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      Knowledge, beliefs, and concerns about bone health from a systematic review and metasynthesis of qualitative studies

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          Abstract

          Background

          Patients with low bone density or osteoporosis need information for effective prevention or disease management, respectively. However, patients may not be getting enough information from their primary care providers or other sources. Inadequate disease information leaves patients ill-informed and creates misconceptions and unnecessary concerns about the disease.

          Objective

          We systematically reviewed and synthesized the available literature to determine patient knowledge, beliefs, and concerns about osteoporosis and identify potential gaps in knowledge.

          Methods

          A systematic search was conducted for full-text qualitative studies addressing understanding, literacy, and/or perceptions about osteoporosis and its management, using Medline, EMBASE, Web of Science, Cochrane Library, CINAHL, ERIC, PsychINFO, Psyc Behav Sci Collec, and PubMed, from inception through September 2016. Studies were selected by two reviewers, assessed for quality, and themes extracted using the Joanna Briggs Institute data extraction tool. Thematic analysis was used to identify themes and subthemes.

          Results

          Twenty-five studies with a total of 757 participants (including 105 men) were selected for analysis out of 1031 unique citations. Selected studies were from Australia, Canada, Denmark, Norway, the United Kingdom, and the United States. Four main themes emerged: inadequate knowledge, beliefs and misconceptions, concerns about osteoporosis, and lack of information from health care providers. Participants had inadequate knowledge about osteoporosis and were particularly uninformed about risk factors, causes, treatment, and prevention. Areas of concern for participants included diagnosis, medication side effects, and inadequate information from primary care providers.

          Conclusion

          Although there was general awareness of osteoporosis, many misconceptions and concerns were evident. Education on bone health needs to reinforce areas of knowledge and address deficits, misconceptions, and concerns.

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          Most cited references40

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          Failure to perceive increased risk of fracture in women 55 years and older: the Global Longitudinal Study of Osteoporosis in Women (GLOW)

          E Siris, S. Gehlbach, J. Adachi … (2010)
          Summary We compared self-perception of fracture risk with actual risk among 60,393 postmenopausal women aged ≥55 years, using data from the Global Longitudinal Study of Osteoporosis in Women (GLOW). Most postmenopausal women with risk factors failed to appreciate their actual risk for fracture. Improved education about osteoporosis risk factors is needed. Introduction This study seeks to compare self-perception of fracture risk with actual risk among postmenopausal women using data from GLOW. Methods GLOW is an international, observational, cohort study involving 723 physician practices in 17 sites in ten countries in Europe, North America, and Australia. Participants included 60,393 women ≥55 years attended by their physician during the previous 24 months. The sample was enriched so that two thirds were ≥65 years. Baseline surveys were mailed October 2006 to February 2008. Main outcome measures were self-perception of fracture risk in women with elevated risk vs women of the same age and frequency of risk factors for fragility fracture. Results In the overall study population, 19% (10,951/58,434) of women rated their risk of fracture as a little/much higher than that of women of the same age; 46% (27,138/58,434) said it was similar; 35% (20,345/58,434) believed it to be a little/much lower. Among women whose actual risk was increased based on the presence of any one of seven risk factors for fracture, the proportion who recognized their increased risk ranged from 19% for smokers to 39% for current users of glucocorticoid medication. Only 33% (4,185/12,612) of those with ≥2 risk factors perceived themselves as being at higher risk. Among women reporting a diagnosis of osteopenia or osteoporosis, only 25% and 43%, respectively, thought their risk was increased. Conclusion In this international, observational study, most postmenopausal women with risk factors failed to appreciate their actual risk for fracture.
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            Knowledge about osteoporosis: assessment, correlates and outcomes.

            Perla Werner (2005)
            During the last 10 years, we have witnessed an impressive increase in the number of studies examining knowledge about osteoporosis. The aim of the present paper is to examine the status of research on knowledge about osteoporosis by reviewing and analyzing the current literature as it pertains to assessment of knowledge about osteoporosis, factors associated with knowledge, and relationship between knowledge about osteoporosis and participation in health-related behaviors. Finally, future directions in the field are discussed. Many of the studies are still characterized by the lack of a theoretical framework, as well as by various methodological flaws. Serious deficits in knowledge are reported among healthy and diagnosed women and men, as well as among health professionals. Educational interventions are accompanied by an increase in knowledge, but no change in behavior. There is need to expand the research on knowledge about osteoporosis, especially in an effort to increase its impact on the prevention and early diagnosis of the disease. The deficits found in the knowledge of both the general population and among health care professionals, should be addressed by providing updated and reliable information through appropriate health promotion and professional venues.
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              How do osteoporosis patients perceive their illness and treatment? Implications for clinical practice.

