Carol A. Sedlak

DXA, Health Beliefs, and Osteoporosis Prevention Behaviors

Objective: This experimental longitudinal study was designed to examine the relationship between having a bone density through dual energy X ray absorptiometry (DXA) and osteoporosis preventing behaviors (OPB) among healthy postmenopausal women. Methods: Subjects were 203 healthy community-based women 50-65 years of age. Mediating variables were general knowledge of osteoporosis and revised health belief model variables. Treatment group women (n = 101) had a DXA screen and control group women (n = 102) did not. Study questionnaires were completed at three time points; initially and at 6 months and 12 months. Results: Repeated measures ANOVA revealed treatment group women scored significantly higher on perceived susceptibility and calcium intake. Wilkss Lambda F revealed a significant difference in use of osteoporosis preventing medications. Discussion: Personal knowledge gained from DXAs increased perceived susceptibility to osteoporosis, calcium intake, and use of osteoporosis preventing medications and appears to be an effective intervention in promoting OPB in younger postmenopausal women.

Osteoporosis in Older Men: Knowledge and Health Beliefs

Purpose: The purpose of this theory‐based descriptive study was to describe older mens (≥65 years of age) knowledge of osteoporosis, their health beliefs about osteoporosis (specifically their perceived susceptibility), their confidence to perform osteoporosis‐prevention behaviors, and actual performance of osteoporosis‐prevention behaviors. Design: A descriptive design was used to determine mens knowledge and health beliefs of osteoporosis, confidence to perform osteoporosis prevention behaviors, and performance of osteoporosis prevention behaviors. Sample: A community‐based convenience sample of 138 men 65 years of age and older was obtained in Northeastern Ohio community centers where men were likely to gather. Method: Men completed a questionnaire that included the Osteoporosis Knowledge Test, Osteoporosis Health Belief Scale, Osteoporosis Self‐Efficacy Scale (Kim, Horan & Gendler, 1991), and the Osteoporosis Preventing Behaviors Survey (Doheny & Sedlak, 1995). Main Research Classifications: Osteoporosis, Men, Prevention, Health Beliefs, Orthopaedic Nursing. Findings: Men had poor knowledge of osteoporosis, did not perceive themselves as susceptible to osteoporosis, and engaged in few osteoporosis preventing behaviors such as weight‐bearing exercises and dietary calcium intake. Conclusion: Men need osteoporosis education and modification of lifestyle to include osteoporosis prevention behaviors. Implications for Nursing Research. Future research should include the development of osteoporosis awareness programs for men.

OSTEOPOROSIS PREVENTION IN YOUNG WOMEN

PURPOSE To assess whether young women who participate in an osteoporosis prevention program based on the Health Belief (Rosenstock, 1966) and Self-Efficacy Models (Bandura, 1977) demonstrate higher levels of knowledge regarding osteoporosis prevention than young women who do not participate in such a program. DESIGN A classic experimental design with one treatment group and one control group was used to test the efficacy of the osteoporosis prevention program. Pretest data on knowledge, health belief attitudes (7 subscales), and self-efficacy (2 subscales) were collected in the treatment and control groups. SAMPLE A convenience sample of 31 young college women were randomly assigned to an experimental group or to a control group to receive an osteoporosis prevention program. METHOD Subjects in the experimental and control groups completed the Osteoporosis Knowledge Test, the Osteoporosis Health Belief Scale, and the Osteoporosis Self-Efficacy Scale (Kim et al., 1991) at two times. The experimental group received an osteoporosis prevention program. MAIN RESEARCH CLASSIFICATIONS Osteoporosis, Health Belief, Self-Efficacy, Womens Health. FINDINGS Subjects in the experimental group had significantly higher knowledge and health belief scores after receiving the intervention than their pretest scores while subjects in the control group had no change in scores. CONCLUSION The osteoporosis program was effective in increasing awareness of osteoporosis prevention in this group of young women. IMPLICATIONS FOR NURSING RESEARCH The results may be useful for developing young womens awareness and knowledge of osteoporosis prevention. Future research could include developing osteoporosis prevention programs at an earlier age when girls are in grade school and junior high school. Teaching health promotion strategies for bone health is essential to all women across the life span.

Osteoporosis Knowledge, Health Beliefs, and DXA T-Scores in Men and Women 50 Years of Age and Older.

