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Published in: BMC Musculoskeletal Disorders 1/2014

Open Access 01-12-2014 | Research article

Development and validation of a health belief model based instrument for measuring factors influencing exercise behaviors to prevent osteoporosis in pre-menopausal women (HOPE)

Authors: Atoosa Soleymanian, Shamsaddin Niknami, Ebrahim Hajizadeh, Davoud Shojaeizadeh, Ali Montazeri

Published in: BMC Musculoskeletal Disorders | Issue 1/2014

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Abstract

Background

The health belief model (HBM) is the most commonly used conceptual framework for evaluating osteoporosis health belief and behaviors. The purpose of this study was to develop and evaluate the psychometric properties of a health belief model based questionnaire for exercise behavior for preventing osteoporosis among women aged 30 years and over.

Methods

This was a cross sectional study of a convenience sample of women aged 30 years and over in Tehran, Iran using a theory-based instrument (HOPE). The instrument contained 39 items covering issues relate to osteoporosis prevention behavior. In this methodological study, exploratory and confirmatory factor analyses were used for psychometric evaluation. The Cronbach’s alpha coefficient and Intraclass Correlation Coefficient (ICC) was used to evaluate the reliability of the scale.

Results

In all 240 women participated in the study. The mean age of participant was 39.2±7.8 years. The initial analysis extracted nine factors for the questionnaire that jointly accounted for 66.5% of variance observed. Confirmatory factor analysis showed that the data obtained was fit with Health Belief Model (HBM) and self-regulation construct (X2=1132.80, df=629, P<0.0001, CFI=0.94, GFI=0.91, RMSEA=0.05 and SRMR=0.06). The Cronbach’s alpha coefficient for the subscales ranged from 0.72 to 0.90 and Intraclass Correlation Coefficient (ICC) ranged from 0.71 to 0.98; well above acceptable thresholds.

