Qualitative Insights from the Osteoporosis Research: A Narrative Review of the Literature

Table 2

Data extraction of evidence included in the narrative review.

Author (Year)	Geography	Purpose of the study	Methods	Sample	Key findings
Åberg, 2008 [38]	Sweden	Explore preferences of elderly care regarding activity-related life space and life satisfaction	Interviews; general motor function assessment; thematic framework analysis	Geriatric rehabilitation patients (80–94 YA; )	Importance of socializing, going out of doors, continuity of activities in familiar settings, and body-related activities identified.
Baheiraei et al., 2006 [24]	Australia	Explore understandings of risk factors and barriers to osteoporosis prevention and control	Interviews; focus groups; group discussions; thematic analysis	Iranian-Australians (35–70 YA; )	Many culturally-specific misunderstanding and obstacles concerning osteoporosis prevention.
Besser et al., 2012 [41]	England	Explore patients’ perceptions of osteoporosis and treatment	Interviews; drawings; self-regulation model	Osteoporosis/osteopenia patients (avg. age 69; )	Patients understand of osteoporosis but not medication and risk. Pictures elicit emotional responses.
Bhavnani and Fisher, 2010 [51]	UK	Explore patients’ views of decision-aids	Focus groups; thematic content analysis	Patients of numerous conditions (42–83 YA; )	Decision-aids valuable as conversation starters should not replace clinical decision-making.
Breedveld-Peters et al., 2012 [64]	Netherlands	Explore barriers and facilitators of implementing hip fracture nutrition intervention	Interviews; focus groups; triangulation	Healthcare professionals ()	Barriers include lack of knowledge, role clarity, communication, and standardization in care.
Brod et al., 2008 [49]	USA	Understanding patient and physician adherence issues of self-injectable osteoporosis medication	Interviews; focus groups; analyzed for themes and conceptual model development	Osteoporosis patients (42–88 YA; ); physicians ()	Motivation, physician messages, side effects, and clinical profile affected patients’ adherence and persistence. Physicians were affected by knowledge, patients’ clinical profile, and resources for patient education.
Claesson et al., 2015 [65]	Sweden	Explore nurses’ perceptions of osteoporosis management	Focus groups; thematic content analysis; triangulation	Nurses ()	Barriers: insufficient knowledge/time to treat osteoporosis, a low priority condition; distrust of bisphosphonates; opportunities: competence in fall prevention and collaboration; willingness to learn more and identify at-risk patients.
Drew et al., 2015 [62]	England	Understand how and why secondary fracture prevention services can be implemented	Interviews; Normalization Process Theory	Healthcare professionals ()	Highly workable and easily integrated due to planning, multidisciplinary meetings, and technology. Challenges in coordination with primary care, lack of resources, staff, and patient access.
Drieling et al., 2011 [57]	USA	Develop and explore internet-based fracture-risk intervention	Mixed method randomized clinical trial: questionnaires; focus groups; tutorial evaluation forms	Women (≥19 YA )	Improvements in knowledge: qualitative results suggest benefits in behavior not evident in quantitative results.
Emmett et al., 2012 [63]	UK	Explore acceptability of osteoporosis screening	Interviews; focus groups; thematic framework analysis	Women (70–85 YA; ); general practitioners ()	Screening viewed positively and not a promoter of anxiety. Must be cost-effective.
Claesson et al., 2015 [65]	Turkey	Examining medicalization and conceptualizations of risk regarding postmenopausal menopause	Group and individual interviews, participant-observation; media analysis; situational analysis	Menopausal women (); clinicians ()	Menopause is a risky period leading to osteoporosis. Traditional lifestyles also produce osteoporosis risk.
Hallberg et al., 2010 [34]	Sweden	Explore health-related-quality-of-life and daily life effects of vertebral fractures	Interviews, inductive content analysis	Females who experienced vertebral fracture ~9 years ago (68–74 YA; )	Independence was highly valued and threatened. Pain, self-esteem, and social life were affected. Various coping mechanisms were deployed including social support, self-care, and personal meaning.
