Effect of a Screening and Education Programme on Knowledge, Beliefs, and Practices Regarding Osteoporosis among Malaysians
Abstract
:1. Introduction
2. Materials and Methods
Statistical Analysis
3. Results
3.1. Characteristics of Subjects during the Recruitment
3.2. Comparison of Characteristics of Subjects Compliant with or Lost to Follow Up
3.3. Characteristics of Subjects before and after Intervention
3.4. Barriers to Achieve Optimal Bone Health through Osteoprotective Practices
3.5. Changes in Hip and Spine BMD after Intervention
3.6. Referral Information and % of Successful Referrals and Reasons for Not Meeting Doctors
3.7. Treatment Prescribed and Compliance of Subjects Who Met Medical Doctors with Referral Letters
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variable of Interest | Mean (SD) | |||
---|---|---|---|---|
Men (n = 190) | Women (n = 210) | Overall (n = 400) | p-Value * | |
Age (years) | 57.78 (9.58) | 56.07 (8.10) | 56.88 (8.87) | 0.054 |
Age of menarche (years) | - | 13.05 (1.87) | - | - |
Number of children (n) | - | 2.47 (1.52) | - | - |
Age of menopause (years) | - | 51.08 (3.59), n = 146 | - | - |
Years since menopause (years) | - | 9.01 (5.98), n = 146 | - | - |
Body anthropometry | ||||
Height (cm) | 167.14 (6.02) | 154.51 (5.35) | 160.51 (8.49) | <0.001 a |
Weight (kg) | 70.77 (11.59) | 60.12 (11.91) | 65.18 (12.89) | <0.001 a |
BMI (kg/m2) | 25.33 (4.96) | 25.22 (4.96) | 25.27 (4.48) | 0.816 |
Body fat percentage (%) | 29.55 (4.92) | 40.09 (5.36) | 35.08 (7.36) | <0.001 a |
Lean body mass | 47.02 (6.21) | 33.60 (5.11) | 39.98 (8.78) | <0.001 a |
Waist circumference (cm) | 88.60 (12.38) | 82.17 (10.53) | 85.22 (11.87) | <0.001 a |
Hip T-score | −0.61 (1.23) | −1.13 (1.27) | −0.88 (1.28) | <0.001 a |
Spine T-score | 0.17 (1.23) | −0.80 (1.41) | −0.34 (1.41) | <0.001 a |
Hip BMD (g/cm2) | 0.93 (0.13) | 0.83 (0.12) | 0.88 (0.14) | <0.001 a |
Spine BMD (g/cm2) | 1.00 (0.16) | 0.90 (0.16) | 0.95 (0.17) | <0.001 a |
Dietary intake | ||||
Energy level (kcal) | 1709.35 (494.45) | 1464.03 (457.46) | 1581.08 (490.25) | <0.001 a |
Protein (g) | 78.26 (23.78) | 69.25 (23.64) | 73.52 (24.10) | <0.001 a |
Carbohydrate (g) | 221.23 (71.36) | 183.47 (56.71) | 201.40 (66.73) | <0.001 a |
Total fat (g) | 60.50 (25.69) | 53.42 (28.16) | 56.78 (27.21) | 0.009 a |
Vitamin A (RE) | 929.11 (611.22) | 795.38 (416.67) | 858.90 (521.90) | 0.010 a |
Sodium (mg) | 3773.68 (1429.63) | 3393.68 (1448.00) | 3574.18 (1450.00) | 0.009 a |
Selenium (ug) | 58.53 (40.01) | 49.28 (34.47) | 53.67 (37.44) | 0.016 a |
n (%) | ||||
Age range | ||||
Middle age (40–59 years old) | 100 (52.6) | 132 (62.9) | 232 (58.0) | 0.039 b |
Elderly (60 years old and above) | 90 (47.4) | 78 (37.1) | 168 (42.0) | |
Ethnicity | ||||
Malay | 91 (47.9) | 102 (48.6) | 193 (48.3) | 0.615 |
