The reliability of the Arabic version of osteoporosis knowledge assessment tool (OKAT) and the osteoporosis health belief scale (OHBS)

Translation and cross-cultural adaptation of Osteoporosis Knowledge Assessment Tool (OKAT) for Chinese populations in Australia

The increased prevalence of osteoporosis among Chinese-speaking communities in Australia deemed it necessary to have a culturally appropriate tool for assessing knowledge. This study describes the cultural adaption of the validated Osteoporosis Knowledge Assessment Tool (OKAT). The adapted tool is readable and understandable for diverse Chinese-speaking communities.

PURPOSE

With an expected increasing prevalence of osteoporosis among Chinese-speaking communities in Australia, a cross-culturally adapted questionnaire is necessary to assess knowledge levels among the group. We aimed to cross-culturally adapt the Osteoporosis Knowledge Assessment Tool (OKAT) questionnaire for Chinese-speaking populations in Australia.

METHODS

Cross-cultural adaptation guidelines were employed to culturally adapt the OKAT to simplified Chinese. This involved translation, revision, retroversion, and expert discussion before finalizing the Chinese version of OKAT. The participants were recruited through convenience sampling from a cohort of Chinese-speaking populations who attended a bone health promotion program. The adapted questionnaire was piloted with Chinese-speaking communities in the Greater Western Sydney area for face and content validity. The adapted questionnaire was compared with the original version for response agreement using Cohen's kappa goodness of fit. The face validity of the adapted tool was analysed through a binary scale rating for readability and understandability.

RESULTS

The cross-culturally adapted version of OKAT has a 71.8% total response agreement with the original version of OKAT. The cross-culturally adapted OKAT yielded higher total scores than the translated version. The cross-culturally adapted tool had a good face and content validity.

CONCLUSION

The cross-culturally adapted version of OKAT improves the overall readability and understandability of the questionnaire among Chinese-speaking populations in Australia.

Questionnaires assessing knowledge and beliefs about musculoskeletal conditions are potentially suitable for use, but further research is needed: a systematic review

OBJECTIVES

To evaluate the measurement properties of Patient-reported outcome measures (PROMs) for knowledge and/or beliefs about musculoskeletal conditions.

STUDY DESIGN AND SETTING

A systematic review was performed according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines. This review was prospectively registered on PROSPERO - ID: CRD42022303111. Electronic databases, reference lists, forward citation tracking, and contact with experts were used to identify studies. Eligible studies were reports developing or assessing a measurement property of a PROM measuring musculoskeletal condition specific-knowledge and/or beliefs. We assessed the methodological quality and measurement properties of included studies. A modified Grading of Recommendations Assessment Development and Evaluation approach was used to rate the quality of evidence for each PROM.

RESULTS

The literature search was performed from inception to 11th September 2023. Sixty records were included, reporting 290 individual studies, and provided information on 25 PROMs. Five PROMs presented sufficient structural validity, three presented sufficient cross-cultural validity, ten presented sufficient reliability, three presented sufficient criterion validity, six presented sufficient hypothesis-testing, and four presented sufficient responsiveness. No PROM presented sufficient evidence for content validity, internal consistency, and measurement error. Based on the available evidence, no PROM was classified as suitable for use according to the COSMIN recommendations. Twenty-four PROMs are potentially suitable for use, and one PROM is not recommended for use.

CONCLUSION

No PROM designed to assess knowledge and/or beliefs about musculoskeletal conditions meets the COSMIN criteria of suitable for use. Most PROMs identified in this systematic review were considered as potentially suitable for use and need further high-quality research to assess their measurement properties.

An osteoporosis knowledge assessment instrument - development and validation

INTRODUCTION

The consequences of osteoporotic fractures are extremely detrimental to the individual as well as to society. Adopting effective preventative measures is a top public health priority.

Development and Validation of India-specific Hindi Version of Osteoporosis Knowledge Assessment Tool

Purpose

Patient education is one of the important components of reducing the morbidity of osteoporosis. The aim of this study is to validate the Hindi version of the Osteoporosis Knowledge Assessment Tool (OKAT-H) among a hospital-based sample in the age group of 18-44 years of age.

