@2024 Afarand., IRAN
ISSN: 2383-2150 Journal of Education and Community Health 2018;5(3):48-56
ISSN: 2383-2150 Journal of Education and Community Health 2018;5(3):48-56
Predictors of Osteoporosis Preventive Behaviors among Women: An Application of the Transtheoretical Model
ARTICLE INFO
Article Type
Descriptive & Survey StudyAuthors
Etehadnezhad Sajad (1)Moradi Zahra (2)
Kashfi Mansour (3)
Khani-jeihooni Ali (4*)
Khiyali Zahra (4)
(1) General Physician Department, Medicine Faculty, Fasa University of Medical Sciences, Fasa, Iran
(2) Nursing Department, Nursing Faculty, Fasa University of Medical Sciences, Fasa, Iran
(3) Public Health Department, Health Faculty, Shiraz University of Medical Sciences, Shiraz, Iran
(4*) Public Health Department, Health Faculty, Fasa University of Medical Sciences, Fasa, Iran
Correspondence
Address: Fasa University of Medical Sciences, Ibn Sina Square, Fasa, Iran. Postal Code: 7461686688Phone: 07153316324
Fax: 07153357091
khani_1512@yahoo.com
Article History
Received: May 29, 2018Accepted: October 14, 2018
ePublished: December 20, 2018
ABSTRACT
Aims
Behavioral change is one of the most powerful strategies for preventing osteoporosis .The aim of this study was to investigate the osteoporosis preventive behaviors in women based on the transtheoretical model.
Instrument & Methods This cross sectional descriptive-analytical study was performed on 400 women over 30 years covered by Fasa health care centers in 2018 that were selected by simple random sampling. The instruments of data collection included a personal information questionnaire, awareness, change stages, decision-making balance, self-efficacy in two parts of physical activity and dietary calcium, and a calcium intake questionnaire, as well as a checklist for physical activity and calcium intake performance. The data were analyzed by SPSS 22 software, using Pearson correlation coefficient, Chi-square, independent t-test, and multiple regression analysis.
Findings The majority of the participants were involved with calcium intake performance (41.25%) and walking (46.25%) at the precontemplation stage. There was a direct correlation between calcium intake performance and self-efficacy of calcium intake (p=0.032; r=0.125) and an inverse correlation with perceived barriers of calcium intake (p=0.045; r=-0.187). There was a direct correlation between walking performance with exercise benefits (p=0.020; r=0.128) and exercise self-efficacy (p=0.032; r=0.184), and a reverse correlation with perceived barriers of exercise (p=0.040; r=-0.102). Totally, the variables under the study predicted 28.6% of the variance in walking and 30.2% of the variance in calcium intake behavior.
Conclusion Transtheoretical model structures can predict osteoporosis preventive behaviors in women. The predictive power of self-efficacy for walking behavior and calcium intake is more than other structures.
Instrument & Methods This cross sectional descriptive-analytical study was performed on 400 women over 30 years covered by Fasa health care centers in 2018 that were selected by simple random sampling. The instruments of data collection included a personal information questionnaire, awareness, change stages, decision-making balance, self-efficacy in two parts of physical activity and dietary calcium, and a calcium intake questionnaire, as well as a checklist for physical activity and calcium intake performance. The data were analyzed by SPSS 22 software, using Pearson correlation coefficient, Chi-square, independent t-test, and multiple regression analysis.
Findings The majority of the participants were involved with calcium intake performance (41.25%) and walking (46.25%) at the precontemplation stage. There was a direct correlation between calcium intake performance and self-efficacy of calcium intake (p=0.032; r=0.125) and an inverse correlation with perceived barriers of calcium intake (p=0.045; r=-0.187). There was a direct correlation between walking performance with exercise benefits (p=0.020; r=0.128) and exercise self-efficacy (p=0.032; r=0.184), and a reverse correlation with perceived barriers of exercise (p=0.040; r=-0.102). Totally, the variables under the study predicted 28.6% of the variance in walking and 30.2% of the variance in calcium intake behavior.
Conclusion Transtheoretical model structures can predict osteoporosis preventive behaviors in women. The predictive power of self-efficacy for walking behavior and calcium intake is more than other structures.
