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Original Article

Development of a Smartphone Application for Promoting Bone Health in Korean Young Adult Women: A Pilot Study

Young-Joo Park1, Sook-Ja Lee1, Nah-Mee Shin1, Hyunjeong Shin1, Sungjin Yoon2, Songi Jeon2, Inhae Cho3
Korean Journal of Adult Nursing 2015;27(4):459-471.
Published online: August 31, 2015

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Corresponding author: Shin, Hyunjeong College of Nursing, Korea University, 145 Anam-ro, Sungbuk-gu, Seoul 136-705, Korea. Tel: +82-2-3290-4927, Fax: +82-2-927-4676, E-mail: hyunjshin@korea.ac.kr
• Received: June 30, 2015   • Accepted: August 12, 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
    The purpose of this study was to develop a smartphone application and evaluate it's effectiveness and usability for promoting bone health in Korean young adult women.
  • Methods
    A smartphone application was developed covering exercise, nutrition, and health habits related to bone health. A pilot testing was conducted using a one-group pre/posttest design. A total of 22 female college students with low bone mass participated in the 8-week use of a pilot testing.
  • Results
    The “Strong bone Fit body (SbFb)" application was developed using Android platform. In the pilot testing, bone mineral density, serum CTX, and 25 (OH)Vit.D were significantly decreased. There is no significant change in serum osteocalcin and calcium. Serum phosphorus concentration, nutrient intakes (fiber, VitB6, and pantotenic acid), and all bone composition profiles were significantly increased. Bone-health knowledge was significantly increased but no change in health belief and self-efficacy.
  • Conclusion
    The results of this pilot testing suggest the effectiveness of the SbFb application to enhance and promote self-managing abilities for bone health. It can provide continuous feedback and high-quality bone health information. However, some contents and working methods of the application need to be modified and its effectiveness on bone health requires further investigations.
  • Key Words: Women; Young adults; Bone density; Biochemical markers; Smartphone applications
Figure 1.
Screenshots of ‘Strong Bone Fit Body' application.
kjan-27-459f1.jpg
Table 1.
Mean Differences of BMD, BTMs, Body Composition, and Psychosocial Variables between Pretest and Posttest (N=22)
Variables Pretest Posttest Difference t (p)
M±SD M±SD M±SD
BMD Z-score -1.55±0.65 -1.87±0.57 0.32±0.25 6.18 (＜.001)
T-score -1.48±0.59 -1.79±0.51 0.31±0.23 6.34 (＜.001)
SOS (m/sec) 1,526.26±23.88 1,517.20±22.76 9.06±11.23 3.78 (.001)
BUA (dB/MHz) 38.54±9.54 33.57±7.26 4.96±6.94 3.35 (.003)
BQI 76.41±11.08 70.65±9.73 5.76±4.33 6.24 (＜.001)
BMs Osteocalcin (ng/mL) 19.12±4.63 21.54±5.48 -2.27±5.40 -1.93 (.068)
CTX (ng/mL) 0.41±0.17 0.32±0.13 0.08±0.13 2.55 (.020)
Calcium (mg/dL) 9.61±0.35 9.42±0.74 0.17±0.83 0.95 (.355)
Phosphorus (mg/dL) 3.95±0.42 4.33±0.52 -0.41±0.55 -3.42 (.027)
25 (OH)Vit D 13.92±3.53 8.77±3.08 5.17±2.69 8.37 (＜.001)
Body composition Body weight 50.02±4.90 50.94±4.98 -0.92±0.85 -5.11 (＜.001)
Free fat mass 38.18±2.66 38.54±2.81 -0.36±0.63 -2.69 (.014)
Body fat mass 11.84±2.74 12.40±2.70 -0.56±0.60 -4.43 (＜.001)
Muscle 35.31±2.41 35.60±2.56 -0.29±0.59 -2.31 (.031)
Body fluid 27.50±1.91 27.75±2.03 -0.25±0.46 -2.57 (.018)
BMI 19.29±1.65 19.64±1.69 -0.35±0.31 -5.27 (＜.001)
Body fat ratio 23.44±3.28 24.14±3.12 -0.70±1.00 -3.30 (.003)
Abdominal fat ratio 0.73±0.03 0.73±0.03 -0.01±0.01 -2.22 (.038)
Psychosocial variables related to bone health
Knowledge   16.90±2.41 17.79±1.53 0.91±1.44 -3.03 (.006)
Health belief Susceptibility 19.14±3.75 19.64±4.46 -0.50±3.17 -0.74 (.468)
Seriousness 17.14±3.85 18.45±5.51 -1.32±5.30 -1.17 (.267)
Benefit exercise 24.64±2.82 24.73±2.00 -0.09±2.78 -0.15 (.879)
Benefit calcium intake 21.82±2.99 22.59±2.34 -0.77±2.33 -1.56 (.135)
Barriers exercise 15.41±4.78 17.18±3.72 -1.77±4.09 -2.03 (.055)
Barriers calcium intake 13.18±3.08 13.05±3.79 0.14±3.52 0.18 (.858)
Health motivation 20.59±3.70 20.18±3.65 0.41±2.58 0.74 (.465)
Self-efficacy 125.23±19.13 117.00±20.92 8.23±28.45 1.36 (.189)
Exercise self-efficacy 59.07±14.30 52.83±14.47 6.22±18.69 1.60 (.125)
Calcium intake self-efficacy 66.33±11.80 64.08±12.86 2.65±13.74 0.93 (.365)

