Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

A descriptive study of knowledge, beliefs and practices regarding osteoporosis among female medical school entrants in Sri Lanka

A descriptive study of knowledge, beliefs and practices regarding osteoporosis among female... Background: Osteoporosis is a significant problem in rapidly ageing populations in Asian regions. It causes a significant personal and societal impact and increases the burden on health care services. Objectives: Aim of this study is to determine the knowledge, beliefs and practices regarding osteoporosis among young females entering medical schools in Sri Lanka. Methods: This is a descriptive cross sectional study conducted amongst 186 female medical school entrants of the Faculties of Medicine, Universities of Colombo and Kelaniya from September to December 2010. A self administered questionnaire was used to assess knowledge, beliefs and practices on osteoporosis, including a food frequency chart to assess the calcium intake. Results: The mean age was 20.7 +/− 2.1 years. Majority of the participants (51.6%, n = 96) had an average score (40? 60) on the knowledge test, while 40.8% (n = 76) had a poor score (<40). However, in depth knowledge on risk factors, and protective factors was lacking. Perceived susceptibility for osteoporosis was low with only 13.9% (n = 26) of women agreeing that their chances of getting osteoporosis are high. The mean calcium intake was 528 mg/day and only 18.8% (n = 35) of the participants achieved the Recommended Daily Allowances (RDA) for Calcium. Exercise was grossly inadequate in the majority and only 13.6%( n = 23) engaged in the recommended exercises. Only 3.8% (n =7) of the participants currently engaged in specific behaviours to improve bone health while 10.8% (n = 20) had thought of routinely engaging in such behaviours. Conclusions: Although majority of participants had a modest level of knowledge on osteoporosis, there were gaps in their knowledge in relation to risk factors, protective factors and on the insidious nature of osteoporosis. Perceived susceptibility for osteoporosis was low. Practices towards preventing Osteoporosis were inadequate. Keywords: Osteoporosis knowledge, Osteoporosis beliefs, Calcium intake, Osteo-protective behaviours, Womens health Background Due to increasing proportions of ageing populations in Osteoporosis is a global health problem. Osteoporosis the Asian region, osteoporosis has become more preva- and fractures secondary to osteoporosis are an important lent and increases the health care expenditure in this cause of mortality and morbidity [1]. Approximately 1.6 region [2,3]. As osteoporosis is a silent disease, it is in- million hip fractures occur each year worldwide, the in- tuitive that primary preventive measures including early cidence is set to increase to 6.3 million by 2050 [1]. detection of risk factors for osteoporosis, educating the individuals at risk on preventive measures, and timely intervention with regard to treatment will reduce the morbidity and mortality and cut down the cost of treat- * Correspondence: erandie_ediriweera@yahoo.com Family Medicine Unit, Faculty of Medicine, University of Colombo, Kynsey ment [4,5]. Road, Colombo 8, Sri Lanka Full list of author information is available at the end of the article ? 2014 Ediriweera de Silva et al.; licensee BioMed Central. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. Ediriweera de Silva et al. Asia Pacific Family Medicine 2014, 13:15 Page 2 of 6 http://www.apfmj.com/content/13/1/15 Females are at higher risk of developing osteoporosis. frequency questionnaire to assess the calcium intake Female medical school entrants consist of an educated [17,18]. The food frequency questionnaire also included young population, with a gender-based higher risk of de- local calcium dense food items, after wide literature re- veloping osteoporosis later in life. Studies carried out view and expert opinion. among females report that their knowledge about osteo- Informed consent was obtained prior to the study. porosis is limited [6-9]. A study carried out in Australia Ethical clearance for the study was obtained from the among Asian women revealed that their calcium intake Ethics Review Committee of the Faculty of Medicine, was lower and their knowledge on osteoporosis was University of Colombo. poor [10]. It is known that knowledge on osteoporosis contributes to enhance behaviours towards preventing Data analysis osteoporosis [9]. The variables were grouped in to blocks of knowledge, Several factors have been recognized as critical to- beliefs and practices, and within these blocks we have wards improving bone health. These include modifiable used descriptive statistics and the Pearson? s chi-square factors such as calcium intake, physical activity, and test to compare the two populations studied. The results non-modifiable factors such as genetic makeup [11,12]. were analysed using SPSS (version 19) and Excel com- Some of the established risk factors include ageing, fe- puter software. A p value of <0.05 was considered as male gender, family history of osteoporosis, early meno- significant. pause, cigarette smoking, excessive alcohol consumption The knowledge on osteoporosis was scored as follows: and certain medications [13]. It is reported that bone each correct response scored one point and each incor- gain occurs in young adults till the age of 30 years rect response and ? Do not know? response scored zero [14]. Primarily, preventive strategies should be aimed at points. The total correct responses were given a score young women, as these interventions have the potential out of 20, and multiplied by five to obtain a score out of to delay the onset of osteoporosis. However, studies on 100. The scores were categorized as follows- <20: Very the subject among young females in South Asian coun- Poor, 20? 39: Poor, 40? 59: Average, 60? 79: Good and 80 tries are scarce. or > 80: Very Good. This study assesses the knowledge and beliefs on The questionnaire to assess practices was pre-coded to osteoporosis and practices towards preventing osteopor- indicate positive and negative behaviours towards osteo- osis among young females of two major medical schools porosis, and the individual behaviours were analysed in the country. separately. The calcium intake was calculated based on the data recorded in the 40 item food frequency Methods questionnaire. This study was carried out among the female medical The number of portions of each food item consumed school entrants of the Faculties of Medicine, at the per week, as defined by the questionnaire was obtained Universities of Colombo and Kelaniya from September for each participant. The amount of calcium contributed to December 2010. A pre-tested self administered by each food item was derived by calculating the calcium questionnaire was used to assess knowledge, beliefs, and content of food items taken from references. The weekly practices towards osteoporosis. Osteoporosis Knowledge calcium intake for each respondent was calculated and Assessment Tool (OKAT), a validated tool was used [15]. the average daily calcium intake was obtained from this This consists of 20 questions to assess knowledge. Content value. The total daily calcium intake was categorized as areas assessed include knowledge on osteoporosis risk fac- adequate (750 mg or more) and inadequate (less than tors, preventive measures, diagnosis, and management. 