Female Employee’s Knowledge toward Osteoporosis in University of Sulaimani / Old Campus

Female Employee’s Knowledge toward Osteoporosis in University of Sulaimani /Old Campus

Dr. Gona Othman Faris¹, A.L. Lana Abdul Hamed Muhamad Nury², Dr. Mahabat Hassan Saeed ³*

1. Department of maternal neonate nursing, College of Nursing, University of Sulaimani, City of Sulaimani, Iraq;
2. Department of maternal neonate nursing, College of Nursing, University of Sulaimani, City of Sulaimani, Iraq.
3. Department of maternal neonate nursing, College of Nursing, University of Sulaimani, City of Sulaimani, Iraq.

Corresponding author: Dr.  Gona Othman Faris

Email: Gona.Faris@univsul.edu.iq

ORCID 0000-0002-7083-935X

ABSTRACT

Background: Osteoporosis is one of the top five illnesses that lead to lengthy hospital stays and disability, but it is still underdiagnosed globally, particularly in developing nations. Consequently, the purpose of this study was to ascertain the awareness of this condition among female employees in Sulaimani city. Methods: A cross-sectional study of female employees at the University of Sulaimani old campus was done from October to December 2022. The convenience sample size was used to enroll 100 female workers in total. The Osteoporosis Knowledge Assessment Tool (OKAT) was used to present a self-administered structured questionnaire to gather information about sociodemographic factors and female awareness of osteoporosis. Results: The age range of the study's participating employees was between 35 and 45 years old, with a mean age and a standard deviation of 35.1 and 12.9 years, respectively. The majority of them (50 percent, 64 percent, and 58 percent, respectively) were unmarried, urban dwellers, barely surviving, and highly educated. According to the participant's knowledge score, 56% had fair awareness about osteoporosis, 38% had strong knowledge, and only 6% had poor knowledge. Age and economic level had a statistically significant relationship with knowledge of osteoporosis (p-value = 0.001), as did knowledge score. Conclusions: The majority of participants scored fairly well on knowledge about osteoporosis. Nonetheless, there was a sizable knowledge gap with relation to the same risk factors. In the current study, the good knowledge score was much lower than the global average. The quality and trustworthiness of information about osteoporosis must therefore be improved through educational efforts.

Keywords: Osteoporosis, Knowledge, Employee, risk

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Received: 21 March 2023, Revise Date: 17 May 2023 Accepted:29 May 2023, Available online: 28 July 2023

INTRODUCTION

Both men and women are susceptible to osteoporosis, which is a global public health issue (GH, 2017)(Danish et al., 2014)(Kanis, 2007). It is a significant health issue with a high prevalence (Amin, S., Mukti, 2017)(Bilal et al., 2017). Almost 75 million people suffer from osteoporosis globally (Amin, S., Mukti, 2017). Ten million Americans over the age of 50 in the US are affected by osteoporosis, with about 80% of them being women (GH, 2017).

A systemic skeletal condition called osteoporosis has been described as having a bone mineral density (BMD) that is 2.5 or more standard deviations (SD) below the mean for healthy young white women (T-score of 2.5 or less) (Lindsay & Cosman, 2020)(Anthony DW, 2003). Nowadays, osteoporosis is one of the top five illnesses leading elderly individuals to become disabled and require extended hospital stays (Jalili et al., 2007). Even if it cannot be cured, the sickness can be avoided.

Osteoporosis is a quiet, degenerative condition that damages the skeleton, depletes bone density, and increases the risk of fracture (Weppner DAR, 2018). Osteoporosis-related fractures (ORF) place a significant financial, morbidity, and death burden. According to estimates, 60% of osteoporotic women will experience one or more ORFs, and 70% of women will have osteoporosis in the hip, spine, or forearm by the age of 80. The expenses of osteoporosis-related fractures in the US were around $1.9 billion (GH, 2017). 

