Keywords
knowledge - preventive practice - osteoporosis - menopausal women - survey
Introduction
Osteoporosis is a major and growing public health problem in both sexes but particularly
among women. It is a systemic skeletal disorder, characterized by reduction of bone
mass, deterioration of the bone structure, increased bone fragility and fracture risk.[1] It is a major cause of fractures in the elderly, resulting in pain, disability,
costly rehabilitation, poor quality of life, and premature death.[2] Developing countries continue to be ill-equipped to handle the burden of this disease.
This coupled with poor literacy rates and lack of awareness of the risk factors and
symptoms results in a poor prognosis.[3] Despite emerging therapies to treat osteoporosis, prevention is still preferable
for controlling this disease. To plan for the prevention of osteoporosis, sufficient
information about people's health beliefs and knowledge is necessary, and to change
the health behaviors related to modifiable risk factors of osteoporosis. Besides,
it is also necessary to be familiar with the individuals' practice in case of prevention
and also their cultural and socioeconomic features.[4] Good lifestyle practices such as adequate exposure to sunlight, regular exercise,
and appropriate diet prove to have a positive impact on bone health and metabolism
among Indians. These measures prove to be safe and cost-efficient for large populations
and are recommended as an important health measure to overcome the condition.[5] The World Health Organization (WHO) reported that osteoporosis accounts for greater
co-morbidity second only to cardiovascular disease and studies proved that post-menopausal
women's chance of getting hip fractures as from breast cancer risk is almost equal
to it. The burden among the health care system on the elderly population, which is
escalated day to day, is more as the treatments are costly. Rapid action needs to
be taken to counter this economic threat.[6] The peak occurrence of osteoporosis is during old age in India but it is not so
in other Western countries as it occurs during 70 to 80 years with a comparative difference
of about 10 to 20 years between Eastern countries.[7] Osteoporosis is caused by a combination of genetic, hormonal, environmental, and
dietary factors. Attempts to monitor, identify and where possible, control these factors
are the only recourse for managing this condition. The need to fully understand the
impact of age-related diseases such as osteoporosis is critically apparent.[8] Health care providers must also explore strategies to deal with the increasing numbers
of elderly people who are susceptible to a condition known as osteoporosis. Therefore,
during the transition into menopause, an emphasis on understanding and managing osteoporosis
remains crucial.
Materials and Methods
Study Design and Participants
A descriptive correlational survey design was carried out, using a purposive sampling
technique. The study was conducted in one of the primary health centers of Mangalore
Taluk, named Natekal. A total of 100 samples between the ages of 45 and 56 years were
surveyed for the study. The survey was carried out between 5/12/2019 and 13/01/2020.
The inclusion criteria for the study participants were menopausal women who were 1)
aged between 45 and 56 years, 2) able to read and understand Kannada, 3) not menstruated
for the past 12 months, 4) willing to participate in the study, and 5) presently not
under any sort of medications for osteoporosis. The exclusion criteria for study participants
were 1) having any condition that prevents the subjects to provide consent in written
format and 2) having physical or mental diseases which restrict the respondents from
finishing the study as scheduled.
Data Collection Instruments
The data were collected using the socio-demographic proforma, self-structured knowledge
questionnaire, and preventive practice checklist. The socio-demographic proforma consist
of eight items which include age in years, age at menopause, education and nature
of work of women, income status of women (per month), the total number of years after
menopause, type of family, and do you have any information regarding osteoporosis.
Self-structured knowledge questionnaire consists of 25 items. The maximum score was
25 and the minimum score was 0. The scoring was graded as follows: adequate (>12)
and inadequate (<12). The respondents were requested to place a tick mark against
the appropriate response. The Preventive Practice Checklist includes 15 items regarding
the preventive aspect of osteoporosis. The respondents were asked to tick against
their practice to prevent osteoporosis in their lifetime. The maximum score was 30
and the minimum score was 15. The scoring was graded as follows: favorable practice
(>20) and unfavorable practice (<20). To establish reliability, a structured knowledge
questionnaire and preventive practice checklist were administered to 10 menopausal
women. The reliability of the structured knowledge questionnaire was established by
the split-half technique, and the computed coefficient correlation value was found
to be r = 0.92 and considered reliable. The internal consistency of the preventive practice
checklist was established by Cronbach's alpha technique and computed coefficient correlation
values were found to be r = 0.88. Women were approached by the research investigators at their houses, followed
by which, the participants' knowledge and preventive practices were assessed.
