Promoting resilience, retention, and mental health. \u003cem\u003eJournal of Adolescent Health, 68\u003c/em\u003e(3), 87-93.\u003cbr\u003e https://rossierapps.usc.edu/facultydirectory/publications/219/Eisenberg%20Lipson%20Posselt_2016_Promoting.pdf\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eFabio, R. A., Di Pietro, A., \u0026amp; Suriano, R. (2026). \u003c/strong\u003eSleep Quality, Stress, and Mental Health in College Students: The Protective Role of Optimism and Critical Thinking. \u003cem\u003ePsychiatry International\u003c/em\u003e, \u003cem\u003e7\u003c/em\u003e(1), 5. https://doi.org/10.3390/psychiatryint7010005 \u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eFang, J., Ren, X., \u0026amp; Sotardi, V. A. (2025). \u003c/strong\u003eRethinking Student Wellbeing in Higher Education: A Multifaceted Approach to Stress Management. \u003cem\u003eEducation Sciences\u003c/em\u003e, \u003cem\u003e15\u003c/em\u003e(7), 872. https://doi.org/10.3390/educsci15070872 \u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eGosadi, I. M., \u0026amp; Shnaimer, J. A. (2025). \u003c/strong\u003eAssociation Between Depression, Anxiety, and Stress and Sleep Quality Among University Students from Saudi Arabia: A Cross-Sectional Study. \u003cem\u003ePsychology research and behavior management\u003c/em\u003e, \u003cem\u003e18\u003c/em\u003e, 2287\u0026ndash;2298. https://doi.org/10.2147/PRBM.S562798\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eHan, F., Regalia, M. R., Carisma, R. D. L., (2025). \u003c/strong\u003eThe Impact Of Campus Culture To Student Well \u0026ndash; Being In Chinese Secondary Vocational Schools: Basis For The Development Of Management Model. 2025 IJCSPUB, Volume 15, Issue 1 February 2025 | ISSN: 2250-1770. IJCSPTH00050 International Journal of Current Science (IJCSPUB) www.ijcspub.org 126. https://rjpn.org/ijcspub/papers/IJCSPTH00050.pdf\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eHyseni Duraku, Z., Davis, H., Blakaj, A., Ahmedi Seferi, A., Mullaj, K., \u0026amp; Grei\u0026ccedil;evci, V. (2024). \u003c/strong\u003eMental health awareness, stigma, and help-seeking attitudes among Albanian university students in the Western Balkans: a qualitative study. \u003cem\u003eFrontiers in public health\u003c/em\u003e, \u003cem\u003e12\u003c/em\u003e, 1434389. https://doi.org/10.3389/fpubh.2024.1434389 \u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eJara, Ver\u0026oacute;nica \u0026amp; Pereira, N\u0026aacute;yade \u0026amp; Monsalve, Rodrigo. (2023). \u003c/strong\u003eBarriers perceived to assume promoting health conduct in university students. International Journal of Family \u0026amp; Community Medicine. 7. 151-155. 10.15406/ijfcm.2023.07.00330. \u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eJerrim, J. (2023). \u003c/strong\u003eTest anxiety: Is it associated with performance in high-stakes examinations? \u003cem\u003eOxford Review of Education\u003c/em\u003e, \u003cem\u003e49\u003c/em\u003e(3), 321\u0026ndash;341. https://doi.org/10.1080/03054985.2022.2079616 \u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eKnettel, B. A,. Ganapathy, P., Rougier-Chapman, C., (2024) \u003c/strong\u003eExamining factors associated with mental health stigma and attitudes toward help-seeking among international college students during the COVID-19 pandemic. PLOS Ment Health 1(1): e0000063. https://doi.org/10.1371/journal.pmen.0000063\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eLipson, S. K., Zhou, S., Abelson, S., Heinze, J., Jirsa, M., Morigney, J., Patterson, A., Singh, M., \u0026amp; Eisenberg, D. (2022).\u003c/strong\u003e Trends in college student mental health and help-seeking by race/ethnicity: Findings from the national healthy minds study, 2013-2021. \u003cem\u003eJournal of affective disorders\u003c/em\u003e, \u003cem\u003e306\u003c/em\u003e, 138\u0026ndash;147. https://doi.org/10.1016/j.jad.2022.03.038\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eLi, X., Braakhuis, A., Li, Z., \u0026amp; Roy, R. (2022). \u003c/strong\u003eHow Does the University Food Environment Impact Student Dietary Behaviors? A Systematic Review. \u003cem\u003eFrontiers in nutrition\u003c/em\u003e, \u003cem\u003e9\u003c/em\u003e, 840818. https://doi.org/10.3389/fnut.2022.840818\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eLi, H., (2025). \u003c/strong\u003eStudents\u0026rsquo; wellbeing in positive higher education: conceptual frameworks and influencing factors. Front. Educ. 10:1607364. doi: 10.3389/feduc.2025.1607364 \u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eLiu, Xinqiao \u0026amp; Ping, Siqing \u0026amp; Gao, Wenjuan. (2019). \u003c/strong\u003eChanges in Undergraduate Students\u0026rsquo; Psychological Well-Being as They Experience University Life. International Journal of Environmental Research and Public Health. 