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Osteoporosis prevention education: Behavior theories and calcium intake

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Abstract

Osteoporosis is a worldwide health concern. Preventing osteoporosis, and subsequent fractures, has become a goal of many health care practitioners, especially dietetics professionals. However, few prevention models have proven effective. The goal of this project was to determine whether an educational, theory-based osteoporosis prevention program would significantly impact calcium intake. This project used a convenience sample of 42 women who participated in an 8-week educational intervention, similarly to a community class. The program included hands-on activities to increase self-efficacy and was based on the Health Belief Model and Theory of Reasoned Action (TRA). The main outcome measures were calcium intake and constructs from the Health Belief Model and TRA. Significant changes in the Health Belief Model and TRA constructs at postintervention included increased perceived susceptibility to osteoporosis (P<.001), perceived benefits to increasing calcium intake (P<.001), and increased self-efficacy related to calcium intake (P≤.003). Statistically significant regression equations were found for all preintervention intentions related to calcium. Postintervention calcium intake significantly increased to 821±372 mg/day (P<.0001). Results of this project can be used as guidelines for dietetics professionals to develop osteoporosis prevention programs for their clientele.

Section snippets

Program development

Prior work in our laboratory identified constructs of both the Theory of Reasoned Action (TRA) (23) and the Health Belief Model (24) as significant in osteoporosis-related behavior. These constructs were used to develop the program content and evaluation tool (25). Each of the eight lessons was based on one of the constructs from either the TRA, Health Belief Model, or both. Each lesson of the 8-week program included a short lecture, hands-on activities to increase self-efficacy or the belief

Results

Overall retention within the program was 82% (n=42). Those who dropped out were not significantly different from those who participated in terms of baseline calcium, but they were significantly younger (51±6 vs 42±8 years, respectively, P≤.05). The participants from the spring and fall intervention groups were pooled for statistical analysis because there were no significant differences in baseline dietary calcium or age. The mean age of the women was 48 years, ranging from 32 to 67 years, and

Discussion

The main outcome variable of this project was dietary calcium intake. Unlike other osteoporosis prevention studies (19, 21), a statistically significant increase in mean dietary calcium was found at postintervention. It should be noted that Sedlak and colleagues (21) provided education as either three 1-hour sessions, one 3-hour session, or one 45-minute session, and each was evaluated 3 weeks after the program. Rolnick and colleagues (19) used a one-time 2-hour educational session, and

Limitations and recommendations

Because of convenience sampling, the results cannot be generalized to the general public. However, such a convenience sample is reflective of the type of client who may participate in a class or community program in that they are interested in the topic, tend to have at least some college education, and tend not to be ethnically diverse (21, 37). Participation as well as results may be very different if participants’ interest in the topic was low, their education was limited, or they were

Conclusions

Several important points emerged from our research that provide applicability to creating successful osteoporosis prevention programs.

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    Using tools such as the Health Belief Model and TRA can help identify areas that need additional emphasis within programs. For instance, the barriers to increasing calcium or exercise may differ depending on the ethnicity or life stage of the participants. Identifying areas that need more emphasis allows the educator to tailor the program and optimize outcomes.

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L. Tussing is a graduate student, Department of Human Nutrition, University of Illinois at Chicago, Chicago, IL, USA; at the time of the study she was a graduate student in nutritional sciences at the University of Illinois, Urbana, IL, USA.

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    • Cited by (0)

    L. Tussing is a graduate student, Department of Human Nutrition, University of Illinois at Chicago, Chicago, IL, USA; at the time of the study she was a graduate student in nutritional sciences at the University of Illinois, Urbana, IL, USA.

    K. Chapman-Novakofski is an associate professor of nutrition and extension specialist, University of Illinois Urbana-Champaign, IL, USA.

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    Copyright © 2005 American Dietetic Association. Published by Elsevier Inc. All rights reserved.