750 mg) based on the recommended daily allowance for The Osteoporosis Health Belief Scale was used to assess calcium for young Sri Lankan females [19]. Physical ac- beliefs [16]. This scale includes questions on perceived tivity was assessed based on the type and duration of susceptibility (3 questions), perceived barriers to Calcium weight bearing exercises engaged during a week. intake (3 questions), perceived benefits of Calcium (3 questions), perceived seriousness (3 questions) and per- Results ceived health motivation (3 questions) [16]. The response rate was 100% with 86 participants from The questionnaire to assess practices related to osteo- the University of Colombo and 100 participants from porosis included questions on positive and negative be- the University of Kelaniya. The mean age of the partici- haviours towards osteoporosis. The positive behaviours pants was 20.7 +/− 2.1 (mean +/− SD) years. The know- assessed were dietary calcium intake, physical activity ledge score on osteoporosis revealed that, 96(51.6%) and exposure to sun. The negative behaviours assessed had an Average score, while 71(38.2%) had a Poor score, were on smoking status and alcohol intake. The ques- and 5(2.7%) had a Very poor score based on the categor- tionnaire included a modified validated 40 item food isation defined in the methodology. 14(7.5%) of the Ediriweera de Silva et al. Asia Pacific Family Medicine 2014, 13:15 Page 3 of 6 http://www.apfmj.com/content/13/1/15 participants had a good score while none had a score When considering the two medical schools, students above 80. The mean and median scores were 34.8 +/− 10 from the University of Kelaniya indicated better health and 35 respectively, out of a total score out of 100. motivation towards osteoporosis (p < 0.01). Health mo- Table 1 shows that, only 60(32.3%) recognized that a tivation towards osteoporosis was satisfactory; however family history of osteoporosis is a risk factor for osteo- motivation towards exercise was poor. porosis. Old age was not considered a risk factor by 81 (43.5%), whilst 158(84.9%) did not know that smoking Practices was a risk factor. 150(80.6%) did not know that a higher The mean calcium intake was 528 mg/day and only 35 peak bone mass is protective. 111(59.7%) did not know (18.8%) of the participants achieved the Recommended that weight bearing exercises were protective for osteo- Daily Allowances (RDA) for Calcium. When considering porosis, however the students from the University of the respondents who met the RDA, 9(4.8%) were Kelaniya had better knowledge on the protective effect taking supplements in the form of multivitamins, while of weight bearing exercises on osteoporosis (p <0.01). 26(14%) were not taking any calcium supplements. The The dietary sources of calcium were not known by 67 top calcium providing food groups consumed by the (36%), and the students from University of Colombo participants amongst the daily intake of food types were, demonstrated better knowledge for this question (p < milk, tea with milk, yoghurt, small fish, rice, and cheese. 0.01). Only 34(18.3%) participants were aware that osteo- As indicated in Table 3, only 23(13.6%) engaged in the porosis is usually asymptomatic. recommended exercises in type and duration. Walking was found to be the commonest mode of exercise. 158 Beliefs (85.9%) were exposed to the sun for at least 30 minutes Table 2 shows that, only 26(13.9%) women agreed that a week. 184(99%) of the participants were teetotallers their chances of getting osteoporosis were high. Percep- and non-smokers. Only 7(3.8%) participants were cur- tions, towards barriers to calcium intake and benefits of rently engaged in specific behaviours to improve bone calcium intake revealed that 55(29.5%) participants felt health whilst 20(10.8%) had thought of routinely en- eating calcium rich food was difficult, while 14 (7.5%) gaging in such behaviour. felt that they are unable to tolerate calcium rich foods or that they dislike calcium rich foods, and 15(8%) felt that calcium rich foods are too expensive. On assessing the Discussion perceived seriousness of osteoporosis, 100(53.7%) felt that The aim of the study was to assess knowledge, beliefs if they had osteoporosis that it would change their whole and practices regarding osteoporosis among female life. 102(54.8%) mentioned that the thought of osteopor- medical school entrants. Medical school entrants were osis scares them, and 155(83.3%) felt that having osteopor- selected for the study as they would not have been osis would make daily activities more difficult. exposed to any teaching regarding osteoporosis in the Health motivation towards osteoporosis as shown in medical school. It was inferred that these study subjects Table 2, indicate that 116(62.3%) were motivated fre- would possess only the knowledge of a high school biol- quently to do changes to improve their health, and 110 ogy graduate. In addition, this was a young group of fe- (59.1%) were motivated to eat a well-balanced diet, how- males wherein interventions to improve bone health had ever only 41(22%) were motivated to exercise regularly. the potential to be of the highest long-term value. Table 1 Percentage of correct responses for osteoporosis risk factors and preventive practices Risk factor/Preventive practice Total (n = 186) University of Colombo (n = 86) University of Kelaniya (n = 100) P value* Family history of osteoporosis 60 (32.3) 32 (37.2) 28 (28.0) 0.19 Female sex 177 (95.2) 81 (94.2) 96 (96.0) 0.56 Old age 105 (56.4) 54 (62.8) 51 (51.0) 0.11 Premature menopause 14 (7.5) 4 (4.7) 10 (10.0) 0.17 Smoking 28 (15) 17 (19.8) 11 (11.0) 0.10 Physical activity ( Weight bearing exercises) 75 (40.3) 25 (29.1) 50 (50.0) < 0.01 Daily calcium requirement from food 84 (45.2) 41 (29.1) 43 (43.0) 0.52 Sources of calcium 119 (63.9) 70 (81.4) 49 (49.0) <0.01 Hormone therapy after menopause 45 (24.2) 22 (25.6) 23 (23.0) 0.44 Data are presented as n (%). *The Pearson? s Chi-square test was performed. Ediriweera de Silva et al. Asia Pacific Family Medicine 2014, 13:15 Page 4 of 6 http://www.apfmj.com/content/13/1/15 Table 2 Affirmative responses regarding beliefs on Osteoporosis Perceived Susceptibility Total University of Colombo University of Kelaniya P value* (n = 186) (n = 86) (n = 100) Chances of getting osteoporosis are high 26 (13.9) 15 (17.4) 11 (11.0) 0.20 We are more likely to get the disease 35 (18.8) 20 (23.3) 15 (15.0) 0.15 Family history makes us more likely to get osteoporosis 17 (9.1) 4 (4.7) 13 (13.0) 0.05 Perceptions, towards barriers to calcium intake Eating calcium rich food is difficult 55 (29.5) 28 (32.6) 27 (27.0) 0.21 Calcium rich foods do not agree with us or we dislike calcium rich foods 14 (7.5) 5 (5.8) 9 (9.0) 0.41 Calcium rich foods are too expensive 15 (8) 5 (5.8) 10 (10.0) 0.30 Perceptions, towards benefits of calcium intake Eating calcium rich foods reduces risks of broken bones 157 (84.4) 72 (83.7) 85 (85.0) 0.81 Eating calcium rich foods helps to build bones 131 (70.4) 57 (66.3) 74 (74.0) 0.25 Eating calcium rich foods prevents future problems from osteoporosis 153 (82.2) 71 (82.6) 82 (82.0) 0.92 Perceived seriousness of osteoporosis Total University of Colombo University of Kelaniya P value* (n = 186) (n = 86) (n = 100) If we had osteoporosis it would change our whole life 100 (53.7) 50 (58.1) 50 (50.0) 0.27 Thought of osteoporosis scares us 102 (54.8) 50 (58.1) 52 (52.0) 0.40 Having osteoporosis would make daily activities more difficult 155 (83.3) 75 (87.2) 80 (80.0) 0.19 Health motivation towards osteoporosis We are motivated frequently do things to improve our health 116 (62.3) 42 (48.8) 74 (74.0) <0.01 We are motivated to eat a well-balanced diet 110 (59.1) 41 (47.7) 69 (69.0) <0.01 Motivated to exercise regularly 41 (22) 12 (14) 29 (29.0) 0.01 Data are presented as n (%). *The Pearson? s Chi-square test was performed. The basic demographic characteristics, such as age expected to have a high level of knowledge even prior to and the level of education were similar as all students in entry to medical school the general knowledge on osteo- the country study the same curriculum and sit for the porosis, among our participants was at a modest level, same advanced level examination and qualified to med- with only half of the population achieving an average ical schools based on merit. Also all medical schools in score and a mere 7.5% achieving a good score based on the country receive medical students from all parts of the total knowledge score questionnaire. The mean and the country. Although it can be hypothesised that these median scores were 34.8 +/− 10 and 35 respectively out students are representative of female medical school en- of a total score out of 100. Similar results were seen in a trants in Sri Lanka generally, we do not have the data to study among Salvadorean women aged 25? 