BMD=bone mineral density, BMs=biochemical bone markers, SOS=speed of sound, BUA=broadband ultrasound attenuation, BQI=bone quality index, CTX=C-telopeptide of collagen cross-links, BMI=body mass index.

Table 2.
Mean Differences of Nutrients Intakes between Pretest and Posttest (N=22)
Nutrients Pretest Posttest Difference t (p)
M±SD M±SD M±SD
Calolie (Kcal) 1,389.37±303.71 1,437.92±341.98 -48.55±92.06 -0.53 (.603)
Carbohydrate (g) 192.26±49.78 200.33±44.31 -8.07±12.91 -0.63 (.539)
Fat (g) 43.78±11.02 45.25±15.03 -1.47±17.21 -0.40 (.692)
Protein (g) 51.20±13.82 57.15±17.05 1.59±13.28 0.56 (.580)
Fiber (g) 11.62±3.22 13.81±3.93 -2.19±4.33 -2.37 (.027)
Water (mL) 679.50±263.74 656.01±213.26 23.48±222.40 0.50 (.626)
Vit. A (㎍) 564.31±361.21 662.57±259.52 -98.27±393.20 -1.17 (.254)
Vit. D (㎍) 2.65±2.26 2.64±2.13 0.01±3.13 0.01 (.996)
Vit. E (mg) 11.37±5.20 12.61±5.05 -1.25±6.67 -0.88 (.390)
Vit. K (㎍) 95.16±72.96 114.68±62.78 -19.53±72.54 -1.26 (.221)
Vit. C (mg) 55.62±36.32 57.88±27.91 -2.26±43.11 -0.25 (.808)
Thiamin (mg) 0.93±0.28 0.97±0.29 -0.04±0.33 -0.59 (.562)
Riboflabin (mg) 1.00±0.47 1.13±0.40 -0.13±0.51 -1.19 (.246)
Niacin (mg) 12.05±4.01 12.53±3.74 -0.48±4.82 -0.46 (.649)
Vit. B6 (mg) 0.98±0.35 1.16±0.37 -0.18±0.39 -2.19 (.040)
Folic acid (㎍) 270.55±123.10 316.25±103.35 -45.70±122.60 -1.75 (.095)
Vit B12 (㎍) 4.95±3.90 6.54±3.31 -1.59±4.29 -1.73 (.098)
Panto (mg) 3.03±1.12 3.63±1.06 -0.60±1.28 -2.21 (.039)
Biotin (㎍) 11.08±7.72 14.38±7.13 -3.31±9.55 -1.62 (.119)
Calcium (mg) 411.84±151.35 440.64±225.39 -28.80±227.40 -0.59 (.559)
Phosphorus (mg) 734.99±186.68 779.01±185.52 -44.02±250.80 -0.82 (.420)
Sodium (mg) 2,571.32±904.17 2,615.02±732.55 -43.70±1215.30 -0.17 (.868)
Chroride (mg) 247.02±145.09 407.73±315.92 -160.70±380.70 -1.98 (.061)
magnesium (mg) 53.26±21.14 60.92±22.62 -7.67±35.98 -1.00 (.329)
Fe (mg) 9.56±3.23 12.04±4.92 -2.48±6.32 -1.84 (.080)
Zn (mg) 6.61±1.83 7.63±1.91 -1.02±2.67 -1.78 (.089)
Cu (㎍) 0.75±0.23 0.84±0.26 -0.09±0.33 -1.27 (.218)
Cholesterol (mg) 265.03±180.40 310.33±146.23 -45.30±244.60 -0.87 (.395)
K (mg) 1,633.17±484.75 1,824.91±512.85 -191.70±595.00 -1.51 (.146)
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    Development of a Smartphone Application for Promoting Bone Health in Korean Young Adult Women: A Pilot Study
    Korean J Adult Nurs. 2015;27(4):459-471.   Published online August 31, 2015
    DOI: https://doi.org/10.7475/kjan.2015.27.4.459
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    Development of a Smartphone Application for Promoting Bone Health in Korean Young Adult Women: A Pilot Study
    Korean J Adult Nurs. 2015;27(4):459-471.   Published online August 31, 2015
    DOI: https://doi.org/10.7475/kjan.2015.27.4.459
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    Development of a Smartphone Application for Promoting Bone Health in Korean Young Adult Women: A Pilot Study
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    Figure 1. Screenshots of ‘Strong Bone Fit Body' application.

