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Structural Model for Osteoporosis Preventive Behaviors in Postmenopausal Women: Focused on their Own BMD Awareness

Young Joo Park1, Sook Ja Lee1, Nah Mee Shin1, Hyun Cheol Kang2, Sun Haeng Kim3, Tak Kim3, Song I Jeon4, In hae Cho4
Korean Journal of Adult Nursing 2013;25(5):527-538.
Published online: October 18, 2013

1College of Nursing, Korea University, Seoul

2Department of Informational Statistics, Hoseo University, Cheonan

3College of Medicine, Korea University, Seoul

4Graduate School, College of Nursing, Korea University, Seoul, Korea

Corresponding author: Shin, Nah Mee College of Nursing, Korea University, 145, Anam-ro, Seongbuk-gu, Seoul 136-713, Korea. Tel: +82-2-3290-4924, Fax: +82-2-927-4676, E-mail: nshin@korea.ac.kr
• Received: May 20, 2013   • Accepted: October 9, 2013

© 2013 Korean Society of Adult Nursing

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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  • Purpose
    The purpose of this study was to develop a model that explains causal relationships between post-menopausal women's osteoporosis general knowledge and awareness of their own bone mass density(BMD) and their osteoporosis health beliefs and preventive behaviors.
  • Methods
    Retrospective design using structural equation model tested seven variables by using questionnaires of osteoporosis knowledge test, osteoporosis health belief scale, osteoporosis self-efficacy scale, and osteoporosis preventive behaviors scale. 162 middle age and post-menopausal women were recruited.
  • Results
    Mediating effect of health beliefs was not significant in the relationship between BMD awareness and preventive behaviors. Instead, BMD awareness had a direct influence on the preventive behaviors that is strong and significant. Between the relationship of the BMD awareness and health beliefs, direct pathways of perceived threat, relative benefits, and self-efficacy were not significant. However, relative benefits and self-efficacy showed direct influence on the preventive behaviors.
  • Conclusion
    Having middle age women get their BMD test done in order for them to be aware of their own BMD results might be a critical strategy to promote osteoporosis preventive behaviors. There is a need to develop diverse strategies to enhance their self- efficacy which has been shown to be important to osteoporosis preventive behaviors.
  • Key Words: Bone density; Osteoporosis; Prevention; Post-menopause
Figure 1.
Theoretical framework.
kjan-25-527f1.jpg
Figure 2.
Standardized parameter estimates of path diagram for the final model.
kjan-25-527f2.jpg
Table 1.
General Characteristics of Participants and Mean Differences of Research Variables
Characteristics Categories n (%) GOK PT RB OSE HM OPHB
M±SD F (p) M±SD F (p) M±SD F (p) M±SD F (p) M±SD F (p) M±SD F (p)
Age (year) ≤50 37 (22.8) 17.49±2.19 1.63 36.22±7.27 0.39 13.95±9.00 1.53 114.24±39.55 0.99 19.78±3.79 3.08 30.10±6.50 3.80
≥51 125 (77.2) 16.90±2.50 (.203) 35.31±7.83 (.532) 15.99±8.80 (.218) 121.64±39.89 (.322) 20.99±3.64 (.081) 27.65±7.38 (.053)
Ed ≤Middle school 53 (32.7) 16.15±2.50 6.09 36.62±7.65 0.83 12.04±8.89 7.36 113.08±39.15 1.31 20.09±4.07 1.20 29.35±7.25 0.04
High school 75 (46.3) 17.31±2.32 (.003) 35.08±7.31 (.438) 16.53±8.51 (＜.001) 122.00±40.45 (.274) 21.12±3.91 (.303) 29.69±6.69 (.959)
≥College 34 (21.0) 17.82±2.25   34.77±8.59   18.74±7.98   126.15±39.04   20.79±2.36   29.47±6.33  
SES Upper 4 (2.5) 16.75±0.96 1.09 28.00±3.56 4.20 12.75±13.77 3.84 97.25±59.01 4.07 21.25±2.99 1.57 31.00±1.83 4.09
Middle 129 (79.6) 17.18±2.52 (.339) 35.12±7.46 (.017) 16.48±8.58 (.023) 124.3±38.29 (.019) 20.95±3.71 (.211) 30.19±6.96 (.019)
Lower 29 (17.9) 16.45±2.13   38.35±8.23   11.66±8.57   103.48±39.95   19.62±3.68   26.29±5.29  
Job Housewife 97 (59.9) 16.78±2.47 3.08 34.85±7.13 2.19 15.26±8.39 1.16 124.32±38.81 1.60 20.99±3.69 0.09 30.04±6.59 0.28
Full or part time job 45 (27.8) 17.56±2.37 (.082) 36.82±7.95 (.141) 16.91±8.73 (.283) 115.51±38.31 (.209) 20.80±3.03 (.764) 29.40±7.00 (.598)
Missing 20 (12.3)  
Mar Unmarried 6 (3.7) 16.50±2.43 3.20 35.50±9.33 0.04 14.17±11.75 0.92 119.67±50.61 3.50 21.33±3.14 3.04 28.83±3.06 0.60
With spouse 142 (87.7) 16.91±2.39 (.044) 35.58±7.82 (.956) 15.87±8.72 (.402) 122.57±39.52 (.033) 20.92±3.75 (.051) 29.74±6.83 (.548)
S/D/D 14 (8.6) 18.57±2.53   34.93±5.99   12.64±9.11   93.50±29.57   18.43±2.74   27.71±7.19  
Osteoporosis or osteopenia Yes 34 (21.0) 17.85±2.45 2.46 37.24±7.98 1.18 16.68±8.28 0.40 124.00±39.80 1.52 21.32±3.57 1.06 31.56±6.68 4.57
No 126 (77.8) 16.82±2.39 (.089) 35.02±7.64 (.311) 15.25±9.05 (.672) 119.59±39.81 (.221) 20.60±3.73 (.348) 29.16±6.63 (.012)
Missing 2 (1.2)  
Fracture history Yes 20 (12.4) 17.45±2.26 0.65 37.60±5.10 1.68 12.25±7.61 3.16 104.90±38.49 3.31 19.45±4.11 2.70 28.10±7.22 1.03
No 142 (87.7) 16.98±2.47 (.420) 35.23±7.96 (.197) 15.99±8.95 (.077) 122.07±39.67 (.071) 20.89±3.62 (.103) 29.74±6.70 (.312)
Parental osteoporotic fracture history Yes 35 (21.6) 17.63±2.24 2.38 37.94±7.94 5.17 13.94±7.38 1.71 112.89±34.26 1.26 20.57±4.31 0.08 28.06±5.55 2.03
No 125 (77.2) 16.91±2.48 (.125) 34.66±7.43 (.024) 16.14±9.11 (.191) 121.43±41.17 (.263) 20.77±3.55 (.783) 29.90±7.08 (.157)
Missing 2 (1.2)  