Hvas et al., 2005 [23]	Danish	Explore effects of knowledge of osteoporosis risks	Interviews; editing analysis style	Menopausal women ()	Confusion, anxiety, and uncertainty accompanied awareness of osteoporosis risk; some dismissed personal risk.
Iversen et al., 2011 [45]	USA	Describe and contrast providers’ and patients’ views on adherence	Focus groups; open coding	Osteoporosis patients (65–85 YA; ); general practitioners (); nurse practitioner ()	Relationship with provide could affect adherence as could confusion, issues with taking medication, source of information, and satisfaction with clinician; self-image and psychological wellbeing affected by osteoporosis; physicians felt cost, structural barriers side effects, knowledge issues impacted adherence, recommended memory aids.
Jaakkola, 2007 [52]	USA and UK	Investigate physicians’ view of patients’ participation in treatment	Interviews; analyzed for themes	Specialist physicians ()	Patients do influence treatment based on their resources and preferences, efforts and actions, expectations, and role expectations.
Jaglal et al., 2003 [66]	Canada	Explore physicians’ experiences and perspectives of osteoporosis and educational needs	Focus groups; constant comparative analysis	Family physicians ()	There was confusion over management. Tests were ordered but lacked rationale. Required greater clinical education.
Johnson et al., 2013 [58]	Canada	Examine information exchange during rural hip fracture transitions	Interviews, participant observation, record and policy analysis; focused coding and framework development	Hip fracture patients (>65 ), healthcare providers (); caregivers ().	Information needed to be timely but had to navigate numerous sources to obtain information. Families often had difficulty obtaining information.
Kastner et al., 2010 [60]	Canada	Understand physicians’ perceptions of an osteoporosis clinical decision support system	Progressive, iterative focus groups; open, axial, and selective coding	Physicians ()	Suggestions were made for modifying tool. Barriers included use of tablet device in waiting room, potential for patient confusion, concerns over extracting information from tool.
Kastner et al., 2010 [61]	Canada	Conduct a usability study of an osteoporosis clinical decision support system	Qualitative components: interviews; audio-taped one-on-one usability sessions; constant comparison analysis	Study 1: physicians (); study 2: patients (avg. 72 YA; ); study 3 (avg. 73 YA; )	Patients found most components of the tool comprehensible and valuable to clinical encounters. Found questionnaire difficult to initiate. Physicians concerned over timing, workflow, and disruption of clinical encounter.
Lau et al., 2008 [44]	Canada	Explore factors influencing adherence and perceptions of adherence strategies	Focus groups; analyzed for themes; triangulation through member checking	Females taking osteoporosis medication (48–88 YA; )	Factors affecting adherence: beliefs regarding medications, importance of medication, and health; medication-specific factors; information exchange; and adherence strategies; memory aids, information, systems, and ongoing provider follow-up.
Meadows and Mrkonjic, 2003 [30]	Canada	Understand experiences and sequelae of midlife fractures in women and whether connections are made to underlying bone health	Interviews; crystallization/immersion	Female fracture patients 40–65 YA at time of fracture ()	Fractures produced pain and major life confusion. Connection between bone health and fracture was often confused and care was discontinuous. Women often devastated by osteoporosis diagnosis and felt they had been low risk.
Meadows et al., 2005 [31]	Canada	Explore women’s perceptions and experiences of fracture	Interviews; immersion	Female fracture patients (40–65 YA; )	Three responses to risk: laissez faire approach, inconsistent adoption of change/knowledge, actively engaged in knowledge seeking/behaviour change.
Nahm et al., 2013 [56]	USA	Explore caregivers’ caregiving experiences while using an online hip fracture resource centre	Content analysis of online discussion board postings	Caregivers of recovering hip surgery patients ()	Caregivers discussed types of care and coping strategies; fracture prevention strategies; themes included: recognition of clinicians, utility of program, caregivers’ stress and lack of knowledge; care recipients’ need for adjustment; desire for baseline status, and transition difficulties.
Neuman et al., 2013 [46]	USA	Explore racial variations in preferences for hip fracture care	Qualitative component: freelist exercises	Black and White geriatric medicine patients (; 69–79 YA)	Blacks and Whites differed in salient downsides of surgery. Whites more concerned with complications and surgical skills. Blacks more concerned with recovery time, inability to care for oneself, lack of success, and death. Pain and recovery time concern for all. Quantitative results: Blacks less favorable view of surgery.
