Structural Model for Osteoporosis Preventive Behaviors in Postmenopausal Women: Focused on their Own BMD Awareness

Young Joo Park; Sook Ja Lee; Nah Mee Shin; Hyun Cheol Kang; Sun Haeng Kim; Tak Kim; Song I Jeon; In hae Cho

doi:10.7469/KJAN.2013.25.5.527

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Park, Lee, Shin, Kang, Kim, Kim, Jeon, and Cho: Structural Model for Osteoporosis Preventive Behaviors in Postmenopausal Women: Focused on their Own BMD Awareness

Original Research

Korean J Adult Nurs 2013;25(5):527-538.

Published online: 18 October 2013

DOI: https://doi.org/10.7469/KJAN.2013.25.5.527

Structural Model for Osteoporosis Preventive Behaviors in Postmenopausal Women: Focused on their Own BMD Awareness

Young Joo Park¹, Sook Ja Lee¹, Nah Mee Shin^1,, Hyun Cheol Kang², Sun Haeng Kim³, Tak Kim³, Song I Jeon⁴, In hae Cho⁴

^¹College of Nursing, Korea University, Seoul

^²Department of Informational Statistics, Hoseo University, Cheonan

^³College of Medicine, Korea University, Seoul

^⁴Graduate School, College of Nursing, Korea University, Seoul, Korea

Corresponding author: Shin, Nah Mee College of Nursing, Korea University, 145, Anam-ro, Seongbuk-gu, Seoul 136-713, Korea. Tel: +82-2-3290-4924, Fax: +82-2-927-4676, E-mail: nshin@korea.ac.kr

Received 20 May 201319 August 2013 Accepted 9 October 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to develop a model that explains causal relationships between post-menopausal women's osteoporosis general knowledge and awareness of their own bone mass density(BMD) and their osteoporosis health beliefs and preventive behaviors.

Methods

Retrospective design using structural equation model tested seven variables by using questionnaires of osteoporosis knowledge test, osteoporosis health belief scale, osteoporosis self-efficacy scale, and osteoporosis preventive behaviors scale. 162 middle age and post-menopausal women were recruited.

Results

Mediating effect of health beliefs was not significant in the relationship between BMD awareness and preventive behaviors. Instead, BMD awareness had a direct influence on the preventive behaviors that is strong and significant. Between the relationship of the BMD awareness and health beliefs, direct pathways of perceived threat, relative benefits, and self-efficacy were not significant. However, relative benefits and self-efficacy showed direct influence on the preventive behaviors.

Conclusion

Having middle age women get their BMD test done in order for them to be aware of their own BMD results might be a critical strategy to promote osteoporosis preventive behaviors. There is a need to develop diverse strategies to enhance their self- efficacy which has been shown to be important to osteoporosis preventive behaviors.

Keywords: Bone density, Osteoporosis, Prevention, Post-menopause

REFERENCES

Babatunde O. T.., Himburg S. P.., Newman F. L.., Campa A.., Dixson J.2011. Theory-driven intervention improves calcium intake, osteoporosis knowledge, and self-efficacy in community-dwelling older black adults. Journal of Nutrition Education and Behavior. 43(6):434–440. http://dx.doi.org/10.1016/j.jneb.2010.07.004.

Bentler P. M.., Chou C.1987. Practical issues in structural modeling. Sociological Methods & Research. 16:78–117.

Byun Y. S.., Kim O. S.2000. Development of the education program and it effect on osteoporosis and life style among women. Journal of Korean Academy of Nursing. 30:764–775.

Champion V. L.., Skinner C. S.2008. The health belief model, health behavior and health education. Glanz K., Rimer B. K., Viswanath K., editorsHealth behavior and health education. p. 44–65. San Francisco, CA: John Wiley & Sons, Inc.

Chang S. M.., Park C. M.., Chang S. H.., Shin C. S.., Ha Y. C.2010. Study on medical service use and prescription pattern of osteoporosis 2008-2009. Seoul: Health Insurance Review & Assessment Service.

Choi H. J.2009. Risk factors and assessment of low bone mass in the young adult female. Korean Journal of Family Medicine. 3:924–933. http://dx.doi.org/10.4082/kjfm.2009.30.12.924.