Methods

The study was conducted in two phases - translation and adaption of the OKAT in Hindi followed by its validation. The translated tool was analyzed by Flesch reading ease, McNemar test, Cronbach alpha, difficulty index, discrimination index, and principal factor analysis.

Results

Two hundred and sixty women with a mean age of 28.3 ± 17.2 years were enrolled in the study. The mean score of the OKAT-H tool obtained in the study was 11.3 ± 2.1. A significant difference was noted in the scores based on educational qualification or with any family history of either osteoporosis or fracture (P < 0.05). The Flesch score for the OKAT-H tool was 86. Inter-item correlation for all the items ranged between 0.15 and 0.5. The Cronbach's alpha measured 0.892 suggesting high internal consistency. Items number 6, 7, 8, 9, 13, and 14 showed a significant difference on the McNemar test questioning its consistency on test-retest.

Conclusion

A new shorter version of the tool may be developed since six items showed low consistency. The use of such an instrument in local language would help spread awareness about the disease as well as help the population in adopting osteoprotective strategies and also to seek help and advice regarding treatment.

Assessment of osteoporosis knowledge, awareness, and risk factors among premenopausal and postmenopausal women from Jordan: a cross-sectional study

RATIONALE

Lack of information about osteoporosis knowledge and awareness among premenopausal compared to postmenopausal women in Jordan.

MAIN RESULT

Women had an average-poor knowledge and awareness about osteoporosis.

SIGNIFICANCE

This study highlights the need to improve women's knowledge about osteoporosis, its consequences, potential risk factors, preventive measures, and treatment options.

PURPOSE

To assess osteoporosis knowledge, awareness, and risk factor profile among premenopausal and postmenopausal women from Jordan.

METHODS

This was a cross-sectional study that involved 490 premenopausal and 488 postmenopausal women from the general population of Jordan. Face-to-face interviews were conducted to collect the sociodemographic and clinical data and to complete the Osteoporosis Knowledge Assessment Tool (OKAT) questionnaire.

RESULTS

Premenopausal and postmenopausal women had an average-poor level of knowledge and awareness regarding osteoporosis, with a total mean score of 51.3 and 50.9, respectively, out of the total OKAT score of 100. More than 50% of premenopausal women correctly answered 11 questions, while >50% of postmenopausal women correctly answered 9 questions out of 20 in OKAT, which are related to knowledge and awareness about osteoporosis. The participants' marital status (being married), higher educational level, and higher economic status were significantly associated with better knowledge and awareness about osteoporosis (p-values < 0.05). Postmenopausal women had higher osteoporosis risk profile including older age, higher body mass index, less regular exercise, and less exposure to sunlight versus premenopausal women.

CONCLUSION

Premenopausal and postmenopausal women from Jordan had an average-poor level of knowledge and awareness about osteoporosis. Higher educational levels and higher income are associated with better knowledge and awareness about osteoporosis. It is therefore crucial to improve the knowledge of women in Jordan about osteoporosis and its consequences, as well as the potential risk factors, preventive measures, and treatment options. Conducting periodic osteoporosis awareness and educational campaigns are necessary to spread the awareness of the disease.

Evaluation of Osteoporosis Perception Among Saudi Arabian Premenopausal Women: A Cross-Sectional Survey Study Using the Osteoporosis Knowledge Assessment Tool (OKAT)

INTRODUCTION

Osteoporosis is a major clinical problem that affects the whole population, especially women. It is a condition that is becoming more prevalent with aging. The increase in bone fragility associated with the disease can lead to fractures, even from minor trauma. Our goal is to evaluate the extent of knowledge about osteoporosis and perceptions of it among premenopausal women in Saudi Arabia.

METHOD

This descriptive cross-sectional study was conducted among premenopausal women during the months of June and July 2021. We distributed an online questionnaire on social networking sites and applications that Saudi women use on a daily basis. We used the Osteoporosis Knowledge Assessment Tool (OKAT) to evaluate the responses.