    Figure 1.

    Development of a Smartphone Application for Promoting Bone Health in Korean Young Adult Women: A Pilot Study

    Mean Differences of BMD, BTMs, Body Composition, and Psychosocial Variables between Pretest and Posttest (N=22)

    Variables Pretest Posttest Difference t (p)
    M±SD M±SD M±SD
    BMD Z-score -1.55±0.65 -1.87±0.57 0.32±0.25 6.18 (＜.001)
    T-score -1.48±0.59 -1.79±0.51 0.31±0.23 6.34 (＜.001)
    SOS (m/sec) 1,526.26±23.88 1,517.20±22.76 9.06±11.23 3.78 (.001)
    BUA (dB/MHz) 38.54±9.54 33.57±7.26 4.96±6.94 3.35 (.003)
    BQI 76.41±11.08 70.65±9.73 5.76±4.33 6.24 (＜.001)
    BMs Osteocalcin (ng/mL) 19.12±4.63 21.54±5.48 -2.27±5.40 -1.93 (.068)
    CTX (ng/mL) 0.41±0.17 0.32±0.13 0.08±0.13 2.55 (.020)
    Calcium (mg/dL) 9.61±0.35 9.42±0.74 0.17±0.83 0.95 (.355)
    Phosphorus (mg/dL) 3.95±0.42 4.33±0.52 -0.41±0.55 -3.42 (.027)
    25 (OH)Vit D 13.92±3.53 8.77±3.08 5.17±2.69 8.37 (＜.001)
    Body composition Body weight 50.02±4.90 50.94±4.98 -0.92±0.85 -5.11 (＜.001)
    Free fat mass 38.18±2.66 38.54±2.81 -0.36±0.63 -2.69 (.014)
    Body fat mass 11.84±2.74 12.40±2.70 -0.56±0.60 -4.43 (＜.001)
    Muscle 35.31±2.41 35.60±2.56 -0.29±0.59 -2.31 (.031)
    Body fluid 27.50±1.91 27.75±2.03 -0.25±0.46 -2.57 (.018)
    BMI 19.29±1.65 19.64±1.69 -0.35±0.31 -5.27 (＜.001)
    Body fat ratio 23.44±3.28 24.14±3.12 -0.70±1.00 -3.30 (.003)
    Abdominal fat ratio 0.73±0.03 0.73±0.03 -0.01±0.01 -2.22 (.038)
    Psychosocial variables related to bone health
    Knowledge   16.90±2.41 17.79±1.53 0.91±1.44 -3.03 (.006)
    Health belief Susceptibility 19.14±3.75 19.64±4.46 -0.50±3.17 -0.74 (.468)
    Seriousness 17.14±3.85 18.45±5.51 -1.32±5.30 -1.17 (.267)
    Benefit exercise 24.64±2.82 24.73±2.00 -0.09±2.78 -0.15 (.879)
    Benefit calcium intake 21.82±2.99 22.59±2.34 -0.77±2.33 -1.56 (.135)
    Barriers exercise 15.41±4.78 17.18±3.72 -1.77±4.09 -2.03 (.055)
    Barriers calcium intake 13.18±3.08 13.05±3.79 0.14±3.52 0.18 (.858)
    Health motivation 20.59±3.70 20.18±3.65 0.41±2.58 0.74 (.465)
    Self-efficacy 125.23±19.13 117.00±20.92 8.23±28.45 1.36 (.189)
    Exercise self-efficacy 59.07±14.30 52.83±14.47 6.22±18.69 1.60 (.125)
    Calcium intake self-efficacy 66.33±11.80 64.08±12.86 2.65±13.74 0.93 (.365)

    BMD=bone mineral density, BMs=biochemical bone markers, SOS=speed of sound, BUA=broadband ultrasound attenuation, BQI=bone quality index, CTX=C-telopeptide of collagen cross-links, BMI=body mass index.

