Association of Health Belief Model Constructs with Stages of Exercise Behavior Change in Prevention of Osteoporosis among Iranian Female Employees

Document Type : Original Research

Authors
Z. Shaahmadi 1
A. Fallahi 2
N.A. Azadi 3
T. Pashei 4
1 Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
2 Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
3 Biostatistics Department, Public Health Faculty, Iran University of Medical Sciences, Tehran, Iran
4 Public Health Department, Health Faculty, Kurdistan University of Medical Sciences, Sanandaj, Iran
10.29252/HEHP.7.1.49
Abstract
Aims: Female employees are more prone to develop osteoporosis. Exercise is the main factor preventing osteoporosis and an efficient method to increase bone density. This study was aimed to evaluate the relationship between health belief model constructs and stages of exercise behavior change in the prevention of osteoporosis among Iranian female employees.

Instruments & Methods: This cross-sectional study was carried out in Iran, in 2016. A total of 585 female employees were selected through multi-stage sampling. A three-part questionnaire, including demographic information, health belief model constructs and stages of exercise behavior change was completed by the participants through self-report. The obtained data were analyzed by SPSS 22 software.

Findings: The findings showed that 64.1% of female employees had no exercise activity. Perceived benefits and perceived self-efficacy were directly correlated with cues to action external and cues to action internal, respectively (p<0.01). The means of perceived benefits, perceived self-efficacy and cues to action external showed statistically significant differences during the stages of exercise behavior change (p<0.05). In logistic regression, the remains of the influencing factors of exercise behavior were perceived self-efficacy and cues to action external.

Conclusion: Exercise activity among the female employees was low. Interventional studies seem necessary to be conducted to promote exercise behavior in female employees.

