A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING
PROGRAMME IN INCREASING THE KNOWLEDGE REGARDING
PREVENTION OF OSTEOPOROSIS AMONGTHEPOSTMENOPAUSAL
WOMEN AGED 40-60 YEARS OFAGE IN SELECTED
AREAOFTUMKUR.
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
Mr. MANINDER SINGH
COMMUNITY HEALTHNURSING
Akshaya College of Nursing,
Tumkur, Karnataka.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
1. Name of the Candidate: Mr. MANINDER SINGH
And address M.Sc Nursing, 1st Year
Akshaya College of Nursing,
Tumkur, Karnataka.
2. Name of the Institution: Akshaya College of Nursing
3. Course of Study: M.Sc. Nursing 1st year,
And Subject COMMUNITY HEALTH NURSING
4. Date of Admission to:30-10-2009
Course
5. Title of the Topic:“A study to assess the effectiveness of structured teaching programme in increasing the knowledge regarding prevention of osteoporosis among the postmenopausal women aged 40-60 years of age in selected area of Tumkur.
6.Introduction
Osteoporosis, or porous bone, is a chronic, progressive metabolic bone disease characterized by low bone mass and structural deterioration of bone tissue, leading to increased bone fragility. Osteoporosis is 8 times more common in women than in men for several reasons: women tend to have lower calcium intake than men throughout their lives, women have less bone mass because of the small frame, bone resorption begins at an earlier age in women and is accelerated at menopause, pregnancy and breastfeeding deplete a women’s skeletal reserve unless calcium intake is adequate, longevity increases the likelihood of osteoporosis.1
Osteoporosis is often called the "silent disease" because bone loss occurs without symptoms. In many cases,the first "symptom" is a broken bone. Patients with osteoporosis may not know that they have the disease untiltheir bones become so weak that a sudden strain, bump, or fall causes a hip fracture or a vertebra to collapse.Collapsed vertebra may initially be felt or seen in the form of severe back pain, loss of height, or spinaldeformities such as kyphosis, or severely stooped posture.2
Osteoporosis can be classified into primary and secondary forms. Primary or type I postmenopausal osteoporosis is the most common and cannot be associated with an underlying medical condition. Secondary or type II osteoporosis results from an associated underlying condition, such as hyperparathyroidism or long term corticosteroid therapy.3
Any bone can be affected, but of special concern are fractures of the hip and spine. A hip fracture almost always requires hospitalization and major surgery. It can impair a person's ability to walk unassisted and may cause prolonged or permanent disability or even death. Spinal or vertebral fractures also have serious consequences, including loss of height, severe back pain, and deformity. Women with a hip fracture are at a four-fold greater risk of a second one.4
People cannot feel their bones getting weaker. They may not know that they have osteoporosis until they break a bone. A person with osteoporosis can fracture a bone from a minor fall, or in serious cases, from a simple action such as a sneeze or even spontaneously. Vertebral (spinal) fractures may initially be felt or seen in the form of severe back pain, loss of height, or spinal deformities such as kyphosis or stooped posture. In many cases, a vertebral fracture can even occur with no pain. Women can lose up to 20 percent of their bone mass in the five to seven years after menopause, making them more susceptible to osteoporosis.4
Specialized tests called bone mineral density (BMD) tests can measure bone density in various sites of the body. Experts recommend a type of BMD test using a central DXA (which stands for dual energy x-ray absorptiometry).5
Osteoporosis can be prevented by taking the daily recommended amounts of calcium and vitamin D. Engage in regular weight-bearing exercise. Avoid smoking and excessive alcohol. Talk to your healthcare provider about bone health. When appropriate, have a bone density test and take medication.5
6.1.Need for the study
This silently progressing metabolic bone disease is widely prevalent in India, and osteoporotic fractures are a common cause of morbidity and mortality in adult Indian men and women. Rapid bone loss occurs in postmenopausal women due to hormonal factors which lead to increased risk of fractures. Biochemical markers of bone metabolism are used to assess skeletal turnover4.
