Development of a Smartphone Application for Promoting Bone Health in Korean Young Adult Women: A Pilot Study

Young-Joo Park; Sook-Ja Lee; Nah-Mee Shin; Hyunjeong Shin; Sungjin Yoon; Songi Jeon; Inhae Cho

doi:10.7469/kjan.2015.27.4.459

Journal List > Korean J Adult Nurs > v.27(4) > 1076345

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Park, Lee, Shin, Shin, Yoon, Jeon, and Cho: Development of a Smartphone Application for Promoting Bone Health in Korean Young Adult Women: A Pilot Study

Original Article

Korean J Adult Nurs 2015;27(4):459-471.

Published online: NaN August 2015

DOI: https://doi.org/10.7469/kjan.2015.27.4.459

Development of a Smartphone Application for Promoting Bone Health in Korean Young Adult Women: A Pilot Study

Young-Joo Park¹, Sook-Ja Lee¹, Nah-Mee Shin¹, Hyunjeong Shin¹, Sungjin Yoon², Songi Jeon², Inhae Cho³

^¹College of Nursing, Korea University, Seoul

^²Department of Physical Education, College of Education, Korea University, Seoul

^³Department of Nursing, Graduate School, Korea University, Seoul, Korea

Corresponding author: Shin, Hyunjeong College of Nursing, Korea University, 145 Anam-ro, Sungbuk-gu, Seoul 136-705, Korea. Tel: +82-2-3290-4927, Fax: +82-2-927-4676, E-mail: hyunjshin@korea.ac.kr

Received 30 June 20159 August 2015 Accepted 12 August 2015

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 smartphone application and evaluate it's effectiveness and usability for promoting bone health in Korean young adult women.

Methods

A smartphone application was developed covering exercise, nutrition, and health habits related to bone health. A pilot testing was conducted using a one-group pre/posttest design. A total of 22 female college students with low bone mass participated in the 8-week use of a pilot testing.

Results

The “Strong bone Fit body (SbFb)" application was developed using Android platform. In the pilot testing, bone mineral density, serum CTX, and 25 (OH)Vit.D were significantly decreased. There is no significant change in serum osteocalcin and calcium. Serum phosphorus concentration, nutrient intakes (fiber, VitB6, and pantotenic acid), and all bone composition profiles were significantly increased. Bone-health knowledge was significantly increased but no change in health belief and self-efficacy.

Conclusion

The results of this pilot testing suggest the effectiveness of the SbFb application to enhance and promote self-managing abilities for bone health. It can provide continuous feedback and high-quality bone health information. However, some contents and working methods of the application need to be modified and its effectiveness on bone health requires further investigations.

Keywords: Women, Young adults, Bone density, Biochemical markers, Smartphone applications

REFERENCES

1.Murray CJL., Vos T., Lozano L., Naghavi M., Flaxman AD., Michaud C, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the global burden of diseases study 2010. Lancet. 2012. 380:2197–223.

2.Wright NCW., Looker AC., Saag KG., Curtis JR., Delzell ES., Randall S, et al. The recent prevalence of osteoporosis and low bone mass in the united states based on bone mineral density at the femoral neck or lumbar spine. Journal of Bone and Mineral Research. 2014. 29(11):2520–6. http://dx.doi.org/10.1002/jbmr.2269.

3.Park EJ., Joo IW., Jang MJ., Kim YT., Oh K., Oh HJ. Prevalence of osteoporosis in the Korean population based on Korea national health and nutrition examination survey (KHANES), 2008-2011. Yonsei Medical Journal. 2014. 55(4):1049–57. http://dx.doi.org/10.3349/ymj.2014.55.4.1049.

4.Chang SM, Park CM, Chang SH, Shin CS, Ha YC, Medical utilization and prescription pattern of Korean patients with osteoporosis. Seoul: Health Insurance Review & Assessment Service;2009.

5.Hernandez CJ., Beaupre GS., Carter DR. A theoretical analysis of the relative influences of peak BMD, age-related bone loss and menopause on the development of osteoporosis. Osteoporosis International. 2003. 14:843–7. http://dx.doi.org/10.1007/s00198-003-1454-8.

6.Harvey N., Dennison E., Cooper C. Osteoporosis: a lifecourse approach. Journal of Bone and Mineral Research. 2014. 29(9):1917–25. http://dx.doi.org/10.1002/jbmr.2286.