Keywords

Subjects

  1. 1. Gallagher JC. Effect of early menopause on bone mineral density and fractures menopause. Menopause. 2007;14(5):67-71.
    2. shari M, Sarah S. The silent thief : osteoporosis and women's health care across the life span. health and social work. 2006;31(1):44-53.
    3. Axel svedbon EH. Epidemiology and Economic Burden of osteoporosis in Austeralia. Arch osteoporos. 2013;8(137):218.
    4. Bayat N, Haji Amini Z. Frequency of osteoporosis and osteopenia in post-menopausal military family's women. journal of army university of medical sciences of the IRIran. 2008;6(1):25.
    5. karimzadeh Shirazi K, Wallace L, Niknami S, Hidarnia A, Torkaman G, Gilchrist M, et al. A home-based transtheoretical change model designed strength training intervention to increase exercise to prevent osteoporosis in Iranian women aged 40-65 years: a randomized controlled trial. Hakim Resarch journal. 2007;22:305-17.
    6. Chang S. A cross-sectional survey of calcium intake in relation to knowledge of osteoporosis and
    beliefs in young adult women. Int J Nurs Pract. 2006;12(1):21-7.
    7. Alemayehu BK, Fikre E, Zenebe G, Abebe T, Tsigabu B. Risk factors of osteoporosis among adults in Ethiopia, the case of Tigrai region: A case control study. Journal of Public Health and Epidemiology. 2014;6(2):92-100.
    8. Urmal s, Jaspreet kaur S, Sharma k. Osteoporosis Prevalence among Women in a Selected Hospital, Ludhiana, Punjab. International Journal of Healthcare Sciences. 2014;2(1):88-91.
    9. jalilian F, Emdadi S, Mirzaie M, Barati M. The Survey Physical Activity Status of Employed Women in Hamadan University of Medical Sciences: The Relationship Between the Benefits, Barriers, Self-Efficacy and Stages of Change. Tolooe Behdasht. 2010;4(9):89-98.
    10. Carter N, Kannus P, Khan K. Exercise in the prevention of falls in older people: a systematic literature review examining the rationale and the evidence. Sports Med. 2001;31(6):427-38.
    11. Chang J, Morton S, Rubenstein L, Mojica W, Maglione M, Suttorp M, et al. Interventions for the prevention of falls in older adults: systematic review and meta-analysis of randomised clinical trials. BMJ. 2004:328: 680.
    12. Schmitt N, Schmitt J, Dören M. The role of physical activity in the prevention of osteoporosis in postmenopausal women-An update. Maturitas. 2009;63(1):34-8.
    13. Marcus BH, Simkin LR. The transtheoretical model: applications to exercise behavior. Medicine and science in sports and exercise. 1994;26(11):1400-4.
    14. Turner LW, Hunt S, DiBrezzo R, Jones C. Design and implementation of an Osteoporosis Prevention Program using the Health Belief Model. American Journal of Health Studies. 2004;19(2).
    15. Gammage K, Klentrou P. Predicting osteoporosis prevention behaviors: health beliefs and knowledge. Am J Health Behav. 2011;35(3):371-82.
    16. Edmonds E. Osteoporosis knowledge, beliefs, and behaviors of college students: utilization of the health belief model: The University of Alabama TUSCALOOSA; 2009.
    17. Narengii F AS. study of preventive behaviors of osteoporosis in the health caregivers and pratice of osteoporotic patients payeshy. 2006;3(1):71-87.
    18. Kim K, Horan M, Gendler P. Development and evaluation of the Osteoporosis Health Belief Scale. Res Nurs Health. 1991;14(2):155-63.
    19. Soleymanian A, Niknami S, Hajizadeh E, Shojaeizadeh D, Montazeri A. Development and validation of a health belief model based instrument for measuring factors influencing exercise behaviors to prevent osteoporosis in pre-menopausal women (HOPE). Musculoskeletal Disorders. 2014;15:61.
    20. Marcus B, Rakowski W, Rossi J. Assessing motivational readiness and decision making for exercise. Health Psychol. 1992;11:257-61.
    21. Dumith S, Gigante D, Domingues MR. Stages of change for physical activity in adults from Southern Brazil: a population-based survey. International Journal of Behavioral Nutrition and Physical Activity. 2007;4(1):1.
    22. Nigg CR, Courneya KS. Transtheoretical model: Examining adolescent exercise behavior. Journal of Adolescent Health. 1998;22(3):214-24.
    23. Emdadi S, Nilsaze M, Hosseini B, Sohrabi F. Application of the Trans-Theoretical Model (TTM) to exercise behavior among female college students. Journal of research in health sciences. 2007;7(2):25-30.
    24. Marshall SJ, Biddle S. The transtheoretical model of behavior change: a meta-analysis of applications to physical activity and exercise. Annals of behavioral medicine. 2001;23(4):229-46.
    25. Saffari M, Shojaeizadeh D. Health education and promotion theories, models and methods. Tehran, Iran: Sobhan Publication. 2010:53-64.
    26. Lovell G, Ansari W, Parker J. Perceived Exercise Benefits and Barriers of Non-Exercising Female University Students in the United Kingdom. Int J Environ Res Public Health. 2010;7(3):784–98.
    27. Mattson M. Toward a reconceptualization of communication cues to action in the health belief model: HIV test counseling. Communications Monographs. 1999;66(3):240-65.
