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Race Plays a Role in the Knowledge, Attitudes, and Beliefs of Women with Osteoporosis

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Abstract

Using a concurrent mixed methods design, we investigated how knowledge, attitudes, values, and beliefs among women with osteoporosis can explain racial disparities in bone health. We recruited African American and White women ≥ 65 years of age with osteoporosis to participate in focus groups. We quantitatively compared scores of the “Osteoporosis & You” knowledge scale and each domain (internal, powerful others, and chance) of the Multidimensional Health Locus of Control scale by race using t tests. We qualitatively explored potential racial differences in attitudes, values, and beliefs in the domains: (1) osteoporosis and bone health concerns, (2) knowledge about osteoporosis, (3) utilization of medical services for osteoporosis, (4) facilitators of osteoporosis prevention activities, and (5) barriers to osteoporosis prevention activities. A total of 48 women (White: 36; African American: 12) enrolled in the study. White women had a mean (SD) of 7.8 (0.92), whereas African American women score a 6.6 (2.6) (p = 0.044) out of 10 on the Osteoporosis & You Scale. The powerful others domain was significantly higher among African American for both general and bone health [General Health — African American: 26.7 (5.9) vs. White: 22.3 (3.8); p = 0.01]. Qualitative thematic analysis revealed differences by race in knowledge, types of physical activity, coping with comorbidities, physician trust, religion, and patient activation. Using both quantitative and qualitative methods, our study identified racial differences in knowledge, attitudes, and beliefs in women with osteoporosis that could result in racial disparities in bone health, indicating the need to improve education and awareness about osteoporosis in African American women.

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Acknowledgements

We would like to thank the participants of this study. This study was supported by K12 HS023009 and a pilot project from the Deep South Resource Center for Minority Aging Research.

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Authors and Affiliations

  1. Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA

    Nicole C. Wright, Maira Sohail & Emily B. Levitan

  2. Division of Clinical Immunology and Rheumatology, School of Medicine, University of Alabama at Birmingham, 1665 University Blvd, RPHB 230N, Birmingham, AL, 35294, USA

    Nicole C. Wright, Mary E. Melton & Kenneth G. Saag

  3. School of Medicine, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA

    Ivan Herbey

  4. Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA

    Susan Davies

  5. Department of Health Services Administration, School of Health Profession, University of Alabama at Birmingham, Birmingham, AL, USA

    Natalia V. Ivankova

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  1. Nicole C. Wright
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  4. Ivan Herbey
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Correspondence to Nicole C. Wright.

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Conflict of Interests

NCW: Research: Amgen; Expert Witness: Pfizer; Honorarium: Columbia University Medical Center

MEM: Research: Amgen

MS: None

IH: None

SD: None

EBL: Research: Amgen; Advisory Boards: Amgen; Consultant: Novartis

KGS: research grant, consulting (Amgen, Mereo, Radius, Roche)

NVI: None

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Appendices

Appendix 1: Osteoporosis & You Questionnaire

Table 3 Now we will ask some questions about your knowledge about osteoporosis and bone health. Beside each statement is a scale which ranges from strongly disagree (1) to strongly agree (5). For each item we would like you to circle the number that represents the extent to which you agree or disagree with that statement
Full size table

Appendix 2: Multidimensional Health Locus of Control Questionnaire

A – General Health

Table 4 Each item below is a belief statement about your overall health with which you may agree or disagree. Beside each statement is a scale which ranges from strongly disagree (1) to strongly agree (6). For each item we would like you to circle the number that represents the extent to which you agree or disagree with that statement. The more you agree with a statement, the higher will be the number you circle. The more you disagree with a statement, the lower will be the number you circle. Please make sure that you answer EVERY ITEM and that you circle ONLY ONE number per item. This is a measure of your personal beliefs; there are no right or wrong answers
Full size table

B – Bone Health

Table 5 The next set of belief statements are about your bone health with which you may agree or disagree. Beside each statement is a scale which ranges from strongly disagree (1) to strongly agree (6). For each item we would like you to circle the number that represents the extent to which you agree or disagree with that statement. The more you agree with a statement, the higher will be the number you circle. The more you disagree with a statement, the lower will be the number you circle. Please make sure that you answer EVERY ITEM and that you circle ONLY ONE number per item. This is a measure of your personal beliefs; again, there are no right or wrong answers
Full size table

Appendix 3: Discussion Guide

Q1 Were you concerned about your bone health before your bone density test?

Q2. Did you get the results of your bone density test?

Q2.1. Was there an explanation about the results?

Q2.2. What did the results mean to you?

Q3. Does your primary care doctor regularly talk to you about your bone health?

Now we are going to talk about things that make it easier or harder for you to do things that help protect your bones. The two examples I will give are taking medications prescribed by your doctor and performing weight-bearing activities like walking fast outside or on a treadmill or climbing stairs.

Q4. What are some things that make it easier for you to do things that help protect your bones like take medications that are prescribed by your doctor?

Q5. What are some things that make it harder for you to that are prescribed by your doctor to protect your bone health?

Q6. What are some things that make it easier for you to do weight-bearing activities to protect your bones?

Q7. What are some things that make it harder for you to do weight-bearing activities to protect your bones?

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Wright, N.C., Melton, M.E., Sohail, M. et al. Race Plays a Role in the Knowledge, Attitudes, and Beliefs of Women with Osteoporosis. J. Racial and Ethnic Health Disparities 6, 707–718 (2019). https://doi.org/10.1007/s40615-019-00569-w

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  • DOI: https://doi.org/10.1007/s40615-019-00569-w

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