The Paradox of Medical Education: Lifestyle and the Sense of Self-Efficacy and Locus of Health Control Among Medical Students in the Eastern Borderlands of the European Union

Abstract

This cross-sectional study evaluated health behaviors, diet, physical activity, and psychological determinants (self-efficacy, life satisfaction, health locus of control) among medical and health sciences students across seven EU borderland countries to investigate the “knowledge–behavior paradox.” A cross-sectional multicenter study was conducted among N  = 2,965 medical and health sciences students from seven countries. Data were collected via online questionnaires evaluating health behaviors, physical activity, and psychological determinants (e.g., Health Behavior Inventory [HBI], Generalized Self-Efficacy Scale [GSES]). The analytical framework involved non-parametric group comparisons and Spearman’s rank correlation analyses. Global health behavior scores (HBI) did not differ macro-regionally (median 79.0 in EU vs. 80.0 in non-EU; p  > 0.05), nor did physical activity or sedentary time (median 300 min/day). However, non-EU cohorts scored higher in positive health practices (PHP, p  < 0.001) and preventive behaviors (PB, p  < 0.05). The lowest HBI scores occurred in Poland and Turkey (median 77.0), coinciding with lower life satisfaction (SWLS). EU students showed greater dietary harmony (higher DHI, p  < 0.001; lower nHDI, p  < 0.001) and stronger internal health locus of control (IHLC, p  < 0.01). Self-efficacy and life satisfaction were positively associated with health-promoting behaviors. Medical students exhibit a pronounced knowledge–behavior paradox with widespread sleep and recovery deficits. While EU status was not associated with global health behavior intensity, it was associated with better dietary harmony, higher life satisfaction, and stronger internal health agency. Psychological resources were positively associated with healthier lifestyle habits. Medical faculties must modernize curricula to mitigate fatigue, foster internal health locus of control, and implement institutional psychological support, particularly in Poland and Turkey.