R E S E A R CH A R T I C L E
Finnish adolescents' perceptions of their health choices:
A qualitative study
Tanja Moilanen PhD1 | Nina Rahkonen MHS2 | Mari Kangasniemi PhD1
1Department of Nursing Science, Faculty of
Medicine, University of Turku, Turku, Finland
2Women's Inpatient Ward, Obstetrics and
Gynaecology, Kuopio University Hospital,
Kuopio, Finland
Correspondence
Tanja Moilanen, Department of Nursing
Science, University of Turku 20014, Finland.
Email: tanja.moilanen@utu.fi
Abstract
This study described adolescents' perceptions of the aims of their daily health
choices and how they make them. We used a qualitative, explorative design, with
67 adolescents aged 15–16 years taking part in semi-structured focus groups in Fin-
land in 2016. We analyzed the data with qualitative inductive content analysis. Ado-
lescents perceived their health choices as automatic and driven by knowledge and
mistakes, and these decisions reflected their values and feelings. Their health choices
were based on immediate and long-term goals and they reported that making good
choices improved their self-confidence and enhanced their individuality. Adolescents
also used health choices to promote other people's health. Health choices were
linked to parental help and restrictions, and seeking acceptance from friends. Adoles-
cents' health choices were also enabled and limited by society and the environment
that they lived in. In conclusion, adolescents' health choices were an integral part of
their daily decision-making, reflected the environment they lived in, and aimed to
promote their health and express their individuality.
K E YWORD S
adolescence, adolescents, decision-making, focus groups, health choices, health literacy,
health promotion
Key points
• Adolescents make health choices to promote their own immediate and long-term health, and
that of others, and to express their individuality.
• Their health choices are linked to individual and social contexts, such as parental restrictions,
seeking acceptance from friends, and the environment they live in.
• Adolescents' health choices are an integral part of their daily decision-making, and this age
group may need support from healthcare professionals to make decisions.
1 | INTRODUCTION
The average health of adolescents has improved since the turn of the
millennium, but considerable global differences have emerged in indi-
viduals from 10 to 19 years of age. Today's adolescents face a range
problems linked to their health choices, such as not eating breakfast,
skipping meals, and consuming highly processed food (World Health
Organization [WHO], 2017a). Adolescents' physical activity levels are
low, and studies have focused on their problematic use of social
media. There are ongoing concerns about substance use, but some
improvements have been identified. Overall, adolescents' health
seems to have improved, but high social inequalities still exist (Inchley
Received: 5 March 2021 Revised: 27 June 2021 Accepted: 1 July 2021
DOI: 10.1111/nhs.12866
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any
medium, provided the original work is properly cited and is not used for commercial purposes.
© 2021 The Authors. Nursing & Health Sciences published by John Wiley & Sons Australia, Ltd.
Nurs Health Sci. 2021;1–9. wileyonlinelibrary.com/journal/nhs 1
et al., 2020.) The greatest improvements have been in Western coun-
tries. One reason for the global variations in adolescents' daily lives is
the difference in opportunities they have for accessing health services
and making health choices (Inchley et al., 2020).
Health choices are decisions that can have a direct or indirect
influence on health and they form the basis for adolescents' health
and well-being. These decisions can be made consciously or uncon-
sciously and are based on a number of reasons and motivations
(Moilanen, Pietilä, Coffey, & Kangasniemi, 2018; Moilanen, Pietilä,
Coffey, Sinikallio, & Kangasniemi, 2018). Individual health choices are
emphasized by health promotion activities (WHO, 2017b) that aim to
enhance adolescents' opportunities for healthy choices (WHO, 1986).
Individual health choices are part of both ethical and legal autonomy
and the rights of adolescents to participate in, and influence, decisions
concerning their own health and the issues that relate to them
(Archard, 2016; United Nations, 1990; Purcell, 2010; United
Nations, 1948). Health choices also play an integral role in the lives of
adolescents, by supporting them as they become independent from
their parents and take responsibility for their own health
(Ivanitskii, 2016; Moilanen, Pietilä, Coffey, Sinikallio, &
Kangasniemi, 2018; Soenens et al., 2007).
