The effect of educational intervention based on theory of planned behavior on behavioral responses of premenopausal women in prevention of osteoporosis
Authors: Jeihooni Ali Khani , Rakhshani Tayebeh , Khiyali Zahra , Ebrahimi Mohammad Mehdi , Harsini Pooyan Afzali 
Published: September 2022

Abstract
Background
Osteoporosis is one of the most prevalent bone diseases which is preventable. Implementing educational programs is an important step in prevention of chronic diseases in the community setting. One of the theories used for predicting behavior and performing educational intervention is theory of planned behavior (TPB) which predicts the intention of an individual toward doing a specific behavior. This study was conducted to assess the effect of educational intervention based on TPB on behavioral responses of premenopausal women in prevention from osteoporosis in Fasa city, Iran.

Methods
This study is a quasi-experimental study performed on 200 women aging from 35 and 55 years who referred to health centers in Fasa city; iran in 2019. Simple random sampling was applied to assign participants to control and intervention groups (100 participant for each group). Data were gathered by a "valid" and "reliable" questionnaire arranged based on the constructs of TPB, nutrition performance and physical activity. An educational program on osteoporosis prevention was conducted. educational intervention was performed in six sessions through group discussions and educational films and booklet for experimental group and then the changes in the scores of the two groups were evaluated and compared. Obtained data were analyzed by SPSS-22 software through Chi-square, independent t-test, paired t-test and ANOVA tests.

Results
The mean ages of studied participants in experimental and control groups were respectively 43.39 $$\pm$$
±
5.20 and 42.94 $$\pm$$
±
5.52. In experimental group, the average scores of knowledge [2 weeks (31.12 $$\pm$$
±
4.20) and 2 months (39.04 $$\pm$$
±
4.10) after educational intervention (p < 0.001)], constructs of theory of planned behavior [attitude construct: 2 weeks (89.32 $$\pm$$
±
9.22) and 2 months (98.57 $$\pm$$
±
9.13) after educational intervention (p < 0.001), Subjective norms construct: 2 weeks(88.39 $$\pm$$
±
8.84) and 2 months (122.57 $$\pm$$
±
8.58) after educational intervention (p < 0.001), Perceived behavioral control construct: 2 weeks (88.56 $$\pm$$
±
8.38) and 2 months (120.15 $$\pm$$
±
8.33) after educational intervention (p < 0.001), Behavioral intention construct: 2 weeks (54.44 ± 4.72) and 2 months (60.26 $$\pm$$
±
4.12) after educational intervention (p < 0.001)], nutrition performance [2 weeks (19.88 ± 2.56) and 2 months (24.14 $$\pm$$
±
2.36) after educational intervention (p < 0.001)] and physical activity [2 weeks (16.75 $$\pm$$
±
1.42) and 2 months (18.94 $$\pm$$
±
1.68) after educational intervention (p < 0.001)] had more significant enhancement than control group 2 weeks and 2 months after educational intervention.

Discussion
TPB was effected in nutrition performance and physical activity in osteoporosis prevention of subjects. This theory can be used as a framework for designing and performing educational intervention for preventing osteoporosis and promoting women’s health.