16. 2864. 10.3390/ijerph16162864.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eMcLafferty, M., Lapsley, C. R., Ennis, E., Armour, C., Murphy, S., Bunting, B. P., Bjourson, A. J., Murray, E. K., \u0026amp; O\u0026apos;Neill, S. M. (2017).\u003c/strong\u003e Mental health, behavioural problems and treatment seeking among students commencing university in Northern Ireland. \u003cem\u003ePloS one\u003c/em\u003e, \u003cem\u003e12\u003c/em\u003e(12), e0188785. https://doi.org/10.1371/journal.pone.0188785\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eMoore, G. F., Evans, R. E., Hawkins, J., Littlecott, H., Melendez-Torres, G. J., Bonell, C., \u0026amp; Murphy, S. (2019). \u003c/strong\u003eFrom complex social interventions to interventions in complex social systems: Future directions and unresolved questions for intervention development and evaluation. \u003cem\u003eEvaluation (London, England : 1995)\u003c/em\u003e, \u003cem\u003e25\u003c/em\u003e(1), 23\u0026ndash;45. https://doi.org/10.1177/1356389018803219\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eNewton, Joanne \u0026amp; Dooris, Mark \u0026amp; Wills, Jane. (2016). \u003c/strong\u003eHealthy universities: an example of a whole-system health-promoting setting. Global Health Promotion. 23. 57-65. 10.1177/1757975915601037.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eOkanagan Charter for Health Promoting Universities and Colleges. (2015); reaffirmed 2023). \u003c/strong\u003e\u003cem\u003eAn international charter for health-promoting universities and colleges\u003c/em\u003e. https://president.media.uconn.edu/wp-content/uploads/sites/3778/2024/04/Okanagan_Charter_Oct_6_2015.pdf\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eOsborn, T.G., Li, S., Saunders, R. et al., (2022). \u003c/strong\u003eUniversity students\u0026rsquo; use of mental health services: a systematic review and meta-analysis. \u003cem\u003eInt J Ment Health Syst\u003c/em\u003e 16, 57 (2022). https://doi.org/10.1186/s13033-022-00569-0\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eOsborn, T. G., Town, R., Bawendi, M., Stapley, E., Saunders, R., Fonagy, P., (2024). \u003c/strong\u003eUniversity students\u0026rsquo; access to mental health services: A qualitative study of the experiences of health service professionals through the lens of candidacy in England. Journal of Health Services Research \u0026amp; Policy. 2024;29(4):230-239. doi:10.1177/13558196241235877\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003ePimenta, S. M., Hunter, S. C. \u0026amp; Rasmussen, S\u003c/strong\u003e., (2023)The Influence of Stigma and Trust in Young People Seeking Support for Their Own or a Friend\u0026rsquo;s Symptoms: The Role of Threat Appraisals. \u003cem\u003eChild Youth Care Forum\u003c/em\u003e 52, 559\u0026ndash;581 (2023). https://doi.org/10.1007/s10566-022-09698-6\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003ePramesti, Getut \u0026amp; Rohman, Rifki \u0026amp; Cahyarani, Sanggita. (2025). \u003c/strong\u003eHow sleep deprivation and academic stress shape statistical achievement: Evidence of academic resilience in undergraduate learners. Jurnal Elemen. 11. 980-995. 10.29408/jel.v11i4.32075. \u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003ePengpid, S., Peltzer, K., Kassean, H. K., Tsala Tsala, J. P., Sychareun, V., \u0026amp; M\u0026uuml;ller-Riemenschneider, F. (2015).\u003c/strong\u003e Physical inactivity and associated factors among university students in 23 low-, middle- and high-income countries. \u003cem\u003eInternational journal of public health\u003c/em\u003e, \u003cem\u003e60\u003c/em\u003e(5), 539\u0026ndash;549. https://doi.org/10.1007/s00038-015-0680-0 \u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003ePolillo. A., Foussias. G., Wang, W, et. al., (2023). \u003c/strong\u003eCare Pathways and Initial Engagement in Early Psychosis Intervention Services Among Youths and Young Adults. JAMA Netw Open. 2023;6(9):e2333526. doi:10.1001/jamanetworkopen.2023.33526 \u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003ePrieto-Gonz\u0026aacute;lez, P., \u0026amp; Alkouatli, C. (2025). \u003c/strong\u003eIdentifying barriers to physical activity participation and engagement among college students in Riyadh (Saudi Arabia): gender differences in perceived barriers. \u003cem\u003eFrontiers in sports and active living\u003c/em\u003e, \u003cem\u003e7\u003c/em\u003e, 1657854. https://doi.org/10.3389/fspor.2025.1657854 \u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eQuinn, Neil \u0026amp; Wilson, Alistair \u0026amp; Macintyre, Gillian \u0026amp; Tinklin, Teresa. (2009). \u0026lsquo;\u003c/strong\u003ePeople look at you differently\u0026rsquo;: students\u0026rsquo; experience of mental health support within Higher Education. British Journal of Guidance \u0026amp; Counselling. 