Conclusions

The HOPE was found to be appropriate instrument for measuring health belief and self-regulation for prevention of osteoporosis.
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Literature
1.
go back to reference World Health Organization: Assessment of Fracture Risk and its Application to Screening for Postmenopausal Osteoporosis. 1994, Geneva: WHO World Health Organization: Assessment of Fracture Risk and its Application to Screening for Postmenopausal Osteoporosis. 1994, Geneva: WHO
2.
go back to reference Ridout CF: Old bones in young bodies. Am Fit. 1999, 17: 28-31. Ridout CF: Old bones in young bodies. Am Fit. 1999, 17: 28-31.
3.
go back to reference Shong LK: Osteoporosis primary prevention in the community. Med J Malays. 2007, 62: 355- Shong LK: Osteoporosis primary prevention in the community. Med J Malays. 2007, 62: 355-
4.
go back to reference Lau E, Woo J, Lam V, Hong A: Milk supplementation of the diet of postmenopausal Chinese women on a low calcium intake retards bone loss. J Bone Miner Res. 2001, 16: 1704-1709. 10.1359/jbmr.2001.16.9.1704.CrossRefPubMed Lau E, Woo J, Lam V, Hong A: Milk supplementation of the diet of postmenopausal Chinese women on a low calcium intake retards bone loss. J Bone Miner Res. 2001, 16: 1704-1709. 10.1359/jbmr.2001.16.9.1704.CrossRefPubMed
5.
go back to reference Aghaei Meybodi H, Khashayar P, Heshmat R, Rezaei Homami M, Larijani B: The prevalence of osteoporosis in an Iranian population. J Clin Densitom. 2010, 13: 112- Aghaei Meybodi H, Khashayar P, Heshmat R, Rezaei Homami M, Larijani B: The prevalence of osteoporosis in an Iranian population. J Clin Densitom. 2010, 13: 112-
6.
go back to reference Salehi I, Khazaeli S, Najafizadeh SR, Ashraf H, Malekpour M: High prevalence of low bone density in young Iranian healthy individuals. Clin Rheumatol. 2009, 28: 173-177. 10.1007/s10067-008-1008-8.CrossRefPubMed Salehi I, Khazaeli S, Najafizadeh SR, Ashraf H, Malekpour M: High prevalence of low bone density in young Iranian healthy individuals. Clin Rheumatol. 2009, 28: 173-177. 10.1007/s10067-008-1008-8.CrossRefPubMed
7.
go back to reference Prince RL, Smith M, Dick IM, Price RI, Webb PG, Henderson NK, Harris MM: Prevention of postmenopausal osteoporosis: a comparative study of exercise, calcium supplementation, and hormone replacement therapy. N Engl J Med. 1991, 325: 1189-1195. 10.1056/NEJM199110243251701.CrossRefPubMed Prince RL, Smith M, Dick IM, Price RI, Webb PG, Henderson NK, Harris MM: Prevention of postmenopausal osteoporosis: a comparative study of exercise, calcium supplementation, and hormone replacement therapy. N Engl J Med. 1991, 325: 1189-1195. 10.1056/NEJM199110243251701.CrossRefPubMed
8.
go back to reference Heaney RP: Bone mass, nutrition, and other lifestyle factors. Am J Med. 1993, 95: 29s-33s. 10.1016/0002-9343(93)90378-3.CrossRefPubMed Heaney RP: Bone mass, nutrition, and other lifestyle factors. Am J Med. 1993, 95: 29s-33s. 10.1016/0002-9343(93)90378-3.CrossRefPubMed
9.
go back to reference Lau EMC, Donnan SPB, Barker DJ, Cooper C: Physical activity and calcium intake in fractured proximal femur in Hong Kong. Br Med J. 1988, 297: 1441-1443. 10.1136/bmj.297.6661.1441.CrossRef Lau EMC, Donnan SPB, Barker DJ, Cooper C: Physical activity and calcium intake in fractured proximal femur in Hong Kong. Br Med J. 1988, 297: 1441-1443. 10.1136/bmj.297.6661.1441.CrossRef
10.
go back to reference Esteghamati A, Khalilzadeh O, Rashidi A, Kamgar M, Meysamie A, Abbasi M: Physical activity in Iran: results of the third national surveillance of risk factors of non-communicable diseases (SuRFNCD-2007). J Phys Act Health. 2011, 8: 27-35.PubMed Esteghamati A, Khalilzadeh O, Rashidi A, Kamgar M, Meysamie A, Abbasi M: Physical activity in Iran: results of the third national surveillance of risk factors of non-communicable diseases (SuRFNCD-2007). J Phys Act Health. 2011, 8: 27-35.PubMed
11.
go back to reference Becker JMH: The health belief model and sick role behavior. Health Educ Monogr. 1974, 2: 409-419.CrossRef Becker JMH: The health belief model and sick role behavior. Health Educ Monogr. 1974, 2: 409-419.CrossRef
12.
go back to reference Baumeister RF, Vohs KD: Handbook of self-regulation: research, theory and applications. 2004, New York: Guilford Press, NY Baumeister RF, Vohs KD: Handbook of self-regulation: research, theory and applications. 2004, New York: Guilford Press, NY
13.
go back to reference Kim K, Horan M, Gendler P: Osteoporosis Health Belief Scale. 1991, Allendale, MI: Grand Valley State University Kim K, Horan M, Gendler P: Osteoporosis Health Belief Scale. 1991, Allendale, MI: Grand Valley State University
14.
go back to reference Rovniak LS, Anderson ES, Winett RA, Stephens RS: Social cognitive determinants of physical activity in young adults: a prospective structural equation analysis. Ann Behav Med. 2002, 24: 149-156. 10.1207/S15324796ABM2402_12.CrossRefPubMed Rovniak LS, Anderson ES, Winett RA, Stephens RS: Social cognitive determinants of physical activity in young adults: a prospective structural equation analysis. Ann Behav Med. 2002, 24: 149-156. 10.1207/S15324796ABM2402_12.CrossRefPubMed
15.
go back to reference Brislin RW: Back-translation for cross-cultural. Psychology. 1970, 31: 185-216. Brislin RW: Back-translation for cross-cultural. Psychology. 1970, 31: 185-216.
16.
go back to reference Gable RK, Wolf MB: Instrument Development in the Affective Domain. 1993, Boston: Kluwer Academic Publishers, 2CrossRef Gable RK, Wolf MB: Instrument Development in the Affective Domain. 1993, Boston: Kluwer Academic Publishers, 2CrossRef
17.