Keywords:
Behavior,
Preventive Care ,
Osteoporosis ,
Transtheoretical Model of Behavior Change,
Women ,
CITATION LINKS
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[20]Araban M, Tavafian SS, Mitesaddi Zarandi S, et al. Predictors of air pollution exposure behavior among pregnant women: a trans-theoretical model - based study. J Knowledge Health. 2013;8(2):83-88. [Persian]
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[24]Prevention disease office, ministry of health and medical education. Guide to diagnosis, prevention and treatment of osteoporosis. Tehran: Pub Centered Prevention Disease; 2009.
[25]Khani Jeihooni A, Askari A, Kashfi SM, Khiyali Z, Kashfi SH, Safari O, et al. Application of health belief model in prevention of osteoporosis among primary school girl students. Int J Pediatr. 2017;5(11):6017-29.
[26]Mazloumi Mahmoudabad SS, Mohammadi M, Morovati Sharifabad MA. Exercise and its relation to self-efficacy based on stages of change model in employees of Yazd in 2008. J Kerman Univ Med Sci. 2010;17(4):346-54. [Persian]
[27]Moeini B, Hezavei SMM, Jalilian M, Moghimbeigi A, Tarighseresht N. Factors affecting physical activity and metabolic control in type 2 diabetic women referred to the diabetes research center of Hamadan: applying trans-theoretical model. Avicenna J Clin Med. 2011;18(2):31-37. [Persian]
[28]Mohamadzadeh Sh, Rajab A, Mahmoodi M, Adili F. Assessment of effect of applying the trans-theoretical model to physical activity on health indexes of diabetic type 2 patients. Med Sci J Islamic Azad Univ. 2008;18(1):21-27. [Persian]
[29]Swaim RA, Barner JC, Brown CM. The relationship of calcium intake and exercise to osteoporosis health beliefs in postmenopausal women. Res Soc Adm Pharm. 2008;4(2):153-63.
[30]Mahdavi Sh, Karimzadeh shirazi K, Malekzadeh JM, Fararooei M. Preventing of osteoporosis: applying the health belief model. Adv Nurs Midwifery. 2014;24(87):15-22. [Persian]
[31] Soleimanian A, Niknami Sh, Hajizadeh E, Shojaeezadeh D, Tavousi M. Predictors of physical activity to prevent osteoporosis based on extended Health Belief Model. Payesh. 2014;13(3):313-20. [Persian]
[32]BaghianiMoghadam 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]
[33]Tierney S, Elwers H, Sange C, Mamas M, Rutter MK, Gibson M, Neyses L, Deaton C. What influences physical activity in people with heart failure? A qualitative study. Int J Nurs Stud. 2011;48(10):1234-43.
[34] Kaveh MH, Golij M, Nazari M, Mazloom Z, Rezaeian Zadeh A. Effects of an osteoporosis prevention training program on physical activity-related stages of change and self-efficacy among university students, Shiraz, Iran: a randomized clinical trial. J Adv Med Educ Prof. 2014;2(4): 158-64.
[35]Glanz K, Rimer BK, Viswanath K. Health behavior and health education: theory, research, and practice. 4th Edition. New Jersey: John Wiley and Sons; 2008. p. 40.
[36]Charkazi A, Daneshnia M, Mirkarimi K, Pahlevanzadeh B, Bahador E, Dehghan H, et al . Decisional balance and its relationship with stages of change in exercise behavior among employees of Gorgan: A cross-sectional study. J Clin Basic Res. 2017;1(2):8-15. [Persian]
[37]Tsai M. The relationship between osteoporosis knowledge, beliefs and dietary calcium intake among South Asian women in Auckland [Dissertation]. Auckland, New Zealand: Science in Human Nutrition at Massey University; 2008.
[38]Estok PJ, Sedlak CA, Doheny MO, Hall R. Structural model for osteoporosis preventing behavior in postmenopausal women. Nurs Res. 2007;56(3):148-58.
[39]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]
[40]Sayed-Hassan R, Bashour H, Koudsi A. Osteoporosis knowledge and attitudes: a cross-sectional study among female nursing school students in Damascus. Arch Osteoporos. 2013;8(1-2):1-8.