7.Bohaty K., Rocole H., Wehling K., Waltman N. Testing the effectiveness of an educational intervention to increase dietary intake of calcium and vitamin D in young adult women. Journal of the American Academy of Nurse Practitioners. 2008. 20:93–9. http://dx.doi.org/10.1111/j.1745-7599.2007.00281.x.

8.Sedlak CA., Doheny MO., Jones SL. Osteoporosis education programs: changing knowledge and behaviors. Public Health Nursing. 2000. 17(5):398–402.

9.Wu F., Laslett LL., Wills K., Oldenburg B., Jones G., Winzenberg T. Effects of individualized bone density feedback and educational interventions on osteoporosis knowledge and self-efficacy: a 12 year prospective study. Journal of Clinical Densitometry: Assessment & Musculoskeletal Health. 2014. 17(4):466–72. http://dx.doi.org/10.1016/j.jeod.2014.07.008.

10.Barlow J., Wright C., Sheasby J., Turner A., Hainsworth J. Self-management approaches for people with chronic conditions: a review. Patient Education and Counseling. 2002. 48:177–87.

11.Robinson JH., Callister LC., Berry JA., Dearing KA. Patient-centered care and adherence: definitions and applications to improve outcomes. Journal of the American Academy of Nurse Practitioners. 2008. 20:600–7. http://dx.doi.org/10.1111/j.1745-7599.2008.00360.x.

12.Bandura A. Health promotion by social cognitive means. Health Education & Behavior. 2004. 31(2):143–64. http://dx.doi.org/10.1177/1090198104263660.

13.Klein M., Mogles N., van Wissen A. Intelligent mobile support for therapy adherence and behavior change. Journal of Biomedical Informatics. 2014. 51:137–51. http://dx.doi.org/10.1016/j.jbi.2014.05.005.

14.Reid SC., Kauer SD., Hearps SJC., Crooke AHD., Khor AS., Sanci LA. A mobile phone application for the assessment and management of youth mental health problems in primary care: a randomized controlled trial. BMC Family Practice. 2011. 12:131. http://www.biomedcentral.com/1471-2296/12/131.

15.Gustafson DH., McTavish FM., Chih MY., Atwood AK., Johnson RA., Boyle MG. A smartphone application to support recovery from alcoholism: a randomized clinical trial. JAMA Psychiatry. 2014. 71(5):566–72. http://dx.doi.org/10.1001/jamapsychiatry.2013.4642.

16.Park YJ., Lee SJ., Shin NM., Shin H., Kim YK., Cho YJ, et al. Bone mineral density, biochemical bone turnover markers and factors associated with bone health in young Korean women. Journal of Korean Academy of Nursing. 2014. 44(5):504–14. http://dx.doi.org/10.4040/jkan.2014.44.5.504.

17.Howe TE., Shea B., Dawson LJ., Downie F., Murray A., Ross C, et al. Exercise for preventing and treating osteoporosis in postmenopausal women. The Cochrane Database of Systematic Reviews. 2011. 7:CD000333. http://dx.doi.org/10.1002/14651858.cd000333.pub2.

18.The Korean Nutrition Society. Dietary reference intakes for Koreans. Seoul: Author;2010.

19.Waller J., Eriksson O., Foldevi M., Kronhed A-CG., Larssen L., Lofman O, et al. Knowledge of osteoporosis in a swedish municipality: a prospective study. Preventive Medicine. 2002. 34(4):485–91. http://dx.doi.org/10.1006/pmd.2002.1007.

20.Kim KK., Horan M., Gendler P., Patel M. Osteoporosis health belief, self-efficacy, and knowledge tests. Redman BK, editor. editor.Measurement tools in patient education. New York, NY: Springer Publishing Company;1998. p. 307–8.

21.Horan ML., Kim KK., Gendler P., Froman RD., Patel MD. Development and evaluation of the osteoporosis self-efficacy scale. Research in Nursing and Health. 1998. 21(5):395–403.

22.Weeks BK., Beck BR. The BPAQ: a bone-specific physical activity assessment instrument. Osteoporosis International. 2008. 19:1567–77. http://dx.doi.org/10.1007/s00198-008-0606-2.