Chinese | 79 (41.6) | 90 (42.9) | 169 (42.3) | |
Indian | 20 (10.5) | 18 (8.6) | 38 (9.5) | |
District | ||||
Klang | 6 (3.2) | 9 (4.3) | 15 (3.8) | 0.064 |
Hulu Langat | 149 (78.4) | 178 (84.8) | 327 (81.8) | |
Petaling | 23 (12.1) | 15 (7.1) | 38 (9.5) | |
Gombak | 12 (6.3) | 8 (3.8) | 20 (5.0) | |
Marital status | ||||
Single | 9 (4.7) | 20 (9.5) | 29 (7.2) | 0.065 |
Married | 181 (95.3) | 190 (90.5) | 371 (92.8) | |
Nature of job | ||||
Manual | 18 (9.5) | 10 (4.8) | 28 (7.0) | 0.065 |
Sedentary | 172 (90.5) | 200 (95.2) | 372 (93.0) | |
Classification of monthly incomes | ||||
B40 | 173 (91.1) | 206 (98.1) | 379 (94.8) | 0.002 b |
M40 | 17 (8.9) | 4 (1.9) | 21 (5.3) | |
Highest education level | ||||
No formal education | 1 (0.5) | 2 (1.0) | 3 (0.8) | 0.493 |
Primary school | 19 (10.0) | 14 (6.7) | 33 (8.3) | |
Secondary school | 85 (44.7) | 112 (53.3) | 197 (49.3) | |
Certificate/diploma | 46 (24.2) | 46 (21.9) | 92 (23.0) | |
University degree | 23 (12.1) | 24 (11.4) | 47 (11.8) | |
Postgraduate | 16 (8.4) | 12 (5.7) | 28 (7.0) | |
Current menstrual status | ||||
Pre-menopause | - | 41 (19.5) | - | - |
Peri-menopause | - | 23 (11.0) | - | - |
Postmenopause | - | 146 (69.5) | - | - |
Number of lifetime pregnancies (parity) | ||||
Nulliparous | - | 36 (17.1) | - | - |
1–3 Pregnancies | - | 104 (49.5) | - | - |
More than 3 Pregnancies | - | 70 (33.3) | - | - |
Dairy intake | ||||
Do not drink | 137 (72.1) | 113 (53.8) | 250 (62.5) | <0.001 b |
Regular drinker | 53 (27.9) | 97 (46.2) | 150 (37.5) | |
Calcium supplement intake | ||||
Yes | 17 (8.9) | 38 (18.1) | 55 (13.8) | 0.008 b |
No | 173 (91.1) | 172 (81.9) | 345 (86.3) | |
Coffee or tea intake | ||||
Do not drink | 30 (15.8) | 53 (25.2) | 83 (20.8) | 0.020 b |
Regular drinker | 160 (84.2) | 157 (74.8) | 317 (79.3) | |
Alcohol drinking | ||||
Non drinker | 125 (65.8) | 173 (82.4) | 298 (74.5) | <0.001 b |
Ever-drinker | 65 (34.2) | 37 (17.6) | 102 (25.5) | |
Smoking status | ||||
Non-smoker | 112 (58.9) | 203 (96.7) | 315 (78.8) | <0.001 b |
Ever-smoker | 78 (41.1) | 7 (3.3) | 85 (21.3) | |
Physical activity status | ||||
Inactive | 80 (42.1) | 99 (47.1) | 179 (44.8) | 0.094 |
Minimally active | 73 (38.4) | 85 (40.5) | 158 (39.5) | |
HEPA active | 37 (19.5) | 26 (12.4) | 63 (15.8) | |
Body mass index | ||||
Normal | 16 (8.4) | 24 (11.4) | 40 (10.0) | 0.451 |
Underweight | 88 (46.3) | 95 (45.2) | 183 (45.8) | |
Overweight | 86 (45.3) | 91 (43.3) | 177 (44.3) | |
Bone health status | ||||
Normal | 111 (58.4) | 71 (33.8) | 182 (45.5) | <0.001 b |
Osteopenia | 68 (35.8) | 101 (48.1) | 169 (42.3) | |
Osteoporosis | 11 (5.8) | 38 (18.1) | 49 (12.3) |
Variable of Interest | Mean (SD) | ||
---|---|---|---|
Came for Follow Up (n = 328) | Lost to Follow Up (n = 72) | p-Value | |
Age (years) | 57.58 (8.58) | 53.72 (9.51) | 0.002 * |
