Skip to main content

Advertisement

SpringerLink
Log in

Osteoporosis knowledge, self-efficacy, and health beliefs among Chinese individuals with HIV

  • Original Article
  • Published:
Archives of Osteoporosis Aims and scope Submit manuscript

Abstract

Summary

Individuals with HIV are at increased risk for osteoporosis and fracture. Using the Health Beliefs Model, we identified key relationships between knowledge, self-efficacy and health beliefs pertaining to physical activity and dietary calcium intake, two key modifiable preventive measures for osteoporosis.

Purpose

Individuals with HIV are at increased risk for osteoporosis and fracture. Few studies have systematically explored concerns related to osteoporosis prevention among this group. Applying the Health Beliefs Model (HBM), we examined associations between osteoporosis-related preventive health behaviors (i.e., physical exercise and dietary intake) and knowledge, self-efficacy and health beliefs in a large cohort of Chinese individuals with HIV.

Methods

We conducted a cross-sectional study with participants from an ongoing multi-center trial. Volunteers completed a questionnaire consisting of the International Physical Activity Questionnaire (IPAQ), a calcium and vitamin D intake assessment, the Osteoporosis Knowledge Test, Osteoporosis Self-Efficacy Scale, Osteoporosis Health Beliefs Scale, and relevant sociodemographic and clinical risk factors.

Results

A total of 263 of 297 eligible participants enrolled in this study. Mean age of participants was 38.4 ± 9.8 years, average BMI was 21.6 ± 2.6 kg/m2, and 76 % were men. About 30 % of the sample reported low physical activity. Consumption of foods from each calcium and vitamin D-rich category averaged between multiple times per month to weekly. Knowledge regarding osteoporosis was universally low and self-efficacy correlated directly with engagement in preventive behaviors. Women and individuals with lower education perceived greater barriers to adopting preventive behaviors. Multivariate logistic regression adjusted for age, sex and BMI showed that calcium and vitamin D intake was directly correlated with knowledge and self-efficacy, whereas physical activity correlated with manual labor occupation, perceived barriers to exercise and health motivation.

Conclusions

Behavioral frameworks such as the HBM may provide important insight into promoting adoption and maintenance of osteoporosis-related preventive behaviors among individuals with HIV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Cooper C, Campion G, Melton LJ III (1992) Hip fractures in the elderly: a worldwide projection. Osteoporos Int 2:285–289

    Article  CAS  PubMed  Google Scholar 

  2. Lippuner K, von Overbeck J, Perrelet R et al (1997) Incidence and direct medical costs of hospitalizations due to osteoporotic fractures in Switzerland. Osteoporos Int 7(5):414–425

    Article  CAS  PubMed  Google Scholar 

  3. Osteoporosis prevention, diagnosis, and therapy, (2000) NIH Consens Statement 17(1):1–36

    Google Scholar 

  4. McComsey GA, Tebas P, Shane E et al (2010) Bone Disease in HIV Infection: A practical review and recommendations for HIV care providers. Clin Infect Dis 51:937–946

    Article  PubMed Central  PubMed  Google Scholar 

  5. Guerri-Fernandez R, Vestergaard P, Carbonell C et al (2013) HIV infection is strongly associated with hip fracture risk, independently of age, gender and comorbidities: a population-based cohort study. J Bone Miner Res 28:1259–1263

    Article  PubMed  Google Scholar 

  6. Hansen AB, Gerstoft J, Kronborg F et al (2012) Incidence of low and high-energy fractures in persons with and without HIV infection: a Danish population-based cohort study. AIDS 26:285–293

    Article  PubMed  Google Scholar 

  7. Womack JA, Goulet JL, Gibert C et al (2011) Increased risk of fragility fractures among HIV infected compared to uninfected male veterans. PLoS One. doi:10.1371/journal.pone.0017217

    Google Scholar 

  8. Triant VA, Brown TT, Lee H, Grinspoon SK (2008) Fracture prevalence among human immunodeficiency virus (HIV)-infected versus non-HIV-infected patients in a large U.S. healthcare system. J Clin Endocrinol Metab 93:3499–3504

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  9. McLeod KM, Johnson CS (2011) A systematic review of osteoporosis health beliefs in adult men and women. J Osteoporos 2011:197454

    PubMed Central  PubMed  Google Scholar 

  10. Glanz K, Rimer BK, Viswanath V (eds) (2008) Health Behavior and Health Education: Theory, Research, and Practice, 4th edn. Jossey-Bass Inc, San Francisco