35 years make a definitive pronouncement on this. Therefore this which revealed a mean score of 12.1 out of 42 points is a limitation of this study in terms of the applicability (percentage 28.8) [20], although it must be noted that to the wider Sri Lankan medical student entrant. this study was carried out among the general population. Although it is perceived that medical school entrants Knowledge on risk factors and preventive practices are amongst the best students in the country and are are important in preventing or delaying the onset of Table 3 Duration of weight bearing exercise per week in the study population Total University of Colombo University of Kelaniya P value* (n = 186) (n = 86) (n = 100) <30 min/Week 79 (46.7) 37 (43) 42 (42.0) 0.62 30 min ? 60 min (1 hr) 42 (24.9) 11 (12.8) 31 (31.0) <0.01 60 min ? 90 min 25 (14.8) 13 (15.1) 12 (12.0) 0.53 >90 min 23 (13.6) 15 (17.4) 8 (8.0) 0.05 Recommended duration of weight bearing exercise per week: > 90 min. Data are presented as n (%). *The Pearson? s Chi-square test was performed. Ediriweera de Silva et al. Asia Pacific Family Medicine 2014, 13:15 Page 5 of 6 http://www.apfmj.com/content/13/1/15 Osteoporosis as well as in minimising morbidity due to higher mean bone mineral density at the spine and Osteoporosis. However, the knowledge on osteoporosis femur when compared with those with a mean intake risk factors among our study participants appeared to be below 300 mg/day [28]. Nearly all Asian countries are re- poor compared to a similar study among college women ported to be far below the Food and Agriculture Organisa- in the US [14]. Another study among medical students tion (FAO) and the World Health Organisation (WHO) from a medical school in Turkey revealed that know- recommendations for calcium intake [29]. Majority of the ledge on risk factors for osteoporosis, nutritional factors study population is not engaging in osteo-protective and diseases resulting in osteoporosis were poor [8]. It behaviours as evidenced by their poor consumption of cal- has been reported in several studies that women possess cium rich food and lack of physical activity. This is also limited knowledge about the disease, and are not taking reported in other studies [15,23], where the need for adequate measures to prevent or treat osteoporosis as osteo-protective behaviours has been emphasised. they age [7,21]. With respect to the results of this study, comparing The importance of health motivation in influencing the knowledge, beliefs and behaviours of the students of health related behaviours is described by Kim et al. [16]. the two different medical schools significant differences Perceived susceptibility towards osteoporosis appeared in knowledge was not seen in most parameters. How- to be low in our study population, with only 13.9% of ever, participants from the University of Kelaniya were women agreeing that their chances of getting osteopor- better motivated towards osteoporosis preventive behav- osis are high. A study in New Zealand among females iour. These differences cannot be directly explained aged 20? 49 years showed that the perceived personal based on the data available from this study. susceptibility was 29% [22] and Edmonds et al. also re- Among the limitations of the study is the fact that only ported similar results [23]. More than half of the study two medical schools were included. Also there might be population perceived osteoporosis as a serious disease. other contributing factors that were not explored in this Von Hurst et al. revealed that there was higher level of study, such as socio-economic differences, access to fa- agreement about the seriousness of osteoporosis, how- cilities such as access to sports equipment, gymnasiums, ever only less than a quarter of the subjects regarded swimming pools and nutritious meals although the study osteoporosis as a crippling disease [22]. Barriers towards provides baseline data for further study. These factors calcium intake were low and perceived benefits of cal- might be contributing towards the differences seen in cium intake were high, indicating that our study popula- health motivation and practices. Future research specif- tion was motivated towards taking calcium rich food. ically targeted towards socio-economic factors, access to Farr et al. reported that low levels of physical activity facilities and health beliefs will be useful in understand- may compromise bone development in young girls [24]. ing these differences. Also future qualitative studies may It is also reported that physical activity and strength be helpful in exploring the reasons for these differences. were positively associated with Bone Mineral Density This study highlights the need for health education (BMD) even in very elderly men [25]. In our study, exer- targeted to young females on osteoporosis, improving cise was grossly inadequate in the majority with a mere calcium intake and physical activity. In addition, primary 13.6% engaged in the recommended exercises. When health care interventions such as preventive health edu- compared with a similar study among college women in cation may help to reduce the burden of osteoporosis in the US, 59.8% were getting inadequate osteo-protective the community. exercise [14]. Wallace et al. reported lean mass to be a powerful predictor of BMD in young women. They reit- Conclusions erated that lean mass can be modified to some extent by Although majority of participants had a modest know- physical activity, thus physical activity must be increased ledge on osteoporosis, there were important gaps in throughout the lifespan [26]. knowledge in relation to risk factors and protective fac- Reduced calcium intake is linked to the osteoporosis tors of osteoporosis and on the insidious nature of risk in later life. Dietary calcium is important in achiev- osteoporosis. Perceived susceptibility for osteoporosis ing optimal peak bone mass early in life, and having in- was low. Practices towards preventing osteoporosis were creased bone mass in middle aged and elderly women inadequate. This study indicates a lack of knowledge on [27]. Only 18.8% of the participants achieved the RDA osteoporosis in young female undergraduates in Sri for Calcium, despite being motivated towards taking cal- Lanka and highlights the need for health education on cium rich food. The mean calcium intake in our study osteoporosis targeted to young females. population was 528 mg/day. In a study carried out Abbreviations among Chinese women aged 21? 