Body anthropometry | |||
Height (cm) | 160.60 (8.44) | 160.10 (8.73) | 0.649 |
Weight (kg) | 64.22 (12.68) | 69.55 (13.02) | 0.002 * |
BMI (kg/m2) | 24.85 (4.26) | 27.20 (4.96) | <0.001 * |
Body fat percentage (%) | 34.88 (7.11) | 36.00 (8.42) | 0.299 |
Lean body mass | 39.57 (8.74) | 41.84 (8.75) | 0.635 |
Waist circumference (cm) | 84.36 (11.82) | 89.15 (11.39) | 0.002 * |
Hip T-score | −0.94 (1.25) | −0.60 (1.35) | 0.036 * |
Spine T-score | −0.40 (1.39) | −0.04 (1.46) | 0.048 * |
Hip BMD (g/cm2) | 0.91 (0.14) | 0.87 (0.13) | 0.041 * |
Spine BMD (g/cm2) | 0.98 (0.17) | 0.94 (0.16) | 0.065 |
Dietary intake (only significant results are shown) | |||
Carbohydrate (g) | 197.75 (66.69) | 218.56 (64.73) | 0.017 * |
Mean % (SD) | |||
Knowledge regarding osteoporosis | |||
General knowledge regarding osteoporosis | 70.68 (18.43) | 73.15 (14.95) | 0.289 |
Prevention knowledge regarding osteoporosis | 63.41 (16.83) | 62.73 (16.67) | 0.755 |
Total knowledge regarding osteoporosis | 67.05 (13.27) | 67.94 (13.02) | 0.605 |
Beliefs regarding osteoporosis | |||
I: Perceived susceptibility to osteoporosis | 59.76 (13.90) | 57.22 (13.96) | 0.162 |
II: Perceived seriousness of osteoporosis | 72.68 (18.58) | 69.44 (20.41) | 0.189 |
III: Perceived benefits of exercise | 80.37 (12.01) | 78.33 (14.54) | 0.271 |
IV: Perceived benefits of calcium intake | 77.87 (12.50) | 80.00 (12.10) | 0.187 |
V: Barriers to exercise | 51.40 (15.44) | 53.06 (15.89) | 0.414 |
VI: Barriers to calcium intake | 44.79 (9.58) | 44.31 (10.85) | 0.707 |
VII: Health motivation | 74.88 (10.39) | 73.43 (10.58) | 0.285 |
Total beliefs regarding osteoporosis | 63.95 (5.65) | 63.10 (5.92) | 0.252 |
Dairy intake | |||
Do not drink | 201 (61.6) | 49 (68.1) | 0.282 |
Regular drinker | 127 (38.7) | 23 (31.9) | |
Calcium supplement intake | |||
Yes | 46 (14.0) | 9 (12.5) | 0.734 |
No | 282 (86.0) | 63 (87.5) | |
Coffee or tea intake | |||
Do not drink | 72 (22.0) | 11 (15.3) | 0.206 |
Regular drinker | 256 (78.0) | 61 (84.7) | |
Alcohol drinking | |||
Non drinker | 239 (72.9) | 59 (81.9) | 0.109 |
Ever-drinker | 89 (27.1) | 13 (18.1) | |
Smoking status | |||
Non-smoker | 264 (80.5) | 51 (70.8) | 0.070 |
Ever-smoker | 64 (19.5) | 21 (29.2) | |
Physical activity status | |||
Inactive | 142 (43.3) | 37 (51.4) | 0.426 |
Minimally active | 132 (40.2) | 26 (36.1) | |
HEPA active | 54 (16.5) | 9 (12.5) |
Variable of Interest | Mean (SD) | ||
---|---|---|---|
Baseline (n = 328) | Follow-Up (n = 328) | p-Value | |
Age (years) | 57.60 (8.57) | 57.60 (8.57) | 1.000 |
Body anthropometry | |||
Height (cm) | 160.59 (8.44) | 160.59 (8.44) | 1.000 |
Weight (kg) | 64.24 (12.73) | 64.17 (13.35) | 0.119 |
BMI (kg/m2) | 24.86 (4.29) | 24.35 (4.88) | 0.420 |
Body fat percentage (%) | 34.89 (7.11) | 34.88 (6.95) | 0.686 |
Lean body mass | 39.57 (8.74) | 40.25 (8.75) | 0.610 |