    Mean Differences of Nutrients Intakes between Pretest and Posttest (N=22)

    Nutrients Pretest Posttest Difference t (p)
    M±SD M±SD M±SD
    Calolie (Kcal) 1,389.37±303.71 1,437.92±341.98 -48.55±92.06 -0.53 (.603)
    Carbohydrate (g) 192.26±49.78 200.33±44.31 -8.07±12.91 -0.63 (.539)
    Fat (g) 43.78±11.02 45.25±15.03 -1.47±17.21 -0.40 (.692)
    Protein (g) 51.20±13.82 57.15±17.05 1.59±13.28 0.56 (.580)
    Fiber (g) 11.62±3.22 13.81±3.93 -2.19±4.33 -2.37 (.027)
    Water (mL) 679.50±263.74 656.01±213.26 23.48±222.40 0.50 (.626)
    Vit. A (㎍) 564.31±361.21 662.57±259.52 -98.27±393.20 -1.17 (.254)
    Vit. D (㎍) 2.65±2.26 2.64±2.13 0.01±3.13 0.01 (.996)
    Vit. E (mg) 11.37±5.20 12.61±5.05 -1.25±6.67 -0.88 (.390)
    Vit. K (㎍) 95.16±72.96 114.68±62.78 -19.53±72.54 -1.26 (.221)
    Vit. C (mg) 55.62±36.32 57.88±27.91 -2.26±43.11 -0.25 (.808)
    Thiamin (mg) 0.93±0.28 0.97±0.29 -0.04±0.33 -0.59 (.562)
    Riboflabin (mg) 1.00±0.47 1.13±0.40 -0.13±0.51 -1.19 (.246)
    Niacin (mg) 12.05±4.01 12.53±3.74 -0.48±4.82 -0.46 (.649)
    Vit. B6 (mg) 0.98±0.35 1.16±0.37 -0.18±0.39 -2.19 (.040)
    Folic acid (㎍) 270.55±123.10 316.25±103.35 -45.70±122.60 -1.75 (.095)
    Vit B12 (㎍) 4.95±3.90 6.54±3.31 -1.59±4.29 -1.73 (.098)
    Panto (mg) 3.03±1.12 3.63±1.06 -0.60±1.28 -2.21 (.039)
    Biotin (㎍) 11.08±7.72 14.38±7.13 -3.31±9.55 -1.62 (.119)
    Calcium (mg) 411.84±151.35 440.64±225.39 -28.80±227.40 -0.59 (.559)
    Phosphorus (mg) 734.99±186.68 779.01±185.52 -44.02±250.80 -0.82 (.420)
    Sodium (mg) 2,571.32±904.17 2,615.02±732.55 -43.70±1215.30 -0.17 (.868)
    Chroride (mg) 247.02±145.09 407.73±315.92 -160.70±380.70 -1.98 (.061)
    magnesium (mg) 53.26±21.14 60.92±22.62 -7.67±35.98 -1.00 (.329)
    Fe (mg) 9.56±3.23 12.04±4.92 -2.48±6.32 -1.84 (.080)
    Zn (mg) 6.61±1.83 7.63±1.91 -1.02±2.67 -1.78 (.089)
    Cu (㎍) 0.75±0.23 0.84±0.26 -0.09±0.33 -1.27 (.218)
    Cholesterol (mg) 265.03±180.40 310.33±146.23 -45.30±244.60 -0.87 (.395)
    K (mg) 1,633.17±484.75 1,824.91±512.85 -191.70±595.00 -1.51 (.146)
    Table 1. Mean Differences of BMD, BTMs, Body Composition, and Psychosocial Variables between Pretest and Posttest (N=22)

    BMD=bone mineral density, BMs=biochemical bone markers, SOS=speed of sound, BUA=broadband ultrasound attenuation, BQI=bone quality index, CTX=C-telopeptide of collagen cross-links, BMI=body mass index.

    Table 2. Mean Differences of Nutrients Intakes between Pretest and Posttest (N=22)

    Table 1.

    Table 2.

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