PURPOSE To compare the knowledge of osteoporosis, revised health belief model variables (RHBM), and DXA (dual energy x-ray absorptiometry) T-scores among men and women 50 years of age and older. DESIGN This was a secondary analysis that used 218 healthy community-based women 50 to 65 years of age and 226 healthy community-based men ≥50 years of age. Data for women were collected for 18 months during 2001–2003, and data for men were collected for 18 months during 2004–2006. The variables were knowledge of osteoporosis, RHBM variables (susceptibility, seriousness, benefits and barriers of calcium intake and of exercise, health motivation, self-efficacy of calcium intake and exercise), and DXA T-scores. METHOD The women and men completed an osteoporosis questionnaire prior to having a DXA screening test. A total of 190 women and 187 men had DXA scans. FINDINGS More than half of the sample had abnormal bone density scans. Knowledge of osteoporosis was low for women and even lower for men. Seven of the nine health belief variables were associated with gender. Women perceived osteoporosis to be serious and that they were susceptible. Men did not perceive osteoporosis to be serious or that they were susceptible. Men were more health motivated and more confident of their ability to engage in exercise.

Structural model for osteoporosis preventing behavior in postmenopausal women.

Background: Osteoporosis prevention behaviors (OPBs) can prevent and delay bone deterioration; dual-energy X-ray absorptiometry (DXA) scan can identify osteoporosis and provide personal osteoporosis risk information that may promote prevention behaviors. Objectives: This study was designed to estimate relationships between receiving personal knowledge of bone mineral density (gained through DXA scan), general knowledge of osteoporosis, health beliefs, and the two OPBs of calcium intake and weight-bearing exercise in healthy postmenopausal women 50 to 65 years. Methods: In this longitudinal, randomized clinical trial (including covariates), receipt of personal DXA information was manipulated by random assignment to the experimental or control group. The remaining antecedent and outcome variable measures were collected by questionnaire at three time points (initial [T1; pre-DXA], 6 months [T2], 12 months [T3]) and by bone density assessment from 203 women over an 18-month period in 2001-2003. Results: The experimental manipulation (DXA results) had a direct positive effect (&bgr; = .23, p < .05) on calcium intake at T2, and indirectly at T3 through T2. Women in the experimental group who were informed they had osteopenia or osteoporosis had a greater T1-T2 change in daily calcium intake than those with normal bone density (&bgr; = .23, p < .05). However, providing DXA results did not relate to change in exercise. Health beliefs and general osteoporosis knowledge predicted initial calcium and exercise levels; there was tentative evidence that susceptibility beliefs partially mediate between DXA results and change in calcium intake. Discussion: Personal knowledge of DXA results was related significantly to increases in calcium intake in postmenopausal women, but not to exercise. Directions for further study are discussed.

Knowledge and health beliefs of osteoporosis in college nursing students.

PURPOSE: This purpose of this study was to describe college students’ knowledge of osteoporosis, health beliefs regarding osteoporosis, self-efficacy to perform osteoporosis-preventing activities, and actual performance of osteoporosis-preventing activities. METHOD: This descriptive study used a survey method. Participants completed a questionnaire consisting of the Osteoporosis Preventing Behaviors Survey, the Osteoporosis Knowledge Test, the Osteoporosis Health Belief Scale, and the Osteoporosis Self-Efficacy Scale. SAMPLE: One-hundred ninety-four nursing student subjects (86 sophomore students and 108 senior students). RESULTS: Senior students were more knowledgeable about osteoporosis than sophomore students and were more confident about performing osteoporosis-preventing behaviors. There were no significant differences between the groups regarding their health beliefs about osteoporosis, their performance of weight-bearing exercise, dietary calcium intake, or intake of caffeinated products. CONCLUSION: These results may be useful in examining the nursing curricula at colleges of nursing, as well as investigating methods of helping beginning nurses, as health promoters, to make lifestyle changes. This, in turn, may lead to behaviors to prevent osteoporosis in themselves and those for whom they provide care.

Tailored interventions to enhance osteoporosis prevention in women.