[41]Khani Jeihooni A, Hidarnia A, Kaveh MH, Hajizadeh E, Askari A. Application of the health belief model and social cognitive theory for osteoporosis preventive nutritional behaviors in a sample of Iranian women. Iran J Nurs Midwifery Res. 2016;21(2):131-41.
[42] Amiri S, Keshtkar A, Aghaie Meybodi H, Larijan B, Nabipoor I, Heshmat R, et al. Relationship between tea drinking and bone mineral density in Bushehr population. Zahedan J Res Med Sci. 2011;13(4):18-23 [Persian]
[43] Kamran A, Heydari H. Predictive Power of the Trans Theoretical Model for Physical Activity in Patients with Diabetic Patients. J Health. 2015;6(4):388-403. [Persian]
[44]Zhao G, Ford ES, Li C, Balluz LS. Physical activity in U.S. older adults with diabetes mellitus: prevalence and correlates of meeting physical activity recommendations. J Am Geriatr Soc. 2011;59(1):132-9.
[45]Mossalanejad L, Shahsavari S. Calcium intake and bone mineral densitometry in patient referring to Shiraz bone densitometry center (2003). J Rafsanjan Univ Med Sci. 2005;4(3):146-51. [Persian]
[46]Khani Jeihooni A, Hidarnia A, Kaveh MH, Hajizadeh E, Gholami T. Survey of osteoporosis preventive behaviors among women in Fasa: The application of the health belief model and social cognitive theory. Iran South Med J. 2016;19(1):48-62. [Persian]
[47]Menshavi F, Azari A, Kouhpayehzadeh J, Ghasemi M. Knowledge, attitude and practice of osteoporosis among a group of Iranian adolescent females (2007). J Mod Rehibilit. 2009;2(3 and 4):47-54. [Persian]
[2]Solomon DH, Finkelstein JS, Polinski JM, et al. A randomized controlled trial of mailed osteoporosis education to older adults. Osteoporos Int. 2006;17(5):760-7.
[3]Kasper DL, Braunwald E, Hauser S, Dan Longo D, Jameson JL, Anthony S. Fauci AS. Harrison’s principles of internal medicine. 16th Edition. New York: McGraw-Hill; 2005.
[4]Gerber LM, Bener A, Al-Ali HM, Hammoudeh M, Liu LQ, Verjee MA. Bone mineral density in midlife women: the study of women's health in Qatar. Climacteric 2014;18(2):1-15.
[5]Muir JM, Ye C, Bhandari M, Adachi JD, Thabane L. The effect of regular physical activity on bone mineral density in post-menopausal women aged 75 and over: a retrospective analysis from the Canadian multicentre osteoporosis study. BMC Musculoskelet Disord. 2013;14:1-9.
[6]Acar B, Ozay AC, Ozay OE, Okyay E, Sisman AR, Ozaksoy D. Evaluation of thyroid function status among postmenopausal women with and without osteoporosis. Int J Gynaecol Obstet. 2016;134(1):53-7.
[7]Castro JP, Joseph LA, Shin JJ, Arora S, Nicasio J, Shatzkes J, et al. Differential effect of obesity on bone mineral density in white, Hispanic and African American women:a cross sectional study. Nutr Metab (Lond). 2005;2(1):2-9.
[8]Shirazi KK, Wallace LM, Niknami S, Hidarnia A, Torkaman G, Gilchrist M, Faghihzadeh S. A home-based, trans-theoretical change model designed strength training intervention to increase exercise to prevent osteoporosis in Iranian women aged 40-65 years: a randomized controlled trial. Health Educ Res. 2007;22(3):305-17.
