The team of writers have stated a problem (POPULATION-BASED OSTEOPOROSIS EDUCATION FOR OLDER WOMEN) of the present world which is ignored probably all over the world especially in developing countries. They want to enhance the importance of OSTEOPOROSIS. In which bones to become weak and brittle — so brittle that a fall or even mild stresses like bending over or coughing can cause a fracture. Osteoporosis-related fractures most commonly occur in the hip, wrist or spine.

Bone is living tissue that is constantly being broken down and replaced. Osteoporosis occurs when the creation of new bone doesn’t keep up with the removal of old bone.

It affects men and women of all races. But white and Asian women — especially older women who are past menopause — are at highest risk.


  • Osteoporosis is an age related metabolic disease that primarily affects women and causes bone demineralization that results in fractures. Early identification of risk factors for osteoporosis and development of prevention programs is needed to halt the increasing incidence of the disease.

Public health nurses (PHNs), with their emphasis on primary, secondary, and tertiary prevention with individuals and families, are in a unique position to protect the health of these vulnerable populations who are at risk for osteoporosis.

  • This article describes the implementation and program evaluation of three osteoporosis prevention educational programs that use three levels of intensity of design. Each design is based upon the learning needs of the targeted audience. The goals of each program were to increase knowledge of osteoporosis, increase health beliefs, and increase the frequency of osteoporosis preventing behaviors.

Theoretical aspects from adult learning and the Health Belief Model (HBM) were used to develop the programs.

3-  The impact of osteoporosis education and bone mineral density testing for postmenopausal women in a managed care setting.

4-  The Relation of Exercise Habits to Health Beliefs and Knowledge about Osteoporosis.

5-  Adherence to Osteoporosis Medications After Patient and Physician Brief Education:

To examine whether adherence to osteoporosis medications can be improved by educational interventions targeted at primary care physicians (PCPs) and patients. Improving patient adherence with osteoporosis medications is an important challenge.

Higher levels of adherence may be associated with reduced fracture rates1; however, studies2,3 demonstrate suboptimal adherence among patients in the community.

Oft-cited barriers to achieving adequate adherence include insufficient patient education, specific patient health beliefs, complex medication regimens, polypharmacy, poor provider-patient relations, patient forgetfulness, and medication costs.46 Strategies targeting these barriers, as well as patient monitoring systems and feedback based on clinical markers, have been proposed to improve medication adherence for osteoporosis treatments.

Successful medication adherence interventions for other chronic diseases such as hypertension and asthma have been multifactorial and focused on the patient.5 A small randomized trial attempted to enhance adherence to raloxifene hydrochloride among 75 women with osteopenia; a nurse-run patient monitoring program with clinic appointments every 12 weeks improved adherence to raloxifene at 1 year.

10 Another population-based study11 of patients with osteoporosis who sustained distal forearm fractures showed that timely provision of educational brochures, primary care provider appointments, and bone mineral density testing appointments improved adherence over 6 months of follow-up. However, many of the most adherent patients had the best bone mineral density.

While medication adherence may be primarily a patient behavior, it is unclear whether physician-directed interventions can influence this behavior. To our knowledge, no prior intervention for osteoporosis medication adherence has focused on the physician. In this study, we performed a post hoc analysis of data from a randomized controlled trial for improving osteoporosis management to determine whether a brief physician-oriented intervention improved compliance or persistence with osteoporosis medications.

  • In my opinion, this study measures medication compliance as the primary end point and persistence as a secondary end point. Patients and caregivers may access this content for use in relation to their own personal healthcare or that of a old family members.

               Education regarding osteoporosis prevention seems to encourage women to make lifestyle changes. The inclusion of BMD testing enhances the likelihood that women will consider pharmaceutical therapy.



  1. Were the pre- to post-test knowledge changes significant:                                                                                                      (a) for the total group and                                                                 (b) for the three individual groups?


In community-based health strategies, community members have control; the nurse is partner and coach to the community (Wells, 2000). The knowledge, skill, and experience assets of individual members and their community are incorporated into the design, implementation, and evaluation of community programs (National Institute of Nursing Research, 2000; Brownson, Baker, & Novick, 1999). With this community-nurse partnership community-based health education is more likely to be culturally appropriate, promote social support, and create collective attitudes and actions that support individual health activities.


               It took me the longest time to learn this distinction.

           The key to designing any experiment is to look at what research variables could affect the outcome. There are total four groups in this thesis. Variables aren’t always ‘quantitative’ or numerical. It’s also important to realize that variables aren’t only things that we measure in the traditional sense.

