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Wednesday, March 28, 2012

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.

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