Relationship between Type D personality and adverse health outcomes in people with type 2 diabetes: The parallel mediating roles of diabetes distress and social isolation.

AIM: To investigate the relationship between Type D personality and adverse health outcomes [glycated haemoglobin (HbA1c) and health-related quality of life (HRQOL)] directly, and indirectly via diabetes distress and social isolation in people with type 2 diabetes. DESIGN: A secondary analysis of 524 participant's data derived from a cross-sectional, correlational study with people with type 2 diabetes. METHODS: Data were analysed using the PROCESS macro of SPSS. RESULTS: Type D personality was present in 31.3% of the participants, and exerted a direct effect on HRQOL but not on HbA1c. Type D personality indirectly affected both HbA1c and HRQOL via the mediators of diabetes distress and social isolation. Nurses need to monitor people with type 2 diabetes to determine whether Type D personality is present. Those with Type D personality should be provided with interventions to reduce diabetes distress and alleviate social isolation in order to improve HbA1c and HRQOL.

The Relationship Between Duration of Stay and Self-rated Health Among International College Students in South Korea.

This study examined relationships between duration of stay and self-rated health among international students in South Korea and compared participants' health-related characteristics according to duration of stay. The study recruited a convenience sample of 165 international students enrolled in undergraduate or graduate programs. For this cross-sectional, descriptive study, participants were recruited at one South Korean university. Data were subjected to ordinal logistic regression analyses. After controlling for covariates, a stay of 6 months or less was a significant predictor of better self-rated health. Compared to those in their first semester, international students staying more than 6 months more frequently experienced short sleep duration, physical health symptoms, healthcare utilization, unmet healthcare needs, and perceived discrimination. Study findings indicate that international students' health tends to deteriorate after their first semester. To promote the health and academic success of international students, universities should provide timely health promotion programs.

Pathways Linking Health Literacy to Self-Management in People with Type 2 Diabetes.

Health literacy is considered to be an emerging determinant of health behaviors and outcomes. The underlying mechanisms linking health literacy to diabetes self-management are currently unclear. This study assessed a mediation model consisting of a direct pathway between health literacy and self-management, and indirect pathways via social isolation only, self-efficacy only, and social isolation and self-efficacy serially in people with type 2 diabetes. A cross-sectional design was employed, and a total of 524 participants were recruited from outpatient clinics of multi-institutions from June 2020 to February 2021. The mediation model was analyzed using the PROCESS macro on SPSS with bootstrap bias-corrected 95% confidence intervals (CIs) with 10,000 bootstrapping iterations. Health literacy positively affected self-management. The estimated indirect effect of health literacy on self-management via social isolation was significant, at 0.018 (95% CI = 0.004-0.036). The indirect effect via self-efficacy was estimated at 0.214 (95% CI = 0.165-0.266). The indirect effect via social isolation and self-efficacy serially was 0.013 (95% CI = 0.006-0.023). The findings of this study suggest that clinical practice can be improved through more comprehensive diabetes self-management interventions that promote all of the components of health literacy, social contacts/networks, and self-efficacy in particular.

eHealth Literacy Instruments: Systematic Review of Measurement Properties.