[9]Bayat N, Hajiamini Z, Alishiri Gh.H, Paidar M, Ebadi A, Parandeh A. Risk factors of low bone mineral density in premenopausal women. J Milit Med. 2010;12(1):1-6. [Persian]
[10]Pajouhi M, Komeylian Z, Sedaghat M, Baradar Jalili R, Soltani A, Larijani B. Efficacy of educational pamphlets for improvement of knowledge and practice in patients with osteoporosis. Payesh. 2004;3(1):71-8. [Persian]
[11]Hemmati F, Sarokhani D, Sayehmiri K, Motadayen M. Prevalence of osteoporosis in postmenopausal women in Iran: a systematic review and meta-analysis. Iran J Obstet Gynecol Infertil. 2018;21(3):90-102. [Persian]
[12]Nobakht Motlagh B, Khani Jeihooni A, Hidarnia AR, Kaveh MH, Hajizadeh E, Babaei Heydarabadi A, Hemmati R. Prevalence of osteoporosis and its related factors in women referred to Fasa densitometry center. J Ilam Univ Med Sci. 2013;21(4):150-8. [Persian]
[13] Vaasanthi PA, Radha S, Nambisan B. Prevalence and determinants of osteoporosis in women aged 40-60 years. Int J Reprod Contracept Obstet Gynecol 2016;5(12):4434-40.
[14]Howard WJ. A critical review of the role of targeted education for osteoporosis prevention. Orthop Nurs. 2001;5:131-5.
[15]Turner L, Hunt SB, Dibrezzo RO, Jones C. Design and implementation of an osteoporosis prevention program using the health belief model. Am Health J Stud. 2004;19(2):115-21.
[16]Sarah L, Morgan MD. Calcium and vitamin D in osteoporosis. Rheum Dis Clin North Am. 2001;27(1):101-30.
[17]Henderson K, White CP, Eisman JA. The roles of exercises and fall risk reduction in the prevention of osteoporosis. Endocrinol Metab Clin North Am. 1998;27(2):369-87.
[18]Kelley GA, Kelley KS, Tran ZV. Resistance training and bone mineral density in women: a meta-analysis of controlled trials. Am J Phys Med Rehabil. 2001;80(1):65-77.
[19]Baheiraei A, Ritchie JE, Eisman JA, Nguyen TV. Psychometric properties of the Persian version of the osteoporosis knowledge and health belief questionnaires. Maturitas. 2005;50(2):134-9.
[20]Araban M, Tavafian SS, Mitesaddi Zarandi S, et al. Predictors of air pollution exposure behavior among pregnant women: a trans-theoretical model - based study. J Knowledge Health. 2013;8(2):83-88. [Persian]
[21]Parker EA, Baldwin GT, Israel B, Salinas M. Application of health promotion theories and models for environmental health. Health Educ Behav. 2004;31(4):491-509.
[22]Malekshahi F, Hidarnia A, Niknami Sh, Aminshokravi F, Fallahi Sh, Pournia Y. Using Construct of the trans-theoretical model to physical activity behavior in osteoporosis prevention: a theory-based study. Indian J Fundam Appl Life Sci. 2015;5(S2):1169-1179. [Persian]
[23]Bock BC, Marcus BH, Pinto BM, Forsyth LH. Maintenance of physical activity following an individualized motivationally tailored intervention. Ann Behav Med. 2001;23(2):79-87.
[24]Prevention disease office, ministry of health and medical education. Guide to diagnosis, prevention and treatment of osteoporosis. Tehran: Pub Centered Prevention Disease; 2009.
[25]Khani Jeihooni A, Askari A, Kashfi SM, Khiyali Z, Kashfi SH, Safari O, et al. Application of health belief model in prevention of osteoporosis among primary school girl students. Int J Pediatr. 2017;5(11):6017-29.
[26]Mazloumi Mahmoudabad SS, Mohammadi M, Morovati Sharifabad MA. Exercise and its relation to self-efficacy based on stages of change model in employees of Yazd in 2008. J Kerman Univ Med Sci. 2010;17(4):346-54. [Persian]
[27]Moeini B, Hezavei SMM, Jalilian M, Moghimbeigi A, Tarighseresht N. Factors affecting physical activity and metabolic control in type 2 diabetic women referred to the diabetes research center of Hamadan: applying trans-theoretical model. Avicenna J Clin Med. 2011;18(2):31-37. [Persian]
[28]Mohamadzadeh Sh, Rajab A, Mahmoodi M, Adili F. Assessment of effect of applying the trans-theoretical model to physical activity on health indexes of diabetic type 2 patients. Med Sci J Islamic Azad Univ. 2008;18(1):21-27. [Persian]
[29]Swaim RA, Barner JC, Brown CM. The relationship of calcium intake and exercise to osteoporosis health beliefs in postmenopausal women. Res Soc Adm Pharm. 2008;4(2):153-63.
