University of Southern California Dissertations and Theses

Assessing student burnout using the AllWell? survey at Aalto University: an evaluation study

(USC Thesis Other)

Assessing student burnout using the AllWell? survey at Aalto University: an evaluation study

PDF

Download a page range

Download transcript

Copy asset link

Request this asset

Transcript (if available)

Content Running head: HEALTH AND WELLNESS 1
ASSESSING STUDENT BURNOUT USING THE ALLWELL? SURVEY AT AALTO
UNIVERSITY: AN EVALUATION STUDY
by
Alan Cromlish
A Dissertation Proposal Presented to the
FACULTY OF THE USC ROSSIER SCHOOL OF EDUCATION
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF EDUCATION
August 2019
Copyright 2019 Alan Cromlish
HEALTH AND WELLNESS 2
ACKNOWLEDGEMENTS
I would like to thank my parents. They fostered my core beliefs and values that
cultivated my curiosity about the world, my drive to seek out new experiences, and my desire to
always learn. Nothing would have been possible without them and their support.
Thank you Soo for your support and a source of inspiration on this journey. I needed it
more than I could ever express. I look forward to continuing traveling the world and having new
experiences with you.
Thank you to Dr. Jenifer Crawford for your support, guidance, and leadership throughout
this process. Your energy and enthusiasm are second to none, and I will always appreciate your
ability to lift myself and others during this process.
Thank you to Dr. Robert Filback to provide the necessary guidance and advice to allow
this work to have a wider reach.
Thank you to Dr. Helena Seli for your expertise on learning theory as well as the travel
tips for Estonia.
I would like to say a special thanks to Dr. Mark Robison and Dr. Robert Filback for
designing a world-class program that emphasizes education in a variety of local contexts as well
as global education in an increasingly connected world.
Thank you Cohort 6 for all the wonderful memories we created around the world. I look
forward to what the future holds for you all, and I hope to see you all as we continue to improve
education across the world in our own ways.

HEALTH AND WELLNESS 3

TABLE OF CONTENTS
ACKNOWLEDGEMENTS 2
LIST OF TABLES 6
LIST OF FIGURES 7
ABSTRACT 8
CHAPTER ONE: INTRODUCTION 9
Background of the Problem 9
Higher Education Communities 10
Importance of Addressing the Problem 11
Organizational Context and Mission 12
Organizational Goal 14
Description of Stakeholder Groups 15
Stakeholder Groups’ Performance Goals 16
Stakeholder Group for the Study 18
Purpose of the Project and Questions 18
Conceptual and Methodological Framework 20
Definitions 20
Organization of the Study 21
CHAPTER TWO: REVIEW OF THE LITERATURE 22
Societal Focus on Wellness 22
Well-Being 22
Wellness 24
Defining Wellness 25
Health Promotion 28
Healthy Settings 31
Health and Wellness Issues in Higher Education 32
Healthy Universities 35
Implications of a Healthy University 39
Student Burnout 40
Student Knowledge, Motivation, and Organizational Influences 43
Knowledge and Skills 44
Motivation 47
Organizational Influences 52
CHAPTER THREE: METHODS 55
Participating Stakeholders 55
Survey Sampling Recruitment Strategy and Rationale 56
Interview Sampling Strategy and Rationale 57
Interview Sampling Criterion and Rationale 58
Data Collection and Instrumentation 58
Surveys 59
Interviews 60
Documents 60
Data Analysis 61
Credibility and Trustworthiness 62
Validity and Reliability 63
HEALTH AND WELLNESS 4

Ethics 63
Limitations and Delimitations 66
CHAPTER FOUR: RESULTS AND FINDINGS 68
Student Knowledge and Skills: Knowledge Findings 69
Conceptual Knowledge – Types of Learning 72
Conceptual Knowledge: Dimensions of Wellness 72
Procedural Knowledge: Managing the Symptoms of Burnout 74
Procedural Knowledge: Studying Effectively 76
Procedural Knowledge: Supporting Wellness 78
Metacognitive Knowledge: Managing Burnout 80
Metacognitive Knowledge: Studying Effectively 81
Metacognitive Knowledge: Supporting Wellness 84
Synthesis of Results and Findings for Knowledge Influences 87
Student Motivation: Motivation Findings 88
Utility Value: Value in the AllWell? Survey 89
Self-Efficacy: Ability to Apply Results 92
Goal Orientation: Desire to Improve Study Ability 94
Synthesis of Results and Findings for Motivation Influences 95
Organizational Influences: AU Culture and Resources 96
Cultural Model Influence: Supportive Culture for Study Ability 97
Cultural Model Influence: Students’ Feelings of Support by AU 98
Cultural Setting Influence: Availability of Resources 100
Cultural Setting Influence: Promotion of AllWell? Survey 102
Synthesis of Results and Findings for Organizational Influences 105
Conclusions 105
CHAPTER FIVE: RECOMMENDATIONS, IMPLEMENTATION, AND EVALUATION 107
Validated Needs and Proposed Solutions 107
Proposed Solution 1: Continuing Supportive Development 109
Proposed Solution 2: Positive Cultural Shift 110
Proposed Solution 3: Positive Curriculum Changes 111
Proposed Solution 4: Adopt Healthy University Framework 111
Implementation 112
Strategies and Action Steps 113
Resource Needs 115
Constraints 115
Evaluation 116
Level 1: Reactions 120
Level 2: Learning 120
Levels 3: Behavior 121
Level 4: Results 122
Future Research 123
Conclusion 124
REFERENCES 125
APPENDIX A Survey Items 144
APPENDIX B Interview Protocol 146
APPENDIX C Knowledge, Motivation, Organizational Influences 147
HEALTH AND WELLNESS 5

APPENDIX D Informed Consent for Non-Medical Research 150
APPENDIX E 153

HEALTH AND WELLNESS 6

LIST OF TABLES
Table 1 Organizational Mission and Performance Goals 17

Table 2 Assumed Knowledge Influences 47

Table 3 Assumed Motivation Influences 51

Table 4 Assumed Organizational Influences 54

Table 5 Demographics of Survey Participants 69

Table 6 Assumed Knowledge Influences and Validation 70

Table 7 Select Quotes from AU Students’ Interviews Around Feedback from AllWell? Survey 81

Table 8 Select Quotes from AU Students Around Metacognitive Knowledge to Support
Wellness 86

Table 9 Assumed Motivational Influences and Validation 89

Table 10 Assumed Organizational Influences and Validation 96

Table 11 Select Quotes from AU Students Around the AllWell? Survey 104

Table 12 Summary of Validated Findings and Proposed Solutions 108

Table 13 Summary of Partially Validated Findings and Proposed Solutions 109

Table 14 Solution, Action Steps, and Implementation Timeline 113

Table 15 Evaluation Plan (Kirkpatrick & Kirkpatrick, 2006) 117

HEALTH AND WELLNESS 7

LIST OF FIGURES
Figure 1: Students responses to survey question 4 – I know the benefits of wellness. 74
Figure 2: Students’ responses by school to survey question 6 – I can locate where university
support systems are on campus. 76
Figure 3: Students’ responses by school to survey question 5 – Overall, I have been organized
in my studying. 78
Figure 4: Students’ responses by school to survey question 7 – I believe that I can assess how
I study well. 82
Figure 5: Students’ responses by school to survey question 8 – I believe that I can assess how
I am weak at studying. 83
Figure 6: Frequency of student’s ideas to improve study ability. Students’ responded to
interview question 3a, “How can you improve your study ability?” 85
Figure 7: Comparing student responses about who AU resources can help. 90
Figure 8: Students responses to Q12, “If I complete the AllWell? recommendations, my study
ability will improve.” 92
Figure 9: Student responses to Q13, “I can do well in my studies.” 93
Figure 10: Students’ responses to survey Q14, “The AllWell? survey’s connections can help
me graduate.” 95
Figure 11: Student response by school to survey Q15, “Aalto University supports my ability
to study effectively.” 97
Figure 12: Frequency of students’ feelings of AU support. 99
Figure 13: Student response by school to survey Q19, “Aalto University has resources that
will help me study better.” 101
Figure 14: Student response by school to survey Q16, “Aalto University encourages me
participating in the AllWell? survey 103

HEALTH AND WELLNESS 8

ABSTRACT
For decades, health issues continue to rise in students in higher education. These physical,
mental, and social health issues impact learning and academic performance. The current
solutions to treat issues allows students to get the necessary medical help to improve their
situation but improving overall health and awareness would allow for prevention of these issues
occurring through promoting optimal health. This study examined the effectiveness of Aalto
University’s AllWell? survey to provide feedback and resources to students about their study
ability. Using the KMO framework, this study examined students who completed the AllWell?
survey in 2018 to better understand the AllWell? survey and students’ interactions with its
feedback. The study found that overall students possess the knowledge and motivation to
improve their study ability, but the differences in the schools on campus should be examined.

HEALTH AND WELLNESS 9

CHAPTER ONE: INTRODUCTION
Improving wellness has significant effects on people across the globe and crosses
geographical and cultural boundaries. When wellness is low, mental health issues can arise. In
2017, over one million people worldwide were affected by mental health issues (World Health
Organization, 2017). Within higher education, mental health issues are among the factors most
reported to affect students’ academic and personal lives (American College Health Association,
2017; Finnish Student Health Services, 2018).
Viewing health as a lack of illness instead of aiming to be healthier inhibits our ability to
flourish as individuals and thrive as a society (Huffman et al., 2016; Ji, Holmes, & Blackwell,
2017; Seligman, Schulman, DeRubeis, & Hollon, 1999). Re-conceptualizing health to live
optimally where we work, play and live allows individuals and the community to promote health
throughout individuals’ lives. Focusing on improving health and wellness instead of treating
illness can improve the lives of healthy individuals as well as those with mental health issues
(Chida & Steptoe, 2008; Hone, Jarden, Schofield, & Duncan, 2014; Pretty et al., 2017).
Background of the Problem
It is important to understand the contextual factors that affect our health and wellness.
Subjective beliefs, healthy settings, well-being, and wellness are paramount to promoting health.
Additionally, reshaping how we conceptualize health is important; shifting from a lack of illness
to promoting optimal health needs to occur for us to live a more holistic, healthier life. Focusing
on improving our health, considering these factors, can lead to greater happiness, increase life
satisfaction, increase emotions, and prevent diseases (Diener, 1984; Diener & Chan, 2011;
Dooris, 2009). Because of the complexity of subjective well-being and the variety of factors that
are associated with it, the World Health Organization recommended a healthy setting approach to
HEALTH AND WELLNESS 10

improve not only subjective well-being, but also overall well-being to achieve health (World
Health Organization, 1986).
Higher Education Communities
Higher education institutions play a key role in students’ development as academics and
as individuals and have been trying to address health issues. However, these attempted initiatives
usually lack support from the leadership or coordination with a local health agency (Doherty &
Dooris, 2006). Supporting health and wellness on campus requires holistic strategies that
embrace the core values of health and wellness. Additionally, the universities’ holistic strategies
for health and wellness should align with community health. With these aligned, higher
education institutions can create a healthy, sustainable working and learning environment that
promotes both the flourishing of individuals and a thriving community (Dooris, Cawood,
Doherty, & Powell, 2010). This will allow students’ non-cognitive skills to flourish within the
thriving university community.
It is important that this system-wide change happen on all levels. The health of the
campus is directly linked to the health of the members within it. Creating a sustainable, healthy
campus is necessary to promote thriving communities for individuals to flourish, and it is
necessary that higher education institutions continue to attract, develop, and promote quality
students, staff, faculty, and researchers (American College Health Association, 2018; Dooris,
2009; Okanagan Charter, 2015; van den Berg et al., 2015; World Health Organization, 1991).
This means placing an emphasis on promoting health and well-being instead of treating illness.
Promoting health within higher education provides benefits to students’ overall health
and wellness along with their academic performance. Improving health and wellness at
universities provides students the opportunity to perform optimally academically in addition to
HEALTH AND WELLNESS 11

preventing mental illness that hinders academic performance (Richardson, Abraham, & Bond,
2012). Increased GPA, engagement, and productivity have been linked with student wellness,
and provide evidence that universities must consider supporting all the needs of students if they
want them to perform at their best (Grossmeier, Mangen, Terry, & Haglund-Howleson, 2015;
Keyes, 2007a; Walton & Cohen, 2011). These benefits of improving student wellness also
contribute to decreasing the stressors and health issues commonly experienced by students in
higher education.
Across the world, students enrolled in higher education experience various stressors that
impact their health and wellness. This could lead to increased burnout. University is a time of
transition and challenges for students personally and academically. Students across the world
feel increased stress, feelings of inadequacy, and pressure to succeed. This environment has led
to students reporting high levels of stress, lack of sleep, and mental health issues (American
College Health Association, 2017; Finnish Student Health Services, 2018). Burnout stems from
exhaustion, cynicism, and ineffectiveness, and this is directly impacted by the stress and effects
from universities (Marek, Schaufeli, & Maslach, 2017). These factors contribute to the 59%
graduation rate in the United States and the 53% graduation rate in Finland (OECD, 2018b) in
addition to the mental health issues present in over half of American students and 33% of Finnish
students (American College Health Association, 2017; Finnish Student Health Services, 2018).
Students are starting university, but they are not receiving the necessary support from the
university to succeed.
Importance of Addressing the Problem
Higher education institutions play a key role in students’ development. Universities help
lay the foundation for a balanced life that promotes health and wellness within all aspects of the
HEALTH AND WELLNESS 12

individual (Hoyt, Chase-Lansdale, McDade, & Adam, 2012). Mental health concerns are
common for students within higher education, and depression, anxiety, stress, and suicide are
prevalent issues that affect students personally and academically (American College Health
Association, 2017; Killian, 2017). The promotion of health and wellness encourages students to
live healthier lives. Moreover, it acts as a preventive measure for disease and improves retention
and academic performance (Diener & Chan, 2011; Dooris, 2009; Hettler, 1980; Johnstone,
Rooney, Hassan, & Kane, 2014; Seligman, 2011).
Supporting student health and wellness on campus must occur if burnout is to be reduced.
Creating support for students across all areas of life, including academics, is required if students
are to live optimally. Creating a supportive environment that provides care across all areas of a
student’s life is necessary to allow the individual to perform their best academically and be at
their best holistic health both as individuals and as a community (Dooris, 2009). This promotion
of healthy behavior and increased wellness also prevents diseases that affect students
academically and personally (Dooris, Cawood, Doherty, & Powell, 2010; Killian, 2017; Tsouros,
Dowding, Thompson, Dooris, & World Health Organization, 1998)
Organizational Context and Mission
Aalto University (AU) is a public research institution located in Helsinki, Finland. It was
founded in 2010 from the merger of three historical universities, Helsinki University of
Technology, Helsinki School of Economics, and the University of Art and Design Helsinki. AU
is a foundation-based university where the Finnish government donated the majority of the
capital needed, amounting to 500 million euros. Finnish industries and financiers donated the
remaining sum, at least 200 million euros. It is a competitive university that ranked
• 5
th
in the world by Business of Fashion
HEALTH AND WELLNESS 13

• 140
th
in the world by Quacquarelli Symonds (QS) overall
• 9
th
in the world by QS in Art in Design
• 9
th
by QS for universities that are established within the last 50 years,
• 22
nd
by Times Higher Education (THE) for universities that are established within the last
50 years
• 58
th
by the THE for Business and Economics
• 190
th
by THE in the world overall in 2018
Domestically, AU is the top-ranked school for technology, business, and art and design
(AU, 2018). The university enrolls 12,113 full-time students, 10,819 of whom are bachelor’s
and master’s students, and 1,294 are doctoral students. Approximately 60% of the student
population is male. The university employs 386 professors, 411 students as research and teaching
assistants, 1,228 service personnel, 997 doctoral students, 505 post-doc researchers, and 462
other teaching and research personnel for a combined 3,989 faculty members. Of the staff at
AU, 62% of the staff is male (AU, 2018).
AU’s mission is to shape the future by using science and art alongside technology and
business. The university envisions an innovative society that uses systemic solutions that
accelerate innovation to have breakthrough discoveries that are integrated with design and
business. This is accomplished through their values of passion, courage, freedom, responsibility,
and integrity to research their strategic objectives that focus on research and innovation, art and
creative practices, education, collaborative campus, and advancement of the academic mission
(AU, 2018). In 2016, AU created the AllWell? survey and resources to assist students in
understanding their risk of burnout and provide feedback. AU wants to expand and continue to
create support for students’ mental, physical, and social health.

HEALTH AND WELLNESS 14

Organizational Goal
AU’s goal is to reduce the student burnout rate from 20% to 10% by 2020 through the
Success of Students initiative (AU, 2018). Reducing burnout requires an increase in study ability
through four areas: teacher, personal resources, study skills, study environment, and support
throughout campus personally and academically. AU aims to increase student health and
wellness through its Success of Students initiative that aims to create support for students within
the university using student-submitted information. Reducing the burnout rate of students on
campus through the promotion of health emphasizes the university’s commitment to creating a
culture that promotes health and wellness, provides students the necessary support, and prevents
health issues through this promotion of health.
The initiative aims to increase student health and wellness by developing teaching, study
skills, student services, and study advising (AllWell? study, 2018). The initiative uses a survey
called the AllWell? survey to assess student burnout and link students to the resources necessary
to develop well-being, wellness, and study ability. The AllWell? survey is distributed through
AU’s email system to all second-year undergraduate and first-year master level students in
February of every year. The AllWell? survey assesses student burnout through students’
personal experiences and interpretations and provides individual feedback to each student via
email. This email addresses 14 areas of study ability and how they can reduce their risk of
burnout by providing online information, support programs, or classes. This feedback aims to
improve the areas that students perceive as weak in terms of improving their study ability. In
addition to each student receiving feedback, the student’s major and college also receive the
feedback to improve upon the teaching conducted at the university to better support students.

HEALTH AND WELLNESS 15

Description of Stakeholder Groups
Students directly benefit and contribute to the organizational goals. Student success is
necessary for the university to continue operations. For optimal performance, it is important that
students are holistically well. Students need to be healthy holistically to be able to succeed
academically (Richardson et al., 2012; Walton & Cohen, 2011). Holistic health is difficult for
students to achieve since university students tend to participate in unhealthy behaviors (Heller &
Sarmiento, 2016; Hopper & Moninger, 2017; Turner & Shu, 2004). In Finland, 72% of higher
education students in 2016 reported a recurring or long-term illness that had been diagnosed by a
dentist, physician, or psychologist (Finnish Student Health Services, 2018; Kunttu, Pesonen, &
Saari, 2016). Through the promotion of health and knowledge of the wellness services offered
by AU, students can increase their overall wellness and decrease illnesses (Baldwin, Towler,
Oliver, & Datta, 2017; Hoyt et al., 2012).
The AllWell? survey staff is part of the student health services, and it is vested in the
organization’s goal of a healthy campus. The staff, employees, and faculty associated with the
AllWell? survey the additional resources provided need to be healthy. They need to lead by
example. The center needs to offer services that promote mental, social, and physical health and
well-being to the students, staff, and faculty of the university to promote a healthy campus.
When offering these services, it is important that the employees are certified in their discipline.
Additionally, the staff needs to focus on improving the campus to create communities to promote
learning and meet the students’ needs for health and well-being. The AllWell? survey’s holistic
concept to health and well-being is imperative to evaluating the health and well-being of the
campus and how to support the campus both immediately and its future (AU, 2018).
HEALTH AND WELLNESS 16

The administration will work from the top down to achieve the goals of the organization.
The president, executive level administrators, deans, and heads of the departments must work to
foster a healthy campus, and it starts with creating policies that place an emphasis on well-being
and health across the campus. The administration needs to fund initiatives on campus to create
learning environments that provide opportunities to support student wellness. It is necessary that
the administration support the Success of Students initiative that will focus on improving
wellness on campus. It is vital that this center is well funded to support the students and
employees of the campus to promote a healthy campus.
Stakeholder Groups’ Performance Goals
The performance goals for each stakeholder are key to the organization’s success.
Students, the staff associated with the AllWell? survey and its resources, and the administration
all play an important role in increasing flourishing on campus within the student population.
Each stakeholder must complete the goals outlined for the organization’s performance goal to be
successful.
It is imperative that students understand health and wellness. They should understand the
main dimensions of wellness and their interrelatedness. The students need to use the resources at
AU to better understand their own health and wellness. Improving their health and wellness will
decrease their risk of burning out, improve their academic performance, and improve students’
chances of graduation (Richardson et al., 2012; Walton & Cohen, 2011).
The learning services department plays an important role on campus through being a
pillar of information, planning, and health and wellness promotion. The learning services
department works with the Success of Students initiative to provide resources for the students to
connect to after taking the AllWell? survey. The AllWell? survey is a questionnaire currently
HEALTH AND WELLNESS 17

given to second-year bachelors’ students and first-year masters’ students to provide personalized
feedback to promote stress management, study skills, procrastination, and emotional
management. The learning services department plays a key role in decreasing the number of
students at risk of burning out through the improvement of wellness through workshops for
teachers and students, support students with courses and workshops to improve study skills, and
courses to improve supervision skills.
Table 1
Organizational Mission and Performance Goals
Organizational Mission
The mission of Aalto University is to shape the future by combing science and art with technology and
business.
Organizational Performance Goal
By 2020, Aalto University aims to decrease risk of burnout from 20% to 10% for students who
participate in the AllWell? survey by increasing three key skills: personal resources, study skills, and
study environment.
Students
By 2020, students will increase their
study ability.

Learning Services
By 2020, the AllWell?
services staff will increase
participation in the AllWell?
survey.
Administration
By 2020, the administration will
add health and wellness
programs as part of AU’s
strategic plan.

The administration provides a top-down approach to health and wellness within the
organization. The administration needs to add health and wellness policies that show that the
organization values health and well-being as well as include it in their strategic plan when
looking towards the future to improve the health and well-being of the students, staff, and
faculty. The administration is also responsible for the physical construction of the campus, and,
therefore, it should invest into healthy buildings that promote health and well-being. By
providing policy, future goals, and healthy buildings, student flourishing can improve allowing
HEALTH AND WELLNESS 18

for improve health, well-being, and academic performing and thus improving retention rates and
graduation rates.
Stakeholder Group for the Study
While the joint efforts of all stakeholders will contribute to the achievement of the overall
organizational goal of implementing a systematic method to ensure the increased health and
well-being goals are met, it is important to understand the needs of the students on campus.
Therefore, the stakeholders of focus for this study will be second-year AU undergraduate
students and first-year AU master’s level students. The stakeholders’ goal, supported by the
students, Student Health Services, and the administration, is that students will improve their
study ability through personal resources, study skills, and study environment.
A college campus is more than just education; it is a home for many people. Students
live, eat, play, work, and learn within the environment created by the staff, faculty, and
administration. It is imperative that those creating the environment for the students to enter into
are supportive, knowledgeable, and motivated. Students must be able to seek out support when it
is needed to assist with their physical, mental, or social health and well-being or the academic
endeavors. Through the creation of this environment, students should be studied to better
understand how the organization disseminates knowledge and motivates students to increase
health and wellness within AU.
Purpose of the Project and Questions
The purpose of this project is to evaluate the degree to which AU is achieving its goal of
improving health and wellness through improved student study skills and decreasing the students
at risk of burning out. The analysis will focus on knowledge, motivation, and organizational
influences related to achieving this organizational goal. While a complete needs’ analysis would
HEALTH AND WELLNESS 19

focus on all stakeholders, for practical purposes the stakeholder of focus in this analysis includes
all students who completed the AllWell? survey in 2018 at AU. As such, the questions that
guide this study are the following:
1. What are the knowledge and motivation related to the three skills the AllWell? survey
promotes for students who participated in the 2018 AllWell? survey and resources?
2. What is the interaction between AU culture and context and AU students’ capacity to
improve study ability?
3. What are the recommendations for organizational practice in the area of knowledge,
motivation, and organizational resources?
By better understanding the knowledge and motivation of the students and how they
interact within the organization as well as the local culture, student health and wellness can be
increased. Knowing how AU’s culture impacts the students’ knowledge and motivation to
increase health and wellness, there can specific changes that will directly affect the students. By
promoting health and wellness, the students can flourish individually and thrive within the
college community, thus promoting non-cognitive skills to increase GPA, chances of graduation,
and lower dropout rates.
The university can promote health and wellness to ensure that students at AU are
supported and can perform at their best. Promoting health and wellness will allow students to
increase their social, physical, and emotional health. The benefits of health promotion include
higher academic performance and a healthy student who feels wanted by the community,
supported by peers and staff, and has mental and physical support systems to support the students
and thus decrease the risk of feelings of burnout.

