title: Effects of an osteoporosis prevention training program on physical activity-related stages of change and self-efficacy among university students, Shiraz, Iran: a Randomized Clinical Trial.
abstract: BACKGROUND
  Osteoporosis is a major problem in today's world, being characterized by decreased bone mass and bone change. Due to deficiency of theory-based studies in young population, especially in students, there are significant knowledge gaps of effective planning. Thepresent study was performed in response to this need. The present study investigated the effect of an empowerment program on physical activity related stages of change and self-efficacyin preventing osteoporosis among university students.
  
  
  METHODS
  In this randomized controlled trial (IRCT: IRCT201212016261N2), 152 female students of Shiraz University of Medical Sciences were selected through multi-stages cluster sampling and were randomly assigned to an experimental (n=76) and a control (n=76) group.The pre-and post-intervention data were collected using the Stages of Exercise Change Questionnaire (SECQ) of Marcos with Cronbach's alpha reliability of 0.89 and also the self-efficacy scale with a Cronbach's alpha reliability of 0.88 and Test-Retest Correlation Coefficient of 0.80. The educational intervention for the experimental group took place through problem-based learning method, small group discussion, and training manuals. In addition, training CDs and brochures were given to the subjects and short SMSs were sent to them. The data were analyzed throughSPSS, version 14, usingMann-Whitney test, Chi-square test, Wilcoxon and regression tests.
  
  
  RESULTS
  Pre-intervention findings showed that participants had behavioral constructs below the expected levels. The results showed that the experimental group received significant statisticalincrease after the intervention in stage of change. Before the intervention, the mean scores of stages of changes in the experimental groups was 2.28±0.86 but this rose to 3±0.84 in the first post-test and 3.22±0.84 in the second post-test. The control group showed a significant increase in stage of change without intervention (pre-test 2.04±0.82, first post-test 2.18±0.87 and second post-test 2.3±0.89).However, this increase was more significant in the experimental group (p<0.001). The mean score of self-efficacy in physical activity in the intervention group upon completion of the course showed a significant increase (p<0.001). A significant correlation was found between the construct stage of change and self-efficacy.
  
  
  CONCLUSIONS
  Theory-based curriculum is effective in empowering individuals in stage of change and developing self-efficacy in physical activity of university students.
authors.affiliation: Department of Health Education and Promotion, Faculty of Health, Research Center for Health Sciences, Shiraz University of Medical Sciences, Shiraz, Iran;
authors.forename: Mohammad Hossien
authors.initials: MH
authors.lastname: Kaveh
authors.affiliation: Department of Health Education and Promotion, Faculty of Health, Shiraz University of Medical Sciences, Shiraz, Iran;
authors.forename: Monire
authors.initials: M
authors.lastname: Golij
authors.affiliation: Department of Health Education and Promotion, Faculty of Health, Shiraz University of Medical Sciences, Shiraz, Iran;
authors.forename: Mahin
authors.initials: M
authors.lastname: Nazari
authors.affiliation: Department of Nutrition, Faculty of Nutrition and Science Food, Shiraz University of Medical Sciences, Shiraz, Iran;
authors.forename: Zohreh
authors.initials: Z
authors.lastname: Mazloom
authors.affiliation: Department of Epidemiology, Faculty of Health, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Abbas
authors.initials: A
authors.lastname: Rezaeian Zadeh
keywords: Behavior; Empowerment; Exercise; Osteoporosis; Self efficacy