Education Program on Increasing Osteoporosis Awareness Given to Women Aged 18-49
Condition: Osteoporosis Risk
MeSH terms: Osteoporosis
Study type: Interventional

Summary: 
      Summary Purpose: To examine the effect of the education program to increase osteoporosis
      awareness given to women aged 18-49.

      The research is carry out as a randomized controlled experimental in a pretest-posttest
      design. The population of the research consisted of women registered in four different
      women's cultural and education centers affiliated with Ankara Altındağ Municipality between
      the dates of data collection.The number of women to be included in the sample of the study
      was determined as 70 women, 35 of which were in the control group, in the analysis made using
      the G*Power 3.1.9.2 program. Intervention and control groups were assigned to the groups by
      randomization method. The data collection tools used in the research are the Introductory
      Information Form, the Osteoporosis Health Belief Scale and the Osteoporosis Awareness Scale.
      In the implementation of the research, the education program to increase awareness of
      osteoporosis was carried out on certain days of the week with groups of at least two and at
      most five women. The education program aimed at raising awareness of osteoporosis was carried
      out in 3 sessions, one week apart, and each session lasted approximately 40-50 minutes.
      Before the first session of the education program, pre-test data were collected from the
      intervention and control groups. Post-test data will be collected through the Osteoporosis
      Health Belief Scale and the Osteoporosis Awareness Scale from women in the intervention and
      control groups twelve weeks after finishing the education program.
    

Detailed description: 
      Type of Research The research will be conducted as a randomized controlled experimental study
      in the pre-test-post-test order.

      Research hypotheses H11 : There is a difference between the osteoporosis awareness scores of
      the women who participated in the training program to increase the awareness of osteoporosis
      and the osteoporosis awareness scores of the women who did not participate in the training
      program.

      H01: There is no difference between the osteoporosis awareness scores of the women who
      participated in the training program to increase the awareness of osteoporosis and the
      osteoporosis awareness scores of the women who did not participate in the training program.

      H12: There is a difference between the osteoporosis health belief scores of women who
      participated in the training program to increase awareness of osteoporosis and the
      osteoporosis health belief scores of women who did not participate in the training program.

      H02: There is no difference between the osteoporosis health belief scores of the women who
      participated in the training program to raise awareness of osteoporosis and the osteoporosis
      health belief scores of the women who did not attend the training.

      Place of Research

      The research is planned to be carried out in the Women's Culture and Education Centers of
      Ankara Altındağ Municipality. Altındağ Municipality has 24 Women's Culture and Education
      Centers in 24 different neighborhoods with a total of 60000 registered members
      (https://www.altindag.bel.tr/#!kadin_egitim_kultur_merkezleri). The research was conducted in
      the first four centers with the highest number of members among the 24 Women's Culture and
      Education Centers. Necessary permissions were obtained from the centers where the research
      would be conducted. The permission obtained was reported to the Ethics Committee.

      Population and Sample of the Research

      In this study, the G*Power-3.1.9.2 program was used to calculate the sample size. The sample
      size was calculated at a 95% confidence level based on the Osteoporosis Health Belief Scale
      scores as a result of the study conducted by Pınar and Pınar (2020). As a result of the
      analysis, α=0.05 level, standardized effect size was calculated as d=0.9530, and with a power
      of 0.95, a minimum of 60 women, 30 in the intervention group and 30 in the control group,
      were found.

      Considering the possibility of participants who did not want to continue with the research,
      the number of women to be included in the sample of the study was determined as 70, taking
      into account the dropout rate of a similar study (Eyimaya & Tezel, 2021). According to the
      results of the power analysis, intervention and control groups will be determined by
      randomization among women who meet the inclusion criteria and agree to participate in the
      study.

      The managers of the institutions in the centers where the research will be conducted made an
      announcement about osteoporosis awareness training to women aged between 18-49, and the women
      were invited to the research and a list of volunteers was created. The researcher contacted
      the volunteer women and identified the women who met the inclusion criteria in the study. The
      list of the volunteers who met the criteria for inclusion in the study, including their age,
      educational status and the center they were a member of, was sent to a statistics expert in
      order to determine the intervention and control groups by randomization method.