HEALTH AND WELLNESS 20

Conceptual and Methodological Framework
Clark and Estes’ (2008) gap analysis, a systematic, analytical method that helps to clarify
organizational goals and identify the gap between the actual performance level and the preferred
performance level within an organization, will be adapted for needs’ analysis as the conceptual
framework. The methodological framework is a mixed-methods case study with descriptive and
inferential statistics. Assumed knowledge, motivation, and organizational needs will be
generated based on personal knowledge and related literature. Using surveys, interviews,
literature review, and content analysis will attempt to validate these assumed needs. Research
based solutions will be recommended and evaluated in a comprehensive manner.
Using the gap analysis model, the study will explore the students’ knowledge of health
and wellness as well as the services offered at AU to promote flourishing students and a thriving
community the study will also examine the student motivation to use those services to improve
their own health and wellness. Additionally, the study explored AU as an organization. By
doing so, we can understand AU’s role and the culture within AU and how it effects the students’
knowledge and motivation. Finally, it is important to understand the regional culture and its
impact on the students’ knowledge and motivation to improve health and wellness and AU as an
organization.
Definitions
Burnout – a syndrome of emotional exhaustion, depersonalization, and reduced personal
accomplishment
Flourish – having high well-being and low mental illness; a construct of mental health
Health - a state of complete physical, mental, and social well-being and not merely the absence
of disease or infirmity
HEALTH AND WELLNESS 21

Thriving - optimal functioning in academia, engagement, relationships, and well-being; creative
adaptation and acquiring better coping skills when faced with a challenge
Well-being – the presence of positive emotions, engagement, positive relationships, meaning,
and accomplishment
Wellness – optimal state of health of individuals and groups that is allows the individual to
realize their fullest potential and fulfill their role in their settings in life
Organization of the Study
Five chapters are used to organize this study. This chapter provided the reader with the
key concepts and terminology commonly found when discussing health and wellness promotion.
The organization’s mission, goals and stakeholders as well as the initial concepts of gap analysis
adapted to needs analysis were introduced. Chapter Two provides a review of current literature
surrounding the scope of the study. Topics of wellness, health issues in higher education, health
promotion, healthy universities, and burnout will be addressed. Chapter Three details the
assumed needs for this study as well as methodology when it comes to choice of participants,
data collection, and analysis. In Chapter Four, the data and results are assessed and analyzed.
Chapter Five provides solutions, based on data and literature, for addressing the needs and
closing the performance gap as well as recommendations for an implementation and evaluation
plan for the solutions.
HEALTH AND WELLNESS 22

CHAPTER TWO: REVIEW OF THE LITERATURE
Reviewed in this chapter are the current trends in health promotion and wellness, the
importance of health promotion, the implications of health promotion, and an established
Healthy University Framework. This chapter also reviews learning and motivation theory,
paying special attention to knowledge and skills, motivational, and organizational issues.
Finally, staff knowledge, motivation, and organizational factors specific are reviewed.
Societal Focus on Wellness
A societal focus on wellness can promote optimal health and wellness in individuals and
communities. Improving wellness provides a multitude of benefits for the individual. It is tied to
the core belief that the major areas of life are interconnected (Melkas, 2013; National Wellness
Institute, 2018). This interconnectedness is why all areas of life need to be addressed when
looking to promote health and wellness. The World Health Organization recognized this when it
established the Ottawa Charter for Health Promotion and the more current Healthy Cities to
improve wellness in areas where people are living (Boonekamp, Colomer, Tomás, & Nuñez,
1999; World Health Organization, 1986). The shift towards health promotion only stands to
benefit individuals and the community they belong throughout their lives.
Well-Being
Well-being is defined as the presence of positive emotions, engagement, positive
relationships, meaning, and accomplishment in an individual. Utilizing individuals’ character
strengths are necessary to flourish (Disabato, Short, Kashdan, Curby, & Jarden, 2014). These
strengths play important roles in a multitude of areas and emphasize utilizing strengths. None of
these elements individually defines well-being. Moreover, the focus is not happiness but to
increase flourishing, which is both high well-being and low mental illness (Compton &
HEALTH AND WELLNESS 23

Hoffman, 2012; Seligman, 2011). Each piece contributes to well-being as a whole even though
they can be measured individually. Utilizing these strengths to facilitate well-being goes beyond
happiness. Development of well-being promotes non-cognitive skills that benefit the individual
across their lifetime. Important non-cognitive skills, such as optimistic thinking, self-regulation,
problem-solving, coping skills, are necessary to flourish in life (Credé, Roch, & Kieszczynka,
2010; OECD, 2017; Richardson et al., 2012). Additionally, well-being promotes a growth
mindset, resiliency, grit, and persistence to overcome challenges through adaptation and coping
skills (Duckworth, Peterson, Matthews, & Kelly, 2007; Dweck, 2008). Well-being also allows
for a flow state to provide the individual the prospect to savor an experience as well as the
opportunity to experience peak performance (Csikszentmihalyi, 1990; Norsworthy, Gorczynski,
& Jackson, 2017). Due to the increase in non-cognitive skills, well-being has been linked with
academic benefits for students across all levels (Heffner & Antaramian, 2016). These non-
cognitive skills can help the individual with their long-term goals promoting well-being.
The conceptualization of well-being is comprehensive and well documented
(Csikszentmihalyi, 1990; Diener, 1984; Killian, 2017; Lane, Carroll, Ring, Beevers, & Lip,
2001; Ryff & Keyes, 1995; Seligman, 2002; Seligman, 2011). Numerous studies have correlated
well-being with health and mental illness. Health and well-being have been positively correlated
in addition to well-being being linked with the prevention and treatment of mental health issues
and improving the quality of life through well-being (Compton & Hoffman, 2012; Okun, Stock,
Haring, & Witter, 1984; Rosenberg, Schooler, & Schoenbach, 1989; Seligman, 2011). Studies
have found the opposite to be true as well with high mental illness linked to a decrease well-
being suggesting an inverse relationship between well-being and mental health issues (Hone et
al., 2014 Keyes, 2009; Keyes & Simoes, 2012). The improvement of well-being across an
HEALTH AND WELLNESS 24

individual’s lifespan can play a preventive role in health maintenance (Steptoe, Deaton, & Stone,
2015). Resiliency programs promote well-being as a preventive measure against depression,
anxiety, and suicide using data-driven research (Bajaj & Pande, 2016; Johnstone et al., 2014;
Sankaranarayanan & Cycil, 2014; Satici, 2016). Additionally, well-being research indicates that
it can improve quality of life and improve survival rates (Chan et al., 2015). Overall, research
suggests that improving well-being has a range of positive health outcomes ranging from
psychological, emotional, social, and physical benefits (Quick & Abdallah, 2015; Yang & Farn,
2005). In addition to these range of positive health outcomes, the findings are not bound to
gender or age (Buettner, 2005).
Wellness
Wellness takes a different approach to individual health by incorporating key areas of life
as well as the individual’s community. This approach to health places an emphasis on the
individual and the individual’s role within the community to emphasize optimal living (Hettler,
1980). Additionally, promoting health within all areas of life is beneficial to one’s holistic
health. Because of the interconnectedness of our lives, the interconnectedness of wellness and
health promotion allows us to improve one area of our lives and have it impact others.
Conceptualizing health as more than just a subjective thought about ourselves defines areas of
our lives beyond the individual’s own personal beliefs about themselves, and it provides a
pathway to optimal living that can permeate into major domains within our lives that are
interconnected. This holistic health contradicts previously conceived concepts of health as the
lack of illness, and this multi-domain approach to health and emphasis on health promotion was
soon adopted worldwide.
HEALTH AND WELLNESS 25

Enhancing wellness has been rooted in health promotion and the creation of healthy
communities. Health promotion has been a theme for the World Health Organization’s Ottawa
Charter in 1986 (World Health Organization, 1986). Health promotion, like wellness, seeks to
promote health in all areas of our lives as opposed to focusing on the lack of illness as a concept
of health. Promoting health in our various spaces of our lives means improving our
surroundings. Improving the community or the settings that we are part of can improve our
lives, promote health, and prevent illness and premature deaths death (Dooris, 2009; Newton,
Dooris, & Wills, 2016).
This shift from treatment of illness to promotion of health is playing an ever increasingly
important role on higher educational campuses. Promoting a student’s health and wellness
during their academic pursuit is paramount to their success (Heffner & Antaramian, 2016;
Tsouros et al., 1998). The promotion of health and wellness within the higher education
community provides a number of benefits for students, faculty, administrators, and the
community as a whole (Tsouros et al., 1998).
Defining Wellness
The definitions regarding wellness all contain the same central ideas of promoting health
in multiple areas of our lives but are presented with varying degrees of complexity (National
Wellness Institute, 2018; World Health Organization, 2006). This concept derives from Dunn’s
description of a state of health that gave an overall sense of well-being physically, spiritually,
and mentally as well as being dependent on the environment (Dunn, 1959a, 1959b). Today, the
National Wellness Institute (2018) defines wellness as “an active process through which people
become aware of, and make choices toward, a more successful existence” (para. 4) while the
World Health Organization (2006) defines wellness as “the optimal state of health of individuals
HEALTH AND WELLNESS 26

and groups” (p. 5). It can often be confused with happiness or life satisfaction, and, while both of
those elements play a role in wellness, they do not define wellness completely. The complexity
of wellness’s can be seen through the range of dimensions that are listed by various
organizations that alter Hettler’s (1980) original model comprised of six dimensions: emotion,
occupation, physical, social, intellectual, and spiritual. While it is a complex definition, the core
interconnectedness of the dimensions is within all definitions as well as the six core dimensions
that Hettler originally described.
Flourishing. As with wellness, there are a number of definitions that revolve around the
central theme of mental health. (Bringing Theory to Practice, 2013; Keyes, 2002; Seligman,
2002; Seligman, 2011). It is best defined by Keyes (2002, 2007b) who describes flourishing as
being mentally healthy. According to Keyes, being mentally healthy equates to high subjective
well-being with optimal psychological and social functioning (Westerhof & Keyes, 2010).
Fredrickson and Losada contribute to this definition by measuring mental health in positive
terms instead of the absence of mental illness. They also describe the benefits of flourishing as
“to live within an optimal range of human functioning, one that connotes goodness, generativity,
growth, and resilience” (Fredrickson & Losada, 2005, p. 678).
Flourishing provides benefits to the individual. Keyes’ (2007b) extensive work on the
subject has demonstrated that flourishing provides the highest levels of psychosocial functioning.
This results in the lowest levels of perceived helplessness, the highest level of self-reported
resilience, and the highest level of intimacy with friends and family (Keyes, 2007a; Keyes,
2007b). In addition to the psychosocial benefits, individuals who flourished had
functioned superior to all others in terms of the fewest workdays missed, fewest half-day
or less cutbacks of work, lowest level of health limitations of activities of daily living, the
HEALTH AND WELLNESS 27

fewest chronic physical diseases and conditions, the lowest health care utilization.
(Keyes, 2007a, p. 97)
Individuals who have complete mental health are evident, and, when compared individuals with
moderate or low mental health, those with complete mental health functioned better. These
effects of flourishing are beneficial to the individual and their contribution to society, and these
benefits emphasize the need for health promotion.
Thriving. Unlike flourishing, thriving goes beyond mental health, and it is associated
with optimal functioning in academic engagement and performance, relationships, and well-
being (Schreiner, 2010a, 2010b; Schreiner, Pothoven, Nelson, & McIntosh, 2009; Seligman,
2002, 2011). Thriving is best described by Schreiner et al. (2009) when they said,
Thriving implies more than just surviving in the college environment; it conveys that a
student is fully engaged intellectually, socially, and emotionally, and is experiencing a
sense of psychological well-being that contributes not only to his or her persistence to
graduation, but also to success in life. (p. 4)
Implications of wellness. The promotion of wellness can provide benefits to both the
individual and the community (Hettler, 1980; Seligman, 2002, 2011). Improving wellness
provides a pathway to live optimally by contributing to each core area of life (Dunn, 1959a;
Hettler, 1980). Research and promotion of wellness from local and global organizations
contributes to previous research on the importance of improving wellness to optimize our lives
(Jamner, & Stokols, 2000; World Health Organization, 1986). Individually, wellness increases
our physical, mental, and social health while also preventing disease (Dooris et al., 2010; Killian,
2017; Tsouros et al., 1998; Yang & Farn, 2005). There is more engagement and enjoyment
within our professional and personal lives (Lowensteyn et al., 2018). Socially, we look to work
HEALTH AND WELLNESS 28

for economic support, contribute to the community, and socialize with others which also acts as a
barrier for mental illness (Baldwin et al., 2017; Myers, Sweeney, & Witmer, 2000). Supporting
all areas of wellness results in holistic health that creates healthy, active, engaged individuals
who contribute to the community.
Health Promotion
The promotion of health is important in giving individuals control over their health
instead of looking to medical professionals for treatment (Dooris, 2009). Shifting the paradigm
of health away from illness and towards health promotion reframes how we conceptualize health.
Health promotion means not just a lack of illness, but also instilling preventive healthcare that
optimizes health in individuals and communities (World Health Organization, 2005). It is a
comprehensive approach that improves health and wellness within individuals and communities.
The concept of health promotion and the strategies for it are guided by the WHO’s principles of
empowerment, participatory, holistic, intersectional, equitable, sustainable, and multistate
(Rootman, 2001). These principles work in tandem with wellness to give individuals and
communities an increased control of their own health and wellness in all domains. To promote
health, the WHO has outlines three necessary key elements: health-focused governance, Healthy
Cities, and health literacy.
Health-focused governance requires that the government implement policies across a
multitude of sectors to coordinate effectively and cohesively implement policies. A number of
policy makers, doctors, and researchers have suggested for the developing a clear plan that will
alter or create policy that emphasizes health promotion needs to be emphasized (Jamner &
Stokols, 2000; Rootman, 2001; Rootman et al. 2001; Tsouros et al., 1998). Policies need to
reflect the right for health and health equity in sectors that may seem to have little connection to
HEALTH AND WELLNESS 29

health, but the interconnectedness of our society and promotion of health in all areas of life
requires that we enact policies that promote health where we live, work, and socialize (World
Health Organization, 2018b). According to the WHO (2018a), “Health is a precondition for all
three dimensions of sustainable development – social, economic and environmental – and action
on the social and environmental determinants of health is in turn critical to creating inclusive,
equitable, economically productive and healthy societies” (para. 6). Policies promoting health
have been advocated and supported for decades with calls for health promotion within policy
starting with the Alma Ata Declaration on Primary Health Care in 1978 and the Ottawa Charter
for Health Promotion in 1986. Recently, the Rio Political Declaration on the Social
Determinants of Health in 2011 and the Helsinki Statement on Health in All Policies in 2014
have supported previous callings for aligned governance to promote health (World Health
Organization, 2018b). These callings echo previous and current suggestions to shift the
conception of illness towards health promotion, thus creating effective and cohesive policies are
necessary to promote health.
With the majority of the world’s population living in cities, the WHO identified
urbanization as a public health challenge (World Health Organization, 2014). Creating Healthy
Cities and Healthy Settings within people’s daily lives is imperative to our health. The Healthy
Cities initiative began in 1986 with 21 European cities to build on the Health for All strategy that
focused on creating equitable health (World Health Organization, 1978). Healthy cities were
formally defined in 1995 by the WHO:
A healthy city is one that is continually creating and improving those physical and social
environments and expanding those community resources which enable people to
HEALTH AND WELLNESS 30

mutually support each other in performing all the functions of life and in developing to
their maximum potential. (World Health Organization, 1997b, p. 13)
This long-term project aims to work with healthy governance concepts to create healthy
spaces that provide health supportive environments, good quality of life, basic sanitation and
hygiene needs, and supply access to health care through political leadership (Kenzer, 2000;
Tsouros, 1995).
Healthy Cities incorporates similar ideas to Healthy Settings. Healthy Settings is a top-
down approach to health promotion by creating a healthy environment for individuals and
communities to flourish and thrive and, like Healthy Cities, it builds on the Health for All
strategy (Newton et al., 2016; Patrick, Dooris, & Poland, 2016; Tsouros et al., 1998; World
Health Organization, 1978). The Ottawa Charter better described Healthy Settings: “Health is
created and lived by people within the settings of their everyday life; where they learn, work,
play, and love”(World Health Organization, 1986, p. 4). In 1991, the Sundsvall Statement urged
the creation of supportive environments for health, and the Jakarta Declaration emphasized the
value of providing the infrastructure necessary to provide healthy settings and valuing healthy
strategies that emphasize health in various settings (World Health Organization, 1991; World
Health Organization, 1997b). These founding and more recent publications are used to facilitate
health where people live. Municipal level strategies and leadership are necessary for Healthy
Cities and Healthy Settings to create a healthy environment where people spend their lives.
Health literacy is the third component necessary to promote health. Health literacy
comprises the need for knowledge, information, and skills to make healthy decisions. Defining
health literacy is difficult with no unanimously accepted definition (Sørensen et al., 2012). On
the other hand, the WHO (1997a) states, “Health literacy represents the cognitive and social
HEALTH AND WELLNESS 31

skills which determine the motivation and ability of individuals to gain access to, understand and
use information in ways which promote and maintain good health” (p. 10). Health literacy
works in combination with Healthy Cities and health-focused polices to provide people the
opportunity to make good decisions. Empowering individuals with knowledge and skills gives
them the foundation to make informed decisions and play an active role in improving their
health, improve engagement within the community regarding health, and check that governance
is addressing health issues for the community (Rudd, 2015; World Health Organization, 2018).
The WHO specifically discusses the need to improve the health literacy of those at the greatest
disadvantaged or marginalized in the community to accelerate the process of reducing inequality
(World Health Organization, 2018).
Healthy Settings
The Healthy Settings approach focuses on promoting public health. It builds on the
Ottawa Charter for Health Promotion reflects the complexity of health, which is defined as
complete physical, social, mental well-being (World Health Organization, 1986). The promotion
of health, as opposed to the lack of illness, is derived from our everyday lives. Health is where
we work, live, play, and socialize. The action plan for the Ottawa Charter suggested five areas
for action including, building healthy public policy, create supportive environments for health,
strengthen community action, develop personal skills, and re-orient health services (World
Health Organization, 1986). This action plan contributed to the settings approach and its positive
correlation with subjective well-being (Dooris, 2009; Okun et al., 1984). This approach
conceptualizes health as part of our everyday lives through our education, economy, justice
system, community, leisure, and our healthcare, and we would benefit from improving policy,
knowledge, motivation, and organizations to promote health on all scales. A holistic system-
HEALTH AND WELLNESS 32

wide change that prioritizes sustainability and healthy communities is necessary to create
sustainable health (Dooris, 2009). Higher education campuses are examples of places that are
integral to society.
Health and Wellness Issues in Higher Education
The health and wellness of students in higher education is a concern. Regardless of
ethnicity, background, or family history, students have health and wellness needs that must be
fulfilled. Students in higher education must make the transition adjusting academically, socially,
culturally, and personally. To assist students, higher education institutions attempt to teach
survival skills necessary for success, but surveys indicate that health and wellness issues are
trending upward and have large influences on all students (American College Health
Association, 2017; Anderson, 2015; Finnish Student Health Services, 2018). The transition into
higher education and the vast amount of potential influences ranging from finances, extra-
curricular activities, study skills, and the academic component of higher education impact
students’ health and wellness, and universities need to recognize that students need holistic
health and wellness support (Anderson, 2015).
Surveys conducted by the American College Health Association assess students’ health,
habits and behaviors in higher education. Overall, the general health of students in a self-
reported 2017 survey is good, with 85.9% of students reporting that their health is good, very
good, or excellent. Academically, students reported that stress (30.6%), anxiety (24.2%), and
sleep difficulties (19.7%), depression (15.9%), cold/flu/sore throat (14.6%), work (13%), and
concern for a troubled friend or family member (10.3%) had the largest impact on students’
academic performance (American College Health Association, 2017). Other influences such as
participation in extracurricular activities (9.7%), internet use/computer games (9.6%),
HEALTH AND WELLNESS 33

relationships difficulties (9.1%), finances (6.1%), and alcohol use (3.5%) have a lower reported
impact on academic performance, but these issues may have a greater impact but not be
recognized by students in this self-reported survey (American College Health Association,
2017).
Beyond academics, American university students reported the largest influence on their
personal safety was being verbally threatened (17.7%). Students felt safe on campus and in the
community during the daytime. The same cannot be said for nighttime, and it presents a major
hurdle for universities to address. Only 40.5% of students felt safe on campus, with only 31% of
women feeling safe, and it was worse when asked about the surrounding community where only
21.5% of students felt safe. Women in particular felt extremely unsafe at night, and only 15%
felt safe in the community at nighttime. Students’ tobacco, alcohol, and marijuana use was also
reported. There is a difference between perceived use and actual use, and students believe that
other students are using substances more frequently than their actual use. Additionally, 63.3% of
students reported drinking four or fewer drinks the last time they drank, and 31.5% of students
reported consuming five or more drinks in a sitting within two weeks of taking the survey.
Students who drank alcohol also reported that 35.2% did something they later regretted and
29.1% forgot where they were or what they did suggesting that the number of consumed drinks
does not equate to responsible drinking or full control of the situation (American College Health
Association, 2017).
Students’ physical and mental health were also reported. Lack of sleep is large
contributor affecting students’ academic performance, and students are reporting that they are
not getting enough sleep, resulting in feeling tired and directly impacting their daytime activities.
Only 12.8% of students reported that they felt rested in the morning six or seven days of the
HEALTH AND WELLNESS 34

week. Almost half the students (44.2%) reported feeling tired or sleeping during the day, and
42% of students reported that sleepiness during the day was more than a little problem, a big
problem, or a very big problem. One in five students (20.7%) reported no moderate exercise and
nearly two out of five students (38.9%) reported no vigorous intensity exercise.
Lack of sleep contributes to the BMI data that was recorded from students that showed
4.9% of student as underweight, 22% as overweight, 7.1% as Class I obesity, 2.7% Class II
obesity, and 1.9% as Class III obesity. Mentally, students reported feeling overwhelmed (87%),
exhausted (84%), very sad (67.3%), lonely (62.2%), overwhelming anxiety (60.8%), and
hopeless (51.1%) at some point in the past year. This has contributed to 39.1% of students
feeling so depressed that it was difficult to function and 10.3% of students seriously considering
suicide. While it is not directly linked within the survey, 1.5% of students reported attempting
suicide, and 7% reported intentionally hurting themselves. These physical and mental statistics
should be alarming for colleges and universities and signal the need for improved health and
wellness within higher education.
The Finnish Student Health Services survey contributes to data found by the ACHA
showing that health and wellness issues are an international concern that contributes to student
health and wellness. The 2016 Student Health Survey reported that 72% of the students in
higher education in Finland suffered from a chronic, long-term or frequently recurring illness,
handicap, or injury (Kunttu et al., 2016). At the same time, the self-reported survey found that
76% of students said their physical health and 66% of their mental health as good or very good.
The survey also asked about health issues students faced on a daily basis and found that 16%
suffered from psychological issues such as sleep problems, depression, anxiety, 14% suffered
HEALTH AND WELLNESS 35

from general symptoms such as headaches, dizziness, and fatigue, and 10% suffered from
abdominal symptoms such as stomach pain, nausea/vomiting, and diarrhea.
The 2016 Student Health Survey also inquired specifically about students’ mental and
physical health. It found that 30% of the students suffered from mental problems that were
commonly manifested as continuous overstrain, unhappiness, depression, difficulties
concentrating, and loss of sleep. The total mental problems stem from rising depression and
anxiety in students over the years, and the Student Health Survey found that 18.8% of students
had depression symptoms and 19% of students had anxiety symptoms at least once a week. The
survey found that 33% of students experienced considerable stress that stemmed from
performing in public and management of one’s studies. It also found that more than every fifth
student negatively perceived their mood, future, available resources, and capabilities. Students
in Finland are more overweight than in America with 36% of males and 26% of females being
overweight as well as underweight with 7% of females and 3% of males being reported using a
BMI measure. The obesity rate is similar with 8% of males and 7.5% of female students being
classified with major obesity. Fitness was also self-reported and 21.7% of students said they do
not exercise which contributes to the overweight and obesity statistics. As with the ACHA
findings, Finnish universities should seek to improve student health and wellness with large
portions of the population self-reporting issues with their holistic health and wellness.
Healthy Universities
Health promotion is necessary in higher education to develop control over and improve
their own health and wellness in a setting that should be safe and supportive (DeRoos, 1978;
Tsouros et al., 1998). Healthy universities take a holistic approach to health and promote health
within all areas of the university. The Okanagan Charter describes the unique role that higher
HEALTH AND WELLNESS 36

education institutions play within health promotion when it stated, “A university or College is,
by its very nature, an essential part of any systemic health promotion strategy, working
collaboratively in trans-disciplinary and cross-sector ways” (Okanagan Charter, 2015, p. 5).
Like Healthy Cities and Healthy Settings, healthy universities are locations where students live,
learn, play, and socialize in addition to being organizations that shape individuals and the
university community to create impact at the local, regional, national, and global levels (Newton
et al., 2016). To facilitate this growth, universities have implemented strategies to prevent or
respond to issues faced in universities such as drug use and sexual health, but, since the late
1990s, the framework for health-promoting universities has emphasized additional measures
(Doherty & Dooris, 2006). The use of medical and health professionals to treat health and
wellness issues within the university has been established, but healthy universities follow
previous callings to emphasize promotion of health within the community. Creating a healthy
learning, working, and living environment with meaningful connections to the community and
increasing knowledge of health and wellness to promote policy, teaching, and research create
healthy universities that allow individuals and the community to flourish and thrive.
Healthy University Framework. Research and data-driven decisions have created
foundational frameworks that can be used to foster health and wellness within higher education
institutions (Newton et al., 2016; Parish, 2001; Tsouros et al., 1998). In 1998, the World Health
Organization and lead professionals in the health promotion area published a conceptual
framework for universities to promote health and wellness (Tsouros et al., 1998). This
framework builds on previous charters, specifically the Ottawa Charter for Health Promotion,
and callings for health promotion while understanding that universities play a pivotal role in
HEALTH AND WELLNESS 37

societal development. This framework aims to target all members of the university and the local
community through emphasizing eight key points:
• Promoting healthy and sustainable policies and planning throughout the university.
• Providing healthy working environments
• Offering health and supportive social environments
• Establishing and improving primary health care
• Facilitating personal and social development
• Ensuring a healthy and sustainable physical environment
• Encouraging wider academic interest and developments in health promotion
• Developing links with the community.
This framework has been used to build the Healthy University Network in the UK. This network
utilizes the World Health Organization’s Ottawa Charter and the original Healthy University
Framework’s key points to emphasize a holistic approach within universities. This approach
incorporates six key elements: generating high visibility innovative action, leading
organizational and cultural change, securing senior level commitment and corporate
responsibility, enabling wide-ranging participation, anticipating and responding to public health
challenges, and helping to deliver the institutional agenda. The approaches taken by the Healthy
University Network have a greater emphasis on the organizational agenda, policy, and culture.
This revised version provides an additional framework for universities to align health and
wellness promotion with the organization’s core goals as opposed to instituting policy and
resources (Doherty & Dooris, 2006; Dooris & Doherty, 2008).
Over the years, the Healthy University Framework and strategies continue to develop and
become more defined. Research regarding health and wellness as well as healthy university has
HEALTH AND WELLNESS 38

become more robust. These findings have identified qualities that are necessary for universities
to be healthy. There needs to be an obvious commitment to health, equity, and sustainability
within the university’s mission statement and policies in addition to promoting health within its
curriculum and research. The university also promotes high levels of participation by its
members in decisions that impact the academic, working, and social experiences (Dooris, 2009).
The university has mechanisms that allow effective vertical and horizontal communication
within the university between the members. The university also needs to provide a clean, safe,
and healthy physical environment that minimizes that impact on the environment and the health
on all levels ranging from local to global (Ryan, Browning, Clancy, Andrews, & Kallianpurkar,
2014).
The university delivers physical and mental health support services that meet the needs of
the members of the university in addition to providing opportunities for those members to
develop healthy and useful life skills. The university offers social support services, such as
leisure activities, sports, and cultural facilities, which support the members of the university and
reflect the diverse population that will allow the members to make healthy choices. Finally, the
university has expertise and skills that benefit the local community’s health and wellness
development (Dooris & Doherty, 2006; McAlexander, Koenig, & Schouten, 2006; Tsouros et al.,
1998). The development of framework, strategies, and outcomes for universities provides the
necessary structure for changes to be made, a list of major stakeholders involved, and necessary
outcomes for health and wellness to be promoted and exist within universities.
The outcomes derived from the framework and strategies must be implemented for
members of the university and the local community, but this is both the largest drawback and the
greatest benefit. Cultivating and promoting health and wellness within the university and the
HEALTH AND WELLNESS 39

local community requires cohesion in addition to having expert knowledge of the university and
the local community. Without knowledge of the university, the culture of the university, and an
understanding of the local community, it is difficult to create the collective, positive community
required to promote health and wellness in all areas of the university and local community
members lives (Newton et al., 2016; Tsouros et al., 1998).
Implications of a Healthy University
Health-promoting universities provide evidence that investing in health and wellness
improves students, staff, and the community’s health through localized health and wellness
strategies (Tsouros et al., 1998). These strategies and outcomes are valuable to the university,
providing benefits that go beyond the university and healthy living. Implementing these
strategies increases knowledge of the members of the university population and provides
opportunities for the university to identify strengths and weaknesses. This increase in knowledge
allows individuals to utilize the resources available to increase their health and wellness through
resources provided by the university (Dooris et al., 2007; Tsouros et al., 1998). These supportive
resources and health-promoting environment allow the members of the university to be healthy
through all aspects of the university, ranging from the physical layout to social activities to
policies that promotes health (Newton et al., 2016; Myers et al., 2000). Increasing the welfare of
the members of the university and providing healthy working and studying conditions allows
individuals and the community to flourish and thrive (Schreiner, 2010b; Seligman, 2011).
Because of the better culture that is created at the university, the profile and public image of the
university become more favorable with current local, regional, and global trends emphasize
health promotion, prevention of disease, and sustainability (Tsouros et al., 1998; United Nations,
2017).
HEALTH AND WELLNESS 40