30 years, mean dietary OKAT: Osteoporosis knowledge assessment tool; FAO: Food and agriculture calcium intake was 448 mg/day [28]. Those with a diet- organisation; WHO: World Health Organisation; RDA: Recommended daily ary calcium intake of at least 600 mg/day had a 4%? 7% allowances; BMD: Bone mineral density. Ediriweera de Silva et al. Asia Pacific Family Medicine 2014, 13:15 Page 6 of 6 http://www.apfmj.com/content/13/1/15 Competing interests women: the Framingham osteoporosis study. J Bone Miner Res 2000, The authors declare that they have no competing interests. 15:710? 720. 14. Kasper MJ, Peterson MGE, Allegrante JP, Galsworthy TD, Gutin B: Knowledge, beliefs and behaviours among college women concerning Authors? contributions the prevention of osteoporosis. Arch Fam Med 1994, 3:696? 702. REED designed and managed the study, contributed to the data collection, 15. Winzenberg TM, Oldenburg B, Frendin S, Jones G: The design of a valid data analysis and drafting the paper. MRH contributed to designing the and reliable questionnaire to measure osteoporosis knowledge in study, contributed to the data collection and reviewed the paper. KDKG women: the Osteoporosis Knowledge Assessment Tool (OKAT). BMC contributed in designing and managing the study, data collection, and data Musculoskelet Disord 2003, 4:17. analysis. IA contributed to the designing of the study and editing the paper. 16. Kim KK, Horan ML, Gendler P, Patel MK: Development and evaluation of PF and WLSPP contributed to collection of data, data analysis and editing of the osteoporosis health belief scale. Res Nurs Health 1991, 14:155? 163. the paper. All authors read and approved the final manuscript. 17. Andrea HT, Robertson TP, Sellmeyer DE: Validation of two food frequency questionnaires for dietary calcium assessment. J Am Diet Assoc 2009, 109:1237? 1240. Acknowledgements 18. Taylor C, Lamparello B, Kruczek K, Anderson EJ, Hubbard J, Misra M: The authors would like to thank the medical students who took part in the Validation of a food frequency questionnaire for calcium and vitamin D study and the medical schools of the Universities of Kelaniya and Colombo intake in adolescent girls with anorexia nervosa. J Am Diet Assoc 2009, and Dr.Chandima Jeewandara and Dr.W.D.D. de Silva for critically reviewing 109:479? 485. the article, and Dr.N.M.I.A Seneviratne and Dr.Kanchana Maddumabandara for 19. Medical Research Institute: Recommended Dietary Allowances for Sri Lankans. assistance in data management. Department of Nutrition, Medical Research Institute; 2007. 20. Hernandez-Rauda R, Martinez-Garcia S: Osteoporosis-related life habits Author details and knowledge about osteoporosis among women in El Salvador: Family Medicine Unit, Faculty of Medicine, University of Colombo, Kynsey a cross-sectional study. BMC Musculoskelet Disord 2004, 5:29. Road, Colombo 8, Sri Lanka. Behavioural Sciences Stream, Faculty of 21. Ribeiro V, Blakeley J, Laryea M: Women? s knowledge and practices Medicine, University of Colombo, Kynsey Road, Colombo 8, Sri Lanka. regarding the prevention and treatment of osteoporosis. Health Care Department of Clinical Medicine, Faculty of Medicine, University of Women Int 2000, 21:347? 353. Colombo, Kynsey Road, Colombo 8, Sri Lanka. Department of Anatomy, 22. Von Hurst PR, Wham CA: Attitudes and knowledge about osteoporosis Faculty of Medicine, University of Kelaniya, PO Box 6Thalagolla Road, risk prevention: a survey of New Zealand women. Public Health Nutr 2007, Ragama, Sri Lanka. Provincial Directorate of Health Services, R H 10:747? 753. Gunawardhana Mawatha, Badulla, Uva Province, Sri Lanka. 23. Edmonds E, Turner LW, Usdan SL: Osteoporosis knowledge, beliefs, and calcium intake of college students: utilization of the health belief model. Received: 3 August 2013 Accepted: 6 December 2014 Open J Prev Med 2012, 2:27? 34. 24. Farr JN, Blew RM, Lee VR, Lohman TG, Going SB: Associations of physical activity duration, frequency, and load with volumetric BMD, geometry, References and bone strength in young girls. Osteoporos Int 2011, 22:1419? 1430. 1. International Osteoporosis Foundation (IOF). [http://www.osteofound.org/ 25. Bleicher K, Cumming RG, Naganathan V, Seibel MJ, Sambrook PN, Blyth FM, facts-statistics] Le Couteur DG, Handelsman DJ, Creasey HM, Waite LM: Lifestyle factors, 2. Mithal A, Dhingra V, Lau E: The Asian Audit: Epidemiology, Costs and Burden medications, and disease influence bone mineral density in older men: of Osteoporosis in Asia. International Osteoporosis Foundation 2009; 24? 9. findings from the CHAMP study. Osteoporos Int 2011, 22:2421? 2437. [http://www.iofbonehealth.org/sites/default/files/PDFs/Audit%20Asia/ 26. Wallace LS, Ballard JE: Lifetime physical activity and calcium intake related Asian_regional_audit_2009.pdf] to bone density in young women. J Womens Health Gend Based Med 2002, 3. Lau EM: The epidemiology of osteoporosis in Asia. IBMS Bone Key 2009, 11:389? 398. 6:190? 193. 27. Hu JF, Zhao XH, Jia JB, Parpia B, Campbell TC: Dietary calcium and bone 4. Juby AG, Davis P: A prospective evaluation of the awareness, knowledge, density among middle-aged and elderly women in China. Am J Clin Nutr risk factors and current treatment of osteoporosis in a cohort of elderly 1993, 58:219? 227. subjects. Osteoporos Int 2001, 12:617? 622. 28. Ho SC, Leung PC, Swaminathan R, Chan C, Chan SSG, Fan YK, Lindsay R: 5. Yin-King Lee L, King-Fai Lai E: Osteoporosis in older Chinese men: Determinants of bone mass in Chinese women aged 21? 40 years. II. knowledge and health beliefs. J Clin Nurs 2006, 15:353? 355. Pattern of dietary calcium intake and association with bone mineral 6. Terrio K, Auld GN: Osteoporosis knowledge, calcium intake, and density. Osteoporos Int 1994, 4:167? 175. weight-bearing physical activity in three age groups of women. 29. Fleming KH, Heimbach JT: Consumption of calcium in the US; food J Community Health 2002, 27:307? 320. sources and intake levels. J Nutr 1994, 124(Suppl 8):1426? 1430. 7. Pande K, Pande S, Tripathi S, Kanoi R, Thakur A, Patle S: Poor knowledge about osteoporosis in learned Indian women. J Assoc Physicians India doi:10.1186/s12930-014-0015-y 2005, 53:433? 436. Cite this article as: Ediriweera de Silva et al.: A descriptive study of 8. Eyig?r S, Karapolat H, Durmaz B: Medical Students? knowledge of knowledge, beliefs and practices regarding osteoporosis among female osteoporosis in Ege University Faculty of Medicine. Rheumatism 2008, medical school entrants in Sri Lanka. Asia Pacific Family Medicine 23:77? 81. 2014 13:15. 9. Riaz M, Abid N, Patel J, Tariq M, Khan MS, Zuberi L: Knowledge about Osteoporosis among healthy women attending a tertiary care hospital. J Pak Med Assoc 2008, 58(4):190? 194. 10. Liew YL, Mann D, Piterman L: Osteoporosis risks. A comparative study of Asian Australian and Caucasian Australian women. Aust Fam Physician 2002, 31:291. 11. Schwab P, Klein RF: Non pharmacological approaches to improve bone health and reduce osteoporosis. Curr Opin Rheumatol 2008, 20. [http://journals.lww.com/co-rheumatology/pages/articleviewer.aspx? year=2008&issue=03000&article=00017&type=abstract] 12. Mazess RB, Barden HS: Bone density in pre-menopausal women: effects of age, dietary intake, physical activity, smoking, and birth-control pills. Am J Clin Nutr 1991, 53:132? 142. 13. Hannan MT, Felson DT, Dawson-Hughes B, Tucker KL, Cupples LA, Wilson PW, Kiel DP: Risk factors for longitudinal bone loss in elderly men and http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Asia Pacific Family Medicine Springer Journals

A descriptive study of knowledge, beliefs and practices regarding osteoporosis among female medical school entrants in Sri Lanka

Loading next page...
