Development of a Smartphone Application for Promoting Bone Health in Korean Young Adult Women: A Pilot Study

Young-Joo Park; Sook-Ja Lee; Nah-Mee Shin; Hyunjeong Shin; Sungjin Yoon; Songi Jeon; Inhae Cho

doi:10.7475/kjan.2015.27.4.459

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Development of a Smartphone Application for Promoting Bone Health in Korean Young Adult Women: A Pilot Study

Young-Joo Park¹, Sook-Ja Lee¹, Nah-Mee Shin¹, Hyunjeong Shin¹, Sungjin Yoon², Songi Jeon², Inhae Cho³

Korean Journal of Adult Nursing 2015;27(4):459-471.
Published online: August 31, 2015

DOI: https://doi.org/10.7475/kjan.2015.27.4.459

¹College of Nursing, Korea University, Seoul

²Department of Physical Education, College of Education, Korea University, Seoul

³Department of Nursing, Graduate School, Korea University, Seoul, Korea

Corresponding author: Shin, Hyunjeong College of Nursing, Korea University, 145 Anam-ro, Sungbuk-gu, Seoul 136-705, Korea. Tel: +82-2-3290-4927, Fax: +82-2-927-4676, E-mail: hyunjshin@korea.ac.kr

• Received: June 30, 2015 • Accepted: August 12, 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
REFERENCES

Abstract

Purpose
The purpose of this study was to develop a smartphone application and evaluate it's effectiveness and usability for promoting bone health in Korean young adult women.
Methods
A smartphone application was developed covering exercise, nutrition, and health habits related to bone health. A pilot testing was conducted using a one-group pre/posttest design. A total of 22 female college students with low bone mass participated in the 8-week use of a pilot testing.
Results
The “Strong bone Fit body (SbFb)" application was developed using Android platform. In the pilot testing, bone mineral density, serum CTX, and 25 (OH)Vit.D were significantly decreased. There is no significant change in serum osteocalcin and calcium. Serum phosphorus concentration, nutrient intakes (fiber, VitB6, and pantotenic acid), and all bone composition profiles were significantly increased. Bone-health knowledge was significantly increased but no change in health belief and self-efficacy.
Conclusion
The results of this pilot testing suggest the effectiveness of the SbFb application to enhance and promote self-managing abilities for bone health. It can provide continuous feedback and high-quality bone health information. However, some contents and working methods of the application need to be modified and its effectiveness on bone health requires further investigations.
Key Words: Women; Young adults; Bone density; Biochemical markers; Smartphone applications

Figure 1.

Screenshots of ‘Strong Bone Fit Body' application.

Table 1.

Mean Differences of BMD, BTMs, Body Composition, and Psychosocial Variables between Pretest and Posttest (N=22)

Variables		Pretest	Posttest	Difference	t (p)
Variables		M±SD	M±SD	M±SD	t (p)
BMD	Z-score	-1.55±0.65	-1.87±0.57	0.32±0.25	6.18 (＜.001)
	T-score	-1.48±0.59	-1.79±0.51	0.31±0.23	6.34 (＜.001)
	SOS (m/sec)	1,526.26±23.88	1,517.20±22.76	9.06±11.23	3.78 (.001)
	BUA (dB/MHz)	38.54±9.54	33.57±7.26	4.96±6.94	3.35 (.003)
	BQI	76.41±11.08	70.65±9.73	5.76±4.33	6.24 (＜.001)
BMs	Osteocalcin (ng/mL)	19.12±4.63	21.54±5.48	-2.27±5.40	-1.93 (.068)
	CTX (ng/mL)	0.41±0.17	0.32±0.13	0.08±0.13	2.55 (.020)
	Calcium (mg/dL)	9.61±0.35	9.42±0.74	0.17±0.83	0.95 (.355)
	Phosphorus (mg/dL)	3.95±0.42	4.33±0.52	-0.41±0.55	-3.42 (.027)
	25 (OH)Vit D	13.92±3.53	8.77±3.08	5.17±2.69	8.37 (＜.001)
Body composition	Body weight	50.02±4.90	50.94±4.98	-0.92±0.85	-5.11 (＜.001)
	Free fat mass	38.18±2.66	38.54±2.81	-0.36±0.63	-2.69 (.014)
	Body fat mass	11.84±2.74	12.40±2.70	-0.56±0.60	-4.43 (＜.001)
	Muscle	35.31±2.41	35.60±2.56	-0.29±0.59	-2.31 (.031)
	Body fluid	27.50±1.91	27.75±2.03	-0.25±0.46	-2.57 (.018)
	BMI	19.29±1.65	19.64±1.69	-0.35±0.31	-5.27 (＜.001)
	Body fat ratio	23.44±3.28	24.14±3.12	-0.70±1.00	-3.30 (.003)
	Abdominal fat ratio	0.73±0.03	0.73±0.03	-0.01±0.01	-2.22 (.038)
Psychosocial variables related to bone health
Knowledge		16.90±2.41	17.79±1.53	0.91±1.44	-3.03 (.006)
Health belief	Susceptibility	19.14±3.75	19.64±4.46	-0.50±3.17	-0.74 (.468)
	Seriousness	17.14±3.85	18.45±5.51	-1.32±5.30	-1.17 (.267)
	Benefit exercise	24.64±2.82	24.73±2.00	-0.09±2.78	-0.15 (.879)
	Benefit calcium intake	21.82±2.99	22.59±2.34	-0.77±2.33	-1.56 (.135)
	Barriers exercise	15.41±4.78	17.18±3.72	-1.77±4.09	-2.03 (.055)
	Barriers calcium intake	13.18±3.08	13.05±3.79	0.14±3.52	0.18 (.858)
	Health motivation	20.59±3.70	20.18±3.65	0.41±2.58	0.74 (.465)
	Self-efficacy	125.23±19.13	117.00±20.92	8.23±28.45	1.36 (.189)
	Exercise self-efficacy	59.07±14.30	52.83±14.47	6.22±18.69	1.60 (.125)
	Calcium intake self-efficacy	66.33±11.80	64.08±12.86	2.65±13.74	0.93 (.365)