Student Burnout
The calling to place an emphasis on health and wellness promotion in higher education
has still resulted from issues that led to students having a higher risk of burnout. University is
synonymous with challenge, development, experiences, and transition. Physical, mental, and
social health and wellness implications are common for students, and actually have been rising
since 2000 (American College Health Association, 2017; Finnish Student Health Services,
2018). Previously mentioned specific issues contribute to burnout in Finland and the United
States, but burnout in university students is seen in universities globally (American College
Health Association, 2017; Finnish Student Health Services, 2018; Hernesniemi et al., 2017;
Schaufeli, Martinez, Pinto, Salanova, & Bakker, 2002). This decrease of health and wellness has
directly impacted students drive, worldview, and self-efficacy (Maslach, Schaufeli, & Leiter,
2001).
Defining burnout. The concept of burnout was credited to Freudenberger (1974) who
defined it as exhaustion, wearing out, or unable to cope because of severe stress and demands
placed upon an individual. Burnout has also been defined as a syndrome that is caused from
chronic emotional and interpersonal stress (Maslach et al., 2001). Burnout is most frequently
cited from Maslach and Jackson (1986) when they said, “Burnout is a syndrome of emotional
exhaustion, depersonalization, and reduced personal accomplishment that can occur among
individuals who work with other people in some capacity” (p. 192).
Researchers contest the meaning of burnout (Marek et al., 2017; Maslach et al., 2001).
There are common elements of individual feelings, expectations, attitudes, and motives
(Maslach, Leiter, & Schaufeli, 2009). However, there are three core dimensions of burnout:
exhaustion, cynicism, and ineffectiveness (Maslach et al., 2001). Exhaustion refers to stress and
HEALTH AND WELLNESS 41

feelings of being overextended. These feelings cause individuals to be depleted emotionally and
physically (Maslach et al., 2001; Maslach & Leiter, 2016). Cynicism is the interpersonal
component that generates feelings of negativity, distancing from others, detachment from
responsibilities and the self. This leads to being less efficient and further depersonalization
(Galbraith & Merrill, 2015; Leiter, 1992). Feelings of ineffectiveness is a self-efficacy
component examining the individual and his or her own self-evaluation (Werther, 2012). This
refers to the individuals’ feelings of incompetence, lack of achievement, or low productivity
(Maslach et al., 2001). With burnout being associated with higher education, students within
higher education reflect higher stress levels, cynicism, and self-efficacy issues that comprise of
burnout (American College Health Association, 2017; Finnish Student Health Services, 2018;
Galbraith & Merrill, 2015).
History of how burnout has been treated in higher education. Burnout within higher
education is a complicated issue to examine. Students within higher education are susceptible to
burnout because of the challenges and changes faced academically and personally. Universities
recognize this issue, but they also expect students to be able to identify their own issues, whether
they are academic or personal (Anderson, 2015). Universities have online content on their
websites that describe what burnout is and tips about recognizing it, correcting or treating the
issue, and even ways to prevent it, but it has a heavy reliance on the student having the proper
metacognitive skills to self-assess and that students understanding that these resources exist.
The university site does link student to tangible resources for students to access. These
resources are largely preventive with counselors, therapists, and doctors on site to treat students.
Universities require students to enroll in first-year classes to assist in integration to university life
assisting with the new challenges associated with university as well as teaching students the
HEALTH AND WELLNESS 42

necessary skills the university feels are necessary to be successful within the university. In
addition to these classes, universities offer additional academic support to students through
tutoring and academic centers on campus. There are also a number of extracurricular activities
that support students’ personal needs outside of academia. These all work to ensure that the
students have the necessary skills and support to live and learn while at the university.
Skills to avoid burnout. With the various definitions of burnout, it is important to look
at the core elements to derive skills to avoid burnout (Maslach et al., 2009). Skills that are
necessary to avoid burnout require that they address exhaustion, cynicism, and insufficiency.
Research in Finland has researched student burnout and the skills necessary to prevent burnout
(Kunttu, 2008; Salmela-Aro & Kunttu, 2010; The Kyky Project, 2014). The research indicates
that preventing burnout requires promoting study ability. Study ability is conceptualized as
personal resources, study skills, and choice of study environment (The Kyky Project, 2014).
Improving study ability suggests a decrease in burnout, and it is seen as a prevention and
treatment to burnout (Kunttu, 2008; Salmela-Aro & Kunttu, 2010; The Kyky Project, 2014).
Personal resources. The promotion of personal resources encompasses the development
of life management skills, healthy habits, self-regulation, social relations, health and wellness,
and a better understanding of the student’s own self (Dembo & Seli, 2016; The Kyky Project,
2014). Additionally, knowing about social support as well as how others utilize their own
personal resources can have an impact on study ability (The Kyky Project, 2014). Increasing
student’s personal resources allows the individual to effectively utilize his or her own strengths
and effectively manage themselves (Dembo & Seli, 2016; The Kyky Project, 2014).
Study skills. Beyond student’s own personal resources, it is necessary to have good
study skills. The Kyky Project (2014) identified study orientation, study techniques, critical
HEALTH AND WELLNESS 43

thinking, problem-solving skills, study plan formulation, time planning, study habits, and social
skills as study skills that contribute to study ability. Dembo and Seli’s (2016) work reaffirms
this through emphasizing the learning and study strategies. These are the skills are necessary for
university success, avoiding burnout, and work beyond university.
Study environment. Improving study ability requires that a good study environment is
used to utilize the personal resources and study skills required. The physical environment, such
as organizing accessible areas where students can concentrate, needs to be considered for
effective studying. Furthermore, the psychological and social environment must also be
considered such as internal distractors, the study atmosphere, and the study community (Dembo
& Seli, 2016; The Kyky Project, 2014). Effective study environments and community building
contribute to the students’ study ability in tandem with personal resources and study skills.
University students report a number of factors that contribute to health and wellness
issues. Knowing that improving health and wellness in individuals and community is key to
increasing student success at university, and doing so requires exploring students’ knowledge,
motivation, and organizational influences. Understanding these influences is key to improving
student health and wellness since they are key drivers and influential to students.
Student Knowledge, Motivation, and Organizational Influences
To understand organizational performance and stakeholder’s goal to improve their study
ability, Clark and Estes (2008) recommend understanding knowledge, motivation, and
organizational influences. The knowledge, motivation, and organizational influences that impact
students’ ability to improve their study ability will be examined using established theoretical
concepts. Using the gap analysis framework, these influences’ impact the ultimate
organizational goal of reducing student burnout.
HEALTH AND WELLNESS 44

Knowledge and Skills
To comprehensively understand student knowledge to reduce student burnout at AU, the
study utilizes Krathwohl’s (2002) categorization of knowledge. The framework assesses
knowledge across four categories: factual, conceptual, procedural, and metacognitive knowledge
(Krathwohl, 2002). Factual knowledge is the base element that is required for performance in
any area that includes terminology and specific details of the topic. Conceptual knowledge is
understanding the base elements within a larger structure such as classifications, principles,
generalizations, theories, and models. Procedural knowledge is knowing how to do something,
such as applying specific study skills in the context of this study. Metacognitive knowledge is
the knowledge and awareness of one’s own cognition resulting in awareness and control in one’s
thinking. Table 1 presents the knowledge influences that are assumed to effect students’ study
ability for this study. Understanding and assessing the students’ knowledge and skills related to
using the university’s resources as well as specific study skills and the ability to manage the
study environment helps understand if the organization is effectively teaching the skills
necessary to promote health and wellness and thus prevent and manage burnout.
Knowledge of resources related to managing and preventing burnout. Students must
increase their understanding and management of the resources that are available to them to be
aware of, manage, and prevent burnout. A student’s personality, identity, life management,
physical health, and mental health are only some of the personal resources available to the
student that affect their study ability and risk of burnout (Aaltonen, Isacsson, Laukia, &
Vanhanen-Nuutinen, 2013). Burnout is exhaustion and cynicism, and burnout directly eaffects
academic efficiency (Marek et al., 2017). To improve a student’s health and wellness, they need
both conceptual and procedural knowledge. This increase in knowledge gives students the
HEALTH AND WELLNESS 45

ability to increase their own self-efficacy, emotional regulation, and values. This increase in
knowledge can improve success in higher education and provide individuals the knowledge that
gives students the ability to make optimal health choices. Promoting health provides students’
knowledge and skills to prevent illness and promote optimization, and it can also treat illnesses
and unhealthy behaviors (Dembo & Seli, 2016; Okun et al., 1984; Rahmati, 2015; Rosenberg et
al., 1989; Seligman, 2011).
Students need knowledge and skills that reflect health promotion ideas instead of treating
illness. Conceptually, students need to know the different dimensions of their wellness, and
procedurally students need to know how to manage the symptoms of burnout to promote their
own health and wellness. It is also necessary that students have the metacognitive ability to
effectively assess their own strengths and weaknesses to manage burnout (IsHak et al., 2009;
Stoliker & Lafreniere, 2015). This gives students the necessary knowledge to become aware of
burnout and how to manage it throughout their academic career at AU.
Connections to effective study strategies. The acquisition of new study skills and
building upon previously established study skills are essential to decreasing burnout. Improving
study skills allows students to be more effective with their studying (Naqvi, Chikwa, Menon, &
Al Kharusi, 2018; Robbins et al., 2004; Shaw, 2017; Stanley & Nillas, 2017). These skills range
from study techniques, orientations, preferences, and habits to critical thinking and problem-
solving skills. Study skills also include the student’s social skills and planning management. All
focus on the students’ ability to learn in a more effective manner. These skills are necessary for
students to effectively develop deeper learning instead of having surface level learning that lacks
the critical thinking, application, and understanding of what is being learned (Houghton, 2004).
Improving a student’s knowledge and skills can bolster a student’s self-efficacy, social
HEALTH AND WELLNESS 46

relationships, and improved study ability (Quick & Abdallah, 2015; Seligman, 2011; Tsouros et
al., 1998).
Increasing the knowledge and skills to improve studying requires specific knowledge in
multiple categories (Krathwohl, 2002). Conceptually, students need to understand the
differences between deep and surface learning (Entwistle & Ramsden, 2015; Houghton, 2004;
McLean, Attardi, Faden, & Goldszmidt, 2016). This is paramount so that students can recognize
when deep, meaningful learning occurs. Students also need to know how to study effectively to
be able to allow deep learning to occur (Danker, 2015; Houghton, 2004; Robbins et al., 2004).
Students need to know how to effectively assess their own strengths and weaknesses in studying
effectively (Chevalier, Parrila, Ritchie, & Deacon, 2017). Improving all areas of knowledge is
paramount for students to effectively build and use study skills to reduce burnout.
Knowledge of improving wellness. To reduce burnout, students need to improve their
knowledge of wellness. Awareness of the knowledge and skills to support wellness is necessary
to create healthy and supportive communities to achieve optimal living (Hettler, 1980; Hoyt et
al., 2012; Seligman, 2011). Hettler’s six dimensions of wellness model conceptualizes the areas
of healthy living and their interconnectedness (Hettler, 1980). Students need to have knowledge
of the dimensions of wellness so that they have the necessary information and ability to improve
their overall health (Hoyt et al., 2012). Students need the conceptual knowledge of the theory of
wellness to be able to understand healthy and appropriate settings to identify study environments.
Students need the procedural knowledge of how to support their wellness, and students also need
the metacognitive ability to effectively assess their own strengths and weaknesses in supporting
their wellness. Increasing wellness has a direct impact on burnout and enables students to
increase all areas of wellness knowledge (IsHak et al., 2009; IsHak et al., 2013). Increasing
HEALTH AND WELLNESS 47

student knowledge regarding wellness is only one component. It is necessary to explore student
motivation to use the knowledge students have.
Table 2
Assumed Knowledge Influences
Assumed Knowledge Influence Knowledge Type
Students need to understand differences between deep
and surface learning.
Declarative (conceptual)
Students need to understand the dimensions of
wellness.
Declarative (conceptual)
Students need to know how to manage the symptoms
of burnout.
Procedural
Students need to know how to study effectively. Procedural
Students need to know how to support their wellness. Procedural
Students need the ability to effectively assess their
own strengths and weaknesses in managing burnout.
Metacognitive
Students need the ability to effectively assess their
own strengths and weaknesses in studying effectively.
Metacognitive
Students need the ability to effectively assess their
own strengths and weaknesses in supporting their
wellness.

Metacognitive

Motivation
In addition to knowledge, motivation is a key influence in performance to student
burnout. Motivation is an investment in reaching a goal, state, or outcome, and for students, it is
a core component in learning outcomes and success for students (Clark & Estes, 2008).
Ambrose et al. (2010) best described it when they said, “Students’ motivation determines,
directs, and sustains what they do to learn” (p. 5). Within higher education, autonomy plays a
greater role in student’s lives than in the K-12 level, and motivation becomes a key role in
behavior (Dembo & Seli, 2016). The autonomy given to students within higher education
equates to more goals that compete for the students’ energy, attention, and time. Students are
responsible for registering for their own classes, managing their time, being familiar with the
HEALTH AND WELLNESS 48

resources available, and being more self-directed with their work when compared to secondary
education. Therefore, it is necessary to understand the role that motivation plays in students
using the AllWell? survey and its resources to understand their risk of burnout and the available
resources to them to reduce burnout. Previous research regarding burnout has correlated
employee motivation and burnout displaying that there is a need to monitor motivation to prevent
burnout (Carbonneau, Vallerand, Fernet, & Guay, 2008; Mageau & Vallerand, 2007). More
recent research has negatively correlated academic burnout and motivation (Stoeber, Childs,
Hayward, & Feast, 2011). Reviewing the literature of expectancy value theory and self-efficacy
theory offers the necessary motivational framework to review student motivation with regards to
accessing resources to enhance personal and academic success and reduce burnout.
Expectancy value theory. Understanding what students’ value for engaging with tasks
is vital to understanding their motivation. Students need to value a goal in order to be motivated
to pursue it, and expectancy value theory focuses on two central ideas: whether the individual
can do the task and whether the individual wants to do the task (Eccles, 2010). Students need to
value the task and must choose to perform it before any results or processes can be assessed.
Motivating a student to have value in the task is the first step in creating pursuit of the goal.
Knowing if a student wants to do a task and feels that they can do a task can link to the student’s
achievement performance, persistence, and choice to their expectancy-related and task value
beliefs (Wentzel & Miele, 2009). These benefits hinge on that the student values the task or
goal, and if AU wants to reduce burnout by 2020, it needs to increase the value of improving
study ability through personal resources, study skills, and study environment. Without ensuring
value in increasing study ability, there will be a lack of motivation to increase study ability.
Students must feel value in increasing personal resources, study skills, and study environments to
HEALTH AND WELLNESS 49

decrease burnout. While students at AU are at a higher than average burnout rate, understanding
student motivation to reduce burnout using the expectancy value theory provides necessary
information regarding student motivation. Students at AU need to value the feedback that they
received from the AllWell? survey that link them to the necessary resources. Without the
necessary value in the goal as motivation, students are not likely to pursue the support services
offered by AU.
Expectancy value theory has four components. First, attainment value allows the
individual to view the task as central to their own sense of self or express themselves. Next,
intrinsic value is the enjoyment that the individual acquires when doing a task. Utility value is
the degree to which a task is useful for the individual. Finally, the cost of the goal needs to be
assessed to understand what the individual will give up in order to do the task. These four
components can be assessed for every goal to comprehensively determine if the individual can
do the task or wants to do the task (Wentzel & Miele, 2009). For this study, utility value plays a
central role in the students, and it should be explained critically and foremost to understand
student motivation. Students at AU looking to improve their study ability need to increase the
value of the skills that they are learning to increase motivation to apply the skills and learn new
skills from the AllWell? survey’s recommendations. Having students see the value of the skills
linked in the survey results can have students increase students’ personal resources, study skills,
and choices for study environment.
Self-efficacy theory. Bandura’s foundational work describes the importance of self-
efficacy and its role in motivation (Bandura, 1977). Bandura defines self-efficacy as, “the belief
in one’s capabilities to organize and execute the courses of action required to manage
prospective situations” (Bandura, 1995, p. 2). Research names five sources of efficacy beliefs:
HEALTH AND WELLNESS 50

mastery experiences, vicarious experiences, verbal persuasion, emotional and physiological
states, and imaginal experiences (Bandura, 1977; Maddux, 2005; Pajares, 2010). Increasing
one’s confidence translates to anticipated success and, thus, more motivation. Self-efficacy’s
vital importance to motivation indicates that cultivating, supporting, and increasing self-efficacy
is necessary to increase students’ likelihood to engage with supportive resources and ultimately
reduce burnout. Building student self-efficacy is key to applying the results of the AllWell?
survey and utilizing the resources available at AU. While studying and being a student is not
new for students at AU, confidence in their study skills and ability to study may be lacking and
result in increased burnout.
Self-efficacy’s role in motivation is evident. Low self-efficacy and low academic self-
efficacy have been negatively correlated to academic success in higher education. Students’
negative perception of themselves and their own academic performance contributes to student
burnout in higher education (Sowislo & Orth, 2013; Stoliker & Lafreniere, 2015). Self-efficacy
is a predictive of students' choice to engage with tasks as well as their persistence and mental
effort (Dembo & Seli, 2016). Based on this finding, self-efficacy directly impacts the students’
mental effort and mental strategies that impact preventing student burnout. While the AllWell?
survey offers feedback and suggestions to courses and programs to improve students study
ability, students need the self-efficacy to believe that they have the efficacy to apply the feedback
received from the AllWell? survey and the resources that are connected to the students. Table 2
outlines the assumed motivational influences of students scoped within the KMO framework.
Goal orientation theory. Social-cognitive ideas frame how motivation is constructed.
The goal orientation theory has two types of motivation for goals. The first type is the mastery
goal. Mastery goals are sought to achieve a true understanding or the best performance, and
HEALTH AND WELLNESS 51

individuals who hold these goals are typically interested in self-improvement and compare their
own past performances to their own current performance (Pintrich, 2003; Young & Anderman,
2003). The second type is the performance goal. This goal is focused around demonstrating
one’s ability when compared to others. It derives around competition, performance, and
comparison with others instead of mastery (Pintrich, 2003; Young & Anderman, 2003).
Additionally, each mastery or performance goal divides into approach or avoidance goals.
Approach goals focus on improvement while avoidance goals revolved around the evasion of a
negative outcome. This provides four possible goal pursuits. Mastery approach goals focuses on
improving to master something. Mastery avoidance focuses on mastery to avoid
misunderstanding. Performance approach concentrates on demonstrating that one is more
competent than others. Performance avoidance concentrates on demonstrating that one is not
inept (Pintrich, 2003; Young & Anderman, 2003). It is also possible for students to hold
multiple goals with multiple goal orientations. For students to increase their motivation, it is
necessary that SMART goals are created while working towards mastery for optimal benefits
(Rueda, 2011). Students at AU need to focus on mastery instead of performance in addition to
approach goals instead of avoidance goals for optimal motivation. Thus, increasing goal
orientation can improve students study ability through the desire to be more effective students.
Table 3
Assumed Motivation Influences
Motivation Construct Assumed Motivation Influence
Utility Value Students need to see the value of the AllWell? survey in
supporting their ability to improve study ability.
Self-Efficacy Students need to believe that they have the ability to apply the
results of the AllWell? survey.
Goal Orientation Students should want to have effective study ability to become
more effective students.
HEALTH AND WELLNESS 52

Organizational Influences
In addition to knowledge and motivational influences, organizational factors impact
performance. Cultural models and settings are two prominent concepts that address the impact
of organizational culture (Gallimore & Goldenberg, 2001). Cultural models are the values that
an organization embraces. Cultural settings are more concrete manifestations of the models such
as policies and resources available. (Gallimore & Goldenberg, 2001). These two concepts
contribute to Clark and Estes’ (2008) conceptualization of organizational influence within the
gap analysis model. Clark and Estes’ (2008) work suggests that an organization has a direct
influence on its stakeholders’ knowledge and motivation. This work suggests that the AU
student burnout rate that AU faces has organizational components that need to be explored and
how these influences impact knowledge and motivation. Table 3 outlines organizational
influences such as AU’s supportive culture, the level of support availed by AU, the AllWell?
services, and resources for students to be connected.
AU culture of supporting student wellness. AU needs to foster a culture of support for
students to increase their study ability. Literature on organizational influences reports that
cultural influences are not always visible, and that cultivating a culture that supports students
requires organizational support (Clark & Estes, 2008; Rueda, 2011). Because of this, it is
necessary that AU creates a supportive organizational culture with resources available to support
students. AU is looking to continue to develop its dynamic culture to promote study abilities to
reduce burnout. While the AllWell? survey and its resources are physical, cultural settings, the
culture within AU needs to shift to create new norms. These norms need to create an
environment that promotes personal resources, study skills, and study environments.
Additionally, AU needs to encourage support and trust within its organization. Influencing trust
HEALTH AND WELLNESS 53

and support must be created so that it can be learned and be generated as new students enter AU
through current members of AU. Since culture is a dynamic process, it is imperative that AU
continues to influence current and future students to continue to promote trust and support.
Doing so will influence the group, students at AU, to teach new members the correct way to
perceive, think, and feel about life at AU. This study will explore student experiences with AU
culture and how AU is supporting students.
Available resources. Increasing study abilities in students to decrease burnout requires
tangible resources from AU. Clark and Estes (2008) stress that organizations require a vast
variety of equipment that includes specialized environments and building to support specific
needs. AU has created the AllWell? survey to survey student wellness and their risk of burnout
while also linking students to resources available to improve their study ability. Clark and Estes
(2008) emphasize that the organizations processes, materials, and culture should contribute to the
value chain to deliver a valuable product or service. AU’s AllWell? survey and supportive
services are necessary to build student knowledge and motivation and contribute to the value
chain that will improve student health and wellness. Increasing the availability and efficiency of
these resources is necessary for AU and AU students to reach the goal of reducing burnout.
AllWell? survey and resources. The AllWell? survey and resources are an aspect of the
cultural setting that helps students identify strengths and weaknesses in their study ability and
their risk of burnout while providing links to programs and courses for students to take to
improve themselves. The purpose of the survey is to a cultural setting that promotes AU’s
culture of student support, and it needs to be accessible to students. This survey is an item that is
the start of the value chain linking students to available resources. It is necessary to have this
survey and the resources associated with it be accessible and easy to use to promote its use to
HEALTH AND WELLNESS 54

facilitate the supportive culture that AU needs to promote. This study will probed into whether
the students experience the AllWell? survey and the resources provided through it as accessible.
Table 4
Assumed Organizational Influences
Organizational Influence Category Assumed Organizational Influences

Cultural Model Influence 1 AU needs to cultivate a culture that supports
students’ study ability in all three areas:
personal resources, study skills, and study
environment.
Cultural Model Influence 2 AU needs to increase students’ feeling of
being supported by AU.
Cultural Setting Influence 1 AU needs to provide resources for students to
increase their study ability.
Cultural Setting Influence 2 AU needs to promote the participation of the
AllWell? survey.

HEALTH AND WELLNESS 55

CHAPTER THREE: METHODS
The study evaluates AU’s AllWell? survey and how it is currently meeting the needs of
reducing student burnout at AU to the national average. The evaluation focused on knowledge,
motivation, and organizational influences that related to AU’s goal. While studying all
stakeholders that impact AU’s goal of reducing student burnout is ideal, only AU students, the
key stakeholders, will be studied. This study of evaluating burnout at AU is guided by four key
research questions:
1. What are the knowledge and motivation related to the three skills the AllWell? survey
promotes for students who participated in the 2018 AllWell? survey and resources?
2. What is the interaction between AU culture and context and AU students’ capacity to
improve study ability?
3. What are the recommendations for organizational practice in the area of knowledge,
motivation, and organizational resources?
This chapter details the research design and methods for data collection and analysis.
This chapter outlines how students will be recruited, criteria for student sampling and
recruitment, and how data is collected from them using surveys interviews, and document
analysis. Then how the data were analyzed is discussed. Issues related to credibility,
trustworthiness, reliability, ethics, and the researcher’s role are also discussed.
Participating Stakeholders
My stakeholder population is the student population at AU in Helsinki, Finland. The
2018 AllWell? survey was sent to second-year undergraduate and first-year masters students. Of
the 3,549 students who received the survey, only 1,381 students completed it. The population
that completed the survey is the targeted population since they have all received feedback
HEALTH AND WELLNESS 56

regarding burnout and how to improve their study ability through the three key areas identified
by AU, personal resources, study skills, and study environment. The additional criterion for this
study beyond completing the 2018 AllWell? survey was that the student must be currently
enrolled at AU. Additional criteria are not necessary since both domestic and international
students of both genders attend and use the services offered by AU and the AllWell? survey.
Survey Sampling Recruitment Strategy and Rationale
I plan to seek out the 1,381 students who participated in the 2018 AllWell? survey.
While a 100% response rate is highly unlikely, the already specific population of interest sample
of the population has seen the AU population of 12,000 students to a targeted population of
1,381. For a population of about that size, it is recommended that 300 students be surveyed
(Johnson & Christensen, 2008). If the study expects a 20% response rate from the AllWell?
survey, all 1,381 students would need to be recruited to reach the recommended sample
population. Mr. Inkinen expects a 20% response rate. A short, impactful survey will allow the
study to gather relevant information that directly relates to the AllWell? survey’s perceived
impact on students’ knowledge, motivation, and organizational influences. This sampling
approach allows for any of the participants in the 2018 AllWell? survey to be participate
(Johnson & Christensen, 2010). The survey will be at the beginning of the data collection
process. Surveys will be sent to Mr. Inkinen and then he will distribute the surveys to all 1,381
students. Having Mr. Inkinen send the emails will increase the validity and trust of the survey
since students will be receiving the survey from a reliable contact within the university as
opposed to receiving the survey from an unknown email from an outsider email address.
Criterion 1. Participants must be currently enrolled at AU. The AllWell? survey started
in 2016 and has a strategic mission to reduce burnout rates through study skills courses and
HEALTH AND WELLNESS 57

programs. Surveying students in previous years would serve little purpose to understand the
perceived impact that the AllWell? survey has on current students’ knowledge and motivation
because of those services as well as the AllWell?’s perceived impact on the students.
Criterion 2. Participants must have completed the 2018 AllWell? survey. Students who
did not complete the AllWell? survey were not surveyed since the AllWell? survey would not
have an influence on those students’ knowledge and motivation. Completing the survey was a
necessary criterion to understand how the AllWell? survey has influenced the students within the
organization as well as the students’ development of knowledge and motivation to better their
health and wellness.
Interview Sampling Strategy and Rationale
Selecting participants for the interviews required a stratified-random sample method that
represents the population that took the AllWell? survey. The students’ perceived impact of the
AllWell? surveys was the key focus of the study, and the key focus was that the student who is
enrolled at AU has participated in the AllWell? survey. Stratified-random sampling would be
appropriate if the number of participants who indicated that they would want to participate in the
survey were large. The stratified-random sampling would allow each participant an equal chance
of being chosen to participate in interviews for each key demographic (Johnson & Christensen,
2010). Students will opt into the interview through signing up via email sent to all 1,381
students by Mr. Inkinen. By opting into the interview, students have decided that they would
elaborate their views on the AllWell? survey and its perceived impact on themselves.
Interviewing at least 10 participants selected randomly would be ideal given the length and depth
of the interviews. If the number of participants who completed the survey and indicated that
they are willing to participate in the survey is small, less than 10, then I would need to use all of
HEALTH AND WELLNESS 58

the participants in the interview phase. The interviews were conducted after the surveys were
completed. Interviews were conducted until I reached a saturation of information that provided
no new insights. The interviews were conducted on site at AU or nearby in a private area.
Interview Sampling Criterion and Rationale
Criterion 1. Participants would need to have completed the 2018 AllWell? survey. For
participants to partake in the interview, they needed to complete the initial survey and received
the feedback provided. These are the participants whose opinions are desired regarding the
AllWell? survey since they have completed the 2018 AllWell? survey (Merriam & Tisdell,
2015).
Criterion 2. Participants had to consent that they would want to participate in an
interview. Not all participants in the survey wanted to be interviewed. Given the depth of
information that is necessary for this study, it was best if participants volunteered and consented
to be studied. Students who volunteered to be interviewed expressed a desire to explain more
about their experiences with the AllWell? survey and be potentially more data rich to better
understand the perceived impact of the AllWell? survey.
Data Collection and Instrumentation
Data collection consist of a survey and interviews. These methods were chosen to gain
depth and understanding of the issues of burnout that AU is facing. The survey provided
quantitative information that provides generalizations about the AllWell? survey that provide
patterns that can be used to understand the effectiveness of the survey. The interview provided
depth to explore the opinions of the survey and its impact on students. AU created the AllWell?
survey and its resources to assess students’ wellness and provide the necessary resources to build
effective study skills that are designed to improve a student’s personal resources, study skills,
HEALTH AND WELLNESS 59

and choice of study environment. Through these areas, AU aims to reduce the risk of student
burnout. Surveys and interviews are effective methods to provide both generalizations and
trends about the program as well as a deeper understanding of the opinions, motivations, and
insight into the AllWell? survey and its resources effectiveness of accomplishing its goal
(Merriam & Tisdell, 2016). These methods focus on the main stakeholder of the AllWell?
survey, and directly connect with students to hear their thoughts and opinions to develop a
deeper understanding of the AllWell? survey, its resources, and its perceived impact on students.
Surveys
The surveys were administered by email to Mikko Inkinen, AllWell?’s study
psychologist, who then forwarded the survey to all students who completed the 2018 AllWell?
survey, and the survey was anonymous. Mr. Inkinen is a trusted insider within the university and
having the emails sent to students through him increases the trust and validity of the survey.
Additionally, I did not have access to student information since I am not working for the
university. The 2018 AllWell? survey had a response rate of 38%, and, to increase the response
rate I had the students be introduced to the study through Mr. Inkinen. Since he works for AU
and the AllWell? survey, this makes the survey more trustworthy than if I were to send the
survey directly from another email account. Fink’s (2012) text on how to conduct surveys
suggests using language that the participants are familiar with to increase reliability and validity.
Dr. Crawford, the Chair of the doctorate committee, reviewed the survey to provide expert
assistance to ensure that the survey is well designed and easy to use to increase the reliability and
validity.

