Social Determinants of Health of Multicultural Adolescents in South Korea: An Integrated Literature Review (2018~2020)

Purpose@#This study is an integrated literature review to analyze health problems and social determinants of multicultural adolescents in South Korea. @*Methods@#An integrative review was conducted according to Whittemore & Knafl’s guideline. An electronic search that included publications from 2018 to 2020 in the PubMed, EMBASE, Cochrane Library, CINAHL, RISS, and KISS databases was conducted. Of a total of 67 records that were identified, 13 finally met full inclusion criteria. Text network analysis was also conducted to identify keywords network trends using NetMiner program. @*Results@#The health problems of multicultural adolescents were classified into mental health (depression, anxiety, suicide and acculturative stress) and health risk behaviors (smoking, risky drinking, smartphone dependence and sexual behavior). As social determinants affecting the health of multicultural adolescents, the biological factors such as gender, age, and visible minority, and the psychological factors such as acculturative stress, self-esteem, family support, and ego-resiliency were identified. The sociocultural factors were identified as family economic status, residential area, parental education level, and parents' country of birth. As a result of text network analysis, a total of 41 words were identified. @*Conclusion@#Based on these results, mental health and health risk behaviors should be considered as interventions for health promotion of multicultural adolescents. Our findings suggest that further research should be conducted to broaden the scope of health determinants to account for the effects of the physical environment and health care system.

Influence of Nursing Professional Value and Political Participation of Nurses on Patient Advocacy / 임상간호연구

Purpose@#This study aimed to identify the level of patient advocacy and to determine the influence of nursing professional value and political participation of nurses on patient advocacy theory. @*Methods@#This study used a cross-sectional descriptive study design. Data were collected from 232 nurses from a tertiary hospital, three general hospitals, and a public health center in two districts of a metropolitan using self-reporting questionnaires.Data were analyzed by t-test, One-way ANOVA, Pearson’s correlation coefficient, and multiple linear regression using SPSS/ WIN 21.0. @*Results@#The mean score of patient advocacy was 4.64±0.55 out of 6, nursing professional value was 3.60±0.49 out of 5, and political participation was 2.21±0.71 out of 5. Nursing professional value (r=.37, pppp=.014). @*Conclusion@#Based on the findings that nursing professional value and political participation are key factors of patient advocacy, educational strategies and endeavors as level of professional organization are recommended for enhancing patient advocacy.

Influence of Nursing Professional Value and Political Participation of Nurses on Patient Advocacy / 임상간호연구

Purpose@#This study aimed to identify the level of patient advocacy and to determine the influence of nursing professional value and political participation of nurses on patient advocacy theory. @*Methods@#This study used a cross-sectional descriptive study design. Data were collected from 232 nurses from a tertiary hospital, three general hospitals, and a public health center in two districts of a metropolitan using self-reporting questionnaires.Data were analyzed by t-test, One-way ANOVA, Pearson’s correlation coefficient, and multiple linear regression using SPSS/ WIN 21.0. @*Results@#The mean score of patient advocacy was 4.64±0.55 out of 6, nursing professional value was 3.60±0.49 out of 5, and political participation was 2.21±0.71 out of 5. Nursing professional value (r=.37, pppp=.014). @*Conclusion@#Based on the findings that nursing professional value and political participation are key factors of patient advocacy, educational strategies and endeavors as level of professional organization are recommended for enhancing patient advocacy.