Ethical Considerations
The study was reviewed and approved on 11/04/2019 by the Institutional Review and
Ethics Committee of Nitte Usha Institute of Nursing Sciences, NITTE (Deemed to be
University) and the registration number was NUINS/CON/NU/IEC/2019-20. The present
study fits into the principles defined in the Declaration of Helsinki[9] (World Medical Association, 2013). A subject information sheet was provided with
a clear explanation of the study purpose and written informed consent was obtained
before surveying the study participants. Confidentiality was assured to the entire
subjects. They were instructed to sign the consent form, and fill out the demographic
Performa, structured knowledge questionnaire, and preventive practice checklist.
Data Collection Procedure
Before data collection, administrative permission was obtained from the Principal,
Nitte Usha Institute Nursing Sciences. Next, formal written permission was also obtained
from the Medical officer of the respective PHC. A house-to-house survey was conducted
and 100 respondents who fulfilled the sampling criteria were selected purposively.
The aim of the research study was explained to the participants and wholehearted risk-free
participation was requested. The data collection instruments were administered to
the participants after obtaining their informed consent. The design was found to be
feasible by the investigator. Purposive sampling technique was used to survey the
participants of the study. The data collection period was from 05/12/2019 to 13/01/2020.
The data analysis was done using SPSS 20.
Result
Baseline Information
The distributions of the demographic characteristics were analyzed by descriptive
statistics such as frequency and percentage. The data in [Table 1] show that the majority of the menopausal women (65%) were between the age group
of 53 and 56 years, out of 100 samples, 79% of menopausal women were having primary
education, 77% of the menopausal women were unskilled workers, 89% were having a monthly
income of > 2,424. With regard to the total number of years after menopause, 38% of
menopausal women expressed they were between 1 and 4 years and 76% of menopausal women
were from nuclear families. In this study, out of 100 samples, 44% attained menopause
between 49 and 52 years of age and none of the participants had health information
regarding osteoporosis.
Table 1
Distribution of demographic characteristics among participants
|
Demographic characteristics (n = 100)
|
f
|
%
|
|
Age in years
|
|
45-48
|
6
|
6
|
|
49-52
|
29
|
29
|
|
53-56
|
65
|
65
|
|
Age at menopause (y)
|
|
45-48
|
39
|
39
|
|
49-52
|
61
|
61
|
|
Educational status of women
|
|
Primary education
|
79
|
79
|
|
High school education
|
15
|
15
|
|
Higher secondary education
|
6
|
6
|
|
Nature of work of women
|
|
Unskilled workers
|
77
|
77
|
|
Semi-skilled workers
|
26
|
26
|
|
Skilled workers
|
7
|
7
|
|
Income status of women per month (in rupees)
|
|
> 2,424
|
89
|
89
|
|
2,425-6,662
|
8
|
8
|
|
6,663-11,103
|
3
|
3
|
|
Total number of years after menopause
|
|
1-4 years
|
38
|
38
|
|
5-8 years
|
46
|
46
|
|
> 8 years
|
16
|
16
|
|
Type of family
|
|
Nuclear family
|
76
|
76
|
|
Joint family
|
24
|
24
|
|
Do you have any information regarding osteoporosis
|
|
Yes
|
−
|
−
|
|
No
|
100
|
100
|
The data in [Table 2] show that 50% of the participants had attained adequate knowledge with a median
score of 12 and the remaining half of the participants attained less than 12, and
had inadequate knowledge.
Table 2
Frequency and percentage of knowledge score of menopausal women regarding osteoporosis
|
Level of knowledge
|
Frequency
|
Percentage
|
|
Adequate
>12
|
50
|
50
|
|
In adequate
< 12
|
50
|
50
|
n = 100.
The data in [Table 3] show that 56% of the participants had favorable practices toward the prevention
of osteoporosis and 44% of the participants had unfavorable practices toward osteoporosis.
