الفهرس 
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Abstract
Based on the current study results and research hypothesis, the following can be concluded:
The knowledge and reported practices of adolescent girls about osteoporosis improved after implementing the educational program through applying health belief model. More than two fifth of the adolescent girls had positive beliefs regarding osteoporosis, while more than half of them had negative beliefs.
Recommendations
The finding of the present study, suggested the following recommendations:
More comprehensive interventions on the benefits and barriers of calcium intake and use of other behavioral modification theories. It is advised that researchers explain social and behavioral barriers in calcium intake in different cultural contexts.
Further research about:
Applying health belief model on wide range of female’s age group including adolescents, young, middle aged and elderly women.
Investigate contributing factors of osteoporosis among young adults to improve understanding and management.
Study the correlation between demographic characteristics and behavioral, social barriers in calcium intake in different cultural contexts.
Summary
Osteoporosis is not curable, and irreversible chronic disease once established. Thus, prevention is better than treatment. Fortunately, the risk of osteoporosis can be recognized and also potentially the onset of bone loss prevented or delayed with modifiable health behaviors such as cessation of smoking and reduction of alcohol consumption, adequate exercise, dietary calcium and vitamin D intake, and fall prevention. Currently, health strategies for the prevention of osteoporosis as a cost-effective approach have gained more importance than treatment methods for dealing with this major public health problem.
Prevention of osteoporosis can be implemented at any age. However, because 40–45% of the bone mass develops in early adulthood, prevention is most effective if done in childhood and adolescence. In addition, if people develop and commit to lifestyles that support strong bones when they are adolescents or young adults, they increase the likelihood that they will have healthy bones throughout their lives.
Aim of the Study:
The aim of this study is to evaluate the effect of applying health belief model on prevention of osteoporosis among adolescent girls through:
• Assessing knowledge and reported practices of adolescent girls about osteoporosis according to their beliefs.
• Developing and implementing program for adolescent girls based on domains of health belief model.
• Evaluating the effectiveness of the health belief model on their improvement of knowledge and reported practices of adolescent girls regarding to osteoporosis.
Research Hypothesis:
The knowledge and reported practices of adolescent girls about osteoporosis will be improved after applying health belief model.
Research Design:
A quasi experimental study design was used to explore the effect of the health belief model on improving the knowledge and practices of adolescence girls regarding osteoporosis.
Technical Design:
The technical design includes; the setting, subject & tools were used in the study.
Setting:
The study was conducted at schools of Mrs. Aisha, Secondary Girls Alqadima (Mohamed Gaber Qusla) and Secondary Girls Alhaditha in Beni-Suef city.
Sample type:
Multistage random sample technique was used for selection of adolescent girls. First stage: three schools were chosen randomly from total five schools. Second stage: second year from each school was chose. Third stage: one class was chose from each school.
School name Total number of second year Selected number
Secondary Girls Alhaditha 436 46
Secondary Girls Alqadima 396 41
Mrs. Aisha 410 43
Sample size (total number of adolescent girl) 130
Tools of data collection: to achieve the aim of the study, data was collected by using the following tools:
Tool І: interviewing Questionnaire was used to collect data and include three parts
a) First part: designed to assess socio-demographic data of adolescent girls and it included Name of school, The father’s educational level, The mother’s educational level, Father’s occupation, Mother’s occupation, Family Income, medical history of fracture and family history of osteoporosis and anthropometric measurement that include weight, height to assess BMI of adolescent girls. The investigator checked the scale for accuracy. Weight was measured to the nearest 0.1 kg with an electronic scale with adolescent girls wearing light clothing and without shoes. Adolescent girls height was measured to the nearest 0.1 cm with a wooden stadiometer placed on a flat surface. It was calculated by the equation: BMI = Weight in Kg / Height² in meters. (Q1-Q13)
b) Second part: was designed to assess knowledge of adolescent girls’ about osteoporosis (pre/post implementation of health belief model) through asking questions (Q14-Q37). It covered knowledge about osteoporosis, exercise as a protective behavior against osteoporosis, sources and importance of calcium and vitamin D and their body requirements, drinking soft drinks and caffeine and their harm and Importance of sun exposure.