Theoretical evaluation of Cox’s interaction model of client health behavior for health promotion in adultwomen

Purpose@#This literature review aimed to evaluate Cox’s interaction model of client health behavior (IMCHB) as used in studies on women’s health. @*Methods@#Using keyword combinations of “women” and “IMCHB” or “interaction model of client health behavior,” we searched the PubMed, MEDLINE, Embase, and RISS databases for studies on the promotion of women’s health published from January 2009 to April 2019. Finally, 11 studies were selected and evaluated according to seven criteria for theory evaluation, which combined Fawcett’s theory evaluation criteria and Chinn and Kramer’s criteria. @*Results@#We found that the IMCHB corresponds to a verifiable practical level of a middle-range theory, although it may be partially abstract. It contains all four concepts of the metaparadigm of nursing, in terms of a holistic philosophical approach. A theoretical evaluation demonstrated that the IMCHB has significance, generality, testability, empirical adequacy, and pragmatic adequacy for nursing practice and research. However, the lack of clear conceptual definitions and the presence of complex relationships among concepts resulted in a lack of internal consistency and parsimony. @*Conclusion@#According to an in-depth verification through a review of the literature, the IMCHB has been used as a health promotion intervention strategy for various populations of women and has led to useful results in nursing practice. The IMCHB was confirmed to be a suitable theory for experimental and clinical research. Future research can build on this middle-range theory for women’s health research and practice.

Multilevel Effects of Community Capacity on Active Aging in Community-Dwelling Older Adults in South Korea

Purpose@#This study aimed at identifying the level of active aging in older adults and the influence of the individual and community levels of community capacity on active aging. @*Methods@#A cross-sectional survey was conducted on a stratified sample of 380 older adults living in 35 neighborhoods of five regions in Seoul, the capital of South Korea. The structured questionnaire included the Korean version of instruments that measure active aging and community capacity at the individual level. Secondary data including metropolitan statistical information, a public data portal, and a city plan were used to acquire community-capacity factors at the community level. Data were analyzed with multilevel models. @*Results@#The overall active aging mean score was 3.00 ± 0.55 out of 5; the highest mean score was in the security domain (3.46 ± 0.65) and the lowest one was in the participation domain (2.71 ± 0.66). Individual factors associated with active aging included age, education, income, and community capacity at the individual level. At the community level, two community-capacity factors (senior leisure welfare facilities and cooperative unions) were significantly associated with active aging. In active aging, 6.4% and 4.1% of total variance could be explained by 35 neighborhoods, after considering individual and community level variables, respectively. @*Conclusion@#This study showed that community capacity is important for active aging among older adults. Appropriate strategies that consider both individual and community factors, such as contextual indicators of community capacity, are necessary to improve active aging.

Multilevel Effects of Community Capacity on Active Aging in Community-Dwelling Older Adults in South Korea

Purpose@#This study aimed at identifying the level of active aging in older adults and the influence of the individual and community levels of community capacity on active aging. @*Methods@#A cross-sectional survey was conducted on a stratified sample of 380 older adults living in 35 neighborhoods of five regions in Seoul, the capital of South Korea. The structured questionnaire included the Korean version of instruments that measure active aging and community capacity at the individual level. Secondary data including metropolitan statistical information, a public data portal, and a city plan were used to acquire community-capacity factors at the community level. Data were analyzed with multilevel models. @*Results@#The overall active aging mean score was 3.00 ± 0.55 out of 5; the highest mean score was in the security domain (3.46 ± 0.65) and the lowest one was in the participation domain (2.71 ± 0.66). Individual factors associated with active aging included age, education, income, and community capacity at the individual level. At the community level, two community-capacity factors (senior leisure welfare facilities and cooperative unions) were significantly associated with active aging. In active aging, 6.4% and 4.1% of total variance could be explained by 35 neighborhoods, after considering individual and community level variables, respectively. @*Conclusion@#This study showed that community capacity is important for active aging among older adults. Appropriate strategies that consider both individual and community factors, such as contextual indicators of community capacity, are necessary to improve active aging.

