|Year : 2016 | Volume
| Issue : 1 | Page : 107-110
Evaluation of osteoporosis educational program on knowledge, attitude, and practice of secondary school female students
Hala M El Meselhy1, Howaida A AlShazly2, Aml A Salama1, Dina S El Karsh3
1 Department of Family Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Department of Public Health, Faculty of Medicine, Menoufia University, Menoufia, Egypt
3 Department of Family Medicine, MOH, Menoufia, Egypt
|Date of Submission||14-Dec-2014|
|Date of Acceptance||08-Feb-2015|
|Date of Web Publication||18-Mar-2016|
Aml A Salama
MD, Department of Family Medicine, Faculty of Medicine, Shebeen El-koom District, Menoufia Governorate, 32511
Source of Support: None, Conflict of Interest: None
This study aimed to assess the effect of educational program concerning osteoporosis on the knowledge, attitude, and practice among secondary school female students (Shebin El-Kom City, Menoufia Governorate).
Osteoporosis is a systemic disease characterized by a decrease in skeletal bone mass. It is considered a worldwide health problem, including Egypt. Raising awareness about its burden and risk factors is an essential step in modifying behaviors related to it.
Participants and methods
The study was conducted on 302 secondary school female students. They were chosen randomly from three secondary schools during the scholastic year 2013/2014. A predesigned questionnaire was used to test their knowledge, attitude, and practice on osteoporosis (a pretest). In addition, a health education program was conducted for improving their knowledge, attitude, and practice. A post-test was conducted after 3 months for 294 of the pretest participants (response rate = 97.4%).
The mean score of knowledge on osteoporosis risk factors, diagnosis, and protective measures (e.g. nutritional and physical activity) showed a significant improvement. The mean score of attitude as regards calcium-containing food and barrier to have calcium, healthy intentions such as attitude toward disease (regular exercise and barriers to exercise) showed significant improvement. Healthy nutritional practice and regular exercise showed significant improvement after osteoporosis preintervention and postintervention program.
The applied health education program improved female secondary school students' knowledge, attitude, and practice as regards osteoporosis, which is a cornerstone in its prevention through modification of related risk factors.
Keywords: Attitude, females students, knowledge, osteoporosis, practice
|How to cite this article:|
El Meselhy HM, AlShazly HA, Salama AA, El Karsh DS. Evaluation of osteoporosis educational program on knowledge, attitude, and practice of secondary school female students. Menoufia Med J 2016;29:107-10
|How to cite this URL:|
El Meselhy HM, AlShazly HA, Salama AA, El Karsh DS. Evaluation of osteoporosis educational program on knowledge, attitude, and practice of secondary school female students. Menoufia Med J [serial online] 2016 [cited 2020 Feb 24];29:107-10. Available from: http://www.mmj.eg.net/text.asp?2016/29/1/107/178998
| Introduction|| |
Osteoporosis is a systemic disease characterized by a decrease in skeletal bone mass . The WHO defines osteoporosis as a bone mineral density value more than 2.5 SD below the mean for normal, young, white women .
Osteoporosis is considered a health problem in Egypt, as Egyptian women generally have lower bone mineral density compared with women in Western countries .
Poor nutritional behaviors have a major contribution in the development of osteoporosis. Insufficient calcium or vitamin D consumption and sedentary lifestyle were proved to have a role in the development of osteoporosis , and healthy lifestyles may protect female adolescents against osteoporosis in later life .
Improving knowledge on osteoporosis has been shown to be effective among different age groups of female population .
| Objectives|| |
The aim of this study was to assess the effect of an interventional education program concerning osteoporosis on the knowledge, attitude, and practice of secondary school girls.
| Participants and methods|| |
This was a cross-sectional interventional study conducted in secondary schools for girls in Shebin El-Kom City, Menoufia Governorate, through a multistage random sampling technique to choose the participants. Stage 1: three of 10 schools were selected randomly. Stage 2: one class from each grade (in chosen schools) was recruited. Stage 3: the needed sample size was lastly chosen randomly from the selected classrooms.
