Skip to main content
SpringerLink
Log in

Validity, reliability, and responsiveness to change of the “Osteoporosis and You” knowledge scale

Osteoporosis International volume 28, pages 3379–3388 (2017)Cite this article

Abstract

Summary

We studied the Osteoporosis and You knowledge scale in 7749 participants enrolled in a clinical trial. Results confirmed its psychometric properties in a diverse audience. Baseline scores were associated with better recall of bone mineral density test results at follow-up; however, the scale was not responsive to knowledge change.

Introduction

The goal of this study was to confirm the measurement properties of the Osteoporosis and You (O&Y) knowledge scale using classic test theory methods in the 7749 men and women participating in the Patient Activation After DXA Result Notification (PAADRN) randomized controlled trial. We hypothesized a simple factor structure that would reflect the four-factor model previously published.

Methods

We conducted psychometric analyses which included item analysis, internal consistency reliability, construct validity using exploratory and confirmatory factor analysis (EFA and CFA), comparing knowledge levels across pre-specified groups, and responsiveness to change.

Results

PAADRN participants were predominantly college educated, White females with low bone density, and a moderate level of 10-year fracture risk. EFA revealed four domains closely matching those in two previous reports. While overall scale reliability was minimally acceptable at 0.68, the reliabilities of the domain subscales were unacceptably low (0.59, 0.64, 0.45, and 0.36 for the Biological, Lifestyle, Consequences, and Prevention and Treatment subscales). CFA revealed the data fit the hypothesized model reasonably well with the items loading on their expected latent variable. The scale was not responsive to change, but although not significant, improved knowledge indicated better DXA result recall at 12 and 52 weeks.

Conclusions

In the PAADRN population, the O&Y knowledge scale had psychometric properties similar to those previously reported. Over 12 and 52 weeks, participants did not demonstrate significant changes in knowledge, but those with higher knowledge at baseline were more likely to accurately recall their baseline DXA result.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1

References

  1. National Osteoporosis Foundation (2014) Debunking the myths

  2. Office of the Surgeon General (2004) Bone health and osteoporosis: a report of the Surgeon General

  3. U.S. Department of Health and Human Services Office of Disease Prevention and Health Promotion (2015) Arthritis, Osteoporosis, and Chronic Back Conditions http://wwwhealthypeoplegov/2020/topics-objectives/topic/Arthritis-Osteoporosis-and-Chronic-Back-Conditions/objectives Accessed April 8 2015

  4. Laliberte MC, Perreault S, Jouini G, Shea BJ, Lalonde L (2011) Effectiveness of interventions to improve the detection and treatment of osteoporosis in primary care settings: a systematic review and meta-analysis. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 22:2743–2768

    Article  Google Scholar 

  5. Simone MJ, Roberts DH, Irish JT, Neeman N, Schulze JE, Lipsitz LA, Schwartzstein R, Aronson MD, Tan ZS (2011) An educational intervention for providers to promote bone health in high-risk older patients. J Am Geriatr Soc 59:291–296

    Article  PubMed  Google Scholar 

  6. Werner P (2005) Knowledge about osteoporosis: assessment, correlates and outcomes. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 16:115–127

    Article  Google Scholar 

  7. Yood RA, Mazor KM, Andrade SE, Emani S, Chan W, Kahler KH (2008) Patient decision to initiate therapy for osteoporosis: the influence of knowledge and beliefs. J Gen Intern Med 23:1815–1821

    Article  PubMed  PubMed Central  Google Scholar 

  8. Rosenstock IM, Strecher VJ, Becker MH (1988) Social learning theory and the health belief model. Health Educ Q 15:175–183

    Article  CAS  PubMed  Google Scholar 

  9. Green CA, Perrin NA, Polen MR, Leo MC, Hibbard JH, Tusler M (2010) Development of the patient activation measure for mental health. Admin Pol Ment Health 37:327–333