Nielsen et al., 2011 [40]	Denmark	Examine how men handle osteoporosis in everyday lives	Focus groups; critical psychology analysis	Men with osteoporosis (; 51–82 YA)	Men concerned with maintaining masculine identity through maintaining strength, activity, and being proactive in treatment.
Nielsen et al., 2013 [35]	England and Denmark	Explore importance of osteoporosis knowledge on patients’ everyday handling of osteoporosis	Interviews; participation observation; phenomenological meaning condensation; critical psychology analysis	Osteoporosis patients ()	Life conditions affect how osteoporosis is handled, everyday life influenced by handling of treatment, handling of osteoporosis information affected patient experiences and relationships.
Otmar et al., 2012 [67]	Australia	Investigate barriers and enablers affecting osteoporosis investigation and management	Focus groups; analytic/nominal comparison; thematic coding	General practitioners () and practice nurses ()	Osteoporosis of less concern than other conditions. Unsure of guidelines regarding men and duration of treatment. Believed in bisphosphonate efficacy but worried about cost.
Popejoy et al., 2013 [53]	USA	Describe types of care transitions and problems experienced by hip fracture patients	Chart reviews and interviews	Hip fracture patients (68–97 YA; )	Patients experienced a median of 4 transitions. Families vital for advocacy and identifying problems. Care complicated by comorbid conditions. Patients desired faster recoveries and more aggressive treatment. Transition to skilled nursing facility experienced greater issues than transition to inpatient rehabilitation facilities. Common issues: delirium, depression, falls, urinary incontinence, pressure ulcers, and weight loss.
Qvist et al., 2011 [50]	Sweden	Investigate experiences of a back muscle exercise group for women with osteoporosis-related vertebral fractures and thoracic kyphosis	Interviews; content analysis	Participants in the back muscle group for women with osteoporosis-related vertebral fractures and thoracic kyphosis ()	Participants described physical, behavior, and psychosocial benefits from the group. Awareness and experiences of the body from the exercise (awareness of straightening the back and usefulness of increased strength and mobility) and social dimensions of the training (affinity and support and sense of trust and safety).
Reventlow and Bang, 2006 [20]	Denmark	Explore Danish women’s ideas regarding osteoporosis and risk	Focus groups; meaning-centred analysis	Women (60-61 YA; )	Risk of osteoporosis assessed by appearance; vacillation between osteoporosis as product of ageing or preventable disease; women concerned with osteoporosis risk viewed it in catastrophic terms.
Reventlow et al., 2008 [21]	Denmark	Explore women’s conceptions and models of osteoporosis risk	Focus groups; interviews; analyzed for metaphors; coded for schemata-based structures	Women born in 1936 who had heard of osteoporosis ()	Findings suggest a lack of trust in one’s body and negative view of ageing. Osteoporosis is nonnormative and destructive. Commonest metaphor was a collapsing building. Imagery included porous bones, frail bodies, and collapsing backbones.
Roberto and Reynolds, 2001 [39]	USA	Explore functional and psychosocial consequences of living with osteoporosis	Focus groups; open coding for themes and patterns	Females with osteoporosis living in rural communities (53–89 YA; )	Main categories: describing history of identifying and diagnosing osteoporosis; changes in daily activities (functional abilities and social interactions and relationships); concerns and challenges (including self-concept, fears, and independence); coping interventions (pharmaceuticals, supplements, devices, and exercise); advice for other women with osteoporosis.
Rothmann et al., 2014 [22]	Denmark	Explore patients’ patients’ perspectives, experiences, and acceptance of the program	Interviews; focus groups; critical psychology approach; analyzed for themes	Women (65–80 YA; )	Limited knowledge of osteoporosis. Acceptance of screening affected by patients’ overall life, experiences, and view of risk and preventive measures. Health-seeking perceived as moral obligation, whether or not screening accepted. Screening served valuable role in reassurance or elevating concerns.