The sole cause of osteoporosis is no longer thought to be aging. Although it can affect toddlers, adults, males, and premenopausal women, this syndrome can also be brought on by specific disorders and medications (Society, n.d.). It is extremely important to reach your maximal bone mass during adolescence because osteoporosis can strike at any age (HT, 2000). Ageing, Asian or Caucasian race, feminine gender, family history of osteoporosis, or fragility fractures are all risk factors for osteoporosis. Low body mass index, menopause before age 45, extended amenorrhea unrelated to menopause, nulliparity, or prolonged lactation are additional risk factors. Moreover, a diet low in calcium and vitamin D, as well as lactose intolerance and poor intestinal absorption of calcium. Exceptional behaviors include smoking, drinking too much alcohol or caffeine, and leading a sedentary lifestyle. Some circumstances, such as long-term use of anticoagulants, glucocorticoids, anticonvulsants, aluminum antacids, and thyroid hormone therapy (Sultan A, Khan DA, Mushtaq M, 2006)(Habiba U, Ahmad S, 2002)(Health, 2000).

Caucasians are more likely to have osteoporosis, and by 2050, it is predicted that Asia would account for more than half of all osteoporotic fractures (Lau, 2009). Compared to western nations, it appears that BMD is lower in the majority of Middle Eastern nations (Maalouf et al., 2007)(Kanis, 2007). According to the National Institutes of Health (NIH), environmental factors may account for up to 25% of bone mass and hereditary factors for up to 75% of it. Therefore, it is crucial to comprehend what constitutes a risk factor and who may be more susceptible to bone fragility ((NIAMS), 2009). Osteoporosis is characterized by fractures, and addressing this consequence involves educating patients (Harmanjit S, Manoj G, 2013). These women will not be able to assess their risk of getting osteoporosis, ask for diagnostic testing, take preventative measures to fend off this disease, or understand that osteoporosis begins several years before menopause if they do not have the knowledge. As a result, individuals might believe that prevention should wait until after menopause (Lane, 2006)(McLeod & Johnson, 2011)(20). As a result, it is urgently necessary to raise both older and younger women's understanding of and beliefs about osteoporosis.

Therefore, spreading awareness of osteoporosis should be a top goal for future intervention programs that encourage specific behavioral techniques for osteoporosis prevention, especially since that it affects people of all ages and is not just a disease of older people. As a result, the current study was carried out to evaluate the female employees' understanding of osteoporosis at Sulamani University's old campus.

METHOD

Design:  A cross-sectional survey was done, which included other colleges outside the medical colleges, was carried out among female employees at Sulaimani University's old campus between October and December 2022.

Study sample: Via a convenience sample, anybody working on the old campus of Sulaimani University who provided oral consent was eligible for this study. Thirteen surveys were removed due to insufficient data out of a total of 130 that were distributed and 113 that were returned.

Data collection: Disseminated a self-administered questionnaire with a list of inquiries about knowledge of osteoporosis. The questionnaire had two parts. The first part asked about the participants' identification, including their age, marital status, economic situation, educational attainment level, place of residence, prior diagnosis of osteoporosis and other bone diseases, history of personal fractures, and family history of osteoporosis. The Osteoporosis Knowledge Assessment Tool (OKAT) questionnaire was used to gauge the knowledge of the female participant in the second section. Twenty true and false questions about people's awareness of osteoporosis were included in the OKAT questionnaire (Winzenberg et al., 2003).

Data analysis: The data on knowledge of osteoporosis was analyzed using SPSS (version 22.0), a statistical package for the social sciences. The significant correlation between knowledge of osteoporosis and risk factor was compared using the Pearson's chi-square test. 0.05 was established as the threshold for significance. Participants' knowledge of osteoporosis was graded using the following system: one point was awarded for each response that was correct and zero points for each response that was wrong or unknowing. The total number of correct answers received a score out of 20; the scores were divided into three categories: inadequate knowledge (scoring 10), fair knowledge (score > 15), and strong knowledge (score > 15). Scale dichotomous random variable scoring scales for reevaluation, and scales according to the following intervals: Strong effect 0.66-1.00, Moderate effect 0.34-0.66, and Low effect 0.00-0.33.