    Article  Google Scholar 

  10. Hibbard JH, Mahoney ER, Stockard J, Tusler M (2005) Development and testing of a short form of the patient activation measure. Health Serv Res 40:1918–1930

    Article  PubMed  PubMed Central  Google Scholar 

  11. Hibbard JH, Stockard J, Mahoney ER, Tusler M (2004) Development of the patient activation measure (PAM): conceptualizing and measuring activation in patients and consumers. Health Serv Res 39:1005–1026

    Article  PubMed  PubMed Central  Google Scholar 

  12. Gold DT, McClung B (2006) Approaches to patient education: emphasizing the long-term value of compliance and persistence. Am J Med 119:S32–S37

    Article  PubMed  Google Scholar 

  13. Ailinger RL, Harper DC, Lasus HA (1998) Bone up on osteoporosis. Development of the Facts on Osteoporosis Quiz. Orthop Nurs/Natl Assoc Orthop Nurses 17:66–73

    CAS  Google Scholar 

  14. Palacios S, Sanchez-Borrego R, Neyro JL, Quereda F, Vazquez F, Perez M, Perez M (2009) Knowledge and compliance from patients with postmenopausal osteoporosis treatment. Menopause Int 15:113–119

    PubMed  Google Scholar 

  15. Nadler M, Alibhai S, Catton P, Catton C, Jones J (2014) The impact of bone mineral density testing, fracture assessment, and osteoporosis education in men treated by androgen deprivation for prostate cancer: a pilot study. Support Care Cancer : Off J Multinatl Assoc Supportive Care Cancer 22:2409–2415

    Article  Google Scholar 

  16. Krebs P, Prochaska JO, Rossi JS (2010) A meta-analysis of computer-tailored interventions for health behavior change. Prev Med 51:214–221

    Article  PubMed  PubMed Central  Google Scholar 

  17. Walker SN, Pullen CH, Hageman PA, Boeckner LS, Hertzog M, Oberdorfer MK, Rutledge MJ (2010) Maintenance of activity and eating change after a clinical trial of tailored newsletters with older rural women. Nurs Res 59:311–321

    Article  PubMed  PubMed Central  Google Scholar 

  18. Winzenberg T, Oldenburg B, Frendin S, De Wit L, Riley M, Jones G (2006) The effect on behavior and bone mineral density of individualized bone mineral density feedback and educational interventions in premenopausal women: a randomized controlled trial [NCT00273260]. BMC Public Health 6:12

    Article  PubMed  PubMed Central  Google Scholar 

  19. Brenneman SK, Blau EM, Chen Y, Abbott TA (2002) Validation of a patient questionnaire, ‘osteoporosis and you’, designed to assess osteoporosis related attitudes, knowledge and behavior. J Bone Miner Res 17:S466

    Google Scholar 

  20. Cadarette SM, Gignac MA, Beaton DE, Jaglal SB, Hawker GA (2007) Psychometric properties of the “osteoporosis and you” questionnaire: osteoporosis knowledge deficits among older community-dwelling women. Osteoporosis International : a Journal Established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 18:981–989

    Article  CAS  Google Scholar 

  21. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42:377–381

    Article  PubMed  Google Scholar 

  22. Edmonds SW, Wolinsky FD, Christensen AJ, Lu X, Jones MP, Roblin DW, Saag KG, Cram P, Investigators P (2013) The PAADRN study: a design for a randomized controlled practical clinical trial to improve bone health. Contemp Clin Trials 34:90–100

    Article  PubMed  Google Scholar 

  23. Edmonds SW, Cram P, Lou Y, Jones MP, Roblin DW, Saag KG, Wright NC, Wolinsky FD (2016) Effects of a DXA result letter on satisfaction, quality of life, and osteoporosis knowledge: a randomized controlled trial. BMC Musculoskelet Disord 17:369

    Article  PubMed  PubMed Central  Google Scholar 

  24. van Buuren S (2007) Multiple imputation of discrete and continuous data by fully conditional specification. Stat Methods Med Res 16:219–242