Women are at a risk for early bone loss related to menopause. In postmenopausal women, estrogen production and bone calcium storage decreases. Estrogen appears to protect against bone loss. Accelerated bone loss occurs with women who have early or surgically induced menopause or amenorrhea as a result of prolactin-producing pituitary tumors or anorexia nervosa or in those who undertake intense long-distance running associated with undernourishment. Bone loss also occurs when estrogen therapy is withdrawn. The presence of the so-called “dowager hump” or collapse and wedging of the vertebra in a mother may indicate a risk for her daughter6.
Osteoporosis affects an estimated 75 million people in Europe, USA and Japan .For the year 2000, there were an estimated 9 million new osteoporotic fractures, of which 1.6 million were at the hip, 1.7 million were at the forearm and 1.4 million were clinical vertebral fractures. Europe and the Americas accounted for 51% of all these fractures, while most of the remainder occurred in the Western Pacific region and Southeast Asia. 1 in 3 women over 50 will experience osteoporotic fractures.By 2050, the worldwide incidence of hip fracture in men is projected to increase by 310% and 240% in women. It is projected that more than about 50% of all osteoporotic hip fractures will occur in Asia by the year 2050.4
Osteoporosis is greatly underdiagnosed and undertreated in Asia, even in the most high risk patients who have already fractured. The problem is particularly acute in rural areas. In the most populous countries like China and India, the majority of the population lives in rural areas (60% in China), where hip fractures are often treated conservatively at home instead of by surgical treatment in hospitals.In a study among Indian women aged 30-60 years from low income groups, bone mineral density at all the skeletal sites were much lower than values reported from developed countries, with a high prevalence of osteopenia (52%) and osteoporosis (29%) thought to be due to inadequate nutrition.4
Nearly all Asian countries fall far below the FAO/WHO recommendations for calcium intake of between 1000 and 1300 mg/day. The median dietary calcium intake for the adult Asian population is approximately 450 mg/day, with a potential detrimental impact on bone health in the region.7
6.2.REVIEW OF LITERATURE
Review of literature is the reading and organizing of previously written materials relevant to the specific problems to be investigated; framework and methods appropriate to perform the study8
A study was conducted on Knowledge and awareness about osteoporosis and its related factors among rural Turkish women. The aim of this study is to evaluate the awareness, perception, sources of information, and knowledge of osteoporosis in a sample of rural Turkish women, to examine the factors related to their knowledge, and organize effective education programs. A total of 768 women mean age 53.6 ± 8.2 (40–70) were randomly selected and interviewed during their visits to primary care centers in three rural towns in West Anatolia. A structured questionnaire was administered by trained nurses. Chi-square test was performed in age and educational level groups for revealing factors influencing the awareness, perception, and knowledge sources of osteoporosis. One-way analysis of variance (ANOVA) analysis was carried out in calculating the difference of knowledge scores among groups. Of the women, 60.8% had heard of and 44.9% had the correct definition for osteoporosis. Awareness and accurate definition of osteoporosis was high in younger and high educated women (p < 0.001). Television was the main source of knowledge with the rate of 55%, doctors and nurses/midwives were the second and third sources, respectively. Osteoporosis knowledge was low with a mean score of 5.52 out of 20. Younger and more educated women had higher knowledge scores. Low calcium in diet and menopause were the first two risk factors chosen for osteoporosis. Knowledge about osteoporosis among rural Turkish women is low, and majority of women are unaware of the risk factors and consequences of osteoporosis. Therefore, appropriate educational programs should be planned according to community needs, and the target of these programs should be less educated and older women.9
