Application of the FANTASTIC Lifestyle Questionnaire in the Academic Context

Studying citizens’ lifestyles is extremely important for understanding society and the social conditions of the personal lifestyle. Understanding the lifestyles of university students is especially important because they will be the future citizens and professionals who will shape society’s future. The aim of this study was a systematic review of the scientific literature about the use of the FANTASTIC Lifestyle questionnaire in an academic context. The reflective systematic literature review was carried out on PubMed, MEDLINE, Science Direct, and SCIELO databases with the keywords (“FANTASTIC Lifestyle questionnaire” OR “FANTASTICO questionnaire” OR “FANTASTIC questionnaire” OR “FANTASTIC survey” OR “FANTASTIC checklist”) AND (“university students”). The PRISMA criteria for reporting systematic reviews and meta-analyses were applied. The inclusion criteria were the use of the “FANTASTIC Lifestyle questionnaire” instrument for measuring lifestyles, the presentation of quantitative or qualitative results, and psychometric studies. The exclusion criteria were no use of FANTASTIC Lifestyle Questionnaire; other population, no quantitative or qualitative analysis, incomplete articles. The 15 scientific articles included in the study were analyzed. This literature review allowed us to conclude the importance and usefulness/actuality of this questionnaire. Furthermore, the importance of diagnosis should be emphasized, as should the development of strategies and intervention programs for the maintenance or creation of healthy societies.


Introduction
Lifestyles and health behaviors are key elements that condition the health of a society [1]. They determine a direct and/or indirect impact on health on the physical, mental, and social dimensions. Healthy lifestyles such as a healthy diet, regular physical activity, moderate alcohol consumption, and drug abstinence are factors that enhance citizens' health and well-being. On the other hand, drug consumption (illegal drugs or tobacco and alcohol), malnutrition and an incorrect diet, sedentary behavior, and risky sexual behaviors are considered unhealthy lifestyles and are associated with the development and/or intensification of diseases, affecting the citizen's health [2]. Therefore, it is important to diagnose lifestyles at all ages, especially at younger ages, for better intervention with promising results for the future of society. In this sense, it is important to develop promotion and intervention plans and strategies, as well as increase health literacy on this topic. The World Health Organization (WHO) highlights health literacy as a key element in the development of strategies to improve lifestyles [3,4].
Acting on younger populations and raising their awareness of the issue will help to promote health for future generations. In this sense, it is important to know the lifestyle of Healthcare 2022, 10, 2503 2 of 9 our young people today, the future professionals of tomorrow. It is important to make them aware of this issue, to increase their knowledge, and to adopt better practices in the future.
The academic environment is often an enabler of unhealthy lifestyles due to the many variables involved. University students are a critical group in terms of the adoption of risky health behaviors such as unhealthy diets, sedentary behavior, unhealthy sexual behavior, tobacco and alcohol consumption, poor (with reduced hours as well as the quality of) sleep, and others [4][5][6]. However, these young people are also more susceptible to change. If effective strategies are developed, they can not only encourage the development of healthy lifestyles but also be promoters of healthy lifestyles in the population. So, the university should be an active agent in health promotion [5]. The university has the responsibility to develop strategies (activities, programs) to promote and improve health and increase health literacy. The health-promoting practices are important in order to develop or increase healthy lifestyles in students and in future communities.
The FANTASTIC Lifestyle questionnaire was developed in 1983 by Wilson and collaborators to evaluate the population's lifestyles and for use in a community health education program [7,8]. It is a simple questionnaire that can be completed quickly and evaluates nine dimensions. FANTASTIC is the acrostic that includes the dimensions: F = Family and friends (2 items); A = Activity and Associativity (3 items); N = Nutrition (3 items); T = Tobacco (2 items); A = Alcohol and other substances (6 items); S = Sleep and stress (3 items); T = Type of personality (3 items); I = Introspection (3 items); and C = Control of health (3 items).
Although it is a questionnaire used over several years, it is still used today because it is easy and accessible to fill out and because it can assess several dimensions [9]. Thus, this study aimed to know the use of this questionnaire in the university context (in university students), over time.

