The relation of exercise habits to health beliefs and knowledge about osteoporosis

Better Bones Buddies: An Osteoporosis Prevention Program

Although osteoporosis typically surfaces in later life, peak bone mass attained before age 20 is a key factor in its prevention. However, most American children’s diets lack sufficient calcium during the critical growth periods of preadolescence and adolescence to achieve peak bone mass. Better Bones (BB) Buddies is an educational program targeting children ages 9–15 years in an effort to improve their knowledge of bone health and to increase their intake of calcium-rich foods, thereby reducing the risk for osteoporosis later in life. In the 1998–1999 school year, Better Bones Buddies was given to more than 2,200 school children in southeastern South Dakota and southwestern Minnesota. Posttest results ( N = 900) indicate participants improved in their knowledge of osteoporosis, and half reported modifications in their dietary habits to increase calcium consumption. Implications of the Better Bones Buddies program are discussed, with recommendations for future use of this program to increase children’s knowledge about bone growth and osteoporosis.

Evaluation of the osteoporosis health belief scale in korean women

Background

The Osteoporosis Health Belief Scale (OHBS) is a 42-item questionnaire designed to assess susceptibility, seriousness, calcium benefits, calcium barriers, exercise benefits, exercise barriers, and health motivation related to osteoporosis. We aimed to evaluate its psychometric properties to enable the provision of educational tips regarding osteoporosis.

Methods

All women who had visited the department of obstetrics and gynecology (OBGYN) and whose bone mineral density was measured from January 2010 to December 2011 were enrolled by interview using the OHBS. We also evaluated the women's general clinical characteristics.

Results

One hundred seventy-seven women were enrolled in the present study. In the present study, the barriers to calcium intake subscale had the lowest mean score (15.03±3.02), and the Benefit of Exercise subscale had the highest (23.02±3.03). The scores for participants in their 20s were significantly higher than scores for those in their 70s on the Benefits of Exercise subscale and Barriers to Exercise subscale (P=0.014 and P=0.022, respectively).

Conclusions

Education for health motivation to prevent osteoporosis is important for young women. Additional systematic education programs are needed for the general population.

Osteoporosis knowledge, health beliefs, and preventive behavior: a comparison between younger and older women living in a rural area

Osteoporosis is widely recognized as one of the major health problems in postmenopausal and older women. Raising awareness about osteoporosis is an important step in examining how much people know about the disease and their attitudes toward preventive behaviors. The aims of the present study were to examine the differences in osteoporosis knowledge, health beliefs, and preventive behaviors between younger and older Thai women, and to examine the relationship between their osteoporosis knowledge, health beliefs, and preventative behaviors. An understanding of these variables measured in younger and older women is essential for the development and delivery of effective age-tailored intervention programs.

Gender differences in osteoporosis health beliefs and knowledge and their relation to vigorous physical activity in university students

OBJECTIVE

The purpose of this cross-sectional investigation was to examine (1) gender differences in osteoporosis-related knowledge and beliefs and (2) if these beliefs could predict vigorous physical activity behavior in university students.

PARTICIPANTS

Male (n = 176) and female (n = 351) university students participated in the study.

METHODS

Participants completed self-report measures of osteoporosis knowledge and health beliefs and vigorous physical activity.

RESULTS

Regardless of gender, osteoporosis knowledge was relatively poor. Women reported higher knowledge, perceived susceptibility, perceived severity, and calcium barriers, and lower exercise self-efficacy than men. Regression analyses showed that for women, perceived susceptibility, health motivation, and exercise self-efficacy predicted vigorous physical activity, whereas for men, exercise barriers was the only predictor.

CONCLUSIONS

Gender differences in osteoporosis health beliefs appear to be greater in older adults than college-aged students. Interventions designed to increase vigorous physical activity may want to target different beliefs for men and women.

The relationship of calcium intake and exercise to osteoporosis health beliefs in postmenopausal women

BACKGROUND

Little is known about postmenopausal women's health beliefs and preventative behaviors regarding osteoporosis. Determining their beliefs and behaviors regarding osteoporosis can be helpful in developing effective interventions for osteoporosis prevention.

OBJECTIVES

To use the Health Belief Model to assess the associations between postmenopausal women's osteoporosis health beliefs and osteoporosis preventative behaviors.