BACKGROUND: The internet is now a major source of health information. With the growth of internet users, eHealth literacy has emerged as a new concept for digital health care. Therefore, health professionals need to consider the eHealth literacy of consumers when providing care utilizing digital health technologies. OBJECTIVE: This study aimed to identify currently available eHealth literacy instruments and evaluate their measurement properties to provide robust evidence to researchers and clinicians who are selecting an eHealth literacy instrument. METHODS: We conducted a systematic review and meta-analysis of self-reported eHealth literacy instruments by applying the updated COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) methodology. RESULTS: This study included 7 instruments from 41 articles describing 57 psychometric studies, as identified in 4 databases (PubMed, CINAHL, Embase, and PsycInfo). No eHealth literacy instrument provided evidence for all measurement properties. The eHealth literacy scale (eHEALS) was originally developed with a single-factor structure under the definition of eHealth literacy before the rise of social media and the mobile web. That instrument was evaluated in 18 different languages and 26 countries, involving diverse populations. However, various other factor structures were exhibited: 7 types of two-factor structures, 3 types of three-factor structures, and 1 bifactor structure. The transactional eHealth literacy instrument (TeHLI) was developed to reflect the broader concept of eHealth literacy and was demonstrated to have a sufficient low-quality and very low-quality evidence for content validity (relevance, comprehensiveness, and comprehensibility) and sufficient high-quality evidence for structural validity and internal consistency; however, that instrument has rarely been evaluated. CONCLUSIONS: The eHealth literacy scale was the most frequently investigated instrument. However, it is strongly recommended that the instrument's content be updated to reflect recent advancements in digital health technologies. In addition, the transactional eHealth literacy instrument needs improvements in content validity and further psychometric studies to increase the credibility of its synthesized evidence.

E-learning cultural competence for public health workers: A feasibility and pilot study.

OBJECTIVE: To describe the development, feasibility, and preliminary efficacy of a seven-module e-learning for enhancing cultural competence of public health workers. DESIGN: The study was based on the framework of the new Medical Research Council; a mixed methods design was used. SAMPLE: A four-week pilot cluster-randomized controlled trial was conducted with 39 public health workers and 74 migrants in South Korea. Feasibility and preliminary efficacy were assessed according to initiation, retention, adherence, usability, acceptability, individual and organizational cultural competence, and migrant trust and satisfaction. Quantitative data were collected at baseline, 4 weeks, and 12 weeks. Focus group interviews were conducted with eight public health workers at 12 weeks. RESULTS: Initiation, retention, and adherence rates were high. Participants agreed on acceptability, but exhibited mixed results on usability. Participants were satisfied with "well-structured content," "authentic case stories and videos," "increased interest in migrant care," and "opportunity for self-reflection." However, "flawless and trouble-free system," "screen design for easy navigation," "instructor's expertise," and "more situational cases and videos" were desired. Statistically significant differences were observed for individual cultural competence, migrant trust, and satisfaction. CONCLUSION: Generally, the intervention seems feasible and has preliminary efficacy, yet usability improvement is necessary for full-scale randomized controlled trials.

Reasons Behind Generation Z Nursing Students' Intentions to Leave their Profession: A Cross-Sectional Study.

This study aims to identify predictors of turnover intention within 2 years of employment among 3rd and 4th grade Generation Z nursing students. Turnover intention is a multi-stage process ranging from mere desire, to serious thoughts, decision-making, and actual planning. Previous studies have focused on identifying the factors affecting turnover intention among practicing nurses. However, undergraduate nursing students also contemplate their decision to stay or leave the nursing profession after graduation. This cross-sectional descriptive study recruited 210 nursing students from 3 colleges in South Korea. A self-administered survey was conducted using the Career Preparation Behavior Scale, the Calling and Vocational Questionnaire, the Social Responsibility Scale, and the Revised Self-Leadership Questionnaire. Four questions were used to explore participants' turnover intention, their motivation for studying nursing, their major satisfaction, and their clinical experience satisfaction. Descriptive and multiple logistic regression statistics were obtained using SPSS. Of the participants, 17.6% had turnover intention within 2 years of employment. Multiple logistic regression analysis indicates that clinical experience satisfaction is the only significant predictor. In the univariate analysis, nursing students who had turnover intentions were less likely to practice career preparation behaviors and had lower levels of vocational consciousness and social responsibility. To keep a proficient nursing workforce in the profession, professional commitments from universities and hospital institutions are needed to provide quality clinical learning experiences for nursing students. Further prospective study is needed to observe how Generation Z undergraduate students' turnover intentions change and what factors influence this process.

A New Self-management Scale with a Hierarchical Structure for Patients with Type 2 Diabetes.

