Development and Validation of the Osteoporosis Knowledge, Attitude, and Behaviors Questionnaire for Female Osteoporosis Patients in Taiwan: A Mediation Model
Abstract
:1. Introduction
2. Materials and Methods
2.1. Hypothesis
2.2. Study Design and Participants
2.2.1. Phase I—Initial Item Pool and Pilot Study
2.2.2. Phase IIa—Item Analysis, Assess Validity and Reliability of OKABQ
2.2.3. Phase IIb—Mediation Analysis
2.3. Data Analysis
2.4. Ethical Aspects
3. Results
3.1. Phase I
3.1.1. Preparatory and Integration Period
3.1.2. Construct Period
3.2. Phase IIa
3.2.1. Descriptive Analyses
3.2.2. Construct Validity
3.2.3. Reliability
3.3. Phase IIb
Estimated Model and Mediation Analysis
4. Discussion
5. Conclusions
6. Limitation
Author Contributions
Funding
Institutional Review Board Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristics | Phase I (n = 23) | Phase II (n = 262) |
---|---|---|
Age | 74.2 ± 10.5 | 71.7 ± 9.4 |
Education | ||
Illiteracy | 2 (8.7%) | 31 (11.8%) |
Elementary school | 13 (56.6%) | 76 (29.0%) |
Junior high school | 3 (13.0%) | 43 (16.4%) |
Senior high school | 3 (13.0%) | 67 (25.6%) |
University | 2 (8.7%) | 35 (13.4%) |
Graduate school | 0 (0.0%) | 10 (3.8%) |
Dietary | ||
Mainly meat-based | 13 (56.5%) | 24.1 (91.9%) |
Vegan | 6 (26.1%) | 13 (5.0%) |
Vegetarian | 4 (17.4%) | 8 (3.1%) |
Marriage | ||
Partner | 4 (17.4%) | 11 (4.2%) |
Married | 7 (30.4%) | 150 (57.3%) |
Widowed | 11 (47.9%) | 93 (35.5%) |
Divorced | 1 (4.3%) | 8 (3.0%) |
Menstrual condition | ||
Climacteric period | 0 (0.0%) | 4 (1.5%) |
Postmenopausal period | 20 (87.0%) | 241 (92.0%) |
Hysterectomy or ovariectomy | 3 (13.0%) | 17 (6.5%) |
Smoking | ||
Never | 21 (91.4%) | 259 (98.9%) |
Ever smoked | 1 (4.3%) | 2 (0.8%) |
Current smoking | 1 (4.3%) | 1 (0.4%) |
Family history of osteoporosis | 1 (4.3%) | 68 (26.0%) |
Items | Group | n | Mean | SD | t-Value | Correlation to Total Scale |
---|---|---|---|---|---|---|
Total scores | Low Group | 70 | 38.81 | 4.810 | −23.853 ** | 1 |
High Group | 71 | 53.03 | 1.320 | |||
Knowledge scores | Low Group | 70 | 9.03 | 3.097 | −13.274 ** | 0.762 * |
High Group | 71 | 14.39 | 1.368 | |||
OA-01 | Low Group | 70 | 3.31 | 0.925 | −5.522 ** | 0.460 * |
High Group | 71 | 3.94 | 0.232 | |||
OA-02 | Low Group | 70 | 3.40 | 0.788 | −5.622 ** | 0.517 * |
High Group | 71 | 3.96 | 0.264 | |||
OA-06 | Low Group | 70 | 2.96 | 0.999 | −8.733 ** | 0.601 * |
High Group | 71 | 4.00 | 0.000 | |||
OA-07 | Low Group | 70 | 2.73 | 1.089 | −9.603 ** | 0.564 * |
High Group | 71 | 3.99 | 0.119 | |||
OA-10 | Low Group | 70 | 3.34 | 0.866 | −5.967 ** | 0.499 * |
High Group | 71 | 3.97 | 0.167 | |||
OB-01 | Low Group | 70 | 2.34 | 1.034 | −7.488 ** | 0.482 * |
High Group | 71 | 3.46 | 0.714 | |||
OB-04 | Low Group | 70 | 3.70 | 0.922 | −1.689 ** | 0.130 * |
High Group | 71 | 3.90 | 0.384 | |||
OB-05 | Low Group | 70 | 2.47 | 1.259 | −6.495 ** | 0.378 * |
High Group | 71 | 3.62 | 0.781 | |||
OB-06 | Low Group | 70 | 1.89 | 1.518 | −9.974 ** | 0.593 * |
High Group | 71 | 3.82 | 0.568 | |||
OB-08 | Low Group | 70 | 3.64 | 0.762 | −3.530 ** | 0.307 * |
High Group | 71 | 3.97 | 0.167 |
1. Knowledge | |||||
Items | Yes | No | Not sure | ||
1. Osteoporosis causes bone loss and fractures easily. | |||||
2. Only women develop osteoporosis. * | |||||
3. Bone density does not change with age. * | |||||
4. To sit up comfortably, choosing a lower chair or cushion is fine. * | |||||
5. Obvious symptoms of osteoporosis will appear in the early stage. * | |||||
6. Drinking more than three cups of black coffee, strong tea and carbonated beverages a day will increase bone loss. | |||||
7. Vitamin D promotes calcium absorption. | |||||
8. Healthy bone isn’t affected by sun exposure. | |||||
9. Bone loss is accelerated in menopausal women due to a decrease in female hormones. | |||||
10. Dietary habits are not associated with osteoporosis. * | |||||
11. Adequate intake of calcium-containing foods can prevent osteoporosis. | |||||
12. Speed walking or jogging can help bone formation. | |||||
13. Once having bone loss, diet, exercise, calcium lactate or medication cannot prevent osteoporosis from getting worse. * | |||||