Ed=education; Mar=marriage; SES=socioeconomic status; S/D/D=separated/divorced/death; GOK=general osteoporosis knowledge; PT=perceived threats; RB=relative benefits; OSE=osteoporosis self-efficacy; HM=health motivation; OPHB=osteoporosis preventive health behavior.

Table 2.
Mean, Standard Deviations, and Correlations among Variables
Variables n (%) or M±SD P_ BMD_K GOK PT RB OSE HM
r (p) r (p) r (p) r (p) r (p) r (p)
P_ BMD_K              
   Know 117 (72.2)            
   Do not know 45 (27.8)            
GOK 17.04±2.44 -.01 (.905)          
PT 35.52±7.69 -.06 (.449) -.10 (.219)        
RB 15.53±8.86 -.04 (.614) -.01 (.945) -.32 (＜.001)      
OSE 119.95±39.81 -.03 (.723) -.05 (.521) -.15 (.059) .47 (＜.001)    
HM 20.72±3.70 -.16 (.040) -.05 (.507) -.14 (.067) .36 (＜.001) .47 (＜.001)  
OPHB 29.53±6.76 -.26 (.001) -.07 (.374) -.08 (.329) .37 (＜.001) .47 (＜.001) .35 (＜.001)

P_BMD_K=personal bone mineral density knowledge; BMD=bone mineral density; GOK=general osteoporosis knowledge; PT=perceived threats; RB=relative benefits; OSE=osteoporosis self-efficacy; HM=health motivation; OPHB=osteoporosis preventive health behavior.