 
/lp/springer-journals/a-descriptive-study-of-knowledge-beliefs-and-practices-regarding-G2B6kWc03e
Publisher
Springer Journals
Copyright
Copyright © 2014 by Ediriweera de Silva et al.; licensee BioMed Central.
Subject
Medicine & Public Health; General Practice / Family Medicine; Primary Care Medicine
eISSN
1447-056X
DOI
10.1186/s12930-014-0015-y
pmid
25548540
Publisher site
See Article on Publisher Site

Abstract

Background: Osteoporosis is a significant problem in rapidly ageing populations in Asian regions. It causes a significant personal and societal impact and increases the burden on health care services. Objectives: Aim of this study is to determine the knowledge, beliefs and practices regarding osteoporosis among young females entering medical schools in Sri Lanka. Methods: This is a descriptive cross sectional study conducted amongst 186 female medical school entrants of the Faculties of Medicine, Universities of Colombo and Kelaniya from September to December 2010. A self administered questionnaire was used to assess knowledge, beliefs and practices on osteoporosis, including a food frequency chart to assess the calcium intake. Results: The mean age was 20.7 +/− 2.1 years. Majority of the participants (51.6%, n = 96) had an average score (40? 60) on the knowledge test, while 40.8% (n = 76) had a poor score (<40). However, in depth knowledge on risk factors, and protective factors was lacking. Perceived susceptibility for osteoporosis was low with only 13.9% (n = 26) of women agreeing that their chances of getting osteoporosis are high. The mean calcium intake was 528 mg/day and only 18.8% (n = 35) of the participants achieved the Recommended Daily Allowances (RDA) for Calcium. Exercise was grossly inadequate in the majority and only 13.6%( n = 23) engaged in the recommended exercises. Only 3.8% (n =7) of the participants currently engaged in specific behaviours to improve bone health while 10.8% (n = 20) had thought of routinely engaging in such behaviours. Conclusions: Although majority of participants had a modest level of knowledge on osteoporosis, there were gaps in their knowledge in relation to risk factors, protective factors and on the insidious nature of osteoporosis. Perceived susceptibility for osteoporosis was low. Practices towards preventing Osteoporosis were inadequate. Keywords: Osteoporosis knowledge, Osteoporosis beliefs, Calcium intake, Osteo-protective behaviours, Womens health Background Due to increasing proportions of ageing populations in Osteoporosis is a global health problem. Osteoporosis the Asian region, osteoporosis has become more preva- and fractures secondary to osteoporosis are an important lent and increases the health care expenditure in this cause of mortality and morbidity [1]. Approximately 1.6 region [2,3]. As osteoporosis is a silent disease, it is in- million hip fractures occur each year worldwide, the in- tuitive that primary preventive measures including early cidence is set to increase to 6.3 million by 2050 [1]. detection of risk factors for osteoporosis, educating the individuals at risk on preventive measures, and timely intervention with regard to treatment will reduce the morbidity and mortality and cut down the cost of treat- * Correspondence: erandie_ediriweera@yahoo.com Family Medicine Unit, Faculty of Medicine, University of Colombo, Kynsey ment [4,5]. Road, Colombo 8, Sri Lanka Full list of author information is available at the end of the article ? 2014 Ediriweera de Silva et al.; licensee BioMed Central. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. Ediriweera de Silva et al. Asia Pacific Family Medicine 2014, 13:15 Page 2 of 6 http://www.apfmj.com/content/13/1/15 Females are at higher risk of developing osteoporosis. frequency questionnaire to assess the calcium intake Female medical school entrants consist of an educated [17,18]. The food frequency questionnaire also included young population, with a gender-based higher risk of de- local calcium dense food items, after wide literature re- veloping osteoporosis later in life. Studies carried out view and expert opinion. among females report that their knowledge about osteo- Informed consent was obtained prior to the study. porosis is limited [6-9]. A study carried out in Australia Ethical clearance for the study was obtained from the among Asian women revealed that their calcium intake Ethics Review Committee of the Faculty of Medicine, was lower and their knowledge on osteoporosis was University of Colombo. poor [10]. It is known that knowledge on osteoporosis contributes to enhance behaviours towards preventing Data analysis osteoporosis [9]. The variables were grouped in to blocks of knowledge, Several factors have been recognized as critical to- beliefs and practices, and within these blocks we have wards improving bone health. These include modifiable used descriptive statistics and the Pearson? s chi-square factors such as calcium intake, physical activity, and test to compare the two populations studied. The results non-modifiable factors such as genetic makeup [11,12]. were analysed using SPSS (version 19) and Excel com- Some of the established risk factors include ageing, fe- puter software. A p value of <0.05 was considered as male gender, family history of osteoporosis, early meno- significant. pause, cigarette smoking, excessive alcohol consumption The knowledge on osteoporosis was scored as follows: and certain medications [13]. It is reported that bone each correct response scored one point and each incor- gain occurs in young adults till the age of 30 years rect response and ? Do not know? response scored zero [14]. Primarily, preventive strategies should be aimed at points. The total correct responses were given a score young women, as these interventions have the potential out of 20, and multiplied by five to obtain a score out of to delay the onset of osteoporosis. However, studies on 100. The scores were categorized as follows- <20: Very the subject among young females in South Asian coun- Poor, 20? 39: Poor, 40? 59: Average, 60? 79: Good and 80 tries are scarce. or > 80: Very Good. This study assesses the knowledge and beliefs on The questionnaire to assess practices was pre-coded to osteoporosis and practices towards preventing osteopor- indicate positive and negative behaviours towards osteo- osis among young females of two major medical schools porosis, and the individual behaviours were analysed in the country. separately. The calcium intake was calculated based on the data recorded in the 40 item food frequency Methods questionnaire. This study was carried out among the female medical The number of portions of each food item consumed school entrants of the Faculties of Medicine, at the per week, as defined by the questionnaire was obtained Universities of Colombo and Kelaniya from September for each participant. The amount of calcium contributed to December 2010. A pre-tested self administered by each food item was derived by calculating the calcium questionnaire was used to assess knowledge, beliefs, and content of food items taken from references. The weekly practices towards osteoporosis. Osteoporosis Knowledge calcium intake for each respondent was calculated and Assessment Tool (OKAT), a validated tool was used [15]. the average daily calcium intake was obtained from this This consists of 20 questions to assess knowledge. Content value. The total daily calcium intake was categorized as areas assessed include knowledge on osteoporosis risk fac- adequate (750 mg or more) and inadequate (less than tors, preventive measures, diagnosis, and management. 