[30]Mahdavi Sh, Karimzadeh shirazi K, Malekzadeh JM, Fararooei M. Preventing of osteoporosis: applying the health belief model. Adv Nurs Midwifery. 2014;24(87):15-22. [Persian]
[31] Soleimanian A, Niknami Sh, Hajizadeh E, Shojaeezadeh D, Tavousi M. Predictors of physical activity to prevent osteoporosis based on extended Health Belief Model. Payesh. 2014;13(3):313-20. [Persian]
[32]BaghianiMoghadam 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]
[33]Tierney S, Elwers H, Sange C, Mamas M, Rutter MK, Gibson M, Neyses L, Deaton C. What influences physical activity in people with heart failure? A qualitative study. Int J Nurs Stud. 2011;48(10):1234-43.
[34] Kaveh MH, Golij M, Nazari M, Mazloom Z, Rezaeian Zadeh A. Effects of an osteoporosis prevention training program on physical activity-related stages of change and self-efficacy among university students, Shiraz, Iran: a randomized clinical trial. J Adv Med Educ Prof. 2014;2(4): 158-64.
[35]Glanz K, Rimer BK, Viswanath K. Health behavior and health education: theory, research, and practice. 4th Edition. New Jersey: John Wiley and Sons; 2008. p. 40.
[36]Charkazi A, Daneshnia M, Mirkarimi K, Pahlevanzadeh B, Bahador E, Dehghan H, et al . Decisional balance and its relationship with stages of change in exercise behavior among employees of Gorgan: A cross-sectional study. J Clin Basic Res. 2017;1(2):8-15. [Persian]
[37]Tsai M. The relationship between osteoporosis knowledge, beliefs and dietary calcium intake among South Asian women in Auckland [Dissertation]. Auckland, New Zealand: Science in Human Nutrition at Massey University; 2008.
[38]Estok PJ, Sedlak CA, Doheny MO, Hall R. Structural model for osteoporosis preventing behavior in postmenopausal women. Nurs Res. 2007;56(3):148-58.
[39]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]
[40]Sayed-Hassan R, Bashour H, Koudsi A. Osteoporosis knowledge and attitudes: a cross-sectional study among female nursing school students in Damascus. Arch Osteoporos. 2013;8(1-2):1-8.
[41]Khani Jeihooni A, Hidarnia A, Kaveh MH, Hajizadeh E, Askari A. Application of the health belief model and social cognitive theory for osteoporosis preventive nutritional behaviors in a sample of Iranian women. Iran J Nurs Midwifery Res. 2016;21(2):131-41.
[42] Amiri S, Keshtkar A, Aghaie Meybodi H, Larijan B, Nabipoor I, Heshmat R, et al. Relationship between tea drinking and bone mineral density in Bushehr population. Zahedan J Res Med Sci. 2011;13(4):18-23 [Persian]
[43] Kamran A, Heydari H. Predictive Power of the Trans Theoretical Model for Physical Activity in Patients with Diabetic Patients. J Health. 2015;6(4):388-403. [Persian]
[44]Zhao G, Ford ES, Li C, Balluz LS. Physical activity in U.S. older adults with diabetes mellitus: prevalence and correlates of meeting physical activity recommendations. J Am Geriatr Soc. 2011;59(1):132-9.
[45]Mossalanejad L, Shahsavari S. Calcium intake and bone mineral densitometry in patient referring to Shiraz bone densitometry center (2003). J Rafsanjan Univ Med Sci. 2005;4(3):146-51. [Persian]
[46]Khani Jeihooni A, Hidarnia A, Kaveh MH, Hajizadeh E, Gholami T. Survey of osteoporosis preventive behaviors among women in Fasa: The application of the health belief model and social cognitive theory. Iran South Med J. 2016;19(1):48-62. [Persian]
[47]Menshavi F, Azari A, Kouhpayehzadeh J, Ghasemi M. Knowledge, attitude and practice of osteoporosis among a group of Iranian adolescent females (2007). J Mod Rehibilit. 2009;2(3 and 4):47-54. [Persian]