BONE UP!

BONE UP!
--A Health Communication Campaign to Promote Bone Health Among Geriatric Population in Taiwan

BACKGROUND
Osteoporosis has been called a silent disease. In most cases, it is not until bone fractures are noticed do patients come to recognize the severity in his bone mineral loss; and that best explains why osteoporosis and its related public health problems are not major concerns on the agenda.
However, with a rapid growing geriatric population, osteoporosis is now considered by the World Health Organization (WHO) as one of the most prevalent age-associated diseases affecting the skeleton; it is currently a major public health problem worldwide in association with high morbidity and mortality rates especially for the geriatric.
With a growing population of the elderly, Taiwan also has been considered as a geriatric society since 2004. This has highlighted the importance of preventing the disease, for the mortality rate associated with these bone fractures (hip fractures especially) occurred in the elderly is higher than that for cancer victims in their first year as cancer sufferers, and half of those who survive face pain, disability and dependence.
Chang, Huang and Chang in their research “Risk and Outcome of Hip Fracture from a Fall in Elder People” reveals how the elderly with osteoporosis who are constant victims of falling averagely suffer from 21days of hospitalization, with a morality rate about 25%. This study also addresses the need for further investigation to develop effective methods of care-giving.
Osteoporosis patients also require medical devices as well as resources and nursing personnel to assist activity throughout their life and have to spend much of their limited lifetime left in nursing homes to receive care. This has a profound affect on the patient and their family’s health as well as quality of life, and surely, under Taiwan’s healthcare system, does create enormous amount of expenditure and cost.
The calcium-lacking dietary habit of most older generation of Taiwanese, and limited outdoor exercise and activities, osteoporosis becomes a common disease among Taiwanese elderly.
Hwua, Li, Lin in their “Diagnosis of Osteoporosis” shows that bone mass is one of the most important determinant of bone strength and accounts for up to 80% of its variance; and also by comparing the strength and limitations with bone radiography explains why bone densitometry has matured in the last 10 years to become an integral part of clinical practice, particularly in the evaluation and management of methodologies use in clinical diagnosis, prediction of fracture risk, and monitoring of patients with osteoporosis.
Not only does their low bone mass and micro architectural deterioration of bone tissue lead to diminished biomechanical competence of the skeleton but also negligence among general public to environment safety (the bumpy, uneven sidewalks and slippery grounds in the bathroom) lead to fractures of the spine, hip and wrist companied by other common clinical complications.
Lin and Wang in their research points out how falls among the elderly resulted from bone density loss and deterioration deserves general public’s attention by providing its outcome. By noting how falls among older people with osteoporosis are one of the most important public health issues in the world, this review paper reveals that the fearful fact that falling is the second leading cause of injury-related death among older people in Taiwan, and may lead to severe physical injuries, lack of independence in daily living, psychological trauma, and social dysfunction that results in enormous social costs.
Therefore, the proposed osteoporosis prevention health education is in dire need. It can facilitate the public (especially the elderly who are at risk and most costly in terms of money and resources) in their understanding of osteoporosis, their willingness to take bone density examinations on a regular basis, and become much careful when moving around. It may also encourages the government to create an environmental-friendly and safer setting for our society.

KEY RESULTS FROM FORMATIVE RESEARCH
--Knowledge about osteoporosis among participants in community bone density tests is negatively related to age, with an obvious drop in their understanding about osteoporosis for those age 50; their perceived severity, perceived benefits, and perceived barriers are also negatively correlated with participants’ age as well.
--Participants with a family history related to bone fracture or density loss in Chen’s 2002 survey show a higher rate of 77.8% in perceived susceptibility and possessing greater willingness to obtain and update information and news about bone health.
--The major source of participants’ osteoporosis knowledge was from television, but just a few got theirs through interpersonal communication from their health professionals or through group channels such as community groups.
Corresponding researches show the current efforts by Department of Health in
Dissemination of health messages addressing bone density tests are campaigns with a large use of mass media (TV, news on government or hospital websites) ; also this campaign is separated from concerns over the environmental safety issues among daily life of the elderly.
--Over 75 % of the elderly over 50 regard prevention of Osteoporosis as difficult and did not know how to reduce the barriers.
--Only 14% of the elderly over 50 are not taking their bone density test for the first time and 67% take the test out of pure curiosity.