One particular characteristic of adolescents' health choices is that
they can have a long-lasting and serious impact on their future
(WHO, 2017a). In addition, adolescence is a phase of life that is char-
acterized by rapid and individual biological, cognitive, emotional, and
social changes (Hashmi, 2013). This rapid development influences an
adolescent's level of maturity and thought processes and affects their
ability to make their health choices (Banich et al., 2013; Swanson
et al., 2013). It also has an impact on adolescents' health literacy,
which is their ability to acquire, understand (Fleary et al., 2018; Parnell
et al., 2019), and use health information to aid their decision-making
(Parnell et al., 2019).
Adolescents make health choices in their daily lives, and these are
influenced by their personal preferences and linked to peers and fri-
ends (Moilanen, 2018; Moilanen, Pietilä, Coffey, Sinikallio, &
Kangasniemi, 2018). Health choices are also associated with adoles-
cents' parents and families, because socioeconomic, educational, and
geographic factors can either promote or hinder their opportunities to
make their own choices. Society enables adolescents to make health
choices by controlling their wider opportunities and the environments
they live in (Moilanen, 2018).
The literature already provides multidimensional knowledge on
the factors that determine adolescents' health and their health behav-
ior. Compared to behavioral theories and models of individual theories
(Opalinski et al., 2018; Short & Mollborn, 2015), the health choices
approach emphasizes their agency and their individual opportunities
to influence and control their decision-making (Ivanitskii, 2016;
Moilanen, Pietilä, Coffey, Sinikallio, & Kangasniemi, 2018; Paternoster
& Pogarsky, 2009). For example, in recent years attention has been
paid to adolescents' particular health choices in areas such as dietary
patterns (Tebar et al., 2020; Williams et al., 2020), exercise (Matud &
Díaz, 2020), and smoking (Ho et al., 2020; Veronda et al., 2020), and
their associations with background factors and health. However, little
is known about adolescents' perceptions of their health choices and
how they make them. We need to understand adolescents' percep-
tions so that we can support them and enable them to make their
own health choices. Information about how adolescents make daily
choices that have an impact on their health may be helpful when
designing health promotion interventions.
1.1 | Aim
This study aimed to describe Finnish adolescents' perceptions of the
health choices they make in their daily life. The research ques-
tions were:
1. How do adolescents describe their health choices?
2. What kind of aims do adolescents have with regard to their health
choices?
3. How do adolescents perceive the way they achieve their health
choices?
2 | METHOD
2.1 | Data collection
We collected the data by holding semi-structured focus group inter-
views with 15- and 16-year-old Finnish adolescents in the spring of
2016. Participants were in the ninth grade, which is the last level
of compulsory basic education in Finland.
The semi-structured interview guide that was used was based on
previous literature (Kangasniemi et al., 2012; Moilanen, Pietilä, Coffey,
Sinikallio, & Kangasniemi, 2018; Snelling, 2012), and it focused on
adolescents' health choices, their rights, their responsibilities and
duties, and their freedom to make health choices (Table 1). This study
provides feedback on two key themes: the health choices that adoles-
cents make and their opportunities to achieve those health choices.
We gathered the data from four public schools in Eastern Finland.
Three of the schools had students aged 7–16 years (grades 1–9) and
one had students aged 12–16 years (grades 7–9). Two of the schools
were in urban areas and two were in rural areas. They had 130 to
456 pupils.
After receiving ethics committee approval, and with acknowledg-
ment from the principals of the four schools, we contacted the head
teachers so that the participants could be recruited. The researcher
(T.M.) presented the study to the adolescents during lessons, while
the teachers were present, and asked them if they had any questions.
After that, the adolescents who were happy to take part contacted
the researcher to agree on the interview dates.
At the beginning of each focus group, the researcher explained the
aims of the study and the voluntary and anonymous nature of the par-
ticipation. The ground rules for the focus groups were also described.
The interviews followed the semi-structured interview guide, but the
researcher encouraged the adolescents to raise any issues that they
2 MOILANEN ET AL.
considered relevant to the topic or to the questions they were asked.
The adolescents were also encouraged to engage in open discussions
about any comments made by their peers. In addition, the researcher
encouraged participants to expand on the answers that they had given
to make sure that their meaning was clear.