Differences between Perceived Readiness for Interprofessional Learning in Nursing and Other Health-related Students / 한국간호교육학회지

PURPOSE: The purpose of this study was to investigate the level of perceived readiness for interprofessional learning and its differences between nursing and other health-related students. Methods METHODS: A web-based survey was conducted from April 25 to June 30, 2017 in one university in Korea. A total of 325 undergraduate nursing students and other health-related disciplines completed the structured questionnaire consisting of Readiness for Interprofessional Learning Scale and general characteristics. Data were analyzed by descriptive statistics, t-test, ANOVA, and multiple linear regression. RESULTS: The scores of readiness for interprofessional learning in nursing students were significantly higher than those in other health-related students (t=3.50, p=.001). Nursing students had higher collaboration, professional identity, and roles and responsibilities than other health-related students. The class experiences with other major students was a significant factor related to the readiness for interprofessional learning both in nursing (p=.001) and other health-related students (p=.001). CONCLUSION: The findings suggest that nursing educators consider the different level of readiness for interprofessional learning between nursing and other health-related students while integrating interprofessional education into nursing education curricula.

Factors Influencing Work-life Balance in Female Service Workers / 한국직업건강간호학회지

PURPOSE: The study aimed to identify factors influencing work-life balance in female service workers. METHODS: A cross-sectional descriptive study was conducted with an online survey of 234 service workers using volunteer panels. Data were collected using a self-administered questionnaire from July 16 to 24, 2017. Major variables included work-life balance, resilience, emotional intelligence, job stress, and fatigue. Using the SPSS 24.0 program, descriptive statistics, t-test, ANOVA, correlation analysis, and multiple regression analysis were conducted. RESULTS: The mean score of the work-life balance level of female service workers was 2.9±0.85 on a total score of 6. A multiple regression analysis revealed that smoking, resilience, job stress and fatigue were statistically significant factors in the model (p<.001), with an explanatory power of 50.3%. Emotional intelligence was not significantly associated with work-life balance. CONCLUSION: The level of work-life balance was considerably low in female service workers. This study suggests that nursing interventions to enhance work-life balance are required at both the individual and organizational levels.

Development and Evaluation of Cardiovascular Disease Prevention Education Materials for Middle-aged Korean-Chinese Female Workers: Applying Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P)

PURPOSE: The purpose of this study was to develop and evaluate the quality (understandability and actionability) of health education materials for Korean-Chinese (KC) female migrant workers, using Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P). METHODS: Educational needs assessment was conducted with 3 focus groups with 20 KC women and a focus group with 4 community stakeholders. The quality of the educational materials was evaluated by 3 experts and a community stakeholder, followed by a survey with 15 KC women using 17 items for understandability and 7 items for actionability by means of a Korean version PEMAT-P. RESULTS: The health educational calendar consists of 12 subjects out of 9 topics related to healthy lifestyles for preventing cardiovascular diseases. The overall mean understandability score was 98.8% and the overall mean actionability was 100%. CONCLUSION: Involvement of KC women and community stakeholders in the development of educational materials was found to be an effective strategy for increasing understandability and actionability of educational materials for KC female migrant workers. This study also demonstrates the PEMAT-P is a useful evaluation tool, emphasizing the actionability of educational materials.

The Effectiveness of a Cultural Competence Training Program for Public Health Nurses using Intervention Mapping

PURPOSE: This study evaluated the effects of a cultural competence training program for public health nurses (PHNs) using intervention mapping. METHODS: An embedded mixed method design was used. Forty-one PHNs (experimental: 21, control: 20) and forty marriage migrant women (MMW) (20, in each group) who were provided nursing care by PHN participated in the study. The experimental group was provided with a four-week cultural competence program consisting of an eight hour offline and online course, e-mail newsletters and social networking services (BAND). Transcultural Self-efficacy (TSE) of the PHNs, client-nurse trust, and satisfaction with nursing care of MMW were measured. Ten PHNs in the experimental group were interviewed after the experimental study. RESULTS: The experimental group showed a significantly greater improvement in TSE, client-nurse trust, and satisfaction with nursing care than did the control group. Six themes emerged from qualitative data: (a) Recognizing cultural differences, (b) Being interested in the multicultural policy, (c) Trying to communicate in MMW's own language, (d) Providing medical information using internet and smart phone, (e) Embracing culturally diverse people into society, and (f) Requiring ongoing cultural competence training. CONCLUSION: Cultural competence training enabled PHNs to provide culturally competent care and contribute to MMW's health outcomes.

Correlations among Emotional Labor, Servant Leadership, and Communication Competence in Hospital Nurses / 한국직업건강간호학회지

PURPOSE: The purpose of this study was to identify correlations among emotional labor, servant leadership, and communication competence in hospital nurses. METHODS: A self-administrated survey was conducted with a convenient sample of 210 nurses, using a structured questionnaire. The data were analyzed by descriptive statistics, t-test, ANOVA, and Pearson's correlation coefficient using SPSS/WIN 20.0 program. RESULTS: The mean emotional labor score was 3.4+/-0.60. There was very strong and negative correlation between emotional labor and servant leadership (r=-.896, p<.001). Communication competence was positively correlated with servant leadership (r=.298, p<.001) and moderately and negatively correlated with both frequency of emotional labor (r=-.166, p=.016) and the degree of attention to emotional expression (r=-.143, p=.039). CONCLUSION: As a strategy to reduce emotional labor of hospital nurses, the findings suggest training programs for nurses to enhance servant leadership and communication competence.

Global Health Competencies for Undergraduate Nursing Students in Korea / 한국간호교육학회지

PURPOSE: The purpose of this study was to identify essential global health competencies for undergraduate nursing students in Korea. METHODS: This study used a mixed methods design including an online survey with a convenient sample of 223 nursing educators, followed by an expert discussion with four nursing educators with expertise in global health. The global health competency was measured using the Global Health Competencies for Nurses in the America, which consists of 30 competencies in 6 domains. Each competency was measured by a 4-point Likert Scale, with at least 80% of 3 or 4 point scores indicating consensus that competency was considered essential for undergraduate nursing students. RESULTS: Nursing educators most strongly agreed the competencies of the Social and Environmental Determinants of Health domain as essential global health competencies for nursing students. A total of 21 items in 5 out of 6 competency domains were initially identified with at least 80% agreement. Finally, the experts decided on 24 global health competencies through the revision and integration of several competencies. CONCLUSION: The findings indicate that nursing educators perceived that nursing students need to be prepared for responding to emerging global health needs. The proposed list of global health competencies can provide guidance to develop a framework for integrating global health into undergraduate nursing curriculums.

The Relationships between Social Determinants of Health and Health-related Quality of Life among the Community-dwelling Elderly

PURPOSE: The purpose of this study was to examine the social determinants of health (SDH) associated with health-related quality of life (HQOL) among the community-dwelling elderly, based on the conceptual framework of the Commission on Social Determinants of Health (CSDH). METHODS: A survey was conducted with 199 elders aged 65 years or older sampled through convenient sampling. Data were collected through face to face interviews by trained interviewers using a structured questionnaire, which included scales of the residential area, social support, sense of community, social network, health behaviors, and HQOL. Data were analyzed by ANOVA and stepwise multivariate regression. RESULTS: Major SDH affecting HQOL included the participants' residential area, sense of community, and health behavior. The HQOL of the elderly residing in the B area with a low rate of basic livelihood security recipients was higher than that of those residing in other areas. CONCLUSION: CSDH framework was useful to determine the factors associated with HQOL among the community-dwelling elderly. In addition to their health behavior, their sense of community was found to be a SDH of HQOL, indicating the need of health promotion programs tailored to the characteristics of residential areas and strategies to enhance involvement in community activities.

Influence of Self Efficacy, Social Support and Sense of Community on Health-related Quality of Life for Middle-aged and Elderly Residents Living in a Rural Community

PURPOSE: The purpose of this study was to examine the relationship between self-efficacy, social support, sense of community and health-related quality of life (HRQoL), including the direct and indirect effects of the variables on HRQoL. METHODS: A cross-sectional survey was conducted with a convenience sample of 249 middle-aged and elderly residents living in a rural community in A-County, K Province. The structured questionnaire included 4 scales from the Euro Quality of life-5 Dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression), and measures of General Self-Efficacy, Social Support, and Sense of Community. Data were analyzed using SPSS WIN 20.0 and AMOS 21.0 program. RESULTS: The mean HRQoL score for the participants was 0.87+/-0.13. Self-efficacy (beta=.13, p=.039) and age (beta= -.38, p<.001) were significantly associated with HRQoL, explaining 21% of the variance. In the path analysis, self-efficacy showed a significant direct effect on HRQoL (beta=.14, p=.040) and significantly mediating relationships between both social support (beta=.05, p=.030) and sense of community (beta=.02, p=.025) and HRQoL. CONCLUSION: Although self-efficacy was found to be the main predictor for HRQoL, the findings imply that social environmental factors such as social support and sense of community need to be considered when developing interventions to increase HRQoL in middle-aged and elderly residents in rural communities.

Factors Associated with Physical Activity among Chinese Immigrant Women

PURPOSE: This study was done to assess the level of physical activity among Chinese immigrant women and to determine the relationships of physical activity with individual characteristics and behavior-specific cognition. METHODS: A cross-sectional descriptive study was conducted with 161 Chinese immigrant women living in Busan. A health promotion model of physical activity adapted from Pender's Health Promotion Model was used. Self-administered questionnaires were used to collect data during the period from September 25 to November 20, 2012. Using SPSS 18.0 program, descriptive statistics, t-test, analysis of variance, correlation analysis, and multiple regression analysis were done. RESULTS: The average level of physical activity of the Chinese immigrant women was 1,050.06+/-686.47 MET-min/week and the minimum activity among types of physical activity was most dominant (59.6%). As a result of multiple regression analysis, it was confirmed that self-efficacy and acculturation were statistically significant variables in the model (p<.001), with an explanatory power of 23.7%. CONCLUSION: The results indicate that the development and application of intervention strategies to increase acculturation and self-efficacy for immigrant women will aid in increasing the physical activity in Chinese immigrant women.

Factors Influencing Medication Adherence in Patients with Hypertension: Based on the 2008 Korean National Health and Nutrition Examination Survey

PURPOSE: The purpose of this study is to examine factors influencing medication adherence in patients with hypertension. METHODS: This study carried out a secondary analysis of data from the 2008 Korean National Health and Nutrition Examination Survey (KNHANES). Stratified sampling was used to select a participant sample that was representative of patients with hypertension throughout the country. Using the SPSS/WIN 18.0 program, data were analyzed using descriptive statistics, chi2 test, t-test, and logistic regression. RESULTS: Of the patients with hypertension, 8.8% had showed non-adherence to medication. Medication adherence was associated with age, spouse, Medicare insurance, number of other diseases, and current smoking status. The cases with older age, a spouse, Medicare insurance, higher number of other diseases, and no current smoking status showed significantly high medication adherence. CONCLUSION: Nursing interventions and further studies are needed to achieve high levels of medication adherence based on factors influencing medication adherence such as age, spouse, Medicare insurance, number of other disease, and current smoking status.

Acculturation, Social Network, and Health-related Quality of Life in Korean-Chinese Immigrants

PURPOSE: The purpose of this study is to identify relationships between acculturation, social network, and health-related quality of life (HRQOL) among Korean-Chinese immigrants. METHODS: A cross-sectional descriptive study was conducted with 147 Korean-Chinese immigrants who were residing more than 1 year in Korea. Physical and mental dimensions of HRQOL were assessed by Short Form-12 Health Survey that consisted of a physical component summary (PCS) and a mental component summary (MCS). Data were analyzed with Pearson's correlation and multiple regression. RESULTS: The mean PCS score was 41.14+/-10.72 and the mean MCS score was 49.09+/-11.31 (possible range 10-70). Depression (beta=-6.43) and Social network frequency (beta=2.44) explained 28.4% of the variance in PCS while depression (beta=-11.54) and visiting clinic/hospital (beta=-4.00) explained 34.3% of the variance in MCS. Acculturation was not significantly associated with HRQOL. CONCLUSION: This study confirmed that the social network frequency influences HRQOL among Korean-Chinese Immigrants. The findings suggest that social network analysis should be considered in the process of developing health intervention strategies for Korean-Chinese immigrants.

Experiences of Middle-aged Korean-Chinese Female Migrant Workers in Korea: With Focus on Risk Factors in Work-related Musculoskeletal Diseases

PURPOSE: This study was to explore situations that might put the middle-aged Korean-Chinese female migrant workers at risk for work-related musculoskeletal diseases (WMSDs). At the development phase of a continuing health project, the study aimed to clarify health promotion program needs of the migrant population. METHODS: A qualitative description research design was used with three focus groups of 23 Korean-Chinese female migrant workers. Each focus group interview was conducted for 70-minutes using semi-structured interview guidelines. The data were analyzed using directed qualitative content analysis techniques. RESULTS: The majority of the participants were household workers and their work included heavy material handling, standing for a long time, and working in awkward postures. They experienced discrimination from employers, lack of control at work, limitations in open-communication, job insecurity, and acculturation. They had needs to have health promotion programs for preventing and managing chronic diseases, depression and menopause as well as WMSDs. CONCLUSION: The participants were situated in work environments with physical demanding tasks, acculturative and job-related stress and lack of opportunities to participate in health promotion programs. It is suggested to develop a comprehensive program to better meet the needs of middle-aged Korean-Chinese female migrant workers rather than targeting the reduction of WMSDs.

A Study on the Cultural Competence of Community Health Practitioners

PURPOSE: This study aimed to describe the cultural competence among community health practitioners (CHPs). METHODS: A cross-sectional descriptive study design was used with a convenience sample of 257 CHPs. Data collection was conducted with a structured questionnaire, including Cultural Competence Assessment. Data were analyzed by t-test and ANOVA with the SPSS/WIN 17.0 program. RESULTS: Most participants reported a moderate level of cultural competence (M=3.0, SD=0.41). Scores for culturally competent behaviors were high (M=3.4, SD=0.48) and cultural knowledge scores were low (M=2.6, SD=0.54). Those CHPs who were living with their family, were working in rural area, and had more opportunities to contact with multicultural patients and experience abroad showed significantly higher cultural competence. CONCLUSION: The findings support the need for future education and training to enhance CHPs' cultural competence.

Cancer Unit Nurses' End-of-Life Care-Related Stress, Understanding and Training Needs / 한국호스피스완화의료학회지

PURPOSE: This study was performed to identify the level of stress perceived by nurses who attend dying patients in the cancer care unit; their understanding regarding end-of-life care and related training needs. METHODS: A cross-sectional descriptive study was conducted with 151 nurses stationed at the cancer care units of four general hospitals located in Seoul and Gyeonggi province in Korea. Data were collected using self-reported questionnaires and the response rate was 96%. The data were analyzed using t-test, ANOVA and Pearson's correlation analysis. SPSS 12.0 was used for data analysis. RESULTS: Nurses experienced a high level of stress in the end-of-life care settings. Their understanding of end-of-life care was above the mid-point of the scale while their training needs for end-of-life care was relatively high. The more experienced the nurses were, the more stressed they were, particularly due to excessive workload. Nurses who served longer in the cancer unit tended to show greater needs for end-of-life care training. CONCLUSION: This study found nurses perform end-of-life care with a high level of stress but with insufficient understanding, and thus, showed great needs for related training. Such findings can be useful to develop an end-of-life care training program for nurses.