    28. Legler J, Meissner H, Coyne C, Breen N, Chollette V, Rimer B. The effectiveness of interventions to promote mammography among women withhistorically lower rates of screening. Biomarkers & Prevention. 2002;11:59-71.
    29. Glanz K, Rimer B, Lewis F. Health behavior and health education: theory, research, and practice. edn.Wiley r, editor. San Francisco2002.
    30. Macintosh D. Socio-economic, educational, and status characteristics of Ontario interschool athletes. Canadian journal of applied sport sciences Journal canadien des sciences appliquees au sport. 1982;7(4):272-83.
    31. Leslie E, Owen N, Salmon J, Bauman A, Sallis J, Lo S. Insufficiently active Australian college students: perceived personal, social, and environmental influences. Preventive Medicine. 1999;28(1):20-7.
    32. Boreham C, Riddoch C. The physical activity, fitness and health of children. Journal of sports sciences. 2001;19(12):915-29.
    33. Juniper K, C, Oman R, F, Hamm R, M, Kerby D, S. The Relationships Among Constructs in the Health Belief Model and the Transtheoretical Model Among African-American College Women for Physical Activity. American Journal of Health Promotion. 2004;18:354-7.
    34. Pender NJ, Murdaugh CL, Parsons M. Health Promotion in Nursing Practice (6th Edition) 6th (sixth) Edition. USA: Prentice Hall; 2010.
    35. Schwarzer R, Fuchs R. Self-efficacy and health behaviours. Predicting health behaviour: Research and practice with social cognition models. 1996:163-96.
    36. Berry T, Naylor P, Wharf-Higgins J. Stages of change in adolescents: an examination of self-efficacy, decisional balance, and reasons for relapse. Journal of Adolescent Health. 2005;37(6):452-9.
    37. Kim Y. Korean adolescents' exercise behavior and its relationship with psychological variables based on stages of change model. Journal of Adolescent Health. 2004;34(6):523-30.
    38. Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychological Review. 1977;84:191–215.
  2. Gallagher JC. Effect of early menopause on bone mineral density and fractures. Menopause. 2007;14(3 Pt 2):567-71. [Link] [DOI:10.1097/gme.0b013e31804c793d]
  3. Munch S, Shapiro S. The silent thief: Osteoporosis and women's health care across the life span. Health Soc Work. 2006;31(1):44-53. [Link] [DOI:10.1093/hsw/31.1.44]
  4. Svedbom A, Ivergård M, Hernlund E, Rizzoli R, Kanis J. Epidemiology and economic burden of osteoporosis in Switzerland. Arch Osteoporos. 2014;9:187. [Link] [DOI:10.1007/s11657-014-0187-y]
  5. Bayat N, Haji Amini Z, Alishiri GH, Ebadi A, Hosseini M, Laluee A. Frequency of osteoporosis and osteopenia in post-menopausal military family's women. Ann Mil Health Sci Res. 2008;6(1):25-30. [Persian] [Link]
  6. Karimzadeh Shirazi K, Wallace LM, Niknami Sh, Hidarnia AR, Torkaman G, Gilchrist M, et al. A home-based, transtheoretical change model designed strength training intervention to increase exercise to prevent osteoporosis in Iranian women aged 40-65 years: A randomized controlled trial. Health Educ Res. 2007;22(3):305-17. [Link] [DOI:10.1093/her/cyl067]
  7. Chang SF. A cross-sectional survey of calcium intake in relation to knowledge of osteoporosis and beliefs in young adult women. Int J Nurs Pract. 2006;12(1):21-7. [Link] [DOI:10.1111/j.1440-172X.2006.00546.x]
  8. Kahsay AB, Gashe FE, Debessai ZG, Tegegne A, Bezabih T. Risk factors of osteoporosis among adults in Ethiopia, the case of Tigrai region: A case control study. J Public Health Epidemiol. 2014;6(2):92-100. [Link] [DOI:10.5897/JPHE2013.0594]
  9. Urmal S, Jaspreet Kaur S, Sharma K. Osteoporosis prevalence among women in a selected hospital, Ludhiana, Punjab. Int J Healthc Sci. 2014;2(1):88-91. [Link]
  10. Jalilian F, Emdadi Sh, Mirzaie Alavijeh M, Barati M. The survey physical activity status of employed women in Hamadan University of Medical Sciences: The relationship between the benefits, barriers, self-efficacy and stages of change. Toloo e Behdasht. 2010;9(4):89-99. [Persian] [Link]
  11. Carter ND, Kannus P, Khan KM. Exercise in the prevention of falls in older people: A systematic literature review examining the rationale and the evidence. Sports Med. 2001;31(6):427-38. [Link] [DOI:10.2165/00007256-200131060-00003]
  12. Chang JT, Morton SC, Rubenstein LZ, Mojica WA, Maglione M, Suttorp MJ, et al. Interventions for the prevention of falls in older adults: Systematic review and meta-analysis of randomised clinical trials. BMJ. 2004;328:680. [Link] [DOI:10.1136/bmj.328.7441.680]
  13. Schmitt NM, Schmitt J, Dören M. The role of physical activity in the prevention of osteoporosis in postmenopausal women - an update. Maturitas. 2009;63(1):34-8. [Link] [DOI:10.1016/j.maturitas.2009.03.002]
  14. Marcus BH, Simkin LR. The transtheoretical model: Applications to exercise behavior. Med Sci Sports Exerc. 1994;26(11):1400-4. [Link] [DOI:10.1249/00005768-199411000-00016]
  15. Turner LW, Hunt SB, Di Brezzo R, Jones C. Design and implementation of an osteoporosis prevention program using the health belief model. Am J Health Stud. 2004;19(2):115-21. [Link]