    Article  PubMed  Google Scholar 

  25. Hair JF, Jr., Black WC, Rabin BJ, Anderson RE (2010) Multivariate data analysis. Upper Saddle River, N.J.: Prentice Hall, Upper Saddle River, N.J

  26. Harrington D (2008) Confirmatory factor analysis by Donna Harrington. In Oxford university P (ed). New York : Oxford University Press, New York

  27. Tabachnick BG, Fidell LS (2007) Using multivariate statistics. Pearson/Allyn & Bacon,

    Google Scholar 

  28. Qi BB, Resnick B, Nahm ES (2014) Reliability and validity of the revised osteoporosis knowledge test. J Nurs Meas 22:342–356

    Article  PubMed  Google Scholar 

  29. Pande KC, de Takats D, Kanis JA, Edwards V, Slade P, McCloskey EV (2000) Development of a questionnaire (OPQ) to assess patient’s knowledge about osteoporosis. Maturitas 37:75–81

    Article  CAS  PubMed  Google Scholar 

  30. Winzenberg TM, Oldenburg B, Frendin S, Jones G (2003) The design of a valid and reliable questionnaire to measure osteoporosis knowledge in women: the osteoporosis knowledge assessment tool (OKAT). BMC Musculoskelet Disord 4:17

    Article  PubMed  PubMed Central  Google Scholar 

  31. Curry LC, Hogstel MO (2001) Risk status related to knowledge of osteoporosis in older women. J Women Aging 13:71–83

    Article  CAS  PubMed  Google Scholar 

  32. Curry LC, Hogstel MO, Davis GC, Frable PJ (2002) Population-based osteoporosis education for older women. Public Health Nurs (Boston, mass) 19:460–469

    Article  Google Scholar 

  33. Giangregorio L, Dolovich L, Cranney A, Adili A, Debeer J, Papaioannou A, Thabane L, Adachi JD (2009) Osteoporosis risk perceptions among patients who have sustained a fragility fracture. Patient Educ Couns 74:213–220

    Article  PubMed  Google Scholar 

  34. Sedlak CA, Doheny MO, Jones SL (1998) Osteoporosis prevention in young women. Orthop Nurs 17:53–60

    Article  CAS  PubMed  Google Scholar 

  35. Sedlak CA, Doheny MO, Jones SL (2000) Osteoporosis education programs: changing knowledge and behaviors. Public health nursing (Boston, mass) 17:398-402

  36. Blalock SJ, Currey SS, DeVellis RF, DeVellis BM, Giorgino KB, Anderson JJ, Dooley MA, Gold DT (2000) Effects of educational materials concerning osteoporosis on women's knowledge, beliefs, and behavior. American journal of health promotion : AJHP 14:161–169

    Article  CAS  PubMed  Google Scholar 

  37. Brecher LS, Pomerantz SC, Snyder BA, Janora DM, Klotzbach-Shimomura KM, Cavalieri TA (2002) Osteoporosis prevention project: a model multidisciplinary educational intervention. The Journal of the American Osteopathic Association 102:327–335

    PubMed  Google Scholar 

  38. Piaseu N, Schepp K, Belza B (2002) Causal analysis of exercise and calcium intake behaviors for osteoporosis prevention among young women in Thailand. Health care for women international 23:364–376

    Article  PubMed  Google Scholar 

  39. Raab CA, Gregerson D, Shaw JM, Snow C (1999) Postmenopausal women take steps to reduce their osteoporosis risk. Women’s health issues : official publication of the Jacobs Institute of Women's Health 9:211–218

    Article  CAS  Google Scholar 

  40. Gaskin J (2016) Data screening. http://statwikikolobkreationscom Accessed (May 5 2016)

  41. Weems GH, Onwuegbuzie AJ (2001) The impact of midpoint responses and reverse coding on survey data. Measurement & Evaluation in Counseling & Development (American Counseling Association) 34:166