PURPOSE: The aims of this study were to develop a new instrument for measuring self-management with a hierarchical structure [the Diabetes Self-Management Scale (DSMS)] in patients with type 2 diabetes, and evaluate its psychometric properties. METHOD: The DSMS instrument was developed in three phases: (1) conceptualization and item generation; (2) content validity and pilot testing; and (3) field testing of its psychometric properties. A convenience sample of 473 participants was recruited in three university hospitals and one regional health center, South Korea. RESULTS: Exploratory and confirmatory factor analyses yielded two second-order component models explaining the common variance among six first-order factors. Principal axis factoring with a varimax rotation accounted for 60.88% of the variance. Confirmatory factor analysis of the hierarchical structure revealed the following fit indices: χ2/df = 1.373, standardized root-mean-square residual = .050, goodness-of-fit index = .935, incremental fit index = .975, comparative fit index = .974, and root-mean-square error of approximation = .039. All Cronbach' α values for internal consistency exceeded the criterion of .70. All of the intraclass correlation coefficients for test-retest reliability exceeded .70 except that for the taking-medication subscale. The components of the DSMS were moderately correlated with the comparator measures of self-efficacy and health literacy administered for convergent validity. CONCLUSION: The DSMS is a new instrument for measuring the complex nature of self-management in patients with type 2 diabetes, comprising 17 items scored on a five-point Likert scale. The DSMS exhibits satisfactory psychometric properties for five reliability and validity metrics, and so is a suitable instrument to apply in both research and clinical practices.

Self-efficacy instruments for type 2 diabetes self-care: A systematic review of measurement properties.

AIMS: To identify currently available self-efficacy instruments for type 2 diabetes self-care and to evaluate the evidence for their measurement properties. DESIGN: Systematic review of measurement properties. DATA SOURCES: The PubMed, Embase and CINAHL databases were searched from their inception to 27 May 2019. REVIEW METHODS: The updated COnsensus-based Standards for the selection of health Measurement INstruments methodology were applied. RESULTS: Twelve instruments were identified from 3,665 records. Eight instruments were related to self-efficacy in performing a comprehensive set of the tasks/behaviours for diabetes self-care and the other four addressed specific behaviours related to diabetes self-care, such as insulin management. Most of the 12 instruments were developed based on Bandura's self-efficacy theory as their theoretical background. Overall, sufficient high-quality evidence for measurement properties was seldom identified. The Diabetes Management Self-Efficacy Scale is currently the best instrument, with particularly the 4-factor, 16-item version being demonstrated to have sufficient high-quality evidence for structural and internal consistency and sufficient moderate-quality evidence for reliability and convergent validity. CONCLUSIONS: None of the instruments evaluated all of the relevant measurement properties. The Diabetes Management Self-Efficacy Scale is currently the most suitable instrument for potential use in practice and research. The measurement invariance across languages, measurement error and responsiveness of this instrument still need be evaluated. IMPACT: This systematic review provides clinicians and researchers with a comprehensive list of available instruments for measuring self-efficacy in diabetes self-care, as well as evidence for helping them to select the most appropriate instrument. Using a psychometrically sound instrument will accurately inform practitioners about the levels of self-efficacy in self-care among patients with type 2 diabetes in practice and avoid threatening the credibility of research studies on self-efficacy in diabetes self-care.

Concomitants of menopause-specific quality of life in premenopausal and post-menopausal women living in South Korea.

The present study investigated the concomitants of menopause-specific quality of life among premenopausal and postmenopausal women. Based on the Wilson and Cleary model of quality of life, this cross-sectional study recruited 329 women of age 40-65 years following operational convenience. The study was conducted in the office of the Korea Population, Health and Welfare Association (KPHWA) in Incheon, South Korea. Data collected on sociodemographic characteristics, social support, biological/physiological characteristics, the Pittsburgh Sleep Quality Index (PSQI-K), and self-rated health. Menopause-specific quality of life questionnaire (MENQOL) was used in this study. Hierarchical multiple linear regression analysis was performed. The study found that social support and self-rated health were negatively correlated with MENQOL in premenopausal women, while the income level and self-rated health were negatively associated with MENQOL in postmenopausal women. Sleep quality was positively correlated with MENQOL in both premenopausal and postmenopausal women. The study results indicate the need for tailored approaches based on menopausal status. Especially, social support may help improve the MENQOL of premenopausal women, while in postmenopausal women, improved sleep quality may enhance their menopause-specific quality of life.

