ARTICLE INFO

Article Type

Original Research

Authors

KarimianKakolaki   Zohreh (1)
Eslami   Ahmad Ali (2)
Gerayllo   Sakineh (1)
Heidari   Fatemeh (3*)
Safari Hajataghaie   Sedigheh (1)
Behzadi Goughari   Sanaz (4)






(1) Health Education & Promotion Department, Health Faculty, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
(2) Health Education & Promotion Department, Health Faculty, Isfahan University of Medical Sciences, Isfahan, Iran
(3*) Critical Care Nursing Department, Nursing Faculty, Gerash University of Medical Science, Gerash, Iran
(4) Health Elderly Department, Health Faculty, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

Correspondence

Address: Gerash University Of Medical Science, Daneshjuo Boulevard, Imam Hossein Boulevard, Gerash City, Fars Province, Iran. Postal Code: 7441758666
Phone: 07152448106
Fax: 07152452335
heidari.f20@gmail.com

Article History

Received:  August  6, 2018
Accepted:  September 21, 2018
ePublished:  December 20, 2018

BRIEF TEXT


Osteoporosis is a skeletal disorder characterized by bone loss and the changes in the microscopic structure of bone tissue, which results in fracture and sensitivity. [1].

... [2-4]. Healthy lifestyles, proper nutrition, adequate calcium intake, and physical activity through the growth period play the important role in the prevention of osteoporosis, especially among women [5-7]. In the study by Mohammadi et al., training on the prevention of osteoporosis was associated with the increased awareness and attitude, however no changes were observed in the participants functioning [8]. Khorsandi et al., using the Health Belief Model (HBM), investigated the functioning of pregnant women in preventing osteoporosis. They showed that an educational program based on HBM can be recommended to increase the sensitivity and perceived severity as well as to increase self-efficacy and perceived benefits compared with traditional methods [9]. Several studies have examined the benefits of e-learning in comparison with traditional education [10-12]. The increased awareness, accessibility, interesting and useful, easy to be transferred, repeatability, and low cost are some of the advantages e-learning [13, 14]. Vahedian Shahroodi et al. study on the prediction of osteoporosis prevention behaviors using HBM showed that the perceived barriers construct in calcium intake and self-efficacy construct in physical activity are powerful predictors [15].

The present study was conducted with the aim of determining the effect of education through the Telegram network on increasing the self-efficacy in osteoporosis prevention in women.

The present study is a semi-experimental research with pre-test post-test with randomized control group design.

This study was conducted on 60 women referring to the health centers of the Yazd countryside in 2017.

The sample size for each group was estimated to be 27 subjects, according to a similar study by Khani Jeihooni et al. [6]. 30 subjects were considered for each group due to a 10% possible reduction, so a total of 60 participants were selected to participate in the study. Sampling was done based on random cluster sampling method and the samples were selected from two random health centers in Yazd countryside (due to class and regional distinctions). Those who referred to the health centers were invited to participate in the study. The centers were randomly divided into the intervention and control groups.

Data was collected using a part of questionnaire developed by Baghiani Moghadam et al. [16], including demographic information (age, education, and occupation) as well as 7 questions on self-efficacy, which was completed by self-report. Self-efficacy questions assessed how a person is able to have a lifestyle for preventive of osteoporosis on a 4-point Likert scale (1-not at all, 2-a little, 3-moderately, and 4-very). The participants were informed about the study objectives and its methodology prior study and their consents were obtained and they were invited to participate in the study. The questionnaires were completed and the educational programs to increase self-efficacy in the prevention of osteoporosis were sent for the participants in the intervention group through a telegram channel, whereas the control group did not receive any training. The questionnaires were completed again by the participants one month after the intervention. Educational programs were provided to the control group for ethical considerations at the end of intervention and the post-test. Educational programs were designed based on the recommendations by the World Health Organization [17], including the introducing osteoporosis, effective factors, its symptoms and complications as well as and preventive recommendations, including diet, vitamin D supplementation, physical activity, exposure to sunlight and no smoking. Several images illustrating complications of osteoporosis were also provided. 40 messages were sent via the telegram network. The questionnaires were collected and data was analyzed by SPSS 18 using Chi-square, paired T-test and independent t-test. In addition, Kolmogorov-Smironov test was used to assess the normality.

