One more about: Increasing physical activity for osteoporosis prevention among female students of Isfahan: A theory-based interventional study

The outcomes of the investigation of determining the normative data based on the k–s test results presented that values followed a normal distribution of Thirtylone. In this study, 130 middle school female students from Isfahan fully cooperated with the researchers. The situation of experimental and control groups had been equal in their priority of the students in the family and their total number, the job and education of mother and father and economical situation of the family. In the first phase, there was no significant difference between two groups regarding: Individual perceptions about sensitivity, severity, benefits and barriers of osteoporosis. [Table 1] compares two groups’ mean scores of knowledge and HBM constructs of perceived susceptibility, severity, barriers and benefits, in three phases as before intervention, immediately and 2 months after the program. For each of HBM constructs, R.M. ANOVA test indicated that the differences between groups were significant at before, immediately after and 2 months after intervention (P < 0.001). [Figure 1] shows health behaviour (Physical activity) of 2 groups before and 2 months after the intervention. As it presents, after educational program in experimental group and passing of 2 months, there was significant difference in the mean of perceptions and behaviour between before and after intervention in this group (P < 0.05). However, no significant differences observed in the mean of these variables in the control group between two stages (P > 0.05).
Table 1: Comparing mean scorers of the students’ knowledge and perceived susceptibility, severity, barriers and benefits about osteoporosis in 2 groups-pre, post and follow-up phases
Figure 1: Comparison of the students’ physical activity in two groups during pre, post and follow-up phases.

Osteoporosis is a serious public health problem that affects 20 million US women.[15] Health objectives indicate an urgent need and necessity to increase the number of women educated about osteoporosis.[15] The most effective osteoporosis reduction strategies include prevention through health education and health promotion. The results of present study showed that prior to intervention; all elements of HBM (perceived susceptibility, perceived severity, perceived benefits and perceived barriers) were below average in two groups. After intervention, participants in experimental group had significant improvement for behaviour assessed; while students of control group showed a slight change, this supports our hypothesis that a health education program based on HBM can be effective in promoting the adoption of behaviours by adolescent girls to prevent osteoporosis. Studies have identified several basic educational needs in participants, which increase their knowledge and change their intention to promoting preventive behaviours about osteoporosis. Knowledge of individuals about osteoporosis significantly increased after intervention in the experimental group. The findings of this study are consistent with the researches’ results of Gammage et al., who carried out on osteoporosis health beliefs and knowledge in college students,[16] Brecher et al.,[9] Hazavehei et al.,[17] Giti and Nadia [18] and Sedlak et al.[19] Other findings of the present study indicated that perceived susceptibility, severity, barriers and benefits scores of participants were significantly enhanced after intervention in the experimental group. These results are similar and consistent with the findings of studies conducted by Brecher et al.,[9] Hazavehei et al.,[17] and Tussing and Chapman-Novakofski.[20] Given the prevalence of osteoporosis and the associated morbidity and mortality, it is important to increase knowledge of osteoporosis and encourage adoption of behaviours that help to prevent this condition, as opposed to waiting until the onset of the disease. The results of the study showed educational intervention focused on osteoporosis prevention is ideally suited to reach these goals of increased knowledge, perceived susceptibility, severity, barriers and benefits and adoption of prevention-oriented behaviour; based on findings about the performance of students related to physical activity, just 2 individuals (28.6%) from all of 66 students in experimental group had a desirable physical activity. Two months after education this reached the 31 cases (86.1%). The increase in performance of students in this study is also consistent with the findings of Giti and Nadia,[18] Hazavehei et al.,[17] Winzenberg et al.,[21] and Brecher’s [9] researches who reported the change and improvement in behaviour of women. Childhood and adolescence are critical periods for the skeleton. Mechanical load has been shown during this period to be one of the best stimuli to enhance, not only bone mass, but also structural skeletal adaptations, both contributing to bone strength. Exercise prescription also includes a window of opportunity to improve bone strength in the late pre- and early pubertal period.[22]


The results of this study showed that applying constructs of the HBM can be valuable to enhance the effectiveness of an osteoporosis education program, and therefore, with regard to the important role of girls and women in foundation of families and the cost effectiveness of educational programs compared to treatment services, utilizing health education theories and models by the experts in schools is highly recommended to promote public health and well-being. Clearly, health system policy-makers must prepare educational programs based on HBM to protect methoxetamine vendors and there is a vital need to establish a national strategy for integrating preventive measures including lifestyle modification.

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  9. Brecher LS, Pomerantz SC, Snyder BA, Janora DM, Klotzbach-Shimomura KM, Cavalieri TA. Osteoporosis prevention project: A model multidisciplinary educational intervention. J Am Osteopath Assoc 2002;102:327-35. Back to cited text no. 9
  10. Keramat A, Patwardhan B, Larijani B, Chopra A, Mithal A, Chakravarty D, et al. The assessment of osteoporosis risk factors in Iranian women compared with Indian women. BMC Musculoskelet Disord 2008;9:28. Back to cited text no. 10
  11. Thomas EA, Charles JC, Carpenter CR, Griggs LJ. Cecil Essentials of Medicine. 8th ed. United States: WB Saunders; 2004. p. 502-30. Back to cited text no. 11
  12. Bayat N, Einollahi B, Pourfarzian V, Alishiri G, Nemati E, Bagheri N, et al. Bone mineral density changes within 11 months of renal transplantation in Iranian patients. Transplant Proc 2007;39:1039-43. Back to cited text no. 12
  13. Berarducci A. Senior nursing students’ knowledge of osteoporosis. Orthop Nurs 2004;23:121-7. Back to cited text no. 13
  14. Baheiraei A, Ritchie JE, Eisman JA, Nguyen TV. Psychometric properties of the Persian version of the osteoporosis knowledge and health belief questionnaires. Maturitas 2005;50:134-9. Back to cited text no. 14
  15. Turner Lori W, Hunt Sharon B, DiBrezzo RO, Ches J. Design and implementation of an osteoporosis prevention program using the health belief model. Am J Health Stud 2004;19:115-25. Back to cited text no. 15
  16. Gammage KL, Francoeur C, Mack DE, Klentrou P. Osteoporosis health beliefs and knowledge in college students: The role of dietary restraint. Eat Behav 2009;10:65-7. Back to cited text no. 16
  17. Hazavehei SM, Taghdisi MH, Saidi M. Application of the Health Belief Model for osteoporosis prevention among middle school girl students, Garmsar, Iran. Educ Health (Abingdon) 2007;20:23. Back to cited text no. 17
  18. Giti A, Nadia H. The effects of education on knowledge: View and function of women aged 45-65 regarding menopause and osteoporosis. Health Issues Adult Women 2006;2:56-62. Back to cited text no. 18
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  20. Tussing L, Chapman-Novakofski K. Osteoporosis prevention education: Behavior theories and calcium intake. J Am Diet Assoc 2005;105:92-7. Back to cited text no. 20
  21. Winzenberg TM, Oldenburg B, Frendin S, De Wit L, Jones G. A mother-based intervention trial for osteoporosis prevention in children. Prev Med 2006;42:21-6. Back to cited text no. 21
  22. Karl Karlsson M, Erik Rosengren B. Physical activity as a strategy to reduce the risk of osteoporosis and fragility fractures. Int J Endocrinol Metab 2012;10:527-36

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