750 mg) based on the recommended daily allowance for The Osteoporosis Health Belief Scale was used to assess calcium for young Sri Lankan females [19]. Physical ac- beliefs [16]. This scale includes questions on perceived tivity was assessed based on the type and duration of susceptibility (3 questions), perceived barriers to Calcium weight bearing exercises engaged during a week. intake (3 questions), perceived benefits of Calcium (3 questions), perceived seriousness (3 questions) and per- Results ceived health motivation (3 questions) [16]. The response rate was 100% with 86 participants from The questionnaire to assess practices related to osteo- the University of Colombo and 100 participants from porosis included questions on positive and negative be- the University of Kelaniya. The mean age of the partici- haviours towards osteoporosis. The positive behaviours pants was 20.7 +/− 2.1 (mean +/− SD) years. The know- assessed were dietary calcium intake, physical activity ledge score on osteoporosis revealed that, 96(51.6%) and exposure to sun. The negative behaviours assessed had an Average score, while 71(38.2%) had a Poor score, were on smoking status and alcohol intake. The ques- and 5(2.7%) had a Very poor score based on the categor- tionnaire included a modified validated 40 item food isation defined in the methodology. 14(7.5%) of the Ediriweera de Silva et al. Asia Pacific Family Medicine 2014, 13:15 Page 3 of 6 http://www.apfmj.com/content/13/1/15 participants had a good score while none had a score When considering the two medical schools, students above 80. The mean and median scores were 34.8 +/− 10 from the University of Kelaniya indicated better health and 35 respectively, out of a total score out of 100. motivation towards osteoporosis (p < 0.01). Health mo- Table 1 shows that, only 60(32.3%) recognized that a tivation towards osteoporosis was satisfactory; however family history of osteoporosis is a risk factor for osteo- motivation towards exercise was poor. porosis. Old age was not considered a risk factor by 81 (43.5%), whilst 158(84.9%) did not know that smoking Practices was a risk factor. 150(80.6%) did not know that a higher The mean calcium intake was 528 mg/day and only 35 peak bone mass is protective. 111(59.7%) did not know (18.8%) of the participants achieved the Recommended that weight bearing exercises were protective for osteo- Daily Allowances (RDA) for Calcium. When considering porosis, however the students from the University of the respondents who met the RDA, 9(4.8%) were Kelaniya had better knowledge on the protective effect taking supplements in the form of multivitamins, while of weight bearing exercises on osteoporosis (p <0.01). 26(14%) were not taking any calcium supplements. The The dietary sources of calcium were not known by 67 top calcium providing food groups consumed by the (36%), and the students from University of Colombo participants amongst the daily intake of food types were, demonstrated better knowledge for this question (p < milk, tea with milk, yoghurt, small fish, rice, and cheese. 0.01). Only 34(18.3%) participants were aware that osteo- As indicated in Table 3, only 23(13.6%) engaged in the porosis is usually asymptomatic. recommended exercises in type and duration. Walking was found to be the commonest mode of exercise. 158 Beliefs (85.9%) were exposed to the sun for at least 30 minutes Table 2 shows that, only 26(13.9%) women agreed that a week. 184(99%) of the participants were teetotallers their chances of getting osteoporosis were high. Percep- and non-smokers. Only 7(3.8%) participants were cur- tions, towards barriers to calcium intake and benefits of rently engaged in specific behaviours to improve bone calcium intake revealed that 55(29.5%) participants felt health whilst 20(10.8%) had thought of routinely en- eating calcium rich food was difficult, while 14 (7.5%) gaging in such behaviour. felt that they are unable to tolerate calcium rich foods or that they dislike calcium rich foods, and 15(8%) felt that calcium rich foods are too expensive. On assessing the Discussion perceived seriousness of osteoporosis, 100(53.7%) felt that The aim of the study was to assess knowledge, beliefs if they had osteoporosis that it would change their whole and practices regarding osteoporosis among female life. 102(54.8%) mentioned that the thought of osteopor- medical school entrants. Medical school entrants were osis scares them, and 155(83.3%) felt that having osteopor- selected for the study as they would not have been osis would make daily activities more difficult. exposed to any teaching regarding osteoporosis in the Health motivation towards osteoporosis as shown in medical school. It was inferred that these study subjects Table 2, indicate that 116(62.3%) were motivated fre- would possess only the knowledge of a high school biol- quently to do changes to improve their health, and 110 ogy graduate. In addition, this was a young group of fe- (59.1%) were motivated to eat a well-balanced diet, how- males wherein interventions to improve bone health had ever only 41(22%) were motivated to exercise regularly. the potential to be of the highest long-term value. Table 1 Percentage of correct responses for osteoporosis risk factors and preventive practices Risk factor/Preventive practice Total (n = 186) University of Colombo (n = 86) University of Kelaniya (n = 100) P value* Family history of osteoporosis 60 (32.3) 32 (37.2) 28 (28.0) 0.19 Female sex 177 (95.2) 81 (94.2) 96 (96.0) 0.56 Old age 105 (56.4) 54 (62.8) 51 (51.0) 0.11 Premature menopause 14 (7.5) 4 (4.7) 10 (10.0) 0.17 Smoking 28 (15) 17 (19.8) 11 (11.0) 0.10 Physical activity ( Weight bearing exercises) 75 (40.3) 25 (29.1) 50 (50.0) < 0.01 Daily calcium requirement from food 84 (45.2) 41 (29.1) 43 (43.0) 0.52 Sources of calcium 119 (63.9) 70 (81.4) 49 (49.0) <0.01 Hormone therapy after menopause 45 (24.2) 22 (25.6) 23 (23.0) 0.44 Data are presented as n (%). *The Pearson? s Chi-square test was performed. Ediriweera de Silva et al. Asia Pacific Family Medicine 2014, 13:15 Page 4 of 6 http://www.apfmj.com/content/13/1/15 Table 2 Affirmative responses regarding beliefs on Osteoporosis Perceived Susceptibility Total University of Colombo University of Kelaniya P value* (n = 186) (n = 86) (n = 100) Chances of getting osteoporosis are high 26 (13.9) 15 (17.4) 11 (11.0) 0.20 We are more likely to get the disease 35 (18.8) 20 (23.3) 15 (15.0) 0.15 Family history makes us more likely to get osteoporosis 17 (9.1) 4 (4.7) 13 (13.0) 0.05 Perceptions, towards barriers to calcium intake Eating calcium rich food is difficult 55 (29.5) 28 (32.6) 27 (27.0) 0.21 Calcium rich foods do not agree with us or we dislike calcium rich foods 14 (7.5) 5 (5.8) 9 (9.0) 0.41 Calcium rich foods are too expensive 15 (8) 5 (5.8) 10 (10.0) 0.30 Perceptions, towards benefits of calcium intake Eating calcium rich foods reduces risks of broken bones 157 (84.4) 72 (83.7) 85 (85.0) 0.81 Eating calcium rich foods helps to build bones 131 (70.4) 57 (66.3) 74 (74.0) 0.25 Eating calcium rich foods prevents future problems from osteoporosis 153 (82.2) 71 (82.6) 82 (82.0) 0.92 Perceived seriousness of osteoporosis Total University of Colombo University of Kelaniya P value* (n = 186) (n = 86) (n = 100) If we had osteoporosis it would change our whole life 100 (53.7) 50 (58.1) 50 (50.0) 0.27 Thought of osteoporosis scares us 102 (54.8) 50 (58.1) 52 (52.0) 0.40 Having osteoporosis would make daily activities more difficult 155 (83.3) 75 (87.2) 80 (80.0) 0.19 Health motivation towards osteoporosis We are motivated frequently do things to improve our health 116 (62.3) 42 (48.8) 74 (74.0) <0.01 