A preliminary study was done in a hospital to study osteoporosis in postmenopausal women. A cross-sectional study of 150 pre- and post menopausal women was carried out at S.D.M College of Medical Sciences and Hospital, Dharwad, during the period of May 2005 to September 2005. The study group consisted of 75 Premenopausal women in the age group of 25–45 years and 75 Postmenopausal women in the age group of 46–65 years. Bone formation markers (Total Calcium, Ionised calcium, Phosphorus, Alkaline phosphatase), and bone resorption markers (Urinary Hydroxyproline) were analysed in pre and post menopausal women. Bone formation markers, Total and ionised calcium were significantly decreased (p<0.001) and Alkaline phosphatase was significantly increased (p<0.001) in postmenopausal women compared to premenopausal women. Bone resorption markers, Urinary hydroxyproline excretion was significantly increased (p<0.001) in postmenopausal women. The results from this study suggest that simple, easy, common biochemical markers can still be used to assess the bone turnover in postmenopausal women and hence their risk of developing osteoporosis and fractures.10
A study was conducted on prospective evaluation of the awareness, knowledge, risk factors and current treatment of osteoporosis in a cohort of elderly subjects.This was a prospective cohort study of 145 seniors attending a senior’s clinic and social day program using a self-administered questionnaire. Its objective was to evaluate the awareness, knowledge, risk factors and current treatment of osteoporosis in our two patient groups.Participants included 39 men and 106 women, with an average age of 76 years. Of these, 89% were aware of osteoporosis and 61% gave the correct definition. Awareness and accurate definition were less in men compared with women (p<0.01, and p<0.05) and clinic compared to day program groups (p<0.01). Only 54% of men knew osteoporosis could affect them. Television, newspapers and friends were identified as the main source of information. Physicians ranked as fifth as a source of information. In all, 84% knew diet was important. Prevalence of risk factors other than age were < 20%, except for senescence (38%) and alcohol use (40%). Utilization of specific therapies for osteoporosis was only 18% overall with a rate of 3% in men (p<0.01). In women, 50% and were taking calcium supplements compared with 15% men (p<0.001) and for multivitamins the figures were 57% and 33% respectively (p<0.05). These results show a high level of awareness and correct definition of osteoporosis in this cohort of patients. Specific therapy for prevention or treatment of osteoporosis was inappropriately low in the face of high risk. This study highlights the care gap in osteoporosis in seniors and the need for increased physician involvement in patient education and treatment.11
A study was done to assess the health promotion and osteoporosis prevention among postmenopausal women.One hundred women completed measures of benefits and barriers to calcium intake, exercise participation, ERT/HRT usage; self-efficacy; control of health; importance of health; and health status. Participants also reported their actual calcium intake, exercise participation, and use of estrogen/hormonal replacement therapy (ERT/HRT). Participants consumed an average of 1,243 mg of calcium from milk, yogurt, calcium-rich foods, and supplements; 81% participated in weight-bearing and resistant training exercise but on an irregular basis; and 31% were users of ERT/HRT at the time of data collection. There were significant relationships between some of the HPM (health promotion model) variables and calcium intake and exercise participation. There was a significant difference between past and current users of ERT regarding benefits and barriers to taking hormones. Hormone users reported higher calcium intake and greater exercise participation than nonusers. There is early evidence that variables of the HPM are associated with OPBs. After continued testing, intervention programs for osteoporosis prevention may use variables of the HPM as a theoretical base for behavior changes.12
A study was conducted on womens knowledge on osteoporosis. In this study of 247 women, their knowledge of osteoporosis was assessed with the Facts on Osteoporosis Quiz. The instrument measured their responses to questions about self-care practices related to risk factors and preventive behavior associated with osteoporosis. Respondents came from occupational and primary health care settings and a health fair. The women ranged in age from 22 to 84 years. Findings indicated that the majority of women had inadequate knowledge of osteoporosis risk factors and preventive behavior.13
A study was undertaken to explore how menopausal women are affected by awareness of potential risk of osteoporosis.A qualitative interview study, including analysis of in-depth interviews with 17 women who independently gave views on risk, out of 24 women interviewed about their menopausal symptoms. The women were selected on the basis of a survey including 1261 women chosen at random, to cover a broad spectrum of Danish women, their menopausal experiences, and contact with the healthcare system. Awareness of osteoporosis risk caused a feeling of uncertainty and worry in some women. Only women reacting in this way seemed to act in order to prevent future fractures. The affected women were puzzled to realize that risk-reducing medication could introduce new hazards. Most of the women had heard about osteoporosis related to menopause as culturally embedded knowledge. Making individual women uncertain and worried must be considered a potentially serious side effect of health promotion. The findings raise the question of whether introducing healthy people to the threat of future diseases are ethically justifiable. As hormonal treatment is no longer recommended for long-term use, it is suggested that the strong link between osteoporosis and menopause should be toned down when counselling menopausal women.14