CAMPAIGN GOALS AND OBJECTIVES
The overall goals the campaign will be reduction in Taiwan’s geriatric population suffering from osteoporosis and related bone fractures. The primary objectives will be facilitate the elderly who are at risk and most costly in terms of money and resources in their understanding of osteoporosis, their willingness to take bone density examinations on a regular basis, and become much careful when moving around.
Specific Bone Health Campaign Objectives
--75% of the elderly over 50 can recognize the campaign logo “BONE UP!”
--30% increase of the target audience’s KAP in prevention of Osteoporosis by taking bone density tests.
--24% of the elderly over 50 are taking their bone density test for at least the second time
TARGETED AUDIENCE
--Primary Audience
Since all these research papers above show that our generic population is the most at-risk audience of osteoporosis and related fractures, the most ignorant of the importance of bone health, as well as the knowledge about bone density tests, I would consider the elderly as the primary audience.
--Secondary Audience
Community women who are peri-menopausal (within the age range of 30-50) show much higher perceived susceptibility as well as accuracy in knowledge regarding osteoporosis and its prevention, and are also significantly higher in taking regularly bone density check; Moreover, most of the community women in 30-50 feel that they are playing a highly-important or important role in care-giving in their family (53.1% of the subjects play the role of decision maker in their families, and 52.6% of the females perform the role of care-giver when their family members are sick)
Therefore, in our health campaign aimed at enriching the knowledge of bone health and reduction in osteoporosis and related bone fractures in the elderly, community women would best serve as the secondary audience who may have a great influence among the elderly
MIX USE OF INTERPERSONAL AND GROUP COMMUNICATION
Since the interpersonal and group health education could effectively improve community women’s knowledge, perceived susceptibility, perceived severity and behavior intention as an immediate outcome, and 67% of the elderly get their health information from relatives or friends while less than 10% are exposed regularly to mass media, for both of our primary and secondary audience, it is through the mix of group and interpersonal health education that the knowledge, perceived susceptibility, perceived severity, perceived benefits and behavioral change are most likely to be enhanced significantly.
POSSIBLE PARTICIPATING ORGANIZATIONS
--Department of Health:
The primary sponsoring agency for the campaign; responsible for coordinating and overseeing the whole campaign progress.
--Society of Prevention Medicine in Taiwan;
Physical Therapy Taiwan;
Taiwan Orthopedic Association;
Central Research Institute;
Providing technical input and professional guidance into all campaign stages, (especially for in terms of study and evaluation of the campaign’s conceptualization, design, operation and effects)
--Health, Welfare and Environment Foundation
http://www.hwe.org.tw/hs.asp
Possible sponsor for funding the campaign; providing technical guidance and input into the messages and materials as well as developing relevant activities for the senior population; possible influence on the advocacy level for there is a branch of HWE foundation which is comprised of legislators.
--community colleges;
community clinics or hospitals and teaching hospitals
old age homes
providing technical guidance and input into the messages and materials as well as developing relevant activities for the senior population; possible volunteer and health professional resource in both community outreach and interpersonal consultation; integrating the community-oriented educational program and experience-sharing activities
TONE AND MANNER OF COMMUNICATION MESSAGES
Since the formative research reveals that over 75 % of the elderly over 50 regard prevention of Osteoporosis as difficult, the tone of the communication must be caring, encouraging and filled with a strong sense of empowerment. A cartoon logo of a bone with a slogan with some hit expression can embed more optimistic, youthful elements in campaign messages.
LINKING TARGET AUDIENCES WITH MESSGES AND MEDIA
Target Audience Message Ideas Small Media as useful reminder and Face-to-Face(interpersonal /group) Ideas
The Elderly
(women with the age group from 30-50 as secondary ) 1.
(You can) “bone up” your health on
--exercise (as indicated in the uprising hands and dancing feet of the cartoon bone in the logo)
(Curriculum in community colleges on weight-bearing exercises that are best for the elderly)
--regular bone density examination
Group discussion with family members or caregivers of patients suffer from osteoporosis and related bone fractures sharing their experience and stress how prevention method could be taken in advance
--intake of calcium(both of these massages are embedded in the bone-shaped post-it note pad with a chart of bone density or a cute “bone up on calcium” cartoon)

2. Warning: watch out your steps! (the wooden toy animal that may fall down when the button is being pressed.)
(It is a translation of “一失”足”成千古恨” in Chinese Proverb; I intentionally tackle the risk message with cute wooden animals in order to reduce fear while keeping the audience informed of the risks.) hold high-calcium food sampling events to familiarize the audience with knowledge about the calcium rich food.
Contest on recipe design contest for high-calcium diet
(for community women who take care of the elderly)
Best Building and Best Interior Design with the ideal environmental safety plan for seniors (for community women who take care of the elderly)

Further Discussion and Follow-up Campaigns
During the feedback and Q&A period, I was asked what good will the increase in bone density tests do in terms of promoting the bone health of the elderly for causes of degradation in one’s bone health is complex and accumulative. Taking bone density exams regularly does little or even no good at all in enlarging proportion of bone mineral in the elderly; it would not significantly lower the numbers of osteoporosis patients, either.
However, since the result of our formative research shows that participants with a family history related to bone fracture or density loss in Chen’s 2002 survey show a higher rate of 77.8% in perceived susceptibility and possessing greater willingness to obtain and update information and news about bone health, we can expect follow-up campaigns in addressing similar bone health issues targeting teenagers or people in their early 20s or 30s (those who are rather remote from risks and sufferings) may be much more effective than they used to be.
Or else it would be almost impossible to facilitate the behavioral changes in higher intake of calcium and vitamin D, as well as habits of regular outdoor exercises that are keys to reduction in numbers of osteoporosis cases.