A total of 67 adolescents were recruited into the study, for-
ming 14 focus groups with three to six participants in each group,
until a decision was made to cease data collection. The partici-
pants were 42 girls and 25 boys aged 15 and 16 years old. The
members of each focus group all came from the same class, as we
felt they would be more comfortable discussing issues in front of
people they already knew. The audiotaped interviews were carried
out in the classrooms during school time and they lasted 30 to
45 min. We collected and analyzed the data until no new content
emerged, and to ensure that we had achieved saturation and thus
new themes would no longer emerge, an additional three focus
groups were conducted before terminating data collection (Guest
et al., 2006).
2.2 | Analysis
We analyzed the data using qualitative inductive content analysis
(Graneheim & Lundman, 2004), after the audiotaped interviews had
been transcribed verbatim. This produced 161.5 pages of text in
12-point Times New Roman, with 1.5 line spacing. The data were
read thoroughly to gain an overview of the content. Then we induc-
tively identified the meaning units, namely the words and sen-
tences that described the health choices. These meaning units were
condensed into codes and subcategorized according to their differ-
ences and similarities. They were then further abstracted into three
main categories and named inductively as health choices that were
an integral part of daily life, the aims and expected consequences
of health choices and the context in which health choices were
made. The analysis was conducted by two researchers (N.R. and
T.M.) up to the subcategory phase, and then finalized in collabora-
tion with all authors.
2.3 | Ethical considerations
The Ethical Committee of the University of Eastern Finland
(Statement 17/2015), the school district, and the principals of the
participating schools approved the study. We obtained oral and
written informed consent from the adolescents, and informed their
parents about the study. Parental approval was not sought,
because this type of study does not need it according to Finnish
law (Medical Research Act, 1999). The research ethics principles
outlined in the Declaration of Helsinki and responsible research
practices were followed during all phases of this study (Finnish
National Board on Research Integrity TENK, 2019; World Medical
Association, 2013).
3 | RESULTS
3.1 | Adolescents' descriptions of health choices
3.1.1 | Integrated decisions about health and well-
being
Adolescents described their health choices as decisions that were
integrated into their daily life (Table 2). For example, they made
decisions about what and how much food they ate and where
they ate it. They felt that these choices had an influence on their
weight, for example, that they were relevant to any weight prob-
lems. Their daily health choices also included regulating their
screen time and making sure that it did not disrupt the amount of
sleep they got.
The adolescents also recognized that their health played a role in
daily decisions about whether they went to school by foot or by bicy-
cle. They saw this as an essential way to take care of their own health.
Daily health choices also included decisions on hygiene, such as how
often they cleaned their teeth, showered, or changed their clothes. It
also included how clean they kept their bedrooms. The adolescents
also mentioned using substances during the discussions on daily
TABLE 1 The interview themes, content, and references used to produce the semi-structured interview guide
Main themes Content Referencesa
Health and health
choices
• Health and what it means
• Health-related choices made on the day of the focus
group
•Making independent choices
• Potential consequences of choices
Crondahl & Eklund, 2012; Ioannou, 2003;
Lee et al., 2010; McDade et al., 2011
Freedom related to
health choices
• The context of being free to make own choices
• Opportunities to make own choices
Hirjaba et al., 2015; Moilanen et al., 2018;
Purcell, 2010; Rose et al., 2013;
Snelling, 2012
Rights, duties and responsibilities
related to health choices
• Health related rights: focus and content
• Health-related responsibilities: focus and content
• Potential duties
• Supporting and inhibiting factors for adolescents'
rights, duties and responsibilities
Hirjaba et al., 2015; reference blinded for
review; McDade et al., 2011; Meah et al.,
2010; Moilanen et al., 2018;
Snelling, 2012
aIncludes references not presented in this study.
MOILANEN ET AL. 3
health choices and said that they wondered what difference smoking
or drinking alcohol, or abstaining, had on their health.
At school you can decide whether you go and eat at
lunch and how much you are going to eat. Even though
the food is not necessarily so good, you can still eat
it. (FG1)
I can decide by myself, whether am I going to stay
awake or try to go to bed at a certain time. (FG9)
3.1.2 | Reasoning driven by knowledge
Adolescents made their health choices based on consciously and
actively thinking about eating, rest, exercises, and social relationships.
