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
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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)