37. 405-418. 10.1080/03069880903161385. \u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eRadebe, S. S., Breukelman, G. J., Joubert, A. S., \u0026amp; Millard, L. (2025). \u003c/strong\u003ePrimary Motives and Barriers to Physical Activity Participation Among Students Registered at a Semi-Rural University: A Mixed-Methods Study. \u003cem\u003eInternational Journal of Environmental Research and Public Health\u003c/em\u003e, \u003cem\u003e22\u003c/em\u003e(3), 344. https://doi.org/10.3390/ijerph22030344 \u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eRahmi, Kus \u0026amp; Jamaluddin, Zakiyah \u0026amp; Yahaya, Mahathir \u0026amp; Chik, Azlini \u0026amp; Subardhini, Meiti \u0026amp; Huripah, Enung \u0026amp; Fahrudin, Adi. (2025\u003c/strong\u003e). Barriers to accessing mental health services among university students: A systematic review. Environment and Social Psychology. 10. 10.59429/esp.v10i9.3936. \u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eRomeo I, Stanislaw H, McCreary J, Hawley M (2024)\u003c/strong\u003e. The importance of belonging for well-being in college students. PLOS Ment Health 1(1): e0000057. https://doi.org/10.1371/journal. pmen.000005\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eRoy, R., Hebden, L., Kelly, B., De Gois, T., Ferrone, E. M., Samrout, M., Vermont, S., \u0026amp; Allman-Farinelli, M. (2016).\u003c/strong\u003e Description, measurement and evaluation of tertiary-education food environments. \u003cem\u003eThe British journal of nutrition\u003c/em\u003e, \u003cem\u003e115\u003c/em\u003e(9), 1598\u0026ndash;1606. https://doi.org/10.1017/S0007114516000568 \u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eRoy, S., Biswas, A. K., \u0026amp; Sharma, M. (2025). \u003c/strong\u003eStres\u003cstrong\u003es\u003c/strong\u003e, Anxiety, and Depression as Psychological Distress Among College and Undergraduate Students: A Scoping Review of Reviews Guided by the Socio-Ecological Model. \u003cem\u003eHealthcare\u003c/em\u003e, \u003cem\u003e13\u003c/em\u003e(16), 1948. https://doi.org/10.3390/healthcare13161948\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eSalgado, Arnel \u0026amp; Salgado, Jan \u0026amp; Razak, Aqsa \u0026amp; Hussain, Shimna \u0026amp; Fatima, Wafeeqa. (2024). \u003c/strong\u003eMental Health and Resilience of University Students in the United Arab Emirates: A Study on Migrant Students at RAK Medical and Health Sciences University. 10.21203/rs.3.rs-4257679/v2.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eSalama, Rasha \u0026amp; Javaid, Saima \u0026amp; Mohsin, Mariam \u0026amp; Mohsin, Aisha \u0026amp; Wadid, Nihal. (2024). \u003c/strong\u003eAssessment of academic burnout among undergraduate medical and health sciences students: a survey study from the United Arab Emirates. Journal of Public Mental Health. 23. 10.1108/JPMH-04-2024-0050. \u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eShi, H., Zhao, H., He, M., Ren, Z., Wang, S., Cui, L., Zhao, J., Li, W., Wei, Y., Zhang, W., Chen, Z., Liu, H., \u0026amp; Zhang, X. (2023). \u003c/strong\u003eThe mediating roles of coping styles and academic burnout in the relationship between stressors and depressive symptoms among Chinese postgraduates. \u003cem\u003ePeerJ\u003c/em\u003e, \u003cem\u003e11\u003c/em\u003e, e16064. https://doi.org/10.7717/peerj.16064\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eSiddiqui, Aesha \u0026amp; AlAmri, Saad \u0026amp; AlKatheri, Assaf \u0026amp; AlHassani, Khalid. (2017). \u003c/strong\u003ePerceived stress in Saudi undergraduate medical students. Journal of Medical and Allied Sciences. 7. 41. 