       For instance, in much social research and in program evaluation, we consider the treatment or program to be made up of one or more variables (i.e., the ’cause’ can be considered a variable).

         So even the program can be considered a variable (which can be made up of a number of sub-variables).

An attribute (specific value) is taken as a variable.

               Another important distinction is taken as to do with the term ‘variable’ is the distinction between an independent and dependent variable. This distinction is particularly relevant during investigating cause-effect relationships in this thesis.

       In my opinion, Descriptive variables are used which are reported on, without relating them to anything in particular.

Identifying the key variables in this thesis which are not found here because they are very important for the following reasons:

  • The key variables provide focus when writing the Introduction section.
  • The key variables are the major terms to use when searching for research articles for the Literature Review.
  • The key variables are the terms to be operationally defined if an Operational Definition of Terms section is necessary.
  • The key variables provide focus to the Methods section.
  • The Instrument measures the key variables. These key variables must be directly measured or manipulated for the research study to be valid.


  • The purpose, research questions, and hypotheses is written about the variables based on the research design.
  • The Instruments is developed to measure the key variables       are written to describe the instruments.
  • The Procedures section describes the treatment for experimental studies and/or how the instrument will be administered.
  • The Method of Data Analysis describes how the data is summarized and tested based on the research questions and hypotheses.






Community-based health education synthesizes ideas from community health nursing, health education, and adult learning. Communities are aggregates of human beings bound together by one or more geographic or social characteristics, such as age, socioeconomic status, and health status. Community-based health care seeks to improve aggregate health, Community-based strategies and partnerships appear to be effective tools for improving health; however———————————————————————-


     (a) Literature review of this thesis is not fully equipped with attributes of Literature review criteria given by experts.

According to Caulley (1992) of La Trobe University, the literature review should:

  • compare and contrast different authors’ views on an issue
    • group authors who draw similar conclusions
    • criticise aspects of methodology
    • note areas in which authors are in disagreement
    • highlight exemplary studies
    • highlight gaps in research
    • show how your study relates to previous studies
    • show how your study relates to the literature in general
    • conclude by summarising what the literature says


             After completing the study of thesis we feel that on many places the literature review is not qualifying the purposes described by experts like

  • it does not define and limit the problem you are working on
    • it does not place your study in an historical perspective
    • it does not avoid unnecessary duplication
    • it does not evaluate promising research methods
    • it does not relate your findings to previous knowledge and suggest further research


The overall structure of review depends largely on their own thesis or research area.

courtesy of the University of Melbourne states the checklist for literature review:

Selection of Sources

Have you indicated the purpose of the review?
Are the parameters of the review reasonable?
Why did you include some of the literature and exclude others?
Which years did you exclude?
Have you emphasised recent developments?
Have you focussed on primary sources with only selective use of secondary sources?
Is the literature you have selected relevant?
Is your bibliographic data complete?

Critical Evaluation of the Literature

Have you organised your material according to issues?
Is there a logic to the way you organised the material?
Does the amount of detail included on an issue relate to its importance?
Have you been sufficiently critical of design and methodological issues?
Have you indicated when results were conflicting or inconclusive and discussed possible reasons?
Have you indicated the relevance of each reference to your research?

             On the other hand it is lengthy and detailed description and informative literature review.

In community-based health strategies, community members have controlled. The nurse is partner and coach to the community (Wells, 2000). The knowledge, skill, and experience assets of individual members and their community are incorporated into the design, implementation, and evaluation of community programs (National Institute of Nursing Research, 2000; Brownson, Baker, & Novick, 1999).—————————–





Experts argue that a “citation” is the way you tell your readers that certain material in your work came from another source. It also gives your readers the information necessary to find that source again, including:

  • information about the author
  • the title of the work
  • the name and location of the company that published your copy of the source
  • the date your copy was published
  • the page numbers of the material you are borrowing

Citation has several important purposes:

-to uphold intellectual honesty (or avoiding plagiarism),

– to attribute prior or unoriginal work and ideas to the correct sources,

-to allow the reader to determine independently whether the referenced material supports the author’s argument in the claimed way, and

– to help the reader gauge the strength and validity of the material the author has used.