HEALTH AND WELLNESS 60

Interviews
Interviews were conducted at AU in Helsinki, Finland. It is anticipated to have at least
10 interviews. The interviews were conducted in a private room at AU. Interviews were
formally conducted one at a time. A semi-structured interview approach was used since it will
provide the necessary structure to guide the interview yet allow the interviewer flexibility. The
interviewer can use both structured and unstructured questions, and this gives the interviewer the
option to gain more depth when needed to better understand the views and opinions of the
participant on topics. Only one interview per volunteered participant was conducted, and each
interview was 45 to 60 minutes long. These interviews addressed KMO influences outlined by
the research questions but were shaped by survey results. The results of the survey needed to be
considered to explore patterns discovered. The interview began by identifying to the participant
the researchers’ role, the relationship with Mr. Inkinen, and the topic being studied, and followed
up by asking for permission to record the interview. Questions were open-ended and related to
students’ knowledge and motivation related to burnout and the students’ perceived effectiveness
of the AllWell?’s resources to provide supportive information and AllWell?’s effectiveness in
implementing the survey. Through asking the students, the key stakeholders, the study can
triangulate with the survey data provided by a larger sample of students, while also enabling me
to go into more depth about the AllWell? survey through the interviews.
Documents
Documents were collected from AU’s AllWell? survey and its resources. These
documents were previous AllWell? surveys, the resulting percentage of students who are at risk
of burnout categorized by major and department, and a sample of personalized feedback sent to
students to improve their study ability and reduce their risk of burnout with links to programs
HEALTH AND WELLNESS 61

and courses to support students. Collecting official and internal documents gives necessary
additionally context to AU’s culture, strengths, and future goals. Official documents were
collected from globally available websites and social media platforms in addition to AU’s
publicly available documents sent to those affiliated with AU through its online portal, such as
courses available, AllWell? updates, and presentations. Internal documents were collected
through Mr. Inkinen. These documents include previous AllWell? surveys, its resources, the
resulting percentage of students who are at risk of burnout categorized by major and department,
and a sample of personalized feedback sent to students to improve their student ability and
reduce their risk of burnout with links to programs and courses to support students. These
documents provided additional context to student burnout through the current risk of student
burnout. Obtaining these documents gives additional context to what feedback students are
receiving, how feedback is issued to students, the resources linked to students, and how effect are
these methods when looking longitudinally. This provides a necessary scope to the situation at
AU and shapes the potential impact that the AllWell? survey could have on students.
Data Analysis
For survey responses, frequencies were calculated. The mean and standard deviation are
presented to identify average levels for each response. Descriptive statistical analysis were
conducted once all survey results were submitted. Understanding the students’ responses helped
identify patterns within the data between key subgroups of gender and student status. This
information can be used in the interviews to gain more depth to understand why these patterns
occur.
For interviews, data analysis began during data collection. I wrote analytic memos after
each interview. I documented my thoughts, concerns, and initial conclusions about the data in
HEALTH AND WELLNESS 62

relation to my conceptual framework and research questions. This process helped me log
information about the interview that provided insight gained during the interview to better
understand how the interview provided more information and understanding of the questions
being examined. Once I left the field, interviews were transcribed and coded. In the first phase
of analysis, I used open coding, looking for empirical codes, and applying a priori codes from the
conceptual framework to categorize how students perceived (Harding, 2013) KMO issues such
as ease of use of the survey, appropriate knowledge were given to the student regarding available
resources, and students feelings about the feedback. A second phase of analysis was conducted
where empirical and prior codes are aggregated into analytic/axial codes. In the third phase of
data analysis I identified pattern codes and themes that emerged in relation to the conceptual
framework and study questions. I analyzed documents and artifacts for evidence consistent with
the concepts in the conceptual framework that add to how the AllWell? survey and its resources
influence students’ KMO regarding burnout.
Credibility and Trustworthiness
Increasing credibility and trustworthiness depended on my interactions with the
participants. I was the tool utilized in qualitative research, and, as a tool, the research should be
trustworthy and credible. These measures were taken during the survey by having Mr. Inkinen’s
trust as an insider at AU and deliver the survey to the students. When on site for the interviews,
it was important to build credibility and trust to from the participants to improve the interview.
To improve trust and credibility to the participants, it was important that I was transparent about
my background, my role, and my beliefs with study, and by doing so, encourage the participants
to believe that I adhered to the consent information provided to them and use the information
HEALTH AND WELLNESS 63

collected to benefit the students, the AllWell? survey, and AU. Being trustworthy of the study
and the information collected depends on the competence of the researcher.
Merriam and Tisdell (2016) summarize multiple sources that explain how to increase
credibility and trustworthiness by aiming for credibility, transferability, dependability, and
conformability, and Patton (2002) describes that, “the quality of the information obtained during
an interview is largely dependent on the interviewer” (p. 341). Increasing the credibility and
trustworthiness can be achieved through creating an authentic, compelling narrative that makes
sense through the semi-structured process and asking a range of questions that engage the
participants experience, behaviors, feelings, knowledge, and senses regarding burnout at AU and
the AllWell? survey (Firestone, 1987; Patton, 2002). Because of this, the interview protocol was
designed to allow the participant to explain and define their situation at AU and their experience
with the AllWell? survey in an authentic manner (Merriam & Tisdell, 2016). Data collected
from this study were triangulated between surveys, interviews, and document analysis, and the
survey items were based on existing reliable and valid instruments.
Validity and Reliability
Securing the highest level of validity and reliability was sought. To ensure that the
survey was valid and reliable, the questions were concise, clear, and easy to understand questions
that directly addressed students’ knowledge and motivation to use the information available from
the AllWell? survey. Fink (2012) provides text on how to conduct surveys suggests using
language that the participants are familiar with to increase reliability and validity. The
dissertation committee reviewed the survey to provide expert assistance to ensure that the survey
was well designed and easy to use to increase the reliability and validity (Fink, 2012).
Ethics
HEALTH AND WELLNESS 64

The study focuses on understanding the meaning through exploratory research using
mixed methods (Merriam & Tisdell, 2015). Triangulating information from surveys to
understand patterns and trends in the population in conjunction with developing a deeper
understanding using interviews to explore the reasons, opinions, and motivations of the
participants provided a clearer understanding of how students perceive the AllWell? survey and
its resources’ impact on them (Merriam & Tisdell, 2015). It was important that ethical choices
were made when conducting this study, and the survey and interview information collected
required that all participants understand the consent information provided at the commencement
of the study.
Glesne (2011) clarifies that informed consent informs the participants that participation in
the study is voluntary, any aspects of the research that may affect their well-being, and that the
participants can choose to freely stop participating at any point in the study. To ensure the safety
of the participants, I submitted my study to the University of Southern California Institutional
Review Board (IRB) and submitted my research proposal to AU. I also followed the guidelines
and rules set forth by the IRB to protect the rights and welfare of the participants in this study
and information collected during surveys and interviews about the participants was kept
confidential and secure. All participants in the study were notified of consent information prior
to participating in the study, and I reminded each individual that participation in the study was
voluntary and that all information was confidential and secure. I respected the participant’s
choice to withdraw from the study for any reason.
Prior to the interviews, I obtained permission to record the audio of the interviews and
provide the participants the option to review the transcripts of their interview. This gave the
participants the opportunity to ensure that I did not change their words during the transcription
HEALTH AND WELLNESS 65

process (Merriam & Tisdell, 2015). After the interviews, I will not be providing any incentives,
and this is to avoid any coercion as Glesne (2011) warns. When the study was completed, I sent
a thank you card, a thank you email, and a small monetary gift card as my appreciation for
participating in the study.
The study was conducted at AU in Helsinki, Finland. I am not affiliated with AU in any
way, and I am a complete outsider to the university. I have agreed to work with the leadership of
AU to evaluate the AllWell? survey and its resources that was launched in 2016. I have the
support of the administration and the leaders of the AllWell? survey as well as the leaders of the
Success of Students initiative to conduct the study. The participants of the study have no relation
to me, and potential coercion and pressure to participate is minimal. To minimize any
unanticipated risk and potential feelings of coercion, I revealed my role as an outsider of AU as a
researcher as well as my connection to the AllWell? survey. Students were informed that the
information collected is confidential and secure, and that it will be used to improve the AllWell?
survey.
My own personal beliefs and experiences have shaped my life to believe that personal
and communal health and wellness are important. I acknowledge that health and wellness is not
merely the absence of illness but the ability to thrive and flourish. Because of this, I place a high
importance on the development of non-cognitive skills and the health and wellness of the
individual and community. I also place a high emphasis on building trust through building
friendships. During interviews, the use of a semi-structured protocol will allow flexibility to
build more trust and gather more information to develop a deeper meaning. While this allows
me to study real responses to develop a deeper understanding, I need to be aware of ethical
dilemmas that may arise (Glense, 2011).
HEALTH AND WELLNESS 66

When looking at the 2017 study of the AllWell? survey and its resources, I must be aware
of the results of the study to be aware of potential implications of burnout that effect students’
overall health. Students may reveal specific details that require professional help, such as doctor
or police intervention, and this information would cause bring the ethical dilemma of either
stopping and reporting the sensitive information to the appropriate source or keeping the
necessary trust to gain more insight that could help other students. The 2017 survey revealed
that 17% of students are at risk of burnout. This is almost double the national average of 10%.
The lack of positive health and wellness could bring up ethical topics such as drug use or suicide.
During interviews, acknowledging my personal beliefs for health and wellness promotion can
help me gather more information from the participants and break down stereotypes around the
subject (Rubin & Rubin, 2011). This positive mindset in addition to an outsider with the
university provides the participants clarity of the role of the research and the researcher. While
this can be framed as a method to gain more information, this can also be viewed as an outside
with little reason to trust or as someone who knows little about the culture (Rubin & Rubin,
2011).
Limitations and Delimitations
Measures were taken to maintain reliable and valid data, but there were natural
limitations to the study. Two knowledge influences were determined using only one survey
item. This determined more of the perceptions of knowledge rather than the actual knowledge
gained. Interviews and surveys as the methodological instruments rely on self-reported data
which are difficult to verify for complete reliability and validity. The survey also required that
the stakeholders independently complete the surveys without guidance, and this leads to potential
misinterpretation of the questions even while suitable explanations were provided. Truthfulness
HEALTH AND WELLNESS 67

must be considered when reviewing the data collection method and the interpretation of the data.
Surveys and interviews are valuable tools, but they heavily rely on the participants being honest
and truthful in their responses.
Data collect from participants adds additional limitations. Surveys were sent out via
email through Mr. Inkinen. The time difference and the lack of physical presence at AU for
surveys by me equated to a non-ideal situation that left less control for the researcher. It would
be best to be on site to collect interviews to be aware of how they were taken. Being on site
allows me to have an introduction to the survey and build initial trust and credibility to increase
genuine responses. Interviews were conducted on site, but time was constricted because of
travel. Scheduling interviews and the limited time on campus meant that there was little margin
for error when collecting data from students due to restricted time on campus. When collecting
data, the survey instrument and interview protocol were influenced by existing reliable and valid
measures, but the protocols were of the researcher’s own design.
HEALTH AND WELLNESS 68

CHAPTER FOUR: RESULTS AND FINDINGS
The purpose of this chapter is to explore the knowledge, motivation, and organizational
influences using the gap analysis framework developed by Clark and Estes (2008) as AU seeks
to reach its 2020 goal of reducing student burnout to 10%. To do so, AU aims to increase
students’ study ability through increased knowledge and motivation to better their personal
resources, study skills, and choice of study environment. Data were collected through interviews
and surveys over three months between September 2019 and November 2019. In total, 109
respondents completed the survey, and the demographics of the respondents are shown in Table
5. Fourteen students participated in interviews. Online student survey data and face-to-face
interview transcripts were analyzed and triangulated to understand the KMO influences of the
students who completed the 2018 AllWell? survey to evaluate the effectiveness of this survey in
relation to the organizational goal of reducing burnout. The results of the data analysis were then
compared to the KMO assumptions defined in Chapter Two. The assumed KMO influences
were then validated or not validated based on the survey and interview data.
This chapter is organized according to the KMO framework and two questions:
• What are the knowledge and motivation related to the three skills the AllWell? survey
promotes for students who participated in the 2018 AllWell? survey and resources?
• What is the interaction between AU culture and context and AU students’ capacity to
improve their study ability?

HEALTH AND WELLNESS 69

Table 5
Demographics of Survey Participants
Measure Item Frequency Percentage
Student Undergraduate 65 59.6
Graduate 44 40.4
Gender Male 55 50.5
Female 54 49.5
Age 18-20 7 6.4
21-24 57 52.3
25-29 34 31.2
30+ 11 10.1
College Arts, Design, and
Architecture
13 11.9
Business 19 17.4
Chemical
Engineering
18 16.5
Electrical
Engineering
15 13.8
Engineering 24 22.0
Science 20 18.3
N = 109.
Student Knowledge and Skills: Knowledge Findings
Krathwohl (2002) identifies four dimensions of knowledge: factual, procedural,
conceptual, and metacognitive. Factual knowledge consists of isolated information such as
vocabulary or definitions. Conceptual knowledge builds upon a collection of factual knowledge
to create complex ideas, categories, or classifications. Procedural knowledge demands knowing
how something is completed in terms of techniques, methods, or algorithms. Metacognitive
knowledge requires the ability to reflect and evaluate one’s own actions or thoughts. It was
HEALTH AND WELLNESS 70

assumed that students at AU would require a variety of conceptual, procedural, and
metacognitive knowledge to increase their study ability and reduce burnout. Relevant data from
the survey and interviews were analyzed to determine whether AU students possessed the
required types of knowledge and whether the knowledge types were validated. Additionally,
some knowledge influences reflect on the students perceptions and not necessary the
confirmation of their actual obtained knowledge. Those assumed knowledge influences and the
determined validation are summarized in Table 6.
Table 6
Assumed Knowledge Influences and Validation
Assumed
Knowledge
Influence
Knowledge
Type
Validation
Method
Validated Partially
Validated
Not
Validated
Inconclusive
Students need to
understand
differences
between deep and
surface learning.
Declarative
(conceptual)
Survey X
Students need to
understand the
dimensions of
wellness.
Declarative
(conceptual)
Survey,
Interview
X
Students need to
know how to
manage the
symptoms of
burnout.
Procedural Survey,
Interview
X
Students need to
know how to study
effectively.
Procedural Survey X
Students need to
know how to
support their
wellness.
Procedural Survey,
Interview
X
Students need the
ability to
effectively assess
their own strengths
and weaknesses in
managing burnout.
Metacognitive Interview X
HEALTH AND WELLNESS 71

Students need the
ability to
effectively assess
their own strengths
and weaknesses in
studying
effectively.
Metacognitive Survey X
Students need the
ability to
effectively assess
their own strengths
and weaknesses in
supporting their
wellness.

Metacognitive Interview X

HEALTH AND WELLNESS 72

Conceptual Knowledge – Types of Learning
This influence is inconclusive. When examining the skills necessary to increasing study
ability, conceptual knowledge of deep and surface learning is paramount (Entwistle & Ramsden,
2015; Houghton, 2004; McLean, Attardi, Faden, & Goldszmidt, 2016). Students need
conceptual knowledge of deep and surface learning to be able to recognize when deep,
meaningful learning occurs. This knowledge is necessary to build procedural and metacognitive
knowledge and skills that will increase study ability.
When examining the data regarding students’ perceived knowledge of the differences
between deep and surface learning, this influence is inconclusive. Students were asked on the
survey if they agreed with the statement, “I understand when I study well.” Finnish and
international students enrolled at AU are the products of one of the best educational systems in
the world that places an emphasis on deep learning as part of the curriculum (Sahlberg, 2006).
AU students are placed in an environment where they are expected to be critical of information
and connect it to other ideas instead of accepting facts or rote memorization, which aligns with
Finland’s as well as AU’s educational design (Trigwell & Prosser, 1991). The survey results
indicated that students know when deep learning occurs with 94% of students agreeing, 32%
“Strongly Agree” and 62% “Agree,” that they understand when deep learning occurs. Responses
were consistent across all demographics. The students perceive that they understand the
difference between surface and deep learning, and it potentially provides students a foundation to
build processes to achieve quality learning.
Conceptual Knowledge: Dimensions of Wellness
This influence is validated. Conceptual knowledge of the dimensions of wellness is
necessary to reduce student burnout. Living optimally requires creating a healthy environment,
HEALTH AND WELLNESS 73

supportive communities, and being physically, mentally, and socially healthy (Hettler, 1980;
Hoyt et al., 2012; Seligman, 2011). Having the knowledge of the dimensions of wellness
provides the students the information and opportunity to locate healthy study environments,
develop study skills, and improve personal resources that will directly impact burnout (IsHak et
al., 2009; IsHak et al., 2013). Students were asked in the interview to “Describe how you believe
AU supports your studying, if at all.” Students provided comprehensive answers displaying a
range of dimensions that span mental and social as well as academic support. At AU, students
have counselors to support their mental health and emphasize the importance of physical health
through better choices. Interview 7 explained the range of dimensions of wellness to address
social and academic support: “And we have lots of support systems. We have ylioppilaiden
terveydenhoitosaatio, which is the health care system. It's for university students. And we have a
psychologist if we need one.”
Interview 7 detailed the health care system at AU in addition to the mental health support
available for students, suggesting support for a variety of needs if students encounter difficulties.
Interview 1 described how this person improved their wellness when life at AU became stressful:
“I took pretty good control when I had the worst times with my studying and really stressed out.
I slept more. Went to bed early. Stopped drinking. Ate better. Had more exercise.” The majority
of interviews referenced a need for a range of wellness support demonstrating knowledge of the
different dimensions of wellness necessary to improve study ability. The students referenced
multiple dimensions of wellness and areas that support their study ability and overall wellness.
Students understand that health and wellness require a multi-dimensional conceptualization that
provides benefits across all areas of life.
HEALTH AND WELLNESS 74

Figure 1. Students responses to survey question 4 – I know the benefits of wellness.
Additionally, students were asked if they agreed with the statement “I know the benefits
of wellness.” As shown in Figure 1, 60% “Strongly Agree” and 36% “Agree” that they knew the
benefits of wellness. There were no differences by demographics. The survey results of
perceived knowledge of the benefits of wellness match with the themes in the interviews
suggesting that students have the necessary knowledge regarding the benefits of wellness.
Procedural Knowledge: Managing the Symptoms of Burnout
This influence is partially validated. Managing the symptoms of burnout requires having
knowledge of how to support wellness in addition to knowing how to ensure an individual’s
health and wellness (Aaltonen et al., 2013; Marek et al., 2017). Having the procedural
knowledge to manage the symptoms of burnout gives students the necessary steps to prevent
burnout in addition to increasing their own study ability through health promotion.
To determine the students’ procedural knowledge of managing the symptoms of burnout,
students who were interviewed were asked how they can support their wellness at AU. Students
were asked to “Describe how the AllWell? survey provides resources for students to increase
60%
36%
3%
1%
I know the benefits of wellness
Strongly Agree Agree Neither agree nor disagree Disagree
HEALTH AND WELLNESS 75

their study ability, if at all.” The theme of having government health care, psychologists,
academic help from professors, and workshops available on campus became evident throughout
the interviews. Interview 5 supported the theme when the participant said, “we have the student
health service in Finland. That's something that I know I can rely on if I ever have troubles with
mental health or burnout or something like that, so that's like I feel quite safe.” Interview 7
added the experience of working with the psychologist: “The psychologist helped me to get me
out of the burnout because I couldn't read anymore and like that.” Both statements detail sources
to support health and increase study ability.
The interviews indicated that students had the procedural knowledge to manage the
symptoms of burnout. Students knew and described the steps that they can take to manage these
symptoms in both the interviews and surveys. Students at the school of arts, design, and
architecture reported differently from students at other schools and displayed a lack of
understanding, which contributed to the high burnout reported in the 2018 AllWell? survey.
Without interviewing students from this school, it is difficult to understand the disagreement
between reported procedural knowledge from the survey and the procedural knowledge
described in the interviews.
In addition to the interview, students were asked if they agreed with the statement “I can
locate where university support systems are on campus.” Overall, students neither agreed nor
disagreed with the statement, with students averaging a score of 3.35 from strongly disagree, 1,
to strongly agree, 5. This score is slightly negatively correlated to the number of programs
completed that were recommended by the AllWell? survey. The more programs or workshops
that students completed, the lower the level of agreement with being able to locate support on
campus. This inverse relationship indicates that students use the recommendations from the
HEALTH AND WELLNESS 76

survey to gain the knowledge to manage the symptoms of burnout but do not necessarily use the
support systems on campus.

Figure 2. Students’ responses by school to survey question 6 – I can locate where university
support systems are on campus.
While students within the school of electrical engineering, school of engineering, and
school of science scored the highest, averaging 3.8, 3.67, and 3.55 respectively, the students
within the school of arts, design, and architecture scored lower at almost one standard deviation
below everyone else. The students within this school averaged a score of 2.31 with none
selecting either “strongly agree” or “agree” for the statement regarding locating support on
campus. This difference between the school of arts, design, and architecture and other schools
indicates a procedural knowledge gap that needs to be addressed. Figure 2 shows the breakdown
of the responses by each school.
Procedural Knowledge: Studying Effectively
This influence is inconclusive. To increase study ability, students must improve their
study skills, such as studying techniques, habits, and critical thinking (Naqvi et al., 2018;
Robbins et al., 2004; Stanley & Nillas, 2017). Students who take the AllWell? survey are
0% 20% 40% 60% 80% 100%
Arts, Design, and Architecture
Business
Chemical Engineering
Electircal Engineering
Engineering
Science
I can locate where university support
systems are on campus
Strongly Agree Agree Neither agree nor disagree Disagree Strongly Disagree
HEALTH AND WELLNESS 77

provided feedback regarding their study ability, and, if there are areas that are low and cause
burnout, the survey provides feedback and suggestions for courses and programs to help improve
the identified areas. Ensuring that students have the procedural knowledge to study effectively
increases study ability and, in turn, reduces burnout.
To determine if students perceived that they had the necessary procedural knowledge to
study effectively, they were asked if they agreed with the statement. “Overall, I have been
organized in my studying.” The average response was 3.48 on a scale of strongly disagree, 1, to
strongly agree, 5, showing that students, on average, either agreed or felt neutral about the
statement, and Figure 3 shows a detailed breakdown of the students’ responses categorized by
school. Overall, there are no significant differences between the demographics. Schools leaned
towards agreeing with the statement. The results indicate that students do not fully agree or
disagree with the statement that they are organized when they study. It is likely that more
students perceive that they possess the necessary procedural knowledge to study effectively, but
some are disorganized. These latter students would be at risk of burnout due to this lack of
knowledge.

0% 20% 40% 60% 80% 100%
Arts, Design, and Architecture
Business
Chemical Engineering
Electircal Engineering
Engineering
Science
Overall, I have been organized in my
studying.
Strongly Agree Agree Neither agree nor disagree Disagree Strongly Disagree
HEALTH AND WELLNESS 78

Figure 3. Students’ responses by school to survey question 5 – Overall, I have been organized in
my studying.