We are motivated to eat a well-balanced diet 110 (59.1) 41 (47.7) 69 (69.0) <0.01 Motivated to exercise regularly 41 (22) 12 (14) 29 (29.0) 0.01 Data are presented as n (%). *The Pearson? s Chi-square test was performed. The basic demographic characteristics, such as age expected to have a high level of knowledge even prior to and the level of education were similar as all students in entry to medical school the general knowledge on osteo- the country study the same curriculum and sit for the porosis, among our participants was at a modest level, same advanced level examination and qualified to med- with only half of the population achieving an average ical schools based on merit. Also all medical schools in score and a mere 7.5% achieving a good score based on the country receive medical students from all parts of the total knowledge score questionnaire. The mean and the country. Although it can be hypothesised that these median scores were 34.8 +/− 10 and 35 respectively out students are representative of female medical school en- of a total score out of 100. Similar results were seen in a trants in Sri Lanka generally, we do not have the data to study among Salvadorean women aged 25? 35 years make a definitive pronouncement on this. Therefore this which revealed a mean score of 12.1 out of 42 points is a limitation of this study in terms of the applicability (percentage 28.8) [20], although it must be noted that to the wider Sri Lankan medical student entrant. this study was carried out among the general population. Although it is perceived that medical school entrants Knowledge on risk factors and preventive practices are amongst the best students in the country and are are important in preventing or delaying the onset of Table 3 Duration of weight bearing exercise per week in the study population Total University of Colombo University of Kelaniya P value* (n = 186) (n = 86) (n = 100) <30 min/Week 79 (46.7) 37 (43) 42 (42.0) 0.62 30 min ? 60 min (1 hr) 42 (24.9) 11 (12.8) 31 (31.0) <0.01 60 min ? 90 min 25 (14.8) 13 (15.1) 12 (12.0) 0.53 >90 min 23 (13.6) 15 (17.4) 8 (8.0) 0.05 Recommended duration of weight bearing exercise per week: > 90 min. Data are presented as n (%). *The Pearson? s Chi-square test was performed. Ediriweera de Silva et al. Asia Pacific Family Medicine 2014, 13:15 Page 5 of 6 http://www.apfmj.com/content/13/1/15 Osteoporosis as well as in minimising morbidity due to higher mean bone mineral density at the spine and Osteoporosis. However, the knowledge on osteoporosis femur when compared with those with a mean intake risk factors among our study participants appeared to be below 300 mg/day [28]. Nearly all Asian countries are re- poor compared to a similar study among college women ported to be far below the Food and Agriculture Organisa- in the US [14]. Another study among medical students tion (FAO) and the World Health Organisation (WHO) from a medical school in Turkey revealed that know- recommendations for calcium intake [29]. Majority of the ledge on risk factors for osteoporosis, nutritional factors study population is not engaging in osteo-protective and diseases resulting in osteoporosis were poor [8]. It behaviours as evidenced by their poor consumption of cal- has been reported in several studies that women possess cium rich food and lack of physical activity. This is also limited knowledge about the disease, and are not taking reported in other studies [15,23], where the need for adequate measures to prevent or treat osteoporosis as osteo-protective behaviours has been emphasised. they age [7,21]. With respect to the results of this study, comparing The importance of health motivation in influencing the knowledge, beliefs and behaviours of the students of health related behaviours is described by Kim et al. [16]. the two different medical schools significant differences Perceived susceptibility towards osteoporosis appeared in knowledge was not seen in most parameters. How- to be low in our study population, with only 13.9% of ever, participants from the University of Kelaniya were women agreeing that their chances of getting osteopor- better motivated towards osteoporosis preventive behav- osis are high. A study in New Zealand among females iour. These differences cannot be directly explained aged 20? 49 years showed that the perceived personal based on the data available from this study. susceptibility was 29% [22] and Edmonds et al. also re- Among the limitations of the study is the fact that only ported similar results [23]. More than half of the study two medical schools were included. Also there might be population perceived osteoporosis as a serious disease. other contributing factors that were not explored in this Von Hurst et al. revealed that there was higher level of study, such as socio-economic differences, access to fa- agreement about the seriousness of osteoporosis, how- cilities such as access to sports equipment, gymnasiums, ever only less than a quarter of the subjects regarded swimming pools and nutritious meals although the study osteoporosis as a crippling disease [22]. Barriers towards provides baseline data for further study. These factors calcium intake were low and perceived benefits of cal- might be contributing towards the differences seen in cium intake were high, indicating that our study popula- health motivation and practices. Future research specif- tion was motivated towards taking calcium rich food. ically targeted towards socio-economic factors, access to Farr et al. reported that low levels of physical activity facilities and health beliefs will be useful in understand- may compromise bone development in young girls [24]. ing these differences. Also future qualitative studies may It is also reported that physical activity and strength be helpful in exploring the reasons for these differences. were positively associated with Bone Mineral Density This study highlights the need for health education (BMD) even in very elderly men [25]. In our study, exer- targeted to young females on osteoporosis, improving cise was grossly inadequate in the majority with a mere calcium intake and physical activity. In addition, primary 13.6% engaged in the recommended exercises. When health care interventions such as preventive health edu- compared with a similar study among college women in cation may help to reduce the burden of osteoporosis in the US, 59.8% were getting inadequate osteo-protective the community. exercise [14]. Wallace et al. reported lean mass to be a powerful predictor of BMD in young women. They reit- Conclusions erated that lean mass can be modified to some extent by Although majority of participants had a modest know- physical activity, thus physical activity must be increased ledge on osteoporosis, there were important gaps in throughout the lifespan [26]. knowledge in relation to risk factors and protective fac- Reduced calcium intake is linked to the osteoporosis tors of osteoporosis and on the insidious nature of risk in later life. Dietary calcium is important in achiev- osteoporosis. Perceived susceptibility for osteoporosis ing optimal peak bone mass early in life, and having in- was low. Practices towards preventing osteoporosis were creased bone mass in middle aged and elderly women inadequate. This study indicates a lack of knowledge on [27]. Only 18.8% of the participants achieved the RDA osteoporosis in young female undergraduates in Sri for Calcium, despite being motivated towards taking cal- Lanka and highlights the need for health education on cium rich food. The mean calcium intake in our study osteoporosis targeted to young females. population was 528 mg/day. In a study carried out Abbreviations among Chinese women aged 21? 