# An analysis of the factors influencing bone health literacy among middle-aged and elderly breast cancer patients undergoing endocrine therapy: a mixed-methods study based on COM-B theory

## TL;DR

This study explores how well middle-aged and older breast cancer patients understand bone health during endocrine therapy and what factors influence their knowledge.

## Contribution

The study introduces a mixed-methods approach based on COM-B theory to assess and explain bone health literacy in breast cancer patients undergoing endocrine therapy.

## Key findings

- Bone health literacy scores among patients were low, averaging 43.13 out of a possible higher score.
- Educational attainment, self-efficacy regarding osteoporosis, and family care level were significant quantitative factors influencing bone health literacy.
- Qualitative findings identified four themes under COM-B dimensions, highlighting the multidimensional nature of the issue.

## Abstract

Endocrine therapy is a cornerstone in the treatment of breast cancer; however, its prolonged use can exacerbate the deterioration of bone health, particularly in middle-aged and older women, who are already at heightened risk for bone loss due to age-related hormonal changes. Despite the critical role that bone health literacy plays in managing patients′ bone health, there has been a lack of studies examining bone health literacy in middle-aged and older breast cancer patients undergoing endocrine therapy. This study aims to assess the current status of bone health literacy in this demographic and to identify the factors influencing it.

This study was designed based on the theory of COM-B, employing a convergent design within a mixed-methods theory. For the quantitative component, a convenience sampling method was used to select 261 patients undergoing endocrine therapy to complete a questionnaire survey. For the qualitative component, 11 patients were selected through maximum variation purposive sampling to participate in semi-structured interviews.

The bone health literacy score among middle-aged and older breast cancer patients undergoing endocrine therapy was (43.13 ± 7.23). Quantitative analysis indicates that the primary influencing factors include educational attainment, self-efficacy regarding osteoporosis, and the level of family care. The qualitative research identified four themes and nine sub-themes based on the dimensions of capability, motivation, opportunity, and behavior. Mixed results demonstrate that quantitative findings and qualitative findings complement and corroborate one another.

Middle-aged and older patients undergoing endocrine therapy for breast cancer exhibit low levels of bone health literacy, influenced by a combination of capability, opportunity, motivation, and behavioral factors. This suggests healthcare professionals should prioritize assessing and intervening in bone health literacy among this patient group. Multidimensional interventions targeting these influencing factors can enhance patients’ bone health literacy levels.