    Google Scholar 

  42. Kim K, Horan M, Gendler P (1991) Osteoporosis knowledge test, osteoporosis health belief scale, and osteoporosis self-efficacy scale. Allendale, MI

    Google Scholar 

  43. Ungan M, Tumer M (2001) Turkish women’s knowledge of osteoporosis. Fam Pract 18:199–203

    Article  CAS  PubMed  Google Scholar 

  44. Williams B, Cullen L, Barlow JH (2002) “I never realised how little I knew!”: a pilot study of osteoporosis knowledge, beliefs, and behaviours. Health care for women international 23:344–350

    Article  PubMed  Google Scholar 

  45. Yu S, Huang YC (2003) Knowledge of, attitudes toward, and activity to prevent osteoporosis among middle-aged and elderly women. The journal of nursing research : JNR 11:65–72

    Article  PubMed  Google Scholar 

Download references

Funding

This work was supported by R01 AG033035 (Cram/Wolinsky) from the NIA at NIH. Dr. Cram is supported by a K24 AR062133 award from NIAMS at the NIH. Dr. Saag is supported by a K24 AR052361 award from the NIAMS at the NIH.

Author information

Authors and Affiliations

  1. College of Public Health, University of Iowa, 5233 Westlawn, Iowa City, IA, 52242, USA

    V. T. Nguyen, Y. Lou & F. D. Wolinsky

  2. College of Nursing, University of Iowa, Iowa City, IA, USA

    S. W. Edmonds & F. D. Wolinsky

  3. CADRE, Iowa City VA Health System, Iowa City, IA, USA

    S. W. Edmonds

  4. Kaiser Permanente of Atlanta, Atlanta, GA, USA

    D. W. Roblin

  5. School of Public Health, Georgia State University, Atlanta, GA, USA

    D. W. Roblin

  6. School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA

    K. G. Saag

  7. Faculty of Medicine, University of Toronto, Toronto, ONT, Canada

    P. Cram

  8. University Health Network and Mount Sinai Hospital, Toronto, ONT, Canada

    P. Cram

  9. College of Medicine, University of Iowa, Iowa City, IA, USA

    F. D. Wolinsky

Authors
  1. V. T. Nguyen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. W. Edmonds
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Y. Lou
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. D. W. Roblin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. K. G. Saag
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. P. Cram
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. F. D. Wolinsky
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Study design: SE, DR, KS, PC, and FW. Study conduct: VN, SE, DR, PC, and FW. Data collection: VN, SE, DR, PC, and FW. Data analysis: VN, YL, and FW. Data interpretation: VN and FW. Drafting manuscript: VN. Revising manuscript and content: VN, SE, YL, DR, PC, and FW. Approving final version of manuscript: VN, SE, YL, DR, KS, PC, and FW. VN takes responsibility for the integrity of the data analysis.

Corresponding author

Correspondence to V. T. Nguyen.

Ethics declarations

Conflicts of interest

V Nguyen, S Edmonds, Y Lou, D Roblin, P Cram, and F Wolinsky have no conflicts of interest. K Saag has received grants from Amgen, Eli Lilly and Merck and has served as a paid consultant to Amgen, Eli Lilly, and Merck.

Role of the sponsor

The NIA and NIAMS had no roles in the design and conduct of the study; collection, management, analysis, and interpretation of data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.

Additional information

Trial Registration: clinicaltrials.gov Identifier: NCT01507662

Electronic supplementary material

ESM 1

(PDF 159 kb)

ESM 2

(PDF 91 kb)

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nguyen, V.T., Edmonds, S.W., Lou, Y. et al. Validity, reliability, and responsiveness to change of the “Osteoporosis and You” knowledge scale. Osteoporos Int 28, 3379–3388 (2017). https://doi.org/10.1007/s00198-017-4204-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-017-4204-z

Keywords

search

Navigation