Procedural Knowledge: Supporting Wellness
This influence is partially validated. Students need to have the procedural knowledge of
how to support their wellness. Conceptual knowledge of the dimensions of wellness provides
procedural concepts support wellness. Since increasing wellness has an indirect relationship
with burnout, supporting wellness across all dimensions is beneficial (IsHak et al., 2009; IsHak
et al., 2013). Having the procedural knowledge to support wellness allows students to live
optimally and treat or avoid burnout (Hoyt et al., 2012; IsHak et al., 2009; IsHak et al., 2013).
Students’ ability to locate support systems on campus was previously discussed. Students
know where to find available resources, with the exception of those at the school of arts, design,
and architecture. This conceptual knowledge plays a part in students’ having the procedural
knowledge to support their study ability or their physical, mental, and social health. Without
knowing where the AU’s supportive resources are, it is not possible to create the procedural
schemas necessary to promote health, wellness, and study ability.
Students were also asked to “Describe how the AllWell? survey provides resources for
students to increase their study ability, if at all,” and students identified a number of support
systems available. The interviews showed that students could describe a number of support
systems available. Government health care for university students, psychologists, workshops,
professors, and study advisors were the most commonly described supports. In Interview 5 the
participant described these supports:
There is like workshops on how to handle stress and how to like double up your study
skills, and stuff like that. And then, of course, something that I think is very, very good
they, their emphasis is on group work and they teach us from year one goes study with
HEALTH AND WELLNESS 79

your friends and teach each other. So at least when I started in the school of chemical
engineering that was the first year where we got group work and peer support and stuff
like that.
Interview 5 outlines the range of options available at AU to support themselves from professors
and staff to the additional opportunities to learn how to improve specific skills to increase health,
wellness, and study ability. Interview 12 adds the availability of academic help beyond the
already described helpful professors when the participant said, “I'm in constant contact with my,
I think, service tutoring professor.” Additionally, Interview 9 discussed the role of student
mentors from professor:
The mentoring from like this professor who was mentoring groups of students. They do
give like advice about how to study and like they give it a bit like maybe context about
like the greater what can you do with your studies and how that study is generally
progressed and stuff. They're pretty helpful, especially in the first year. Mentoring was
pretty useful.
This is variety of support is similar to the multi-dimensional conceptualization of wellness that is
proposed by Hettler (1980) and the WHO (2006). Both emphasize living optimally across all
areas of life: occupational, social, mental, physical, intellectual, emotional, and spiritual (Hettler,
1980; WHO, 2006).
When examining both the surveys and the interviews, the participants’ ability to locate
support was not always evident. Interviewees lacked confidence in identifying the steps they
could take to support their wellness, and the surveys indicated that students were indifferent
when asked if they knew how to take the appropriate steps to support their wellness. Without
agreeing, students are at risk of not supporting their own wellness, and this has implications for
HEALTH AND WELLNESS 80

their wellness and health. These impacts in students’ lives can hinder them from performing at
their academic best.
Additionally, there are differences among the schools in terms of being able to locate
support. The ability to locate support is reflected in the interviews through the students’
experiences with those supports. The students in the school of arts, design, and architecture
disagreed with being able to locate the necessary support on campus, which demonstrates a
procedural knowledge gap that needs to be addressed. Students at other schools leaned towards
agreeing that they can find the necessary support systems on campus, but the schools’ averages
indicate that there are some students who cannot locate support.
Metacognitive Knowledge: Managing Burnout
This influence is validated. Students need metacognitive knowledge to assess their own
study ability and wellness Managing burnout requires that students are aware of their influences
of burnout across their academic and personal lives. Ensuring that students have the
metacognitive knowledge to manage their burnout prevents issues that can impact their personal
and academic lives and directly affect their performance at AU.
AU offers the AllWell? survey to provide feedback to students to increase their
metacognitive knowledge. Knowing that participants took this survey, they were asked how they
could improve their study ability. Throughout the interviews, students described that the
survey’s feedback was what they expected and that the survey provided no new feedback. While
the feedback was valuable to students and can provide insight into how to increase their study
ability, the feedback confirmed students’ beliefs about their own strengths and weaknesses when
managing burnout. Table 7 provides selected quotes from the participants’ interviews about the
feedback provided from the survey. Since students reported having the necessary metacognitive
HEALTH AND WELLNESS 81

knowledge to manage their burnout, they can use their strengths as a foundation from which to
improve their study ability.
Table 7
Select Quotes from AU Students’ Interviews Around Feedback from AllWell? Survey
Interview 1 “I think it matched pretty well with how I felt about studying here.”
Interview 2 “There was nothing new for me.”
Interview 3 “I mean, I think the feedback was rather, like on the well-being side. So that kind of
was what I expected. Because I feel rather good, confident, and so.”
Interview 5 “So I don't remember specifically what feedback I got but I remember like the
impression I had from the feedback and it was like ah yeah yeah I knew this, I kind of
guessed that and well not too many interesting new ideas what to do to improve.”
Interview 6 “I think it was pretty much what I expected it to be. Maybe I was expecting
something a bit worse actually.”
Interview 7 “And I think my answers, what I got, I knew them already.”
Interview 9 “Well, most of it was like kind of expected that. I probably like internally knew that
okay I'm doing this a little bit wrong. I kind of expected some feedback.”
Interview 12 “Because I knew every single thing that came out of the survey. I already knew it
beforehand.”
Interview 13 “Not to give it new information, but confirm. Its confirmed that I'm doing too much
for my well-being.”
Interview 14 “I guess I had the feelings already but then it just confirmed it.”

Table 7 provides insight into students’ beliefs about the feedback from the AllWell?
survey. These selected quotes indicate a pattern that students possess the necessary cognitive
knowledge to manage burnout since the survey provided no new information or confirmed their
own beliefs.
Metacognitive Knowledge: Studying Effectively
This influence is validated. Having the necessary conceptual and procedural skills
supports and builds study skills to reduce burnout, and it is just as important to have the
metacognitive knowledge to efficiently assess one’s own ability to manage burnout (IsHak et al.,
2009; Stoliker & Lafreniere, 2015). Students’ failure to understand their own strengths and
weaknesses can leave them unable to use their strengths to improve study ability.
HEALTH AND WELLNESS 82

To determine students’ metacognitive knowledge of their own strengths and weaknesses
in managing burnout, they were asked if they agree with the statement “I believe that I can assess
how I study well.” Students agreed that they can assess when they study well. The average
response was 3.86 on a scale of strongly disagree, 1, to strongly agree, 5, and a breakdown of the
responses is displayed in Figure 4. While the schools reported similar findings, the school of
arts, design, and architecture averaged 3.46, placing it in the 32nd percentile. Students in this
school did not agree that they can assess how they study well, but it was clear that they did not
disagree with the statement. Given that most students agreed with the statement, students have
metacognitive knowledge of when they study well, which helps avoid burnout.

Figure 4. Students’ responses by school to survey question 7 – I believe that I can assess how I
study well.

Additionally, students were asked if they agree with the statement, “I believe that I have
the ability to assess how I am weak at studying.” Overall, students agreed with the statement
when they reported an average of 3.98 on a scale of 1 to 5 ranging from strongly disagree to
strongly agree. There was no difference among demographics, and Figure 5 shows the
breakdown of students’ responses. This overall agreement with the statement suggests that
0.00 0.20 0.40 0.60 0.80 1.00
Arts, Design, and Architecture
Business
Chemical Engineering
Electircal Engineering
Engineering
Science
I believe that I can assess how I study
well
Strongly Agree Agree Neither agree nor disagree Disagree Strongly Disagree
HEALTH AND WELLNESS 83

students believe they have the metacognitive skills and knowledge to estimate their weaknesses
in studying. This indicates that students have the metacognitive knowledge to self-assess gaps in
their knowledge. Additionally, this provides an opportunity to enhance areas of perceived
weakness and managing burnout.

Figure 5. Students’ responses by school to survey question 8 – I believe that I can assess how I
am weak at studying.

While students overall reported that they have the knowledge necessary to increase study
ability and reduce burnout, students at the school of arts, design, and architecture reported a large
difference when self-assessing strengths and weaknesses. Students at this school reported less
confidence in assessing their own strengths as compared to students in other majors in addition
to a difference in self-assessing strengths when compared to weaknesses. This indicates
emphasizing the negatives, aligning with the current model of health conceptualization which
treats illness as opposed to promoting health. While students at the school of arts, design, and
architecture do not disagree that they self-assess their strengths, they do not fully agree that they
can.

0.00 0.20 0.40 0.60 0.80 1.00
Arts, Design, and Architecture
Business
Chemical Engineering
Electircal Engineering
Engineering
Science
I believe that I have the ability to assess how I am
weak at studying.
Strongly Agree Agree Neither agree nor disagree Disagree Strongly Disagree
HEALTH AND WELLNESS 84

Metacognitive Knowledge: Supporting Wellness
This influence is validated. Students need the metacognitive knowledge to assess their
own strengths and weaknesses in support of their own wellness. Wellness is multi-dimensional,
and the dimensions are interconnected. Improving students’ overall health is necessary to
improving wellness and preventing health issues as well as the negative impact on learning and
achievement in university (Hoyt et al., 2012; IsHak et al., 2009; Killian, 2017). Students’
metacognitive knowledge to support their own wellness gives them the ability to live optimally,
which allows them to perform without interference from decreased health.
To assess this influence, students were asked, “How can you improve your study
ability?” during the interview. During the interview, students reported awareness of their own
strengths and weaknesses and ways that they can improve their study ability. The largest theme
reported by the students is the need to improve their own time management, as seen in Figure 6.
The recurrence of busy schedules stems from the workload at AU, such as classes, studying, and
assignments, and life beyond AU, such as work and social requirements which have an impact
on their occupational and social health. Students report that balancing their wellness is difficult
due to the time required to support each dimension, but they recognize their own strengths and
weaknesses.
HEALTH AND WELLNESS 85

Figure 6. Frequency of student’s ideas to improve study ability. Students’ responded to
interview question 3a, “How can you improve your study ability?”

Excerpts from the responses to the interview question “How can you improve your study
ability” in Table 8 provide examples that students possess the metacognitive knowledge to
support their wellness. The interviews indicate that students understood their own strengths and
weaknesses across a variety of dimensions when supporting their wellness. This variety of
answers from individual students and from the interviews overall displayed an understanding of
how to use strengths to support their wellness in addition to knowing their weaknesses.

0 2 4 6 8 10 12 14
Self-care
Improve learning skills
Learning community
Self-management
Time management
How can you improve your study ability?
HEALTH AND WELLNESS 86

Table 8
Select Quotes from AU Students Around Metacognitive Knowledge to Support Wellness
Interview 1 “I took pretty good control when I had the worst times with my studying and really
stressed out. I slept more. Went to bed early. Stopped drinking. Ate better. Had more
exercise.”
Interview 2 “Yeah, well the basic stuff. Sleep well, eat better, do not drink that much. Probably one
of the biggest things in future, I think, is going to be how to make students understand
that not every course has to be a five but you can get ones and twos as well. So the
score is one to five, you know?”
Interview 3 “Be less stressed about, I don't know, be a bit more relaxed, and don't try to deliver
100%. And rather, a bit lower… I spent too much time on assignments because I do
them ... I have a hard time in just not completing an assignment, and completing it just
takes a long time. And sometimes, 80% might be just good enough. But yeah.”
Interview 5 “My study ability. I can stop doing small things when I have focus, I should be focusing
on bigger tasks.”
Interview 6 “Just by getting certain basic stuff into control and building on that knowledge because
if a piece is missing, it's really hopeless.”
Interview 7 “Well, I always maybe when I know I have curriculum each semester, I usually make
time table when I have to read and when I go to work because I work two or one day a
week, and then also I have other activities, so I really do good time tables, but that
really turn out to be bad one because then I made so much like scheduling that I didn't
have free time. Of if I scheduled free time, it didn't feel like free time.”
Interview 9 “Probably taking like a dedicated course where they teach you about time management
and planning and probably like different methods of learning maybe. That's one way, of
course. And probably another way would be just to like go see somebody could be just
a colleague or anyone and maybe like explain them how do you do things? And ask
them if they could.”
Interview 10 “I think I was thinking about them maybe a couple years ago when I wasn't studying so
well. But how I have done it is basically just self-reflection and see what do I learn, how
do I actually learn. And then I try to aim for an outcome. I don't just study for a test, or I
don't study in such a way that I must remember this, but I always try to remember the
concepts, for example… There's so much to do nowadays. I don't really have that much
of an interest in that. Especially since I don't feel like I have the problem at the moment
about my studies.”
Interview 11 “Well, I mean these are kind of questions that are fairly difficult to answer. I mean we
don't have much time, it's something that you have to give thought to. But, the
scheduling, of course. I mean I do a lot now, but even more so I know scheduling your
time as much as you can.”
Interview 12 “But what I would personally really need is more of a psychological like coaching
maybe”

HEALTH AND WELLNESS 87

Table 8, continued
Interview 13 “Take less courses. It takes me so much to study, little things, because of my dyslexia.
So, it takes about twice the time to study the same thing. So, there is all this doing less.”
Interview 14 “Well, I don't really ... maybe keeping balance on different parts of life, it's ... you have
to have something to balance the other work of school. And for me, I have participated
in the daily life of our guild, in the guilds board, it's a hobby but sometimes it's hard
because guild things, when you're in the board you just have to do the things you are
assigned to. And then it doesn't matter ... I usually have about five hours of work a
week and then I don't think it's that much, but then sometimes there's a lot of
schoolwork ... you're going to leave something out. But it's really hard to decide which
one will you leave out.”

These selected quotes suggest that students have metacognitive knowledge about their
own strengths and weaknesses to support their wellness. The interviews provided insight into
students’ perceived strengths and weakness as well as what would be necessary to improve their
wellness. These were best summarized in Interview 11 when the participant suggested the
interconnectedness of the domains of wellness. The participant also acknowledged difficulties
with the responsibilities while also suggesting a solution to the issue. This pattern was consistent
among the interviews.
The findings suggest that students have the metacognitive knowledge to effectively
assess their strengths and weaknesses to support their wellness. The participants identified a
range of areas that could be improved to increase study ability. Time management was the most
common response, suggesting that students have the necessary academic and personal
knowledge, yet they need to improve their scheduling to support their overall wellness.
Synthesis of Results and Findings for Knowledge Influences
The students possess the necessary knowledge to increase their study ability and decrease
burnout. Students reported a firm understanding of the differences in learning in addition to the
benefits of promoting wellness across the various dimensions of their lives. Students also
possess the procedural knowledge to increase study ability through the management of burnout
symptoms, studying effectively, and supporting their own wellness. Most importantly, students
HEALTH AND WELLNESS 88

report that they have the metacognitive skills to understand their strengths and weaknesses to
effectively use their knowledge to increase study ability. Overall, students possess the
knowledge to effectively increase their study ability.
While students overall reported the necessary knowledge to increase study ability, those
at the school of arts, design, and architecture reported differently. Students at this school lacked
knowledge in multiple areas. These students are at a higher risk of burnout due to lack of
knowledge regarding managing the symptoms of burnout, supporting their own wellness, and
studying effectively. While these students do possess the conceptual and metacognitive
knowledge necessary to increase their study ability, lack of procedural knowledge is a hindrance.
Student Motivation: Motivation Findings
Motivation is best described as active choice, persistence, and mental effort in a decision
to invest in reaching a goal, state, or outcome (Clark & Estes, 2008). Motivation determines,
directs, and sustains how a student learns (Ambrose et al., 2010). The literature review
emphasized the importance of providing healthy settings and the knowledge to promote health
within students’ lives as well as the factors that influence motivation, including value in tasks,
self-efficacy, and goal orientation. The motivational influences that impact students as well as
the validation of those influences are summarized in Table 9.

HEALTH AND WELLNESS 89

Table 9
Assumed Motivational Influences and Validation
Assumed
Knowledge
Influence
Knowledge Type Validation
Method
Validated Partially
Validated
Not
Validated
Utility
Value
Students need to see the
value of the AllWell?
survey in supporting their
ability to improve study
ability.
Survey X
Self-
Efficacy
Students need to believe
that they have the ability to
apply the results of the
AllWell? survey.
Survey X
Goal
Orientation
Students should want to
have effective study ability
to prevent burnout.
Survey X

Utility Value: Value in the AllWell? Survey
This influence is partially validated. Having the necessary knowledge is not enough
when examining burnout. Students who have the knowledge but lack motivation to use the
knowledge will increase their risk of burnout. Utility value represents the students’ value for any
task or goal (Wentzel & Miele, 2009). Through the AllWell? survey, AU provides feedback and
suggestions for students to increase their study ability to reduce burnout. Increasing the utility
value of the feedback is necessary to have students apply the results of the survey.
To assess student motivation, a series of survey questions were asked. First, students
were asked if they agreed with the statement “The Aalto University’s study skills information,
programs, and courses can help me improve my study ability.” Overall, 45% of students neither
agreed nor disagreed with the statement while 25% agreed and 20% disagreed. The highest
reported score was 3.3 on a scale of 1 to 5 ranging from strongly disagree to strongly agree, but
there was no significant difference among demographics. Second, students were asked if they
HEALTH AND WELLNESS 90

agreed with the statement “The Aalto University’s study skills information, programs, and
courses can help other students improve their study ability.” The most common answers were
“Agree” and “Neither agree nor disagree,” each at 38%. Students averaged 3.5 with the highest
reported average of 3.7. There were no significant differences among demographics.
When examining these two questions, the usefulness of AU support appears. The value
of the support provided by the AllWell? survey and AU is viewed as more valuable to other
students than to themselves. All schools reported lower scores when reporting the value of study
ability support provided for themselves, yet the students believed that the same support systems
are useful for other students. All schools reported that the recommendations can improve other
students’ situations more than their own. These results indicate there is value in the supportive
resources (Figure 7).

Figure 7. Comparing student responses about who AU resources can help.
1
1.5
2
2.5
3
3.5
4
4.5
5
Arts, Design, and
Archtecture
Business Chemical
Engineering
Electical
Engineering
Engineering Science
I believe Aalto University's study skills information,
programs, and courses can help improve study ability.
Myself vs Others
AU can help me AU can help others
HEALTH AND WELLNESS 91

In addition to the survey’s results, students’ motivation was assessed to understand if the
results made students more aware of their own strengths and weaknesses. The AllWell? survey’s
empirically supported design provides evidence beyond students’ own beliefs about their own
skills and conceptions. To assess whether students find value in the survey in terms of
increasing metacognitive awareness, they were asked if they agreed with the statement “The
AllWell? results make me aware of my own strengths and weaknesses in my study ability.” The
majority of students responded that they agree, with 7% reporting “Strongly Agree” and 46%
“Agree.” A nearly equal number of students reported that they neither agreed or disagreed with
the statement, 22%, or disagreed with the statement, 24%. Additionally, the majority of students
in all schools agreed with the statement. This reporting displays that the majority of students
find value in the survey in helping them become more aware of their strengths and weakness in
their study ability and increasing their metacognitive awareness.
Students were also asked about the value of the results of the survey. It is necessary that
students find value in the results to be motivated to use the support they are linked to. The
survey’s linked support provides students the knowledge and skills to increase their study ability
and decrease their chance of burnout. Additionally, increasing study ability improves the
chances of graduation by removing large mental health issues (Finnish Student Health Services,
2018; Richardson et al., 2012; Walton & Cohen, 2011).
Students were asked if they agreed with the statement “If I complete the AllWell?
recommendations, my study ability will improve.” Overall, students averaged 3.2 on a scale of 1
to 5 ranging from strongly disagree to strongly agree. While students did not disagree with the
statement, 46% of students “Neither agree nor disagree,” and 40% agreed with the statement.
HEALTH AND WELLNESS 92

Figure 8 shows the breakdown of the responses. There were no significant differences among
demographics.
Overall, students believe that the AllWell? survey is good for AU students, but all
students believe that the survey is more valuable for others. Figure 8 details the students’
responses regarding whether the survey recommendations will improve their study ability, and it
is unclear if students agree or disagree that these will help them. When comparing the belief that
the survey will help them as compared to others, the results suggest that students are
deemphasizing the benefits of the study ability recommendations for themselves while holding a
belief that those same recommendations would be beneficial for others. Students’ reporting that
the survey makes them aware of their own strengths and weaknesses in their study ability seems
to confirm their own beliefs. This is further suggested by the belief that their study ability is
better than that of others and that completing the recommendations will not improve their study
ability.

Figure 8. Students responses to Q12, “If I complete the AllWell? recommendations, my study
ability will improve.”

Self-Efficacy: Ability to Apply Results
2.8%
36.7%
45.9%
11.9%
2.8%
If I complete the AllWell? recommendations, my
study ability will improve
Strongly Agree Agree Neither agree nor disagree Disagree Strongly Disagree
HEALTH AND WELLNESS 93

This influence is validated. It is important that students are motivated to apply the results
of the AllWell? survey. According to Bandura (1995), having self-efficacy, belief in one’s own
capability, plays an important role in motivation. A lack of efficacy can lead to being
ineffective, and this ineffectiveness is a main component of burnout (Werther, 2012). The
AllWell? survey aims to provide the necessary skills and knowledge in addition to increasing
motivation. One section of the feedback is aimed at specifically assessing and improving self-
efficacy through self-management and time management. For students to be successful at
applying the results of the survey, building study ability, and decreasing burnout, they need to
believe that they can apply the results to improve their own capabilities.

Figure 9. Student responses to Q13, “I can do well in my studies.”
Survey responses from the students, as shown in Figure 9, suggests that students are
confident in their abilities. In total, 89% of students agreed and only 8% disagreed. There was
no significant difference among demographics. The survey responses indicate that students
possess the motivation driven by self-efficacy necessary to increase study ability from the
feedback from the AllWell? survey. The confidence students exhibit in their studies reflects
56.0% 33.0%
2.8%
8.3%
I can do well in my studies.
Strongly Agree Agree Neither agree nor disagree Disagree Strongly Disagree
HEALTH AND WELLNESS 94

their ability to apply the results of the survey. This confidence provides the necessary motivation
for them to increase their personal resources, study skills, and choose an appropriate study
environment.
Goal Orientation: Desire to Improve Study Ability
This influence is not validated. Understanding the motivation for goal attainment is
important. Goal orientation theory provides two types of motivation for goals: mastery and
performance (Pintrich, 2003; Young & Anderman, 2003). Students need to want to have the
effective study ability to increase their overall wellness in addition to avoiding burnout, whether
it is mastering knowledge and skills to increase study ability or performing at a level to avoid
burnout. Students aiming for mastery of study ability as opposed to just performing to avoid
burnout would see the maximum benefits. The AllWell? survey provides students the resources
to increase their study ability and pursuit of graduation.
It was previously discussed that students possess the self-efficacy to apply the results of
the AllWell? survey. Understanding if students view the application of these skills and
knowledge as beneficial to graduation and the starting of their professional career is essential.
To assess if students feel that the survey provides motivation for them to have effective study
abilities to reduce burnout, they were asked whether they agree with the statement, “The
AllWell? survey’s connections can help me graduate.” The majority of students, 51%, “Neither
agree nor disagree” with the statement. Additionally, more students disagreed with the
statement, 31%, than agreed, 18%. When averaging all the students’ responses, students leaned
slightly towards disagreement with 2.79 on a scale of strongly disagree, 1, to strongly agree, 5.
Figure 10 outlines the student responses. There was no significant difference by demographics.
HEALTH AND WELLNESS 95

Figure 10. Students’ responses to survey Q14, “The AllWell? survey’s connections can help me
graduate.”

The students’ statements suggest there is little belief in the AllWell? survey’s
recommendations. The majority of the students did not agree with the statement suggesting that
there is little motivation to use the resources provided. Given that the survey’s purpose is to
increase study ability, only a portion of the students are motivated to use the recommendations to
increase their study ability and decrease burnout, which, in turn, would help them graduate.
Synthesis of Results and Findings for Motivation Influences
Overall, the results of the assessment of motivational influences provides mixed results.
It was evident that students felt there is value in the AllWell? survey and its recommendations.
The survey validates students’ feelings and opinions of their study ability, and they value the
recommendations provided. Students also believe that they can apply the results of the AllWell?
survey recommendations.
When examining the results together, the students’ self-efficacy reflects the differences in
the usefulness of applying the results. While the students did find value in the survey and its
recommendations, all students believe that the AllWell? survey and its recommendations are
1%
17%
51%
23%
8%
The AllWell? survey’s connections can help me
graduate
Strongly Agree Agree Neither agree nor disagree Disagree Strongly Disagree
HEALTH AND WELLNESS 96

better for others than themselves. This is echoed when students believe the survey has little
impact, positive or negative, on helping them graduate since they are confident in their own
ability to do well in their studies.
Organizational Influences: AU Culture and Resources
An organization’s influences impact performance through its culture. The values an
organization holds, and the concrete manifestations of those values, help define an organization’s
culture (Gallimore & Goldenberg, 2001). At AU, major components of its culture consist of the
AllWell? survey, resources for increasing study ability, feelings of support, and promoting a
culture of supporting study ability. AU’s culture influences students’ knowledge and motivation
through the resources available, the feelings of university support of students, and promotion of
study ability. It was assumed that these influences were key features that impact student
burnout. Table 10 summarizes these organizational influences and the determined validation.
Table 10
Assumed Organizational Influences and Validation
Organizational
Influence Category
Assumed Organizational
Influences

Validated Partially
Validated
Not
Validated
Cultural Model
Influence 1
AU needs to cultivate a culture
that supports students’ study
ability in all three areas:
personal resources, study skills,
and study environment.
X
Cultural Model
Influence 2
AU needs to increase students’
feeling of being supported by
AU.
X
Cultural Setting
Influence 1
AU needs to provide resources
for students to increase their
study ability.
X
Cultural Setting
Influence 2
AU needs to promote the
participation of the AllWell?
survey.
X

HEALTH AND WELLNESS 97

Cultural Model Influence: Supportive Culture for Study Ability
This influence is partially validated. AU needs to provide a culture that promotes study
ability to its students. AU conceptualizes study ability across three areas: personal resources,
study skills, and study environment. Promoting a culture that enhances these three areas will
encourage current and future students to increase their study ability, and this establishes a
healthy campus necessary to decrease the burnout rate.
To assess whether participants felt that AU creates a culture that supports their study
ability in all areas, they were asked if they agreed with the statement “Aalto University supports
my ability to study effectively.” Overall, students reported that they slightly agreed. Nearly
60% of students agreed with the statement with 20% “Strongly Agree” and 39.4% “Agree.”
Only 21% disagreed with the statement with 17% “Disagree” and 4% “Strongly Disagree.”
When comparing these results with the number of completed programs or workshops that were
suggested by the AllWell? survey, the results showed a positive correlation. The more programs
or workshops that students completed, the greater their satisfaction with the resources.

Figure 11. Student response by school to survey Q15, “Aalto University supports my ability to
study effectively.”
0% 20% 40% 60% 80% 100%
Arts, Design, and Architecture
Business
Chemical Engineering
Electircal Engineering
Engineering
Science
Aalto University supports my ability to study
effectively
Strongly Agree Agree Neither agree nor disagree Disagree Strongly Disagree
HEALTH AND WELLNESS 98

When examining the responses by school, there was a difference between students at the
school of arts, design, and architecture and students at other schools. The school of arts, design,
and architecture’s average response was only 2.84 on a scale of 1 to 5 from strongly disagree to
strongly agree. This school’s students comprised 75% of the students who “Strongly Disagree”
with the statement regarding AU support. The other schools averaged 3.64. A summary of the
student responses is outlined in Figure 11. The majority of students believe that AU supports
their ability to study effectively, except for students those at the school of arts, design, and
architecture who provided a range of answers. Students from that school did not agree or
disagree with the statement, suggesting a neutral feeling about the culture. Overall, students
believe that there is support from AU.
Cultural Model Influence: Students’ Feelings of Support by AU
This influence is validated. Students need to feel supported by the organization to
increase their wellness. Given that culture is a dynamic process, understanding the current
culture of AU provides the necessary information to influence current and future students to
promote trust and support. Having a supportive culture will facilitate the process of trust and
support to new members when they join AU and its culture.
To assess if participants felt that AU supports them, they were asked in an interview to
“Describe how you believe Aalto University supports your studying, if at all.” Students provided
a theme of support from a variety of sources. This suggests ample trust and support for students
to create the necessary positive climate to enhance study ability. Figure 12 outlines the
frequency of responses. The most common responses were professors, study advisors, and
psychologists. These three areas have been part of the Success of Students initiative promoting
workshops, classes, and the AllWell? survey to increase study ability. Additionally, the students
HEALTH AND WELLNESS 99

provided the Success of Students team an award of recognition for their efforts to support
students at the Aalto Gala 2017. These responses indicate that there is support and trust in AU
personnel, the services provided, and methods used to support students.

