Introduction

The Health information-seeking behavior involves the methods by which individuals consciously search diverse resources for information regarding their health, the risks, diseases, and manners of health preservation [1]. In other words, health information-seeking behavior is a purposive and active behavior for fulfilling an informational need. As an outcome, the information is obtained from different media and resources and is thereafter used. Such behavior represents the way through which individuals search, find, and apply the information related to a disease [2]. The findings of some studies related to the information-seeking behavior demonstrate that people use more accessible resources, such as the Internet, for seeking health-related information [3]. Fitness is one of the topics on which individuals', particularly the youth, are interested in acquiring information. Wang et al. [4] realized in their research that the health information-seeking behavior in people is affected by four categories of psychological, instrumental, contextual, and demographic factors.

In recent years, attaining fitness and an ideal weight has become matter of grave concern to the youth, particularly the girls; As such, diet, exercise, and bodybuilding exercises have interwoven into their daily routines to achieve a desired physical appearance. The modern society has transformed the physical image into a social phenomenon with cultural and symbolic values [5]. Body image is the way individuals see their body and the degree to which they consider themselves attractive [6]. By approaching adolescence and youth, individuals increasingly focus on their appearance and physical attractiveness [7]. Most of the young girls and boys are preoccupied with their body image [8]. They spend most of their time with their peers discussing their appearance and ways to attract the opposite sex and imitate celebrities [9]. The excessive preoccupation of young adults with beauty and fitness contributes to their engagement in rather extreme behaviors to adopt cultural patterns of beauty that are advertised a variety of media and on the Internet [10]. In the past, individuals used to follow more conventional methods of beauty and fitness, but the emergence of media and information resources has changed their attitudes and behaviors. Information-seeking behavior is the way individuals search and use information related to physical and mental health, health threats, and health promotion practices [11].

The findings of some studies showed that in recent years in most societies, including Iran, young girls are more obsessed with their body and physical appearance since body for them conveys a sense of identity [10]. It seems that the important reason for females' obsession is autophobia and a negative body image [12]. The findings of some studies revealed that body management, has a positive and significant relationship with media consumption, social acceptance of the body, and socioeconomic status; though, religiosity and body management are in an inverse relationship [13]. Undoubtedly, TV has a major role in disseminating health information and individuals obtain the majority of their health-related information by watching TV [14].

In addition to television, owing to a wide range of capacities as well as high flexibility in providing health information, the Internet inspires students to seek health information and promote their health [15]. Findings of some studies showed that more than 90% of adolescents receive their health-related information about fitness, sexual health, and nutrition from social networks [16]. Jacob et al. [3] found that the Internet has become the single most important source of information about health. Literature suggests that despite the importance of health information, particularly concerning fitness, not many studies have investigated the fitness information-seeking behaviors. The present study investigates the female students’ information-seeking behavior about fitness. Given the high rates of obesity in Iran, especially the severe rise in the obesity prevalence among Iranian women, as well as the intense inclination of women in the province of Isfahan toward fitness, the findings of this study can provide essential information for Iran’s health policymakers to eliminate the barriers for seeking fitness-related information and reduce the consequences of using invalid information [17].

Materials and methods

The qualitative study using conventional content analysis was carried out from February to July 2018. The participants were female students of different schools of Isfahan University of Medical Sciences. Participants are identified and selected using purposive sampling method. Also, snowball sampling was used for identifying respondents armored with rich information relevant to the study. The Inclusion criteria were the tendency to participate and intending to be fit in the present or the past. The exclusion criterion was withdrawal from participation. For data collection, the researcher went to the faculties, selected the participants, explained the purpose of the study to them, and after obtaining their consent for participation, the time and place of the interviews were arranged.

Semi-structured interviews were used to collect data. The interview questions were developed by the research team (S1 File) and one of the trained researchers conducted the interviews. Before starting the formal interviews, a practice interview was carried out under the surveillance of the main researcher. To foster trust between both parties, the interviews were started by asking open-ended questions like “Please talk about what you have done to attain fitness so far?”, additionally, to clarify the participants’ responses, they were asked to give real-life examples of their statements. The saturation point was reached at 16 face-to-face semi-structured interviews. The interviews were recorded by a voice recorder. Each interview lasted about 30 to 60 minutes depending on the participant’s willingness and her information on the research material.