Davis G. C.., White T. L.., Yang A.2005. A bone health intervention for older adultsliving in residential settings. Research in Nursing and Health. 29:566–575. http://dx.doi.org/10.1002/nur.20162.

Estok P. J.., Sedlak C. A.., Doheny M. O.., Hall R.2007. Structural model for osteoporosis preventing behavior in postmenopausal women. Nursing Research. 56(3):148–158.

Gammage K. L.., Klentrou P.2011. Predicting osteoporosis prevention behaviors: health beliefs and knowledge. American Journal of Health Behavior. 35(3):371–382.

Horan M. L.., Kim K. K.., Gendler P.., Froman R. D.., Patel M. D.1998. Development and evaluation of the osteoporosis self-efficacy scale. Research in Nursing & Health. 21:395–403.

Hsieh C. H.., Wang C. Y.., McCubbin M.., Zhang S.., Inouye J.2008. Factors influencing osteoporosis preventive behaviors: Testing a path model. Journal of Advanced Nursing. 62(3):336–345.

Johnson C. S.., McLeod W.., Kennedy L.., McLeod K.2008. Osteoporosis health beliefs among younger and older men and women. Health Education & Behavior. 35(5):721–733. http://dx.doi.org/10.1177/1090198107301331.

Kim K. K.., Horan M.., Gendler P.., Patel M.1998. Osteoporosis health belief, self-efficacy, and knowledge test. Redman B. K., editorMeasurement tools in patient education. p. 307–317. New York: Springer.

Laslett L. L.., Lynch J.., Sullivan T. R.., McNeil J. D.2011. Osteoporosis education improves osteoporosis knowledge and dietary calcium: Comparison of a 4 week and a one session education course. International Journal of Rheumatic Diseases. 14:239–247.

Rosenstock I. M.., Stretcher V. J.., Becker M. H.1988. Social learning theory and the health belief model. Health Education Quarterly. 15(2):175–183.

Sedlak C. A.., Doheny M. O.., Estok P. J.., Zeller R. A.., Winchell J.2007. DXA, health beliefs, and osteoporosis prevention behaviors. Journal of Aging and Health. 19(5):742–755. http://dx.doi.org/10.1177/0898264307304303.

Sedlock C. A.., Doheny M. O.., Jones S. L.2000. Osteoporosis education programs: Changing knowledge and behaviors. Public Health Nursing. 17(5):398–402.

Shin C. S.., Choi H. J.., Kim M. J.., Yu S. H.., Koo B. K.., Cho H. Y., et al. 2010. Prevalence and risk factors of osteoporosis in Korea: A community-based cohort study with lumbar spine and hip bone mineral density. Bone. 47:378–387. http://dx.doi.org/10.1016/j.bone.2010.03.017.

Sun K. S.2003. The effect of web-based osteoporosis prevention program on the osteoporosis knowledge, self-efficacy, health belief, stage of change in female college student. Unpublished doctoral dissertation, Chonnam National University, Gwangju.

Swaim R. A.., Barner J. C.., Brown C. M.2008. The relationship of calcium intake and exercise to osteoporosis health beliefs in postmenopausal women. Research in Social and Administrative Pharmacy. 4:153–163. http://dx.doi.org/10.1016/j.sapharm.2007.03.004.

The North American Menopause Society. 2010. Management of osteoporosis in post menopausal women: 2010 position statement of The North American Menopause Society. Menopause. 17(1):25–54. http://dx.doi.org/10.1097/gme.0b013e3181c617e6.

Waller J.., Eriksson O.., Foldevi M.., Kronhed A.., Larsson L.., Lofman O., et al. 2002. Knowledge of osteoporosis in a Swedish municipality-A prospective study. Preventive Medicine. 34:485–491. http://dx.doi.org/10.1006/pmed.2002.1007.

Waltz C. F.., Bausel R. B.1981. Nursing research: Design, statistics and computer analysis. Philadelphia: F. A;Davis Company.

Won I. S.2009. A study on osteoporosis knowledge, self-efficacy, health promoting behaviors and BMD among adult women. Unpublished master's thesis, Eulji University, Daejeon.

Yoon E. J.2001. The model explaining variance in health promoting behavior and quality of life in women with osteoporosis. Unpublished doctoral dissertation, Kyung Hee University, Seoul.

Figure 1.

Theoretical framework.

Figure 2.

