Application of the health belief model and social cognitive theory for osteoporosis preventive nutritional behaviors in a sample of Iranian women

Ali Khani Jeihooni, Alireza Hidarnia, Mohammad Hossein Kaveh, Ebrahim Hajizadeh, Alireza Askari

Abstract


Background: Osteoporosis is the most common metabolic bone disease. The purpose of this study is to investigate the health belief model (HBM) and social cognitive theory (SCT) for osteoporosis preventive nutritional behaviors in women.

Materials and Methods: In this quasi‑experimental study, 120 patients who were women and registered under the health centers in Fasa City, Fars Province, Iran were selected. A questionnaire consisting of HBM constructs and the constructs of self‑regulation and social support from SCT was used to measure nutrition performance. Bone mineral density was recorded at the lumbar spine and femur. The intervention for the experimental group included 10 educational sessions of 55–60 min of speech, group discussion, questions and answers, as well as posters and educational pamphlets, film screenings, and PowerPoint displays. Data were analyzed using SPSS 19 via Chi‑square test, independent t‑test, and repeated measures analysis of variance (ANOVA) at a significance level of 0.05.

Results: After intervention, the experimental group showed a significant increase in the HBM constructs, self‑regulation, social support, and nutrition performance, compared to the control group. Six months after the intervention, the value of lumbar spine bone mineral density (BMD) T‑score increased to 0.127 in the experimental group, while it reduced to −0.043 in the control group. The value of the hip BMD T‑score increased to 0.125 in the intervention group, but it decreased to −0.028 in the control group.

Conclusions: This study showed the effectiveness of HBM and constructs of self‑regulation and social support on adoption of nutrition behaviors and increase in the bone density to prevent osteoporosis.

 


Keywords


Health belief model; Iran; nutrition; nutritional status; self‑regulation; social cognitive theory; social support

Full Text:

PDF

References


Stubbs B. Osteoporosis and falls: Some further considerations for the nursing profession. Br J Nurs 2010;19:1431.

Korpelainen R, Keinänen‑Kiukaanniemi S, Nieminen P, Heikkinen J, Väänänen K, Korpelainen J. Long‑term outcomes of exercise: Follow‑up of a randomized trial in older women with osteopenia. Arch Intern Med 2010;170:1548‑56.

Mazor KM, Velten S, Andrade SE, Yood RA. Older women’s views

about prescription osteoporosis medication: A cross‑sectional,

qualitative study. Drugs Aging 2010;27:999‑1008.

Berry SD, Misra D, Hannan MT, Kiel DP. Low acceptance of

treatment in the elderly for the secondary prevention of

osteoporotic fracture in the acute rehabilitation setting. Aging Clin Exp Res 2010;22:231‑7.

Anonymous Osteoporosis; Research Conducted at Veterans Affairs Medical Center has updated our Knowledge about

Osteoporosis. Obesity, Fitness and Wellness Week. Vol. 20. Atlanta: Veterans Affairs Medical Center; 2010. p. 1087.

Adachi JD, Adami S, Gehlbach S, Anderson FA Jr, Boonen S, Chapurlat RD, et al.; GLOW Investigators. Impact of prevalent fractures on quality of life: Baseline results from the global

longitudinal study of osteoporosis in women. Mayo Clin Proc 2010;85:806‑13.

Shirazi KK, Wallace LM, Niknami S, Hidarnia A, Torkaman G, Gilchrist M, et al. A home‑based, transtheoretical 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;22:305‑17.

Kathleen M, Stamp S, Bajan M, Dadkah M. Nutrition and diet therapy Krause’s food nutrition. Pub Nutrition World 2006;12:25.

Prevention Disease Office. Ministry of Health and Medical

Education. Guide to Diagnosis, Prevention and Treatment of

Osteoporosis. Tehran: Pub Centered Prevention Disease; 2009. p. 35‑67.

Khorsandi M, Shamsi M, Jahani F. The effect of education based

on health belief model on the improvement of osteoporosis preventive behaviors in pregnant mothers of Ark city. J Shahed Univ 2010;18:1‑10.

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 Health Monit 2004;3:67‑74.

Pour AA, Tohidi M, Dabbaghmanesh MH, Jafari P, Fattahi MR,

Omrani GR. Prevalence of osteoporosis in rural men of Fars based on both local and WHO reference data. Iran J Endocrinol Metab 2010;12:393‑400.

Motlagh FN, Khani Jihoni A, Haider Nia A, Kave M, Hajizadeh E,

Babaee Haider Abadi A, et al. Prevalence of osteoporosis and its related factors in women referred to Fasa’s Densitometry Center. J Ilam Univ Med Sci 2013;21:150‑8.