BMD=bone mineral density, BMs=biochemical bone markers, SOS=speed of sound, BUA=broadband ultrasound attenuation, BQI=bone quality index, CTX=C-telopeptide of collagen cross-links, BMI=body mass index.

Table 2.

Mean Differences of Nutrients Intakes between Pretest and Posttest (N=22)

Nutrients	Pretest	Posttest	Difference	t (p)
Nutrients	M±SD	M±SD	M±SD	t (p)
Calolie (Kcal)	1,389.37±303.71	1,437.92±341.98	-48.55±92.06	-0.53 (.603)
Carbohydrate (g)	192.26±49.78	200.33±44.31	-8.07±12.91	-0.63 (.539)
Fat (g)	43.78±11.02	45.25±15.03	-1.47±17.21	-0.40 (.692)
Protein (g)	51.20±13.82	57.15±17.05	1.59±13.28	0.56 (.580)
Fiber (g)	11.62±3.22	13.81±3.93	-2.19±4.33	-2.37 (.027)
Water (mL)	679.50±263.74	656.01±213.26	23.48±222.40	0.50 (.626)
Vit. A (㎍)	564.31±361.21	662.57±259.52	-98.27±393.20	-1.17 (.254)
Vit. D (㎍)	2.65±2.26	2.64±2.13	0.01±3.13	0.01 (.996)
Vit. E (mg)	11.37±5.20	12.61±5.05	-1.25±6.67	-0.88 (.390)
Vit. K (㎍)	95.16±72.96	114.68±62.78	-19.53±72.54	-1.26 (.221)
Vit. C (mg)	55.62±36.32	57.88±27.91	-2.26±43.11	-0.25 (.808)
Thiamin (mg)	0.93±0.28	0.97±0.29	-0.04±0.33	-0.59 (.562)
Riboflabin (mg)	1.00±0.47	1.13±0.40	-0.13±0.51	-1.19 (.246)
Niacin (mg)	12.05±4.01	12.53±3.74	-0.48±4.82	-0.46 (.649)
Vit. B6 (mg)	0.98±0.35	1.16±0.37	-0.18±0.39	-2.19 (.040)
Folic acid (㎍)	270.55±123.10	316.25±103.35	-45.70±122.60	-1.75 (.095)
Vit B12 (㎍)	4.95±3.90	6.54±3.31	-1.59±4.29	-1.73 (.098)
Panto (mg)	3.03±1.12	3.63±1.06	-0.60±1.28	-2.21 (.039)
Biotin (㎍)	11.08±7.72	14.38±7.13	-3.31±9.55	-1.62 (.119)
Calcium (mg)	411.84±151.35	440.64±225.39	-28.80±227.40	-0.59 (.559)
Phosphorus (mg)	734.99±186.68	779.01±185.52	-44.02±250.80	-0.82 (.420)
Sodium (mg)	2,571.32±904.17	2,615.02±732.55	-43.70±1215.30	-0.17 (.868)
Chroride (mg)	247.02±145.09	407.73±315.92	-160.70±380.70	-1.98 (.061)
magnesium (mg)	53.26±21.14	60.92±22.62	-7.67±35.98	-1.00 (.329)
Fe (mg)	9.56±3.23	12.04±4.92	-2.48±6.32	-1.84 (.080)
Zn (mg)	6.61±1.83	7.63±1.91	-1.02±2.67	-1.78 (.089)
Cu (㎍)	0.75±0.23	0.84±0.26	-0.09±0.33	-1.27 (.218)
Cholesterol (mg)	265.03±180.40	310.33±146.23	-45.30±244.60	-0.87 (.395)
K (mg)	1,633.17±484.75	1,824.91±512.85	-191.70±595.00	-1.51 (.146)