METHODS

Using a self-administered survey, data were obtained from a convenience sample of 187 postmenopausal (> or =65 years of age) women, with no history of osteoporosis at a community pharmacy and senior nutrition sites in central Texas. The independent variables included health beliefs (susceptibility to osteoporosis, severity of osteoporosis, benefits and barriers of calcium intake, benefits and barriers of exercise, health motivation, self-efficacy of calcium intake and exercise) and modifying factors (demographics and risk factors). Calcium intake and exercise were the dependent variables. Multiple regression was used to assess the relationships between health beliefs and modifying factors with calcium intake and exercise.

RESULTS

The respondents' mean age was 75.4+/-6.5 years, and Mexican Americans comprised approximately 40% (39.6%) of the sample. Their reported calcium intake (mean+/-SD) was 1604.7+/-907mg/d and they engaged in 5 hours ([mean+/-SD]: 5.1+/-5.3) of weight-bearing exercise per week. Self-efficacy of calcium intake and self-efficacy of exercise had significant (P<.05) positive relationships with calcium intake behavior. In addition, self-efficacy of exercise was significantly (P<.05) and positively related to exercise behavior.

CONCLUSIONS

Self-efficacy was significantly associated with postmenopausal women's performance of osteoporosis preventative behaviors. Improving postmenopausal women's confidence in engaging in appropriate calcium intake and weight-bearing exercise behaviors may be beneficial to osteoporosis prevention.

Osteoporosis prevention education programme for women

AIM

This paper reports an evaluation of a nurse-initiated education programme on four specific osteoporosis prevention behaviours which led to their adoption or to positive attitude changes.

BACKGROUND

In the past, osteoporosis was a serious health concern that most commonly affected women in Northern Europe and the United States of America, but was less commonly seen in Asian women. However, in Hong Kong, osteoporosis is currently among the top five conditions causing disability and prolonged hospital stay for older people. From an economic perspective, the most cost-effective approach is to focus on primary prevention via education, and nurses often have the responsibility of providing such educational programmes.

METHOD

A randomized controlled study was conducted from July 2004 to March 2005 with 76 women (38 cases and 38 controls) recruited in two private beauty clinics in Hong Kong. Pre-, post- and follow-up education data were compared regarding attitudes and adoption frequency before and after the education programme.

RESULTS

The results showed statistically significant increases for each behaviour: consumption of soy foods (P < 0.001), milk (P < 0.001), more exercise (P = 0.01) and vitamin D/exposure to sunlight (P < 0.001) for the case group compared with the control group. Most participants either disagreed (n = 15, 39.0%) or strongly disagreed (n = 23, 61.0%) that there was not enough information provided in the education programme to motivate them to change. They rated the nurse's performance as either satisfactory or very satisfactory on presentation, ability to answer their questions and ability to describe each behaviour clearly.

CONCLUSION

Although positive results with a nurse-initiated education programme were demonstrated, future research examining the effects of education and occupation on these four adoption behaviours should focus on more diverse populations with respect to age, income or ethnicity. The findings suggest the value of creative approaches in future health education for the prevention of osteoporosis, and the need for a critical appraisal of current strategies and a re-evaluation of services and funding.

Reasons and risk: factors underlying women's perceptions of susceptibility to osteoporosis

OBJECTIVES

To assess women's perceptions of risk for osteoporosis and to identify factors that shape those perceptions.

METHODS

A community sample of 358 women (aged 40-86) rated their perceived risk of osteoporosis and provided detailed information about factors underlying their risk perceptions. Their open-ended responses were content analysed.

RESULTS

On average, participants believed they were less likely to develop osteoporosis than other women their age. In all, 63% perceived their risk as lower than other women their age; only 16% as higher. In explaining their risk, women mentioned more risk-decreasing factors than risk-increasing factors. Women who rated their risk as low attributed their risk primarily to their own preventive behaviors (e.g. taking calcium, exercising), whereas women who rated their risk as high attributed their risk primarily to their family history. Risk-increasing and risk-decreasing personal actions, hereditary factors, and physiological factors accounted for 53% of the variance in perceived risk for osteoporosis. Only one-half and one-third of all women, however, mentioned calcium consumption and exercise, respectively, as protective factors employed to reduce osteoporosis risk. Women also held misconceptions about osteoporosis risk and protective factors.