30 years, mean dietary OKAT: Osteoporosis knowledge assessment tool; FAO: Food and agriculture calcium intake was 448 mg/day [28]. Those with a diet- organisation; WHO: World Health Organisation; RDA: Recommended daily ary calcium intake of at least 600 mg/day had a 4%? 7% allowances; BMD: Bone mineral density. Ediriweera de Silva et al. Asia Pacific Family Medicine 2014, 13:15 Page 6 of 6 http://www.apfmj.com/content/13/1/15 Competing interests women: the Framingham osteoporosis study. J Bone Miner Res 2000, The authors declare that they have no competing interests. 15:710? 720. 14. Kasper MJ, Peterson MGE, Allegrante JP, Galsworthy TD, Gutin B: Knowledge, beliefs and behaviours among college women concerning Authors? contributions the prevention of osteoporosis. Arch Fam Med 1994, 3:696? 702. REED designed and managed the study, contributed to the data collection, 15. Winzenberg TM, Oldenburg B, Frendin S, Jones G: The design of a valid data analysis and drafting the paper. MRH contributed to designing the and reliable questionnaire to measure osteoporosis knowledge in study, contributed to the data collection and reviewed the paper. KDKG women: the Osteoporosis Knowledge Assessment Tool (OKAT). BMC contributed in designing and managing the study, data collection, and data Musculoskelet Disord 2003, 4:17. analysis. IA contributed to the designing of the study and editing the paper. 16. Kim KK, Horan ML, Gendler P, Patel MK: Development and evaluation of PF and WLSPP contributed to collection of data, data analysis and editing of the osteoporosis health belief scale. Res Nurs Health 1991, 14:155? 163. the paper. All authors read and approved the final manuscript. 17. Andrea HT, Robertson TP, Sellmeyer DE: Validation of two food frequency questionnaires for dietary calcium assessment. J Am Diet Assoc 2009, 109:1237? 1240. Acknowledgements 18. Taylor C, Lamparello B, Kruczek K, Anderson EJ, Hubbard J, Misra M: The authors would like to thank the medical students who took part in the Validation of a food frequency questionnaire for calcium and vitamin D study and the medical schools of the Universities of Kelaniya and Colombo intake in adolescent girls with anorexia nervosa. J Am Diet Assoc 2009, and Dr.Chandima Jeewandara and Dr.W.D.D. de Silva for critically reviewing 109:479? 485. the article, and Dr.N.M.I.A Seneviratne and Dr.Kanchana Maddumabandara for 19. Medical Research Institute: Recommended Dietary Allowances for Sri Lankans. assistance in data management. Department of Nutrition, Medical Research Institute; 2007. 20. Hernandez-Rauda R, Martinez-Garcia S: Osteoporosis-related life habits Author details and knowledge about osteoporosis among women in El Salvador: Family Medicine Unit, Faculty of Medicine, University of Colombo, Kynsey a cross-sectional study. BMC Musculoskelet Disord 2004, 5:29. Road, Colombo 8, Sri Lanka. Behavioural Sciences Stream, Faculty of 21. Ribeiro V, Blakeley J, Laryea M: Women? s knowledge and practices Medicine, University of Colombo, Kynsey Road, Colombo 8, Sri Lanka. regarding the prevention and treatment of osteoporosis. Health Care Department of Clinical Medicine, Faculty of Medicine, University of Women Int 2000, 21:347? 353. Colombo, Kynsey Road, Colombo 8, Sri Lanka. Department of Anatomy, 22. Von Hurst PR, Wham CA: Attitudes and knowledge about osteoporosis Faculty of Medicine, University of Kelaniya, PO Box 6Thalagolla Road, risk prevention: a survey of New Zealand women. Public Health Nutr 2007, Ragama, Sri Lanka. Provincial Directorate of Health Services, R H 10:747? 753. Gunawardhana Mawatha, Badulla, Uva Province, Sri Lanka. 23. Edmonds E, Turner LW, Usdan SL: Osteoporosis knowledge, beliefs, and calcium intake of college students: utilization of the health belief model. Received: 3 August 2013 Accepted: 6 December 2014 Open J Prev Med 2012, 2:27? 34. 24. Farr JN, Blew RM, Lee VR, Lohman TG, Going SB: Associations of physical activity duration, frequency, and load with volumetric BMD, geometry, References and bone strength in young girls. Osteoporos Int 2011, 22:1419? 1430. 1. International Osteoporosis Foundation (IOF). [http://www.osteofound.org/ 25. Bleicher K, Cumming RG, Naganathan V, Seibel MJ, Sambrook PN, Blyth FM, facts-statistics] Le Couteur DG, Handelsman DJ, Creasey HM, Waite LM: Lifestyle factors, 2. Mithal A, Dhingra V, Lau E: The Asian Audit: Epidemiology, Costs and Burden medications, and disease influence bone mineral density in older men: of Osteoporosis in Asia. International Osteoporosis Foundation 2009; 24? 9. findings from the CHAMP study. Osteoporos Int 2011, 22:2421? 2437. [http://www.iofbonehealth.org/sites/default/files/PDFs/Audit%20Asia/ 26. Wallace LS, Ballard JE: Lifetime physical activity and calcium intake related Asian_regional_audit_2009.pdf] to bone density in young women. J Womens Health Gend Based Med 2002, 3. Lau EM: The epidemiology of osteoporosis in Asia. IBMS Bone Key 2009, 11:389? 398. 6:190? 193. 27. Hu JF, Zhao XH, Jia JB, Parpia B, Campbell TC: Dietary calcium and bone 4. Juby AG, Davis P: A prospective evaluation of the awareness, knowledge, density among middle-aged and elderly women in China. Am J Clin Nutr risk factors and current treatment of osteoporosis in a cohort of elderly 1993, 58:219? 227. subjects. Osteoporos Int 2001, 12:617? 622. 28. Ho SC, Leung PC, Swaminathan R, Chan C, Chan SSG, Fan YK, Lindsay R: 5. Yin-King Lee L, King-Fai Lai E: Osteoporosis in older Chinese men: Determinants of bone mass in Chinese women aged 21? 40 years. II. knowledge and health beliefs. J Clin Nurs 2006, 15:353? 355. Pattern of dietary calcium intake and association with bone mineral 6. Terrio K, Auld GN: Osteoporosis knowledge, calcium intake, and density. Osteoporos Int 1994, 4:167? 175. weight-bearing physical activity in three age groups of women. 29. Fleming KH, Heimbach JT: Consumption of calcium in the US; food J Community Health 2002, 27:307? 320. sources and intake levels. J Nutr 1994, 124(Suppl 8):1426? 1430. 7. Pande K, Pande S, Tripathi S, Kanoi R, Thakur A, Patle S: Poor knowledge about osteoporosis in learned Indian women. J Assoc Physicians India doi:10.1186/s12930-014-0015-y 2005, 53:433? 436. Cite this article as: Ediriweera de Silva et al.: A descriptive study of 8. Eyig?r S, Karapolat H, Durmaz B: Medical Students? knowledge of knowledge, beliefs and practices regarding osteoporosis among female osteoporosis in Ege University Faculty of Medicine. Rheumatism 2008, medical school entrants in Sri Lanka. Asia Pacific Family Medicine 23:77? 81. 2014 13:15. 9. Riaz M, Abid N, Patel J, Tariq M, Khan MS, Zuberi L: Knowledge about Osteoporosis among healthy women attending a tertiary care hospital. J Pak Med Assoc 2008, 58(4):190? 194. 10. Liew YL, Mann D, Piterman L: Osteoporosis risks. A comparative study of Asian Australian and Caucasian Australian women. Aust Fam Physician 2002, 31:291. 11. Schwab P, Klein RF: Non pharmacological approaches to improve bone health and reduce osteoporosis. Curr Opin Rheumatol 2008, 20. [http://journals.lww.com/co-rheumatology/pages/articleviewer.aspx? year=2008&issue=03000&article=00017&type=abstract] 12. Mazess RB, Barden HS: Bone density in pre-menopausal women: effects of age, dietary intake, physical activity, smoking, and birth-control pills. Am J Clin Nutr 1991, 53:132? 142. 13. Hannan MT, Felson DT, Dawson-Hughes B, Tucker KL, Cupples LA, Wilson PW, Kiel DP: Risk factors for longitudinal bone loss in elderly men and

Journal

Asia Pacific Family MedicineSpringer Journals

Published: Dec 20, 2014

References