Abstract
Summary
This study aimed to investigate women’s perspectives and experiences with screening for osteoporosis. Focus groups and individual interviews were conducted. Three main themes emerged: knowledge about osteoporosis, psychological aspects of screening, and moral duty. Generally, screening was accepted due to life experiences, self-perceived risk, and the preventive nature of screening.
Purpose
The risk-stratified osteoporosis strategy evaluation (ROSE) study is a randomized prospective population-based trial investigating the efficacy of a screening program to prevent fractures in women aged 65–80 years. It is recommended by the World Health Organization that a set of criteria are met before a screening program is implemented. This sub-study aims to investigate women’s perspectives and experiences with the ROSE screening program in relation to the patient-related criteria recommended by the World Health Organization.
Methods
A qualitative study was carried out involving 31 women by way of 8 focus group interviews and 11 individual interviews. Principles from critical psychology guided the analysis.
Results
Women’s perspectives and experiences with the screening program were described by three main themes: knowledge about osteoporosis, psychological aspects of screening, and moral duty. The women viewed the program in the context of their everyday life and life trajectories. Age, lifestyle, and knowledge about osteoporosis were important to how women ascribed meaning to the program, how they viewed the possibilities and limitations, and how they rationalized their actions and choices. The women displayed limited knowledge about osteoporosis and its risk factors. However, acceptance was based on prior experience, perceived risk, and evaluation of preventive measures. To be reassured or concerned by screening was described as important issues, as well as the responsibility for health-seeking behaviour.
Conclusion
In general, the women accepted the screening program. No major ethical reservations or adverse psychological consequences were detected. Only a minority of women declined screening participation due to a low perceived risk of osteoporosis.
Similar content being viewed by others
References
Brodersen J, Jorgensen KJ, Gotzsche PC (2010) The benefits and harms of screening for cancer with a focus on breast screening. Pol Arch Med Wewn 120:89–94
Wilson JM, Jungner YG (1968) Principles and practice of mass screening for disease. Bol Oficina Sanit Panam 65:281–393
Andermann A, Blancquaert I, Beauchamp S, Dery V (2008) Revisiting Wilson and Jungner in the genomic age: a review of screening criteria over the past 40 years. Bull World Health Organ 86:317–319
Hugod C, Alban A, Dehlholm G, Fog J, Hørder M, Lynge E, Olesen F, Olsen J, Møller-Pedersen K, Worm-Petersen J (1990) Screening hvorfor—hvornår—hvordan
Vestergaard P, Rejnmark L, Mosekilde L (2005) Osteoporosis is markedly underdiagnosed: a nationwide study from Denmark. Osteoporos Int 16:134–141
Johnell O, Kanis J (2005) Epidemiology of osteoporotic fractures. Osteoporos Int 16(Suppl 2):S3–S7
Kanis JA, Johnell O, De LC, Johansson H, Oden A, Delmas P, Eisman J, Fujiwara S, Garnero P, Kroger H, McCloskey EV, Mellstrom D, Melton LJ, Pols H, Reeve J, Silman A, Tenenhouse A (2004) A meta-analysis of previous fracture and subsequent fracture risk. Bone 35:375–382
Mossey JM, Mutran E, Knott K, Craik R (1989) Determinants of recovery 12 months after hip fracture: the importance of psychosocial factors. Am J Public Health 79:279–286
Strom O, Borgstrom F, Kanis JA, Compston J, Cooper C, McCloskey EV, Jonsson B (2011) Osteoporosis: burden, health care provision and opportunities in the EU: a report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 6:59–155
Papaioannou A, Kennedy CC, Ioannidis G, Brown JP, Pathak A, Hanley DA, Josse RG, Sebaldt RJ, Olszynski WP, Tenenhouse A, Murray TM, Petrie A, Goldsmith CH, Adachi JD (2006) Determinants of health-related quality of life in women with vertebral fractures. Osteoporos Int 17:355–363