CONCLUSIONS

The current findings yield a detailed portrait of women's risk perceptions for osteoporosis. Increasing awareness of osteoporosis should be a priority for future osteoporosis prevention campaigns. Interventions should address misconceptions women may hold about their risk for the disease and promote specific behavioral strategies for osteoporosis prevention.

Join the Movement to Have Healthy Bone Project (JHBP): changing behavior among older women in Thailand

Osteoporosis is a common silent disease in older adults presenting with fragility fractures. Lifestyle modifications may be an imperative strategy to minimize the increase of either osteoporosis or osteoporosis-related fractures. Targeted education is one way to promote osteoporosis preventive behaviors. Our aim of this study was to test the feasibility of the Join the Movement to Have Healthy Bone Project (JHBP) that was developed on osteoporosis preventive behaviors for Thai older women. By succeeding in making appropriate lifestyle changes, these women ultimately may reduce the risk of osteoporosis or fractures in later life.

The effectiveness of an osteoporosis prevention education programme for women in Hong Kong: a randomized controlled trial

AIMS

The purpose of this study was to evaluate whether a nurse-initiated education programme on four specific osteoporosis-prevention related behaviours leads to their adoption or positive attitude changes compared with women who did not participate in this programme.

RESEARCH METHOD

The design was a randomized controlled design and the setting was a local private beauty clinic.

OUTCOME MEASURES

Pre-, post- and follow-up education data compared attitudes and consumption frequency before and after the education programme.

RESULTS

The results showed significant increases in the reported follow-up for each behaviour: consumption of soya foods (mean = 4.3, SD = 0.5), milk (mean = 4.2, SD = 0.8), more exercise (mean = 4.3, SD = 0.5) and vitamin D/exposure to sunlight (mean = 4.2, SD = 0.9) for subjects in the case group compared with control group subjects (soya foods: mean = 3.3, SD = 0.9, P < 0.001; milk: mean = 3.0, SD = 0.9, P < 0.001; more exercise: mean = 3.4, SD = 1.0, P = 0.003; vitamin D/sunlight: mean = 2.7, SD = 0.9, P < 0.00). Most of the participants either disagreed (n = 11, 55.0%) or strongly disagreed (n = 9, 45.0%) that there was not enough information provided in the education programme to motivate them to change. On the satisfaction score, they rated the nurse's performance as either satisfactory (n = 11, 55.0%) or very satisfactory (n = 9, 45.0%) on presentation and ability to answer their questions and either satisfactory (n = 12, 60.0%) or very satisfactory (n = 8, 40.0%) on ability to describe each behaviour clearly.

CONCLUSION

A targeted education programme conducted with Hong Kong women resulted in significantly increased consumption of calcium including soya-based foods, milk and vitamin D. According to the reported attitudinal and behavioural intentions, participants' positive feedback suggests that women who participated in this educational programme were motivated to make changes and benefited from the support of this nurse-initiated education programme.

RELEVANCE TO CLINICAL PRACTICE

Osteoporosis was a serious health concern that most commonly affected women. As indicated by the results of this study, this educational programme can act as simple but effective nursing intervention to promote women's attitudinal and behavioural intentions towards osteoporosis-prevention.

Osteoporosis prevention education: Behavior theories and calcium intake

Osteoporosis is a worldwide health concern. Preventing osteoporosis, and subsequent fractures, has become a goal of many health care practitioners, especially dietetics professionals. However, few prevention models have proven effective. The goal of this project was to determine whether an educational, theory-based osteoporosis prevention program would significantly impact calcium intake. This project used a convenience sample of 42 women who participated in an 8-week educational intervention, similarly to a community class. The program included hands-on activities to increase self-efficacy and was based on the Health Belief Model and Theory of Reasoned Action (TRA). The main outcome measures were calcium intake and constructs from the Health Belief Model and TRA. Significant changes in the Health Belief Model and TRA constructs at postintervention included increased perceived susceptibility to osteoporosis ( P <.001), perceived benefits to increasing calcium intake ( P <.001), and increased self-efficacy related to calcium intake ( P </=.003). Statistically significant regression equations were found for all preintervention intentions related to calcium. Postintervention calcium intake significantly increased to 821+/-372 mg/day ( P <.0001). Results of this project can be used as guidelines for dietetics professionals to develop osteoporosis prevention programs for their clientele.