RESULT

A total of 661 women took part in our study; 159 of them were excluded because they had either reached the menopausal period or had already been diagnosed with the disease. The overall perception of osteoporosis is noticeably poor, as only 55% of respondents had an acceptable level of knowledge. In addition, we found a statistically significant association between education level and knowledge level (p-value = 0.044).

CONCLUSION

The findings revealed that more than half the participants scored "acceptable" in terms of their understanding of the disease, which indicates a serious awareness gap. This outcome demonstrates the necessity of increasing community awareness about osteoporosis to reduce potential harm and the financial burden of healthcare.

Gender Disparities in Osteoporosis Knowledge, Health Beliefs and Preventive Behaviors in Najran City, Saudi Arabia

Osteoporosis is a chronic bone disease affecting both men and women, but it is more prevalent in women. Promoting a healthy lifestyle among adults, particularly women, is crucial in preventing and reducing the osteoporosis impact. This study aimed to compare the osteoporosis knowledge, health beliefs and preventive behaviors among adult male and female in Najran city Saudi Arabia. This cross-sectional study was performed on 516 males and 581 females in Najran City, Saudi Arabia, from January to April 2023. The data collection instrument is a self-reported online questionnaire consisting of basic data, the Osteoporosis Preventive Behavior (OPB) scale, the osteoporosis knowledge assessment tool, and the osteoporosis health belief scale. The results revealed that male participants had a higher OPB (26.70) than females (20.32). However, females have a higher knowledge (10.71), perceive themselves as more susceptible to osteoporosis (20.34) and had higher exercise barriers (20.11) compared to males (9.97, 18.79 and 19.20, respectively). Statistically significant correlations (p < 0.001) were observed between OPB, osteoporosis knowledge (r = 0.26), perceived susceptibility (r = 0.33), severity (r = 0.53), exercise (r = 0.54) and calcium (r = 0.33) benefits, exercise (r = 0.40) and calcium (r = 0.81) barriers and health motivation (r = 0.37). The study concluded significant disparities between males and females regarding osteoporosis-related knowledge, preventive behaviors, perceived susceptibility, severity, and exercise perceived barriers. The results suggest gender-based educational interventions to enhance OPB by addressing osteoporosis-related knowledge, perceived susceptibility, seriousness, benefits, and health motivation.

Determinant of Osteoporosis Preventive Behaviors among Perimenopausal Women: A Cross-Sectional Study to Explore the Role of Knowledge and Health Beliefs

Osteoporosis is a silent chronic disease, and many people did not discover it until they were diagnosed with a fracture. Therefore, regular scanning and appropriate Osteoporosis Preventive Behaviors (OPB) are the management cornerstone. OPB is strongly affected by personal knowledge and health beliefs. This study explores the role of knowledge and health beliefs as determinants of OPB among perimenopausal women. This cross-sectional study was performed on 1075 perimenopausal women in Najran City, Saudi Arabia, from January 2023 to March 2023. The data collection instrument is a self-reported questionnaire consisting of basic data, the OPB scale, an osteoporosis knowledge assessment tool, and the osteoporosis health belief scale. The current study results showed that approximately one-quarter (27.8%) of the study participants had high OPB with an overall mean of 20.83 ± 5.08 grade. The group practicing high OPB demonstrated a higher knowledge mean (11.37 ± 2.99) than the low OPB group (9.93 ± 3.51). In addition, all health beliefs constructs significantly differed among the low and high OPB groups (p ˂ 0.05). The participant's age, occupational status, educational level, attendance of training courses, and history of bone fractures were significantly associated with high OPB. Osteoporosis knowledge, perceived susceptibility, perceived seriousness, exercises' perceived benefits, and health motivations are positive predictors of high OPB (p ˂ 0.05). The study concluded that osteoporosis-related knowledge and health beliefs-especially perceived susceptibility, perceived seriousness, exercises' perceived benefits, and health motivations-are positive predictors of high OPB. The health belief model can be an effective tool used to determine high-risk groups who practice low OPB and build need-based educational interventions.