    Google Scholar 

  11. Bandura A (1977) Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev 84:194–215

    Article  Google Scholar 

  12. Rosenstock IM, Strecher VJ, Becker MH (1988) Social learning theory and the health belief model. Health Educ Q 15(2):175–183

    Article  CAS  PubMed  Google Scholar 

  13. Kim KK, Horan ML, Gendler P (1991) Osteoporosis Knowledge Test, Osteoporosis Health Belief Scale, and Osteoporosis Self-Efficacy Scale. Allendale, MI

    Google Scholar 

  14. Johnson CS, McLeod W, Kennedy L, McLeod K (2008) Osteoporosis health beliefs among younger and older men and women. Health Educ Behav 35(5):721–733

    Article  Google Scholar 

  15. Tan S, Ji L, Tsai J et al (2009) Greater osteoporosis educational outreach is desirable among Chinese immigrants in Chinatown. Chicago. Osteoporos Int 20:1517–1522

    Article  CAS  PubMed  Google Scholar 

  16. Gammage KL, Klentrou P (2011) Predicting osteoporosis prevention behaviors: health beliefs and knowledge. Am J Health Behav 35(3):371–382

    Article  PubMed  Google Scholar 

  17. Doheny MO, Sedlak CA, Estok PJ, Zeller RA (2011) Bone density, health beliefs, and osteoporosis preventing behaviors in men. Orthop Nurs 30(4):266–272

    Article  PubMed Central  PubMed  Google Scholar 

  18. Endicott RD (2013) Knowledge, health beliefs, and self-efficacy regarding osteoporosis in perimenopausal women. J Osteoporos. doi:10.1155/2013/853531

    PubMed Central  PubMed  Google Scholar 

  19. Ford MA, Bass M, Zhao Y, Bai JB, Zhao Y (2011) Osteoporosis knowledge, self-efficacy, and beliefs among college students in the USA and China. J Osteoporos. doi:10.4061/2011/729219

    PubMed Central  PubMed  Google Scholar 

  20. Zhang YP, Li XM, Wang DL, Guo XY, Guo X (2012) Evaluation of educational program on osteoporosis awareness and prevention among nurse students in China. Nurs Health Sci 14:74–80

    Article  PubMed  Google Scholar 

  21. Sayed-Hassan R, Bashour H, Koudsi A (2013) Osteoporosis knowledge and attitudes: a cross-sectional study among female nursing school students in Damascus. Arch Osteoporos 8:149

    Article  PubMed  Google Scholar 

  22. Nadler M, Alibhi S, Catton P, Catton C, To MJ, Jones JM (2013) Osteoporosis knowledge, health beliefs, and healthy bone behaviours in patients on androgen-depreivation therapy (ADT) for prostate cancer. BJU J 111:1301–1309

    Article  CAS  Google Scholar 

  23. Elliott JO, Jacobson MP, Seals BF (2006) Self-efficacy, knowledge, health beliefs, quality of life, and stigma in relation to osetoprotective behaviors in epilepsy. Epilepsy Behav 9:478–491

    Article  PubMed  Google Scholar 

  24. Ha M, Hu J, Petrini MA, McCoy TP (2014) The effects of an educational self-efficacy intervention on osteoporosis prevention and diabetes self-management among adults with type 2 diabetes mellitus. Biol Res Nurs 16:357

    Article  PubMed  Google Scholar 

  25. UNAIDS. 2013. AIDS by the numbers. http://www.unaids.org/en/media/unaids/ contentassets/documents/ unaidspublication/2013/JC2571_AIDS_by_the_numbers_en.pdf

  26. International Osteoporosis Foundation. (2009) The Asian Audit: Epidemiology, costs and burden of osteoporosis in Asia. http://www.iofbonehealth.org/sites/default/files/PDFs/Audit%20Asia/ Asian_regional_audit_2009.pdf

  27. Chen YP, Liu XQ, Cai DH (2005) Reliability and validity of the osteoporosis knowledge tests. Chin J Osteoporos 11(3):339–341

    Google Scholar 

  28. He YN, Zhai FY, Wang ZH, Hu YS, Yu WT, Yang XG (2007) Status of dietary calcium intake of Chinese residents. J Hyg Res 36(5):600–602