Standardized parameter estimates of path diagram for the final model.

Table 1.

General Characteristics of Participants and Mean Differences of Research Variables

Characteristics	Categories	n (%)	GOK		PT		RB		OSE		HM		OPHB
Characteristics	Categories	n (%)	M±SD	F (p)	M±SD	F (p)	M±SD	F (p)	M±SD	F (p)	M±SD	F (p)	M±SD	F (p)
Age (year)	≤50	37 (22.8)	17.49±2.19	1.63	36.22±7.27	0.39	13.95±9.00	1.53	114.24±39.55	0.99	19.78±3.79	3.08	30.10±6.50	3.80
Age (year)	≥51	125 (77.2)	16.90±2.50	(.203)	35.31±7.83	(.532)	15.99±8.80	(.218)	121.64±39.89	(.322)	20.99±3.64	(.081)	27.65±7.38	(.053)
Ed	≤Middle school	53 (32.7)	16.15±2.50	6.09	36.62±7.65	0.83	12.04±8.89	7.36	113.08±39.15	1.31	20.09±4.07	1.20	29.35±7.25	0.04
	High school	75 (46.3)	17.31±2.32	(.003)	35.08±7.31	(.438)	16.53±8.51	(＜.001)	122.00±40.45	(.274)	21.12±3.91	(.303)	29.69±6.69	(.959)
	≥College	34 (21.0)	17.82±2.25		34.77±8.59		18.74±7.98		126.15±39.04		20.79±2.36		29.47±6.33
SES	Upper	4 (2.5)	16.75±0.96	1.09	28.00±3.56	4.20	12.75±13.77	3.84	97.25±59.01	4.07	21.25±2.99	1.57	31.00±1.83	4.09
	Middle	129 (79.6)	17.18±2.52	(.339)	35.12±7.46	(.017)	16.48±8.58	(.023)	124.3±38.29	(.019)	20.95±3.71	(.211)	30.19±6.96	(.019)
	Lower	29 (17.9)	16.45±2.13		38.35±8.23		11.66±8.57		103.48±39.95		19.62±3.68		26.29±5.29
Job	Housewife	97 (59.9)	16.78±2.47	3.08	34.85±7.13	2.19	15.26±8.39	1.16	124.32±38.81	1.60	20.99±3.69	0.09	30.04±6.59	0.28
	Full or part time job	45 (27.8)	17.56±2.37	(.082)	36.82±7.95	(.141)	16.91±8.73	(.283)	115.51±38.31	(.209)	20.80±3.03	(.764)	29.40±7.00	(.598)
	Missing	20 (12.3)
Mar	Unmarried	6 (3.7)	16.50±2.43	3.20	35.50±9.33	0.04	14.17±11.75	0.92	119.67±50.61	3.50	21.33±3.14	3.04	28.83±3.06	0.60
	With spouse	142 (87.7)	16.91±2.39	(.044)	35.58±7.82	(.956)	15.87±8.72	(.402)	122.57±39.52	(.033)	20.92±3.75	(.051)	29.74±6.83	(.548)
	S/D/D	14 (8.6)	18.57±2.53		34.93±5.99		12.64±9.11		93.50±29.57		18.43±2.74		27.71±7.19
Osteoporosis or osteopenia	Yes	34 (21.0)	17.85±2.45	2.46	37.24±7.98	1.18	16.68±8.28	0.40	124.00±39.80	1.52	21.32±3.57	1.06	31.56±6.68	4.57
	No	126 (77.8)	16.82±2.39	(.089)	35.02±7.64	(.311)	15.25±9.05	(.672)	119.59±39.81	(.221)	20.60±3.73	(.348)	29.16±6.63	(.012)
	Missing	2 (1.2)
Fracture history	Yes	20 (12.4)	17.45±2.26	0.65	37.60±5.10	1.68	12.25±7.61	3.16	104.90±38.49	3.31	19.45±4.11	2.70	28.10±7.22	1.03
Fracture history	No	142 (87.7)	16.98±2.47	(.420)	35.23±7.96	(.197)	15.99±8.95	(.077)	122.07±39.67	(.071)	20.89±3.62	(.103)	29.74±6.70	(.312)
Parental osteoporotic fracture history	Yes	35 (21.6)	17.63±2.24	2.38	37.94±7.94	5.17	13.94±7.38	1.71	112.89±34.26	1.26	20.57±4.31	0.08	28.06±5.55	2.03
	No	125 (77.2)	16.91±2.48	(.125)	34.66±7.43	(.024)	16.14±9.11	(.191)	121.43±41.17	(.263)	20.77±3.55	(.783)	29.90±7.08	(.157)
	Missing	2 (1.2)