              Sarah Besser, Janet Anderson, John A Weinman (2012)
              Non-adherence inhibits successful treatment of osteoporosis. This study used a theoretical framework to explore osteoporosis patients' cognitive and emotional representations of their illness and medication, using both interviews and drawing. We recorded some misconceptions patients have about their condition and medication which could act as barriers to treatment adherence.
              Article 0 comments Cited 18 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Jude des Bordes: Role: Data curationRole: Formal analysisRole: MethodologyRole: SoftwareRole: ValidationRole: Writing – original draftRole: Writing – review & editing
                Seema Prasad: Role: Data curationRole: Formal analysisRole: Writing – review & editing
                Greg Pratt: Role: Formal analysisRole: MethodologyRole: ResourcesRole: Writing – review & editing
                Maria E. Suarez-Almazor: Role: ConceptualizationRole: MethodologyRole: Writing – review & editing
                Maria A. Lopez-Olivo:
                ORCID: http://orcid.org/0000-0002-5165-8393
                Role: ConceptualizationRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: SoftwareRole: ValidationRole: Writing – original draftRole: Writing – review & editing
                Osama Farouk: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS ONE
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, CA USA )
                ISSN (Electronic): 1932-6203
                Publication date (Electronic): 15 January 2020
                Publication date Collection: 2020
                Volume: 15
                Issue: 1
                Electronic Location Identifier: e0227765
                Affiliations
                [1 ] Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
                [2 ] Department of Gastroenterology Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
                [3 ] Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
                Assiut University Faculty of Medicine, EGYPT
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0002-5165-8393
                Article
                Publisher ID: PONE-D-19-19589
                DOI: 10.1371/journal.pone.0227765
                PMC ID: 6961946
                PubMed ID: 31940409
                SO-VID: 8ef83972-71fe-4e0a-b95a-971f8aad3b1e
                Copyright © © 2020 des Bordes et al
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 18 July 2019
                Date accepted : 27 December 2019
                Page count
                Figures: 3, Tables: 3, Pages: 17
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/100007314, Duncan Family Institute for Cancer Prevention and Risk Assessment;
                Award ID: 600701-80-110770-19
                Award Recipient :
                ORCID: http://orcid.org/0000-0002-5165-8393
                This study was supported by an Institutional Research Grant (# 600701-80-110770-19) awarded to Dr. Maria A. Lopez-Olivo from the University Cancer Foundation and the Duncan Family Institute for Cancer Prevention and Risk Assessment via the Cancer Survivorship Research Seed Money Grants at the University of Texas, MD Anderson Cancer Center.
                Categories
                Subject: Research Article
                Subject: Medicine and Health Sciences
                Subject: Rheumatology
                Subject: Connective Tissue Diseases
                Subject: Osteoporosis
                Subject: Medicine and Health Sciences
                Subject: Critical Care and Emergency Medicine
                Subject: Trauma Medicine
                Subject: Traumatic Injury
                Subject: Bone Fracture
                Subject: Biology and Life Sciences
                Subject: Anatomy
                Subject: Bone
                Subject: Bone Density
                Subject: Medicine and Health Sciences
                Subject: Anatomy
                Subject: Bone
                Subject: Bone Density
                Subject: Biology and Life Sciences
                Subject: Anatomy
                Subject: Biological Tissue
                Subject: Connective Tissue
                Subject: Bone
                Subject: Bone Density
                Subject: Medicine and Health Sciences
                Subject: Anatomy
                Subject: Biological Tissue
                Subject: Connective Tissue
                Subject: Bone
                Subject: Bone Density
                Subject: Research and Analysis Methods
                Subject: Research Design
                Subject: Qualitative Studies
                Subject: Medicine and Health Sciences
                Subject: Health Care
                Subject: Health Education and Awareness
                Subject: Medicine and Health Sciences
                Subject: Health Care
                Subject: Health Care Providers
                Subject: Medicine and Health Sciences
                Subject: Health Care
                Subject: Primary Care
                Subject: Research and Analysis Methods
                Subject: Database and Informatics Methods
                Subject: Database Searching
                Custom metadata
                Data Availability All relevant data are within the paper and its Supporting Information files.

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