23.Turner CH., Robling AG. Designing exercise regimens to increase bone strength. Exercise and Sport Sciences Reviews. 2003. 31(1):45–50.

24.Korean Society for Bone and Mineral Research. Osteoporosis. 3rd ed. Seoul: Hanmee Medical Publishing Company;2006.

25.Cheung AM., Giangregorio L. Mechanical stimuli and bone health: what is the evidence? Current Opinion Rheumatology. 2012. 24:561–6. http://dx.doi.org/10.1097/BOR.0b013e3283570238.

26.Amrein K., Amrein S., Drexler C., Dimai HP., Dobling H., Pfeifer K, et al. Sclerostin and its association with physical activity, age, gender, body composition, and bone mineral content in healthy adults. Journal of Clincal Endocrinology Metabolism. 2012. 97(1):148–54. http://dx.doi.org/10.1210/jc.2011-2152.

27.de Jongh T., Guro-Urganci I., Vodopivec-Jamsek V., Car J., Atun R. Mobile phone messaging for facilitating self-management of long-term illness. Cochrane Database of Systematic Reviews. 2012. 12:Art No.: CD007459.http://dx.doi.org/10.1002/14651858.CD007459.pub2.

Figure 1.

Screenshots of ‘Strong Bone Fit Body' application.

Table 1.

Mean Differences of BMD, BTMs, Body Composition, and Psychosocial Variables between Pretest and Posttest (N=22)

Variables		Pretest	Posttest	Difference	t (p)
Variables		M±SD	M±SD	M±SD	t (p)
BMD	Z-score	-1.55±0.65	-1.87±0.57	0.32±0.25	6.18 (＜.001)
	T-score	-1.48±0.59	-1.79±0.51	0.31±0.23	6.34 (＜.001)
	SOS (m/sec)	1,526.26±23.88	1,517.20±22.76	9.06±11.23	3.78 (.001)
	BUA (dB/MHz)	38.54±9.54	33.57±7.26	4.96±6.94	3.35 (.003)
	BQI	76.41±11.08	70.65±9.73	5.76±4.33	6.24 (＜.001)
BMs	Osteocalcin (ng/mL)	19.12±4.63	21.54±5.48	-2.27±5.40	-1.93 (.068)
	CTX (ng/mL)	0.41±0.17	0.32±0.13	0.08±0.13	2.55 (.020)
	Calcium (mg/dL)	9.61±0.35	9.42±0.74	0.17±0.83	0.95 (.355)
	Phosphorus (mg/dL)	3.95±0.42	4.33±0.52	-0.41±0.55	-3.42 (.027)
	25 (OH)Vit D	13.92±3.53	8.77±3.08	5.17±2.69	8.37 (＜.001)
Body composition	Body weight	50.02±4.90	50.94±4.98	-0.92±0.85	-5.11 (＜.001)
	Free fat mass	38.18±2.66	38.54±2.81	-0.36±0.63	-2.69 (.014)
	Body fat mass	11.84±2.74	12.40±2.70	-0.56±0.60	-4.43 (＜.001)
	Muscle	35.31±2.41	35.60±2.56	-0.29±0.59	-2.31 (.031)
	Body fluid	27.50±1.91	27.75±2.03	-0.25±0.46	-2.57 (.018)
	BMI	19.29±1.65	19.64±1.69	-0.35±0.31	-5.27 (＜.001)
	Body fat ratio	23.44±3.28	24.14±3.12	-0.70±1.00	-3.30 (.003)
	Abdominal fat ratio	0.73±0.03	0.73±0.03	-0.01±0.01	-2.22 (.038)
Psychosocial variables related to bone health
Knowledge		16.90±2.41	17.79±1.53	0.91±1.44	-3.03 (.006)
Health belief	Susceptibility	19.14±3.75	19.64±4.46	-0.50±3.17	-0.74 (.468)
	Seriousness	17.14±3.85	18.45±5.51	-1.32±5.30	-1.17 (.267)
	Benefit exercise	24.64±2.82	24.73±2.00	-0.09±2.78	-0.15 (.879)
	Benefit calcium intake	21.82±2.99	22.59±2.34	-0.77±2.33	-1.56 (.135)
	Barriers exercise	15.41±4.78	17.18±3.72	-1.77±4.09	-2.03 (.055)
	Barriers calcium intake	13.18±3.08	13.05±3.79	0.14±3.52	0.18 (.858)
	Health motivation	20.59±3.70	20.18±3.65	0.41±2.58	0.74 (.465)
	Self-efficacy	125.23±19.13	117.00±20.92	8.23±28.45	1.36 (.189)
	Exercise self-efficacy	59.07±14.30	52.83±14.47	6.22±18.69	1.60 (.125)
	Calcium intake self-efficacy	66.33±11.80	64.08±12.86	2.65±13.74	0.93 (.365)