Patient-reported outcome measures for diabetes self-care: A systematic review of measurement properties.

OBJECTIVES: The aims of the present systematic review were to identify currently available patient-reported outcome measures for diabetes self-care that have been psychometrically evaluated and to evaluate their measurement properties. DESIGN: A systematic literature review with a meta-analysis. DATA SOURCES: A systematic literature search was conducted of the MEDLINE, EMBASE, and CINAHL databases. REVIEW METHODS: The updated COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) was applied using the following steps to evaluate the measurement properties of the diabetes self-care measures: (1) evaluating the methodological quality, (2) evaluating either quantitatively summarized or quantitatively pooled data against criteria for good measurement properties, and (3) the evaluating the quality of evidence by applying the modified Grading of Recommendations Assessment, Development, and Evaluation approach. RESULTS: Among 8434 articles yielded by the database search, 27 full-text articles that reported 34 studies of 13 different patient-reported outcome measures were included in this systematic review. The Diabetes Self-Management Instrument demonstrated the best content validity, with sufficient moderate-quality evidence for relevance, comprehensiveness, and comprehensibility. The Diabetes Self-Management Instrument exhibited sufficient moderate-quality evidence for structural validity and internal consistency, and sufficient high-quality evidence for convergent validity of hypothesis testing and sufficient low-quality evidence for reliability. The eight-item Summary of Diabetes Self-Care Activities-Revised was the most frequently investigated and shortest instrument with sufficient high-quality evidence for structural validity and internal consistency. However, the sufficient but very-low-quality comprehensiveness and the inconsistent very-low-quality comprehensibility for content validity, and the insufficient low-quality evidence for reliability must be considered when selecting this instrument. CONCLUSIONS: None of the identified diabetes self-care instruments appears to be universally superior to the others. The Diabetes Self-Management Instrument might be the best based on current evidence, but this requires further evaluation of the measurement of invariance across languages. The eight-item Summary of Diabetes Self-Care Activities-Revised is the shortest instrument, but current evidence with regards to its content validity and reliability needs to be considered before applying this instrument. Further studies are recommended to evaluate the reliability, measurement error, and responsiveness of the diabetes self-care measurements.

Factors Influencing 1-Year Medication Adherence of Korean Ischemic Stroke Survivors.

BACKGROUND: Medication adherence is important for secondary stroke prevention. However, suboptimal adherence to medication among patients after stroke or transient ischemic attack is reportedly 30.9%. We assessed medication adherence of Korean stroke survivors within 1 year of acute ischemic stroke and identified factors that influence adherence. METHODS: We consecutively enrolled ischemic stroke survivors who visited the Department of Neurology of a university hospital from March 9 to June 15, 2016. Data were collected by face-to-face interviews using a structured questionnaire which assessed general characteristics, clinical characteristics, medication beliefs, social support, and depression. Medication adherence was measured using the 8-item Morisky Medication Adherence Scale. Multiple logistic regression was used to identify factors independently associated with medication adherence. RESULTS: Of the total 250 participants, 183 (73%) were in the optimal adherence group. Age (p = 0.035), smoking (p = 0.020), number of prescribed medicines (p = 0.037), frequency of daily doses (p = 0.040), and beliefs about medication (p < 0.001) were associated with medication adherence. Optimal medication adherence was associated with being a non-smoker (OR, 3.19; 95% CI, 1.29-7.87; p = 0.012), more prescribed medicines (OR, 1.27; 95% CI, 1.05-1.54; p = 0.014), less frequency of daily doses (OR, 0.37; 95% CI, 0.18-0.79; p = 0.010), and stronger beliefs about medication (OR, 1.09; 95% CI, 1.03-1.15; p = 0.004). CONCLUSION: To improve medication adherence of stroke survivors, post-stroke care should focus on bolstering patients' belief in the necessity of medication and encouraging lifestyle modifications, such as quitting smoking, as well as prescribing medicine with simple regimens.