They said that it was easy to get information that helped to guide this
process from parents, teachers, health brochures, television, and the
Internet. The adolescents also preferred information-based advice,
although information about negative health consequences did not
always prevent them from making bad decisions. They said that they
considered the potential consequences of their health choices for
their immediate health and their health in the near future. Adolescents
also considered the impact their decisions would have on the health
of others at the same time.
It is rather easy nowadays to know what is healthy and
what it is not. Or you can find that from the Internet.
You can find everything from there. (FG1)
There are bad choices, such as smoking or drinking
alcohol or things like that. (FG2)
This may not be the healthiest thing to eat, but you
can sometimes eat it, if you acknowledge that you can-
not eat it all the time. (FG1)
When I am making choices, I consider the future. (FG2)
3.1.3 | Automatic and mistake-based decisions
Adolescents said that their health choices could also be a result of
automatic and unconscious routines, such as how often they brushed
their teeth or visited the dentist, or what they ate for breakfast. The
adolescents saw these from a routine point of view. They felt that
since these kinds of decisions were an integral part of daily life, they
did not think about the potential consequences. Some said that
they had learned from their previous mistakes not to make the same
bad health choices again.
I don't really think. It comes from my subconscious
whether this is good for me or not. (FG2)
Usually I go with my current feelings. I might regret it,
but next time I know what to do better. (FG11)
3.1.4 | Reflecting on values and feelings
Adolescents associated their health choices with their values, feelings, and
the opportunities they had to make their own decisions (Table 2). They felt
that their health choices were good and successful if they were in accor-
dance with their own values and instructions. Good health choices also
met the expectations that others had of them, such as their parents and
peers. Adolescents' perceptions about the impact that religion had on their
health choices differed. Some adolescents talked about the influence that
religion had on their food choices, such as not eating pork. Others thought
that religion had more effect on the health choices of previous genera-
tions. Adolescents felt that their health choices were based on their own
feelings, such as their willingness to experiment or search for pleasure.
These included choices about nutrition, rest, exercise, and substance use.
The adolescents said that sometimes they resisted their cravings and
sometimes they gave into them. Regular health choices were also related
to meaningful goals, such as sporting success.
Friends expect something from you and are then disap-
pointed if you don't make choices in accordance with
their expectations. (FG9)
When you are young, you certainly want to try differ-
ent things. (FG4)
Because I want to succeed in sports, I do not use sub-
stances or anything. (FG4)
TABLE 2 Categories of adolescents' perceptions of their health
choices
Main category Subcategory
Adolescents' descriptions of their
health choices
Integrated decisions about
health and well-being
Reasoning driven by knowledge
Automatic and mistake-based
decisions
Reflecting on values and feelings
Aims and expected consequences
of health choices
Promoting comprehensive well-
being
Improving self-confidence and
individuality
Promoting other's health
Achieving health choices Helped and hindered by parents
Acceptance and pressure from
friends and peers
Enabled and limited by society
4 MOILANEN ET AL.
3.2 | Aims and expected consequences of health
choices
3.2.1 | Promoting comprehensive well-being
Adolescents used health choices to promote their comprehensive
well-being (Table 2), which comprised daily happiness, feelings of joy,
and belief in the future. They felt that they could influence their well-
being if they made good health choices on a regular basis. At the same
time, bad health choices risked their health and could decrease their
physical strength, cause weight gain, and decrease their life expec-
tancy. They could irritate friends and argue with them if they did not
get enough sleep. Adolescents felt that occasional bad and unhealthy
choices could actually have a positive influence on their health. They
described their choices as morally right when they only affected
themselves and not others.
You aim to make as many good choices as possible
daily, but sometimes you know that you have made a
slightly worse choice. But if you don't do it too often…
then it does not raise concern. (FG9)
Adolescents said that they could prevent diseases by making
healthy choices, such as eating healthy food, getting sufficient exer-
cise, and abstaining from harmful substances. They controlled their
alcohol use by making sure that they did not drink it every weekend
or multiple days in a row and they regulated the amount they drank.
However, all the participants were unanimous that abstaining from
substances would improve their health. They also acknowledged that
they might get sick, despite making healthy decisions. Adolescents felt
that seeking and using healthcare services were health choices and so
was following the advice given to them by healthcare professionals.
When it came to promoting their own health, the adolescents talked
about making choices about attending regular health and dental
checks. They linked treatment to seeking medical help when they
needed it. This help could be face-to-face support, such as discussions
with public health nurses, or practical solutions if they had toothache.
