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Original Article

An Equation Model Development and Test based on Health Belief Model Regarding Osteoporosis Prevention Behaviors among Postmenopausal Women

Hyun-Jung Jang1, Sukhee Ahn2
Korean Journal of Adult Nursing 2015;27(6):624-633.
Published online: December 31, 2015

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Corresponding author: Ahn, Sukhee College of Nursing, Chungnam National University, 266 Munwha-ro, Jung-gu, Daejeon 301-747, Korea. Tel: +82-42-580-8324, Fax: +82-42-580-8309, E-mail: sukheeahn@cnu.ac.kr
• Received: September 17, 2015   • Accepted: November 29, 2015

Copyright © 2015 Korean Society of Adult Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    This studywas todevelopandtest atheoretical model basedontherevisedhealthbelief model explaining osteoporosis preventionbehaviors amongpostmenopausal womenunder 65.
  • Methods
    This secondary data analysis included 342 postmenopausal women under 65 from original data sources of a total of 734 women. The measured instruments were scales for osteoporosis awareness, osteoporosis health belief scale (benefit, barrier, susceptibility, severity, and health motivation), self-efficacy, and osteoporosis prevention behaviors. Data were analyzed using SPSS/WIN 20.0 and AMOS 20.0.
  • Results
    The mean age of the subjects was 55.2 years and the mean age of menopause was 51.10. The hypothetical model of osteoporosis prevention behaviors was relatively fit. Osteoporosis prevention behaviors were significantly explained up to 62% by expectation factors (relative benefit, self-efficacy, health motivation) and modifying factors(knowledge only). Expectation factors of health belief had a mediation effect between modifying factors and prevention behaviors.
  • Conclusion
    This study partially supported the revised health belief model for explaining osteoporosis prevention behaviors. It provides a basis for developing an educational program focusing on expectation factors and knowledge with the aim of behavioral changes for osteoporosis prevention.
  • Key Words: Osteoporosis; Prevention; Menopause; Health belief; Knowledge
Figure 1.
Theoretical framework for this study.
kjan-27-624f1.jpg
Figure 2.
Standardized estimates and explained variances in tue model for osteoporosis prevention behavior.
kjan-27-624f2.jpg
Table 1.
General Characteristics of the Subjects (N=342)
Characteristics Categories n n (%) or M±SD
Age (year)   55.18±4.15
45~49 (4.1) 14
50~59 (77.5) 265
60~64 (18.4) 63
Age at menopause (year)   51.10±2.89
   