A study was conducted todetermining the risk factors and prevalence of osteoporosis using quantitative ultrasonography in Pakistani adult women. A cross-sectional study was conducted in obstetrics or gynaecology setting during March–April 2007 in Quetta, Pakistan. A total of 334 women older than 20 years of age underwent quantitative ultrasonography and were interviewed to find out the risk factors for osteoporosis.146 (43.7 percent) women were reported to be normal, 145 (43.4 percent) were osteopenicand 43 (12.9 percent) were osteoporotic. The mean age and standard deviation of the participantswere 36.7 years +/- 13.0 years, with a body mass index (BMI) of 25.81 (standard deviation 5.10)kg per square metre. In the univariate analysis, factors that were associated with osteoporosis or osteopenia included age, parity, BMI, smoking (pack years), consumption of calcium-rich food/week, personal and family history of osteoporosis, education and socioeconomic status (p-value isless than 0.05). Using binary logistic regression with osteoporosis or osteopenia as an outcomecompared to normal individuals, BMI, smoking pack years, a family history of osteoporosis.15
A study was conducted on the awareness and knowledge of osteoporosis in the Swisspopulation. A total of 1,006 German and French speaking residents ofSwitzerland aged between 40 and 70 years were interviewed. Mean age was about53 years (52.8±9.2). Nearly 60% of the subjects interviewed were women.A structured questionnaire with 28 steoporosis related questions wasdeveloped for this survey.Approximately 98% of the respondents were aware of osteoporosis(p<0.001). Women were significantly more informed about the four knowledge areasof osteoporosis compared to men (48.8% vs 27.1%, respectively; p<0.001).
Individuals with high interest in health related questions were significantly moreknowledgeable than subjects with a low interest in health issues (44.1% vs 34.4%,respectively; p<0.001). Women’s knowledge was highest in the age group 50-59years (53.2%, p=0.043). Well educated women (56.4%, graduate/post-graduatequalification) knew significantly more than less educated women (37.1%, p<0.001).Men with a professional qualification knew more (29.4%, p<0.001) compared to meneither with a lower (14%) or higher education (27.6%).The awareness of osteoporosis in the Swiss population was high.However, detailed knowledge about health problems, preventative behaviours, ‘bonehealthy’ nutrition habits and risk factors were low. The low self-susceptibility toosteoporosis reflects significant public misperception about the consequences ofosteoporosis.16
6.3. STATEMENT OF PROBLEM
A study to assess the effectiveness of structured teaching programme in increasing the knowledge regarding prevention of osteoporosis among the postmenopausal women aged 40-60 years of age in selected area of Tumkur.
6.4. OBJECTIVES OF THE STUDY
To assess the pretest knowledge of the women’s regarding osteoporosis.
To evaluate the effectiveness of structured teaching programme regarding prevention of osteoporosis.
To compare the mean scores of the pretest and posttest knowledge regarding prevention of osteoporosis.
To assess the association between knowledge of women’s regarding prevention of osteoporosis with selected demographic variables such as age, sex, income, marital status, education and religion etc.
6.5.OPERATIONAL DEFINITION
Assess: - Refers to the statistical measurement of knowledge of the women aged 40-60 years on questionnaire regarding awareness of osteoporosis.
Effectiveness: - It is the significant improvement in knowledge of the women regarding awareness of osteoporosis after the administration of structured teaching programme as evidenced by the differences in pre-test and post-test scores.
Structured Teaching Programme:
It refers to systematically planned teaching programme designed to provide information regarding osteoporosis, its causes, complications and literature regarding prevention of osteoporosis.
Self Instructional Module (SIM):-It refers to a self contained, self sufficient unit of instruction, designed to be managed by the participants or users rather than by an instructor. It contains information’s regarding osteoporosis, its causes, complications and literature regarding prevention of osteoporosis.