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Print ISSN : 2231-7007      Online ISSN : 2462-246X


EFFECT OF HEALTH EDUCTION INTERVENTION ABOUT OSTEOPOROSIS ON KNOWLEDGE AND DIETARY HABITS OF WOMEN EMPLOYEES

Volume-9, Issue 4 (Supplementary), 2018, Pages 29 - 38

Manal Mansour 1; Zainab Gazar Alkotb Alagamy 2 ;

1Community Health Nursing, Faculty of Nursing, Fayoum University, Egypt
2Geriatric Health Nursing, Faculty of Nursing, Fayoum University, Egypt

Abstract :

Background: Osteoporosis is a disorder of decreased bone mass density. The aim of this study was to examine the effect of health education intervention about osteoporosis on knowledge and dietary habits of employees' women. Design: A quasi-experimental design was used with pre-post test. Setting: The study was conducted in administration building at Fayoum University. Sample: A systematic random sample of 104 women employees that represent 20% of total number of women of 518 under certain criteria. Instruments: Two tools were used, the first tool was interviewing questionnaire that covered the demographic characteristics of women, reproductive health data, medical history, dietary habits and their knowledge about osteoporosis. The second tool was physiological measurement for measuring bone mineral density and body mass index. Results: The study revealed that, less than half of the women's age was between 45<55 years with mean age of 46.16±7.12 years old. More than half of the subjects have normal mineral density, more than one third have osteopenia and the minorities of the subjects have osteoporosis. There was highly statistical significant improvement in the post program than pre program in the total dietary habits and women knowledge about osteoporosis and relation between bone mineral density and intake of milk and soft drinks. Conclusion: The health education intervention about osteoporosis on knowledge and dietary habits of employees' women was effective for increasing their knowledge level about osteoporosis and their dietary habits. Recommendations: Periodic check up for bone mineral density testing for early detection of bone loss. Health education about risk factors and consequences of osteoporosis should be started early as possible from pre-school age until adulthood.

Keywords : Osteoporosis, Health education intervention, Osteoporosis

Introduction :

Osteoporosis is a serious disease that affects the bones. It can strike people of any age, but is more prevalent in older people. Osteoporosis is widely viewed as a major public health concern. Osteoporosis – literally means "porous bone’ – is characterized by excessive bone loss, low bone mass, and structural deterioration of skeletal tissue, leading to an increased risk of fracture under minimal trauma (Janz & Becker, 1984; Greer, Krebs & American Academy of Pediatrics, 2006). In addition, it is called  a "silent condition" that happens slowly over years, the rate of bone loss exceeds many times the rate of new bone formation (a cretion), neither a person nor a doctor is aware of weakened of bones until it breaks unexpectedly (Smith & Maurer, 1764).

The incidence of osteoporosis increases with age and females are six times more likely than males to develop primary osteoporosis and senile osteoporosis affects approximately 50% of women aged 70 years (Rodriguez, Langley & Dimarco, 2009). According to the criteria of World Health Organization (WHO) 30% of menopausal women have osteoporosis. Women lose bone mass more rapidly than men. Following the cessation of menses the rate of bone loss is accelerated for approximately 5 to 8 years after menopause (Center for Disease Control & Prevention, 2010).

In the early stages of osteoporosis, the patient probably will not have symptoms. As the disease progresses, symptoms related to weakened bones occur. It includes the symptoms of  chronic pain particularly in the lower back or neck, loss of height and stooped posture, a curved upper back (dowager's hump) and broken bones (fractures) that might occur with a minor injury, especially in the hip, spine and wrist (Sampson, 2002).

Risk factors for osteoporosis can be classified as modifiable and non-modifiable. Modifiable risk factors include: smoking, current low body weight regardless of height, early menopause (<45 years of age), excessive alcohol intake and soft drink, sedentary lifestyle, low calcium intake and poor general health (Janz & Becker, 1984). Non-modifiable factors among women include female sex, ethnic, advanced age, family history, immobilization, delayed puberty and nulliparity (Allegrante, Peterson & Kasper, 2001).