The sample size was estimated to be 280 students using Epi-Info for Windows (Atlanta, Georgia, USA) with α error 1%, and was increased to 302 students. The total number of participants who completed the study were 294 (97.35%) students. Human rights and ethical considerations were followed during the study, with total confidentiality of any obtained data. The Menoufia Faculty of Medicine committee for medical research ethics formally approved the study before it began. A written consent form was obtained from administrative authorities in the studied schools, as well as from all participants, after explaining the aim of the study. Students were interviewed using a predesigned questionnaire before and after implementation of health educational program on osteoporosis. The questionnaire included personal data such as age, residence, and socioeconomic status assessment according to El-Gilany et al. . Assessment of knowledge was carried out using questions about risk factor of osteoporosis (e.g. sex, family history, dietary habits), screening for osteoporosis (e.g. screening test, age of screening), and dietary and physical activity (e.g. food rich in calcium, recommended daily intake of calcium, exercise that has protective effect on bone health, and frequency of exercise per week). Assessment of student's attitude was carried out through questions including general health concept (e.g. balanced diet, relation between smoking and osteoporosis), benefits of calcium consumption (e.g. protective effect of calcium to prevent broken bone, barriers to maintain intake of calcium), exercise (e.g. protective effect of exercise to prevent osteoporosis, presence of suitable place to do exercise), and attitude toward disease (e.g. whether or not osteoporosis is dangerous) to Edmonds . Assessment of students' practice was carried out by using questions related to current dietary intake (e.g. milk, cheese, cake, and yoghurt) in the last month and current physical activity (e.g. walking, running, swimming) for students during the last week. The health educational program was conducted in the randomly selected classrooms in each school. Short lectures (for about 30 min) were given by the researcher in simple Arabic language.
The study was conducted from the beginning of November 2013 to the end of March 2014.
After 3 months, reassessment of students' knowledge, attitude, and practice was carried out using the same questionnaire (post-test). The total scores of correct answers in the pretest were compared with the scores of answers in the post-test. Thereafter, the overall mean score for the pretest was compared with the overall mean score of the post-test.
The data were tabulated and analyzed using Statistical Package of Social Science program (SPSS), version 20, with significance level less than 5%. Quantitative data were expressed as mean and standard deviation (X ± SD) and compared using Student's t-test.
| Results|| |
The total number of students were 302 girls; their mean age was 16.32 ± 0.686 years. As regards education, 48.3% of fathers and 41.7% of mothers of the students were university graduates. As regards occupation, ∼43% of fathers worked in trade and business and 48.7% of mothers were housewives. An overall 61.9% belonged to the middle socioeconomic group [Table 1].
|Table 1: Sociodemographic characters of secondary school female students|
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After conduction of health education program regarding osteoporosis, reassessment of knowledge detected that there was a significant improvement in knowledge on the method of diagnosis of disease, risk factor of osteoporosis, and knowledge about nutrition and physical activity. The total score of knowledge questions was increased from 4.15 ± 1.46 to 9.24 ± 1.76, from 2.97 ± 5.58 to 35.2 ± 2.89, and from 19.75 ± 2.01 to 23.74 ± 1.77, respectively [Table 2].
|Table 2: Comparison of knowledge parameters before and after the intervention program|
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As regards attitude toward osteoporosis, it was found that there was a statistically significant improvement of attitude toward importance of calcium-containing food and healthy intentions such as regular exercise and overcome barriers to exercise [Table 3].
|Table 3: Comparison of attitude parameters before and after the intervention program|
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As regards practice toward prevention of osteoporosis and modifying its risk factors, it was found that there was a statistically significant improvement in healthy and nutritional practice and regular exercise scores (from 64.25 ± 8.65 to 72.65 ± 8.34 and from 8.97 ± 2.42 to 9.35 ± 2.11, respectively) [Table 4].
|Table 4: Comparison of practice parameters before and after the intervention program|
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| Discussion|| |
In this study, the mean age of the studied group was 16.32 ± 0.686 as represented age for adolescent girls. This was in agreement with the findings of Mahfouz et al. , who found that female adolescent age school students ranged from 11 to 18 years old; the majority of the school students (59.9%) were between 14 and 16 years of age.
This study showed significant improvement in the knowledge of female students as regards osteoporosis risk factor, diagnosis of disease, and nutritional and physical activity before and after the intervention program. This result was in agreement with a study conducted in Saudi Arabia  which reported that there is a significant difference between knowledge on risk factor, exercise, calcium-containing food and total knowledge on osteoporosis before and after the intervention program; this was in agreement with a study conducted by El-Sayed and Abdel Megeid , who found a significant increase in overall osteoporosis knowledge in the studied group after attending health education sessions.