10.5455/jmas.252925. \u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eStallman, H., (2010)\u003c/strong\u003e. Psychological distress in university students: A comparison with general population data. DOI: 10.1080/00050067.2010.482109\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eStallman, Helen \u0026amp; Lipson, Sarah \u0026amp; Zhou, Sasha \u0026amp; Eisenberg, Daniel. (2020). \u003c/strong\u003eHow do university students cope? An exploration of the health theory of coping in a US sample. Journal of American College Health. 70. 1-7. 10.1080/07448481.2020.1789149.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eTam, R., Yassa, B., Parker, H., O\u0026apos;Connor, H., \u0026amp; Allman-Farinelli, M. (2017).\u003c/strong\u003e University students\u0026apos; on-campus food purchasing behaviors, preferences, and opinions on food availability. \u003cem\u003eNutrition (Burbank, Los Angeles County, Calif.)\u003c/em\u003e, \u003cem\u003e37\u003c/em\u003e, 7\u0026ndash;13. https://doi.org/10.1016/j.nut.2016.07.007 \u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eTakshe A. A, Khatib R. E, Contu D, Shehaiber S. N, Alkaabi M. (2022). UAE University Students\u0026rsquo; Dietary Practices and Lifestyles at times of COVID-19: A Cross Sectional Study. Curr Res Nutr Food Sci 2022; 10(2). doi : \u003c/strong\u003e\u003cstrong\u003ehttp://dx.doi.org/10.12944/CRNFSJ.10.2.20\u003c/strong\u003e\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eTsouros, A. D., Dowding, G., Thompson, J., \u0026amp; Dooris, M. (1998/updated framework applied). (2021).\u003c/strong\u003e \u003cem\u003eHealth-promoting universities: Concept, experience and framework for action\u003c/em\u003e. World Health Organization Regional Office for Europe\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eVenkatasubramanian P. (2022). \u003c/strong\u003eUniversity Wellness Program-A Pedagogic Innovation to Nudge Wellness and Sustainability Among Students. \u003cem\u003eFrontiers in public health\u003c/em\u003e, \u003cem\u003e10\u003c/em\u003e, 844024. https://doi.org/10.3389/fpubh.2022.844024 \u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eVomhof, M., Bau, J., H\u0026uuml;ter, P., Stehl, S., Haastert, B., Loerbroks, A., Icks, A., Calo, S., Schuster, L., Pischke, C., Kairies-Schwarz, N., Angerer, P., Apolin\u0026aacute;rio-Hagen, J., (2024). \u003c/strong\u003ePreferences Regarding Information Strategies for Digital Mental Health Interventions Among Medical Students: Discrete Choice Experiment. JMIR Form Res 2024;8:e55921. URL: https://formative.jmir.org/2024/1/e55921. DOI: 10.2196/55921 \u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eWorld Health Organization. (1998).\u003c/strong\u003e \u003cem\u003eHealth-promoting universities and colleges: A framework for action\u003c/em\u003e. https://iris.who.int/server/api/core/bitstreams/b90c3808-b480-431c-b650-ac344c3e4b6b/content\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eYoung, Tarli \u0026amp; MacInnes, Sarah \u0026amp; Aaron, Jarden \u0026amp; Colla, Rachel. (2020). \u003c/strong\u003eThe impact of a wellbeing program imbedded in university classes: the importance of valuing happiness, baseline wellbeing and practice frequency. Studies in Higher Education. 47. 1-20. 10.1080/03075079.2020.1793932. \u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eYuting, L., \u0026amp; Rashid,R. B. A., (2025). \u003c/strong\u003eBeyond the books: How sleep, school belonging, and physical activity affect the mental health of students under academic stress, Acta Psychologica, Volume 258, 2025, 105213, ISSN 0001-6918, https://doi.org/10.1016/j.actpsy.2025.105213. \u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eZhang, J.,Peng, C.,Chen, C., (2024).\u003c/strong\u003e Mental health and academic performance of college students: Knowledge in the field of mental health, self-control, and learning in college, Acta Psychologica,Volume 248, 2024, https://doi.org/10.1016/j.actpsy.2024.104351.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eZhang, J., Meng, J., \u0026amp; Wen, X., (2025)\u003c/strong\u003e The relationship between stress and academic burnout in college students: evidence from longitudinal data on indirect effects. Front. Psychol. 16:1517920. doi: 10.3389/fpsyg.2025.1517920\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 7 are available in the Supplementary Files section.