Bone fractures, particularly in the spine or hip, are the most serious complication of osteoporosis. Hip fractures can result in disability, decreased quality of life, lost workdays, and patients suffering from a hip fracture will require long-term nursing home care. Elderly patients can further develop pneumonia and blood clots in the leg veins that can travel to the lungs (pulmonary embolism) due to prolonged bed rest after a hip fracture. Some 20% of women with a hip fracture will die in the subsequent year as an indirect result of the fracture (Leslie, 2000). In addition, once a person has experienced a spine fracture due to osteoporosis, he or she is at very high risk of suffering another fracture in the next few years. About 20% of postmenopausal women who has experienced a vertebral fracture will suffer a new vertebral fracture of bone in the following year (Lindsay et al., 2001).

As there is delayed cure for osteoporosis, prevention is the key to overcome this disease. Community health nurse (CHN) have the opportunity to help raising public awareness about this disease and to offer information about its consequences, prevention and treatment because of their health promotion and their ready accesses to people at various stages in their lives (Dempster & Lindsay, 1993).

Significance of the study:

Community health nurse must consider osteoporosis as a major public health hazard because of two major reasons. Firstly, osteoporotic fractures are most commonly observed in the vertebrae, femur, radius which can cause substantial morbidity and mortality (Chung et al., 2003). Secondly, osteoporosis is a common disease among the elderly and with the improvement in health care, the lifetime expectancy in developed countries has increased. This means that the fracture of elderly individual’s increases with osteoporosis, it is likely to become more prevalent. As a result, the cost of osteoporosis-related health care expenses to the society is high and is likely to rise (Tuzun et al., 2012).

Aim of the study

The aim was to examine the effect of health education intervention about osteoporosis and the dietary habits of the employed women.

Hypothesis

The knowledge of women about osteoporosis will be improved after implementing the educational program.

Research Methodology :

Design: A quasi-experimental design with pre -post test was used.

Setting: The study was conducted in the administration building at Fayoum University.

Sample: A systematic random sample composed of 104employees women that represented 20% of the total number of employee women, 518from administrative building at Fayoum University; Subjects were interviewed at conference hall in the building.

They were selected if they did not attend lectures on health awareness of osteoporosis before (inclusion criteria).

Instruments: Two tools were developed by the researcher to collect data.

1. Interview questionnaire:This questionnaire was designed to collect data about the women.  It consisted of the following:

A. Demographic Characteristics includes age, level of education, marital status and monthly income and number of family member.

B. Reproductivehealth data includes age at first menarche, number of pregnancies, number ofabortion, number of deliveries, contraceptive methods.

C. Healthproblems include medical history and family history of osteoporosis.

D. Dietary habits and exercise such as the amount of salt in foods, pickles, foods rich in calcium, protein and fiber. Intake of drinks is milk, tea, coffee and soft drinks etc.

E. Assessment of knowledge about osteoporosis includes meaning, signs & symptoms, main cause of osteoporosis, gender risk, reasons of awareness for osteoporosis, risk factors, sources of calcium in food, method of prevention, diagnostic methods,treatment, protective exercises and protective foods of osteoporosis.

Scoring system: For knowledge items, a correct complete answer was scored two points and a correct incomplete answer was scored one point, while the wrong answer or unknown was given zero, according to mothers’ answers,their knowledge was categorized into good knowledge = 75% , Average knowledge =50% - < 75% and  poor knowledge <50%.

2. Physiological measurement tool:  It consisted of two parts.

A.The measurement of bone mass density: peripheral machine (Peripheral dual-energy X-ray absorptiometry (P-DEXA) which measures bone mass density in heel bone. This wasused for each subject of the sample.