      Data Collection Tools Introductory Information Form Osteoporosis Awareness Scale Osteoporosis
      Health Belief Scale

      Introductory Information Form

      In order to determine the introductory characteristics of the participants (age, educational
      status, etc.), a form was prepared by the researcher using the literature. The form was
      presented to the opinion of 6 different experts who are faculty members in the fields of
      Gynecology and Obstetrics Nursing, Midwifery, Nutrition and Dietetics, Physiotherapy and
      Rehabilitation and was arranged according to their suggestions.

      Osteoporosis Awareness Scale

      The Osteoporosis Awareness Scale was developed by Choi et al. (2008). In the original version
      of the scale, there are 31 questions and sub-dimensions of "protective behaviors", "risk
      factors", "characteristics of osteoporosis", "bone physiology" and "improving bone health".
      Turkish validity and reliability studies of the scale were performed by Aktürk et al. (2021).
      In the Turkish version of the scale, the "improving bone health" sub-dimension in the
      original scale was not included, but the "exercise" sub-dimension was included. However, the
      number of questions has been reduced to 27. The sub-dimensions in the Turkish form of the
      scale are; "protective behaviors", "risk factors", "characteristics of osteoporosis",
      "exercise" and "bone physiology".

      Cronbach's alpha value of the scale was 0.948 and sub-dimension Cronbach's alpha values;
      0.917 for "protective behaviors", 0.820 for "risk factors", 0.839 for "osteoporosis
      features", 0.821 for "bone physiology" and 0.804 for "bone health promotion". In the
      adaptation study of the scale to Turkish society, Cronbach's alpha value was 0.949 and
      sub-dimension Cronbach's alpha values; It was found to be 0.86 for "protective behaviors",
      0.866 for "bone physiology", 0.882 for "risk factors", 0.866 for "exercise" and 0.858 for
      "characteristics of osteoporosis".

      Osteoporosis Health Belief Scale

      The Osteoporosis Health Belief Scale was developed by Kim et al. (1991) to measure health
      beliefs about osteoporosis based on the Health Belief Model. The Turkish validity and
      reliability analyzes of the scale were performed by Kılıç and Erci (2004). There are 42
      questions and seven sub-dimensions in the scale. The sub-dimensions of the scale are
      "perception of sensitivity", "perception of seriousness", "benefits of exercise", "benefits
      of taking calcium", "barriers to exercise", "obstacles of calcium intake" and "health
      motivation". The Cronbach's alpha value of the scale is between 0.71-0.82 (Kim et al., 1991).
      The Cronbach alpha value of the scale, which was adapted into Turkish, is between 0.79-0.94.

      Education Program to Raise Osteoporosis Awareness

      The education program was prepared using the relevant literature, and the content of the
      training program was presented to the opinion of experts in the field and arranged according
      to their suggestions. Before starting the research, a preliminary application of the
      education program was carried out with three volunteer women who were randomly selected from
      the universe and met the criteria for inclusion in the sampling in a women's cultural center
      affiliated with Altındağ Municipality and for which data was not collected.

      The education program, which was prepared to increase awareness of osteoporosis, was planned
      to be one-to-one education for each woman instead of group training due to the pandemic
      conditions, but on 05.05.2023 the World Health Organization and T.R. Following the Ministry
      of Health's notification that the Covid-19 global emergency has ended and the request from
      the participants in the pre-implementation of the education program, an application was made
      to the Ankara University Ethics Committee, and the necessary permission was obtained for the
      education to be implemented as a group training instead of one-on-one. However, permission
      was obtained from the Ethics Committee to reduce the time between education sessions to one
      week without changing the number of sessions.

      The education program consisting of three sessions was held once a week and each session
      lasted approximately 40-50 minutes. In the realization of the education program, a power
      point presentation consisting of the contents of the education booklet prepared for
      Osteoporosis awareness, a three-dimensional bone model with Osteoporosis and normal bone
      tissue, some food samples containing calcium during nutrition education, and measuring cups
      to show portions and amounts were used. During the training, a question and answer activity
      was also held. The education booklet was also given to the intervention group at the end of
      the first session.

      Contents of the Education Booklet

      A education booklet will be used in the education to be given during the implementation of
      the education program to increase awareness of osteoporosis. The education booklet was
      created in line with the relevant literature. It was sent to a total of 6 experts who are
      faculty members of the field of Gynecology and Obstetrics Nursing, Midwifery, Nutrition and
      Dietetics, Physiotherapy and Rehabilitation for evaluation. The education booklet presented
      to the expert opinions was also evaluated according to the DISCERN measurement tool. In our
      study, after the evaluation of the education booklet, the DISCERN score average was
      calculated as 72.5. The readability coefficient of the education booklet was calculated
      according to Ateşman's (1997) formula. According to the calculations made, the readability
      coefficient of the education Manual for Raising Osteoporosis Awareness for Women aged 18-49
      was calculated as 67.7. It indicates that the readability level of this booklet is medium
      difficulty.