Development and Validation of the Osteoporosis Knowledge, Attitude, and Behaviors Questionnaire for Female Osteoporosis Patients in Taiwan: A Mediation Model

This research develops the Osteoporosis Knowledge, Attitude and Behaviors Questionnaire (OKABQ) with the intent to evaluate the levels of osteoporosis knowledge, attitude and behavior change by developing and validating the OKABQ while establishing a mediation model of the research. A quantitative, descriptive and instrumental study was conducted in two phases: Phase I—development of the scale through Delphi Method by osteoporosis experts; and Phase II—evaluation of the validity and reliability of the scale and construction of a mediation model using SmartPLS. In Phase I, the content validity index (CVI) of the questionnaire was higher than 0.96 and the inter-rater reliability (IRR) kappa was 1.00. In Phase II, exploratory factor analysis showed that two predominating factors of attitude as a mediation were addressed by the 26-item OKABQ. The indirect effect results from the estimated model indicate that attitude mediates the relationship between knowledge and behaviors (β = 0.114, t = 2.627, p < 0.001), which is positive and statistically significant. We concluded that the OKABQ is a valid measure of osteoporosis knowledge, attitudes and behaviors for women with osteoporosis. These assessment results could assist healthcare providers in mitigating insufficiency in health education and help patients better adapt to a more active bone-healthy lifestyle.

Assessing the Knowledge and Attitude towards Osteoporosis among Syrian Women: A Cross-Sectional Study

BACKGROUND

Osteoporosis is a progressive decline in the bone mass, which occurs with no alterations to the bone's composition. It is associated with increased bone fragility that may eventually lead to fractures. In this study, we aim to assess the level of awareness that Syrian women possess regarding osteoporosis and spread the knowledge about its prevention measures.

METHODS

This study was approved by the Institutional Review Board of the Syrian Private University. A validated questionnaire was asked to be filled in by women aged 18 and above, who were presented to clinics at Damascus, Al Helal, and Al Zahrawi hospitals between 28 November 2021 and 5 March 2022.

RESULTS

6082 women were included, of which 63.9% (n = 3884) were under 30 years old and 89.3% (n = 5429) were in their reproductive age. The average knowledge score of osteoporosis was 69.2 ± 7.7 (28-100); 88.1% correctly defined osteoporosis while the majority (93.4%) has heard of it. The majority of our participants were living in rural areas (77.2%; n = 4698) while only 22.8% (n = 1384) were living in urban areas. The respondents from urban areas reported the highest knowledge scores (OR = 1.472; 95% CI: 1.258-1.723; P < 0.0001). 75.60% agreed that aging is a risk factor for osteoporosis. 64.6% were aware that osteoporosis is directly responsible for hip fractures. Smoking, family history, lack of exercise, and menopause were the main risk factors for osteoporosis, at 53.6%, 53.1%, 84.6%, and 60.7%, respectively. Social media represented the ultimate source of information on osteoporosis (64.70%).

CONCLUSION

Our study is the largest in the region and the first of its kind in the country. Syrian women had an average knowledge score regarding osteoporosis; the vast majority has defined it correctly and has heard of it. We found no statistical significance between age or educational level and adequate knowledge about osteoporosis.

Utilizing a Digital Multi-Language Patient Questionnaire for Diagnostic Imaging Examinations

In diagnostic imaging (DI) practice, patient questionnaires allow clinical staff to gather medical history information directly from patients. However, language barriers can prevent patients from completing the questionnaires and may endanger patient safety if the patient fails to indicate critical medical information. Interpreters are commonly employed to help patients convey important medical details; however, there are limits to their practical utilization. Thus, the purpose of this study was to evaluate the feasibility and practicality of a digital multi-language questionnaire designed to help overcome the language barriers between patients and clinical staff. The standard English-language questionnaire for bone mineral density (BMD) examinations was used in this study. It was translated into several languages and presented in an electronic form to patients in a language most suitable for them. The completed questionnaires, along with the patient responses, were automatically converted into English, allowing them to be reviewed by DI staff through a radiological information system (RIS) and picture archiving and communication system (PACS). Patients and clinical staff commented on the comfort of using the translated questionnaires. The modified Wald method was used to establish the confidence interval. The results showed that all patients and clinical staff were comfortable using the translated questionnaires. Ultimately, in this study we have developed a digital multi-language questionnaire for BMD examinations which can be converted into different languages and be stored in RIS and PACS. To the best of our knowledge, this approach had not been applied or tested elsewhere.