Table 3.
Effects of Predictive Variables on Endogenous Variables in Hypothetical and Revised Model
Endogenous variables Exogenous variables Hypothetical model Revised model
SDE SIE STE SMC (R2) SDE SIE STE SMC (R2)
OPHB P_BMD_K - -.02 -.02 .264 -.22∗∗∗ -.03 -.26∗∗∗ .312
GOK - -.03 -.03 - -.02 -.02
PT .05 -.00 .04 .03 -.00 .03
RB .18∗∗ .02 .21∗∗ .18∗∗ .02 .19∗∗
OSE .33∗∗∗ .05∗ .38∗∗∗ .34∗∗∗ .04 .37∗∗∗
HM .14∗ - .14∗ .09 - .09
HM P_BMD_K - -.02 -.02 .249 -.16∗∗ -.02 -.17∗∗ .273
GOK - -.02 -.02 - -.02 -.02
PT -.03 - -.03 -.04 - -.04
RB .18∗∗ - .18∗∗ .17∗∗ - .17∗∗
OSE .38∗∗∗ - .38∗∗∗ .38∗∗∗ - .38∗∗∗
OSE P_BMD_K -.03 - -.03 .004 -.03 - -.03 .004
GOK -.05 - -.05 -.05 - -.05
RB P_BMD_K -.03 - -.03 .001 -.03 - -.03 .001
GOK -.01 - -.01 -.01 - -.01
PT P_BMD_K -.06 - -.06 .013 -.06 - -.06 .013
GOK -.10 - -.10 -.10 - -.10

SDE=standardized direct effect; SIE=Standardized indirect effect; STE=standardized total effect; P_BMD_K=personal bone mineral density knowledge; GOK=general osteoporosis knowledge; PT=perceived threats; RB=relative benefits; OSE=osteoporosis self-efficacy; HM=health motivation; OPHB=osteoporosis preventive health behavior, SMC=squared multiple correlation. ∗p＜.10; ∗∗p＜.05; ∗∗∗p＜.001,

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    Structural Model for Osteoporosis Preventive Behaviors in Postmenopausal Women: Focused on their Own BMD Awareness
    Korean J Adult Nurs. 2013;25(5):527-538.   Published online October 31, 2013
    DOI: https://doi.org/10.7475/kjan.2013.25.5.527
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    Structural Model for Osteoporosis Preventive Behaviors in Postmenopausal Women: Focused on their Own BMD Awareness
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    DOI: https://doi.org/10.7475/kjan.2013.25.5.527
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    Structural Model for Osteoporosis Preventive Behaviors in Postmenopausal Women: Focused on their Own BMD Awareness
    Image Image
    Figure 1. Theoretical framework.
    Figure 2. Standardized parameter estimates of path diagram for the final model.

    Figure 1.

    Figure 2.

    Structural Model for Osteoporosis Preventive Behaviors in Postmenopausal Women: Focused on their Own BMD Awareness

    General Characteristics of Participants and Mean Differences of Research Variables