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Development of a Smartphone Application for Promoting Bone Health in Korean Young Adult Women: A Pilot Study

Korean J Adult Nurs. 2015;27(4):459-471. Published online August 31, 2015

DOI: https://doi.org/10.7475/kjan.2015.27.4.459

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Development of a Smartphone Application for Promoting Bone Health in Korean Young Adult Women: A Pilot Study

Korean J Adult Nurs. 2015;27(4):459-471. Published online August 31, 2015

DOI: https://doi.org/10.7475/kjan.2015.27.4.459

Figure

Development of a Smartphone Application for Promoting Bone Health in Korean Young Adult Women: A Pilot Study

Figure 1. Screenshots of ‘Strong Bone Fit Body' application.

Figure 1.

Development of a Smartphone Application for Promoting Bone Health in Korean Young Adult Women: A Pilot Study

Table 1.

Mean Differences of BMD, BTMs, Body Composition, and Psychosocial Variables between Pretest and Posttest (N=22)

Variables		Pretest	Posttest	Difference	t (p)
Variables		M±SD	M±SD	M±SD	t (p)
BMD	Z-score	-1.55±0.65	-1.87±0.57	0.32±0.25	6.18 (＜.001)
	T-score	-1.48±0.59	-1.79±0.51	0.31±0.23	6.34 (＜.001)
	SOS (m/sec)	1,526.26±23.88	1,517.20±22.76	9.06±11.23	3.78 (.001)
	BUA (dB/MHz)	38.54±9.54	33.57±7.26	4.96±6.94	3.35 (.003)
	BQI	76.41±11.08	70.65±9.73	5.76±4.33	6.24 (＜.001)
BMs	Osteocalcin (ng/mL)	19.12±4.63	21.54±5.48	-2.27±5.40	-1.93 (.068)
	CTX (ng/mL)	0.41±0.17	0.32±0.13	0.08±0.13	2.55 (.020)
	Calcium (mg/dL)	9.61±0.35	9.42±0.74	0.17±0.83	0.95 (.355)
	Phosphorus (mg/dL)	3.95±0.42	4.33±0.52	-0.41±0.55	-3.42 (.027)
	25 (OH)Vit D	13.92±3.53	8.77±3.08	5.17±2.69	8.37 (＜.001)
Body composition	Body weight	50.02±4.90	50.94±4.98	-0.92±0.85	-5.11 (＜.001)
	Free fat mass	38.18±2.66	38.54±2.81	-0.36±0.63	-2.69 (.014)
	Body fat mass	11.84±2.74	12.40±2.70	-0.56±0.60	-4.43 (＜.001)
	Muscle	35.31±2.41	35.60±2.56	-0.29±0.59	-2.31 (.031)
	Body fluid	27.50±1.91	27.75±2.03	-0.25±0.46	-2.57 (.018)
	BMI	19.29±1.65	19.64±1.69	-0.35±0.31	-5.27 (＜.001)
	Body fat ratio	23.44±3.28	24.14±3.12	-0.70±1.00	-3.30 (.003)
	Abdominal fat ratio	0.73±0.03	0.73±0.03	-0.01±0.01	-2.22 (.038)
Psychosocial variables related to bone health
Knowledge		16.90±2.41	17.79±1.53	0.91±1.44	-3.03 (.006)
Health belief	Susceptibility	19.14±3.75	19.64±4.46	-0.50±3.17	-0.74 (.468)
	Seriousness	17.14±3.85	18.45±5.51	-1.32±5.30	-1.17 (.267)
	Benefit exercise	24.64±2.82	24.73±2.00	-0.09±2.78	-0.15 (.879)
	Benefit calcium intake	21.82±2.99	22.59±2.34	-0.77±2.33	-1.56 (.135)
	Barriers exercise	15.41±4.78	17.18±3.72	-1.77±4.09	-2.03 (.055)
	Barriers calcium intake	13.18±3.08	13.05±3.79	0.14±3.52	0.18 (.858)
	Health motivation	20.59±3.70	20.18±3.65	0.41±2.58	0.74 (.465)
	Self-efficacy	125.23±19.13	117.00±20.92	8.23±28.45	1.36 (.189)
	Exercise self-efficacy	59.07±14.30	52.83±14.47	6.22±18.69	1.60 (.125)
	Calcium intake self-efficacy	66.33±11.80	64.08±12.86	2.65±13.74	0.93 (.365)