Waist circumference (cm) | 84.39 (11.89) | 86.49 (11.13) | 0.382 |
Hip T-score | −0.94 (1.25) | −1.06 (1.22) | <0.001 * |
Spine T-score | −0.40 (1.39) | −0.40 (1.41) | 0.971 |
Dietary intake (only significant results are shown) | |||
Calcium (mg) | 604.79 (20.54) | 644.90 (23.26) | 0.018 * |
Copper (mg) | 0.88 (0.06) | 1.08 (0.11) | 0.042 * |
Selenium (mg) | 55.08 (2.18) | 52.86 (2.21) | 0.024 * |
α-tocopherol (mg) | 17.03 (7.61) | 15.26 (7.06) | 0.028 * |
Mean % (SD) | |||
Knowledge regarding osteoporosis | |||
General knowledge regarding osteoporosis | 70.58 (18.45) | 78.25 (17.13) | <0.001 * |
Prevention knowledge regarding osteoporosis | 63.36 (16.80) | 74.64 (15.58) | <0.001 * |
Total knowledge regarding osteoporosis | 66.97 (13.26) | 76.45 (12.32) | <0.001 * |
Beliefs regarding osteoporosis | |||
I: Perceived susceptibility to osteoporosis | 59.76 (13.90) | 56.55 (13.61) | <0.001 * |
II: Perceived seriousness of osteoporosis | 72.68 (18.58) | 75.55 (19.31) | 0.010 * |
III: Perceived benefits of exercise | 80.37 (12.01) | 82.20 (11.39) | 0.002 * |
IV: Perceived benefits of calcium intake | 77.87 (12.50) | 80.49 (10.36) | 0.107 |
V: Barriers to exercise | 51.34 (15.45) | 49.15 (15.00) | 0.060 |
VI: Barriers to calcium intake | 44.79 (9.58) | 44.51 (9.44) | 0.613 |
VII: Health motivation | 74.88 (10.39) | 74.37 (10.56) | 0.266 |
Total beliefs regarding osteoporosis | 63.94 (5.65) | 63.48 (5.30) | 0.118 |
Dairy intake | |||
Do not drink | 201 (61.3) | 202 (61.6) | 1.000 |
Regular drinker | 127 (38.7) | 126 (38.4) | |
Calcium supplement intake | |||
Yes | 46 (14.0) | 72 (22.0) | <0.001 * |
No | 282 (86.0) | 256 (78.0) | |
Coffee or tea intake | |||
Do not drink | 72 (22.0) | 102 (31.1) | <0.001 * |
Regular drinker | 256 (78.0) | 226 (68.9) | |
Alcohol drinking | |||
Non drinker | 239 (72.9) | 239 (72.9) | 1.000 |
Ever-drinker | 89 (27.1) | 89 (27.1) | |
Smoking status | |||
Non-smoker | 264 (80.5) | 264 (80.5) | 1.000 |
Ever-smoker | 64 (19.5) | 64 (19.5) | |
Physical activity status | |||
Inactive | 142 (43.3) | 142 (43.3) | 1.000 |
Minimally active | 132 (40.2) | 132 (40.2) | |
HEPA active | 54 (16.5) | 54 (16.5) |
Variables | Category, n | Mean (SD), g/cm2 | p-Value |
---|---|---|---|
Overall | |||
Spine BMD | First phase (n = 328) | 0.94 (0.16) | 0.206 |
Follow up phase (n = 328) | 0.94 (0.17) | ||
% changes | −0.17 (2.98) | ||
Hip BMD | First phase (n = 328) | 0.87 (0.14) | <0.001 * |
Follow up phase (n = 328) | 0.85 (0.14) | ||
% changes | −1.76 (4.38) | ||
Men | |||
Spine BMD | First phase (n = 153) | 1.00 (0.16) | 0.128 |
Follow up phase (n = 153) | 1.00 (0.16) | ||
% changes | 0.41 (2.96) | ||
Hip BMD | First phase (n = 153) | 0.93 (0.13) | <0.001 * |
Follow up phase (n = 153) | 0.91 (0.14) | ||
% changes | −1.82 (4.17) | ||
Women (Pre-menopause) | |||