\u003c/p\u003e\n"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Health-promoting university, Student well-being, Mixed-methods research, Stress, Physical activity, Nutrition, Campus health, Needs assessment, Abu Dhabi University","lastPublishedDoi":"10.21203/rs.3.rs-8892778/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8892778/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eUniversities are increasingly recognized as critical settings for promoting student health and well-being through whole-system, evidence-based approaches. Abu Dhabi University (ADU) initiated a Health and Wellness Initiative; however, a comprehensive needs assessment was required to inform the development of a structured, culturally responsive program. This study aimed to assess students\u0026rsquo; health behaviours, perceived stress, wellness priorities, and program preferences, and to integrate quantitative and qualitative findings to guide institutional program development.\u003c/p\u003e \u003cp\u003eA convergent mixed-methods design was employed. Quantitative data were collected via an online survey completed by 188 undergraduate and postgraduate students across ADU campuses, assessing physical activity, perceived stress, satisfaction with campus food options, barriers to healthy behaviours, and preferences for wellness services and delivery formats. Descriptive statistics and chi-square tests examined patterns by gender and campus. Qualitative data were gathered through six focus group discussions and analysed using reflexive thematic analysis to explore lived experiences, contextual barriers, and student-generated recommendations. Integration occurred at the interpretation stage.\u003c/p\u003e \u003cp\u003eOverall, 42.6% of students reported high or very high stress, 29.3% reported low physical activity, and 26.6% were dissatisfied with healthy food options on campus. Students expressed strong interest in stress management, time-management, mindfulness-based activities, and group-based physical activity, with a preference for in-person or hybrid delivery outside academic hours. Qualitative findings revealed that stress was chronic and structurally driven by academic and institutional factors, while engagement in healthy behaviours was constrained by time, fatigue, cost, and campus environments. Students emphasized the need for accessible, low-stigma, integrated wellness programming embedded into campus life.\u003c/p\u003e \u003cp\u003eThese findings provide a robust empirical foundation for developing a holistic, student-centred Health and Wellness Program and support the advancement of ADU as a health-promoting university.\u003c/p\u003e","manuscriptTitle":"Mixed methods needs assessment of student health and wellness to inform university health promotion programming at Abu Dhabi University","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-06 09:26:20","doi":"10.21203/rs.3.rs-8892778/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-16T10:56:26+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-13T19:01:14+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-12T20:11:52+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-11T14:33:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"46022960618388012328091379385109080506","date":"2026-03-10T20:20:06+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-10T18:44:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"300098815692937735045378475041087180809","date":"2026-03-10T17:03:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"103914672297553576541781456495700214135","date":"2026-03-09T06:34:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"132066499623612024968479670418864473979","date":"2026-03-09T03:58:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"69910432620572995937132476914636412576","date":"2026-03-09T01:33:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"278996181594888404692503101744720767463","date":"2026-03-06T20:20:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"221746945352342739315870386090682759373","date":"2026-03-03T16:08:52+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-03T09:39:08+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-03T07:51:48+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-02T16:58:49+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-28T18:03:10+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Public Health","date":"2026-02-28T17:56:57+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2803e182-a9a1-414b-b7ef-f4f445f9d6be","owner":[],"postedDate":"March 6th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-08T10:38:59+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-06 09:26:20","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8892778","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8892778","identity":"rs-8892778","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}