Marital status Single 5 (1.5)
Married 306 (89.5)
Divorced/separated 6 (1.8)
Widowed 25 (7.3)
Level of education High school ≤ 213 (62.3)
College ≥ 129 (37.7)
Household income (10,000 won/ month)   372.40±226.55
100 ≤ 40 (11.7)
101~200 63 (18.4)
201~300 72 (21.1)
301~400 51 (14.9)
400 ＞ 116 (33.9)
Occupation Yes 201 (58.8)
No 141 (41.2)
Coffee intake Yes 271 (79.2)
No 71 (20.8)
Alcohol drinking Yes 25 (7.3)
No 317 (92.7)
Smoking Yes 5 (1.5)
No 337 (98.5)
Having chronic illness Yes 123 (36.0)
No 219 (64.0)
Taking calcium supplement Yes 158 (46.2)
No 184 (53.8)
Taking hormone treatment Yes 18 (5.3)
No 324 (94.7)
Table 2.
Descriptive Statistics and Relationships among Study Variables for Osteoporosis Prevention Behaviors (N=342)
Variables Range n (%) or M±SD X1 X2 Y1 Y2 Y3 Y4 Y5 Y6 Y7
Level of education (X1) High school ≤ 213 (62.3) 1                
College ≥ 129 (37.7)                  
Knowledge about osteoporosis prevention (X2) 31~124 85.53±16.66 .24 1              
    (.001) ＜                
Perceived benefits minus barriers (Y1) 0~24 0.72±0.70 .13 .31 1            
    (.015) (.001) ＜              
Perceived self efficacy (Y2) 12~60 39.81±7.77 .14 .40 .45 1          
    (.013) (.001) ＜ (.001) ＜            
Health motivation (Y3) 6~30 19.94±4.09 .20 .30 .33 .35 1        
    (.001) ＜ (.001) ＜ (.001) ＜ (.001) ＜          
Perceived susceptibility (Y4) 6~30 16.06±4.23 -.05 -.06 -.17 -.23 -.06 1      
    (.36) (.265) (.002) (.001) ＜ (.276)        
Perceived severity (Y5) 6~30 16.71±4.36 -.21 -.03 -.10 -.10 .05 .50 1    
    (.001) ＜ (.587) (.080) (.058) (.350) (.001) ＜      
Prevention behavior: Calcium (Y6) 4~16 5.52±2.39 .08 .26 .31 .39 .37 -.08 -.02 1  
    (.137) (.001) ＜ (.001) ＜ (.001) ＜ (.001) ＜ (.120) (.748)    
Prevention behavior: 　 Exercise (Y7) 4~16 5.19±3.07 -.01 .28 .24 .41 .33 -.16 -.01 .39 1
    (.859) (.001) ＜ (.001) ＜ (.001) ＜ (.001) ＜ (.004) (.847) (.001) ＜  
Prevention behavior: Checkup (Y8) 3~12 2.51±2.50 .12 .27 .30 .18 .33 -.07 -.04 .44 .39
    (.023) (.001) ＜ (.001) ＜ (.001) (.001) ＜ (.171) (.476) (.001) ＜ (.001) ＜
Table 3.
Effects of Explanatory Variables on Osteoporosis Prevention Behaviors (N=342)
Endogenous variables Exogenous variables Standardized coefficient SMC
Direct effect Indirect effect Total effect
β (p) β (p) β (p)
Osteoporosis Modifying factors .79 (.001) ＜   .68 .62
prevention behaviors Expectations factors .01 (.924) .68 (.001) ＜ .79  
  Threat factors     .01  
Expectations factors Modifying factors .87 (.001) ＜   .87 .75
Threat factors Modifying factors -.23 (.130)   -.23 .05

SMC=squared multiple correlation.

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    An Equation Model Development and Test based on Health Belief Model Regarding Osteoporosis Prevention Behaviors among Postmenopausal Women
    Korean J Adult Nurs. 2015;27(6):624-633.   Published online December 31, 2015
    DOI: https://doi.org/10.7475/kjan.2015.27.6.624
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    An Equation Model Development and Test based on Health Belief Model Regarding Osteoporosis Prevention Behaviors among Postmenopausal Women
    Korean J Adult Nurs. 2015;27(6):624-633.   Published online December 31, 2015
    DOI: https://doi.org/10.7475/kjan.2015.27.6.624
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    An Equation Model Development and Test based on Health Belief Model Regarding Osteoporosis Prevention Behaviors among Postmenopausal Women
    Image Image
    Figure 1. Theoretical framework for this study.
    Figure 2. Standardized estimates and explained variances in tue model for osteoporosis prevention behavior.

    Figure 1.

    Figure 2.

    An Equation Model Development and Test based on Health Belief Model Regarding Osteoporosis Prevention Behaviors among Postmenopausal Women

    General Characteristics of the Subjects (N=342)

    Characteristics Categories n n (%) or M±SD
    Age (year)   55.18±4.15
    45~49 (4.1) 14
    50~59 (77.5) 265
    60~64 (18.4) 63
    Age at menopause (year)   51.10±2.89
       
