Review

FANTASTIC lifestyle questionnaire from 1983 until 2022: A review

Introduction

Community and individual healthy lifestyles and behaviors has always been a concern, a problem that should be invested in to improve the quality of people’s lives and avoid diseases and health management problems. Lifestyles and health behaviors are crucial factors that determine the health of a society.¹ There is large evidence that some behaviors and lifestyles have the potential of determining direct and/or indirect impact on health, on the physical, mental and social wellbeing of each person. For example, a healthy diet, regular physical activity, moderate alcohol consumption, and drug abstinence are considered healthy lifestyles that can predispose an individual to better health conditions. On the other hand, drug consumption (illegal drugs or tobacco and alcohol), unsuitable diet, sedentary lifestyle, and early and/or promiscuous sexual activity, are behaviors that can determine risks for an individual’s health and life.² These unhealthy lifestyles are seen as the main risk factors for chronic diseases and premature deaths and determine an important part of the deaths and illnesses that occur in the European region.²

Thus, diagnosing lifestyles makes perfect sense, in order to be able to intervene afterward. Designing promotion and intervention plans and increasing the health literacy (HL) of the entire population. One of the most important strategies to improve a healthy lifestyle is to increase knowledge and promote HL among people. The World Health Organization (WHO) refers to HL as a key element of health and recommends that countries create a multi-stakeholder “Council on Health Literacy”.³

Therefore, in 1983 Wilson and his team developed the FANTASTIC Lifestyle questionnaire (FLQ) to evaluate the population lifestyles.⁴ This lifestyles evaluation instrument was developed not only to diagnose population lifestyles but for use in a community health education program. Thus, the aim of this study is to provide an overview of the scientific evidence for using this specific instrument “FANTASTIC questionnaire” to assess lifestyles.

FANTASTIC Lifestyle questionnaire

In 1983, Wilson and collaborators had a marked interest in health promotion and developed FANTASTIC Lifestyle Assessment.^4,5

The FANTASTIC questionnaire incorporates physical, emotional, and social lifestyle factors.⁴ The origin of the word “FANTASTIC”, is the acronym of the names of the 9 dimensions in which 28 items are distributed: 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); C = Control of health (3 items). More recently, in some countries the FANTASTIC update to FANTASTICO, was increase one more dimension, O = Other conducts (2 items).^6,7 Each item has three Likert-type response options.^5,6

The questionnaire was first used at McMaster for clinical applications and as a survey instrument in planning health promotion services.^5,8 FANTASTIC lifestyle assessment was a good instrument to help the general practitioner to assess and to promote healthy lifestyles in their patients. Nowadays, it is also valuable for exploring lifestyle and health. The FANTASTIC lifestyle assessment is a fairly reliable tool, and it is a simple method for people to quickly assess lifestyle behaviors.⁵ This instrument has been used in different countries, due to the speed and ease of filling.

Materials and Methods

We conducted a study of the reflective systematic literature review. We found several scientific papers published in international journals, using a search of the databases in digital format, Medline, PubMed, Science Direct and SciELO. The descriptors used in the research were: [FANTASTIC Lifestyle questionnaire” OR “FANTASTICO questionnaire” OR “FANTASTIC questionnaire” OR “FANTASTIC survey” OR “FANTASTIC checklist”]. From the 105 articles found, the duplicates and those that did not meet the inclusion criteria were removed and we obtained 41 articles. We found others publication, but not indexed in these databases.

Inclusion criteria

All studies that used the FLQ, presented/analyzed quantitative/qualitative data, and psychometric studies of psychometric validation of scale/instrument were eligible to include in the study. Also, it included articles written in English, Brazilian, Spanish and Portuguese languages.

Exclusion criteria

Studies with the following criteria were excluded: did not used the FLQ and did not present/analyze quantitative/qualitative data.

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria were applied (). The information collected was compiled and analyzed in relation to the year of publication, authors, sample, country, type of study/methodology, results and aim. The cataloging and identification of repeated references were made through the computer program EndNote bibliographic referencing.

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Figure 1. Flowchart - applying the inclusion and exclusion criteria in research

Results

For a better understanding of the systematic literature review, the studies analyzed were compiled in a summary table (Table 1). In this table, they were several items: year of publication/authors, sample, country, methodology, instruments, domains of FANTASTIC, results and aims.

We analyzed 41 complete articles that fulfilled the inclusion criteria. The studies involved a total of 27 012 participants of different age groups (adolescents, university students, adults, and elderly), and some studies were carried out with families, 495 families were evaluated. The studies analyzed were conducted in different countries such as, Brazil, Colombia, Peru, Spain, Croatia, Portugal, Chile, Poland, China, Mexico, Australia, Iran, and Canada. Several evaluation instruments were used in the studies, but this review aims to analyze a specific instrument – FLQ.