Petrella RJ, Payne M, Myers A, Overend T, Chesworth B (2000) Physical function and fear of falling after hip fracture rehabilitation in the elderly. Am J Phys Med Rehabil 79:154–160
Vestergaard P, Rejnmark L, Mosekilde L (2007) Increased mortality in patients with a hip fracture-effect of pre-morbid conditions and post-fracture complications. Osteoporos Int 18:1583–1593
Murad MH, Drake MT, Mullan RJ, Mauck KF, Stuart LM, Lane MA, Abu Elnour NO, Erwin PJ, Hazem A, Puhan MA, Li T, Montori VM (2012) Clinical review. Comparative effectiveness of drug treatments to prevent fragility fractures: a systematic review and network meta-analysis. J Clin Endocrinol Metab 97:1871–1880
Reventlow SD (2007) Perceived risk of osteoporosis: restricted physical activities? Qualitative interview study with women in their sixties. Scand J Prim Health Care 25:160–165
Weston JM, Norris EV, Clark EM (2011) The invisible disease: making sense of an osteoporosis diagnosis in older age. Qual Health Res 21:1692–1704
Reventlow S, Bang H (2006) Brittle bones: ageing or threat of disease exploring women’s cultural models of osteoporosis. Scand J Public Health 34:320–326
Reventlow SD, Hvas L, Malterud K (2006) Making the invisible body visible. Bone scans, osteoporosis and women’s bodily experiences. Soc Sci Med 62:2720–2731
Kanis JA, Johansson H, Oden A, McCloskey EV (2009) Assessment of fracture risk. Eur J Radiol 71:392–397
Kvale S (2007) Doing interviews
Maxwell J (2005) Qualitative research design. An interactive approach
Morgan D (1997) Focus group as qualitative research. 2nd edn
Barbour R (2007) Doing focus groups
Stewart DW, Shamdasani PN, Rook DW (2007) Focus groups theory and practice. 2nd edn
Mørck LL, Huniche L (2006) Critical psychology in Danish context. Annual review of Critical Psychology:1–9
Dreier O (2008) Psychotherapy in everyday life
Jartoft V (1996) Kritisk psykologi en psykologi med fokus på subjektivitet og handling
Janz NK, Becker MH (1984) The health belief model: a decade later. Health Educ Q 11:1–47
Sujic R, Gignac MA, Cockerill R, Beaton DE (2011) A review of patient-centred post-fracture interventions in the context of theories of health behaviour change. Osteoporos Int 22:2213–2224
Rosenstock IM, Strecher VJ, Becker MH (1988) Social learning theory and the health belief model. Health Educ Q 15(2):175–183
Clarke LH, Griffin M (2008) Failing bodies: body image and multiple chronic conditions in later life. Qual Health Res 18:1084–1095
Giangregorio L, Papaioannou A, Thabane L, Debeer J, Cranney A, Dolovich L, Adili A, Adachi JD (2008) Do patients perceive a link between a fragility fracture and osteoporosis? BMC Musculoskelet Disord 9:38
Gerend MA, Erchull MJ, Aiken LS, Maner JK (2006) Reasons and risk: factors underlying women’s perceptions of susceptibility to osteoporosis. Maturitas 55:227–237
Meadows LM, Mrkonjic LA, Lagendyk LE, Petersen KM (2004) After the fall: women’s views of fractures in relation to bone health at midlife. Women Health 39:47–62
Meadows LM, Mrkonjic L, Lagendyk L (2005) Women’s perceptions of future risk after low-energy fractures at midlife. Ann Fam Med 3:64–69
Rimes KA, Salkovskis PM (2002) Prediction of psychological reactions to bone density screening for osteoporosis using a cognitive-behavioral model of health anxiety. Behav Res Ther 40:359–381
Malterud K (2005) Qualitative methods in medical research—conditions, possibilities and challenges. Ugeskr Laeger 167:2377–2380
Acknowledgments
We thank all the participating women, staffs at the outpatient clinics and the research groups that have contributed to ROSE, Teresa Holmberg for carrying out a focus group and Claire Gudex for the translations of quotations and editorial comments on the manuscript.
Funding
ROSE was funded by INTERREG 4A and The Region of Southern Denmark.
Conflicts of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Rothmann, M.J., Huniche, L., Ammentorp, J. et al. Women’s perspectives and experiences on screening for osteoporosis (Risk-stratified Osteoporosis Strategy Evaluation, ROSE). Arch Osteoporos 9, 192 (2014). https://doi.org/10.1007/s11657-014-0192-1
Received:
Accepted:
Published:
DOI: https://doi.org/10.1007/s11657-014-0192-1