    Marital status Single 5 (1.5)
    Married 306 (89.5)
    Divorced/separated 6 (1.8)
    Widowed 25 (7.3)
    Level of education High school ≤ 213 (62.3)
    College ≥ 129 (37.7)
    Household income (10,000 won/ month)   372.40±226.55
    100 ≤ 40 (11.7)
    101~200 63 (18.4)
    201~300 72 (21.1)
    301~400 51 (14.9)
    400 ＞ 116 (33.9)
    Occupation Yes 201 (58.8)
    No 141 (41.2)
    Coffee intake Yes 271 (79.2)
    No 71 (20.8)
    Alcohol drinking Yes 25 (7.3)
    No 317 (92.7)
    Smoking Yes 5 (1.5)
    No 337 (98.5)
    Having chronic illness Yes 123 (36.0)
    No 219 (64.0)
    Taking calcium supplement Yes 158 (46.2)
    No 184 (53.8)
    Taking hormone treatment Yes 18 (5.3)
    No 324 (94.7)

    Descriptive Statistics and Relationships among Study Variables for Osteoporosis Prevention Behaviors (N=342)

    Variables Range n (%) or M±SD X1 X2 Y1 Y2 Y3 Y4 Y5 Y6 Y7
    Level of education (X1) High school ≤ 213 (62.3) 1                
    College ≥ 129 (37.7)                  
    Knowledge about osteoporosis prevention (X2) 31~124 85.53±16.66 .24 1              
        (.001) ＜                
    Perceived benefits minus barriers (Y1) 0~24 0.72±0.70 .13 .31 1            
        (.015) (.001) ＜              
    Perceived self efficacy (Y2) 12~60 39.81±7.77 .14 .40 .45 1          
        (.013) (.001) ＜ (.001) ＜            
    Health motivation (Y3) 6~30 19.94±4.09 .20 .30 .33 .35 1        
        (.001) ＜ (.001) ＜ (.001) ＜ (.001) ＜          
    Perceived susceptibility (Y4) 6~30 16.06±4.23 -.05 -.06 -.17 -.23 -.06 1      
        (.36) (.265) (.002) (.001) ＜ (.276)        
    Perceived severity (Y5) 6~30 16.71±4.36 -.21 -.03 -.10 -.10 .05 .50 1    
        (.001) ＜ (.587) (.080) (.058) (.350) (.001) ＜      
    Prevention behavior: Calcium (Y6) 4~16 5.52±2.39 .08 .26 .31 .39 .37 -.08 -.02 1  
        (.137) (.001) ＜ (.001) ＜ (.001) ＜ (.001) ＜ (.120) (.748)    
    Prevention behavior: 　 Exercise (Y7) 4~16 5.19±3.07 -.01 .28 .24 .41 .33 -.16 -.01 .39 1
        (.859) (.001) ＜ (.001) ＜ (.001) ＜ (.001) ＜ (.004) (.847) (.001) ＜  
    Prevention behavior: Checkup (Y8) 3~12 2.51±2.50 .12 .27 .30 .18 .33 -.07 -.04 .44 .39
        (.023) (.001) ＜ (.001) ＜ (.001) (.001) ＜ (.171) (.476) (.001) ＜ (.001) ＜

    Effects of Explanatory Variables on Osteoporosis Prevention Behaviors (N=342)

    Endogenous variables Exogenous variables Standardized coefficient SMC
    Direct effect Indirect effect Total effect
    β (p) β (p) β (p)
    Osteoporosis Modifying factors .79 (.001) ＜   .68 .62
    prevention behaviors Expectations factors .01 (.924) .68 (.001) ＜ .79  
      Threat factors     .01  
    Expectations factors Modifying factors .87 (.001) ＜   .87 .75
    Threat factors Modifying factors -.23 (.130)   -.23 .05

    SMC=squared multiple correlation.
    Table 1. General Characteristics of the Subjects (N=342)

    Table 2. Descriptive Statistics and Relationships among Study Variables for Osteoporosis Prevention Behaviors (N=342)

    Table 3. Effects of Explanatory Variables on Osteoporosis Prevention Behaviors (N=342)

    SMC=squared multiple correlation.

    Table 1.

    Table 2.

    Table 3.

    Korean J Adult Nurs : Korean Journal of Adult Nursing

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