Screening for Bone Mineral Density and Assessment Knowledge Level of Low Peak Bone Risk Factors and Preventive Practices Among Kuwaiti Future Mothers

Background

Attaining greater peak bone mass (PBM) prior to the onset of bone loss is getting increasing public health attention as healthy strong bones are essential to maintain our life. Females are more susceptible to bone loss. Knowledge and awareness about low peak bone mass and its related risk factors are important contributors to its preventive behavior.

Objective

To screen apparently healthy young Kuwaiti future mothers for low bone mineral density (BMD) and to assess their knowledge level about determinants of PBM and preventive practices.

Methods

A cross-sectional comparative study on 445 eligible women aged 18–35 years (either students or employees from Kuwait University) was performed. Data on socio-demographic and lifestyle variables were obtained by a semi-structured questionnaire. Their knowledge was assessed using the modified Osteoporosis Knowledge Assessment Tool (OKAT). Bone mineral Density (BMD) was measured using Quantitative Ultrasonography (QUS).

Results

More than half (59.3%) of females had poor knowledge. A statistically significant relation was noted between the overall knowledge score and age, college, occupation, and socioeconomic class (P<0.05 for each). Only 13.9% have low Z-score by QUS. By logistic regression, less carbonated beverages and coffee consumption positively affect BMD, while inadequate exercises level, indoor exposure to sunlight, and less frequency of brisk walking negatively affect BMD.

Conclusion

Unacceptable knowledge score significantly associated with BMD Z-score status. More attention should be devoted to education programs targeting adolescents and young females to promote knowledge about PBM and practice towards accrual and maintenance of bone health.

Cross-Cultural Adaptation and Psychometric Properties of Osteoporosis Knowledge Tool-Arabic Version Among Iraqi Population

Background:

Osteoporosis is a major public health problem as the majority of people are not aware of the disease until the complications occur.

Objective:

The aims of this study were to validate Osteoporosis Knowledge Tool (OKT-A) Arabic version and to assess the osteoporosis knowledge among Iraqi general population.

Methods:

A descriptive, cross-sectional study was carried out in the city of Baghdad with a random cluster sampling method from the community. Forward–backward-forward translation method was used to translate the OKT questionnaire from English into Arabic language. The psychometric assessment process includes: face validity, reliability (Cronbach’s alpha and test-retest), item difficulty index, point biserial correlation and discriminatory power.

Results:

The results showed good face validity. The Cronbach’s alpha and Pearson correlation coefficient of the test re-test reliability were 0.775 and 0.412, respectively. Item difficulty index, point biserial correlation ranges and discriminatory power were 0.105 to 0.852, 0.105 to 0.445 and 0.933, respectively. These results demonstrated that OKT-A was a reliable and stable tool. The results showed low OKT-A scores 11.50±3.958. Furthermore, the OKT-A scores and its subscales were less than 50%. In addition, there were significant differences between the following independent variables in relation to total OKT-A scores: educational level, do you have osteoporosis or ever heard about osteoporosis. Moreover, there was a significant association between ever heard about osteoporosis groups and the OKT-A knowledge levels.

Conclusion:

This study showed good validity and reliability of OKT-A tool among Arabic general population. In addition, the results showed an urgent need for implementing an educational programme and should be a public health practice to increase the knowledge toward osteoporosis and its related risk factor.

Osteoporosis knowledge and beliefs in diabetic patients: a cross sectional study from Palestine

BACKGROUND

Osteoporosis is a potential metabolic complication of diabetes mellitus (DM). Therefore, patients with DM should have adequate osteoporosis knowledge and beliefs in order to get engaged in osteoporosis preventive behaviors. The objective of this study was to assess osteoporosis knowledge and beliefs among diabetic patients.