PURPOSE The purpose of this pilot study was to determine if tailored nursing interventions based on personal knowledge of bone mineral density from a dual-energy x-ray absorptiometry cause increases in knowledge of osteoporosis, health beliefs, or osteoporosis-prevention behaviors in postmenopausal women 50–65 years of age, 6 months after the intervention. METHOD The design for this pilot study was a two group quasi-experimental design. The treatment group received a tailored intervention; the control group did not. Outcome data were gathered at 6 months after dual-energy x-ray absorptiometry. The tailored intervention was designed and given to each woman via telephone using her dual-energy x-ray absorptiometry results and osteoporosis questionnaire data that addressed her knowledge of osteoporosis and osteoporosis-prevention behaviors of calcium intake, exercise, smoking, and alcohol use. A written mailed copy of the intervention followed the telephone interview. Six months after the intervention, the women were mailed another osteoporosis questionnaire to determine if the tailored intervention made a difference in the outcome variables. SAMPLE A total 124 women between the ages of 50 and 65 (101 control, 23 treatment) comprised the sample. RESULTS There was no difference in knowledge between groups. On the average, there were significantly more perceived barriers to calcium in the tailored group (mean = 13.48) than in the nontailored group (mean = 11.55) (t = 2.147; df = 122; p = .034). There were significantly more perceived barriers to exercise in the tailored group (mean = 14.39) than in the nontailored group (mean = 12.21) (t = .144; df = 122; p = .034). Daily calcium intake increased in both the tailored and the nontailored groups. The tailored intervention increased womens daily calcium intake from 614.28 to 1039.10 mg (t = −2.896; df = 22; p = .008). The nontailored group daily calcium intake increased from 587.91 to 916.30 mg (t = −3.541; df = 100; p = .001); there was no significant difference between the groups. Weight-bearing exercise behaviors decreased from 96.04 minutes to 59.2 minutes in the tailored group but increased slightly in the nontailored group from 81.47 to 87.26 minutes of exercise. CONCLUSION Tailored interventions increased womens perceived barriers to calcium and exercise. Both groups increased calcium intake. The mixed findings of increased perception of barriers to calcium and exercise and decreased exercise behaviors indicate the need for further study. This important intervention has implications for orthopaedic nurses and healthcare professionals involved in health promotion and prevention of osteoporosis.

Structural Model for Osteoporosis Preventing Behavior in Men

This longitudinal study evaluates the effect of bone mineral density screening on calcium intake and daily exercise of 196 healthy men older than 50 years over a period of 1 year. In this randomized clinical trial, the experimental group received personal bone density information via dual-energy X-ray absorptiometry (DXA). The men completed measures addressing knowledge, health beliefs, calcium intake, and exercise behaviors. Outcome measures were collected by a questionnaire at three time points: initial (Time 1 [T1]; pre-DXA), 6 months (Time 2 [T2]), and 12 months (Time 3 [T3]). Using structural equation modeling for data analysis, results indicated that men in the experimental group had a significantly higher T2 calcium intake than the control group, with no additional direct effect at T3. T1 daily calcium intake was significantly predicted by T1 health beliefs. Men with higher levels of health motivation tended to have higher initial levels of daily calcium intake. Personal knowledge of DXA results relate significantly to increased calcium intake.

Development of the National Association of Orthopaedic Nurses guidance statement on safe patient handling and movement in the orthopaedic setting.

High-risk patient-handling tasks lead to work-related musculoskeletal disorders for orthopaedic nurses and other members of the healthcare team who are involved in moving patients with orthopaedic issues. Serious consequences can arise from manually moving/lifting these patients. A task force was organized that included representatives from the National Association of Orthopaedic Nurses, the Patient Safety Center of Inquiry at the James A. Haley Veterans Administration Medical Center in Tampa, the National Institute for Occupational Safety and Health, and the American Nurses Association to identify high-risk tasks performed in the orthopaedic setting and to develop evidence-based solutions to minimize the risk of musculoskeletal disorders. High-risk tasks for moving and lifting orthopaedic patients were identified. Four orthopaedic algorithms and a clinical tool were developed by the task force to direct nurses and healthcare team members caring for orthopaedic patients through the use of scientific evidence and available safe patient-handling equipment and devices.

Navigating the System: How Transgender Individuals Engage in Health Care Services

PURPOSE Transgender individuals (TIs) experience a number of healthcare disparities that result in compromised access to health care, placing them at high risk for poor health outcomes. Despite their unique health concerns, there is little known about how they engage in health care. The purpose of this grounded theory study was to construct a theoretical framework that depicts the process by which transgender individuals engage in health care. METHODS In this grounded theory study, data from interviews with 25 individuals who self-identified as transgender were used to develop a theoretical framework that depicts the process by which TIs engage in health care. Data analysis included open coding, category formation, and theoretical coding. Constant comparative analysis was used to facilitate theory generation. CONCLUSIONS The central phenomenon of how TIs engage in health care was the core process of navigating the system. The core process involves four subprocesses: needing to move forward, doing due diligence, finding loopholes, and making it work. CLINICAL RELEVANCE The theoretical framework of navigating the system can provide healthcare providers with a way to understand how TIs engage in health care as they move through the subprocesses of moving forward, doing due diligence, finding loopholes, and making it work in order to get their healthcare needs met. With a better understanding of the healthcare journeys of TIs, healthcare providers can provide better care for this population and advocate for change in policies that contribute to the health disparities TIs experience.