RESULTS

Table 1 shows the study's inclusion of 100 female workers at the former campus of Sulaimani University. Participants' ages ranged from under 35 to over 45, with a mean and standard deviation of 35.1 and 12.9 years, respectively. Moreover one-third (40%) of those examined were under 35, 32% were over 45, and 28% were in the 35–45 age range. About half of the participants (50%) and (58%) were unmarried, highly educated, and living on just enough money. 64% of people (more than two-thirds) reside in cities.  According to the study, 80% of the sample did not have an osteoporosis diagnosis, and just 14% of females had a personal fracture history. In Table 2, the level of awareness regarding osteoporosis among the study sample's female employees is examined. Yet, the outcome indicated that the mean value of knowledge ranged from (0.08-0.94). Of the twenty knowledge items, eleven (11) had means between 0.66 and 1.00, indicating a high degree of knowledge. The remaining seven items, with averages of (0.42, 0.62, 0.66, 0.52, 0.58, 0.66, and 0.36), however, show a modest level of understanding. While just knowing (2) of the items, the respondents. Considering the study sample's overall mean and standard deviation for knowledge of osteoporosis is (13.3±2.37).

Table 1 Socio-demographic characteristics of respondents:

Table 2 Percentage of correct responses of various questions regarding knowledge of osteoporosis among the respondents:

MS: Mean of score    H: High effect 0.66-1.00;

M: Moderate effect 0.34- 0.66   L: Low effect 0.00-0.33

Table 3:  Overall Knowledge score of female osteoporosis among employees

Table 4: Association between socio-demographic characteristics and overall knowledge female employee regarding osteoporosis. 

x^{2 =} Chi-square

DISCUSSION

Osteoporosis is a serious and spreading public health issue that primarily affects women but affects all sexes. For senior people, it is the leading cause of fractures. It results in suffering, incapacity, expensive rehabilitation, a lackluster quality of life, and death. One of the most prevalent musculoskeletal conditions, osteoporosis is highly prevalent globally. Hence, the degree of public awareness of osteoporosis determines the effectiveness of osteoporosis prevention and control. The goal of the current study was to determine how well female employees at the University of Sulaimani's old campus informed were about osteoporosis.

 The participants in the current study had a mean age of 35.1 12.9 years; the participants in the Erbil study had a mean age of 35 8.24 years; the majority of them were married and had a family history of osteoporosis (Mohammed & Dauod, 2021). Similar to our study, which found that 50% of the studied sample were barely surviving in terms of their economic status, highly educated (58.0%), and living in urban areas (64.0%), a study conducted in Egypt found that the majority of the studied sample were barely surviving, highly educated, and lived in urban areas (Elsabagh et al., 2015).

People who do not believe they are at risk for osteoporosis do not maintain a healthy lifestyle that is proactive. Compared to a study conducted in Saudi Arabia where the results were 37%, 39%, and 23%, respectively, the current study's participants were more aware of the significance of female gender, alcohol intake, and smoking in osteoporosis (62%) (Al-Shahrani et al., 2010).

 This result is similar with earlier research conducted in Turkey and Iran (Anthony DW, 2003)(Ungan & Tümer, 2001) . This may be due to the general perception in our society that drinking and smoking are detrimental for a person's overall health, rather than knowledge of their specific effects on bone, especially as only 34% of people were aware that hormone replacement treatment can stop further bone loss.

The majority of study participants were aware of the dietary sources of calcium, but only 42% understood that a family history of osteoporosis is a risk factor for the condition. This conclusion conflicts with those of women in the USA, the majority of whom are aware that a family history of osteoporosis is a risk factor (Endicott, 2013). The greater healthcare access, public health education, and prevention of diseases like osteoporosis among American women may be the cause of the discrepancy across research.

 The findings of our investigation revealed that 36% of the sample lacked sufficient knowledge of the white race. On the other hand, they are sufficiently aware of the effects of corticosteroids (80%), high salt intake (88%), and early menopause (68%). Nonetheless, half of them (52%) were aware that osteoporosis can cause a person's height to shorten as they age. According to the Abril study, there was a variance in the degree to which participants recognized early menopause (51.4%), female gender (59.5%), and smoking (53.4%) as risk factors for osteoporosis. However, they had insufficient knowledge about their race—being white (46.8%), their family history (40.8%), their high salt intake (46.8%), and their use of corticosteroids (10.6%) (Mohammed & Dauod, 2021).