B. Assessbody mass index (BMI) by measuring body weight and height.

Procedure for data collection:

Study period: The process of data collection was carried out in the period from November 2014 to March 2015.

Tool development:

Reliability of the tools: Reliability was applied by the researcher for testing the internal consistency of the tool, bythe administration of the same tools to the same subjects under similar conditions on one or more occasions. The answers from repeated testing were compared (test-re-testreliability=0.84%), Cronbach's Alpha reliability=0.84.

Validity of the tools: The tools were tested by five experts in community health nursing and some modification was done according to expertise opinion. The content and face validity of the study tools were  measured to evaluate the individual items as well as the entire tools used for the study as being relevant and appropriate to test what they wanted to measure.

Pilot study: It was carried out on 10 women employees at her workplace in October, 2014. They were excluded from the study sample to test the clarity of data collection tools and also to detect any obstacle or problem that might arise in data collection, and estimate the time needed to fill the tools. 

Ethical considerations: The agreements for participation were taken orally after the purpose of the study was explained. Before data collection, the employees' were informed about the aim of the study. They were given an opportunity to refuse to participate and they were notified that they could with draw at any stage of research. Each Participant was interviewed for 30-45 minutes using the structured interview questionnaire. The researcher started an individual’s interview after arranging the suitable time. The purpose of the study was explained to the women in a simple way. The women interviewed two days per week and three women in each day at conference hall in the building. 

Health education intervention:

The researcher implemented the educational through four phases as following:

· Assessment phase: In this phase of the program, knowledge and habits were assessed through collection and analysis of baseline data from the filled tools. In this phase the researcher did the pre-test.  

·  Planning phase: The researcher identified the important needs for the target group, set priorities of needs, and objectives were developed.

·  Objective: Improve the knowledge of the employed women and the habits to control osteoporosis. 

· Implementation phase: In this phase the researcher implemented the educational program to the studied women. They were divided into ten groups, and each group consists of 10 women. The program was divided into six sessions, each session lasted 30-45 minutes and they immediately did the post-test.

First session: At the beginning the first session started with an orientation to the program, introduction and meaning about osteoporosis, taking into consideration the use of simple language according to the educational level.Discussion, motivation and reinforcement during program/media used/ session were used to enhance learning. Each session started by summary about the previous session and new topics.

Second session: covered types of osteoporosis.

Third ession: covered signs, symptoms and risk factors of osteoporosis.

Fourth session: covered method of measuring of osteoporosis and complications.

Fifth session: covered methods of prevention and role of nutrition in preventing of osteoporosis.

Sixth session:covered example of meals for 24 hours for preventing osteoporosis.

Evaluation phase: After implementing the education program,immediately the researcher applied the post-test to evaluate their improvement.

Statistical Design:

Data were analyzed using the statistical package for social sciences SPSS version 16.Qualitative data was presented as number and percent. Comparison between groups was done using Chi-square test. P > 0.05 was considered to be statistically significant of results.

Results :

Figures 1 clarifies that only 8.7% were under weight, 31.7% were ideal weight, 34.6% were overweight and 23.1% were obese and 1.9% was extremely obese.

Figure 1: Distribution of the studied subjects according to body mass index (BMI) (n=104)

Figure 2 show that 53.8% had normal bone mineral density, 40.4% having osteopenia while 5.8 %  had osteoporosis.

Figure 2: Distribution of the studied subjects according to bone mineral density measurements

Figure 3 shows that highly statistical significance improvement between pre and post total knowledge score.

Figure 3: Comparison between pre- post total score of knowledge about osteoporosis of the studied subjects

Table 1 displayed the reported demographic characteristics of the subject, with mean age 46.16±7.12 years. About 82.7% of the subjects are married. Regarding their monthly income, 52.9% reported having enough monthly income, 78.9% reported having three to five family members. About 45.2% have secondary education, while 29.8% have university education and only 4.8% are above university education.