The forms of citations generally subscribe to one of the generally accepted citations systems, such as the Oxford, Harvard, MLA, American Sociological Association (ASA), American Psychological Association (APA), and other citations systems, as their syntactic conventions are widely known and easily interpreted by readers. Each of these citation systems has its respective advantages and disadvantages relative to the trade-offs of being informative (but not too disruptive) and thus are chosen relative to the needs of the type of publication being crafted. Editors often specify the citation system to use.

Citation content can vary depending on the type of source and may include:

  • Book: author(s), book title, publisher, date of publication, and page number(s) if appropriate.
  • Journal: author(s), article title, journal title, date of publication, and page number(s).
  • Newspaper: author(s), article title, name of newspaper, section title and page number(s) if desired, date of publication.
  • Web site: author(s), article and publication title where appropriate, as well as a URL, and a date when the site was accessed.
  • Play: inline citations offer part, scene, and line numbers, the latter separated by periods: 4.452 refers to scene 4, line 452. For example, “In Eugene Onegin, Onegin rejects Tanya when she is free to be his, and only decides he wants her when she is already married” (Pushkin 4.452-53).
  • Poem: spaced slashes are normally used to indicate separate lines of a poem, and parenthetical citations usually include the line number(s). For example: “For I must love because I live / And life in me is what you give.” (Brennan, lines 15–16).
  • Interview: name of interviewer, interview descriptor (ex. personal interview) and date of interview.



This article has sufficient references which accommodate readers to read about the topic with all aspects in detail freely.




















RELEVANCE (Clustering)

                 Relevance denotes how well a retrieved document or set of documents meets the information need of the user. Relevance may include concerns such as timeliness, authority or novelty of the result. It is also called bibliometrics.

A second interpretation, most notably advanced by Ellen Voorhees, focuses on the local relationships between documents. The local interpretation avoids having to model the number or size of clusters in the collection and allow relevance at multiple scales. Methods in this spirit include,

  • multiple cluster retrieval
  • spreading activation and relevance propagation methods
  • local document expansion
  • score regularization

In my opinion, because the local methods require an accurate and appropriate document similarity measure. So as parameters states the thesis does not support appropriate document similarity measure.

         One more thing that could be used for retrieval of relevant papers is comparison of references in different papers and decision how similar they are based on that overlap (falling into comparative genomics, I guess).

Alex Voznyy argues “The problem of finding the new knowledge is enhanced by the fact that all potential knowledge is not directly available to you, i.e. you cannot analyze what is relevant to you without knowing that it exists. Publishers could do such analysis, and maybe they do (though, not sure they use the above mentioned references overlap).”


Problem is that the writer still basing relevance and quality on popularity. However a paper that is completely wrong may appear “popular” among respected researchers in the field – because people read things that they agree with, and also that they disagree with. There may be a need for some sort of rating system to go alongside it in order to separate the reason for reading from the fact that someone is reading an article.













Way of writing is easy and simple according to the topic. On the other hand, so many words are used only to stuff the thesis.

This process-rather-than-substance view of writing invites a final, dual reflection:

  1. Writers may not be special or talented in any usual sense. They are simply engaged in sustained use of a language skill we all have. Their “creations” come about through confident reliance on stray impulses that will, with trust, find occasional patterns that are satisfying.
  2. But writing itself is one of the great, free human activities. There is scope for individuality, and elation, and discovery, in writing.
  3. For the person who follows with trust and forgiveness what occurs to him, the world remains always ready and deep, an inexhaustible environment, with the combined vividness of an actuality and flexibility of a dream. Working back and forth between experience and thought, writers have more than space and time can offer.
  4. They have the whole unexplored realm of human vision.







To generate awareness of health issues among community.

———————————-Individuals can become more aware of health issues, change personal expectations for health. and build skills needed for high-level wellness (Pender, l997).                                                                                                                                      Knowles’s (1970) theory of adult learning theory shares several principles with community health nursing. These Include;                                                                                                  -Respecting persons and recognizing their individual and collective wealth of experiences, talents, and personal resources.                                                                                                  – Supporting learner self-direction, with an emphasis on self-help and solving current problems.                                                                                                                          – Actively engaging the learner as partner in planning, implementing, and evaluation.                                                                                                                                         – Providing opportunities to free self from preconceptions.                                                     – Viewing the teacher/nurse as a facilitator, consultant, and partner to the learner.                                                                                                                                              – Advocating for a community in which teacher and learner are in dialogue and in a mutual process,                                                                                                         Because education of communities and adults focuses on partnerships between learners and teacher, information-giving strategies, such as lecture, should be used in combination with participative and collaborative meth- ods such as task groups, games, and discussion groups.


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