This study showed significant improvement in the attitude of female students as regards importance of Ca-containing food and barriers to have Ca, healthy intentions, attitude toward the disease, and regular exercises and barriers to exercise before and after the intervention program. This result was in agreement with the study conducted by Al Seraty and Ali , who found that a health belief model based intervention increases girls' perception about osteoporosis susceptibility and seriousness after the intervention showed that more than two-third of the adolescents had a positive view of health after intervention. This finding was in agreement with that of Chan et al. , who mentioned that a health belief model based education increases the average score of perceived susceptibility and increases perception about seriousness of osteoporosis and motivates positive view of health.
In this study the practice of female students in secondary schools showed significant improvement in healthy and nutritional practice and regular exercises before and after the intervention program. This result was in agreement with that of Tsai , who mentioned that an individual's dietary behavior can be altered by increasing their knowledge and changing internal beliefs. Moreover, they mentioned that interventions that focus on osteoporosis awareness, calcium self efficiency, health motivation, as well as overcoming personal barrier to calcium intake, may be the most effective methods for osteoporosis prevention. They also reported that adolescent osteoporosis preventive behaviors (e.g. daily calcium intake, daily physical activity time, and sun exposure time) were improved significantly after the intervention.
| Conclusion|| |
Educational program improves the knowledge, attitude, and practice of secondary school female students concerning osteoporosis, which is a cornerstone in its prevention through modification of its risk factors and early detection.
Ministry of Education in Egypt should be involved in health education on osteoporosis and its related factors in schools, or could even provide educational program through their curriculum to improve the awareness of this disease among students, thus ensuring they receive accurate information.
| Acknowledgements|| |
The authors thank the secondary school female students who accepted to participate in this work.
Conflicts of interest
| References|| |
Heaney RP. Calcium, dairy products and osteoporosis. J Am Coll Nutr 2000; 19
World Health Organization (WHO). Prevention and management of osteoporosis. Report of a WHO scientific group. WHO technical report series 921
. Geneva: WHO; 2003.
Salem D, Tattawi S, Ebrashi H. Evaluation of osteoporosis among males and females in clinical practice bone densitometry. Med J Cairo Univ 2000; 68
Anderson JJB. Nutrition and bone health. In: Mahan LK, Escott-Stump S. editors. Krause′s food, nutrition and diet therapy
. 12th ed. Philadelphia: W. B. Saunders Company; 2008; 614-35.
Hernandez-Rauda, R, S Martinez-Garcia. Osteoporosis-related life habit and knowledge about osteoporosis among women in el Salvador: across sectional study. BMC Musculoskelet Disord 2004; 5
Jamil WA, Aziz ME, Huat FL. Knowledge, attitude and dietary and lifestyle practices on bone health status among undergraduate university students in health campus, Universiti Sains Malaysia. Kelantan Health Environ J 2010; 1
El-Gilany A, El-Wehady A, El-Wasify M. Updating and validation of the socioeconomic status scale for health research in Egypt. East Mediterr Health J 2012; 18
Edmonds E, Turner L, Stuart L. Osteoporosis knowledge, beliefs, and calcium intake of college students: Utilization of heath belief model. Open Journal of Preventive Medicine 2012; 2:27-34.
Mahfouz FM, Kamel E, Mosalem F, Sameh E. Osteoporosis-related lifestyle choices and knowledge among adolescent female in El-Minia city, Egypt. El-Minia Med Bull 2007; 18
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. J Biol Agric Healthcare 2014; 4
El-Sayed MA, Abdel Megeid FY. Osteoporosis-related life habits, knowledge and attitude among group of female employees in King Saud University. World Appl Sci 2013; 22
Chan M, Kwong W, Zang Y, Wan P. Evaluation of an osteoporosis prevention education program for young adults. J Adv Nurs 2006; 57
Tsai M. The relation between osteoporosis knowledge, beliefs, and dietary calcium intake among South Asian women in Auckland [master thesis in human nutrition]. Auckland, New Zealand: Massey University; 2008; 5
[Table 1], [Table 2], [Table 3], [Table 4]