Abstract
Background. Osteoporosis is a silent disease of the present era, which is of particular importance due to the high incidence of this disease in women and its complications. This disease is preventable. This study aims to investigate the determinants of osteoporosis prevention behaviors among postmenopausal women using the Health Belief Model (HBM).
Methods. The present cross-sectional analytical study was conducted in 2023 on 185 postmenopausal women in Sarab city. Sampling was done using a multi-stage cluster method. After collecting data using standard questionnaires based on the health belief model regarding osteoporosis, the data were analyzed using SPSS version 25 and independent t-tests, ANOVA, and regression.
Results. Based on the correlation test results for the HBM constructs, there was a statistically significant relationship between perceived barriers and awareness, perceived sensitivity, perceived severity, and perceived benefits (P<0.05). Based on the results of linear regression in the second model, with the addition of constructs to demographic characteristics, the predictive ability reached 37%, and awareness had the strongest predictive power (β=0.316).
Conclusion. The findings of this study confirmed the effectiveness and efficiency of HBM in adopting preventive actions against osteoporosis. Considering the aging population in Iran and the increasing prevalence of osteoporosis among women due to menopause, the results of the present study can be used to reduce perceived barriers, increase awareness, perceived sensitivity, perceived severity, and perceived benefits. In addition to other care provided in health centers, it is suggested that special care for menopausal women be considered so that all menopausal women are covered and referred to health centers.
Extended Abstract
Background Osteoporosis is a silent disease of the present era, which is of particular importance due to the high incidence of this disease in women and its complications. This disease is preventable. Osteoporosis is one of the most common calcium-related disorders, characterized by decreased bone mass density and bone tissue destruction. Osteoporosis is the most common metabolic disease, a chronic socioeconomic threat that has become a global epidemic with the growing population aging. The results of the study showed that the prevalence of osteoporosis and osteopenia in Iranian menopausal women is 33.70 % and 47.60 %, respectively. As a result, osteoporosis and osteopenia are very common in Iranian menopausal women, with one-third of women suffering from osteoporosis and about half of them experiencing osteopenia. This study aims to investigate the determinants of osteoporosis prevention behaviors among postmenopausal women using the Health Belief Model (HBM).
Methods This cross-sectional analytical study was conducted in 2023 on 185 postmenopausal women in Sarab city. Sarab (37°56′32″N, 47° 32′ 12″ E) is a city in the Central District of Sarab County, East Azerbaijan province, the northwestern part of Iran. The citizens in Sarab are Azerbaijani and speak Turkish. The 2016 census measured the population of the city as 45,031 people in 13,953 households.
Sampling was done using a multi-stage cluster probability method. There were five health centers in the city of Sarab in 2023, so each center was considered a cluster. Menopausal women referred from each cluster to the centers were selected for the study. The entry criteria encompassed menopausal women who expressed satisfaction with the study; women diagnosed with research-related diseases, including ovarian and uterine cancers, were excluded. Following the invitation to participate and an explanation of the study's objectives, the researcher completed the questionnaires.
In the present study, a standard HBM-based questionnaire was used regarding osteoporosis and preventive behaviors. There were 24 questions related to assessing awareness of osteoporosis. For the awareness questions, each correct answer received a score of 1, while incorrect and “I don’t know” responses received a score of zero. six questions for perceived susceptibility, six for perceived severity, six for perceived benefits, and six for perceived barriers, all measured on a five-point Likert scale (strongly agree, agree, neutral, disagree, strongly disagree). Scoring for this section ranged from 1 to 5, where “strongly disagree” received one point, “disagree” two points, “neutral” three points, “agree” four points, and “strongly agree” five points. After collecting data using standard questionnaires based on the health belief model regarding osteoporosis, the data were analyzed using SPSS version 25 and independent t-tests, ANOVA, Pearson's correlation, and hierarchical regression. In this study, a significant level (P <0.05) was considered.
Results
In the present study, 185 postmenopausal women participated. Among them, 103 (55%) were under 55 years of age, and 82 (44%) were 55 and older. Most of them were housewives (91%) and had no education up to the fifth grade (67%). In terms of income, the majority were in the middle range (30%). The study findings showed that all the model constructs were significantly related to the demographic variables of education, income, and occupation of postmenopausal women (P<0.05).
Based on the correlation analysis, there was a significant correlation between awareness, perceived sensitivity, and perceived severity with perceived barriers (P<0.001). With increasing awareness, perceived sensitivity and perceived severity increase, and perceived barriers decrease. Also, there was no significant correlation between perceived benefits and barriers (P=0.429). Thus, increasing perceived benefits did not reduce perceived barriers.
In the first stage of the linear regression model, demographic variables accounted for 27% variation in perceived barriers. In this stage, the individual's own education was a significant predictor of perceived barriers (P<0.05). In the second model, by adding the health belief model constructs to demographic characteristics, the model’s predictive ability increased to 37%. Awareness was the strongest significant predictor of perceived barriers to osteoporosis preventive behaviors (P<0.001, β=0.316).
Conclusion
According to this study, the constructs of awareness, perceived sensitivity, perceived severity, and perceived benefits were significantly related to perceived barriers to osteoporosis preventive behaviors among postmenopausal women. Also, the construct of awareness was the strongest determinant in the HBM. The individual's own education, occupation, and income were among the determinants of the constructs of the HBM. Higher education leads to greater awareness among individuals, and women with jobs and income were more socially active and therefore showed fewer barriers to osteoporosis preventive behaviors. Given the aging population in Iran and the subsequent increasing incidence of postmenopausal osteoporosis in women, the results of this study can be used to identify determinants and reduce perceived barriers, increase awareness, perceived sensitivity, perceived severity, and perceived benefits. It is suggested that, in addition to other care provided in health centers, special care for postmenopausal women be considered so that all postmenopausal women are covered and referred to health centers.
Practical Implications of Research
Given the aging population in Iran and the increase in problems caused by it in the future, examining the determinants of osteoporosis prevention in postmenopausal women can help health and prevention policymakers to improve the situation of this group of women and reduce the barriers ahead. Given the emphasis on prevention over treatment and complications of fractures caused by osteoporosis, including health-oriented programs based on identifying factors determined by relevant authorities in the care programs of health centers, will lead to the referral of all postmenopausal women, their coverage, and the reduction of complications caused by this health problem.