If you get dental caries, you need to go to the dentist,
so that it will not worsen. (FG11)
You need to be able to seek help, for example from the
school psychologist. (FG4)
3.2.2 | Improving self-confidence and individuality
Adolescents felt that if they made good health choices, they could
improve their confidence in their ability to do the right thing and con-
centrate on positive social relationships. They believed that if they made
good health choices that were generally acceptable to others, that their
parents would give them more responsibility to make more independent
decisions in the future. These included decisions about curfews.
However, some of the adolescents were critical about their own health
choices, as they had set high standards for themselves. They were disap-
pointed if they were unable to make daily decisions according to their
own values and standards. Adolescents made health choices that
expressed their individuality, by making decisions about their clothing,
hair, and makeup, as this had a positive effect on their mental health.
It is important that you are able to dress as you like
and no-one orders that. It improves your self-confi-
dence. (FG11)
3.2.3 | Promoting others' health
Adolescents said that one of aims of their own health choices was to
protect the health of others and protect their relationships with fri-
ends, family, and school personnel. This included decisions about
spending time with friends and making sure that they had good rela-
tionships. The health choices they made in relation to social health
also included taking care of those they cared about as best they could
at their age. They said they had to help others, such as to discussing
concerns or encouraging others to access services. However, they
were very aware of the need to protect their own well-being when
helping others. They also said that they gave greater thought to health
choices that could also have an impact on others. One example they
gave was not letting small children or younger siblings see them
smoking.
You can always look after your friends, and what they
are doing, so that they won't get involved in any-
thing. (FG10)
You don't dare smoke in front of preschoolers or walk
past them when smoking. (FG3)
3.3 | Achieving health choices
3.3.1 | Helped and hindered by parents
Adolescents said that their health choices were never completely
independent or free (Table 2). They had varying opportunities to make
independent decisions about some aspects of their health and influ-
ence the health choices their parents made for them. Some said that
they could make independent health choices and that their parents lis-
tened to their views, while others said that their parents made deci-
sions about their health without asking them. Family values and
customs were reflected in the adolescents' health choices. For exam-
ple, some parents promoted environmental values or had views on
how money should be used. This influenced adolescents' opportuni-
ties to choose what hobbies they could have or what food they could
eat at home. However, most of the adolescents felt that they had
enough opportunities to make their own health choices and that
MOILANEN ET AL. 5
having more opportunities could actually make them feel stressed and
tired.
The adolescents felt that their parents tried to influence their
health choices by offering support and by imposing rules and sanc-
tions. They said that the best way to influence their health choices
was mutual discussion, information sharing, and encouragement. They
felt that support and positive pressure by parents could encourage
them to try harder to make better health choices than they would
have done on their own. In addition, if their parents yelled and exerted
their authority this decreased adolescents' self-confidence and their
trust in their parents. Adolescents felt that their parents' rules on
health choices focused on doing housework, going outdoors daily, and
curfews. Sanctions for making choices that went against their parents'
rules could include restricting how much money they were given or
having their mobile phones confiscated for a period of time. Adoles-
cents felt that another sanction was to lose their parents' trust. How-
ever, some adolescents said that their parents' rules did not prevent
them from making their own decisions. In addition, the parents'
opportunities to influence adolescents' health choices were limited to
the time they spent with the adolescents at home. All the adolescents
said that they could make independent health choices when they
were not with their parents.
They cannot prevent what their kid does, where they
do it and when. (FG3)
I was alone at home one weekend and then I felt that I
could do anything. (FG5)
3.3.2 | Acceptance and pressure from friends
and peers
Adolescents' health choices were evaluated by their friends and peers,
and positive feedback from their friends supported their health
choices. Making similar health choices could strengthen a sense of
belonging to a peer group and ties with friends. For example, adoles-
cents tended to follow their peers with regard to drinking and
smoking or abstaining from substance use.
Adolescents felt that the pressure on them to make good or bad
health choices was more significant if they only had a few friends or
were scared about being alone. Some participants mentioned that
they felt no need to pressure their friends, even though it was very
easy to do. Good friends did not put each other under pressure and
they respected each other's health choices. The adolescents all agreed
that everyone was responsible for their health choices, even if those
decisions were made under pressure.