Spine BMD | First phase (n = 183) | 1.00 (0.15) | <0.001 * |
Follow up phase (n = 183) | 1.00 (0.15) | ||
% changes | 0.36 (2.95) | ||
Hip BMD | First phase (n = 183) | 0.92 (0.13) | < 0.001 * |
Follow up phase (n = 183) | 0.90 (0.14) | ||
% changes | −1.78 (4.01) | ||
Women (Peri-menopause) | |||
Spine BMD | First phase (n = 183) | 1.02 (0.13) | <0.001 * |
Follow up phase (n = 183) | 1.00 (0.13) | ||
% changes | −1.39 (2.07) | ||
Hip BMD | First phase (n = 20) | 0.85 (0.09) | <0.001 * |
Follow up phase (n = 20) | 0.85 (1.00) | ||
% changes | −0.22 (7.23) | ||
Women (Postmenopause) | |||
Spine BMD | First phase (n = 125) | 0.85 (0.15) | <0.001 * |
Follow up phase (n = 125) | 0.84 (0.15) | ||
% changes | −0.75 (3.00) | ||
Hip BMD | First phase (n = 125) | 0.80 (0.12) | <0.001 * |
Follow up phase (n = 125) | 0.79 (0.12) | ||
% changes | −1.99 (4.30) |
Reasons | Example of Response |
---|---|
Changes of lifestyle at home | “My nephew taught me to exercise at home” |
“I started to consume calcium supplements and dairy products after consulting with doctor” | |
Busy with work/class | “I need to attend 10 slamic class 5 days a week” |
“I am busy with work and have no time to meet the doctor” | |
“Waiting time at hospital was too long, I have no time to wait so long” | |
Fear of taking medication | “I am afraid of taking medication and later kidney failure” |
Medical cost was high | “I can’t afford high medical costs because I am already retired, with no income” |
Hospital was far from home | “I went to clinic but was referred to hospital; the hospital was far, so I didn’t go” |
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Chan, C.Y.; Subramaniam, S.; Chin, K.-Y.; Ima-Nirwana, S.; Muhammad, N.; Fairus, A.; Ng, P.Y.; Aini, J.N.; Aziz, N.A.; Mohamed, N. Effect of a Screening and Education Programme on Knowledge, Beliefs, and Practices Regarding Osteoporosis among Malaysians. Int. J. Environ. Res. Public Health 2022, 19, 6072. https://doi.org/10.3390/ijerph19106072
Chan CY, Subramaniam S, Chin K-Y, Ima-Nirwana S, Muhammad N, Fairus A, Ng PY, Aini JN, Aziz NA, Mohamed N. Effect of a Screening and Education Programme on Knowledge, Beliefs, and Practices Regarding Osteoporosis among Malaysians. International Journal of Environmental Research and Public Health. 2022; 19(10):6072. https://doi.org/10.3390/ijerph19106072
Chicago/Turabian StyleChan, Chin Yi, Shaanthana Subramaniam, Kok-Yong Chin, Soelaiman Ima-Nirwana, Norliza Muhammad, Ahmad Fairus, Pei Yuen Ng, Jamil Nor Aini, Noorazah Abd Aziz, and Norazlina Mohamed. 2022. "Effect of a Screening and Education Programme on Knowledge, Beliefs, and Practices Regarding Osteoporosis among Malaysians" International Journal of Environmental Research and Public Health 19, no. 10: 6072. https://doi.org/10.3390/ijerph19106072