Kelley GA, Kelley KS. Exercise and bone mineral density at the femoral neck in postmenopausal women: A meta‑analysis of controlled clinical trials with individual patient data. Am J Obstet Gynecol 2006;194:760‑7.

Madureira MM, Bonfá E, Takayama L, Pereira RM. A 12‑month

randomized controlled trial of balance training in elderly women with osteoporosis: Improvement of quality of life. Maturitas 2010;66:206‑11.

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.

Sedlak CA, Doheny MO, Estok PJ, Zeller RA. Tailored interventions to enhance osteoporosis prevention in women. Orthop Nurs 2005;24:270‑8.

Turner LW, Hunt SB, DiBrezzo R, Jones C. Design and

implementation of an osteoporosis prevention program using the health belief model. Am J Health Stud 2004;19:115.

Ryan P, Schlidt A, Ryan C.The impact of osteoporosis revention

programs on calcium intake: a systematic review.Osteoporos Int. 2013;24:1791‑801. doi: 10.1007/s00198‑012‑2259‑4. Epub 2013 Jan 12. Review.

Sharma M, Romas I. Theoretical Foundations of Health Education and Health Promotion. Sudbury: Jones and Bartlet; 2010. p. 84‑120.

Ievers‑Landis CE, Burant C, Drotar D, Morgan L, Trapl ES, Kwoh

CK. Social support, knowledge, and self‑efficacy as correlates of osteoporosis preventive behaviors among preadolescent females. J Pediatr Psychol 2003;28:335‑45.

Marmot M, Wilkinson RG. Social Determinants of Health. Translate by Montazeri A. Tehran: Jahad Daneshgahi; 2008. p.

Aarts H. Health and goal‑directed behavior: The nonconscious

regulation and motivation of goals and their pursuit. Health Psychol Rev 2007;1:53‑82.

Hofman W, Friese M, Wiers RW. Impulsive versus reflective

influence on health behavior: A theatrical framework and empirical review. Health Psychol Rev 2008;2:111‑37.

Ito M, Harada A, Nakano T, Kuratsu S, Deguchi M, Sueyoshi Y,et al. Retrospective multicenter study of surgical treatments for

osteoporotic vertebral fractures. J Orthop Sci 2010;15:289‑93.

Cadarette SM, Beaton DE, Hawker GA. Osteoporosis health belief scale: Minor changes were required after telephone

administration among women. J Clin Epidemiol 2004;57:154‑66.

Burke‑Doe A, Hudson A, Werth H, Riordan DG. Knowledge of osteoporosis risk factors and prevalence of risk factors for osteoporosis, falls, and fracture in functionally independent older adults. J Geriatr Phys Ther 2008;31:11‑7.

Anderson KD, Chad KE, Spink KS. Osteoporosis knowledge,

beliefs, and practices among adolescent females. J Adolesc Health 2005;36:305‑12.

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.

Ghaffari M, Tavassoli E, Esmaillzadeh A, Hasanzadeh A. The effect of education based on health belief model on the improvement of osteoporosis preventive nutritional behaviors of second grade middle school girls in Isfahan. J Health Syst Res 2011;6:714‑23.

Winzenberg TM, Oldenburg B, Frendin S, De Wit L, Jones G. Effects of bone density feedback and group education on osteoporosis knowledge and osteoporosis self‑efficacy in

premenopausal women: A randomized controlled trial. J Clin Densitom 2005;8:95‑103.

Al Seraty WH, Ali WG. The impacts of health belief model based intervention for osteoporosis prevention among female students in Al Dawadmi Applied Medical Science, Shaqraa University, Saudi Arabia. Journal of Biology, Agriculture and Healthcare 2014;4:125‑31.

Tussing Lisa, Chapman‑Novakofski Karen. Osteoporosis prevention education: Behavior theories and calcium intake. J Am Diet Assoc 2005;105:92‑7.

Doheny MO, Sedlak CA, Hall RJ, Estok PJ. Structural model for

osteoporosis preventing behavior in men. Am J Mens Health

;4:334‑43.

Nasab HS, Tavakoli R, Farrokhian A, Zarchi AA, Amini ZH. The effect of educational intervention with the health belief model on knowledge, perceptions and self‑efficacy among adolescent of high school girls about osteoporosis, Tehran, Iran 2010‑2011. The Journal of Urmia University of Medical Sciences 2013;24:163‑9.

Ebadi Fard Azar F, Solhi M, Zohoor AR, Hosseini AM. The effect

of health belief model on promoting preventive behaviors of osteoporosis among rural women of Malayer. J Qazvin Univ Med Sci Health Serv 2012;16:58‑64.