Methods
In this systematic literature review, studies were identified using a search of the databases in digital format, MEDLINE, PubMed, Science Direct, and SCIELO, between June 7 and August 25, 2022.
The keywords used in the research were: [(FANTASTIC Lifestyle questionnaire" OR "FANTASTICO questionnaire" OR "FANTASTIC questionnaire" OR "FANTASTIC survey" OR "FANTASTIC checklist") AND ("University students")]. The 33 articles found were then reduced to 15 following the removal of duplicates and those that did not meet the inclusion criteria. Other publications were discovered, but they were not indexed in these databases. The inclusion and exclusion criteria for the studies are described in Table 1. The procedure for conducting this systematic review was based on the PRISMA criteria, that is, preferred reporting items for systematic reviews and meta-analyses (Prisma)ª, were applied ( Figure 1). The data were analyzed for several parameters, such as year of publication, authors, sample, country, type of study/methodology, results, and aim. The referencing was made through EndNote bibliographic referencing.
The procedure for conducting this systematic review was based on the PRISMA criteria, that is, preferred reporting items for systematic reviews and meta-analyses (Prisma)ª, were applied ( Figure 1). The data were analyzed for several parameters, such as year of publication, authors, sample, country, type of study/methodology, results, and aim. The referencing was made through EndNote bibliographic referencing.

Results and Discussion
For this systematic review, 15 complete articles that met the inclusion criteria were analyzed. For a better understanding and analysis of the studies, a summary table was designed ( Table 2). The table was created according to several elements: year of publication/authors, sample, country, methodology, instruments, domains of FANTASTIC, results, and aims.
A cross-sectional study methodology was clearly distinguished, and two studies reported the instrument validation [9,18].