Sale et al., 2010 [26]	Canada	Investigate understanding of osteoporosis and related care after osteoporosis screening and care	Focus groups; analyzed for themes	Fracture patients screened at an osteoporosis screening clinic (47–80 YA; )	Uncertainty common. Patients were ambiguous about the cause of their fracture (not linking falls to osteoporosis); osteoporosis’s presentation as a disease (due to asymptomatic nature); BMD testing and results; and medication and supplements.
Sale et al., 2010 [27]	Canada	Assess patients’ interpretations of BMD results and perceptions of bone health	Interviews; iterative, phenomenological analysis	Fracture patients with a previous BMD test (49–82 YA; )	A third of patients accurately recounted test results. Test results not related to medication adherence. Patients presumed (not necessarily accurately) that receiving no news was indicative of healthy status. Test results not taken seriously or viewed as accurate and these views were related to adherence.
Sale et al., 2011 [42]	Canada	Examine patients’ experiences making osteoporosis medication decisions following a fracture	Interviews; phenomenological analysis guided by Giorgi’s methodology	Fracture patients at high risk for future fracture (65–88 YA; )	Ease of decision affected by relationship with provider. Less sure participants sought outside information and were concerned over side effects. Decisions were subject to change.
Sale et al., 2014 [36]	Canada	Explore patients’ nonpharmacological/diagnostic strategies for managing bone health/fracture risk	Interviews; phenomenological analysis guided by Giorgi’s methodology	Fracture patients at high risk for future fracture (65–88 YA; )	Participants focused on being careful and altering perceived modifiable personal and environmental factors, exercising, altering diet, and using aids and supplements.
Sale et al., 2014 [47]	Canada	Examine members of an osteoporosis patients group members’ behaviours and experiences managing bone health	Interviews; phenomenological analysis guided by Giorgi’s methodology	Members of a national osteoporosis group who sustained a fracture ≥50 YA when not taking medication (51–89 YA; )	Patients were categorized as more or less effective health consumers. Over half were effective consumers based on interactions with providers for medications, tests, referrals and other behaviours.
Sale et al., 2015 [28]	Canada	Examine perceived bone health messages among members of an osteoporosis patient group	Interviews; phenomenological analysis guided by Giorgi’s methodology	Members of a national osteoporosis group who sustained a fracture ≥50 YA when not taking medication (51–89 YA; )	Perceived messages were very inconsistent. Greater osteoporosis interest perceived in specialists. Other providers rarely relayed messages.
Schiller et al., 2015 [55]	Canada	Summarize patients’ messages or advice for recovering from hip fractures and how these messages can be used in clinical communication.	Interviews; inductive coding	Patients ≥60 with a previous hip fracture and their caregivers	Three main messages helped recovery: seeking support, moving more, and preserving perspective.
Sims-Gould et al., 2012 [59]	Canada	Understand key elements of healthcare provider-perceived success in care transitions	Interviews; analytical meetings, coding, and memo writing	Healthcare providers working with hip fracture patients ()	Dominant themes: a focus on process: information gathering and communication; focus on outcomes: autonomy and care pathways.
Toscan et al., 2013 [54]	Canada	Explore multiple transitions of a single hip fracture patient from multiple perspectives	Interviews, participant observation, analysis of current literature; inductive analysis incorporating data reduction, display, and conclusion drawing	One hip fracture patient (age: 80s) who underwent multiple transitions, her family caregivers, and healthcare providers	Four themes over trajectory related to patients and caregivers not feeling involved in care, confusion over healthcare providers’ role, uncertainty, and individualized care hampered by policies.
Unson et al., 2003 [48]	USA	Examine how beliefs about medication and treatments influence selection and adherence	Focus groups; open, selective coding for themes	Racially diverse women ≥60 not on osteoporosis treatment (60–91 YA)	Adherence affected by multiple factors included beliefs about medication safety, costs, treatment goals, belief in physician’s competence, and need for treatment.
Wilkins, 2001 [37]	Canada	Understand relations between self-concept and meanings of aging and chronic illness and implications for everyday lives	Interviews; questionnaire; constant comparative method	Women with osteoporosis (54–80 YA; )	Women with confident selves accepted aging and chronic disease; women with contradictory selves denied effects of aging and chronic disease, and women with disparaged selves were resigned to aging and chronic disease.

YA = years of age.