Figure 12. Frequency of students’ feelings of AU support.
As outlined in Figure 12, AU has created a supportive and positive culture on its campus.
Interview 10 best describes the support students get from professors:
It's really hard to say. I think it supports pretty well. There is enough assistance on the
courses. There is really helpful professors. That said of the hierarchy gap between the
professors and students is pretty low, so it's really low level of step to take to just go there
into his or her office and say that I don't understand this, can you please help me? And
they are super helpful in that way.
They describe the low power distance between the students and professors, availability of expert
help, and feelings of overall support. Students also commented that study advisors play a role in
creating a supportive culture. Interview 5 supported this when the participant said,
0 1 2 3 4 5 6 7 8 9 10
Government Health Care
Learning Communities
Professors
Psychologist
Study Advisor
Workshops and programs
Campus Technology
HEALTH AND WELLNESS 100

Well, there're study advisors here that you can go in and talk to if you're wondering about
courses and what you want to study, when to do it, and you have quite a selection of
people to ask about that really.
The participant describes how study advisors at AU are available to provide more information
about courses as well as discuss how to AU courses can help meet the students future goals.
Additionally, Interview 7 describes AU’s mental health support : “The psychologist help me to
get me out of the burnout because I couldn't read anymore and like that.” The participants
describe the services available from psychologists to support mental health.
The students positive perception of the study advisors, specifically in their first year,
helps create a foundation of support and guidance that allows them to gather information to make
better choices. Professors play a significant role in students’ experiences at AU and are a main
source of interactions with students. For students to perceive them as supportive is indicative of
the supportive culture promoted by the professors. Additionally, psychologists, government
health care, workshops and programs, and other available resources provide opportunities for
students to improve their health, wellness, and study ability to be successful personally,
academically, and professionally in the future.
Cultural Setting Influence: Availability of Resources
The influence is partially validated. For students to increase their study ability to reduce
burnout, it is necessary that AU have the necessary resources available and accessible. AU has
created a number of face-to-face and online resources for students, creating a variety of support
for wellness and study ability in addition to the variety of delivery methods. Ensuring that
resources are available influences students’ knowledge and motivation. The lack of resources
HEALTH AND WELLNESS 101

would leave students without the opportunity to improve their knowledge, and, if the resources
do not match the needs of the students, there is not motivation to use them.
To assess if students believe that AU provides resources to increase their study ability,
they were asked if they agreed with the statement “Aalto University has resources that will help
me study better.” Students averaged a response of 3.58 on a scale of strongly disagree, 1, to
strongly agree, 5. Nearly 60% of the students agreed with the statement with 16% “Strongly
Agree” and 43% “Agree.” Overall, students reported that they agree that AU supports their
study ability with the availability of resources.
When comparing the scores between schools, the school of arts, design, and architecture
scored lower, in the 24th percentile. This school averaged a score of 2.92 compared to an
average of 3.69 when excluding it from the scores. While other schools average at least 50% of
the students agreeing with the statement in some way, the school of arts, design, and architecture
reported that only 30% of their students agreed with the statement. Figure 13 outlines the
students’ responses by school.

Figure 13. Student response by school to survey Q19, “Aalto University has resources that will
help me study better.”
0% 20% 40% 60% 80% 100%
Arts, Design, and Architecture
Business
Chemical Engineering
Electircal Engineering
Engineering
Science
Aalto University has resources that will help me
study better.
Strongly Agree Agree Neither agree nor disagree Disagree Strongly Disagree
HEALTH AND WELLNESS 102

Overall, AU students report that AU provides the resources for them to increase their
study ability. The school of arts, design, and architecture is the exception to this. AU overall is
promoting a supportive culture that provides the necessary resources for students to increase
their personal resources, study skills, and study environment, but the students within the school
of arts, design, and architecture are unsure, suggesting a different supportive culture at that
school.
Cultural Setting Influence: Promotion of AllWell? Survey
This influence is validated. Part of creating a supportive culture is helping those who are
part of it. The AllWell? survey is given to second-year undergraduate and first-year graduate
students and assesses their study ability. The survey also provides feedback on students’
strengths and weakness in addition to providing resources to improve upon weak areas.
Promoting the survey to AU students benefits the AU culture to increase support for the students
as well as provide students the opportunity to assess themselves and be linked with resources to
improve areas of study ability.
To assess if students believe that AU promotes participation in the AllWell? survey, three
questions were asked. First, students were asked if they agreed with the statement, “Aalto
University encourages me participating in the AllWell? survey.” As outlined in Figure 14,
students averaged 3.55 on a scale of strongly disagree, 1, to strongly agree, 5, but, when looking
at the differences between schools, the school of arts, design, and architecture scored lower,
averaging only 2.85. When comparing this to the average, this placed their score at the 18th
percentile. Additionally, when taking the average responses after removing this school, the other
schools averaged 4.2, suggesting that all but students from the school of arts, design, and
architecture feel that they are encouraged to take the survey.
HEALTH AND WELLNESS 103

Students were also asked about the ease of access to the AllWell? survey. Students were
asked if they agreed with the statement, “The AllWell? survey is easy to access.” Students
overwhelmingly agreed that the survey was easy to access with over 84% of students saying that
they agree, 45.9% “Strongly Agree” and 38.5% “Agree.” With no statistical differences between
the demographics, it can be implied that students believe that the survey is easy to access. The
delivery of the survey through the school email system allows the students to access it at a time
and place convenient to them.

Figure 14. Student response by school to survey Q16, “Aalto University encourages me
participating in the AllWell? survey

Students were also asked about the use of the survey when they were asked if they agreed
with the statement, “The AllWell? survey is easy to use.” The responses from the students
indicate that the survey is easy to use, with 86.2% of students reporting that they agree with the
statement, 53% “Strongly Agree” and 37.6% “Agree.” Additionally, no students “Strongly
Disagree” that the survey is easy to use. With no significant differences, it is implied that the
survey is easy for AU students to use.
0% 20% 40% 60% 80% 100%
Arts, Design, and Architecture
Business
Chemical Engineering
Electircal Engineering
Engineering
Science
Aalto University encourages me participating in
the AllWell? survey
Strongly Agree Agree Neither agree nor disagree Disagree Strongly Disagree
HEALTH AND WELLNESS 104

Table 11
Select Quotes from AU Students Around the AllWell? Survey
Interview 1 “It was easy to complete. It was quick. The results came quite soon. There was a lot
of advertising for the survey. I saw it all around. “
Interview 2 “It was a quick survey to do.“
Interview 3 “You can use it on your laptop or any device, I suppose, so that's kind of what you
expect nowadays from a survey.“
Interview 4 “I think it was rather easy to use. I don't remember getting frustrated with it. “
Interview 6 “It was easy to take and I did appreciate the possibility. And the results were easy to
look at and understand. “
Interview 8 “It was easy enough to answer, at least… I don't think there was anything difficult.”
Interview 9 “It pops up in your email if I remember correctly. You have a link directed to the
questionnaire so you don't have to go and find it somewhere. It's just basically okay
you get this. Click the link and go answer the questions. It's pretty easy to just do. “
Interview 10 “It was easy to use.”
Interview 11 “I think it was easy. Again, it was a long time ago since the beginning, I don't
remember having any difficulties with it.”
Interview 12 “It was very easy. I mean anything online nowadays, super easy. No complaints.”
Interview 14 “I don't think it was difficult to use.”

The participants’ interviews made it clear that the AllWell? survey was easy to use. The
survey’s online delivery makes it possible for students to complete the survey with a smart phone
or computer. Even though the survey has 75 questions, participants described the survey as
quick and easy to take as outlined in Table 11. When promoting the survey, it is beneficial to
emphasize that it is quick and easy to complete while also providing personalized feedback to
help them while at AU.
When examining the interview data, student responses were that the AllWell? survey is
easy to access and use. Table 11 summarizes the students’ positive comments about accessibility
and ease of use. While it should be considered that these are students who took the survey, the
consistent theme that the survey is practical to use for students increases the chances of students’
completing the survey. This provides more feedback to a greater number of students and allows
the university to gather the necessary data to support students.
HEALTH AND WELLNESS 105

Overall, the AllWell? survey is accessible and easy to use in addition to AU encouraging
students to take it. While the school of arts, design, and architecture is reporting issues of
promoting and encouraging students to take the survey, AU is creating a culture that supports
students and empowers them to make healthy decisions to support themselves.
Synthesis of Results and Findings for Organizational Influences
Overall, AU has created a supportive culture. AU provides the resources for them to
increase their personal resources, study skills, and study environment in addition to creating a
positive culture that supports students. Professors, study advisors, and psychologists provide
support in various aspects of the students’ life. This supportive culture increases students’ study
ability as well as their feelings of being supported by AU holistically and creates a positive
environment that can allow for academic and personal growth.
Overall, the students believe there is a supportive culture that promotes wellness and
study ability, but the school of arts, design, and architecture reports that the culture within that
school is different. That school’s lack of resources to support students underpins its culture. As
a result, that school has a culture that less strongly promotes the positive and supportive culture
and is different from AU and the other schools where the culture promotes support for both study
ability and wellness.
Conclusions
The findings presented in this chapter suggest that the knowledge, motivation, and
organizational influences of the students are supported by AU and its resources. Healthy
universities create a culture that supports and improves knowledge and motivation among
stakeholders to promote health. Increasing health and wellness benefits the university by
preventing and treating illness that hinders learning and academic outcomes as well as increases
HEALTH AND WELLNESS 106

student achievement (Grossmeier et al., 2015; Richardson et al., 2012). AU culture demonstrates
health promotion and resources for students and that students possess the necessary knowledge
and motivation to promote their own health.
Overall, the AllWell? survey is an easy, accessible survey that gets promoted within the
university. The survey provides students the opportunity to increase their study ability. It
contributes to AU’s culture of supporting students’ study ability and wellness through linking
students to resources. The ease of use and access of the survey is why students take the survey.
When examining motivation to use the recommendations from the survey, an important
finding is that students do not see value in the resources available to them. Students feel their
schedules are too full for them to use the resources recommended. Additionally, students do not
agree that the resources will help them improve their study ability, but they do believe that these
resources are valuable for other students. This attribution error hinders motivation for students
to use the resources recommended by the AllWell? survey. This partially stems from the
students’ high confidence in their ability to study well and reduce burnout.
There were important findings within the school of arts, design, and architecture. The
knowledge, motivation, and organizational issues reported by this school indicates localized
issues. Other schools display sufficient knowledge and motivation in addition to views that
AU’s culture is supportive and has the necessary resources to increase study ability. The culture
of support along with the knowledge and motivation for students in the school of arts, design,
and architecture is lacking, which hinders students’ study ability and increases their burnout, as
reflected in the results of the 2018 AllWell? survey. Students within this school need to increase
their knowledge and motivation. The school also needs to create a more positive culture to see
improvement in study ability.
HEALTH AND WELLNESS 107

CHAPTER FIVE: RECOMMENDATIONS, IMPLEMENTATION, AND EVALUATION
With the high burnout rate experienced at AU, there is a need to provide better support
for students. This study presented multiple assumed influences for the burnout rate. Based on
those assumed causes, results showed that students have the knowledge to increase their study
ability and believe that AU promotes a positive supportive culture with resources to help them do
so, although there are motivational issues when examining the use of the AllWell? survey.
Chapter Five is divided into four sections. First, proposed solutions to the validated
influenced are presented in Table 12. Second, an implementation plan is discussed that considers
the solutions. Third, an evaluation plan is described using four levels of assessment. Fourth,
future researched is addressed in addition to a conclusion to this study.
Validated Needs and Proposed Solutions
Of the 15 assumed knowledge, motivational, and organizational influences, seven were
validated and five were partially validated. Table 12 outlines the four knowledge, one
motivation, and two organizational influences that were validated across all schools at AU with
each influence having a corresponding solution. Additionally, Table 13 outlines the two
knowledge, one motivation, and two organizational influences that were partially validated.
These partially validated solutions found differences between schools with the school of arts,
design, and architecture not being validated and the other schools being validated.

HEALTH AND WELLNESS 108

Table 12
Summary of Validated Findings and Proposed Solutions
Validated Influence Type of Influence Solution
Students need to
understand the
dimensions of wellness.
Knowledge Provide students study aids in early, required
courses to increase knowledge of the areas that
need to be promoted for optimal health
Students need the
ability to effectively
assess their own
strengths and
weaknesses in
managing burnout.
Knowledge Send AllWell? survey twice to increase
opportunities to become more self-aware of
strengths and weaknesses regarding burnout
Students need the
ability to effectively
assess their own
strengths and
weaknesses in studying
effectively.
Knowledge Increased self-reflection built into courses with
professor feedback

Students need the
ability to effectively
assess their own
strengths and
weaknesses in
supporting their
wellness.

Knowledge Develop mentor program that establishes student
to student mentoring and professor to student
mentoring
Students need to
believe that they have
the ability to apply the
results of the AllWell?
survey.
Motivation Create a champion and mentoring programs to
emphasize healthy habits
AU needs to increase
students’ feeling of
being supported by AU.
Organization Professor workshop to increase soft skills,
specifically empathy
AU needs to promote
the participation of the
AllWell? survey.
Organization Promote AllWell? survey through professors,
psychologists, and study mentors to increase
participation

HEALTH AND WELLNESS 109

Table 13
Summary of Partially Validated Findings and Proposed Solutions
Students need to know
how to manage the
symptoms of burnout.
Knowledge Increased awareness of available resources to
students within each school through promotion
from professors, psychologists, study mentors,
and study counselors
Students need to know
how to support their
wellness.
Knowledge Increased attendance of classes within the
Personal Impact program through increased
promotion
Students need to see the
value of the AllWell?
survey in supporting
their ability to improve
study ability.
Motivation Track and evaluate students use of Success of
Students resources
AU needs to cultivate a
culture that supports
students’ study ability
in all three areas:
personal resources,
study skills, and study
environment.
Organization Provide a study counselor position in each
department that can deliver AU resources.
AU needs to provide
resources for students
to increase their study
ability.
Organization Continued development of positive psychology
and happiness courses and programs

Proposed Solution 1: Continuing Supportive Development
For students to increase their study ability to reduce burnout, it is important that they
increase their knowledge and skills related to their personal resources, study skills, and study
environment. AU recently started Personal Impact courses that emphasize personal growth and
which students can take for credit. All courses reached maximum capacity during the program’s
inaugural term, reflecting the same student response that happened when Yale University opened
its course entitled “Psychology and the Good Life” that focused on happiness (Wang, 2018).
Additionally, for students who do not register for these classes, AU should continue to develop
accessible online video workshops on the different areas of study ability. These online
HEALTH AND WELLNESS 110

workshops and courses for the Personal Impact program provide students the opportunity to
increase their knowledge and skills about themselves, their study ability, and their future.
Linking students to these resources is vital to increasing study ability. Students are in
regular contact and report high value for professors, study mentors, psychologists, and these
contact points with students are where the recommendations for increasing knowledge would
occur. Additionally, a study counselor position each department would add an additional access
point for students to reach for suggestions since this person would know the demands of the
department and the students involved.
Proposed Solution 2: Positive Cultural Shift
AU is built on mutual trust among students, professors, and staff. While AU promotes a
positive culture, adding a study counselor position for each school would increase students’
study ability and reduce burnout. A study counselor within each school that is part of the Success
of Students team will provide a local access point with resources to increase study ability. This
counselor would know the demands of the different departments and provide assistance in
promoting students’ study ability. This person would lead biannual workshops at the beginning
of every semester to discuss the needs for the coming semester within the school using AllWell?
data, student feedback, and professor feedback aimed at leading pedagogy adjustments and
informal student assessments of study ability. Finally, this person would lead the mentorship
program that creates connections between students and between professors and students to
reduce burnout and promote effective study skills. Mentoring programs reduce stress, provide
new social support, and heldp solve personal and professional issues in the early stages (Bruce,
Conaglen, & Conaglen, 2005; Thomas & Lankau, 2005). The mentorship program would be
HEALTH AND WELLNESS 111

delivered through a website and mobile application to increase accessibility similar to
otheruniversity networks, such as PeopleGrove, AlmaBase, and Graduway.
Proposed Solution 3: Positive Curriculum Changes
Altering the curriculum to take a more positive approach can improve students’ study
ability. Implementing the skills taught through the Success of Students resources, such as
metacognitive skills, study techniques, time management, and stress management, can identify
early gaps in students’ knowledge. Additionally, promoting study ability in the curriculum helps
AU promote overall health. Bensimon’s (2016) work regarding equity places importance on
ensuring that all students can achieve their goals by providing the necessary support to allow
them to overcome achievement barriers, and literature suggests placing available resources on
syllabi can help link students to necessary resources to overcome barriers to achievement (Dowd
& Bensimon, 2015). Since these are embedded within the syllabi and curriculum, professors can
provide feedback and recommendations to help students increase dialog and trust. Most
important are department-specific resources that meet the demands of the program (Bakker &
Demerouti, 2007; Salmela-Aro & Read, 2017). Each department needs to use the AllWell?
survey information as an ongoing evaluation tool to create resources that improve success within
programs.
Proposed Solution 4: Adopt Healthy University Framework
AU promotes a positive, trusting culture through its Success of Students initiative, but it
would benefit from adopting a health-promoting framework to build towards its 2020 goals to
reduce student burnout. The Okanagan Charter is an international charter that sets out a health-
promoting framework for universities. Adopting this charter and its framework would aid in
creating a campus that promotes health in all areas of life in addition to a positive and trusting
HEALTH AND WELLNESS 112

campus that aids students in increasing their study ability. Adopting this framework involves a
university wide approach that consists of six key processes:
1. Generating high visible innovative action
2. Leading organizational and cultural change
3. Securing senior level commitment and corporate responsibility
4. Enabling wide-ranging participation
5. Anticipating and responding to public health challenges
6. Helping to deliver the institutional agenda (Dooris & Doherty, 2008)
Adopting these processes can cultivate a healthy university culture that demonstrates a
commitment to health, sustainability, and well-being through its mission, policies, and practice.
The university will also offer the necessary support services that meet the needs of the
organization, provide support for personal and academic development, and provide opportunities
for social development while being sustainable and minimizing the negative impact to the
physical environment (Dooris & Doherty, 2008).
Implementation
Solutions for each finding needs the necessary action steps, resources, and timeline to
effectively increase students’ study ability to reduce burnout. Outlined below are
recommendations for AU to improve students study ability, reduce burnout, and create
sustainable policy that emphasizes a healthy culture.

HEALTH AND WELLNESS 113

Table 14
Solution, Action Steps, and Implementation Timeline
Solution Action Steps Implementation Timeline
Continuing Supportive
Development

Continue to development of
positive psychology and human
development courses
2020 – Spring
Continue development of online
study ability videos
2020 – Spring
Continue to Promote Personal
Impact and study ability
resources through points of
professors, psychologists, study
mentors, and study counselors
2020 – Spring
Continue to promote the
AllWell? survey to students
through professors and students
2020 – Spring
Positive Cultural Shift

Create study counselor position
within each school
2020 – Spring
Study counselor workshops and
on-site availability
2020 - Fall
Establish mentorship program 2020 - Fall
Positive Curriculum Changes Embed study ability skills into
the early curriculum
2020 – Spring – 2022 Spring
Provide department and class
specific resources to improve
resources to meet demands of
the program
2020 – Fall
Biannual workshop for each
school
2020 – Fall
Adopt Healthy University
Framework
Embed health promotion into all
aspects of campus culture,
administration, operations, and
academic directives
2020 – Fall
Lead health promotion action
and collaborate locally and
globally
2020 - Spring

Strategies and Action Steps
The four recommended solutions are categorized into three key concepts: continued
supportive development, localization, and healthy policy. These steps emphasize that AU’s
current develop is setting the ground work for future improvement to reduce student burnout
through developing students’ study ability. Localizing support for students emphasizes the
HEALTH AND WELLNESS 114

different needs expressed by the schools as well as makes them more accessible. The knowledge
gathered formally and informally about departments and schools needs to be used by the study
counselor to lead workshops focused around increasing study ability and decreasing student
burnout. Finally, the Success of Students initiative has been positively received by students, and
AU should continue its development to promote study ability and optimal health through
adopting the Healthy University Framework.
Continuation. With the Success of Students initiative ending in 2020, it is strongly
recommended to continue its development and services. The Success of Students initiative’s
creation of the AllWell? survey, student study ability support, and promotion of classes that
emphasize well-being has been positively received by students. Continuing to promote these
services increases students’ knowledge and motivation as well as continues to bolster the
positive, supportive culture created at AU.
Localization. Currently, AU’s resources are either online or at a centralized location on
campus. Study counselors who know department demand, future careers, and student strengths
while understanding study ability and resources from the Success of Students initiative can
increase students’ knowledge and motivation. Each school needs to develop department-specific
resources to meet the demands of each program that can be used by the study counselor,
professor, and staff. Additionally, the Success of Students team and the study counselors should
lead workshops prior to each semester to address issues and trends within each school and
department, acting as a local resource that emphasizes study ability and health promotion on
behalf of the Success of Students initiative.
Healthy policy. The Success of Students initiative has been successful in gathering both
organizational and student support. Expanding the ideas developed by this initiative would
HEALTH AND WELLNESS 115

further reduce burnout and increase students’ overall well-being. AU would benefit from
adopting the Health University Framework outlined in the Okanagan Charter. Emphasizing
health promotion across all of AU would help reduce student burnout as well as build student
study ability.
Resource Needs
For AU to reduce burnout, it will need to consider the financial cost and time of
implementation. AU has considerable knowledge, but can also consult with burnout and teacher
pedagogy experts from the University of Helsinki. Localizing support, developing materials for
AU, and updating AU professors and staff each semester are key to ensuring that the proposed
solutions can be implemented. Additional costs would be necessary to publish the findings and
continue to build the literature within the health promotion community in Finland and throughout
Europe.
Constraints
Currently, AU and its board are supportive of the Success of Students initiative. The first
results of the AllWell? survey indicated a 20% burnout rate, and the 2018 results showed a rate
of 17%. This decrease is an indication that the initiative is working, but, with the initiative
ending in 2020, the most significant constraints come from the uncertainty of the future
commitment from board, executives, and administration. It is necessary to have continued
support for the initiative and its growth. With 2020 approaching, building a culture of health
promotion that emphasizes study ability takes time and resources. Having the top-level support
for development, personnel, and promotion is necessary to see sustainable results beyond 2020.
Time, resources, and support are necessary to continue development of the supportive culture
built at AU beyond 2020 as AU continues to grow.
HEALTH AND WELLNESS 116

Evaluation
Kirkpatrick and Kirkpatrick’s (2006) work outlines four levels of evaluation: Level 1,
Reaction; Level 2, Learning; Level 3, Behavior; and Level 4, Results. Each level of evaluation
helps determine whether policies are effective and how they can be improved (Kirkpatrick &
Kirkpatrick, 2006). Assessments at each level can be either informal or formal to measure
impact instead of outcomes.
When moving through the levels, there is an increase in complexity. The evaluation
processes becomes more difficult and time-consuming while also providing more information on
whether the policies are effective. Reaction seeks to understand if participants reacted favorably
to the solution. Learning measures whether the participants acquired the intended knowledge,
skills, and attitudes. Evaluating reaction and learning should be immediate when possible, either
during implementation or immediately after. The next two levels, behavior and results, are
typically evaluated after the solution is completed. The behavior level aims to understand if the
participants apply what they learned during the solution when they are finished. Kirkpatrick and
Kirkpatrick (2006) emphasize that, for behavior change to occur, four conditions need to be met.
The first two are to focus on the person, emphasizing that the person must want to change and
that the person must know what do to and how to do it. The other two conditions emphasize the
organization creating an environment that supports the change as well as rewards the person for
changing. Finally, the results level assesses the impact of the solution in relation to the
organizational goal. Behavior and results will involve more decisions about how to evaluate,
when to evaluate, and how often to evaluate. In this framework, all four levels of this evaluation
model will need to be used to create a comprehensive plan for AU to qualify and quantify results.