Table 1: Knowledge about different items of osteoporosis of the studied women pre and post educational program (N=104)

knowledge about osteoporosis

The studied subjects (N=104)

 

 

Pre-program

Post-program

?2

P

No.

%

No.

%

 

 

Meaning:

 

 

 

 

 

 

Poor

65

62.5

2

1.9

135.387

0.0001*

Fair

27

26.0

7

6.7

 

 

Good

12

11.5

95

91.3

 

 

Symptoms:

 

 

 

 

 

 

Poor

62

59.6

3

2.9

127.055

0.0001*

Fair

31

29.8

10

9.6

 

 

Good

11

10.6

91

87.5

 

 

Main causes:

 

 

 

 

 

 

Poor

55

52.9

0

0

132.610

0.0001*

Fair

41

39.4

16

15.4

 

 

Good

8

7.7

88

84.6

 

 

Gender risk

 

 

 

 

 

 

Poor

77

74.0

0

0

140.400

0.002*

Fair

18

17.3

17

16.3

 

 

Good

9

8.7

87

83.7

 

 

 Reasons of awareness of osteoporosis

 

 

 

 

 

 

Poor

59

56.7

0

0

140.106

0.0001*

Fair

37

35.6

13

12.5

 

 

Good

 

8

7.7

91

87.5

 

 

Risk factors:

 

 

 

 

 

 

Poor

70

67.4

3

2.9

129.361

0.0001*

Fair

23

22.1

10

9.6

 

 

Good

11

10.5

91

87.5

 

 

Sources of calcium in food:

 

 

 

 

 

 

Poor

57

54.8

0

0

120.220

0.0001*

Fair

33

31.7

14

13.5

 

 

Good

14

13.5

90

86.5

 

 

Preventive measures :

 

 

 

 

 

 

Poor

72

69.2

1

1.0

140.94

0.0001*

Fair

24

23.1

13

12.5

 

 

Good

8

7.7

90

86.5

 

 

Methods of measuring bone density:

 

 

 

 

 

 

Poor

86

82.7

0

0

170.730

0.0001*

Fair

14

13.5

9

8.7

 

 

Good

4

3.8

95

91.3

 

 

 Treatment:

 

 

 

 

 

 

Poor

77

74.0

2

1.9

141.696

0.0001*

Fair

18

17.3

10

9.6

 

 

Good

9

8.7

92

88.5

 

 

The period of treatment:

 

 

 

 

 

 

Poor

77

74.0

1

1.0

141.621

0.0001*

Fair

16

15.4

9

8.7

 

 

Good

11

10.6

94

90.4

 

 

The goal of treatment:

 

 

 

 

 

 

Poor

67

64.4

0

0

147.088

0.0001*

Fair

27

26.0

8

7.7

 

 

Good

10

9.6

96

92.3

 

 

protective exercises:

 

 

 

 

 

 

Poor

76

73.1

0

0

168.641

0.0001*

Fair

24

23.1

8

7.7

 

 

Good

4

3.8

96

92.3

 

 

protective foods

 

 

 

 

 

 

Poor

64

61.6

0

0

153.642

0.0001*

Fair

33

31.7

9

8.7

 

 

Good

7

6.7

95

91.3

 

 

*Significant (P<0.05)

Table 2 shows that there was highly statistical significant improvement in the post program than that of pre as p-value (0.0001).

Table 2: Distribution of the studied women by their dietary habits pre & post intervention (N=104)

Dietary habits

The studied subjects (N=104)

 

 

Pre-program

Post-program

?2

P

No.

%

No.