    CAS  Google Scholar 

  29. Chan R, Leung J, Woo J (2013) A Prospective Cohort Study Examining the Associations of Dietary Calcium Intake with All-Cause and Cardiovascular Mortality in Older Chinese Community-Dwelling People. PLoS One 8(11):e80895. doi:10.1371/journal.pone.0080895

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  30. Kou H, Du X, Li Y et al (2013) Comparison of Nevirapine Plasma Concentrations between Lead-In and Steady-State Periods in Chinese HIV-Infected Patients. PLoS One. doi:10.1371/journal.pone.0052950

    Google Scholar 

  31. Willis G. (1999) Reducing survey error through research on the cognitive and decision processes in surveys. Meeting of the American Statistical Association

  32. Craig CL, Marshall AL, Sjostrom M et al (2003) International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 35(8):1381–1395

    Article  PubMed  Google Scholar 

  33. MacFarlane DJ, Lee CCY, Ho EYK et al (2007) Reliability and validity of the Chinese version of IPAQ (short, last 7 days). J Sci Med Sport 10:45–51

    Article  PubMed  Google Scholar 

  34. International Physical Activity Questionnaire. (2005) Guidelines for Data Processing and Analysis of the International Physical Activity Questionnaire. http://www.ipaq.ki.se/scoring.pdf

  35. Horan ML, Kim K, Gendler P, Froman RD, Patel MD (2001) Development and evaluation of osteoporosis self-efficacy scale. Res Nurs Health 21(5):395–403

    Article  Google Scholar 

  36. Chen YP, Liu XQ (2005) Reliability and validity of the osteoporosis self-efficacy scale. Nurs J Chin PLA 22(8):38–39

    CAS  Google Scholar 

  37. Kim KK, Horan ML, Gendler P, Patel MK (1991) Development and evaluation of the Osteoporosis Health Belief Scale. Res Nurs Health 14(2):155–163

    Article  CAS  PubMed  Google Scholar 

  38. Chen YP, Liu XQ, Cai DH (2005) Evaluation of the reliability and validity of the osteoporosis health belief scale. Chin J Clin Rehabil 9(3):196–197

    Google Scholar 

  39. Sauerbrei W, Royston P, Binder H (2007) Selection of important variables and determination of functional form for continuous predictors in multivariable model building. Statist Med 26:5512–5528

    Article  Google Scholar 

  40. Lee LYK, Lai EKF (2006) Osteoporosis in older Chinese men: knowledge and health beliefs. J Clin Nurs 15:353–355

    Article  CAS  PubMed  Google Scholar 

  41. Werner P (2005) Knowledge about osteoporosis: assessment, correlates and outcomes. Osteoporos Int 16:115–127

    Article  PubMed  Google Scholar 

  42. Von Hurst PR, Wham CA (2007) Attitudes and knowledge about osteoporosis risk prevention: a survey of New Zealand women. Public Health Nutr 10(7):747–753

    Google Scholar 

  43. Bandura A (1997) Self-efficacy: The exercise of control. W.H. Freeman, New York

    Google Scholar 

  44. Swaim RA, Barner JC, Brown CM (2008) The relationship of calcium intake and exercise to osteoporosis health beliefs in postmenopausal women. Res Soc Admin Pharm 4:153–163

    Article  Google Scholar 

  45. Wallace LS (2002) Osteoporosis prevention in college women: application of the expanded health belief model. Am J Health Behavi 6(3):163–172

    Article  Google Scholar 

  46. Tung WC, Lee IFK (2006) Effects of an osteoporosis educational programme for men. J Adv Nurs 56(1):26–34

    Article  CAS  PubMed  Google Scholar 

  47. Qi BB, Resnick B, Smeltzer SC, Bausell B (2011) Self efficacy program to preent osteoporosis among Chinese immigrants. Nurs Res 60(6):393–404

    Article  PubMed  Google Scholar 

  48. Janz NK, Becker MH (1984) The Health Belief Model: A decade later. Health Educ Q 11(1):1–47

    Article  CAS  PubMed  Google Scholar 

  49. Hsieh E, Fraenkel L, Bradley E et al (2014) Osteoporosis knowledge, self-efficacy, and health beliefs among Chinese men and women with HIV. Ann Rheum Dis 73(Suppl 1):A62–A63