      Data Collection

      Collection of intervention group data

      After giving the necessary information about the research to the participants and obtaining
      written permissions, an introductory information form, Osteoporosis Awareness Scale and
      Osteoporosis Health Belief Scale will be applied by the researcher to the women in the
      intervention group who meet the inclusion criteria, just before the education program (before
      first session) in order to collect the pre-test data. Six weeks after the pre-test data were
      collected, the Osteoporosis Awareness Scale and Osteoporosis Health Belief Scale will be
      applied to collect the post-test data. In the awareness studies in the literature, studies
      measuring post-test data 15 days after the intervention or at wider time intervals were found
      (Alnuaimi et al., 2021; Erenoğlu and Yaman Sözbir, 2020; Darawad et al., 2022). In this
      study, a study measuring twelve weeks later was taken as reference (Öz Yıldırım et al.,
      2023).

      Collection of control group data

      After the participants were given the necessary information about the study and written
      consents were obtained, the Introductory Information Form, Osteoporosis Awareness Scale and
      Osteoporosis Health Belief Scale will be applied to the women in the control group who met
      the inclusion criteria in order to collect the pre-test data.Twelve weeks after finishing the
      education program the Osteoporosis Awareness Scale and Osteoporosis Health Belief Scale will
      be applied to collect the post-test data.

      Variables of the Study

      Dependent variable: Osteoporosis awareness and Osteoporosis health belief. Independent
      variable: Education program to raise awareness of osteoporosis.

      Analysis of Data SPSS (Statistical Package for Social Sciences) program will be used to
      evaluate the data obtained from the research. In the analysis of continuous variables
      obtained from the measurements, mean and standard deviation, median (min-max), frequency and
      percentage values will be used in the analysis of categorical variables. It will be evaluated
      whether the continuous variables comply with the normal distribution by analyzing whether
      they comply with the parametric test conditions.

      The average score will be taken in the evaluation of the scales. In order to compare the
      research groups, Student's t test will be used in cases where normal distribution is
      provided, and Mann-Whitney U test will be used in cases where normal distribution is not
      provided. In the analysis of the difference between the pre-test and post-test scores of the
      participants, appropriate tests will be performed after determining whether the data are
      suitable for normal distribution. Cronbach's alpha reliability coefficient will be calculated
      in the internal consistency analyzes of the scales and the reliability of their
      sub-dimensions. In all statistical analyzes, p values less than 0.05 will be considered
      statistically significant.

      Ethical Principles Permission was obtained from the Ankara University Ethics Committee to
      conduct the study. The necessary permissions from the centers where the research will be
      conducted were obtained within the scope of the cooperation protocol between Ankara
      University Nursing Faculty and Altındağ Municipality. The permission obtained was reported to
      the Ethics Committee. In order to use the scales to be used in the research, permission was
      obtained from the authors via e-mail. Participants included in the study will be informed
      about the research through the Informed Voluntary Consent Form, and will be included in the
      study after their written consents are obtained.

      After the education program given to the women in the intervention group is over, the women
      in the control group and all the women who volunteered to participate in the research but
      were not in the control or intervention groups will be given a education and a education
      booklet, consisting of one session, in three groups.
    

Intervention name(s): Education Program on Increasing Osteoporosis Awareness Given to Women Aged 18-49. The research is carry out as a randomized controlled experimental in a pretest-posttest design.
Intervention type(s): Other
Intervention description(s): The education program consisting of three sessions was held once a week and each session lasted approximately 40-50 minutes. In the realization of the education program, a power point presentation consisting of the contents of the education booklet prepared for Osteoporosis awareness, a three-dimensional bone model with Osteoporosis and normal bone tissue, some food samples containing calcium during nutrition education, and measuring cups to show portions and amounts were used. During the training, a question and answer activity was also held. The education booklet was also given to the intervention group at the end of the first session.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The research will be conducted in a pre-test-post-test order, as a randomized controlled experimental.
Masking: Single (Outcomes Assessor)
Primary purpose: Prevention
Keywords: Osteoporosis; Osteoporosis Health Belief; Awareness; Education Program; Women Health