Table 3
Frequency and percentage of preventive practice level among menopausal women regarding
osteoporosis
|
Preventive practice level
|
Frequency
|
Percentage
|
|
Favorable
> 20
|
56
|
56
|
|
Unfavorable
< 20
|
44
|
44
|
n = 100.
The data in [Table 4] shows that the maximum knowledge score was 17 and the minimum score was 5 with 11.47 + 2.4. With regard to preventive practice, the maximum score was 25 and the minimum
score was 14 with 2.12 + 2.22.
Table 4
Mean and standard distribution of knowledge and preventive practice regarding osteoporosis
among menopausal women
|
Variable (n = 100)
|
Mean
|
SD
|
Minimum
|
Maximum
|
|
Knowledge
|
11.47
|
2.46
|
5
|
17
|
|
Preventive practice
|
20.12
|
2.22
|
14
|
25
|
The data in [Table 5] show that the median value for the knowledge score was 11.5 with an IQR ratio of
3.75, whereas for preventive practice, the median score was 20 with an IQR ratio of
3. The calculated spearman rank correlation was 0.017 with a p-value of 0.869.
Table 5
Correlation between knowledge and preventive practice using Spearman rank correlation
coefficient
|
Variable (n = 100)
|
Median
|
IQR
|
|
p-Value
|
|
Knowledge
|
11.5
|
3.75
|
0.017
|
0.869
|
|
Preventive practice
|
20
|
3
|
Discussion
The purpose of the study was to assess the level of osteoporosis knowledge among menopausal
women in the selected community area, especially with regard to preventive practice.
The purpose of selecting menopausal women as study subjects was that they are at the
highest risk for osteoporosis and fragility fractures, and this warrants timely and
pre-emptive screening among women.
In this study, the majority of the menopausal women (65%) were between the age group
of 53 and 56 years. A study conducted by El-Tawab et al
[10] revealed that the mean age of studied women was 49.92 ± 7.75 years.
Study conducted by Senthilraja et al[11] demonstrates that the mean age of attainment of menopause was 46 years. This is
consistent with another study conducted by Ahuja[12] in which the average age of menopause of an Indian woman was 46.2 years. However,
in the present study, 61% of the participants attained menopause between the age group
of 49 and 52 years.
In the present study, 79% of menopausal women were having primary education and 77%
of the menopausal women were unskilled workers. A study conducted by Agarwal and Badkur[9] showed that 20% had elementary education, 12% had high school education, and 14%
were graduates.
The participants of our study had poor knowledge about the risk factors and the consequences
of osteoporosis and the findings show that 50% of the participants had attained adequate
knowledge with a median score of 12 and the remaining half of the participants attained
less than 12, and they are with inadequate knowledge. A similar deficit in knowledge
was observed in a study conducted by Senthilraja et al,[11] where 60% of participants had very poor knowledge.
In the present study, 56% of the participants had favorable practices toward the prevention
of osteoporosis and 44% of the participants had unfavorable practices toward osteoporosis.
The study findings are consistent with findings of another unpublished study, which
revealed that 71.9% of post-menopausal women had healthy practices and remarkable
health status and 28.1% had unhealthy practices and resulted in poor health status.[13]
In our study, the median value for the knowledge score was 11.5 with an IQR ratio
of 3.75, whereas for the preventive practice the median score was 20 with an IQR ratio
of 3. The calculated Spearman rank correlation was 0.017 with a p-value of 0.869. An unpublished study findings revealed that there was a moderately
positive (r = 0.410) correlation between knowledge and attitude toward osteoporosis among post-menopausal
women.[13]
Conclusion
Ideally, conducting a teaching session on osteoporosis, its risk factors, and treatment
modalities and assessing the questionnaire responses before and after the same will
help in determining the result of education on participants' existing state of awareness.
However, menopausal women in our country reside in rural areas, and belong to a lower
socioeconomic status, it is reasonable to imagine that the state of awareness among
the subjects might be worse than what was noted in this study. This justifies the
widespread use of osteoporosis awareness campaigns to promote knowledge in this regard,
especially at the grass-root level in the community.
Thus, this study was an attempt to identify the level of awareness among menopausal
women, and hence these results can be used to implement health education measures
to improve awareness of and preventive practice toward osteoporosis.