Third part: was designed to assess reported practices of adolescent girls’ (pre/post implementation of health belief model) through asking questions (Q38-Q50). It covered practices regarding exercise, calcium intake, caffeine and soft drinks intake and sun exposure.
Tool II: Anthropometric measurement to detect body mass index, three variables were measured by the investigator, weight, height, and BMI (Q11-Q13).
Scoring system for BMI
According the BMI, adolescence girls were classified into: BMI was less than 18.5; it falls within the underweight range, BMI was 18.5 to <25, it falls within the normal and BMI was 25.0 to <30, it falls within the overweight range. It was calculated by the equation: BMI = Weight in Kg / Height² in meters.
Tool ІІІ: Osteoporosis Health Belief model Scale was designed to assess beliefs of adolescent girl’s about osteoporosis, it was adopted from Kim et al., (2013) and it was included perceived susceptibility and seriousness of osteoporosis, perceived benefits of exercise, perceived benefits of calcium intake, perceived barriers of exercise, perceived barriers of calcium intake, perceived cues of action (health motivation) and self-efficacy. (Q51-Q98)
Pilot study:
It was conducted on 10% adolescence were chosen randomly to test the content, the aim of the pilot study was to evaluate clarity, visibility, applicability, as well as the time required to fulfill the developed tools. According to the obtained results, modifications such as omission, addition and rewording were done. The number of the pilot study was excluded from the study sample.
The finding of the present study could be summarized as follows:
• Total number of the studied sample was 130; 8.5% of adolescent girls had family history of osteoporosis, 26.2% of them had history of fracture. 13.1% & 13.8% of adolescent girls had overweight & underweight respectively while 73.1% of them had normal weight.
• Regarding total knowledge of the adolescent girls’ pre/post implementation of health belief model, the current study denoted that 16.9% of the adolescent girls had satisfactory knowledge pre implementation of health belief, and this percentage improved to 93.8% post implementation of health belief model with highly statistically significant differences at P value <.000**.
• As regard total practices of adolescent girls’ pre/post implementation of health belief model, the present study showed that 29.2% of the adolescent girls had adequate practices toward prevention of osteoporosis pre implementation of health belief, which improved to 73.8% post implementation of health belief model.
• In relation to total health beliefs of adolescent girls, the study reported that 46.2 % of the adolescent girls had positive beliefs regarding osteoporosis, while 58.8% of them had negative beliefs.
• There was highly significant positive correlation between total adolescent girls’ satisfactory knowledge about osteoporosis and their practices toward prevention of osteoporosis at pre/post implementation of health belief model at (P= < 0.01).
• There was highly significant positive correlation between most basic items of health belief model and total satisfactory knowledge of adolescent girls about osteoporosis pre implementation of health belief.
• There was highly significant positive correlation between all basic items of health belief model and total adequate practices of adolescent girls toward prevention of osteoporosis pre implementation of health belief.
Conclusion:
Based on the current study results and research hypothesis, the following can be concluded:
The knowledge and reported practices of adolescent girls about osteoporosis improved after implementing the health belief model. More than two fifth of the adolescent girls had positive beliefs regarding osteoporosis, while more than half of them had negative beliefs.
Recommendations
In the light of these findings it can be recommended that:
• More comprehensive interventions on the benefits and barriers of calcium intake and use of other behavioral modification theories. It is advised that researchers explain social and behavioral barriers in calcium intake in different cultural contexts.
• Applying health belief model on wide range of female’s age group including adolescents, young, middle aged and elderly women.
• Investigate contributing factors of osteoporosis among young adults to improve understanding and management.
• Study the correlation between demographic characteristics and behavioral, social barriers in calcium intake in different cultural contexts.