The Development and Validation of the Osteoporosis Prevention and Awareness Tool (OPAAT) in Malaysia

PLOS ONE, Dec 2019

Objectives To develop and validate Osteoporosis Prevention and Awareness Tool (OPAAT) in Malaysia. Methods The OPAAT was modified from the Malaysian Osteoporosis Knowledge Tool and developed from an exploratory study on patients. Face and content validity was established by an expert panel. The OPAAT consists of 30 items, categorized into three domains. A higher score indicates higher knowledge level. English speaking non-osteoporotic postmenopausal women ≥50 years of age and pharmacists were included in the study. Results A total of 203 patients and 31 pharmacists were recruited. Factor analysis extracted three domains. Flesch reading ease was 59.2. The mean±SD accuracy rate was 0.60±0.22 (range: 0.26-0.94). The Cronbach’s α for each domain ranged from 0.286-0.748. All items were highly correlated (Spearman’s rho: 0.761-0.990, p<0.05), with no significant change in the overall test-retest scores, indicating that OPAAT has achieved stable reliability. Pharmacists had higher knowledge score than patients (80.9±8.7vs63.6±17.4, p<0.001), indicating that the OPAAT was able to discriminate between the knowledge levels of pharmacists and patients. Conclusion The OPAAT was found to be a valid and reliable instrument for assessing patient’s knowledge about osteoporosis and its prevention in Malaysia. The OPAAT can be used to identify individuals in need of osteoporosis educational intervention.

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The Development and Validation of the Osteoporosis Prevention and Awareness Tool (OPAAT) in Malaysia

May The Development and Validation of the Osteoporosis Prevention and Awareness Tool (OPAAT) in Malaysia Li Shean Toh 0 1 Pauline Siew Mei Lai 0 1 David Bin-Chia Wu 0 1 Kok Thong Wong 0 1 Bee Yean Low 0 1 Claire Anderson 0 1 0 1 Faculty of Science, School of Pharmacy, University of Nottingham , Semenyih, Selangor , Malaysia , 2 Department of Primary Care Medicine, University of Malaya Primary Care Research Group (UMPCRG), Faculty of Medicine, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia, 3 School of Pharmacy, Monash University Malaysia , Selangor , Malaysia , 4 Division of Social Research in Medicine and Health, School of Pharmacy, University of Nottingham , Nottingham , United Kingdom 1 Academic Editor: Chung-Jung Chiu, Tufts University , UNITED STATES - Competing Interests: The authors have declared that no competing interests exist. Methods 50 years of age and pharmacists were included in the study. and patients. Conclusion The OPAAT was found to be a valid and reliable instrument for assessing patients knowledge about osteoporosis and its prevention in Malaysia. The OPAAT can be used to identify individuals in need of osteoporosis educational intervention. Introduction [8,11]. Hence, the aim of our study was to develop and validate the English version of the Osteoporosis Prevention and Awareness Tool (OPAAT) in Malaysia. Method Phase 1: The development of the Osteoporosis Prevention and Awareness Tool (OPAAT) Despite Malay being the national language of Malaysia, postmenopausal women aged 50 years and above are more fluent in English as schooling was only conducted in the English language then. Hence, the OPAAT was developed in English, based on modifications from the MOKT [11] and findings from a qualitative study which examined the barriers and needs towards an osteoporosis screening and prevention service in Malaysia [28]. We took 10 out of the 50 items from the MOKT, as the other items were related to assessing knowledge on risk factors of osteoporosis, osteoporosis medication or misconceptions about osteoporosis. Six items were rephrased. For item 1, we added the word fracture in parenthesis to emphasize that the word broken bones means fracture (S1 Table). For item 5, early on was removed as patients were unaware that osteoporosis was asymptomatic and the phrase early on may confuse them [28]. As for item 13 and 16, we combined the original four questions to develop two questions; as a loss of height and hunchback were essentially assessing the same thing, and joint pain and swelling of the fingers were both referring to symptoms of osteoarthritis. Four items from the MOKT were used in its original format. Results from the qualitative study found that patients, nurses, general practitioners, pharmacists and policy makers lacked knowledge in the following areas: screening and prevention of osteoporosis, and misconceptions of osteoporosis [28]. Therefore 22 new items were added. The final OPAAT consists of 30 items, and was divided into three domains: osteoporosis in general (domain A), consequences of untreated osteoporosis (domain B) and osteoporosis prevention (domain C). Face and content validity of the OPAAT was established via consultation with an expert panel consisting of four pharmacists with many years of research and clinical experience. Comprehension of the questionnaire was tested on 10 postmenopausal women who understood English. This involved asking the patients for their opinions about the phrasing, format and content of the tool. The patients encountered no difficulty in answering the questionnaire. Hence, no further changes were made. Phase 2: The validation of the Osteoporosis Prevention and Awareness Tool (OPAAT) Design. This cross-sectional study was conducted at a primary care clinic of a tertiary hospital from October 2013 to January 2014. Participants in the patient group. English speaking postmenopausal women aged 50 years and above, who had not been diagnosed with osteoporosis/osteopenia was included (This information was obtained from the patients medical records). Participants who were feeling too unwell to participate in the study were excluded. The OPAAT was administered to the patient group at baseline and 2 weeks later to assess for reliability. Participants in the professional group. To assess discriminative validity, pharmacists were recruited from the same tertiary hospital. Pharmacists were expected to have a higher knowledge of osteoporosis than patients. The OPAAT was administered to the pharmacists only once, as we wanted to assess the instruments ability to discriminate between the knowledge scores of patients and healthcare professionals at baseline. Sample size for the patient group. Sample size was calculated based on a 5:1 participant ratio for factor analysis [29]. Since the OPAAT had 30 items, the total number of participants needed was 150. Allowing for a 20% loss to follow up, the final number of participants r (...truncated)


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Li Shean Toh, Pauline Siew Mei Lai, David Bin-Chia Wu, Kok Thong Wong, Bee Yean Low, Claire Anderson. The Development and Validation of the Osteoporosis Prevention and Awareness Tool (OPAAT) in Malaysia, PLOS ONE, 2015, Volume 10, Issue 5, DOI: 10.1371/journal.pone.0124553