HEALTH AND WELLNESS 117

Table 15
Evaluation Plan (Kirkpatrick & Kirkpatrick, 2006)
Solution Action Steps Reaction Learning Behavior Results
Continuing
Supportive
Development

Continue to
development of
positive
psychology and
human
development
courses
Devoted
research and
content to
improving
and
expanding
personal
impact
courses
More
Personal
Impact
courses
available
Continue
development of
online study
ability videos
Track online
usage of
materials
Students
improve
individual
skills within
study ability
Continue to
Promote
Personal Impact
and study ability
resources
through points
of professors,
psychologists,
study mentors,
and study
counselors
Survey
students if
they know
of the
Personal
Impact
courses
Students will
learn about
the Personal
Impact
courses
Track
statistics and
feedback on
courses
Students
improve
study ability
and life
managements

Continue to
promote the
AllWell? survey
to students
through
professors and
students
Survey
students if
they know
of the
AllWell?
survey
Students will
learn about
the AllWell?
survey
Track
statistics and
feedback on
AllWell?
survey
Increased
response of
the AllWell?
survey

HEALTH AND WELLNESS 118

Table 30, continued
Solution Action Steps Reaction Learning Behavior Results
Positive
Cultural Shift

Create study
counselor
position within
each school
Localized
study ability
support
within each
school
Study counselor
workshops and
on-site
availability
Assess if
students
value the
availability
of the
study
counselor
Students learn
individual
study ability
skills and
improve areas
of well-being
Students
increase study
ability
through
better time
management,
choice of
study
environments,
and study
techniques
Increased
academic
performance
Lower
burnout rate
assessed by
the AllWell?
survey for
each school
Establish
mentorship
program
Survey
students’
happiness
with
mentorship
program
Online survey
to assess if the
mentorship
program
connects and
provides
students more
resources
Students
interact with
mentor, study
ability, and
improve life
management
Increase
engagement
on and off
campus with
jobs,
internships,
guilds, and
clubs
Positive
Curriculum
Changes
Embed study
ability skills into
the early
curriculum
Improved
“not at risk”
students
using
AllWell?
survey
through
increased
study ability
development
Provide
department and
class specific
resources to
improve
resources to
meet demands
of the program
Students
access
department
resources
more often
through
professors or
study
counselor
Increased
feelings of AU
support in
schools
Increased
feelings of
being able to
locate
support
systems

HEALTH AND WELLNESS 119

Table 30, continued
Solution Action Steps Reaction Learning Behavior Results
Positive
Curriculum
Changes,
continued
Biannual
workshop for
each school
Survey
professors
to gauge
value in the
workshops
Professors
will increase
their
understanding
of areas of
strengths and
weakness in
student study
ability.
Professors
implement
strategies into
teaching,
curriculum,
and resources
available to
students
Increased
percentage of
students who
meet learning
objectives

Increased
professor
feedback
from
students
Adopt
Healthy
University
Framework
Embed health
promotion into
all aspects of
campus culture,
administration,
operations, and
academic
directives
Policies and
programs are
designed to
promote
health instead
of stop illness
Increased
health using
health
surveys from
AU
Lead health
promotion
action and
collaborate
locally and
globally
Survey
professors
about
satisfaction
on
exploring
this topic
Professors
perform
research on
the areas of
health
promotion
and the
impact it has
on students,
professors,
and staff
Improve
health
promotion
network in
Finland,
Europe, and
globally.
AU becomes a
contributor
to the global
health
promotion
area

Leads Finland
in health
promotion
activities

HEALTH AND WELLNESS 120

Level 1: Reactions
To evaluate the student’s satisfaction and engagement with reducing burnout at AU,
formal and informal evaluations need to be made. Formally, students should be asked their
reactions, feelings, and opinions at the end of the online workshops and courses, specifically the
Personal Impact courses. Formally evaluating these reactions should occur through short, online
surveys conducted immediately after completing the workshops or courses. Additionally, yearly
focus groups can be conducted with a representative sample of AU’s population to learn more
about students’ reactions to the workshops and programs currently available or that students
desire. Informally, points of contact for the students should take note of students’ reactions
before, during, and after interacting with AU resources by professors, psychologists, study
mentors, and study counselors. Additionally, it is necessary to informally evaluate professors
and deans’ support for the curriculum changes and adopting the Health University Framework.
Level 2: Learning
To determine if students are improving their study ability, evaluations of students’
knowledge and skills are essential. With changes to the curriculum and the offering of Personal
Impact courses, the feedback from professors and course grades offer opportunities to evaluate
students on an ongoing and summative basis. There are also formal assessments that can be
made by the psychologists, study mentors, and study counselors that can evaluate if learning has
occurred during their sessions. Informal assessments can be made from professors,
psychologists, study mentors, and study counselors to determine that learning has occurred
during the interactions from students. Additionally, the Success of Students team should conduct
interviews in the fall with students to determine if students have the necessary knowledge and
skills to reduce burnout.
HEALTH AND WELLNESS 121

It is just as important the study counselors and the Success of Students team ensure that
professors are understanding the importance of soft skills, recent trends in study ability, and
issues faced by students in addition to identifying issues student issues contributing to burnout.
The workshops need to have informal interviews with the professors before and after the
workshops to evaluate if professors have learned about the factors the impact students burnout
and the strategy for AU and the school in the future.
Levels 3: Behavior
As AU continues to provide support to students through its workshops, courses, staff, and
faculty, it is important that student behavior be evaluated. AU needs to track the enrollment of
students in Personal Impact classes, online workshops, interactions with the study counselor, and
interactions with other AU resources. Enrollment in courses should be tracked through the
current online enrollment system. For online workshops, the backend of the website should keep
analytics on the students accessing the workshops. The counseling professional can track
interactions and submit a monthly report that details these interactions by categories such as
face-to-face, email, and phone interactions. Tracking interactions with the AU resources can be
anonymous by tracking only the number of interactions. While AU does not currently track
interactions with the resources for anonymity reasons, determining how many times the
resources were used is beneficial to see if students use the resources prepared by the Success of
Students initiative. This needs to be done through professors, psychologists, study mentors, and
a study counselor. Additionally, informal observations should be conducted to evaluate if
students’ study ability has improved.
For professors, the year-end review process needs to include how they identify issues
with burnout, how they reached out to the students, and how they promoted study ability.
HEALTH AND WELLNESS 122

Observations should be conducted by the study counselors to provide an additional evaluation.
Student evaluations of the professors should be used to evaluate if professors are supporting
students and if they are recommending additional AU resources.
For the administration, current policies would be reviewed, and new policies should
reflect health and wellness promotion using the Healthy University Framework. This will require
committing to promoting health by setting goals for burnout and AllWell? survey response rate
in AU’s 2021-2025 strategic plan. Strategies should be developed from the findings of the 2016-
2020 AllWell? survey results and Success for Student team’s feedback. Additionally, examining
proposed policies in the future would determine if there is a commitment to a healthy, supportive
culture.
Level 4: Results
Aalto University aims to reduce its burnout rate by promoting students’ study ability.
The research suggests that students have the necessary knowledge and culture to improve study
ability. Given that study ability is a holistic concept, it would be beneficial to improve the three
key areas defined by AU to improve student wellness. To determine the effectiveness of the
proposed solutions, AU needs to continue using the AllWell? survey. AU needs to continue to
increase participation in the survey, but as, participation increases, the burnout rate may also
increase. In addition to the survey, it is also important that AU continues to assess its supportive
culture through promotion and accessibility of resources within each school. These can be
evaluated internally through interviews with key stakeholders. These interviews should be
conducted yearly individually or in focus groups with students and student leaders to gather
qualitative feedback about culture as AU pursues its goals for 2020 and beyond.

HEALTH AND WELLNESS 123

Future Research
The potential areas for future research in this study focus on two key areas: students and
higher educational institutions.
Defining and understanding burnout has been extensively studied. Given that recent
research focuses on burnout within specific sectors and across demographics, identifying the
issues pertaining to and influences of burnout on higher education students would be beneficial.
Additionally, it is important to understand the influences of burnout and wellness given the
increased importance, usage, and integration of technology into higher education. Finally,
current research indicates that students have the responsibility of identifying their stressors that
may lead to burnout or health issues (Anderson, 2015). Identifying early predictors of burnout,
health, and wellness issues would contribute to the board body of research on issues and
influences impacting people today. Topics such as performance-based self-esteem and
promoting health have been correlated to preventing burnout (Hallsten & Torgen, 2005; Park &
Peterson, 2009).
Future research is needed to examine the role that higher education organizations play in
burnout, health, and wellness. Health promotion and healthy settings have been advocated for
over 40 years (World Health Organization, 1978, 1986). With the development of the Okanagan
Charter in 2015, continued research would determine the impact the Healthy University
Framework has on university stakeholders. Additionally, the increased awareness of wellness
has seen the promotion of a variety of wellness programs on university campuses. Future
research should aim to determine best practices for establishing wellness programs that prevent
health issues as well as promote optimal health.

HEALTH AND WELLNESS 124

Conclusion
This gap analysis study explored the knowledge, motivation, and organizational
influences of AU’s AllWell? survey in connecting students to resources to improve their study
ability. As discussed in Chapter Two, promoting health and wellness across the university
through all stakeholders is ideal to increase study ability and reduce burnout. Increasing study
ability aims to address the issues derived from burnout, and, by promoting study ability, AU can
prevent exhaustion and depersonalization among students (Kunttu, 2008; Maslach et al., 2001).
This study found that those who took the AllWell? survey have the knowledge and motivation to
improve their study ability. Like health promotion, this study focused on the influences that
encouraged people to take the survey and use the resources linked that increase their study
ability.
Aalto University has taken the necessary steps to address the issue of burnout. Students
have the necessary knowledge and believe that AU is a supportive organization that wants them
to improve. Currently, there are abundant resources to increase students’ study ability, and AU
is currently working on providing more options. As participation in the AllWell? survey
increases, it is possible that the burnout rate will increase, but accurately determining that rate
allows AU to better support students. As AU continues to take steps to reduce burnout, it
cultivates a positive culture with professors, staff, and administrators to foster healthy
professional, academic, and personal growth.
HEALTH AND WELLNESS 125

REFERENCES
Aalto University. (2018). Home page. Retrieved from http://www.aalto.fi/en.
Aaltonen, K., Isacsson, A., Laukia, J., & Vanhanen-Nuutinen, L. (2013). Practical skills,
education and development – Vocational education and training in Finland. Helsinki,
Finland: Haaga-Helia University of Applied Science.
AllWell? 2018 questionnaire: Awareness of study well-being has improved. (2018, March 08).
Retrieved from http://acousticslab.aalto.fi/en/current/news/2018-03-08-003/.
AllWell? study well-being survey in February (2018, January 1). Retrieved from
http://economics.aalto.fi/en/current/news_archive/2018-01-31-012/.
Ambrose, S. A., Bridges, M. W., DiPietro, M., Lovett, M. C., & Norman, M. K. (2010). How
learning works: Seven research-based principles for smart teaching. John Wiley & Sons.
American College Health Association. (2017). American College Health Association-National
College Health Assessment II: Reference group executive summary spring 2017.
Hanover, MD: American College Health Association.
American College Health Association. (2018). Healthy campus 2020. Retrieved from
https://www.acha.org.
Anderson, D. S. (Ed.). (2015). Wellness issues for higher education: A guide for student affairs
and higher education professionals. New York, NY: Routledge.
Ashwood, J. S., Stein, B. D., Briscombe, B., Sontag-Padilla, L. M., Woodbridge, M. W., May,
E., … Burnam, M. A. (2015). Payoffs for California college students and taxpayers from
investing in student mental health. Rand health quarterly, 5(4). 1-13
HEALTH AND WELLNESS 126

Bajaj, B., & Pande, N. (2016). Mediating role of resilience in the impact of mindfulness on life
satisfaction and affect as indices of subjective well-being. Personality and Individual
Differences, 93, 63–67.
Bakker, A. B., & Demerouti, E. (2007). The job demands-resources model: State of the
art. Journal of managerial psychology, 22(3), 309-328.
Baldwin, D. R., Towler, K., Oliver, M. D., II, & Datta, S. (2017). An examination of college
student wellness: A research and liberal arts perspective. Health Psychology Open,
4(2),.1-9.
Bandura, A. (Ed.). (1995). Self efficacy in changing societies. NY: Cambridge University.
Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change.
Psychological Review, 84(2), 191–215.
Bensimon, E. M., Dowd, A. C., & Witham, K. (2016). Five principles for enacting equity by
design. Diversity and Democracy, 19(1), 1-8.
Boonekamp, G. M. M., Colomer, C., Tomás, A., & Nuñez, A. (1999). Healthy Cities Evaluation:
The co-ordinators perspective. Health Promotion International, 14(2), 103–110.
Bringing Theory To Practice (2013). The Well-being and Flourishing of Students. Retrieved
from https://www.naspa.org/images/uploads/kcs/WHPL_Canon_WB_BTtoPWellbeing
Initiative.pdf
Bruce, S. M., Conaglen, H. M., & Conaglen, J. V. (2005). Burnout in physicians: A case for
peer-support. Internal Medicine Journal, 35(5), 272-278.
Buettner, D. (2005). New wrinkles on aging: Residents of Okinawa, Sardinia, and Loma Linda,
California, live longer, healthier lives than just about anyone else on Earth. What do they
know that the rest of us don’t? National Geographic, 208(5), 1-27
HEALTH AND WELLNESS 127

Carbonneau, N., Vallerand, R. J., Fernet, C., & Guay, F. (2008). The role of passion for teaching
in intrapersonal and interpersonal outcomes. Journal of Educational Psychology, 100(4),
977–987.
Chan, C. M. H., Ahmad, W., Azman, W., Yusof, M., Ho, G. F., & Krupat, E. (2015). Effects of
depression and anxiety on mortality in a mixed cancer group: A longitudinal approach
using standardised diagnostic interviews. Psycho-Oncology, 24(6), 718–725.
Chevalier, T. M., Parrila, R., Ritchie, K. C., & Deacon, S. H. (2017). The role of metacognitive
reading strategies, metacognitive study and learning strategies, and behavioral study and
learning strategies in predicting academic success in students with and without a history
of reading difficulties. Journal of Learning Disabilities, 50(1), 34–48.
Chida, Y., & Steptoe, A. (2008). Positive psychological well-being and mortality: A quantitative
review of prospective observational studies. Psychosomatic Medicine, 70(7), 741–756.
Clark, R. E., & Estes, F. (2008). Turning research into results: A guide to selecting the right
performance solutions. Atlanta, GA: CEP.
Compton, W., & Hoffman, E. (2012). Positive psychology: The science of happiness and
flourishing. Belmont, CA: Wadsworth.
Credé, M., Roch, S. G., & Kieszczynka, U. M. (2010). Class attendance in college a meta-
analytic review of the relationship of class attendance with grades and student
characteristics. Review of Educational Research, 80(2), 272–295.
Csikszentmihalyi, M. (1990). Flow. The psychology of optimal experience. New York, NY:
Harper and Row.
Danker, B. (2015). Using flipped classroom approach to explore deep learning in large
classrooms. IAFOR Journal of Education, 3(1), 171–186.
HEALTH AND WELLNESS 128

Dembo, M., & Seli, H. (2016). Motivation and learning strategies for college success: A focus
on self-regulated learning (5th ed.). New York, NY: Taylor & Francis.
DeRoos, R. (1978). Environmental health and safety concerns and energy conservation practices
in academic institutions and hospitals. American Journal of Public Health, 68(10), 1011–
1015.
Diener, E. (1984). Subjective well-being. Psychological Bulletin, 95(3), 542–575.
Diener, E., & Chan, M. Y. (2011). Happy people live longer: Subjective well ‐being contributes
to health and longevity. Applied Psychology. Health and Well-Being, 3(1), 1–43.
Disabato, D. J., Short, J. L., Kashdan, T. B., Curby, T. W., & Jarden, A. (2014). Do character
strengths reduce future depression or does depression reduce character strengths?
Presentation for the American Psychological Association. Washington, DC: American
Psychological Association. https://doi.org/10.1037/e542342014-001
Doherty, S., & Dooris, M. (2006). The healthy settings approach: The growing interest within
colleges and universities. Education for Health, 24, 42-43.
Dooris, M. (2006). Healthy settings: Challenges to generating evidence of effectiveness. Health
Promotion International, 21(1), 55–65.
Dooris, M. (2009). Holistic and sustainable health improvement: The contribution of the
settings-based approach to health promotion. Perspectives in Public Health, 129(1), 29–
36.
Dooris, M. T., Cawood, J., Doherty, S., & Powell, S. (2010). Healthy Universities: Concept,
model and framework for applying the healthy settings approach within higher education
in England. University of Central Lancashire, London: Royal Society for Public Health.
HEALTH AND WELLNESS 129

Dooris, M., & Doherty, S. (2008). English Healthy Universities Network: Framework for action.
Preston: Healthy Settings Development Unit. University of Central Lancashire,132(122),
113–115.
Dooris, M., Poland, B., Kolbe, L., De Leeuw, E., McCall, D. S., & Wharf-Higgins, J. (2007).
Healthy settings. In D.V. McQueen & C. M. Jones, (Eds.), Global perspectives on health
promotion effectiveness (pp. 327–352). New York, NY: Springer.
Dowd, A. C., & Bensimon, E. M. (2015). Engaging the" race question": Accountability and
equity in US higher education. Teachers College Press.
Duckworth, A. L., Peterson, C., Matthews, M., & Kelly, D. (2007). Grit: Perseverance and
passion for long-term goals. Journal of Personality and Social Psychology, 92(6), 1087–
1101.
Dunn, H. L. (1959a). High-level wellness for man and society. American Journal of Public
Health, 49(6), 786–792.
Dunn, H. L. (1959b). What high-level wellness means. Canadian Journal of Public Health, 50,
447–457.
Dweck, C. S. (2008). Mindset: The new psychology of success. New York, NY: Random House.
Eccles, J. C. (2010). Expectancy value motivational theory. Retrieved from Education.com
Entwistle, N., & Ramsden, P. (2015). Understanding student learning (Routledge revivals). New
York, NY: Routledge.
Fink, A. (2012). How to conduct surveys: A step-by-step guide: A step-by-step guide. Sage
Publications.
Finnish Student Health Services (2018). Korkeakouluopiskelijoiden Terveystutkimus 2016.
Retrieved from http://www.yths.fi/filebank/4237-KOTT_2016_korjattu_final_0217.pdf.
HEALTH AND WELLNESS 130

Firestone, W. A. (1987). Meaning in method: The rhetoric of quantitative and qualitative
research. Educational researcher, 16(7), 16-21.
Fredrickson, B. L., & Losada, M. F. (2005). Positive affect and the complex dynamics of human
flourishing. The American Psychologist, 60(7), 678-686.
Freudenberger, H. J. (1974). Staff burn-out. The Journal of Social Issues, 30(1), 159–165.
Galbraith, C. S., & Merrill, G. B. (2015). Academic performance and burnout: An efficient
frontier analysis of resource use efficiency among employed university students. Journal
of Further and Higher Education, 39(2), 255–277.
Gallimore, R., & Goldenberg, C. (2001). Analyzing cultural models and settings to connect
minority achievement and school improvement research. Educational Psychologist,
31(1), 45–56.
Glesne, C. (2011). Becoming qualitative researchers: An introduction (4th ed.). Boston, MA:
Pearson.
Grossmeier, J., Mangen, D. J., Terry, P. E., & Haglund-Howieson, L. (2015). Health risk change
as a predictor of productivity change. Journal of Occupational and Environmental
Medicine,57(4), 347–354.
Hallsten, L., Josephson, M., & Torgén, M. (2005). Performance-based self-esteem: A driving
force in burnout processes and its assessment.
Harding, J. (2013). Qualitative data analysis from start to finish. Thousand Oaks, CA: Sage.
Heffner, A. L., & Antaramian, S. P. (2016). The role of life satisfaction in predicting student
engagement and achievement. Journal of Happiness Studies, 17(4), 1681–1701.
Heller, J., & Sarmiento, A. (2016). Health behaviors of culturally diverse inner-city community
college students. Journal of American College Health, 64(8), 651–663.
HEALTH AND WELLNESS 131

Hernesniemi, E., Räty, H., Kasanen, K., Cheng, X., Hong, J., & Kuittinen, M. (2017). Burnout
among Finnish and Chinese university students. Scandinavian Journal of Psychology,
58(5), 400–408.
Hettler, B. (1980). Wellness promotion on a university campus. Family & Community
Health,3(1), 77–95.
Hone, L. C., Jarden, A., Schofield, G., & Duncan, S. (2014). Measuring flourishing: The impact
of operational definitions on the prevalence of high levels of wellbeing. International
Journal of Wellbeing, 4(1), 62–90.
Hopper, M. K., & Moninger, S. L. (2017). Tracking weight change, insulin resistance, stress, and
aerobic fitness over 4 years of college. Journal of American College Health, 65(2), 81–
93.
Houghton, W. (2004). Engineering subject centre guide: Learning and teaching theory for
engineering academics. Loughborough, England: HEA Engineering Subject Centre.
Hoyt, L. T., Chase-Lansdale, P. L., McDade, T. W., & Adam, E. K. (2012). Positive youth,
healthy adults: Does positive well-being in adolescence predict better perceived health
and fewer risky health behaviors in young adulthood? Journal of Adolescent Health,
50(1), 66–73.
Huffman, J. C., Boehm, J. K., Beach, S. R., Beale, E. E., DuBois, C. M., & Healy, B. C. (2016).
Relationship of optimism and suicidal ideation in three groups of patients at varying
levels of suicide risk. Journal of Psychiatric Research, 77, 76–84.
IsHak, W. W., Lederer, S., Mandili, C., Nikravesh, R., Seligman, L., Vasa, M., … Bernstein, C.
A., & the IsHak. (2009). Burnout during residency training: A literature review. Journal
of Graduate Medical Education, 1(2), 236–242.
HEALTH AND WELLNESS 132

IsHak, W., Nikravesh, R., Lederer, S., Perry, R., Ogunyemi, D., & Bernstein, C. (2013). Burnout
in medical students: A systematic review. The Clinical Teacher, 10(4), 242–245.
Jamner, M. S., & Stokols, D. (Eds.). (2000). Promoting human wellness: New frontiers for
research, practice, and policy. Berkeley: University of California Press.
Ji, J. L., Holmes, E. A., & Blackwell, S. E. (2017). Seeing light at the end of the tunnel: Positive
prospective mental imagery and optimism in depression. Psychiatry Research, 247, 155–
162.
Johnson, R. B., & Christensen, L. B. (2015). Educational research: Quantitative, qualitative,
and mixed approaches. (5th ed.). Ch. 10 (pp. 247-269 ONLY). Thousand Oaks, CA:
SAGE.
Johnstone, J., Rooney, R. M., Hassan, S., & Kane, R. T. (2014). Prevention of depression and
anxiety symptoms in adolescents: 42 and 54 months follow-up of the Aussie Optimism
Program-Positive Thinking Skills. Frontiers in Psychology, 5(364), 1-10.
Kenzer, M. (2000). Healthy Cities: A guide to the literature. Public Health Reports, 115(2), 279–
289.
Keyes, C. L. (2002). The mental health continuum: From languishing to flourishing in life.
Journal of Health and Social Behavior, 43(2), 207–222.
Keyes, C. L. (2007a). Promoting and protecting mental health as flourishing: A complementary
strategy for improving national mental health. The American Psychologist, 62(2), 95-108
Keyes, C. L. (2007b). Towards a mentally flourishing society: Mental health promotion, not
cure. Journal of Public Mental Health, 6(2), 4–7.
HEALTH AND WELLNESS 133

Keyes, C. L. (2009). Toward a science of mental health. In C. R. Snyder & S. Lopez (Eds.),
Oxford Handbook of Positive Psychology (2nd ed., pp. 89–98). New York, NY: Oxford
University.
Keyes, C. L., & Simoes, E. J. (2012). To flourish or not: Positive mental health and all-cause
mortality. American Journal of Public Health, 102(11), 2164–2172.
Killian, S. (2017, July 21). Hattie effect size 2016 update. Retrieved from
http://www.evidencebasedteaching.org.au/hattie-effect-size-2016-update/
Kirkpatrick, D., & Kirkpatrick, J. (2006). Evaluating training programs: The four levels.
Oakland, CA: Berrett-Koehler Publishers.
Krathwohl, D. R. (2002). A revision of Bloom's taxonomy: An overview. Theory into
practice, 41(4), 212-218.
Kunttu, K. (2008). Myös opiskelijan työkykyä on tuettava. (The student’s work ability must also
be supported.). Suomen Lääkärilehti, 63, 3018–3021.
Kunttu, K., Pesonen, T., & Saari, J. (2016). Korkeakouluopiskelijoiden Terveystutkimus 2016.
Helsinki, Finland: YTHS.
Lane, D., Carroll, D., Ring, C., Beevers, D. G., & Lip, G. Y. (2001). Mortality and quality of life
12 months after myocardial infarction: Effects of depression and anxiety. Psychosomatic
Medicine, 63(2), 221–230.
Leiter, M. P. (1992). Burn-out as a crisis in self-efficacy: Conceptual and practical implications.
Work and Stress, 6(2), 107–115.
Lowensteyn, I., Berberian, V., Belisle, P., DaCosta, D., Joseph, L., & Grover, S. (2018). The
measurable benefits of a workplace wellness program in Canada. Journal of occupational
and environmental medicine, 60(3), 211-216.
HEALTH AND WELLNESS 134

Maddux, J. E. (2005). Self-efficacy: The power of believing you can. In C. R. Snyder & S. J.
Lopez (Eds.), Handbook of positive psychology (pp. 227–287). New York: Oxford
University Press.
Mageau, G. A., & Vallerand, R. J. (2007). The moderating effect of passion on the relation
between activity engagement and positive affect. Motivation and Emotion, 31(4), 312–
321. https://doi.org/10.1007/s11031-007-9071-z
Marek, T., Schaufeli, W. B., & Maslach, C. (2017). Professional burnout: Recent developments
in theory and research. New York, NY: Routledge.
Maslach, C. & Jackson, S. (1986). Maslach Burnout Inventory: Second edition. Palo Alto, CA:
Consulting Psychologists Press.
Maslach, C., & Leiter, M. P. (2016). Understanding the burnout experience: Recent research and
its implications for psychiatry. World Psychiatry, 15(2), 103–111.
Maslach, C., Jackson, S. E., Leiter, M. P., Schaufeli, W. B., & Schwab, R. L. (1986). Maslach
burnout inventory (Vol. 21). Palo Alto, CA: Consulting Psychologists.
Maslach, C., Leiter, M. P., & Schaufeli, W. B. (2009). Measuring burnout. In C. L. Cooper & S.
Cartwright (Eds.), The Oxford handbook of organizational well-being. 86-108. Oxford,
UK: Oxford University Press.
Maslach, C., Schaufeli, W. B., & Leiter, M. P. (2001). Job burnout. Annual Review of
Psychology, 52(1), 397–422.
McAlexander, J. H., Koenig, H. F., & Schouten, J. W. (2006). Building relationships of brand
community in higher education: A strategic framework for university advancement.
International Journal of Educational Advancement, 6(2), 107–118.
HEALTH AND WELLNESS 135

McLean, S., Attardi, S. M., Faden, L., & Goldszmidt, M. (2016). Flipped classrooms and student
learning: Not just surface gains. Advances in Physiology Education, 40(1), 47–55.
Melkas, T. (2013). Health in all policies as a priority in Finnish health policy: A case study on
national health policy development. Scandinavian Journal of Public Health, 41, 3–28.
Merriam, S.B. & Tisdell, E. J. (2016). Qualitative research: A guide to design and
implementation (4th ed.). San Francisco, CA: Jossey-Bass.
Myers, J. E., Sweeney, T. J., & Witmer, J. M. (2000). The wheel of wellness counseling for
wellness: A holistic model for treatment planning. Journal of Counseling &
Development,78(3), 251–266.
Naqvi, S., Chikwa, G., Menon, U., & Al Kharusi, D. (2018). Study skills assessment among
undergraduate students at a private university college in Oman. Mediterranean Journal of
Social Sciences, 9(2), 139–147.
National Wellness Institute. (2018). The six dimensions of wellness. Retrieved from
https://www.nationalwellness.org/page/Six_Dimensions
Newton, J., Dooris, M., & Wills, J. (2016). Healthy universities: An example of a whole-system
health-promoting setting. Global Health Promotion, 23(1), 57–65.
Norsworthy, C., Gorczynski, P., & Jackson, S. A. (2017). A systematic review of flow training
on flow states and performance in elite athletes. Graduate Journal of Sport, Exercise &
Physical. Education Research. 6, 16-28.
Okanagan Charter: An International Charter for Health Promoting Universities and Colleges.
(2015). Okanagan Charter. Retrieved from
https://internationalhealthycampuses2015.sites.olt.ubc.ca/files/2016/01/Okanagan-
Charter-January13v2.pdf
HEALTH AND WELLNESS 136