  16. Gammage KL, Klentrou P. Predicting osteoporosis prevention behaviors: Health beliefs and knowledge. Am J Health Behav. 2011;35(3):371-82. [Link] [DOI:10.5993/AJHB.35.3.10]
  17. Edmonds ET. Osteoporosis knowledge, beliefs, and behaviors of college students: Utilization of the health belief model [Dissertation]. Tuscaloosa AL: The University of Alabama; 2009. [Link]
  18. Kwolek D. Women's Health Education. J Gen Intern Med. 2003;18(6):490–1. [Link] [DOI:10.1046/j.1525-1497.2003.30421.x]
  19. Kim KK, Horan ML, Gendler P, Patel MK. Development and evaluation of the osteoporosis health belief scale. Res Nurs Health. 1991;14(2):155-63. [Link] [DOI:10.1002/nur.4770140210]
  20. Soleymanian A, Niknami S, Hajizadeh E, Shojaeizadeh D, Montazeri A. Development and validation of a health belief model based instrument for measuring factors influencing exercise behaviors to prevent osteoporosis in pre-menopausal women (HOPE). BMC Musculoskelet Disord. 2014;15:61. [Link] [DOI:10.1186/1471-2474-15-61]
  21. Marcus BH, Rakowski W, Rossi JS. Assessing motivational readiness and decision making for exercise. Health Psychol. 1992;11(4):257-61. [Link] [DOI:10.1037/0278-6133.11.4.257]
  22. Dumith SC, Gigante DP, Domingues MR. Stages of change for physical activity in adults from Southern Brazil: A population-based survey. Int J Behav Nutr Phys Act. 2007;4:25. [Link] [DOI:10.1186/1479-5868-4-25]
  23. Nigg CR, Courneya KS. Transtheoretical model: Examining adolescent exercise behavior. J Adolesc Health. 1998;22(3):214-24. [Link] [DOI:10.1016/S1054-139X(97)00141-9]
  24. Emdadi Sh, Nilsaze M, Hosseini B, Sohrabi F. Application of the Trans-Theoretical Model (TTM) to exercise behavior among female college students. J Res Health Sci. 2007;7(2):25-30. [Link]
  25. Marshall SJ, Biddle SJ. The transtheoretical model of behavior change: A meta-analysis of applications to physical activity and exercise. Ann Behav Med. 2001;23(4):229-46. [Link] [DOI:10.1207/S15324796ABM2304_2]
  26. Saffari M, Shojaeizadeh D, Ghofranipour F, Heydarnia AR, Pakpour Hajiagha A. Health education and promotion theories, models and methods. Tehran: Sobhan; 2010. pp. 53-64. [Persian] [Link]
  27. Lovell GP, El Ansari W, Parker JK. Perceived exercise benefits and barriers of non-exercising female university students in the United Kingdom. Int J Environ Res Public Health. 2010;7(3):784-98. [Link] [DOI:10.3390/ijerph7030784]
  28. Mattson M. Toward a reconceptualization of communication cues to action in the health belief model: HIV test counseling. Commun Monogr. 1999;66(3):240-65. [Link] [DOI:10.1080/03637759909376476]
  29. Legler J, Meissner HI, Coyne C, Breen N, Chollette V, Rimer BK. The effectiveness of interventions to promote mammography among women with historically lower rates of screening. Cancer Epidemiol Biomarkers Prev. 2002;11(1):59-71. [Link]
  30. Glanz K, Rimer BK, Lewis FM. Health behavior and health education: Theory, research, and practice. San Francisco CA: Jossey-Bass; 2002. [Link]
  31. Macintosh D. Socio-economic, educational, and status characteristics of Ontario interschool athletes. Can J Appl Sport Sci. 1982;7(4):272-83. [Link]
  32. Leslie E, Owen N, Salmon J, Bauman A, Sallis JF, Lo SK. Insufficiently active Australian college students: Perceived personal, social, and environmental influences. Prev Med. 1999;28(1):20-7. [Link] [DOI:10.1006/pmed.1998.0375]
  33. Boreham C, Riddoch C. The physical activity, fitness and health of children. J Sports Sci. 2001;19(12):915-29. [Link] [DOI:10.1080/026404101317108426]
  34. Juniper KC, Oman RF, Hamm RM, Kerby DS. The relationships among constructs in the health belief model and the transtheoretical model among African-American college women for physical activity. Am J Health Promot. 2004;18(5):354-7. [Link] [DOI:10.4278/0890-1171-18.5.354]
  35. Mohebi S, Sharifirad G, Feizi A, Botlani S, Hozori M, Azadbakht L. Can health promotion model constructs predict nutritional behavior among diabetic patients? J Res Med Sci. 2013;18(4):346–59. [Link]
  36. Schwarzer R, Fuchs R. Self-efficacy and health behaviours. In: Conner M. Predicting health behaviour: Research and practice with social cognition models. Conner M, Norman P, editors. Maidenhead: Open University Press; 1996. pp. 163-96. [Link]
  37. Berry T, Naylor PJ, Wharf-Higgins J. Stages of change in adolescents: An examination of self-efficacy, decisional balance, and reasons for relapse. J Adolesc Health. 2005;37(6):452-9. [Link] [DOI:10.1016/j.jadohealth.2004.09.019]
  38. Kim YH. Korean adolescents' exercise behavior and its relationship with psychological variables based on stages of change model. J Adolesc Health. 2004;34(6):523-30. [Link] [DOI:10.1016/S1054-139X(03)00349-5]
  39. Bandura A. Self-efficacy: Toward a unifying theory of behavioral change. Psychol Rev. 1977;84(2):191-215. [Link] [DOI:10.1037/0033-295X.84.2.191]
Health Education and Health Promotion
Volume 7, Issue 1
Winter 2019
Pages 49-55