    Characteristics Categories n (%) GOK PT RB OSE HM OPHB
    M±SD F (p) M±SD F (p) M±SD F (p) M±SD F (p) M±SD F (p) M±SD F (p)
    Age (year) ≤50 37 (22.8) 17.49±2.19 1.63 36.22±7.27 0.39 13.95±9.00 1.53 114.24±39.55 0.99 19.78±3.79 3.08 30.10±6.50 3.80
    ≥51 125 (77.2) 16.90±2.50 (.203) 35.31±7.83 (.532) 15.99±8.80 (.218) 121.64±39.89 (.322) 20.99±3.64 (.081) 27.65±7.38 (.053)
    Ed ≤Middle school 53 (32.7) 16.15±2.50 6.09 36.62±7.65 0.83 12.04±8.89 7.36 113.08±39.15 1.31 20.09±4.07 1.20 29.35±7.25 0.04
    High school 75 (46.3) 17.31±2.32 (.003) 35.08±7.31 (.438) 16.53±8.51 (＜.001) 122.00±40.45 (.274) 21.12±3.91 (.303) 29.69±6.69 (.959)
    ≥College 34 (21.0) 17.82±2.25   34.77±8.59   18.74±7.98   126.15±39.04   20.79±2.36   29.47±6.33  
    SES Upper 4 (2.5) 16.75±0.96 1.09 28.00±3.56 4.20 12.75±13.77 3.84 97.25±59.01 4.07 21.25±2.99 1.57 31.00±1.83 4.09
    Middle 129 (79.6) 17.18±2.52 (.339) 35.12±7.46 (.017) 16.48±8.58 (.023) 124.3±38.29 (.019) 20.95±3.71 (.211) 30.19±6.96 (.019)
    Lower 29 (17.9) 16.45±2.13   38.35±8.23   11.66±8.57   103.48±39.95   19.62±3.68   26.29±5.29  
    Job Housewife 97 (59.9) 16.78±2.47 3.08 34.85±7.13 2.19 15.26±8.39 1.16 124.32±38.81 1.60 20.99±3.69 0.09 30.04±6.59 0.28
    Full or part time job 45 (27.8) 17.56±2.37 (.082) 36.82±7.95 (.141) 16.91±8.73 (.283) 115.51±38.31 (.209) 20.80±3.03 (.764) 29.40±7.00 (.598)
    Missing 20 (12.3)  
    Mar Unmarried 6 (3.7) 16.50±2.43 3.20 35.50±9.33 0.04 14.17±11.75 0.92 119.67±50.61 3.50 21.33±3.14 3.04 28.83±3.06 0.60
    With spouse 142 (87.7) 16.91±2.39 (.044) 35.58±7.82 (.956) 15.87±8.72 (.402) 122.57±39.52 (.033) 20.92±3.75 (.051) 29.74±6.83 (.548)
    S/D/D 14 (8.6) 18.57±2.53   34.93±5.99   12.64±9.11   93.50±29.57   18.43±2.74   27.71±7.19  
    Osteoporosis or osteopenia Yes 34 (21.0) 17.85±2.45 2.46 37.24±7.98 1.18 16.68±8.28 0.40 124.00±39.80 1.52 21.32±3.57 1.06 31.56±6.68 4.57
    No 126 (77.8) 16.82±2.39 (.089) 35.02±7.64 (.311) 15.25±9.05 (.672) 119.59±39.81 (.221) 20.60±3.73 (.348) 29.16±6.63 (.012)
    Missing 2 (1.2)  
    Fracture history Yes 20 (12.4) 17.45±2.26 0.65 37.60±5.10 1.68 12.25±7.61 3.16 104.90±38.49 3.31 19.45±4.11 2.70 28.10±7.22 1.03
    No 142 (87.7) 16.98±2.47 (.420) 35.23±7.96 (.197) 15.99±8.95 (.077) 122.07±39.67 (.071) 20.89±3.62 (.103) 29.74±6.70 (.312)
    Parental osteoporotic fracture history Yes 35 (21.6) 17.63±2.24 2.38 37.94±7.94 5.17 13.94±7.38 1.71 112.89±34.26 1.26 20.57±4.31 0.08 28.06±5.55 2.03
    No 125 (77.2) 16.91±2.48 (.125) 34.66±7.43 (.024) 16.14±9.11 (.191) 121.43±41.17 (.263) 20.77±3.55 (.783) 29.90±7.08 (.157)
    Missing 2 (1.2)  

    Ed=education; Mar=marriage; SES=socioeconomic status; S/D/D=separated/divorced/death; GOK=general osteoporosis knowledge; PT=perceived threats; RB=relative benefits; OSE=osteoporosis self-efficacy; HM=health motivation; OPHB=osteoporosis preventive health behavior.