Okun, M. A., Stock, W. A., Haring, M. J., & Witter, R. A. (1984). Health and subjective well-
being: A meta-analyis. International Journal of Aging & Human Development, 19(2),
111–132. https://doi.org/10.2190/QGJN-0N81-5957-HAQD
Organisation for Economic Co-operation and Development. (2017), PISA 2015 Results (Volume
III): Students’ Well-Being, PISA. Paris, France: Author..
Organisation for Economic Co-operation and Development. (2018a). Better life index. Retrieved
from http://www.oecdbetterlifeindex.org/
Organisation for Economic Co-operation and Development. (2018b). Graduation rate (indicator).
Retrieved from https://data.oecd.org/eduatt/graduation-rate.htm.
Pajares, F. (2010). Self-efficacy theory. www.education.com/reference/article/self-efficacy-
theory/.
Parish, R. (2001). A framework for health promotion evaluation. In I. Rootman, M. Goodstadt,
B. Hyndman, D. McQueen, L. Potvin, J. Springett, & E. Ziglio (Eds.), Evaluation in
health promotion (pp. 171–184). Geneva, Switzerland: World Health Organization.
Park, N., & Peterson, C. (2009). Character strengths: Research and practice. Journal of College
and Character, 10(4).
Patrick, R., Dooris, M., & Poland, B. (2016). Healthy Cities and the Transition movement:
Converging towards ecological well-being? Global Health Promotion, 23(1_suppl), 90-
93.
Patton, M. Q. (2002). Qualitative research & evaluation methods (3rd ed.). Thousand Oaks, CA: SAGE
Publications.
Pintrich, P. R. (2003). A motivational science perspective on the role of student motivation in
learning and teaching contexts. Journal of Educational Psychology, 95(4), 667-686.
HEALTH AND WELLNESS 137

Pretty, J., Griffin, M., Peacock, J., Hine, R., Sellen, M., & South, N. (2017). A countryside for
health and wellbeing: The physical and mental health benefits of green exercise.
Sheffield, UK, Countryside Recreation Network.
Quick, A., & Abdallah, S. (2015). Why personal wellbeing is good for the nation’s health.
Retrieved from https://Www.Novacroft.Com/Wp-Content/Uploads/2017/08/Novacroft_
Thought_Paper_Well_Being-V2.Pdf
Rahmati, Z. (2015). The Study of Academic Burnout in Students with High and Low Level of
Self-efficacy. Procedia: Social and Behavioral Sciences, 171, 49–55.
Richardson, M., Abraham, C., & Bond, R. (2012). Psychological correlates of university
students’ academic performance: A systematic review and meta-analysis. Psychological
Bulletin, 138(2), 353–387.
Robbins, S. B., Lauver, K., Le, H., Davis, D., Langlet, R., & Carlstorm, A. (2004). Do
psychosocial and study skill factors predict college outcomes? A meta-analysis.
Psychological Bulletin, 130(2), 261–288.
Rootman, I. (2001). A framework for health promotion evaluation. In I. Rootman, M. Goodstadt,
B. Hyndman, D. McQueen, L. Potvin, J. Springett, & E. Ziglio (Eds.), Evaluation in
health promotion (pp. 3–6). Geneva: World Health Organization.
Rootman, I., Goodstadt, M., Hyndman, B., McQueen, D., Potvin, L., Springett, J., & Ziglio, E.
(2001). Evaluation in health promotion. Geneva, Switzerland: World Health
Organization.
Rosenberg, M. (1965). Rosenberg self-esteem scale. Princeton, NJ: Princeton University Press.
Rosenberg, M., Schooler, C., & Schoenbach, C. (1989). Self-esteem and adolescent problems:
Modeling reciprocal effects. American Sociological Review, 54(6), 1004–1018.
HEALTH AND WELLNESS 138

Rubin, H. J., & Rubin, I. S. (2012). Qualitative interviewing: The art of hearing data (3rd ed.). Thousand
Oaks, CA: SAGE Publications.
Rudd, R. E. (2015). The evolving concept of Health literacy: New directions for health literacy
studies. Journal of Communication in Healthcare Strategies, 8, 7-9.
Rueda, R. (2011). The 3 Dimensions of Improving Student Performance: Finding the Right
Solutions to the Right Problems. New York, NY: Teachers College.
Ryan, C. O., Browning, W. D., Clancy, J. O., Andrews, S. L., & Kallianpurkar, N. B. (2014).
Biophilic design patterns: Emerging nature-based parameters for health and well-being in
the built environment. International Journal of Architectural Research: ArchNet-IJAR,
8(2), 62–76.
Ryff, C. D., & Keyes, C. L. M. (1995). The structure of psychological well-being revisited.
Journal of Personality and Social Psychology, 69(4), 719-727.
Sahlberg, P. (2006). Education reform for raising economic competitiveness. Journal of
Educational Change, 7(4), 259–287.
Salmela-Aro, K., & Kunttu, K. (2010). Study burnout and engagement in higher education.
Unterrichtswissenschaft, 38(4), 318–333.
Salmela-Aro, K., & Read, S. (2017). Study engagement and burnout profiles among Finnish
higher education students. Burnout Research, 7, 21-28.
Sankaranarayanan, A., & Cycil, C. (2014). Resiliency training in Indian children: A pilot
investigation of the Penn Resiliency Program. International Journal of Environmental
Research and Public Health, 11(4), 4125–4139.
Satici, S. A. (2016). Psychological vulnerability, resilience, and subjective well-being: The
mediating role of hope. Personality and Individual Differences, 102, 68–73.
HEALTH AND WELLNESS 139

Schaufeli, W. B., Martinez, I. M., Pinto, A. M., Salanova, M., & Bakker, A. B. (2002). Burnout
and engagement in university students: A cross-national study. Journal of Cross-Cultural
Psychology, 33(5), 464–481.
Schreiner, L. A. (2010a). Thriving in community. About Campus, 15(4), 2–11.
Schreiner, L. A. (2010b). Thriving in the classroom. About Campus, 15(3), 2–10.
Schreiner, L. A., Pothoven, S., Nelson, D., & McIntosh, E. J. (2009). College student thriving:
Predictors of success and retention. Paper presented at the Association for the Study of
Higher Education, Vancouver, BC.
Seligman, M. (2002). Authentic Happiness: Using the new positive psychology to realize your
potential for lasting fulfillment. New York, NY: Simon and Schuster.
Seligman, M. (2011). Flourish. New York, NY: Free.
Seligman, M., Schulman, P., DeRubeis, R., & Hollon, S. (1999). The prevention of depression
and anxiety. Prevention & Treatment, 2(8), 1-24.
Shaw, S. C. K. (2017). How can we promote and facilitate effective study skills in medical
students? MedEdPublish, 6(1). 1-9.
Sørensen, K., Van den Broucke, S., Fullam, J., Doyle, G., Pelikan, J., Slonska, Z., & Brand, H.
(2012). Health literacy and public health: A systematic review and integration of
definitions and models. BMC Public Health, 12(1), 1-13.
Sowislo, J. F., & Orth, U. (2013). Does low self-esteem predict depression and anxiety? A meta-
analysis of longitudinal studies. Psychological Bulletin, 139(1), 213–240.
https://doi.org/10.1037/a0028931
HEALTH AND WELLNESS 140

Stanley, M., & Nillas, L. (2017). Differentiation and its effects on the development of student
study skills. Retrieved from https://digitalcommons.iwu.edu/cgi/viewcontent.cgi?
referer=https://www.google.co.kr/&httpsredir=1&article=3505&context=jwprc
Steptoe, A., Deaton, A., & Stone, A. A. (2015). Subjective wellbeing, health, and ageing. Lancet,
385(9968), 640–648.
Stoeber, J., Childs, J. H., Hayward, J. A., & Feast, A. R. (2011). Passion and motivation for
studying: Predicting academic engagement and burnout in university students.
Educational Psychology, 31(4), 513–528.
Stoliker, B. E., & Lafreniere, K. D. (2015). The influence of perceived stress, loneliness, and
learning burnout on university students’ educational experience. College Student
Journal,49(1), 146–160.
Tate, K. A., Fouad, N. A., Marks, L. R., Young, G., Guzman, E., & Williams, E. G. (2015).
Underrepresented first-generation, low-income college students’ pursuit of a graduate
education: Investigating the influence of self-efficacy, coping efficacy, and family
influence. Journal of Career Assessment, 23(3), 427–441.
Tellegen, A., Lykken, D. T., Bouchard, T. J., Wilcox, K. J., Segal, N. L., & Rich, S. (1988).
Personality similarity in twins reared apart and together. Journal of Personality and
Social Psychology, 54, 1031–1039.
The Kyky Project. (2014). The Kyky Project. Retrieved from
http://www.opiskelukyky.fi/english/
Thomas, C. H. & Lankau, M. (2005). Preventing Burnout: The Effects Of Lmx And Mentoring
On Socialization, Role Stress, And Burnout. Academy of Management
Proceedings, 2005(1).
HEALTH AND WELLNESS 141

Trigwell, K., & Prosser, M. (1991). Improving the quality of student learning: the influence of
learning context and student approaches to learning on learning outcomes. Higher
education, 22(3), 251-266.
Tsouros, A. (1995). The WHO Healthy Cities Project: State of the art and future plans. Health
Promotion International, 10(2), 133–141. https://doi.org/10.1093/heapro/10.2.133
Tsouros, A., Dowding, G., Thompson, J., Dooris, M., & World Health Organization. (1998).
Health promoting universities: Concept, experience and framework for action.
Copenhagen, Denmark: WHO Regional Office for Europe.
Turner, J., & Shu, J. (2004). Serious health consequences associated with alcohol use among
college students: Demographic and clinical characteristics of patients seen in an
emergency department. Journal of Studies on Alcohol, 65(2), 179–183.
United Nations (2017). The sustainable development goals. Retrieved from
http://www.un.org/sustainabledevelopment/
van den Berg, M., Wendel-Vos, W., van Poppel, M., Kemper, H., van Mechelen, W., & Maas, J.
(2015). Health benefits of green spaces in the living environment: A systematic review of
epidemiological studies. Urban Forestry & Urban Greening, 14(4), 806–816.
Walton, G. M., & Cohen, G. L. (2011). A brief social-belonging intervention improves academic
and health outcomes of minority students. Science, 331(6023), 1447–1451.
Wang, A. X. (2018, April 10). Yale's beloved happiness class is now on the internet for free.
Retrieved from https://qz.com/work/1248972/yales-beloved-happiness-class-is-now-on-
the-
Wentzel, K. R., & Miele, D. B. (Eds.). (2009). Handbook of motivation at school. New York:
Routledge.
HEALTH AND WELLNESS 142

Werther, E. (2012). College adjustment and burnout among undergraduate transfer and native
students (Doctoral dissertation). University of Georgia, Athens, GA.
Westerhof, G. J., & Keyes, C. L. (2010). Mental illness and mental health: The two continua
model across the lifespan. Journal of Adult Development, 17(2), 110–119.
World Health Organization (1978). Declaration of Alma-Ata International Conference on
Primary Health Care. Retrieved from
http://www.who.int/hpr/NPH/docs/declaration_almaata.pdf
World Health Organization (1991) Sundsvall statement on supportive environments for health.
(Report from the International Conference on Health Promotion, Sundsvall, June 1991).
Copenhagen, Denmark: Author.
World Health Organization (2006). Health promotion glossary update. Retrieved from
http://www.who.int/healthpromotion/about/HPR%20Glossary_New%20Terms.pdf
World Health Organization (2013). Mental health action plan: 2013-2020. Retrieved from
http://apps.who.int/iris/bitstream/10665/89966/1/9789241506021_eng.pdf
World Health Organization (2014). Cities for Health. Retrieved from
http://www.who.int/kobe_centre/publications/cities_for_health_final.pdf
World Health Organization (2017). Depression and other common mental disorders: Global
health estimates. Retrieved from
http://apps.who.int/iris/bitstream/10665/254610/1/WHO-MSD-MER-2017.2-eng.pdf
World Health Organization (2018a). Good governance. Retrieved from
http://www.who.int/healthpromotion
World Health Organization (2018b). Health Promotion. Retrieved from
http://www.who.int/healthpromotion
HEALTH AND WELLNESS 143

World Health Organization (2018c). Mental Health. Retrieved from
http://www.who.int/mental_health/SDGs/en/
World Health Organization. (1986). Ottawa Charter for Health Promotion. Geneva, Switzerland:
Author.
World Health Organization. (1997a). Health promotion glossary. Geneva, Switzerland: Author.
World Health Organization. (1997b). Jakarta declaration on health promotion into the 21st
century. Geneva, Switzerland: Author.
World Health Organization. (2005). Bangkok charter for health promotion in a globalized world.
Geneva, Switzerland: Author..
Yang, H. J., & Farn, C. K. (2005). An investigation the factors affecting MIS student burnout in
technical ‐vocational college. Computers in Human Behavior, 21(6), 917–932.
Yough, M., & Anderman, E. (2010). Goal orientation theory.
www.education.com/reference/article/goal-orientation-theory/.

HEALTH AND WELLNESS 144

APPENDIX A
Survey Items
1. How many areas did you score low?
2. How many of the recommended programs or courses did you complete?
Knowledge
3. I understand when I study well. (conceptual)
Strongly Disagree Disagree Neutral Agree Strongly Agree
4. I know the benefits of wellness. (conceptual)
Strongly Disagree Disagree Neutral Agree Strongly Agree
5. Overall, I have been organized in my studying. (metacognitive)
Strongly Disagree Disagree Neutral Agree Strongly Agree
6. I can locate where university support systems are on campus. (factual)
Strongly Disagree Disagree Neutral Agree Strongly Agree
7. I believe that I can assess how I study well. (metacognitive)
Strongly Disagree Disagree Neutral Agree Strongly Agree
8. I believe that I have the ability to assess how I am weak at studying. (metacognitive)
Strongly Disagree Disagree Neutral Agree Strongly Agree

Motivation
9. The Aalto University’s study skills information, programs, and courses can help me
improve my study ability. (utility)
Strongly Disagree Disagree Neutral Agree Strongly Agree
10. The Aalto University’s study skills information, programs, and courses can help other
students improve their study ability. (utility)
Strongly Disagree Disagree Neutral Agree Strongly Agree
11. The AllWell? results make me aware of my own strengths and weaknesses in my study
ability. (utility)
Strongly Disagree Disagree Neutral Agree Strongly Agree
12. If I complete the AllWell? recommendations, my study ability will improve. (utility)
Strongly Disagree Disagree Neutral Agree Strongly Agree
13. I can do well in my studies. (self-efficacy)
Strongly Disagree Disagree Neutral Agree Strongly Agree
HEALTH AND WELLNESS 145

14. The AllWell? survey’s connections can help me graduate. (goal orientation)
Strongly Disagree Disagree Neutral Agree Strongly Agree

Organization
15. Aalto University supports my ability to study effectively. (model)
Strongly Disagree Disagree Neutral Agree Strongly Agree
16. Aalto University encourages me participating in the AllWell? survey. (settings)
Strongly Disagree Disagree Neutral Agree Strongly Agree
17. The AllWell? survey is easy to access. (setting)
Strongly Disagree Disagree Neutral Agree Strongly Agree
18. The AllWell? survey is easy to use. (setting)
Strongly Disagree Disagree Neutral Agree Strongly Agree
19. Aalto University has resources that will help me study better. (settings)
Strongly Disagree Disagree Neutral Agree Strongly Agree

HEALTH AND WELLNESS 146

APPENDIX B
Interview Protocol
Five minutes of introductions and provide consent information.
I would like to thank you for taking the time to meet today. The purpose of this
interview is to explore how the AllWell? survey and its resources helps you increase your study
skills. I am exploring students’ perceptions of how the AllWell? survey and recommendations
can help students at Aalto University improve their confidence, study skills, and choices when
studying. As a participant, you have the option to not answer any question and withdraw at any
time.
If it is okay with you, I will be recording our conversation. The purpose of this is to that I
can get all the details but at the same time to be able to carry on an attentive conversation with
you without having to take lots of notes. I assure you that all your comments will remain
confidential. I will be compiling a report which will contain all students’ comments without any
reference to individuals. Do you agree to allow a recording of this conversation?
Turn on recording
1. After completing the AllWell? survey, how many areas were considered low?
a. From the programs and courses offered to improve those weak areas, how many
did you complete?
b. Describe your experience with those programs.
Let’s move on and talk about Aalto University.
2. Describe how you believe Aalto University supports your studying, if at all.
3. Describe how the AllWell? survey provides resources for students to increase their study
ability, if at all.
a. How can you improve your study ability?
4. Explain how you felt about the feedback from the AllWell? survey.
a. How did this feedback help you improve your studying, if at all?
5. Describe your experience with the AllWell? survey.
a. What made the survey easy to use, if at all?
b. What made the survey difficult to use, if at all?

HEALTH AND WELLNESS 147

APPENDIX C
Knowledge, Motivation, Organizational Influences
Organizational Global Goal
By 2020, Aalto University aims to decrease risk of burnout from 20% to 10%.
Stakeholder Goal
Increase student study ability through personal resources, study skills, and study environment to reduce
burnout from 20% to 10%.
Assumed
Knowledge
Influence
Knowledge Type Knowledge
Influence
Assessment
Learning Solution
Principle*
Proposed
Solution*
Students need to
understand
differences between
deep and surface
learning.
Declarative
(conceptual)
Survey Q3
Students need to
understand the
dimensions of
wellness.
Declarative
(conceptual)
Survey Q4

Interview Q2

Students need to
know how to
manage the
symptoms of
burnout.
Procedural Survey Q6

Interview Q3

Students need to
know how to study
effectively.
Procedural Survey Q5
Students need to
know how to
support their
wellness.
Procedural

Survey Q6

Interview Q3

Students need the
ability to
effectively assess
their own strengths
and weaknesses in
managing burnout.
Metacognitive Interview Q4
Students need the
ability to
effectively assess
their own strengths
Metacognitive Survey Q7,8
HEALTH AND WELLNESS 148

and weaknesses in
studying
effectively.
Students need the
ability to
effectively assess
their own strengths
and weaknesses in
supporting their
wellness.

Metacognitive
Interview Q3a

Motivation
Construct
Assumed
Motivation
Influence
Motivation
Influence
Assessment
Motivational
Solution Principle
Proposed
Solution
Utility Value Students need to
see the value of the
AllWell? survey in
supporting their
ability to improve
study ability.
Survey Q9,10,11,12
Self-Efficacy Students need to
believe that they
have the ability to
apply the results of
the AllWell?
survey.
Survey Q13

Goal Orientation Students should
want to have
effective study
ability to prevent
burnout.
Survey Q15

Organizational
Influence
Category
Assumed
Organizational
Influence
Organizational
Influence
Assessment
Research Based
Recommendation
or Solution
Principle
Proposed
Solution
Cultural Model
Influence 1
AU needs to
cultivate a culture
that supports
students’ study
ability in all three
areas: personal
resources, study
skills, and study
environment.
Survey 15

HEALTH AND WELLNESS 149

Cultural Model
Influence 2
AU needs to
increase students’
feeling of being
supported by AU.

Interview Q2

Documents

Cultural Setting
Influence 1
AU needs to
provide resources
for students to
increase their study
ability.
Survey Q19

Cultural Setting
Influence 2
AU needs to
promote the
participation of the
AllWell? survey.

Survey Q16,17,18

Interview Q5

HEALTH AND WELLNESS 150

APPENDIX D
Informed Consent for Non-Medical Research

University of Southern California
Rossier School of Education
3470 Trousdale Parkway, Los Angeles, CA 90089

INFORMED CONSENT FOR NON-MEDICAL RESEARCH

ALLWELL? SURVEY AT AALTO UNIVERSITY: AN EVALUATION STUDY

You are invited to participate in a research study conducted by Alan Cromlish under the
supervision of Dr. Jenifer Crawford at the University of Southern California, because you are
current students at Aalto University and you participated in the 2018 AllWell? survey. Your
participation is voluntary. You should read the information below, and ask questions about
anything you do not understand, before deciding whether to participate. Please take as much time
as you need to read the consent form. You may also decide to discuss participation with your
family or friends. If you decide to participate, you will be asked to sign this form. You will be
given a copy of this form.

PURPOSE OF THE STUDY
The purpose of this study is to understand your perceptions of the AllWell survey? This includes
knowing if and how the AllWell? survey helped you get connected to resources at Aalto University
to improve your study ability, the access of the AllWell? survey, the ease of use of the AllWell?
survey, and the effectiveness of the AllWell? survey to identify strengths and weaknesses in your
study ability.

STUDY PROCEDURES
If you volunteer to participate in this study, you will be asked to participate in a survey,
interview, or both.

• PARTICIPANT INVOLVEMENT – SURVEY
• If you agree to take part in this study, you will be asked to participate in an 18
question survey. You do not need to answer questions that you do not want to.
There are no identified risks to the participants from this survey. At any time
during this study you are welcome to stop participation.

PARTICIPANT INVOLVEMENT – INTERVIEW
• If you agree to take part in this study and are randomly selected, you will be asked
to participate in an hour long interview that will be recorded. You do not have to
answer any questions that you do not wish to. There are no identified risks to the
participants. At any time during this study you are welcome to stop participation.

HEALTH AND WELLNESS 151

POTENTIAL BENEFITS TO PARTICIPANTS AND/OR TO SOCIETY
The potential benefits of this study aim to improve the AllWell? survey to reduce study burnout.
As a participant, your insight into the AllWell? survey, the delivery of the survey, its ability to
assess your strengths and weaknesses, and its effectiveness to connect you to resources is
valuable. Improving this survey can benefit you, current and future students at Aalto University,
and society to decrease burnout through the improvement of key skills. Additionally, this study
will add to the current literate surrounding the topic of wellness and burnout in higher education.

PAYMENT/COMPENSATION FOR PARTICIPATION
There is no compensation for your survey or interview participation.

CONFIDENTIALITY
We will keep your records for this study confidential as far as permitted by law. However, if we
are required to do so by law, we will disclose confidential information about you. The members
of the research team, the funding agency and the University of Southern California’s Human
Subjects Protection Program (HSPP) may access the data. The HSPP reviews and monitors
research studies to protect the rights and welfare of research subjects.

The data from the survey and interviews will be stored on an encrypted, password protected hard
drive in the researcher’s home for three years then destroyed. Digital recording of the interview
will be transcribed by a third party. Only age, gender, major, and year in school will be collected.
To keep confidentiality, I will work with Mr. Mikko Inkinen of Aalto University to reach the
students and collect data. Distribution of the survey’s and opting into the interviews will be done
by Mr. Inkinen, and during interviews, students will be asked what name they wish to use.

PARTICIPATION AND WITHDRAWAL
Your participation is voluntary. Your refusal to participate will involve no penalty or loss of
benefits to which you are otherwise entitled. You may withdraw your consent at any time and
discontinue participation without penalty. You are not waiving any legal claims, rights or remedies
because of your participation in this research study.

INVESTIGATOR’S CONTACT INFORMATION
If you have any questions or concerns about the research, please feel free to contact the Principal
Investigator via email at Cromlish@usc.edu or phone at +1-864-648-9661 or Faculty Advisor Dr.
Jenifer Crawford at Jenifer.Crawford@usc.edu or phone at +1-530-519-4085.

RIGHTS OF RESEARCH PARTICIPANT – IRB CONTACT INFORMATION
If you have questions, concerns, or complaints about your rights as a research participant or the
research in general and are unable to contact the research team, or if you want to talk to someone
independent of the research team, please contact the University Park Institutional Review Board
(UPIRB), 3720 South Flower Street #301, Los Angeles, CA 90089-0702, (213) 821-5272 or
upirb@usc.edu

HEALTH AND WELLNESS 152

SIGNATURE OF RESEARCH PARTICIPANT

I have read the information provided above. I have been given a chance to ask questions. My
questions have been answered to my satisfaction, and I agree to participate in this study. I have
been given a copy of this form.

□ I agree to audio recording (remove the media not being used)

□ I do not want audio recording (remove the media not being used)

Name of Participant

Signature of Participant Date

SIGNATURE OF INVESTIGATOR

I have explained the research to the participant and answered all of his/her questions. I believe
that he/she understands the information described in this document and freely consents to
participate.

Name of Person Obtaining Consent

Signature of Person Obtaining Consent Date

HEALTH AND WELLNESS 153

APPENDIX E
Summary Infographic

HEALTH AND WELLNESS 154

HEALTH AND WELLNESS 155

HEALTH AND WELLNESS 156

Abstract (if available)

Abstract For decades, health issues continue to rise in students in higher education. These physical, mental, and social health issues impact learning and academic performance. The current solutions to treat issues allows students to get the necessary medical help to improve their situation but improving overall health and awareness would allow for prevention of these issues occurring through promoting optimal health. This study examined the effectiveness of Aalto University’s AllWell? survey to provide feedback and resources to students about their study ability. Using the KMO framework, this study examined students who completed the AllWell? survey in 2018 to better understand the AllWell? survey and students’ interactions with its feedback. The study found that overall students possess the knowledge and motivation to improve their study ability, but the differences in the schools on campus should be examined.

Linked assets

University of Southern California Dissertations and Theses

Conceptually similar

PDF

A California community college's climate action plan: an evaluation study

PDF

Impact of mindfulness on early education teacher well-being: an evaluation study

PDF

Disproportionate exclusionary discipline for special education‐identified students: an improvement study

PDF

Advisor impact on student veterans at a post-secondary institution: an evaluation study

PDF

Initial and continuing physical and behavioral health and wellness education in the fire service: an innovation study on heart attack, suicide, and cancer prevention for Howard County Fire and Rescue

PDF

Closing the access gap to gifted and talented education for Black K-12 students

PDF

Teacher perception on positive behavior interventions and supports’ (PBIS) cultivation for positive teacher-student relationships in high schools: an evaluation study

PDF

An evaluation study of effectiveness of continuous professional development in Ethiopia

PDF

Improving math achievement among fourth graders at Al-Corniche Primary For Girls: a gap analysis

PDF

Developing global competence in a Sino-US joint university: an evaluation study

PDF

Retention rates and burnout among medical assistants: an evaluation study

PDF

Increasing international student enrollment at an East Asian university: a gap analysis

PDF

Effective course design for improving student learning: a case study in application

PDF

Relationship between employee disengagement and employee performance among facilities employees in higher education: an evaluation study

PDF

The impact of Connecticut legislators on teacher diversity

PDF

Instructional technology integration in a parochial school district: an evaluation study

PDF

Asian American college student well-being: racial identity consciousness as model minorities at an elite university

PDF

The board fundraising challenge after nonprofit mergers: an evaluation study

PDF

High school counselors’ support of first-generation students’ postsecondary planning: an evaluative study

PDF

Nonprofit donor retention: a case study of Church of the West

Asset Metadata

Creator Cromlish, Alan (author)

Core Title Assessing student burnout using the AllWell? survey at Aalto University: an evaluation study

School Rossier School of Education

Degree Doctor of Education

Degree Program Global Executive

Publication Date 08/02/2019

Defense Date 04/24/2019

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag Burnout,Health promotion,Higher education,Mental Health,OAI-PMH Harvest,organizational culture,physical health,social health,well-being,wellness

Format application/pdf (imt)

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Crawford, Jenifer (committee chair), Filback, Robert (committee member), Seli, Helena (committee member)

Creator Email acromlish86@gmail.com,cromlish@usc.edu

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c89-203845

Unique identifier UC11662790

Identifier etd-CromlishAl-7728.pdf (filename),usctheses-c89-203845 (legacy record id)

Legacy Identifier etd-CromlishAl-7728.pdf

Dmrecord 203845

Document Type Dissertation

Format application/pdf (imt)

Rights Cromlish, Alan

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the a...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA