Predictors of osteoporosis self-efficacy among young and middle-aged female nurses based on self-efficacy theory and the health belief model: evidence from a tertiary hospital in Eastern China

Abstract

Background Young and middle-aged female nurses face an elevated risk of osteoporosis due to occupational demands and progressive physiological bone loss. However, most existing studies focus on postmenopausal women, and the status of objective and self-perceived osteoporosis risk, knowledge, self-efficacy, and its influencing factors among young and middle-aged female nurses remains unclear. Method A cross-sectional design was used. From August to September 2025, 380female nurses at the First Affiliated Hospital of Ningbo University, a 4,000-bed tertiary referral centre, were invited to participate, and 369 completed valid questionnaires, forming the final sample. Spearman correlation analysis assessed the relationships between osteoporosis self-efficacy and both osteoporosis knowledge and objective osteoporosis risk among young and middle-aged female nurses. Multiple linear regression analysis was then performed to identify factors influencing osteoporosis self-efficacy. Additionally, exploratory subgroup analyses were conducted stratified by menopausal status and osteoporosis training experience to examine potential effect modifications. Result The mean osteoporosis self-efficacy score was 52.53 ± 18.45, suggesting suboptimal confidence in preventive behaviors. A high proportion of nurses (63.41%) had objective osteoporosis risk, yet 35.50% underestimated their personal risk. Multiple linear regression showed that menopausal status, objective osteoporosis risk, osteoporosis knowledge, osteoporosis-related training, and milk consumption frequency were significant predictors of self-efficacy, explaining 18.40% of the variance (R2 = 0.184, F = 10.119, p < 0.001), indicating that additional unmeasured predictors likely contribute to self-efficacy. Subgroup analyses suggested that training experience and menopausal status may moderate the predictive pathways of osteoporosis self-efficacy. Conclusion Young and middle-aged female nurses face high objective osteoporosis risk but exhibit inaccurate risk perception and suboptimal self-efficacy. The mechanism underlying osteoporosis self-efficacy among young and middle-aged female nurses is complex and may be influenced by menopausal status and training experience. Occupational health departments should provide early osteoporosis screening for these nurses to enhance their risk awareness. Furthermore, differentiated, stratified interventions should be implemented: for trained and postmenopausal nurses, efforts should focus on reinforcing motivation and sustaining high levels of health behaviors rather than reiterating foundational knowledge; for untrained and premenopausal nurses, emphasis should be placed on osteoporosis education and the development of basic health habits, thereby establishing an initial foundation for self-efficacy.