title: An Internet-based osteoporotic fracture risk program: effect on knowledge, attitudes, and behaviors.
abstract: OBJECTIVE
  The 2004 Surgeon General's Bone Health Report calls for innovative interventions to reduce osteoporotic fracture. We developed an Internet-based risk- and stage-tailored intervention to promote self-management of fracture risk.
  
  
  METHODS
  We randomized 121 women to receive 18 personalized Internet-based tutorials with behavior modification strategies for nutrition, exercise, and other behaviors (n=61) or to receive standard information (n=60). Tutorials were tailored for 10-year hip fracture risk, osteoporosis knowledge, attitudes about osteoporosis, nutritional intake, and exercise levels. Participants in both groups completed questionnaires at baseline, 3 months, and 6 months. Qualitative data included tutorial evaluation forms and focus groups. Main outcomes were perceived impact of the intervention, and changes in osteoporosis knowledge and beliefs, calcium and vitamin D intake, and exercise levels.
  
  
  RESULTS
  At 6 months, 80% of intervention and 92% of control group participants completed the study. The intervention group significantly increased general osteoporosis knowledge (p=0.03) and calcium knowledge (p=0.02) compared with the control group. At 6 months, intervention participants were not significantly more likely to meet recommendations for calcium (OR: 1.39; 95% CI: 0.64-3.0; p=0.40), vitamin D (OR: 1.27; CI: 0.61-2.66; p=0.53), or aerobic (OR: 1.49; 95% CI: 0.63-3.48; p=0.36) or resistance exercise (OR: 1.36; 95% CI: 0.66-2.79; p=0.40) compared with control group participants. Thematic analyses of two focus groups and 794 tutorial evaluation forms, however, indicated that the intervention improved participant ability to implement and maintain healthy behaviors. Participants suggested program refinements including virtual support groups, applications for portable devices, and tailoring of tutorial length.
  
  
  CONCLUSIONS
  The risk- and stage-tailored intervention was associated with improved knowledge but was not associated with significant behavioral improvements. Qualitative results suggest the intervention improved behavior implementation and maintenance. A refined intervention with additional tailoring capabilities could be used with Internet-based fracture risk assessment tools to confront the growing societal burden of osteoporotic fractures.
authors.affiliation: Program on Prevention Outcomes and Practices, Stanford Prevention Research Center, Stanford School of Medicine, Stanford, California, USA.
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Drieling
authors.forename: Jun
authors.initials: J
authors.lastname: Ma
authors.forename: Sreedevi
authors.initials: S
authors.lastname: Thiyagarajan
authors.forename: Randall S
authors.initials: RS
authors.lastname: Stafford
mesh_terms: D000328:Adult; D005260:Female; D050723:Fractures, Bone / Q000517:prevention & control*; D015438:Health Behavior; D006266:Health Education / Q000379:methods*; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data*; D008875:Middle Aged; D010024:Osteoporosis / Q000517:prevention & control*; D017063:Outcome Assessment, Health Care; D012107:Research Design; D018570:Risk Assessment; D020377:Self Efficacy; D016387:Women's Health