Osteoporosis health beliefs and practices among Korean immigrants in Nova Scotia

The purpose of this research was to investigate osteoporosis knowledge, as well as health beliefs and practices among Korean immigrants in Nova Scotia. Twenty-six participants (18 women and eight men) completed the questionnaire. The mean age of participants was 48, and their average length of stay in Canada was 14 years. The mean osteoporosis knowledge score was 50% for both men and women and perceived susceptibility to the disease was low, especially in men. Perceived seriousness and health motivation was high relative to perceived susceptibility. Only 62% indicated both that their diet met their nutritional and cultural needs, and changes in dietary and exercise habits since arrival in Canada were reported by 73 and 64%, respectively. This study helped identify existing osteoporosis awareness weaknesses in this population: a). Perceived susceptibility, especially for men; and b). knowledge related to prevention and treatment options, including diet and exercise.

After the Fall: Women's Views of Fractures in Relation to Bone Health at Midlife

Past research has established the link between low energy fractures and the risk for future fractures. These fractures are potential markers for investigation of bone health, and may be precursors for osteoporosis. In spite of its significant public health burden, including burden of illness and economic costs, many individuals are not aware of the risk factors for and consequences of osteoporosis. This is a study of women aged 40 and older who experienced low energy fractures (e.g., from non-trauma sources and falls from no higher than standing height). We gathered data, using focus group interviews, about their experiences and understanding of the fractures in relation to bone health. Women often attributed the fractures to particular situations and external events (e.g., slipping on ice, tripping on uneven ground), and viewed the fractures as accidents. Women often felt that others are at risk for poor bone health, but believed that they themselves are different from those really at risk. Although the fractures are potential triggers for preventive efforts, few women connected their fracture to future risk. What is perceived by women (and others) as random and an accident is often a predictable event if underlying risk factors are identified. Only when there is more awareness of poor bone health as a disease process and fractures as markers for bone fragility will women, men and health care providers take action to prevent future fractures and established bone disease.

The design of a valid and reliable questionnaire to measure osteoporosis knowledge in women: the Osteoporosis Knowledge Assessment Tool (OKAT)

BACKGROUND

Osteoporosis knowledge is an important contributor to improving exercise and calcium intake behaviour. However, there are few validated instruments for measuring osteoporosis knowledge levels. The aim of this study was to design a valid and reliable instrument to measure osteoporosis knowledge in Australian women.

METHODS

A 20 item instrument with true, false and don't know responses was drafted, based on the Osteoporosis Australia Osteoporosis Prevention and Self-management course and the information leaflet "Understanding Osteoporosis". The scoring range was 1 to 20. This was administered to a 467 randomly-selected, healthy women aged 25-44 years. Questionnaire performance was assessed by Flesch reading ease, index of difficulty, Ferguson's sigma, inter-item and item-total correlations, Cronbach's alpha and principal component factor analysis.

RESULTS

Flesch reading ease was higher than desirable at 45, but this was due to the use of the word osteoporosis in many items. Of the individual items 17 had an index of difficulty less than 0.75. The questionnaire had a Ferguson's sigma of 0.96, a Cronbach's alpha of 0.70 and factor analysis consistent with only one factor (osteoporosis knowledge) being measured. Levels of osteoporosis knowledge were low with a mean score of 8.8 out of 20 which suggests the OKAT may be sensitive to change.

CONCLUSIONS

The OKAT for measuring osteoporosis knowledge has good psychometric properties in Australian 25-44 year old females. While it should be applicable to other Caucasian populations, this will require confirmation by further research.

