A review of patient-centred post-fracture interventions in the context of theories of health behaviour change

Abstract

The purpose of this literature review is to determine whether and to what extent current post-fracture osteoporosis interventions utilize theories of health behaviour change and whether those that are theory-based are more successful in producing desired behaviour changes. Studies were identified by applying additional criteria to the final selection stage of a systematic review of non-surgical osteoporosis interventions in the orthopaedic environment. We identified 42 primary studies targeted at patients and improving post-fracture osteoporosis care. As well as describing the studies (in terms of design, population, interventions, outcomes), we focused on theoretical framework and elements of behaviour change models. The 42 studies included in this review utilized a variety of post-fracture interventions; however, none of them reported using an underlying theoretical base. Only three studies drew on what we felt to be elements of a theoretical framework. The lack of theoretically based studies points to a currently under-utilized area of behaviour change research that could be applied to post-fracture interventions in order to make them more effective. Despite an abundance of literature supporting theories of behaviour change, post-fracture osteoporosis interventions do not report utilizing these theories. Theories of behaviour change could be applied to post-fracture osteoporosis interventions to explain why patients initiate osteoporosis management. Future research should explore the application of theories of health behaviour change to post-fracture interventions.

Practical implications for nurses caring for patients being treated for osteoporosis

“…Many interventional studies have shown that enhanced knowledge encourages patients to seek additional information about osteoporosis and leads to lifestyle changes. [50][51][52][53] Studies conducted in the USA and other countries have shown a low level of knowledge about osteoporosis among general groups of women and men and those at increased risk for osteoporosis because of age, having first-degree relatives with osteoporosis or fracture, having a disability, or receiving chemotherapeutic agents or other medications that negatively affect bone density or other risk factors. [54][55][56][57][58][59][60][61][62] Research has shown that although participants may have good knowledge of what osteoporosis is, they generally have a low level of understanding of the role of medication in reducing fracture risk, various concerns about the side effects of medication, poor understanding of the causes of osteoporosis, and uncertainty about how it can be controlled.…”

Successful implementation of a Fracture Liaison Service through effective change management: a qualitative study

“…Osteoporosis is associated with increased morbidity and mortality and decreased quality of life. [1,2] Osteoporosis care reduces risk of future fractures by about 50%. [3,4] Regardless, fewer than 20% of adults, 50 years of age and older, are tested or treated for osteoporosis after a lowtrauma fragility fracture [3,4] generating a substantial and unwarranted "care gap."…”

Patients’ Experiences of Nurse Case-Managed Osteoporosis Care: A Qualitative Study

“…Osteoporosis is a chronic condition associated with increased morbidity and mortality and decreased quality of life ( 1 , 2 ). Older adults who suffer from a low trauma (fragility) fracture have a 20% risk of another osteoporosis-related fracture within 1 year ( 1 – 3 ). Fortunately, initiation of bisphosphonate treatment reduces this risk by 50% ( 4 ).…”