Table 2.

Mean Differences of Nutrients Intakes between Pretest and Posttest (N=22)

Nutrients	Pretest	Posttest	Difference	t (p)
Nutrients	M±SD	M±SD	M±SD	t (p)
Calolie (Kcal)	1,389.37±303.71	1,437.92±341.98	-48.55±92.06	-0.53 (.603)
Carbohydrate (g)	192.26±49.78	200.33±44.31	-8.07±12.91	-0.63 (.539)
Fat (g)	43.78±11.02	45.25±15.03	-1.47±17.21	-0.40 (.692)
Protein (g)	51.20±13.82	57.15±17.05	1.59±13.28	0.56 (.580)
Fiber (g)	11.62±3.22	13.81±3.93	-2.19±4.33	-2.37 (.027)
Water (mL)	679.50±263.74	656.01±213.26	23.48±222.40	0.50 (.626)
Vit. A (㎍)	564.31±361.21	662.57±259.52	-98.27±393.20	-1.17 (.254)
Vit. D (㎍)	2.65±2.26	2.64±2.13	0.01±3.13	0.01 (.996)
Vit. E (mg)	11.37±5.20	12.61±5.05	-1.25±6.67	-0.88 (.390)
Vit. K (㎍)	95.16±72.96	114.68±62.78	-19.53±72.54	-1.26 (.221)
Vit. C (mg)	55.62±36.32	57.88±27.91	-2.26±43.11	-0.25 (.808)
Thiamin (mg)	0.93±0.28	0.97±0.29	-0.04±0.33	-0.59 (.562)
Riboflabin (mg)	1.00±0.47	1.13±0.40	-0.13±0.51	-1.19 (.246)
Niacin (mg)	12.05±4.01	12.53±3.74	-0.48±4.82	-0.46 (.649)
Vit. B6 (mg)	0.98±0.35	1.16±0.37	-0.18±0.39	-2.19 (.040)
Folic acid (㎍)	270.55±123.10	316.25±103.35	-45.70±122.60	-1.75 (.095)
Vit B12 (㎍)	4.95±3.90	6.54±3.31	-1.59±4.29	-1.73 (.098)
Panto (mg)	3.03±1.12	3.63±1.06	-0.60±1.28	-2.21 (.039)
Biotin (㎍)	11.08±7.72	14.38±7.13	-3.31±9.55	-1.62 (.119)
Calcium (mg)	411.84±151.35	440.64±225.39	-28.80±227.40	-0.59 (.559)
Phosphorus (mg)	734.99±186.68	779.01±185.52	-44.02±250.80	-0.82 (.420)
Sodium (mg)	2,571.32±904.17	2,615.02±732.55	-43.70±1215.30	-0.17 (.868)
Chroride (mg)	247.02±145.09	407.73±315.92	-160.70±380.70	-1.98 (.061)
magnesium (mg)	53.26±21.14	60.92±22.62	-7.67±35.98	-1.00 (.329)
Fe (mg)	9.56±3.23	12.04±4.92	-2.48±6.32	-1.84 (.080)
Zn (mg)	6.61±1.83	7.63±1.91	-1.02±2.67	-1.78 (.089)
Cu (㎍)	0.75±0.23	0.84±0.26	-0.09±0.33	-1.27 (.218)
Cholesterol (mg)	265.03±180.40	310.33±146.23	-45.30±244.60	-0.87 (.395)
K (mg)	1,633.17±484.75	1,824.91±512.85	-191.70±595.00	-1.51 (.146)

Table 1. Mean Differences of BMD, BTMs, Body Composition, and Psychosocial Variables between Pretest and Posttest (N=22)

Table 2. Mean Differences of Nutrients Intakes between Pretest and Posttest (N=22)

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