Osteoprotective Knowledge in a Multiethnic Epilepsy Population

John O. Elliott, MPH; Brenda F. Seals, PhD, MPH; Mercedes P. Jacobson, MD


J Neurosci Nurs. 2008;40(1):14-24. 

In This Article


Ninety-four epilepsy clinic patients over the age of 18 years participated in the study. Participants were recruited from the department of neurology outpatient clinic at Temple University School of Medicine. Data collection took place during a 6-month period. Inclusion criteria included patients ages 18 years or older with a diagnosis of epilepsy. Exclusion criteria included patients with mental retardation, learning disability, Alzheimer disease, dementia, or schizophrenia. Of the 225 patients invited to participate in the survey, 83 patients were approached during their clinic visits and 142 patients (not scheduled for office visits in the near term) were mailed surveys; 98 were Caucasians (44%), 85 African Americans (38%), 34 Latino (15%), and 8 Asian or other (<1%). The response rate to our questionnaire was 42%. Of those approached during a clinic visit, 27 (33%) completed surveys, and of those who were mailed surveys, 67 (47%) completed and mailed them back. The Temple University Institutional Review Board approved this study, and written informed consent was obtained from each participant.


Participants completed a questionnaire containing the Osteoporosis Knowledge Test (OKT) and a demographic form related to epilepsy and bone health. The OKT is a 24-item multiple-choice test designed by Kim, Horan, and Gendler (1991) to measure knowledge of risk factors for osteoporosis and strategies for prevention related to exercise and calcium (Redman, 2003). The OKT, as displayed in Table 1 , has four sections of questions for the identification of risk factors, appropriate exercise patterns, foods high in calcium, and reasons for taking calcium supplements. There are two subscales for the OKT: exercise (questions 1–16) and calcium (questions 1–9 and 17–24). The OKT exercise subscale internal consistency coefficient using Cronbach's alpha was .69. The OKT calcium subscale internal consistency coefficient, using Cronbach's alpha, was .72. Validity of the OKT was evaluated by factor analysis and discriminant function analysis (Kim et al., 1991). The OKT has been validated in Persian (Baheiraei, Ritchie, Eisman, & Nguyen, 2005) and Chinese (Lee & Lai, 2006) populations in addition to male populations (Sedlak et al., 2000). With a possible range of scores from 0 to 24, higher scores indicate greater knowledge. Poor to moderate knowledge (mean scores = 15.1–17.8) on the OKT has been found among men and women in various age groups (Werner, 2005).

Each participant also completed a demographic questionnaire ( Table 2 ). Information requested included age, gender, ethnicity, marital status, education, yearly income, working status, height, weight, smoking and alcohol use, bone fracture history, family history of osteoporosis, calcium and multivitamin use, age at time of epilepsy diagnosis, number and type of AEDs presently taken, seizure frequency, insurance status, prescription coverage, and driving status. Missing demographic items were gathered from the clinic chart when necessary. Participant confidentiality was maintained by the use of an assigned, study-specific identification number. A Spanish translation of the OKT, provided by the questionnaire developers, was used for patients whose primary language was Spanish. The informed consent form, Health Insurance Portability and Accountability Act (HIPAA) form, demographic questionnaire, and correspondence were also translated into Spanish and verified by two native speakers for accuracy.