    Google Scholar 

Download references

Acknowledgements

We recognize deep gratitude to all the study participants and to the participating centers of the original parent study for their efforts: The Infectious Disease Hospital of Henan Province (Yun He and Hong Li); Shanghai Public Health Clinical Center, Fudan University (Li Liu and Lin Pan); Fuzhou Infectious Diseases Hospital, Fujian Medical University (Hanhui Ye and Aiqiong Huang); Guangzhou No.8 People's Hospital (Xiaoping Tang and Jiansheng Zhang); Shenzhen Third People's Hospital (Boping Zhou and Hui Wang); Beijing You’an Hospital, Capital Medical University (Tong Zhang and Wei Xia); Beijing Ditan Hospital, Capital Medical University (Hongxin Zhao and Guiju Gao); Yunnan AIDS Care Center (Huiqin Li and Shizhen Huang); The First People's Hospital of Honghe State (Xinhua Wu); Tangdu Hospital, Xi’an Fourth Military Medical University (Yongtao Sun, Qin Liu); Kunming Third People's Hospital (Jinsong Bai, Bo Tian). We would also like to acknowledge Phyllis Gendler (Grand Valley State University Kirkof College of Nursing, Grand Rapids, Michigan) and YuPing Chen (Zhujiang Hospital, Nanfang University, Guangzhou) for permission to use the OKT, OSES, and OHBS tools in English and Mandarin respectively, and Qian Zhang (National Institute for Nutrition and Food Safety, Chinese Center for Disease Control and Prevention, Beijing) and Wei Chen (Department of Parenteral and Enteral Nutrition, PUMCH, Beijing) for their input during development of the Dietary Intake assessment tool, and Michael T. Yin (Columbia University Medical Center, New York, New York) for his advice regarding sociodemographic and clinical risk factor measures. We also thank the team at the PUMCH HIV/AIDS Center for Treatment and Diagnosis for their help piloting the questionnaire and preparing study materials: Shanshan Du, Xiaojing Song, and Yanling Li, Jing Xie, Ling Luo, Lixia Zhang and Yijia Li.

Preliminary data from this study was previously presented as an abstract at the 2014 European Workshop for Rheumatology Research in Lisbon, Portugal [49]. This study was funded by the China National Key Technologies R&D Program for the 12th Five-year Plan (2012ZX10001-003). E.H. is funded by the Rheumatology Research Foundation Scientist Development Award. L.F. is supported by NIAMS K24 AR060231-01.

Conflict of interest

None.

Ethical standards

This study was reviewed and approved by the institutional review board of PUMCH and the human investigations committee of Yale School of Medicine prior to initiation, and was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Author information

Authors and Affiliations

  1. Department of Infectious Diseases, Peking Union Medical College Hospital, Peking Union Medical College and the Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Wangfujing Street, Beijing, 100730, CHINA

    Evelyn Hsieh, Qu Cui & Taisheng Li

  2. Section of Rheumatology, Yale School of Medicine, 300 Cedar Street, PO Box 208031, New Haven, CT, 06520-8031, USA

    Evelyn Hsieh & Liana Fraenkel

  3. Department of Health Policy and Management, Yale School of Public Health, 60 College Street, P.O. Box 208034, New Haven, CT, 06520-8034, USA

    Elizabeth H. Bradley

  4. Department of Endocrinology, Key Laboratory of Endocrinology, Peking Union Medical College Hospital, No. 1 Shuaifuyuan, Wangfujing Street, Beijing, 100730, China

    Weibo Xia

  5. Section of Endocrinology, Yale School of Medicine, 300 Cedar Street, PO Box 208020, New Haven, CT, 06520-8020, USA

    Karl L. Insogna

  6. Co-CRO Medical Development Company Ltd. Beijing, 46 Dongsi Xi Street, Beijing, 100711, China

    Kunli Li

Authors
  1. Evelyn Hsieh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Liana Fraenkel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elizabeth H. Bradley
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Weibo Xia
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Karl L. Insogna
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Qu Cui
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kunli Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Taisheng Li
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Taisheng Li.

Additional information

An abstract based upon a preliminary analysis of the dataset was published in a supplement to Annals of Rheumatic Diseases: http://ard.bmj.com/content/73/Suppl_1.toc; http://ard.bmj.com/content/73/Suppl_1/A62.2.abstract?sid=dd1f3954-9a23-47d6-b826-5b9e4d39dd88

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hsieh, E., Fraenkel, L., Bradley, E.H. et al. Osteoporosis knowledge, self-efficacy, and health beliefs among Chinese individuals with HIV. Arch Osteoporos 9, 201 (2014). https://doi.org/10.1007/s11657-014-0201-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11657-014-0201-4

Keywords

Search

Navigation