Friends are quite good at pressuring you to do some-
thing. (FG3)
Well, it depends on the person and how good you are
at resisting. I defend my opinions at length. (FG2)
3.3.3 | Enabled and limited by society
Adolescents felt that their living environment influenced their opportu-
nities to make health choices. For example, smaller villages did not have
the same opportunities for activities as larger cities, and adolescents
thought that they would exercise more if they lived in a bigger city.
The fact that you live in the middle of nowhere compli-
cates your choices. (FG13)
Schools influenced adolescents' health choices, as it had an effect
on their daily routines and lunch times. However, adolescents felt that
they were able to decide what they ate. In some case the school
served ingredients that they did not have at home, such as milk prod-
ucts or salad. Adolescents thought that school lunch reduced the need
to eat unhealthy snacks.
The adolescents felt that society tried to control their health
choices by using health and well-being legislation and regulations,
such as age limits. However, age limits could not prevent adolescents
from making health choices about substances if they wanted to use
them. Some adolescents questioned the need for age limits, because
they could not protect adolescents from harm and only inhibited
health choices. In addition, adolescents said that society provided very
little support for people who were not heterosexual.
4 | DISCUSSION
The adolescents in our study integrated their health choices into their
daily lives. They saw health choices as a way to promote their immediate
and long-term well-being and prevent diseases. Adolescents made some
deliberate health choices, but others were casual choices that were
based on values and feelings. They also used health choices to show
that they were individuals, but they were also considerate of others.
Adolescents acknowledged that they sometimes made unhealthy
decisions, despite having the necessary information to make healthy
choices. This suggests that traditional health education about the ben-
efits and risks of health choices may not be timely and influential in
Western cultures, especially when it is supplemented by restrictions
on adolescents' health choices. At the same time, adolescents need
greater knowledge about health choices, especially in non-Western
cultures (Kyilleh et al., 2018), and better health literacy. For example,
information gained from parents or the Internet could be harmful if
adolescents lacked the appropriate health literacy to assess
it. Developing adolescents' health literacy could be one way to sup-
port awareness of good health choices (Fleary et al., 2018). However,
the adolescents who took part in our study acknowledged that infor-
mation on its own may not be enough, because health literacy may be
influenced by impulsivity (Berkman, 2018) and sensation seeking in
adolescence (Fleary et al., 2018). In addition, health choices are
dynamic and adapt to current circumstances (Parnell et al., 2019).
It is noteworthy that adolescents connected their health choices
to short-term and long-term consequences on nutrition, exercising,
6 MOILANEN ET AL.
and rest, in line with previous studies (Corte et al., 2020). Health
choices were also connected to their well-being and to their develop-
ing identity, which is a crucial phase of adolescence (Tsang
et al., 2012). Considering health choices as part of their developing
identity could support their self-esteem and prevent health risks in
the future (Corte et al., 2020; Tsang et al., 2012).
Health choices depended on the context in which they were
made, including the society they lived in and the insights of their par-
ents. Adolescents' health choices were also related to parental
involvement and their parents' health literacy. One study showed that
adolescents received better guidance and support to make good
health choices if their parents had good education and incomes and
high levels of health literacy (Fleary et al., 2018). This suggests that
improving parents' health literacy could also have a positive impact on
adolescents' health choices. Further studies about the influence of
parental and adolescent health literacy on adolescents' health choices
could strengthen the knowledge that is needed to ensure that health
initiatives support adolescents' daily decision-making.
Adolescents' daily decisions about their health were related to
seeking acceptance from peers and friends and it could be difficult for
them to make decisions that went against their opinions. Health pro-
motion activities aimed at adolescents, such as in schools and youth
centers, could consider this. Interventions that provide practical and
clear guidance about how to make choices, which do not agree with
peers' choices, could help adolescents to make their own value-based
decisions (Berkman, 2018). The guidance could include discussions
with adolescents about potentially challenging situations and how to
handle them in practice. However, the most effective approach
to identifying the best way to support adolescents' health choices is
to carry out research that asks adolescents how they can make their
voices heard and how their needs can be met.