METHODS

This was a cross sectional study carried out at Al-Makhfiah governmental primary healthcare unit in Nablus, Palestine from September 2016 to December 2016. The tools used to assess knowledge and beliefs were Osteoporosis Health Belief Scale (OHBS) and the Osteoporosis Knowledge Test (OKT) respectively.

RESULTS

Three hundred diabetic patients were interviewed regarding their knowledge and belief about osteoporosis. The study sample included 192 (64.0%) females. Mean ± standard deviation (SD) of the participants was 58.5 ± 9.3 years. Regarding co-morbidities, 229 (76.3%) had at least one co-morbidity other than DM. The majority of participants incorrectly answered 19 out of 32 questions of OKT scale. The mean OKT score was 13.5 ± 4.2 indicating poor osteoporosis - related knowledge. Females had significantly higher nutrition (p = 0.037), exercise (p = 0.043), and OKT score (p = 0.021) than males. Regarding OHBS, female participants had significantly higher belief score of susceptibility (p <  0.01) and seriousness (p <  0.01) of osteoporosis compared to males.

CONCLUSIONS

Diabetic patients had poor osteoporosis knowledge and moderate perception of susceptibility and seriousness of osteoporosis. These results require implementation of awareness programs among DM patients to increase their practices regarding preventive measures of osteoporosis such as calcium intake and exercise.

Assessing health beliefs about osteoporosis among women attending primary health care centres in Qatar

Objective

Osteoporosis is a global health problem, and its prevalence is rapidly increasing worldwide. Misconceptions about osteoporosis and the lack of preventive measures among women are still common, emphasizing the need for primary prevention at an early age. The process of planning an effective osteoporosis prevention programme requires sufficient information about women's osteoporosis health beliefs. The objective of this study is to assess the health beliefs of 20–44 year-old Arab women about osteoporosis at primary health care centres in the State of Qatar.

Methods

The researchers utilized a cross-sectional study design, where cluster sampling with proportionate allocation was employed to enrol 766 eligible women who were interviewed using a structured Arabic questionnaire.

Results

The majority of the participating women showed lower perceived susceptibility to osteoporosis (71.7%) but higher perceived benefits of preventive practices (91.7%).

Conclusion

Despite lower perception of susceptibility to osteoporosis, women were highly motivated to take care of their health and believed in the benefits of a calcium-rich diet and regular exercise. The integration of osteoporosis prevention into women's health programmes at the primary health care level, as well as physical activity and nutritional programs, are recommended.

Osteoporosis knowledge and attitudes: a cross-sectional study among female nursing school students in Damascus

SUMMARY

This study was conducted to determine the level of osteoporosis knowledge and beliefs among nursing college students in Damascus. A worrying deficit of knowledge was found. They believed osteoporosis to be a serious disease but did not feel susceptible to or concerned about it. Innovative educational interventions should be considered.

PURPOSE

Increasing awareness, knowledge, and promoting healthy behaviors about osteoporosis and related risk factors are effective prevention measures for building and maintaining strong bone throughout the life-span. We hypothesized a lack of knowledge and unhealthy beliefs about osteoporosis among young women in our setting. The level of osteoporosis knowledge, beliefs, and behavior among nursing college students in Damascus was evaluated in this study.

METHODS

A cross-sectional study was conducted on a convenience sample of female young students seen at the nursing school. All students registered for the year 2011-2012 were included in the study. A self-administered questionnaire was implemented. The questionnaire included background information and both osteoporosis-related tools (Arabic version), namely the Osteoporosis Knowledge Assessment Tool (OKAT) and the Osteoporosis Health Belief Scale.

RESULTS

A total of 353 female students answered the questionnaire with a response rate of 98.3%. A worrying deficit of knowledge was found among surveyed Syrian young adult females with a total mean score of 7.9 (2.7) out of possible 20 points, being 39.6% of possible maximum score on the OKAT. Those young women believed osteoporosis to be a serious disease but did not feel susceptible to or concerned about the illness. Perceived moderate to high barriers to exercises and calcium intake indicated negative health beliefs.

CONCLUSIONS

The findings generally reveal poor knowledge about osteoporosis among nursing school female students at Damascus. Integration of osteoporosis in school curricula and public education efforts is urgently needed.