go back to reference Fabrigar LR, Wegener DT, MacCallum RC, Strahan EJ: Evaluating the use of exploratory factor analysis in psychological research. Psychol Methods. 1999, 4: 272-299.CrossRef Fabrigar LR, Wegener DT, MacCallum RC, Strahan EJ: Evaluating the use of exploratory factor analysis in psychological research. Psychol Methods. 1999, 4: 272-299.CrossRef
18.
go back to reference Hu L, Bentler PM: Cut off criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Model. 1999, 6: 1-55. 10.1080/10705519909540118.CrossRef Hu L, Bentler PM: Cut off criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Model. 1999, 6: 1-55. 10.1080/10705519909540118.CrossRef
19.
go back to reference Nunnally JC, Bernstein IH: Psychometric theory. 1994, New York: McGraw-Hill Inc Nunnally JC, Bernstein IH: Psychometric theory. 1994, New York: McGraw-Hill Inc
20.
go back to reference Powers BA, Knapp TR: Dictionary of Nursing Theory and Research. 2005, New York: Springer Publishing Company Powers BA, Knapp TR: Dictionary of Nursing Theory and Research. 2005, New York: Springer Publishing Company
21.
go back to reference Bring PJ, Wood MJ: Advanced Design in Nursing Research. 1998, Thousand Oaks: Sage Publications, 2 Bring PJ, Wood MJ: Advanced Design in Nursing Research. 1998, Thousand Oaks: Sage Publications, 2
22.
go back to reference Waigandt A, Nguyen VH: The development and effectiveness of an osteoporosis prevention education intervention. 2011, University of Missouri-Columbia, Graduate School: Theses and Dissertations Waigandt A, Nguyen VH: The development and effectiveness of an osteoporosis prevention education intervention. 2011, University of Missouri-Columbia, Graduate School: Theses and Dissertations
23.
go back to reference Cadarette SM, Beaton DE, Hawker GA: Osteoporosis health belief scale: minor changes were required after telephone administration among women. Clin Epidemiol J. 2004, 57: 154-166. 10.1016/j.jclinepi.2003.08.005.CrossRef Cadarette SM, Beaton DE, Hawker GA: Osteoporosis health belief scale: minor changes were required after telephone administration among women. Clin Epidemiol J. 2004, 57: 154-166. 10.1016/j.jclinepi.2003.08.005.CrossRef
24.
go back to reference Maiman LA, Becker MH: Origins and correlates in psychological theory. Health Educ Monogr. 1974, 2: 336-353.CrossRef Maiman LA, Becker MH: Origins and correlates in psychological theory. Health Educ Monogr. 1974, 2: 336-353.CrossRef
25.
go back to reference Rosenstock IM: Historical origins of the health belief model. Health Educ Monogr. 1974, 2: 328-335.CrossRef Rosenstock IM: Historical origins of the health belief model. Health Educ Monogr. 1974, 2: 328-335.CrossRef
26.
go back to reference Bandura A: Self-efficacy: The exercise of control. 1997, New York: W.H. Freeman Bandura A: Self-efficacy: The exercise of control. 1997, New York: W.H. Freeman
27.
go back to reference Gristwood J: Applying the health belief model to physical activity engagement among older adults. Illuminare. 2011, 9: 51-79. Gristwood J: Applying the health belief model to physical activity engagement among older adults. Illuminare. 2011, 9: 51-79.
28.
go back to reference Gould D, Weinberg R: Foundations of Sport and Exercise Psychology. 1999, Human Kinetics: Windsor Gould D, Weinberg R: Foundations of Sport and Exercise Psychology. 1999, Human Kinetics: Windsor
29.
go back to reference Turner LW, Hunt SB, DiBrezzo R, Jones C: Design and implementation of an osteoporosis prevention program using the health belief model. Am J Health Stud. 2004, 19: 115-121. Turner LW, Hunt SB, DiBrezzo R, Jones C: Design and implementation of an osteoporosis prevention program using the health belief model. Am J Health Stud. 2004, 19: 115-121.
30.
go back to reference Tussing L, Chapman-Novakofski K: Osteoporosis prevention education: behavior theories and calcium intake. Am Dietetic Assoc. 2005, 105: 92-97. 10.1016/j.jada.2004.10.025.CrossRef Tussing L, Chapman-Novakofski K: Osteoporosis prevention education: behavior theories and calcium intake. Am Dietetic Assoc. 2005, 105: 92-97. 10.1016/j.jada.2004.10.025.CrossRef
31.
go back to reference Aarts H: Health and goal-directed behavior: the non-conscious regulation and motivation of goals and their pursuit. Health Psychol Rev. 2007, 1: 53-82. 10.1080/17437190701485852.CrossRef Aarts H: Health and goal-directed behavior: the non-conscious regulation and motivation of goals and their pursuit. Health Psychol Rev. 2007, 1: 53-82. 10.1080/17437190701485852.CrossRef
32.
go back to reference Mischel W, Cantor N, Feldman S: Principles of self-regulation: the nature of willpower and self-control. Social Psychology. Handbook of Principles. Edited by: Higgins ET, Kruglanski AW. 1996, New York: Guilford, 329-360. Mischel W, Cantor N, Feldman S: Principles of self-regulation: the nature of willpower and self-control. Social Psychology. Handbook of Principles. Edited by: Higgins ET, Kruglanski AW. 1996, New York: Guilford, 329-360.
33.
go back to reference Hofman W, Friese M, Wiers RW: Impulsive versus reflective influence on health behavior: a theatrical framework and empirical review. Health Psychol Rev. 2008, 2: 111-137. 10.1080/17437190802617668.CrossRef Hofman W, Friese M, Wiers RW: Impulsive versus reflective influence on health behavior: a theatrical framework and empirical review. Health Psychol Rev. 2008, 2: 111-137. 10.1080/17437190802617668.CrossRef
Metadata
Title
Development and validation of a health belief model based instrument for measuring factors influencing exercise behaviors to prevent osteoporosis in pre-menopausal women (HOPE)
Authors
Atoosa Soleymanian
Shamsaddin Niknami
Ebrahim Hajizadeh
Davoud Shojaeizadeh
Ali Montazeri
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2014
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/1471-2474-15-61

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