Adolescents acknowledged that achieving their health choices
was also linked to the opportunities provided by society. One way to
influence how adolescents achieve their own health choices could be
nudging, which refers to positively steering them towards good health
choices (Haviland et al., 2020) and removing barriers to decision-
making. Nudging can include providing healthy food in school
canteens and restaurants (Broers et al., 2017) and providing quality
information about healthy choices (Haviland et al., 2020). However,
not all adolescents react to nudging in the same way (Fowler &
Roberts, 2019), as they have different opportunities to achieve their
own choices. Empirical evidence on the effectiveness of nudging has
been contradictory (Broers et al., 2017; dos Santos et al., 2020). Fur-
ther research is needed to find out how well this technique works
when it comes to supporting the health choices of adolescents from
different backgrounds and life situations.
4.1 | Limitations
This study deepens our understanding of adolescents' health choices,
but it had some limitations. The participants could be regarded as
privileged, compared to other countries, because of the quality of
Finnish schools and equal access to high-quality healthcare. Although
the definition of adolescents ranges from 10 to 19 years, the target
group for this study was students aged 15 to 16 years. This produced
a focused examination of the topic. Another limitation of this study
was that specific background information was not collected from the
participants about their parents. This was because our focus was on
the adolescents' perceptions of their health choices, not on their
actual choices and the potential associations that these had to various
factors such as family background. It is clear that there is a need to
develop a wider understanding of adolescents' perceptions at differ-
ent ages and in different target groups.
A strength of the study was that the focus groups achieved good
rapport, with open conversations and wide-ranging descriptions of
the adolescents' health choices by using a semi-structured approach
(Flanagan et al., 2015; Jayasekara, 2012; Mack et al., 2009). However,
the adolescents may have been influenced by the presence of the
researcher and other students (Jayasekara, 2012). For example, they
freely discussed nutrition and exercise, but hardly mentioned sexual
health and substance use, possibly because they felt uncomfortable
doing so. This could be also due to the fact that the topics that were
discussed were initiated by the participants and not guided by the
researcher. The data were collected until the data were saturated
(Guest et al., 2006). The researchers' understanding of the topic
may have influenced the additional questions that emerged during
the focus group, causing moderator bias. Presenting the results of
the analysis to the participants could have strengthened their trust-
worthiness, but since the participation was anonymous we had no
way to do this. The data collation, analysis, review, and interpreta-
tion are thus solely the result of collaboration among the research
group.
4.2 | Relevance to practice
The way that adolescents perceive their health choices is highly rele-
vant for health promotion initiatives. The participants in our study
considered the potential consequences of their health choices in rela-
tion to their own health and the health of others. They also recog-
nized the relevance of wider opportunities and different contexts
when making choices. We feel that adolescents' perceptions should
be examined by studies that focus on wider and diverse target groups,
in order to gain a deeper understanding of their decision-making. One
option could be strengthening their health literacy and nudging them
to making more decisions that improve their health. However, the
best way to support adolescents in making health choices is to ask
them what help they actually need.
5 | CONCLUSION
This study produced new knowledge about adolescents' perceptions
of their health choices and associated issues. The adolescents' health
choices mainly focused on daily living and aimed to improve their
MOILANEN ET AL. 7
overall well-being and express their individuality. The adolescents
who took part in our study recognized that their health choices were
associated with both individual and social contexts. Improving adoles-
cents' health literacy, and nudging them to make good health choices,
should be emphasized when planning both healthcare and practical
health promotion activities.
AUTHORS' CONRIBUTIONS
Study design: Tanja Moilanen and Mari Kangasniemi. Data collection:
Tanja Moilanen. Data analysis: Tanja Moilanen, Nina Rahkonen, and
Mari Kangasniemi. Manuscript writing: Tanja Moilanen, Nina
Rahkonen, and Mari Kangasniemi.
CONFLICT OF INTEREST
The authors have no conflicts of interest to declare.
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available on
request from the corresponding author. The data are not publicly
available due to privacy or ethical restrictions.
ORCID
Tanja Moilanen https://orcid.org/0000-0003-1657-1791
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How to cite this article:Moilanen, T., Rahkonen, N., &
Kangasniemi, M. (2021). Finnish adolescents' perceptions of
their health choices: A qualitative study. Nursing & Health
Sciences, 1–9. https://doi.org/10.1111/nhs.12866
MOILANEN ET AL. 9