Results and Discussion
For this systematic review, 15 complete articles that met the inclusion criteria were analyzed. For a better understanding and analysis of the studies, a summary table was designed ( Table 2). The table was created according to several elements: year of publication/authors, sample, country, methodology, instruments, domains of FANTASTIC, results, and aims.
A cross-sectional study methodology was clearly distinguished, and two studies reported the instrument validation [9,18]. -Students' lifestyles worsened during the lockdown (female students were especially affected compared to their male peers (p = 0.010)). Female students change the "Good" standard of living for lower levels (classified as "Moderate," "Low," and "Worrying"); -Social/emotional behaviors were deeply affected, while confinement could be a protective factor against previous toxic habits.   -The prevalence of MetS was 6.0%, and it was higher in men than women; -The predisposing factors for having a MetS include being male, over 23 years old, overweight or obese, and having an unhealthy waist-to-height ratio. -The overall rating was "regular", and none of the participants scored in the "very good" or "excellent" categories.
-Domains requiring change include nutrition and physical activity among medical students and cigarette, drug, and alcohol consumption among physical therapy students. -to determine the prevalence of and factors associated with body image dissatisfaction among physical education students enrolled in a public university.
-The prevalence of body image dissatisfaction was 69.5%; 44.1% were dissatisfied with excess weight; -A Body Mass Index ≥ 25.0 kg/m 2 was associated with dissatisfaction with excess weight; -Factors associated with dissatisfaction with slimness were being male, eating an unhealthy diet, and smoking tobacco.
This literature review has shown that despite having been developed in 1983 [7], the FANTASTIC questionnaire is still in use today [22,23]. This instrument has been used in several research areas with different target groups and countries. Recently, during the pandemic, it was used in different studies to diagnose or evaluate the lifestyles of different populations, in particular university students [5,19,22,24,25].
It is a simple and user-friendly instrument that is easy to fill in and easy to interpret and analyze. On the other hand, it is a complete instrument that can be used to diagnose and evaluate several dimensions, as mentioned before. This questionnaire is flexible and can still be used in different contexts and with different target groups, but in the present study, we were concerned to know its use in the university context, more specifically its application to university students, as shown in Table 2.
Based on the literature, we found that this questionnaire has been used in several studies (see Table 2). This topic is very relevant, since the university environment, the transition to a new life, new friends, and being away from family are some of the factors that lead to a change in university students' lifestyles. This behavior modification can be beneficial in some cases or can potentiate the acquisition of risky behaviors. Therefore, studying the students' lifestyles makes perfect sense to understand reality and may help develop strategies to promote healthy practices.
Therefore, knowing the perception of university students' lifestyles is fundamental to designing health promotion actions and strategies for intervention. The university has a leading role in the complete education of students, academically, socially, and for a healthy society, considering the sustainable development goals. The education of these students, the acquisition of personal skills, and the increase in health literacy can contribute to the development of healthier future generations. The adoption of healthy lifestyles will improve quality of life, promote health, and disease prevention. The WHO has been calling attention to this situation, highlighting the role of healthy lifestyles in health and disease prevention [16,[26][27][28]. However, this is a multidimensional and interdisciplinary challenge that involves various dimensions such as environmental, social, economic, governmental, legal, and interpersonal influences on individuals' health and behavior [12,29]. For a healthy society, governments or health entities should adopt diagnosis and intervention strategies. These strategies should be outlined from the beginning of the youth's education. Increased health literacy is fundamental to the adoption of healthy lifestyles in society and the improvement of people's quality of life and health. So, it is necessary to develop interventions mainly aimed at the creation or enhancement of healthy behaviors and toward the reduction of those behaviors that are health risks [30]. Therefore, the data obtained from a survey of students could be used as a basis for providing health coaching, health information, and student literacy related to specific lifestyle-related, changeable health risks.
This literature review draws attention to the relevance of this topic and the studies that have been developed to date. The outcome of this work is information on the utility of the FANTASTIC tool and current patterns of use in assessing university-age individuals. In this sense, the use of the FANTASTIC Lifestyle questionnaire could become a prediagnosis instrument and a preventative tool to evaluate specific risk behaviors in several populations, in particular the university student population. Knowing and improving the lifestyle diagnosis of these young people will enable the design of more effective health promotion strategies. Encouraging wider use of the tool based on the systematic review might be a better-stated outcome.

Limitations and Implications for Practice
One possible limitation in this study could be the methodology selected, which could have conditioned the results obtained. The search strategies, the database, and the keywords selected may have been restrictive and may have left out many valid data studies.
Although the FANTASTIC questionnaire was the specific goal of this study, the limitation to a single instrument of lifestyle evaluation may condition students' perceptions of lifestyle studies in light of world reality.
This literature review allowed us to find studies that reported the use of the FAN-TASTIC questionnaire in the diagnosis of the lifestyles of university students. Thus, the relevance and appropriateness of using this questionnaire are also highlighted, as is the need for further studies.
Its use enables not only the identification and diagnosis of these students' lifestyles but also the improvement of their health literacy. On the other hand, it will allow universities to develop health promotion strategies for these age groups, with an impact on the students themselves and the community.

Conclusions
Lifestyle is considered one of the major determinants of individual and collective health. The university context should be a place of academic and personal education, enabling the acquisition of personal skills that allow the adoption of healthy lifestyles. In this way, universities should develop actions to diagnose lifestyles, enhance health literacy, and promote healthy lifestyles.
The use of diagnostic tools such as the FANTASTIC questionnaire should be a strategy to promote health. This systematic review intended to draw attention to the importance of healthy lifestyles and their diagnosis through the use of a FANTASTIC questionnaire, one that was simple, comprehensive, and easy to access, which allowed not only diagnosis but also increased health literacy on this topic. This questionnaire has been used over time and is of great importance for the analysis of the various components involved in the evaluation of lifestyle. Evaluation to encourage changes that promote health and well-being is one of the outcomes of this work.