Ed=education; Mar=marriage; SES=socioeconomic status; S/D/D=separated/divorced/death; GOK=general osteoporosis knowledge; PT=perceived threats; RB=relative benefits; OSE=osteoporosis self-efficacy; HM=health motivation; OPHB=osteoporosis preventive health behavior.

Table 2.

Mean, Standard Deviations, and Correlations among Variables

Variables	n (%) or M±SD	P_ BMD_K	GOK	PT	RB	OSE	HM
Variables	n (%) or M±SD	r (p)	r (p)	r (p)	r (p)	r (p)	r (p)
P_ BMD_K
Know	117 (72.2)
Do not know	45 (27.8)
GOK	17.04±2.44	-.01 (.905)
PT	35.52±7.69	-.06 (.449)	-.10 (.219)
RB	15.53±8.86	-.04 (.614)	-.01 (.945)	-.32 (＜.001)
OSE	119.95±39.81	-.03 (.723)	-.05 (.521)	-.15 (.059)	.47 (＜.001)
HM	20.72±3.70	-.16 (.040)	-.05 (.507)	-.14 (.067)	.36 (＜.001)	.47 (＜.001)
OPHB	29.53±6.76	-.26 (.001)	-.07 (.374)	-.08 (.329)	.37 (＜.001)	.47 (＜.001)	.35 (＜.001)

P_BMD_K=personal bone mineral density knowledge; BMD=bone mineral density; GOK=general osteoporosis knowledge; PT=perceived threats; RB=relative benefits; OSE=osteoporosis self-efficacy; HM=health motivation; OPHB=osteoporosis preventive health behavior.

Table 3.

Effects of Predictive Variables on Endogenous Variables in Hypothetical and Revised Model

Endogenous variables	Exogenous variables	Hypothetical model				Revised model
Endogenous variables	Exogenous variables	SDE	SIE	STE	SMC (R²)	SDE	SIE	STE	SMC (R²)
OPHB	P_BMD_K	-	-.02	-.02	.264	-.22∗∗∗	-.03	-.26∗∗∗	.312
	GOK	-	-.03	-.03		-	-.02	-.02
	PT	.05	-.00	.04		.03	-.00	.03
	RB	.18∗∗	.02	.21∗∗		.18∗∗	.02	.19∗∗
	OSE	.33∗∗∗	.05∗	.38∗∗∗		.34∗∗∗	.04	.37∗∗∗
	HM	.14∗	-	.14∗		.09	-	.09
HM	P_BMD_K	-	-.02	-.02	.249	-.16∗∗	-.02	-.17∗∗	.273
	GOK	-	-.02	-.02		-	-.02	-.02
	PT	-.03	-	-.03		-.04	-	-.04
	RB	.18∗∗	-	.18∗∗		.17∗∗	-	.17∗∗
	OSE	.38∗∗∗	-	.38∗∗∗		.38∗∗∗	-	.38∗∗∗
OSE	P_BMD_K	-.03	-	-.03	.004	-.03	-	-.03	.004
OSE	GOK	-.05	-	-.05	.004	-.05	-	-.05	.004
RB	P_BMD_K	-.03	-	-.03	.001	-.03	-	-.03	.001
RB	GOK	-.01	-	-.01	.001	-.01	-	-.01	.001
PT	P_BMD_K	-.06	-	-.06	.013	-.06	-	-.06	.013
PT	GOK	-.10	-	-.10	.013	-.10	-	-.10	.013

SDE=standardized direct effect; SIE=Standardized indirect effect; STE=standardized total effect; P_BMD_K=personal bone mineral density knowledge; GOK=general osteoporosis knowledge; PT=perceived threats; RB=relative benefits; OSE=osteoporosis self-efficacy; HM=health motivation; OPHB=osteoporosis preventive health behavior, SMC=squared multiple correlation. ∗p＜.10; ∗∗p＜.05; ∗∗∗p＜.001,

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