Mehrabbeik A. The effect of education on knowledge, attitude

and practice of women clients of Imam Khomeini Relief Foundation in one Isfahan province related to the preventive behavior of osteoporosis using the health belief model. Iran J Epidemiol 2010;7:30‑7.

Baumeister RF, Vohs KD. Self‑regulation, ego depletion, and motivation. Social and Personality Psychology Compass 2007;1:115‑28.

McLeod KM, Johnson CS. A systematic review of osteoporosis

health beliefs in adult men and women. J Osteoporos 2011;2011:197454.

Bandura A. Health promotion by social cognitive means. Health

Educ Behav 2004;31:143‑64.

Piaseu N, Belza B, Mitchell P. Testing the effectiveness of an

osteoporosis educational program for nursing students in Thailand. Arthritis Rheum 2001;45:246‑51.

Jessup JV, Horne C, Vishen RK, Wheeler D. Effects of exercise

on bone density, balance, and self‑efficacy in older women. Biol Res Nurs 2003;4:171‑80.

Ryan P. Integrated theory of health behavior change:

Background and intervention development. Clin Nurse Spec

;23:161‑72.

Besser SJ, Anderson JE, Weinman J. How do osteoporosis

patients perceive their illness and treatment? Implications for clinical practice. Arch Osteoporos 2012;7:115‑24.

MiJeong P, Sue K, Eunhee C, Somi P, Hyuncheol K. A study on the development of a self‑regulated exercise maintenance program for osteoporotic elderly women: Using intervention mapping protocol. J Korean Geriato Soc 2013;33:419‑37.

Wolfe ME. An Evaluation of an Exercise Adherence Intervention

using the Social Cognitive Theory. Ohio: The Ohio State University; 2008. p. 11‑60.

Kelder SH, Perry CL, Klepp KI, Lytle LL, Longitudinal tracking

of adolescent smoking, physical activity, and food choice behaviors. Am J Public Health 1994;84:1121‑6.

Edmonds E, Turner LW, Usdan SL. Osteoporosis knowledge,

beliefs, and calcium intake of college students: Utilization of the health belief model. Open J Prev Med 2012;2:27‑34

Hsieh CH, Wang CY, McCubbin M, Zhang S, Inouye J. Factors

influencing osteoporosis preventive behaviours: Testing a path model. J Adv Nurs 2008;62:336‑45.

Springer AE, Kelder SH, Hoelscher DM. Social support, physical activity and sedentary behavior among 6th‑grade girls: A cross‑sectional study. Int J Behav Nutr Phys Act 2006;3:8.

King KA, Vidourek RA, English L, Merianos AL. Vigorous physical

activity among college students: Using the health belief model to assess involvement and social support. Arch Exerc Health Dis 2014;4:267‑79.

Wen LK, Shepherd MD, Parchman ML. Family support, diet, and

exercise among older Mexican Americans with type 2 diabetes. Diabetes Educ 2004;30:980‑93.

Aalto AM, Uutela A. Glycemic control, self‑care behaviors,

and psychosocial factors among insulin treated diabetics: A test of an extended health belief model. Int J Behav Med 1997;4:191‑214.

Albright TL, Parchman M, Burge SK; RRNeST Investigators.

Predictors of self‑care behavior in adults with type 2 diabetes: An RRNeST study. Fam Med 2001;33:354‑60.

Garay‑Sevilla ME, Nava LE, Malacara JM, Huerta R, Díaz de León J, Mena A, et al. Adherence to treatment and social support in

patients with non‑insulin dependent diabetes mellitus. J Diabetes Complications 1995;9:81‑6.

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.

Tarshizi L, Anousheh M, Ghofranipour FA, Ahmadi FA, Hoshyarrad A. The impact of education based on health belief model on the use of preventive factors of osteoporosis in postmenopausal women. Iran J Nurs 2009;22:71‑82.

Wallace LS. Osteoporosis prevention in college women: Application of the expanded health belief model. Am J Health Behav 2002;26:163‑72.

Shojaezadeh D, Sadeghi R, Tarrahi MJ, Asadi M, Lashgarara B.

Application of health belief model in prevention of osteoporosis

in vo‑lunteers of Khorramabad City Health Centers, Iran. Health

Serv Res 2012;8:183‑92.

Huang CM, Su CY, Chien LY, Gou JL. The effectiveness of an

osteoporosis prevention program among women in Taiwan. Appl Nurs Res 2011;24:e29‑37.

Zhao JX, Zhang L, TianY. Effect of 6 months of Tai Chi Chuan

and calcium supplementation on bone health in females aged 50–59 years. J Exerc Sci Fit 2007;5:88‑94.

Schacter DL. The seven sins of memory. Insights from psychology and cognitive neuroscience. Am Psychol 1999;54:182‑203.


Refbacks

  • There are currently no refbacks.