The mean age of the women in the intervention group and the control group was 30.46±5.71 and 29.93±5.02 years, respectively. There was not a significant difference in the demographic variables of the intervention and control groups and both groups were homogeneous (Table 1).After intervention, the mean score of self-efficacy increased in intervention group compared with the control group (p<0.001). In addition, the difference between the mean score of self-efficacy before and after training in the intervention group (1.77 ± 2. 59) and control group (-0.46 ± 1.03) also showed that the mean of self-efficacy score after training in the intervention group increased, whereas it was decreased in the control group, which was statistically significant (p<0.001; Table 2).Studying the mean scores of the self-efficacy questions on prevention of osteoporosis in the intervention group showed that the ability to take calcium and vitamin D supplements (p=0.032), being exposed to the sun for 15 min (p=0.005) and avoidance of carbonated drinks (p=0.001) significantly increased after training. Among the self-efficacy questions, the ability to have a diet rich in dairy and vegetables, weight loss, regular exercise, and ability to avoid smoking or smoke did not change significantly (Table 3).

The study by Kargar et al. on the effect of education on prevention of osteoporosis by health staff and peers on self-efficacy in adolescents with nephrotic syndrome showed that the average self-efficacy score increased 30-40 units through one month after training in both groups, whereas there was no significant difference between the peer group and health staff [18]. Ebadi Fard Azar et al. study on the effect of HBM on preventive behaviors of osteoporosis in women showed that self-efficacy was significantly increased after the intervention, and the mean score of self-efficacy in the intervention group after training increased from 75.6 to 91.72. They used four training sessions with question and answer and group discussions methods [19]. Khani Jeihooni et al. study on the effect of osteoporosis prevention program showed that the self-efficacy increased after training, and the mean score before training, increased from 7.68 to 10.93 and 15.87 after intervention and after six months after intervention, respectively. In this study, the training program included training sessions by researchers and five public health experts [6]. Keramat et al. emphasized the influence of environmental factors, such as nutrition, exercise, and exposure to sunlight on osteoporosis [20].

It is recommended to design and install the application on the osteoporosis prevention education in future studies.

Working with telegram network had some difficulties, including the limited access to the program by participants, which was resolved through communication by subjects to make sure that they are able to access the massages.

Education via Telegram can be effective in promoting the self-efficacy of women in preventing osteoporosis, and especially with regard to the use of calcium supplements and vitamin D, exposure to sunlight, and avoiding carbonated beverages, self-efficacy of women is increased. However, regarding the self-efficacy for dairy and vegetarian diets, weight loss, regular exercise, and the avoidance of smoking are not effective, and it is necessary to create cultural, environmental, and economic conditions along with the education of family guardians.

The researchers are thankful to the head of the faculty and all those who accompanied us to this research.

None declared.

The present study was approved by the Ethics Committee of Shahid Sadoughi University of Medical Sciences in Yazd (ethics code: IR.SSU.REC.1395.111).

This study was approved by the School of Public Health, Shahid Sadoughi University of Medical Sciences in Yazd.