%

 

 

? Food intake:

 

 

 

 

 

 

? Salt intake:

 

 

 

 

 

 

Without salt

18

17.3

27

26.0

30.344

0.0001*

Average salt

51

49.0

73

70.2

 

 

Excessive salt

35

33.7

9

 

8.7

 

 

Pickles intake:

 

 

 

 

 

 

Never

8

7.7

24

23.1

30.728

0.0001*

Sometimes

30

28.8

53

51.0

 

 

Always

66

63.5

27

26.0

 

 

Food rich in calcium:

 

 

 

 

 

 

Never

3

2.9

0

0

28.083

0.0001*

Sometimes

47

45.2

15

14.4

 

 

Always

54

51.9

89

85.6

 

 

Food rich in protein:

 

 

 

 

 

 

Never

4

3.8

0

0

19.324

0.0001*

Sometimes

43

41.3

25

24.0

 

 

Always

57

54.8

79

76.0

 

 

 

Food rich in fiber:

 

 

 

 

 

 

Never

7

6.7

0

0

27.497

0.0001*

Sometimes

43

41.3

16

15.4

 

 

Always

54

51.9

88

84.6

 

 

*Significant (P<0.05)

Table 3 reveals that there was statistically significant improvement in the post program than the pre program as p-value (0.0001).

                 Table 3: Distribution of the studied women by their intake of drinks pre& post program (N=104)

   intake of drinks 

The studied subjects (N=104)

 

 

Pre-program

Post-program

?2

P

No.

%

No.

%

 

 

Milk intake:

 

 

 

 

 

 

Never

29

27.9

6

5.8

49.455

0.0001*

Sometimes

42

40.4

15

14.4

 

 

Always

33

31.7

83

79.8

 

 

Tea intake:

 

 

 

 

 

 

Never

23

22.1

69

66.3

44.970

0.0001*

Sometimes

36

34.6

23

22.1

 

 

Always

45

43.3

12

11.5

 

 

Nescafe intake:

 

 

 

 

 

 

Never

18

17.3

59

56.7

60.495

0.0001*

Sometimes

23

22.1

34

32.7

 

 

Always

63

60.6

11

10.6

 

 

Coffee intake:

 

 

 

 

 

 

Never

42

40.4

81

77.9

30.651

0.0001*

Sometimes

38

36.5

16

15.4

 

 

Always

24

23.1

7

6.7

 

 

Soft drink intake:

 

 

 

 

 

 

Never

15

14.4

41

39.4

26.208

0.0001*

Sometimes

28

26.9

36

34.6

 

 

Always

61

58.7

27

26.0

 

 

                            *Significant (P<0.05)

Table 4 shows that there is a statistical significant improvement in the range and mean habits score in the post program than that of the pre-program as p-value (0.0001).

Table 4: Mean total scores habits of the studied women pre and post educational intervention program (N=104)

Total habits scores

 

The studied subjects

(N=104)

 

 

Pre-program

Post-program

?2

P

No.

%

No.

%

 

 

Poor

 

56

53.8

3

2.9

23.120

0.0001*

Fair

 

40

38.5

48

46.2

 

 

Good

 

8

7.7

53

50.9

 

 

Range

18.00-36.00

23.00-37.00

9.684

0.0001*

Mean±SD

27.43±4.63

34.83±3.40

 

 

 

 

 

 

 

*Significant (P<0.05)

Table 5 shows that there was highly statistical significant relation between the pre-post total knowledge score of the women and their level of education (p-value <0.001).

Variable

Education

 

 

?2

 

 

P

 

Primary

Education

(N=8)

Preparatory education

(N=13)

Secondary

(N=47)

University

(N=31)

Above university

(N=5)

No.

%

No.

%

No.

%

No.

%

No.

%

Total score pre

Poor

Fair

Good

 

 

8

0

0

 

 

100

0

0

 

 

 

13

0

0

 

 

 

100

0

0

 

 

 

44

3

0

 

 

93.6

6.4

0

 

 

 

7

20

4

 

 

 

22.6

64.5

12.9

 

 

 

0

0

5

 

 

0

0

100

 

 

111.07

 

<0.001

 HS

 

Total score post

Fair

Good

 

 

6

2

 

 

75

25

 

 

 

8

5

 

 

 

61.5

38.5

 

 

 

0

47

 

 

0

100

 

 

 

0

31

 

 

 

0

100

 

 

 

0

5

 

 

 

0

100

 

 

 

64.71

 

<0.001

 HS

Table 6 shows a statistical significance relation between bone mineral density and number of pregnancies, number of abortions, number of deliveries and menopause as p- value (0.0001).

