The aim of this study was to investigate the preventive behaviors of osteoporosis using the Health Belief Model in female health volunteers of health care centers in Rasht. The results of the study showed that the health belief model constructs have predictive power in preventive behaviors of osteoporosis. Heidarnia and Lal Monfared conducted a study among women and Min among the students. They reported that the constructs of this model have a predictive power of osteoporosis (1, 18, and 19). In the present study, health volunteers had moderate physical activity levels. The findings of this study were consistent with the results of other studies (20, 21). Based on the results, perceived susceptibility and self-efficacy constructs were predictive of appropriate physical activity (moderate and severe). Hence, with the increase in physical activity, the score of the perceived susceptibility construct decreases and for one unit increase in the score of the self-efficacy construct the chances of appropriate physical activity increase by 1.2 times (17%).
According to the Health Believe Model, when people feel they are at risk of a disease, do better the preventive behaviors (1). Thus, it can be expected that whenever physical activity of people is high, they feel less at risk for the disease. It is logical that the higher the self-efficacy of the individual, the more confident they can resist the stimuli, and thus they can be successful in performing physical activity, its continuation and promotion. Doheny reported that the perceived susceptibility was an important predictor variable for behaviors such as exercise (22). In studies Haieh (23) and Chang (24), perceived susceptibility was the most important predictor of osteoporosis preventive behaviors. In the study of Hyderinia, perceived susceptibility construct compared to other constructs had more predictive power for walking behavior along with the nutritional behavior of women (1). Given that most of the women studied had high levels of education, they felt vulnerable to osteoporosis. In addition, the women 30-50 years have a key and active role in family health management; they were mainly responsible for providing food for family members, and they have an appropriate physical condition for body exercises. However, in the studies of Sayad Hassan, there was no relationship between perceived susceptibility construct and screening and preventive behavior of osteoporosis in female students in Damascus (25). The probability of contradiction in this study may be the age, geographical, and cultural differences in the research groups. Hatfnia investigated the factors related to the regular physical activity for the prevention of osteoporosis in female employees based on the Health Belief Model. The results showed that self-efficacy was a predictor of physical activity behavior among the constructs of this model, which is in agreement with the results of the present study (5). Hossein Nejad et al reported a significant and positive relationship between the mean score of dietary behavior, athletic activity, and self-efficacy of female students (26). Landis reported that there was a positive correlation between self-efficacy and consumption of calcium-containing foods in girls (27). In the study of Wallace on predictors of the developed health belief model constructs in girl students, self-efficacy and perceived barriers constructs were considered as the most effective factors in the physical activity in the prevention of osteoporosis (28). In addition to the above, in some studies, including the study of Abood, to predict the preventive behaviors of osteoporosis, knowledge and perceived susceptibility have been identified as the most important factor in behavioral change (29). The results of a study on 1056 women aged 16-72 years in the Netherlands showed that osteoporosis was considered as a mild illness and a health problem. Therefore, the failure to take preventive behaviors was the lack of adequate knowledge about the disease (30). In a study conducted among girl students, knowledge and perceived susceptibility were the most important factor in performing the preventive behaviors of osteoporosis (31), which is consistent with the results of the present study. It can be expected that by increasing knowledge of individuals about a behavior, the occurrence of that behavior increases.
According to the results, it seems that the health volunteers of the present study are in a relatively favorable condition in terms of physical activity. It can be stated that the level of women's participation in the Gilan province is significant due to the cultural and climatic characteristics of this province. Therefore, they try to provide their health by doing physical activity and protect their professional position as active health volunteers.
Health volunteers with moderate physical activity are the pioneer for participation. The results of the study showed that among the constructs of the health belief model, perceived barriers and knowledge constructs significantly had the most predictive power regarding the nutritional practice of dietary intake of calcium. Thus, by increasing the score of perceived barriers, the score of the nutritional practice of dietary intake of calcium increases by 0.04 ± 0.016 and by increasing knowledge score, the score of the nutritional practice of dietary intake of calcium increases by 0.01 ± 0.005. In this regard, some studies are consistent with the results of the present study in that they suggest that the construct of the perceived barrier is effective on calcium intake. In the study of Lale Monfared, the perceived barrier structures had the most predictive power in obtaining calcium in women (19).
Sayad Hassan (25) and Wallace reported that among girl students, the perceived barriers construct was one of the most influential factors in the performance of calcium intake (28). Tsai reported that the perceived barrier and health motivation were the most important factor in calcium intake. Hernandez-Rauda reported that the perceived barriers factors especially the economic factor is the most important factor in Lack of calcium intake using the results of the general regression model (20). In addition, studies have shown that in the field of preventive behaviors for osteoporosis, knowledge alone does not lead to change in behavior, and other socioeconomic factors along with knowledge and beliefs of individuals have the significant role in preventive behaviors of osteoporosis (32). In the study of Gharlipour, knowledge had a significant direct relationship with dietary intake of calcium and perceived barrier construct had a significant reverse relationship with dietary intake of calcium in adolescents (33). Chan also reported that the knowledge about osteoporosis among teenage girls is the most effective factor in the preventive behaviors of osteoporosis (34). In the Vafa Jamil study, there was a significant relationship between knowledge and dietary calcium intake of girl students (35). In Hyderinia's study, the predictive power of perceived susceptibility constructs for the nutritional behavior of women aged 30 to 50 years was more than the rest of the constructs, which was not consistent with the results of the study. This is probably due to differences in the nutritional pattern of the studied population as well as the combination of the health belief model and social cognitive theory to examine the predictors of the preventive behaviors of osteoporosis in women, in which other factors were also considered (1).
Conclusion
The results of this study showed that based on the health belief model, perceived susceptibility and self-efficacy for physical activity and perceived barriers and awareness for the nutritional practice of dietary milk and calcium intake were the strongest predictors of the preventive behaviors of osteoporosis. Regarding moderate physical activity and inadequate nutritional practice in dietary calcium intake (less than the recommended daily intake) among health volunteers studied, it is possible to maintain and promote women's health by implementing educational interventions based on health belief model with emphasis on knowledge as well as effective self-efficacy, perceived susceptibility, and perceived barriers constructs. Based on the results of this study, the health belief model was a good predictor of the preventive behaviors of osteoporosis in female health volunteers.
One of the limitations of this research was the effect of some factors such as personality traits, individual differences, and psycho-mental states when answering the questionnaire, which was beyond the control of the researcher. The use of the self-report method was another limitation of the research, which could have an impact on the quality of the data.
Acknowledgements
The present study is part of the Master's thesis in community health nursing and the approved project (No. 95072706 dated 27.6.95) of Gilan University of Medical Sciences with the ethics code of IR.GUMS.REC.1395.202. The authors are grateful for the financial support of the Deputy of Research and Technology of Gilan University of Medical Sciences and Health Services, Social Determinants of Health Research Center, Nursing and Midwifery Faculty, as well as for the cooperation of health volunteers and their authorities at Health Center and community health centers of Rasht.
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