Osteoporosis knowledge, calcium intake, and weight-bearing physical activity in three age groups of women

The purpose of this study was to determine the extent and integration of osteoporosis knowledge in three age groups of women and compare knowledge to calcium intake and weight-bearing physical activity (WBPA). In this cross-sectional study, knowledge, calcium intake and WBPA were assessed using probe interviews, a food frequency and an activity questionnaire, respectively. Seventy-five white women were separated into three groups: young (25-35 years), middle aged (36-46 years) and postmenopausal (50+ years). Concept maps were used to assess knowledge (concepts, integration and misconceptions). Calcium intakes from diet, supplements and fortified orange juice were estimated as were minutes of daily WBPA. Analysis of covariance was used to compare knowledge, calcium intake and WBPA by age group. Covariates included education, family history, physical problems making exercise difficult, and lactose intolerance. Chi square analysis was used to determine differences in these covariates across age groups. Correlations and regression analysis were used to determine relationships between knowledge and behaviors. Knowledge scores averaged 32-44 points (183 possible). Average calcium intake in all groups exceeded the Dietary Reference Intake's recommended Adequate Intake but 20-24% consumed less than 60% of the AI. Housework, walking at work, and standing at home and work accounted for 90% of WBPA. Knowledge about osteoporosis was limited and not associated with age, WBPA or calcium intake. Calcium intake and WBPA were not associated with age. Practitioners need to provide explicit information on osteoporosis and risk reducing behaviors to women of all ages.

"I never realised how little I knew!": a pilot study of osteoporosis knowledge, beliefs, and behaviours

The aim of this study is to examine knowledge of osteoporosis (OP), health behaviours, and health beliefs among a sample of women in the West Midlands of the United Kingdom (N = 163; mean age = 40 years). The study was cross sectional, and data were collected by self-administered questionnaires. Although women were fairly knowledgeable about some aspects of OP, gaps in knowledge were identified in relation to hereditary links, bone density scans, hormone replacement therapy (HRT), vitamin D, and specific exercise. Increased age was associated with increased perception of risk (p = 0.003). Although receipt of OP information was predictive of knowledge (p < .0005), the majority (65%) appeared to be largely unaware of the potential threat. There is an overwhelming need for wider dissemination of information about OP, especially targeting younger women, to halt the progression of this silent disease.

Testing the effectiveness of an osteoporosis educational program for nursing students in Thailand

OBJECTIVE

Osteoporosis, a health problem that is on the rise, has received considerable attention among the health care community and the public. The majority of primary prevention programs for osteoporosis have been focused on women in mid-life. A concern is that young women may not be aware of osteoporosis risk factors and therefore may not be engaging in preventive behaviors. The purpose of this study was to test the effectiveness of an osteoporosis educational program for young women.

METHODS

A sample of 100 female undergraduate students who were enrolled in the first year of a nursing program in Thailand were randomly assigned to a control group or an experimental group. Participants in the experimental group participated in a 3-hour osteoporosis educational program (OEP). At entry to and exit from the study, all participants completed the Osteoporosis Knowledge Test, the Osteoporosis Health Belief Scale, and the Osteoporosis Self-Efficacy Scale.

RESULTS

The experimental group had higher change scores for knowledge, health belief, and self-efficacy than the control group. The OEP increased knowledge of osteoporosis in these young women.

CONCLUSION

These findings indicate the need for further health education concerning the importance of dietary calcium and exercise on osteoporosis prevention in young women.

'I'll worry about that when it comes along': osteoporosis, a meaningful issue for women at mid-life?

This paper reports findings from a qualitative study of the health concerns and perceptions of health risks and osteoporosis of women in the age group 40-55 years. Osteoporosis has been increasingly put forward in the popular and scientific press as an important issue for women in mid-life. A variety of preventive measures, including use of hormone replacement therapy (HRT), are suggested. The medicalization of women's experiences and associated use of HRT at this point in the life course is the subject of considerable debate in the medical, social scientific and feminist literatures, although, to date, this issue has received less attention in health promotion. Much of this debate is informed by quantitative and survey data, and there is a lack of in-depth qualitative information on women's own views. This study casts doubt on the salience of osteoporosis for women at mid-life. Our qualitative research suggests that, unless they had experiential knowledge which had rendered osteoporosis particularly salient, most women in this study evidenced a surprising degree of disinterest in this health issue. To make sense of this disinterest we examined women's wider accounts of their lives, health and the lifecourse, and the menopause. These findings would appear to present a challenge for those in health promotion who might wish to emphasize early preventive strategies for osteoporosis.