The gathered data were analyzed by conventional content analysis by MAXQDA version 10. Based on the research stages proposed by Graneheim and Lundman [18], data analysis was performed continuously and simultaneously with data collection. In the first stage, the sentences and paragraphs that included concepts related to the subject of the study were chosen as semantic units. The initial codes were extracted by converting the semantic units into more brief expressions. At this stage, 164 initial codes were extracted, which were subsequently reviewed and compared. Similar cases were then combined into a single topic. Afterwards, 19 codes were extracted. In the next stage, the related codes were categorized. Ultimately, the concept and hidden content within the data were extracted as the main category by a re-evaluation of the codes and levels.

The four trustworthiness criteria of credibility, confirmability, dependability, and transferability suggested by Lincoln and Guba were used for assessing the quality of the study [19]. Credibility was ensured by the researcher’s prolonged involvement in the project and ongoing interaction with the participants, which in turn facilitated gaining the participants’ trust and a better understanding of their experiences. To ensure the credibility of the research, the findings were returned to some participants for further comments. The dependability of the research was ensured by the implementation of interviews as soon as possible, accurate recording of all stages of the research, and providing the participants with equal situations. To promote the transferability of the findings, we tried to select participants who were diverse in terms of faculty, major, and degree. Finally, parts of the text of the interviews, along with the codes and categories extracted for evaluation, were provided to three experts outside the research team to confirm the correctness of the given data.

To honor ethical considerations, the study was approved by the Ethics Committee of Isfahan University of Medical Sciences before being conducted. Before doing the research, the participants were briefed on the research purposes, data privacy, recording the interviews, and on their authority to attend or leave the interview and their written consent to participate and the recorded interviews. To respect the participants’ privacy, every individual was assigned a code and the data were reported anonymously.

Results

Sixteen female students participated in this research. They are described in Table 1 (i.e. their faculty, major and degree).

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Table 1. Participants' characteristics.

https://doi.org/10.1371/journal.pone.0237735.t001

Based on the content analysis of the interviews regarding fitness information-seeking behavior, four categories were extracted including information-seeking motivations, information resources, information validation, and the obstacles for information-seeking (Table 2).

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Table 2. Category, sub-categories, and codes related to the fitness information-seeking behavior.

https://doi.org/10.1371/journal.pone.0237735.t002

Discussion

The current research was conducted to clarify the information-seeking behavior related to fitness in female students via a qualitative approach. According to the findings of the research, four categories of information-seeking motivations, information-seeking resources, information validation, and information-seeking barriers were extracted within the health information-seeking behavior of students.

The research findings suggest that female students are obsessed with their physical appearance and tend to seek reliable information about how they can attain or maintain fitness. Information need acts as the initiating and instigating point in the health information-seeking behavior of students. In Wilson’s opinion, information need is one of the secondary needs, which is derived from the primary psychological, cognitive, and affective needs [20]. Furthermore, the first stage of the Kuhlthau's model of the Information Search Process (ISP) is “initiation” in which the person realizes that some information is required to resolve a certain problem [21]. This stage is similar to Wilson's model of information-seeking behavior in which the person identifies a perceived information need within a certain environment [20]. The findings of some studies such as the research conducted by Haghighatiyan et al [5] and Sholeha et al [8] show that for several reasons, women are more concerned about their fitness. Participants in this study motivated by reasons like improving physical and mental health, gaining social acceptability and self-confidence or due to their friends’ pressure sought fitness information. The findings of the research by Riyahi et al. confirm that seeking health information for having a healthy lifestyle is among the participants most important information needs [22]. Given obesity contributes to joint pains and many other diseases, it is common for people and the youth, in particular, to try to lose weight and attain fitness. Abdolhosseini and Haghighatiyan argue that there is a significant relationship between attention-seeking and body improvement behaviors [10]. Although striving for beauty is intrinsic motivation, these days has been replaced by obsessive flaunting and body showoff. Mahmoudi and Mohadesi believe that overrated attention to physical beauty in society leaves people prone to fear, doubt, and lack of confidence [12]. Moreover, some studies have shown that there is a direct relationship between social acceptability, self-confidence, fitness, and body image [13, 23, 24]. The excessive attention of newly emerged media to physical beauty and appearance has fueled fears of being excluded, losing the opportunity of marriage, finding a job, and etc. among the youth.

