Rationale: Left untreated – 52.3% lifetime risk for fracture Many women do not engage in prevention behaviors Exercise, diet, and medication are usually recommended for prevention Prevention could increase quality of life for many patients and reduce health care expenditures

(Smeltzer, Bare, Hinkle & Cheever, 2010) 10 million Americans have osteoporosis 33.6 million Americans have osteopenia Fractures potentially result in acute and chronic pain, disfigurement, failure to return to normal functional status, and increased mortality rate (Ryan, Maierle, Csuka, Thomson & Szabo, 2013)

“The Integrated Theory of Health Behavior Change suggests that health behavior change can be enhanced by fostering knowledge and beliefs, increasing self-regulation skills and abilities, and enhancing social facilitation” (Ryan, 2009, p. 161). Polly Ryan, PhD, RN, CNS-BC Kathleen J. Sawin, PhD, CPNP-PC, FAAN University of Wisconsin

Randomized Controlled Trial Intervention: Computer-based information about calcium, vitamin D, diet, and osteoporosis Results: Statistically significant differences in the intervention group versus the control group in calcium intake from food and supplements. No difference in vitamin D intake. (Ryan, Maierle, Csuka, Thomson & Szabo, 2013)

Scenario: 51 year old woman who is not taking any vitamins or supplements, not eating the recommended amounts of calcium or vitamin D, and has a low bone density DXA score. This patient is asking for information about things she can do to prevent fractures and further bone density loss. 1.Identify (variables in the situation) Knowledge deficit Age Possible vitamin deficiency Low bone density scores Woman Diet 2. Relate (or put the variables together to form propositions) Primary Proposition: Patient is curious about things she can do to prevent or reverse bone loss. Possible Assumptions: Patient is unaware that behavior change can prevent or reverse bone loss. Possible Confounding Variables: Lack of education or advice about diet, exercise, or supplements. 3. Understand (the importance of the prepositions, assumptions, and confounding variables) Proposition: If patient does not change her behaviors she is at risk for further bone density loss and subsequently fractures. Significance of Assumptions: If the patient is unaware of behavior changes she is at increased risk to lose more bone density and have fractures. Possible Confounding Variables: If patient does not believe that changes in diet, exercise, or supplements will reduce future bone loss and risk for fractures she will not change her behavior.

4. Explain (the significance of the situation to those involved based on their individual KSVME) Proposition: In terms the patient can understand explain how modifications in diet, exercise, and taking supplements can reduce bone density loss and the risk of fractures. Assumptions: Explain that bone density loss can be modified and the risk of fractures reduced. Confounding Variables: Assess what the patient currently knows about risk factors for osteoporosis and modify messages to fill in gaps in knowledge. 5. Predict (what will happen in this situation if one or more variables are not changed) Proposition: If bone density loss is not addressed the patient may have a debilitating fracture leading to loss of independence and possibly loss of life. Assumptions: If the patient modifies her diet, exercise regimen, and starts supplements as recommended she will stop or reverse bone density loss. Confounding Variables: If the patient is willing to make changes in her habits she will reduce her risk of fractures and bone density loss. 6. Influence (someone to change one or more variables in order to achieve a desired outcome or prevent an undesirable one) Proposition: Help the patient make meaningful changes in her diet, exercise regimen, and supplements. Assumptions: Ensure patient understands the behavior modifications that are being addressed, if not modify teaching. Confounding Variables: If the patient is unwilling to make changes, explore her reluctance to better understand what is motivating her.

Design programs to increase knowledge and beliefs in health change behaviors using technology including handheld devices.

Nurses can help to identify patients at risk and help to implement prevention strategies.