In this review, the most used dimensions of the instrument were also analyzed, highlighting that most studies use the instrument to assess all dimensions. However, some studies referred to in the literature only use the FLQ to assess specific dimensions such as nutrition,^15,25,37 sleep,³⁶ stress,⁴¹ tobacco, alcohol and drugs.^32,44

A cross-sectional study methodology was clearly evidenced; only two studies referred to a psychometric study of a validation scale.^7,51

The literature review showed the continued use of the FANTASTICO instrument until today. This instrument, developed in 1983,⁴ is still used nowadays^10,14 over different areas of investigation, target groups, objectives and countries. It is a simple, user-friendly instrument that assesses several dimensions. It has proven to be an up-to-date tool, because recently, during this pandemic era, it was used in some studies to diagnose or evaluate the lifestyles of different populations.^11-14,19 This questionnaire because of its ease of interpretation and quick completion has been used in different populations such as adolescents, youth, college students, adults with different levels of literacy, and the elderly, as shown in Table 1.

Discussion

The adoption of healthy lifestyles is key to improving quality of life and preventing disease, and the WHO has been calling attention to this topic over time.⁵² The WHO has stated that a significant percentage of non-communicable diseases could be prevented by people modifying their lifestyles and the associated risk factors, mainly by following a healthy diet and controlling their weight, physical activity, and limiting their alcohol and tobacco consumption.^40,53

These results are in line with other investigations, which emphasized that lifestyle is influenced by the habits, attitudes, conduct, traditions, activities, and decisions of a person, or a group of people, regarding the various circumstances in which human beings develop in society or during their daily work/career and which are capable of being modified.^14,40,54 The domains making up lifestyles would include behavior and preferences related to the type of diet/nutrition, physical activity, drinking alcohol, smoking and/or taking other drugs, responsibility for health, interpersonal relationships, sexual practice, work-related activities/career and consumption patterns.^40,48,54,55

Several lifestyle indicators determine people’s health, ranging from social to economic aspects, including environmental and cultural factors, personal attitudes or individual behavior, genetic and physiological characteristics and opportunities.^22,40,42,44 So, the WHO advocates the incorporation of multilevel such environmental, social, economic, governmental, legal, and interpersonal influences on individuals’ health and behavior.^22,56

Although some evidence has shown that adopting and maintaining a healthy lifestyle can improve health, most people have difficulty in adopting a healthy lifestyle.^42,57 This way, it is necessary to develop interventions especially aimed at the creation or the enhancement of healthy behaviors and toward the reduction of those conducts that are health risks.⁵⁷ The promotion of healthy lifestyles improves people’s quality of life, physical and mental health, well-being and self-actualization.¹³

In the literature, these results emphasize not only the importance of diagnosing and achieving healthy lifestyles but also underscore the need to implement interventions to promote HL, aimed at increasing self-acceptance and the adoption of healthy behaviors. In this literature review, we have made a retrospective analysis of the use of the FLQ. There is evidence that a questionnaire is an adequate tool for diagnosis and assessing the lifestyles of several populations and should be used in primary care and epidemiological studies to improve people’s quality of life and health.⁷ Nevertheless, much still needs to be done, particularly in increasing literacy about the importance of adopting healthy lifestyles.

Limitations

The methodology selected for inclusion and exclusion of these studies always conditions the results obtained, leaving out many valid data studies. We found some limitations in the articles analyzed: the cross-sectional design of the study; the target population should be extended to different age groups; a not representative sample of the population; the difficulty of comparing the results of other investigations. On the other hand, this instrument has limitations, such as not providing accurate assessment since they cover various aspects constituting lifestyle and individuals may not be accurate in their responses, thereby masking reports of inadequate/unsuitable behavior.

Conclusion

Lifestyle has been recognized as an important (perhaps the most) determinant of health status (overall in the future of the community) and has become a focus of increasing research interest worldwide.

This systematic review intended to draw attention to the importance of healthy lifestyles and their diagnosis by use of FLQ, a simple and comprehensiveness, of easy access, and with a quantitative result score for individual ranking, associated with specific counselling. We concluded that this questionnaire is still in use today, in several countries, and among a variety of audiences. It is also possible to verify the relevance of its use because knowing the lifestyles is fundamental to designing intervention strategies for a healthy community. Diagnosis and intervention strategies should be adopted by governments or health entities for a healthy society. Despite the scarce funding for intervention programs for the promotion of healthy lifestyles, it is essential to be alert to this issue and promote HL on this topic.

In this sense, the use of FLQ could become a pre-diagnosing instrument and a preventative tool to evaluate specific risk behaviors in several populations. Enhancing the diagnosis for subsequent development of intervention strategies in the community.

Competing Interests

The authors declare no conflict of interest.

Ethical Approval

Not applicable.

Funding

The present publication was supported by CEDH, through the CEECINST/00137/2018 and Project UIDB/04872/2020 of the Fundação para a Ciência e a Tecnologia, Portugal. Also, the CIMA was supported by the Fundação para a Ciência e a Tecnologia, project UID/04674/2020.

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