An Equation Model Development and Test based on Health Belief Model Regarding Osteoporosis Prevention Behaviors among Postmenopausal Women

건강신념 모형 기반 폐경 여성의 골다공증 예방행위 모형 개발 및 검정

Jang, Hyun-Jung;Ahn, Sukhee

  • Received : 2015.09.17
  • Accepted : 2015.11.29
  • Published : 2015.12.31


Purpose: This study was to develop and test a theoretical model based on the revised health belief model explaining osteoporosis prevention behaviors among postmenopausal women under 65. Methods: This secondary data analysis included 342 postmenopausal women under 65 from original data sources of a total of 734 women. The measured instruments were scales for osteoporosis awareness, osteoporosis health belief scale (benefit, barrier, susceptibility, severity, and health motivation), self-efficacy, and osteoporosis prevention behaviors. Data were analyzed using SPSS/WIN 20.0 and AMOS 20.0. Results: The mean age of the subjects was 55.2 years and the mean age of menopause was 51.10. The hypothetical model of osteoporosis prevention behaviors was relatively fit. Osteoporosis prevention behaviors were significantly explained up to 62% by expectation factors (relative benefit, self-efficacy, health motivation) and modifying factors(knowledge only). Expectation factors of health belief had a mediation effect between modifying factors and prevention behaviors. Conclusion: This study partially supported the revised health belief model for explaining osteoporosis prevention behaviors. It provides a basis for developing an educational program focusing on expectation factors and knowledge with the aim of behavioral changes for osteoporosis prevention.


Osteoporosis;Prevention;Menopause;Health belief;Knowledge


  1. Statistics Korea. 2012 Life tables for Korea [Internet]. Daejeon: Author; 2013 [cited 2013 December 20]. Available from:
  2. Nam HS, Kweon SS, Choi JS, Zmuda JM, Leung PC, Lui LY et al. Racial/ethnic differences in bone mineral density among older women. Journal of Bone and Mineral Metabolism. 2013; 31(2):190-8.
  3. Lee JS, Jang SO. A study on reference values and prevalence of osteoporosis in Korea: the Korea National Health and Nutrition Examination Survey 2008-2011. Journal of the Korean Official Statistics. 2013;18(2):42-65.
  4. Moon ES, Lee ES. The relationship between knowledge, health beliefs, and prevention behaviors of osteoporotic fracture in patients receiving osteoporosis treatment. Korean Journal of Women Health Nursing. 2010;16(2):147-56.
  5. Rosenstock IM, Strecher VJ, Becker MH. Social learning theory and the health belief model. Health Education Quarterly. 1988;15:175-83.
  6. Champion, V. L., Skinner, C. S. The health belief model. 4th ed. In: Glanz K, Rimer BK, Viswanath K, editors. Health behavior and health education: theory, research, and practice. San Francisco: Jossey-Bass; 2008. p. 49.
  7. Kim KK, Horan ML, Gendler P, Patel MK. Development and evaluation of the osteoporosis health belief scale. Research in Nursing & Health. 1991;14(2):155-63.
  8. Horan ML, Kim KK, Gendler P, Froman RD, Patel MD. Development and evaluation of the osteoporosis self-efficacy scale. Research in Nursing & Health. 1998;21(5):395-403.<395::aid-nur3>;2-i<395::AID-NUR3>3.0.CO;2-I
  9. Shin SJ, Shin KR, Yi HR, Ju SK. Knowledge, health belief, and self-efficacy related to osteoporosis. Journal of Korean Academy Nursing. 2005;35(5):850-7.
  10. Kim MH, Kim MS. A study on the relationships between knowledge about osteoporosis and cognitive factors in middle-aged women. Korean Journal of Women Health Nursing. 2005;11(1):52-7.
  11. Song HR, So HY. Effects of the knowledge, health belief, and self-efficacy about osteoporosis on calcium intake behavior for postmenopausal osteoporosis patients. Korean Journal of Adult Nursing. 2007;19(5):80-91.
  12. Sedlak CA, Doheny MO, Estok PJ, Zeller RA, Winchell J. DXA, health beliefs, and osteoporosis prevention behaviors. Journal of Aging and Health. 2007;19(5):742-56.
  13. Shakil A, Gimpel NE, Rizvi H, Siddiqui Z, Ohagi E, Billmeier TM, et al. Awareness and prevention of osteoporosis among South Asian women. Journal of Community Health. 2010;35(4):392-7.
  14. Von Hurst PR, Wham CA. Attitudes and knowledge about osteoporosis risk prevention: a survey of New Zealand women. Public Health Nutrition. 2007;10(7):747-53.
  15. Deo P, Nayak R, Rajpura J. Women's attitudes and health beliefs toward osteoporosis screening in a community pharmacy. Journal of Osteoporosis. 2013;2013:650136.
  16. Zhang YP, Xia RY, Zhang B, Zhang F, Zhao XS, Zhang LL, et al. Gender differences on osteoporosis health beliefs and related behaviors in non-academic community Chinese. Journal of Community Health. 2014;39(3):545-51.
  17. Johnson CS, McLeod W, Kennedy L, McLeod K. Osteoporosis health beliefs among younger and older men and women. Health Education & Behavior. 2008;35(5):721-33.
  18. McLeod KM, Johnson CS. A systematic review of osteoporosis health beliefs in adult men and women. Journal of Osteoporosis. 2011;2011:197454.
  19. Lee SH. Prediction model on osteoporosis prevention behavior in middle aged women. [dissertation]. Seoul: Korea University; 2006.
  20. Park YJ, Lee SJ, Shin NM, Kang HC, Kim SH, Kim T, et al. Structural model for osteoporosis preventive behaviors in postmenopausal women: focused on their own BMD awareness. Korean Journal of Adult Nursing. 2013;25(5):527-38.
  21. Estok PJ, Sedlak CA, Doheny MO, Hall R. Structural model for osteoporosis preventing behavior in postmenopausal women. Nursing Research. 2007;56(3):148-58.
  22. Ahn SH, Kim YM, Chun NM, Lee SH. Incidence of osteoporosis and falls and predictors of fracture risk in postmenopausal women. Korean Journal of Women Health Nursing. 2012;18(4):237-47.
  23. Kim GS. Analysis structural equation modeling. Seoul: Hannarae Publishing Co.; 2010.
  24. Wallace LS. Osteoporosis prevention in college women: application of the expanded health belief model. American Journal of Health Behavior. 2002;26(3):163-72.
  25. Choi ES, Kim JH, Chung MY, Hwang KH. Development of an osteoporosis awareness scale for women. Journal of Korean Academy of Nursing. 2008;38(6):813-21.
  26. Doheny MO, Sedlak CA, Hall RJ, Estok PJ. Structural model for osteoporosis preventing behavior in men. American Journal of Men's Health. 2010;4(4):334-43.
  27. Jang HJ, Ahn SH. A predictive model of fall prevention behaviors in postmenopausal women. Journal of Korean Academy Nursing. 2014;44(5):525-33.

Cited by

  1. A Study on the Effect of Info Seeking on Breast Cancer Screening Intention: Focusing on HBM and Autonomous Motives vol.19, pp.7, 2018,
  2. Relationships among Knowledge, Self-efficacy, and Health Behavior of Osteoporosis and Fall Prevention in Old Aged Women vol.24, pp.2, 2018,


Supported by : 한국연구재단