EFFECTIVENESS OF EDUCATIONAL INTERVENTION ON IMPROVING AWARENESS ABOUT OSTEOPOROSIS AMONG UNIVERSITY FEMALE EMPLOYEES

Eman M. mortada 1 , Lulwah Al Bahlal 2 , Rawabi Al Sayer 2 and Alaa Al Ghamdi 2 . 1. PhD in public health and preventive medicine, Assistant Professor in health sciences department, Health and rehabilitation sciences college, Princess Noura Bint Abdelrhaman University. 2. Graduate students, epidemiology program, health sciences department, Health and rehabilitation sciences college, Princess Noura Bint Abdelrhaman University. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History


Inclusion and exclusion criteria:-
This study only included Saudi (teaching and administrative staff) after excluding those who refuse to participate as their participation was voluntary.
Sampling technique:-A Multi-stage cluster sampling technique was used. Different stages were conducted to select the sample, in the first stage one college was selected randomly by simple random sampling. At the 1 st stage, the Sciences colleges were randomly selected out of the three main categories (humanities collages, health colleges, and sciences colleges) at Princess Nourah Bint Abdulrahman University. Then in the 2 nd stage, the college of business and administration was randomly selected out of the four Sciences colleges (college of sciences, college of computer and information science, college of business and administration, college of art and design) included in the sciences colleges as illustrated in figure 1 1018 ( Sample Size:-A total sample size of 120 teaching and administrative female employees calculated in this study by using an open epi calculator. [9] The following parameters were used to calculate the required sample: 95% confidence level, 80.0% power of the testand assuming that the change of knowledge can reach up to 25%, according to the findings from the pilot study. Then the sample was doubled to be 51*2=102, in addition to 15% expected non response from the participants so the final sample= 120. They were from the college of Administration and Business at Princess Nourah BintAbdulrahman University. After removing the incomplete filled questionnaire, the remaining sample number became 112

Questionnaire:-
A self-administrated anonymous Arabic questionnaire, designed using a standard questionnaire, then modified to suit Saudi culture (The Impact of Osteoporosis Continuing Education on Nurses' Knowledge and Attitudes.) [10] Pilot testing of the questionnaire was carried out on 20 females not included in the study. It was performed as an initial step for the study to check the easiness of the questionnaire and the time needed to complete it. Some modifications in some questions were done after the pilot study. The final version covers the following items Personal information included Nine questions, Knowledge: Assess their current knowledge about osteoporosis, withfour questions includes (background, sources of information, magnitude problem estimation…etc.

Intervention tools:-
The tools used displays the main item that was covered in health education message, knowing that it was carried out in Arabic and it was guided by the items asked in the questionnaire which ware: 1. Poster (roll up panel):covered the main outlines of the questionnaire in brief through pictures and small sentences. 2. Booklet: also covered the main outlines of the questionnaire in more details with pictures and verity of tables that shows detailed daily requirement of calcium, vitamin D, sun exposure and physical activity. To motivate 1019 the participants and to increase their cooperation, motivations rich in calcium and vitamin D was attached with the booklets. 3. Lecture: covered the overall idea of the questionnaire which contained seventeen slidesthat took around fifteen minutes with the opportunity for the participants to ask oral questions .The lecture conducted into different days and different times to take the most advantages of involving more participants.

Data Collection phases:-
The data collection strategy performed in the form of three phases in three weeks, one week for each phase. The first phase was the assessment phase took place in the first week was the pretest phase via the questionnaire and took about 7 to 9 min to be completed after obtaining the informed consent from the females. Followed by the next phase in the second week, which was the intervention program by conducting the health education sessions aided by booklet, poster and lecture. Finally, post-test used in the evaluation phase to compare the effectiveness of the educational intervention through the same questionnaire that carried out in the first phase.

Statistical Analysis:-
The data was presented and analyzed by SPSS 23 [11] using descriptive and analytical statistics. McNemar test was used to assess the significant difference between post and pretest results. The main outcome was tomeasure the change in the knowledge by comparing the change between pre and posttest by using paired T test.Level of significance assessed at p<.05.
Ethical Approval:-Ethical approval was taken from the ethical committee at health and rehabilitation sciences collage. As well as, from the dean of business and administration college. Informed consent was attached with the questionnaires to explain the objective and importance of the study, in addition to explaining the phases of the research confirming that their participation or drop out is voluntary. Knowing that the confidentiality of their information is secure by using anonymous coding of the questionnaires.