In summary, the study found that the majority of participants' students (76%) thought that osteoporosis was a risk factor for fractures. Whereas just 14% were aware of the osteoporosis symptoms that occur before bone fracture. This finding is consistent with a study conducted in Saudi Arabia, which notes that (98.9%) of participants' employees believed osteoporosis to be a risk factor for fractures and that (35.8%) of participants' employees were aware of osteoporosis symptoms prior to bone fracture (Utkarsh Shahi et al., 2019).

This finding is consistent with other studies that reported that most of the participants did not know that a higher peak bone mass is protective against osteoporosis (Elsabagh et al., 2015)(De Silva et al., 2014). In the current study, the majority of the employees (68%) knew that having a higher peak bone mass is protective for osteoporosis (Endicott, 2013).

The majority of employees (56%) have fair understanding about osteoporosis, (38%) have strong knowledge, and just (6%) have poor knowledge, according to the survey.

 A study conducted in Saudi Arabia (Utkarsh Shahi et al., 2019) that found 32.2% of participants' employees had bad knowledge scores on osteoporosis—in contrast to a study conducted in Malaysia that found (79.4%) of participants had poor level knowledge—found the opposite of our findings (Amin, S., Mukti, 2017). Another study conducted in Pakistan among women revealed that 82.1% had strong understanding about osteoporosis while 17.9% had low knowledge (Tahir et al., 2016). Many studies found that women have little understanding of osteoporosis (Pande et al., 2005) (Ribeiro V, Blakeley J, 2000).

On the other hand, the current study revealed greater fair knowledge (56%), and the outcome is consistent with a study among female employees in Sri Lanka (51.6%) (De Silva et al., 2014).

 Overall, the results of the current survey show that just 38% of people have an adequate understanding of osteoporosis. According to other studies, 8% of participants in Pakistan and Sri Lanka (Bilal et al., 2017) (De Silva et al., 2014) and 2.5% in Saudi Arabia demonstrated good knowledge (Utkarsh Shahi et al., 2019). As a result, there are differences in knowledge scores about osteoporosis around the globe. Education has a big impact on cognitive abilities, especially knowledge.

According to our study, there was a statistically significant correlation between age and socioeconomic status and knowledge of osteoporosis, with a p-value of 0.001. In contrast to our findings, a study conducted in Iran found no correlation between age and osteoporosis awareness levels (Amani et al., 2015).

On the other hand, there was no real correlation between osteoporosis knowledge score and residency or educational attainment. Other research conducted in the KSA, Iran, and Turkey that contradicted our findings indicated a strong correlation between educational attainment and awareness of osteoporosis (Ungan & Tümer, 2001)(Amani et al., 2015)(Alamri FA, Saeedi MY, Mohamed A, Barzanii A, Aldayel M, 2015).

CONCLUSIONS

According to the findings from this study, the majority of participants had fair awareness of osteoporosis. Nonetheless, there was a sizable knowledge gap with relation to the same risk factors. In the current study, the good knowledge score was much lower than it was globally. Age and financial state were found to be statistically significantly correlated with knowledge of osteoporosis. In order to increase knowledge and the quality and reliability of information about osteoporosis targeted at female employees, the current study advises better involvement of health authorities and higher educational authorities.

ETHICAL CONSIDERATIONS COMPLIANCE WITH ETHICAL GUIDELINES

The scientific and ethical committee of the College of Nursing at the University of Sulaimani has given its approval for this work. Participants gave their unofficial consent.

FUNDING
Author fees were used to pay for this study.

AUTHOR’S CONTRIBUTIONS

Author designed the study, oversaw data collection and management, and prepared the report's manuscript.

DISCLOSURE STATEMENT:

The authors state that they have no conflicts of interest.

ACKNOWLEDGEMENTS

We would like to thank every employee who took part in the study. Special thanks go out to the University of Sulaimani administration at the old campus for their assistance and cooperation in providing the research data.

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