Study Participation
The study recruited participants within ten months. The respondents were recruited from November 1, 2015, to August 31, 2016. The study applied the following factors while determining the eligibility of the participant. First, one should be 50 to 59 years old. Secondly, participants should be free from any cognitive dysfunction. They also should be able to walk and having no malignancy. Participants were selected from three community centers.
The selection process involved a public announcement in the recruitment centers. Two health care providers undertook the task of recruiting participants, where they identified 271 eligible candidates. Although 271 candidates were identified for inclusion, some individuals were excluded from the study due to various factors. Forty candidates were excluded because the information required for evaluating their vitamin D intake and dietary calcium were not available. Seventeen refused to participate in the first survey, while fifteen declined to participate in the second survey. The final evaluated sampleevaluated was 199.
There is low bias because the study reports that there is no difference in the characteristics of participants and those eligible but excluded candidates.
Study Attrition
Since 199 participants ere evaluated, the response rate for the study is 73.43%. The final list of participants included 156 women and 43 men. The current response rate is adequate for the study because the sample size accounts for a arger proportion of the target population. The 271 candidates ere initially evaluated using an individualized education plan. The data collected after the educational program helped to exclude candidates who lacked calcium dietary and vitamin D consumption information. The total number of participants who completed both the educational program and the second survey questionnaire was 199. The study clearly states the number of participants who dropped from the study.
Low bias. The study reports no important difference between vitamin D and dietary calcium in participants who completed the study and those who did not complete the study. The baseline assessment shows that the characteristics are the same for both groups.
Prognostic Factor Measurement
The first variable that is measured is the education level of all the participants. The measurement of education level focused on the level of knowledge of various aspects of osteoporosis. Osteoporosis quiz tool (FOOQ) was utilized when measuring the level of osteoporosis knowledge. The FOOQ data collection tool is described as a validated and psychometrically sound instrument. The questions on the questionnaire relate to specific risk factors and behaviors that are associated with the diagnosis of osteoporosis. The tool presents a total of 20 “true” and “false” questions.
Falling was also measured using a fall self-efficacy questionnaire. The questionnaire uses a fall efficacy scale to measure the knowledge about falling by the participants. The Korean Calcium Assessment Tool (KCAT) was used to collect data about dietary calcium and vitamin D intake. KCAT evaluated the consumption levels of different food groups containing calcium and vitamin D. A proportion of 73% of participants provided adequate data for the osteoporosis-related variables and dietary and calcium variables.
Low bias. The tools used to collect the data are internationally validated tools for clinical research and have been used previously to collect data in clinical surveys.
Outcome Measurement
The study measured outcomes about changes in osteoporosis knowledge among participants. The degree of change concerning the knowledge of osteoporosis was measure in the before the educational and exercise programs were initiated. The level of knowledge was later measured in the second survey using the FOOQ tool that was initially used. The outcome of the level of exercise and education levels were also measured during the second questionnaire. KCAT was used to measure the rates of consumption of calcium and vitamin D during the first and the second survey. The same measurement methods were applied for all the 199 participants who completed the study.
Low bias. The measurement tools are the same in the baseline measurement and during the second survey.
Study Confounding
The study does not measure any confounding variables. Although education level and exercise levels can be affected by other factors such as occupation and income level. Income levels could also affect the consumption of calcium and vitamin D. The type of food consumed is impacted by the amount of money one earns. Thus, the changes in consumption levels of calcium and vitamin D rich food could not be as a result of increased education and exercise level alone.
High bias. Since confounders are not measured and evaluated, the study is bound to biases.
`Statistical Analysis and Reporting
All the variables included in the study were evaluated using the Kolmogorov-Smirnov test for normality. It was discovered that the variables are non-parametric. At a significance level of 5% and power of 80%, the Korean Fracture Risk score model established the optimal sample size to be 164. The continuous variables were analyzed using the t-test. All analyses were undertaken using the SPSS software version 19.0. The results were reported using percentages. The osteoporosis score increased significantly after the education intervention. 62.3% of participants reported increased osteoporosis knowledge, while 30.2% reported decreased scores. With a p-value of 0.0001, the fall-related self-efficacy score increased. Results were also reported using box plots. The box plot is used to present changes in osteoporosis knowledge and calcium intake levels before and after the survey.
Low bias. The analysis is done using scientific tools that are widely accepted. All variables are analyzed using the same tools and results reported in a similar method.