Bone Health Education for Osteoporosis Risk Reduction in Premenopausal Women: A Quality Improvement Project

Bone Health Education for Osteoporosis Risk Reduction in Premenopausal Women: A Quality Improvement Project by Gloria J. Nichols MSN, Walden University, 2009 WHNP, University of Texas Southwestern Dallas, 1997 BA, University of Texas San Antonio, 1984 ADN, San Antonio College, 1976 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University August 2016 Abstract In the United States, about 8.5 million women live with osteoporosis. Osteoporosis is a debilitating systemic skeletal disorder characterized by low bone mass and reduced bone mineral density that occurs with the loss of estrogen. The mortality rate for this group is about 3 to 4 times higher than other women and as many as 1 in 3 experience a fracture. Guided by the Health Belief Model, this project evaluated how a bone health fact sheet impacts knowledge about osteoporosis and self-efficacy for preventative behavioral change in premenopausal women (age 40-58 years). The project also evaluated if an electronic medical record (EMR) alert system with an additional bone health education in the patient instruction menu can improve participation by 11 health care providers (HCPs). Prior to the participants receiving the fact sheet, the knowledge, health beliefs, and perceived risks for developing osteoporosis were measured using the Revised Osteoporosis Knowledge Test (ROKT) and the Osteoporosis Health Belief Scale (OHBS). Although 87% of participants identified menopause as a major osteoporosis risk factor, fewer women (33%) knew that surgical removal of the ovaries was also a risk factor and half agreed or strongly agreed that calcium and exercise can prevent osteoporosis. After receiving the fact sheet, the participants had an average confidence score of 62% on the Osteoporosis Self-Efficacy Scale (OSES) for engaging in exercise and an average confidence score of 65% for adhering to calcium intake guidelines. Furthermore, the EMR alert system facilitated 100% documentation by HCPs. These results indicated the fact sheet can motivate premenopausal women to engage in osteoporosis preventive behaviors. Importantly, the EMR reminder with education fact sheet can facilitate the active involvement of HCPs in patient education.In the United States, about 8.5 million women live with osteoporosis. Osteoporosis is a debilitating systemic skeletal disorder characterized by low bone mass and reduced bone mineral density that occurs with the loss of estrogen. The mortality rate for this group is about 3 to 4 times higher than other women and as many as 1 in 3 experience a fracture. Guided by the Health Belief Model, this project evaluated how a bone health fact sheet impacts knowledge about osteoporosis and self-efficacy for preventative behavioral change in premenopausal women (age 40-58 years). The project also evaluated if an electronic medical record (EMR) alert system with an additional bone health education in the patient instruction menu can improve participation by 11 health care providers (HCPs). Prior to the participants receiving the fact sheet, the knowledge, health beliefs, and perceived risks for developing osteoporosis were measured using the Revised Osteoporosis Knowledge Test (ROKT) and the Osteoporosis Health Belief Scale (OHBS). Although 87% of participants identified menopause as a major osteoporosis risk factor, fewer women (33%) knew that surgical removal of the ovaries was also a risk factor and half agreed or strongly agreed that calcium and exercise can prevent osteoporosis. After receiving the fact sheet, the participants had an average confidence score of 62% on the Osteoporosis Self-Efficacy Scale (OSES) for engaging in exercise and an average confidence score of 65% for adhering to calcium intake guidelines. Furthermore, the EMR alert system facilitated 100% documentation by HCPs. These results indicated the fact sheet can motivate premenopausal women to engage in osteoporosis preventive behaviors. Importantly, the EMR reminder with education fact sheet can facilitate the active involvement of HCPs in patient education. Bone Health Education for Osteoporosis Risk Reduction in Premenopausal Women: A Quality Improvement Project by Gloria J. Nichols MSN, Walden University, 2009 WHNP, University of Texas Southwestern Dallas, 1997 BA, University of Texas San Antonio, 1984 ADN, San Antonio College, 1976 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University August 2016 Dedication This project is dedicated to my Lord and Savior, Jesus Christ who placed within me at the age of twelve the desire to become a nurse along with the promise that if I commit my life to Him the desires of my heart would come to pass. Thank you, Lord, for the mind to comprehend, wisdom to discern and interpret, and the strength to endure until the completion of this project despite delays, personal tests and trials. Acknowledgements Thanks, to my husband, Leslie, who has been with me from the onset of this educational journey. Your confidence in me never wavered. Your love, prayers, and support kept me encouraged. Thank you, babe, I love you. I would also like to thank my committee members, Dr. Eileen Fowles, Dr. Melanie Braswell, and Dr. Patrick Palmieri, for their time, expertise, and guidance toward the completion of this project. Thanks to Dr. Phyllis Gendler for permission to use the instruments that were included in this project. To my mentor and preceptor throughout the development and implementation of the project, Dr. Christine de la Garza, thank you.