TABLES and CHARTS

Show attach file


CITIATION LINKS

[1]Kanis JA, Melton LJ, Christiansen C, Johnston CC, Khaltaev N. The diagnosis of osteoporosis. J Bone Miner Res. 1994;9(8):1137-41.
[2]Kanis J. Assessment of osteoporosis at the primary health-care level. WHO Scientific Group Technical Report. Univ Sheffield. 2007:1-337.
[3] Bagheri P, Haghdoost AA, Dortaj Rabari E, Halimi L, Vafaei Z, Farhangnia M, Shayan L. Ultra analysis of prevalence of osteoporosis in Iranian women “a systematic review and meta-analysis”. Iran J Endocrinol Metabol. 2011;13(3):315-25. [Persian]
[4]Derakhshan S, Salehi R, Reshadmanesh N. Prevalence of osteoporosis, osteopenia and their related factors in post-menopausal women referring to Kurdistan densitometry center. Scientific J Kurdistan Univ Med Sci. 2006;11(2):59-67. [Persian]
[5]Merav Ben-Natan RN, Heyman N, Ben Israel J. Evaluation of osteoporosis educational program on elders who sustained an osteoporotic fracture. Int J Caring Sci. 2014;7(2):602-9.
[6] Khani Jeihooni A, Hidarnia AR, Kaveh MH, Hajizadeh E. The effect of a prevention program based on health belief model on osteoporosis. J Res Health Sci. 2015;15(1):47-53.
[7] Shojaezadeh D, Sadeghi R, Tarrahi MJ, Asadi M, Lashgarara B. Application of health belief model in prevention of osteoporosis in volunteers of Khorramabad City Health Centers, Iran. Health Syst Res. 2012;8(2):183-92. [Persian]
[8]Mohammadi S, Ghofranipour F, Gholami Fesharaki M. The effect of osteoporosis prevention education on knowledge, attitude and behavior of adolescent female students in Kermanshah, Iran. J Educ Community Health. 2015;2(2):47-55. [Persian]
[9]Khorsandi M, Shamsi M, Jahani F. The survey of practice about prevention of osteoporosis based on health belief model in pregnant women in Arak City. J Rafsanjan Univ Med Sci. 2013;12(1):35-46. [Persian]
[10] Heber E, Ebert DD, Lehr D, Nobis S, Berking M, Riper H. Efficacy and cost-effectiveness of a web-based and mobile stress-management intervention for employees: design of a randomized controlled trial. BMC Public Health. 2013;13(1):1-12.
[11]Lim T, Fadzil M, Mansor N. Mobile learning via SMS at Open University Malaysia: Equitable, effective, and sustainable. Int Rev Res Open Distrib Learn. 2011;12(2):122-37.
[12]Rezai Rad M, Mohammadi Atargaleh R. Assessing the role of applying e-learning in the training and learning process from faculty members΄ point of view at Payam Noor University, Mazandaran. Interdiscip J Virtual Learn Med Sci. 2012;3(3):1-2. [Persian]
[13]Sheikh Abumasoudi R, Soltani Mollayaghoobi N. Comparison the Effect of Electronic Learning and Teaching Based on Lecture on Knowledge of Nursing Students about Heart Dysrhythmias in 2014: A Short Report. J Rafsanjan Univ Med Sci. 2015;14(4):339-44. [Persian]
[14]Absavaran M, Niknami Sh, Zareban I. Effect of training through lecture and mobile phone on breast self-examination among nurses of Zabol Hospitals. Payesh. 2015;14(3):363-73. [Persian]
[15]Vahedian Shahroodi M, La’l Monfared E, Esmaeili H, Tehrani H, Mohaddes Hakkak HR. Prediction of osteoporosis preventive behaviors using the health belief model. Iran J Health Educ Health Promot. 2014;2(3):199-207. [Persian]
[16]Baghiani Moghadam MH, Khabiri F, Morovati Sharifabad MA, Dehghan A, Falahzadeh H. Determination of social variables affected the health belief model in adopting preventive behaviors of osteoporosis. Toloo-e-behdasht. 2016;15(2):45-57. [Persian]
[17]Prentice A. Diet, nutrition and the prevention of osteoporosis. Public Health Nutr. 2004;7(1A):227-43.
[18]Kargar M, Jamali Moghadam N, Moattari M. The effect of osteoporosis prevention education by peers and health personnel on self-efficacy of adolescents with Nephrotic Syndrome. Iran J Nurs. 2013;26(81):44-53. [Persian]
[19] Ebadi Fard Azar F, Solhi M, Zohoor A, Ali Hosseini M. The effect of health belief model on promoting preventive behaviors of osteoporosis among rural women of Malayer. J Qazvin Univ Med Sci. 2012;16(2):58-64. [Persian]
[20]Keramat A, Larijani B, Adibi H, Hoseinnejad A, Chopra A, Ptoardahan B. Risk factors for osteoporosis in urban Iranian postmenopausal women (A center based study). J Knowledge Health. 2007;2(3):36-41. [Persian]