BMD=bone mineral density, BMs=biochemical bone markers, SOS=speed of sound, BUA=broadband ultrasound attenuation, BQI=bone quality index, CTX=C-telopeptide of collagen cross-links, BMI=body mass index.

Table 2.

Mean Differences of Nutrients Intakes between Pretest and Posttest (N=22)

Nutrients	Pretest	Posttest	Difference	t (p)
Nutrients	M±SD	M±SD	M±SD	t (p)
Calolie (Kcal)	1,389.37±303.71	1,437.92±341.98	-48.55±92.06	-0.53 (.603)
Carbohydrate (g)	192.26±49.78	200.33±44.31	-8.07±12.91	-0.63 (.539)
Fat (g)	43.78±11.02	45.25±15.03	-1.47±17.21	-0.40 (.692)
Protein (g)	51.20±13.82	57.15±17.05	1.59±13.28	0.56 (.580)
Fiber (g)	11.62±3.22	13.81±3.93	-2.19±4.33	-2.37 (.027)
Water (mL)	679.50±263.74	656.01±213.26	23.48±222.40	0.50 (.626)
Vit. A (㎍)	564.31±361.21	662.57±259.52	-98.27±393.20	-1.17 (.254)
Vit. D (㎍)	2.65±2.26	2.64±2.13	0.01±3.13	0.01 (.996)
Vit. E (mg)	11.37±5.20	12.61±5.05	-1.25±6.67	-0.88 (.390)
Vit. K (㎍)	95.16±72.96	114.68±62.78	-19.53±72.54	-1.26 (.221)
Vit. C (mg)	55.62±36.32	57.88±27.91	-2.26±43.11	-0.25 (.808)
Thiamin (mg)	0.93±0.28	0.97±0.29	-0.04±0.33	-0.59 (.562)
Riboflabin (mg)	1.00±0.47	1.13±0.40	-0.13±0.51	-1.19 (.246)
Niacin (mg)	12.05±4.01	12.53±3.74	-0.48±4.82	-0.46 (.649)
Vit. B6 (mg)	0.98±0.35	1.16±0.37	-0.18±0.39	-2.19 (.040)
Folic acid (㎍)	270.55±123.10	316.25±103.35	-45.70±122.60	-1.75 (.095)
Vit B12 (㎍)	4.95±3.90	6.54±3.31	-1.59±4.29	-1.73 (.098)
Panto (mg)	3.03±1.12	3.63±1.06	-0.60±1.28	-2.21 (.039)
Biotin (㎍)	11.08±7.72	14.38±7.13	-3.31±9.55	-1.62 (.119)
Calcium (mg)	411.84±151.35	440.64±225.39	-28.80±227.40	-0.59 (.559)
Phosphorus (mg)	734.99±186.68	779.01±185.52	-44.02±250.80	-0.82 (.420)
Sodium (mg)	2,571.32±904.17	2,615.02±732.55	-43.70±1215.30	-0.17 (.868)
Chroride (mg)	247.02±145.09	407.73±315.92	-160.70±380.70	-1.98 (.061)
magnesium (mg)	53.26±21.14	60.92±22.62	-7.67±35.98	-1.00 (.329)
Fe (mg)	9.56±3.23	12.04±4.92	-2.48±6.32	-1.84 (.080)
Zn (mg)	6.61±1.83	7.63±1.91	-1.02±2.67	-1.78 (.089)
Cu (㎍)	0.75±0.23	0.84±0.26	-0.09±0.33	-1.27 (.218)
Cholesterol (mg)	265.03±180.40	310.33±146.23	-45.30±244.60	-0.87 (.395)
K (mg)	1,633.17±484.75	1,824.91±512.85	-191.70±595.00	-1.51 (.146)

TOOLS

Similar articles