@2024 Afarand., IRAN

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ISSN: 2383-2150    Journal of Education and Community Health 2018;5(3):48-56

Background
Osteoporosis is the most common chronic metabolic bone disease (MBD) and is characterized by the reduced bone mass and loss of bone microstructure. ... [1, 2].
Previous Studies
... [3-13]. Osteoporosis due to significant economic and social costs is an important health issue, which should be considered by healthcare providers and health organizations. Prevention strategies for osteoporosis should be regarded as a priority in healthcare of the communities [14]. ... [15-19]. Prevention of behavioral factors affecting osteoporosis requires changes in the individuals’ behavior [20], so health education and health promotion theories can be very useful in all three levels of prevention [21]. Transtheoreticlal Model (TTM) developed by Prochaska is one of the health education patterns that can be used by individuals to change behavior. The most important constituent constructs of this model are stages of change (precontemplation, contemplation, preparation, action, and maintenance), decisional balance (perceived barriers and benefits), and self-efficacy (person's perceived ability to perform a task) ... [23].
Aim(s)
The aim of this study was to investigate the osteoporosis preventive behaviors in women based on the TTM.
Research type
This research is a cross sectional descriptive-analytical study.
Research society, place and time
This study was performed on 400 women over 30 years covered by Fasa healthcare centers in 2018.
Sampling method and number
According to the results of the study by Malekshahi et al. [22], the sample size was considered 400 subjects. Samples were randomly selected based on the family health record numbers as well as the inclusion criteria, including those who aged 30 years, lack of rheumatism and mental disorders, fracture, pregnancy, postmenopausal, and lacrimation, and also the informed consent to participate in the study.
Used devices&materials
The participants were invited to the healthcare centers at the same day, at which they were introduced and informed about the study objectives and the informed consent was obtained from the subjects, as well. Data was collected through a researcher-made questionnaire based on the related studies and resources [22, 24, 25]. It measured demographic variables and stages of change, decisional balance (perceived barriers and benefits), and self-efficacy questionnaire, including two parts; physical activity and calcium intake as well as physical functioning (walking) and calcium intake functioning checklist. Demographic variables based on previous studies [22] included age, education, marital status, number of deliveries, occupation, average household income, age of menstruation and menstrual disorder. Stages of physical activity and calcium intake questionnaire was used to measure the stages of behavior change, in which the subjects were assessed in one of the precontemplation, contemplation, preparation stages. The decisional balance of sport questionnaire (benefits and barriers) is a 22-item scale answered by "extremely important", "very important", "important", "a little important", and “not important” and scored from 0 to 4. The minimum score was zero and the maximum was 44. The decisional balance of calcium intake (barriers and benefits) included 14 questions answered by “not important" to "extremely important" scored from 0 to 4. The minimum score was zero and the maximum was 28. The self-efficacy for physical activity questionnaire included 5 questions answered with response choices ranging from “not at all sure” to “very sure" (4-point Likert scale) scored from 0 to 3. The minimum score was zero and the maximum was 15. The next part of the questionnaire included questions on nutrition and walking functioning, the former included eight questions on the type and amount of food intake during the last week (scoring from 0 to 18) and the latter measured type of walking (light-intensity, medium-intensity, and high-intensity) during the last week, according to the guideline (scoring from 0 to 21). The results were collected via self-report. Validity of the questionnaire was measured by impact item index over 0.15 and the content validity index (CVI) over 0.79. Face validity of the scale was evaluated by a list of items developed by 20 women over 30 years and the same demographic, economic and social characteristics as the studied group. The content validity was also determined by asking the 12 experts and professors views (except those in the research team); health education and health promotion (10 experts), orthopedic specialist (one expert) and biostatistics (one expert). The majority of items scored above 0.70. The overall reliability of the scale was 0.89 using Cronbach's alpha. The subjects in the precontemplation, contemplation and preparation stages were placed in the non-action group and those in the action and maintenance placed in the action group (healthy subjects). Data was analyzed by SPSS 22 using Pearson correlation, Chi-square, independent t-test and multiple linear regression analysis.
Findings by Text
The mean age of women was 46.14 ± 5.38 years, mean body mass index (BMI) was 32.23 ± 3.72 kg/m2, the mean delivery numbers was 11.3 ± 1.24, the mean age of menstruation was 14.48 ± 1.238 years and the average household income was 162553427.14±425138.52 Rials (Table 1). A high percentage of subjects were in the non-action phase (those without healthy behaviors), including precontemplation, contemplation, and preparation. In other words, they did not have a favorable status in physical activity and calcium intake (Table 2). There was a direct correlation between calcium intake functioning and calcium self-efficacy (p=0.032, r=0.125) and reverse correlation between perceived barriers of calcium intake (p=0.045, r=-0.187). There was a direct correlation between walking functioning and perceived benefits of walking (p=0.020; r=0.128) and walking self-efficacy (p=0.032; r=0.184), and a reverse correlation between perceived barriers of walking (p=0.04; r=0.102) (Table 3). Age, number of deliveries, education level, occupation and level of income were correlated with walking and calcium intake functioning. Generally, the TTM constructs could predict 28.6% of the variance of walking and 30.2% of the variance of calcium intake to prevent osteoporosis. In addition, self-efficacy was the most powerful predictor construct for walking and calcium intake (Table 4).
Main comparison to the similar studies
The results of stages of change in Malekshahi et al. study showed that 79.9% of women were in the non-action phase (precontemplation, contemplation, and preparation) and 20.1% in the adopting regular physical activity phase (action and maintenance) [22]. The results of Mazlumi et al. study are consistent with the present study [26]. ... [27, 28]. Swaim et al. [29] and Mahdavi et al. [30] reported that there is a positive correlation between self-efficacy and calcium intake in osteoporosis preventive behaviors in women, which is consistent with the present study. Soleimanian et al. [31] BaghianiMoghadam et al. [32] and Malekshahi et al. [22] showed that self-efficacy is one of the most important constructs in predicting walking functioning in preventing osteoporosis in women. ... [33-35]. The results of this study were consistent with the results of BaghianiMoghadam et al. [32] study in decisional balance construct. According to the studies, an increase in the average score of perceived benefits, can 61% lead to move the person to the next stages in TTM [36]. Previous studies also reported that there is no correlation between perceived benefits and calcium intake [37, 38], which is in line with the present study. In contrast, the results of studies by Mahdavi et al. [30] and Khorsandi et al. [39] are not consistent with the present study. In studies by Sayed-Hassan et al. [40], Khani Jeihooni et al. [41] and Mahdavi et al. [30], the perceived barriers were the predictors of calcium intake behavior. ... [42-47].
Suggestions
It is suggested that cohort studies be programmed to identify the cause and effect relationship.
Limitations
The results of the present study should be cautiously generalized, since it was conducted only on women who were referred to the studied healthcare centers.
Conclusions
TTM constructs can predict osteoporosis preventive behaviors in women. The predictive power of self-efficacy for walking behavior and calcium intake is more than other constructs.
Acknowledgments
The researchers are grateful to the Research Deputy of the Fasa University of Medical Sciences and all women participated in the study.
Conflict of interest
None declared.
Ethical Permissions
The present study is a research (ethics code: IR.FUMS.REC.1397.007) approved by the Research Deputy of the Fasa University of Medical Sciences.
Funding Sources
This research was supported by the Fasa University of Medical Sciences.

TABLES and CHARTS

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