The findings show that the participants use different formal and informal resources to obtain information about fitness and body management. Initiating the information-seeking behavior means the students’ deliberate act to search their required information from various resources concerning fitness. Such an act is performed to satisfy an information need regarding fitness, which is stated in Wilson’s model of information-seeking behavior as “active information-seeking” [20]. Findings of some studies prove that the Internet as a new source of information has become more popular in mainstream society at large and among the youth in particular for obtaining health-related information among other purposes [25–29]. Furthermore, some studies suggest the growing popularity of the Internet and social networks for seeking health-related information among people [16, 27, 30, 31] whereas Finny Rutten et al. maintain that despite the availability of health information over online networks, these resources are not used so frequently [32]. Nevertheless, it seems that due to the updated and comprehensive information available on the Internet, the ease of access, and the high costs of visiting doctors; most individuals despite trusting doctors and specialists, opt for electronic resources to obtain information.

According to the participants’ experiences, one of the major challenges in seeking information was the disparities between the information obtained from different resources and uncertainty of the information accuracy. Therefore, the participants try to validate the received information by asking doctors and specialists, seeking out scientific references for information, and asking friends and relatives. The verification behavior of the obtained information is similar to the “verifying” stage in the Ellis’ model of information-seeking behavior who believes that the authenticity of the obtained information must be ensured by a variety of methods before their practical application [33]. Nasrollahzadeh found that when people are not sure about the accuracy of obtained information, they share it with other people particularly their family members and friends [34]. Moreover, the findings some studies demonstrated that despite people’s approximate trust in the information obtained from Internet websites, they consult specialist physicians before applying them [27, 35]. Due to the importance and sensitivity of health information, participants tend to use such information carefully. They trust physicians more than other individuals and resources, and most people believe that “doctors know best”.

According to the research findings, the participants come across different obstacles in searching for fitness-related information like. Shortage of time, high costs of visiting doctors, disparity, and distrust of information, and limited access to websites and social networks. In his research, Nasrollahzadeh demonstrated that the participants pointed to the time limitations as one of the barriers to information-seeking behavior. Therefore, they prefer using oral resources since they require a lesser time investment [34]. Latifi et al. find that participants prefer to obtain their needed information from doctors; however, they refer to doctors less frequently since they are not able to afford it [36]. Additionally, Perzeski, in his research, considered the high costs of information resources as one of the important information-seeking barriers, which deters individuals from utilizing them due to financial inability [37]. In Iran, none of the insurance companies cover the costs of cosmetic and fitness services, so most people cannot afford to pay for doctor or nutritionist visits. Accordingly, despite distrust in free available information, individuals usually do not have any alternatives. Moreover, some social networks and websites are blocked and therefore, many users are deprived of potentially useful information.

Conclusion

This study assessed the fitness-related behavioral information of female collegiate students using an exploratory approach. The results indicated that students attempted to obtain fitness with different motives and gathered information on how to achieve fitness from various sources but they evaluated the validity and accuracy of the data to some extent before putting them into practice. Given the importance of health information, especially fitness, the study focuses on improving people's behavior regarding obtaining health information. Thus, although the research findings cannot be generalized, policy actions may be provided including promoting the general public’s health literacy and media literacy, providing credible information on how to obtain fitness through formal and accessible sources of information and health treatment insurance coverage related to fitness. Furthermore, conducting studies regarding the health information requirements of individuals about fitness and the reasons for their trust or lack of trust in some information sources for obtaining health information can be beneficial.

Supporting information

Acknowledgments

The authors appreciate all the people who have assisted them in conducting this research. Also, they appreciate the Research and Technology Deputy of Isfahan University of Medical Sciences for facilitating the research procedure.