Did you know that you start reducing your risk for osteoporosis during your teenage years? I didn't.

Theories of health behavior may have some answers and may be useful to us as nurses to provide better care. Health Belief Model is a theory that focuses on the individual as the locus of change (Martins, 2011). This model is centered around the premise that people take health actions to avoid diseases. The perceived susceptibility to disease, the perceived threat to disease, and the perceived benefits of some behavior all affect the likelihood of taking some sort of preventative action.  I am not a big fan of theories; my nursing practice is directed by research, so I only “buy it” when I see well-designed studies that show practical applications of theories. 

Health Belief Model turns out to be one of such cases. Despite existing since 1950’s, is has not lost its up-to-date practical application. In last year’s March issue of the American Journal of Health Behavior, Gammage and Klentrou published an article about the use of the Health Belief Model to predict osteoporosis preventing behaviors (Gammage & Klentrou, 2011). Osteoporosis is a disease that affects bone mass, and despite the fact that it affects mostly older women, disease prevention establishes around early adulthood years with lifestyle factors affecting a healthy bone mass formation.

The purpose of the study was to examine whether the variables from the Health Belief Model (HBM) could predict preventative health behaviors such as calcium intake and physical activity in teenage girls. The study was conducted among a relatively small sample of five hundred and ten high school girls who completed questionnaires that looked at the HBM variables. In the end, the investigators examined the anthropomeric measures, such as height, weight, and the percent of body fat. Questionnaires were designed to assess belief about calcium intake and exercise to prevent osteoporosis, the researchers used a health beliefs scale, a self-efficacy scale and other tools to apply the Health Belief Model. What I liked the most about the study is a detailed description of the tools used in the experiment, including the validity of the tests, and the statistical analysis of the data. The results were organized in easy-to-comprehend tables, demonstrating means, medians, and standards deviations.

The researchers reported interesting results: while the girls perceived osteoporosis as a severe disease, they did not see themselves as being at risk. Gammage and Klentrou found out that the barriers to taking calcium supplements were low, and the girls had knowledge about the benefits of taking the supplements. The average calcium intake in the sample population was found to be adequate, yet about half of the girls did not reach the recommended levels of intake. What I found alarming is that physical activity was found to be low, indicating an area of the health care needs that could potentially be addressed by community health nurses. Gammage and Klentrou suggest that the girls, who place more value on the benefit of exercise, tend to better engage in physical activity. 

For more information:

Gammage, K., & Klentrou, P. (2011). Predicting Osteoporosis Prevention Behaviors: Health Beliefs and Knowledge. American Journal of Health Behavior , 371-382.

Martins, D. (2011). Thinking Upstream: Nursing Theories and Population-Focused Nursing Practice. In M. Nies, & M. McEwen, Community / Public Health Nursing: Promoting the Health of Populations (pp. 37-49). St.Louis: Elsevier.

Nurses' Week is around the corner

Nurses Week is around the corner, and for the second year in a row I am helping organize the events for this week in our hospital. Today,  I was thinking about the theme for the National Nurses' Week and how it applies to all of us. Here is what I came up with:

Dear Nurse,

You advocate, you lead, you care.

You know that everyday work is important for the patients and families, but the challenges can sometimes be so overwhelming. During such times, you may just need a little pick-me-up to help you keep going. These words of inspiration are dedicated to YOU.

--  you advocate; you fight for your patients’ well-being, you go through the trouble of making the fifth phone call to the doctor to make sure your cancer patient gets enough pain medication. You know that “Knowing is not enough; we must apply. Willing is not enough; we must do”. (Goete)

 --  you lead, you go through a stress of a specialty certification because you want to lead new nurses to excellence in care. You know that “If your actions inspire others to dream more, learn more, do more and become more, you are a leader”. (John Quincy Adams)

  --  you care.  You hold the hand of the patient, and tell them that everything is going to be just fine. To be a nurse for you is to do what nobody else will do, a way that nobody else can do, in spite of all we go through because you care. “They may forget your name but they will never forget how you made them feel”. (Maya Angelou)

Happy Nurses’ Week!

Body Image and Self-Esteem in High School Students

 I am too fat. I am too skinny. My butt is too big. My hair is too curly. Does any of this sound familiar? To me, these statements help define the issues that the teenage girls have to deal with, the emotions that come along, the behavior that results from the issues and emotions. So this week’s post is devoted to the health behavior as it relates to the body image in teens.
During one of my first visits to a high school somewhere in the United States, I took a tour of the school to familiarize myself with the surroundings in case we get called into one of the buildings for an emergency. When I was walking in the health education section of one of the buildings, my gaze got drawn to a very colorful board made up of clippings from what looked like students’ essays. I came closer, and here is w hat I saw:

  The board was a collection of the thoughts on body image. At the beginning of the semester, one of the health education teachers made up a collage that reflected the feelings the students experienced regarding their body image. She kept the postings anonymous, and displayed the collection on the wall to make the rest of the students realize they were not the only ones to go through changes that affected their body and their self-esteem.
 

 
 
 
 
 
 
 
 
 
 
 
 
 A few weeks later, I was lucky to visit this teacher’s health education class, and I was even luckier to visit it during the time, when body image and disordered eating were discussed with the students. Part of the homework for the class was to visit the board that I mentioned earlier and to make observations about it. I was amazed by the feedback that the students provided about the postings, the students’ comments were very insightful and mature for the age. Here is what I heard:
“All [the postings] were about physical things”
“I can relate to some of them”
“I noticed that some of those things you could change by exercising, or eating right. Other things, you could change my dying your hair, or dressing in different clothes. But doing so can change who you truly are”
“A lot of the postings were about weight. I noticed that it was about what [the students imagined] people thought about you and your body”
“I think about my body image all the time; you can’t escape it, it is everywhere: it is in the mirror, in the movies, and your friends talk about the looks”
The issue of body image and self-esteem is very important during the high school years. Body image is how people feel about their own physical appearance, while self-esteem is about how much people value themselves. Self-esteem is important because feeling good or bad can affect how people act. This is where theories of health behavior may provide some information about why people feel a certain way about themselves, and why people act a certain way. These answers may be useful to the nurses so that they can provide better care. For example, a problem of body image and self-esteem can be viewed from the macroscopic approach of conceptualization of the health problem (Yes, I do think that body image is a community health problem, because it leads to multiple problems including eating disorders, cutting, and suicide). According to this model, the individual, here a teenager, is in the middle, the center contains the problem of interest: inadequate self-esteem based on the distorted body image. In this context, interventions would focus on individual high school students, or a small group of students with this problem.
The rest of the class time was built according to the principle of microscopic approach; the teacher incorporated various activities to examine the students’ attitudes to body image, to examine the prevalence of distorted body image, to locate the sources of influences, and to introduce ways the students can optimize coping with the developmental changes occurring to their bodies as well as mental issues that accompany these changes. She explained that the student struggle with the issue of self-esteem at this vulnerable age, because puberty causes changes in the body. By asking the class respond to how they felt about other people criticizing the way they looked, she examined the sources of influences. Since all the activities were conducted in a very informal manner, and the students could move freely in the classroom, they felt more comfortable expressing their feelings.
I think that this class taught me about the ways to talk to the girls if they come to the nurses’ office to discuss body-image issues, help me find ways to examine causes of disordered eating, and allow me find strategies to make these girls feel like they are not the only ones, that there are things they can do, and that after all, there is a person they can trust and always talk to.