14. Excessive smoking or drinking can increase bone loss. | |||||
15. Excessively carried weight and a long-term slouched position will increase the burden on the lumbar spine. | |||||
16. Osteoporosis is not associated with familial inheritance. * | |||||
2. Attitude | |||||
Items | Strongly agree | Agree | Slight agree | Disagree | Strongly disagree |
1. I think it is important to have bone mass measurement regularly. | |||||
2. I think that we should pay more attention to bone density with age. | |||||
3. I think that increasing the time and frequency of sun exposure is helpful for bone health. | |||||
4. I think smoking or drinking can damage bone health. | |||||
5. I think following the health education of doctors or educator is very helpful for bone health. | |||||
3. Behaviors | |||||
Items | Achievement | ||||
100% | 75% | 50% | 25% | 0% | |
1. I follow a high-calcium diet (such as milk, meats and protein, dried clove fish, green vegetables) every day. | |||||
2. I don’t drink more than three cups of black coffee, strong tea or carbonated drinks every day. | |||||
3. I enjoy the sunshine at least 10 min every day. | |||||
4. I have at least 30 min of physical activity three days a week. | |||||
5. I pay attention to safety in daily life to avoid falling. |
Cronbach’s α | Composite Reliability | Average Variance Extracted (AVE) | |
---|---|---|---|
A01 | 0.815 | 0.915 | 0.844 |
A02 | 0.688 | 0.828 | 0.616 |
Attitude | 0.767 | 0.844 | 0.520 |
Knowledge * | 1.000 | 1.000 | 1.000 |
Constructs | Items | Loadings | Weights | Mean | Standard Deviation (stdev) | t-Value | p Values |
---|---|---|---|---|---|---|---|
A01 | OA-01 | 0.909 | 0.907 | 0.029 | 31.537 *** | 0.000 | |
OA-02 | 0.928 | 0.929 | 0.013 | 69.672 *** | 0.000 | ||
A02 | OA-06 | 0.799 | 0.799 | 0.032 | 24.858 *** | 0.000 | |
OA-07 | 0.789 | 0.788 | 0.039 | 20.021 *** | 0.000 | ||
OA-10 | 0.766 | 0.766 | 0.054 | 14.077 *** | 0.000 | ||
Attitude | OA-01 | 0.717 | 0.718 | 0.056 | 12.765 *** | 0.000 | |
OA-02 | 0.801 | 0.801 | 0.037 | 21.695 *** | 0.000 | ||
OA-06 | 0.715 | 0.713 | 0.046 | 15.474 *** | 0.000 | ||
OA-07 | 0.655 | 0.656 | 0.057 | 11.532 *** | 0.000 | ||
OA-10 | 0.709 | 0.710 | 0.065 | 10.899 *** | 0.000 | ||
Behaviors | OB-01 | 0.509 | 0.483 | 0.148 | 3.44 ** | 0.001 | |
OB-04 | 0.279 | 0.258 | 0.134 | 2.078 * | 0.038 | ||
OB-05 | 0.257 | 0.249 | 0.191 | 1.343 | 0.179 | ||
OB-06 | 0.664 | 0.634 | 0.172 | 3.852 *** | 0.000 | ||
OB-08 | 0.440 | 0.408 | 0.170 | 2.585 * | 0.010 |
DV | IV | Beta | Mean | Standard Deviation (STDEV) | t-Value | p Values | f2 | Q2 | R2 |
---|---|---|---|---|---|---|---|---|---|
Behaviors | Attitude | 0.283 | 0.289 | 0.091 | 3.108 | 0.002 | 0.082 | 0.034 | 0.179 |
Knowledge | 0.220 | 0.228 | 0.086 | 2.561 | 0.010 | 0.195 | - | - | |
Attitude | Knowledge | 0.404 | 0.404 | 0.062 | 6.522 | 0.000 | 0.049 | 0.078 | 0.163 |
Beta | Mean | (STDEV) | t-Value | p Values | 2.5% | 97.5% | |
---|---|---|---|---|---|---|---|
Total effect | |||||||
Knowledge → Behaviors | 0.334 | 0.346 | 0.069 | 4.812 | 0.000 | 0.202 | 0.461 |
Indirect effect | |||||||
Knowledge →Attitude → Behaviors | 0.114 | 0.118 | 0.044 | 2.627 | 0.009 | 0.033 | 0.205 |
Direct effect | |||||||
Knowledge → Behaviors | 0.220 | 0.228 | 0.086 | 2.561 | 0.010 | 0.054 | 0.383 |
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Huang, I.-C.; Wu, H.-C.; Lin, C.-L.; Wang, H.-H. Development and Validation of the Osteoporosis Knowledge, Attitude, and Behaviors Questionnaire for Female Osteoporosis Patients in Taiwan: A Mediation Model. Healthcare 2023, 11, 1023. https://doi.org/10.3390/healthcare11071023
Huang I-C, Wu H-C, Lin C-L, Wang H-H. Development and Validation of the Osteoporosis Knowledge, Attitude, and Behaviors Questionnaire for Female Osteoporosis Patients in Taiwan: A Mediation Model. Healthcare. 2023; 11(7):1023. https://doi.org/10.3390/healthcare11071023
Chicago/Turabian StyleHuang, I-Chin, Hui-Chuan Wu, Chih-Lung Lin, and Hsiu-Hung Wang. 2023. "Development and Validation of the Osteoporosis Knowledge, Attitude, and Behaviors Questionnaire for Female Osteoporosis Patients in Taiwan: A Mediation Model" Healthcare 11, no. 7: 1023. https://doi.org/10.3390/healthcare11071023