    Mean, Standard Deviations, and Correlations among Variables

    Variables n (%) or M±SD P_ BMD_K GOK PT RB OSE HM
    r (p) r (p) r (p) r (p) r (p) r (p)
    P_ BMD_K              
       Know 117 (72.2)            
       Do not know 45 (27.8)            
    GOK 17.04±2.44 -.01 (.905)          
    PT 35.52±7.69 -.06 (.449) -.10 (.219)        
    RB 15.53±8.86 -.04 (.614) -.01 (.945) -.32 (＜.001)      
    OSE 119.95±39.81 -.03 (.723) -.05 (.521) -.15 (.059) .47 (＜.001)    
    HM 20.72±3.70 -.16 (.040) -.05 (.507) -.14 (.067) .36 (＜.001) .47 (＜.001)  
    OPHB 29.53±6.76 -.26 (.001) -.07 (.374) -.08 (.329) .37 (＜.001) .47 (＜.001) .35 (＜.001)

    P_BMD_K=personal bone mineral density knowledge; BMD=bone mineral density; GOK=general osteoporosis knowledge; PT=perceived threats; RB=relative benefits; OSE=osteoporosis self-efficacy; HM=health motivation; OPHB=osteoporosis preventive health behavior.

    Effects of Predictive Variables on Endogenous Variables in Hypothetical and Revised Model

    Endogenous variables Exogenous variables Hypothetical model Revised model
    SDE SIE STE SMC (R2) SDE SIE STE SMC (R2)
    OPHB P_BMD_K - -.02 -.02 .264 -.22∗∗∗ -.03 -.26∗∗∗ .312
    GOK - -.03 -.03 - -.02 -.02
    PT .05 -.00 .04 .03 -.00 .03
    RB .18∗∗ .02 .21∗∗ .18∗∗ .02 .19∗∗
    OSE .33∗∗∗ .05∗ .38∗∗∗ .34∗∗∗ .04 .37∗∗∗
    HM .14∗ - .14∗ .09 - .09
    HM P_BMD_K - -.02 -.02 .249 -.16∗∗ -.02 -.17∗∗ .273
    GOK - -.02 -.02 - -.02 -.02
    PT -.03 - -.03 -.04 - -.04
    RB .18∗∗ - .18∗∗ .17∗∗ - .17∗∗
    OSE .38∗∗∗ - .38∗∗∗ .38∗∗∗ - .38∗∗∗
    OSE P_BMD_K -.03 - -.03 .004 -.03 - -.03 .004
    GOK -.05 - -.05 -.05 - -.05
    RB P_BMD_K -.03 - -.03 .001 -.03 - -.03 .001
    GOK -.01 - -.01 -.01 - -.01
    PT P_BMD_K -.06 - -.06 .013 -.06 - -.06 .013
    GOK -.10 - -.10 -.10 - -.10

    SDE=standardized direct effect; SIE=Standardized indirect effect; STE=standardized total effect; P_BMD_K=personal bone mineral density knowledge; GOK=general osteoporosis knowledge; PT=perceived threats; RB=relative benefits; OSE=osteoporosis self-efficacy; HM=health motivation; OPHB=osteoporosis preventive health behavior, SMC=squared multiple correlation. ∗p＜.10; ∗∗p＜.05; ∗∗∗p＜.001,
    Table 1. General Characteristics of Participants and Mean Differences of Research Variables

    Ed=education; Mar=marriage; SES=socioeconomic status; S/D/D=separated/divorced/death; GOK=general osteoporosis knowledge; PT=perceived threats; RB=relative benefits; OSE=osteoporosis self-efficacy; HM=health motivation; OPHB=osteoporosis preventive health behavior.

    Table 2. Mean, Standard Deviations, and Correlations among Variables

    P_BMD_K=personal bone mineral density knowledge; BMD=bone mineral density; GOK=general osteoporosis knowledge; PT=perceived threats; RB=relative benefits; OSE=osteoporosis self-efficacy; HM=health motivation; OPHB=osteoporosis preventive health behavior.

    Table 3. Effects of Predictive Variables on Endogenous Variables in Hypothetical and Revised Model

    SDE=standardized direct effect; SIE=Standardized indirect effect; STE=standardized total effect; P_BMD_K=personal bone mineral density knowledge; GOK=general osteoporosis knowledge; PT=perceived threats; RB=relative benefits; OSE=osteoporosis self-efficacy; HM=health motivation; OPHB=osteoporosis preventive health behavior, SMC=squared multiple correlation. ∗p＜.10; ∗∗p＜.05; ∗∗∗p＜.001,

    Table 1.

    Table 2.

    Table 3.

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