Figure2:-Participant source of information about osteoporosis
After assessing the source of information about osteoporosis, the Internet was the most frequently reported source (78.6%) followed by specialist (28.6%), other (25%) which falls below television, relatives and patient, then books (19.6%).Knowing that the participants were allowed to choose more than one source. Figure 2 Source of Information 1021 ± 0.81, 2.32 ± 0.85 and 4.13 ± 0.83 respectively in the posttest. In the same hand the mean and standard deviation of the prevention found to be moderate with (p= .003) and it was 1.74 ± 0.74 in the pretest and became 1.97 ± 0.49 in the posttest. However, a negative correlation was found between their level of knowledge in the pretest and posttest and the diagnosis category (p=.116) it was 1.59 ± 0.90 in the pretest and became 1.70 ± 0.86 in the posttest.

Discussion:-
The aim of this research was to reduce the osteoporosis rate due to lack of awareness among Saudi females. An intervention study was carried out where a designed self-administered questionnaire was used in order to collect data. The current study included a total number of 112 female employees. As regards the main source of information about osteoporosis, it was revealed that the internet was the main source of information among the majority (78.6%) of the studied women, while specialists were ranked as the second source of information was less than one third (28%). This was in agreement with what was reported in many studies carried out among (Egyptian, Turkish, American, Bruneian, Indian and Singaporean women) the mass media was rated as the main source of information in (54.2%, 53%, 55%, 70%, 74% and 76.4%) of the studied women respectively. [12][13][14][15][16][17][18][19] This result ought to raise consideration toward the content of the health messages incorporated into broad communications in media programs, articles and advertisements. [19,20] According to a study conducted in Texas that analyzed the data by using one-tailed t-test shows that there was a significant increase in the general knowledge of osteoporosis from the pre to the post (p = .000). Additionally, the mean and standard deviation of the pretest was 6.89±3.30 while it became 9.96±2.65 in the posttest when compared [21] a paired-test was calculated in a study conducted in the United States of America and the results revealed that there was a statistically significant increase in knowledge scores in both groups. For women with a family history of osteoporosis the pretest mean was 12.66 (SD = 1.57), while it became 25.83 (SD = 5. 19) in the posttest. The women without a family history of osteoporosis had a highly significant difference in posttest scores with the mean of 26.11 (SD = 2.67), while it was 12.11 (SD = 2.02) in the pretest. [22] According to a study carried out in California State discussing the knowledge of osteoporosis risk factors, among 49 older adults, included 41 females and 8 males with ages ranging from 78-98 years. The osteoporosis knowledge mean number of correct responses was 8 (SD = 4) out of 20 possible questions. [23] However, in this study the data was analyzed by using paired t-test and revealed that there was a similar significantly increasing as in the previous one in the mean of the knowledge level (P<.0001). The pretest mean and standard deviation was 26.16±4.21 and changed to be 41.64±3.83 in the posttest.
There is a negative correlation between the study conducted in the Unaided States of America that discuss the benefits-exercise among the participant without family history of osteoporosis and the current study. The reveled results in the previous study was 26.0000±2.74874 in the pretest and become 26.7368±5.50598 in the posttest (p=.630). [22] While the physical activity mean and standard deviation in this study was 0.54± 0.66 in the pretest and change to be 2.32± 0.85 (P<.0001).
There is a positive correlation between the previous study and the current study in relation to the dietary awareness were it was 4.54± 2.07 in the pretest and became 6.77± 1.45 in the posttest. Compared to the previous study that indicates calcium benefits were it was 23.6842± 2.05623 in the pretest and became 26.0000±2.66667 in the posttest. [22] On the other hand, a study carried out among 42 women who participated in an 8-week educational intervention. There was statistically significant regression equations were found for all pre intervention intentions related to calcium. Posttest intervention calcium intake significantly increased to 821±372 mg/day (P<.0001). [24] There was a dramatically increased in the mean at the non-modifiable risk factors where it was 2.32± 1.35 in the pretest and increased to be 5.24± 0.85 in the posttest. As well as among the modifiable risk factors where it was 4.19± 1.44 in the pretest and increased to be 6.21± 1.09 in the posttest. However, comparing to a study conducted in Lublin Voivodeship reveals that varied scores between the pretest and the posttest. The level of knowledge about osteoporosis risk factors estimated as an average were it was (M = 59.78) [25] There is a negative correlation regarding the disease complication where it was 1.99± 0.95 in the pretest and increased to be 2.91± 0.78 in the posttest (P<.0001). Compared to the seriousness of the disease among the participants without family history of osteoporosis where it was 16.2105±3.32631 in pretest and became 15.8421±5.06911 in the posttest (p=.702) [22]