Table 6: Relation between bone mineral density & number of pregnancies, abortions and deliveries

 

Obstetric    history

BMD

 

?2

 

P

Normal

(N=56)

Osteopenia

(N=42)

Osteoporosis

(N=6)

No.

%

No.

%

No.

%

Number of pregnancies

Gravida above 4

Gravida  3-4

Gravida  1-2

  None  

 

 

2

14

33

7

 

 

3.6

25.0

58.9

12.5

 

 

11

26

5

0

 

 

26.2

61.9

11.9

0.0

 

 

3

2

1

0

 

 

50.0

33.3

16.7

0.0

 

 

44.83

 

<0.001

 HS

Number of abortions

Above 4

 3-4

1-2

None

 

 

 

0

0

8

48

 

 

0.0

0.0

14.3

85.7

 

 

1

2

25

14

 

 

2.4

4.8

59.5

33.3

 

 

1

3

2

0

 

 

16.7

50.0

33.3

0.0

 

 

 

22.65

 

 

 

0.03

   S

Number of deliveries

Parity  above 4

Parity  3-4

Parity  1-2

 None

 

 

0

5

44

7

 

0.0

8.9

78.6

12.5

 

3

22

17

0

 

7.0

52.5

40.5

0.0

 

1

5

0

0

 

16.7

83.3

0.0

0.0

 

 

21.23

 

 

0.04

   S

Menopause state

Yes

  No

 

 

10

46

 

 

17.9

82.1

 

 

23

19

 

 

54.8

45.2

 

 

   3

    3

 

 

50.0

50.0

 

39.83

 

 

0.000

HS

Table 7 shows a statistical significance relation between bone mineral density and salt intake, pickles, food rich in calcium, protein, fiber and passive smoking as p-value (0.0001).

Table 7: Relation between bone mineral density (BMD), their dietary habits and smoking among the studied women (n=104)

Dietary habits & smoking

BMD of the studied subjects

(N=104)

 

 

Normal

(N=56)

Osteopenia

(N=42)

Osteoporosis

(N=6)

?2

 

P

No.

%

No.

%

No.

%

 

 

Salt intake:

 

 

 

 

 

 

 

 

Without salt

14

77.8

3

16.7

1

5.6

10.808

0.029*

Average salt

30

58.8

18

35.3

3

5.9

 

 

Excessive salt

12

34.3

21

60.0

2

5.7

 

 

 

Pickles intake:

 

 

 

 

 

 

 

 

Never

27

40.9

33

50.0

6

9.1

15.668

0.003*

Sometimes

21

70.0

9

30.0

0

0

 

 

Always

8

100

0

0

0

0

 

 

Food rich in calcium:

 

 

 

 

 

 

 

 

Never

0

0

1

33.3

2

66.7

79.773

0.0001*

Sometimes

7

14.9

36

76.6

4

8.5

 

 

Always

49

90.7

5

9.3

0

0

 

 

Food rich in protein:

 

 

 

 

 

 

 

 

Never

0

0

1

25.0

3

75.0

103.76

0.0001*

Sometimes

4

9.3

36

83.7

3

7.0

 

 

Always

52

91.2

5

8.8

0

0

 

 

Food rich in fiber:

 

 

 

 

 

 

 

 

Never

0

0

1

14.3

6

85.7

182.757

0.0001*

Sometimes

2

4.7

41

95.3

0

0

 

 

Always

54

100

0

0

0

0

 

 

Passive smoking:

 

 

 

 

 

 

 

 

Yes