Effectiveness of cultural competence educational interventions on health professionals and patient outcomes: A systematic review.

PURPOSE: This systematic review aimed to identify, appraise, and synthesize the best available evidence for the effectiveness of cultural competence educational interventions on health professional and patient outcomes. METHODS: We conducted a systematic review of randomized and non-randomized controlled trials. We searched seven electronic databases including MEDLINE, EMBASE, Cochrane Library, and four Korean databases in June 2018. Studies that provided cultural competence educational interventions for health professionals and measured the impact on health professional outcomes, patient outcomes, or both were included. A narrative synthesis of study findings was performed. RESULTS: Eleven studies met the inclusion criteria. Studies used a randomized (n = 5) and a non-randomized controlled trial (n = 6) design and were conducted in the USA (n = 7), South Korea (n = 3), and Sweden (n = 1). Cultural competence education was provided mostly to those of single occupations, nurses (n = 5) or physicians (n = 4). The delivery mode was classroom (n = 7), online (n = 3), or blended learning (n = 1), using mainly lectures, discussions, and case studies as teaching and learning methods. Education duration ranged from less than 1 hr to 3 days. Nine studies reported significantly improved health professional outcomes compared to the control group. Patient outcomes were reported in three studies. Only one study reported significant effect on patient satisfaction (d = 0.94) and trust (d = 0.71). There was no significant effect on patient physiological outcomes. CONCLUSIONS: Cultural competence educational interventions had a positive effect on health professional outcomes. There is a considerable lack of research assessing patient outcomes, and there is limited evidence on whether interventions can change patient outcomes.

Low Body Mass Index for Early Screening of Adolescent Idiopathic Scoliosis: A Comparison Based on Standardized Body Mass Index Classifications.

PURPOSE: Scoliosis is a common musculoskeletal problem in adolescents. This study aimed to identify the prevalence of adolescent idiopathic scoliosis (AIS) and its associated factors among Korean adolescents. The prevalence of thin individuals among students with AIS was compared based on body mass index (BMI) classifications. METHODS: This study was a secondary data analysis and used the 2016 Korean National Health Examination for School Students data. Data from 16,412 students were analyzed using descriptive statistics, Chi-square tests, and logistic regression analysis. RESULTS: The prevalence of AIS was higher in women (3.8%) than in men (1.6%), and a higher school year was a risk factor for AIS in both sexes. In woman adolescents, scoliosis was associated with thinness; however, the risk of AIS was inversely associated with overweight/obesity in both sexes. The prevalence of thin woman students with scoliosis differed based on the criteria used: 3.3% by the World Health Organization criteria and 14.3% by the International Obesity Task Force criteria. CONCLUSION: The prevalence of thin students with scoliosis could increase by up to four times depending on the BMI criteria. For early screening of thin people at risk of AIS among female students, the criterion of International Obesity Task Force should be used as it is more permissive of thinness. This is also because of the underestimation of AIS prevalence when using the BMI Z score of the World Health Organization cutoff.

A multilevel investigation of cultural competence among South Korean clinical nurses.

BACKGROUND: There is lack of empirical evidence on whether organisational variables affect the cultural competence of nurses. AIM: This study aimed to investigate individual and organisational characteristics associated with South Korean clinical nurses' cultural competence. METHODS: A descriptive cross-sectional research design was used. A convenient sample of 401 clinical nurses from 21 hospitals in South Korea was recruited between November 2015 and February 2016. Multilevel modelling was used to estimate the effects of individual- and organisation-level predictors. Data were analysed using the nlme package in R. RESULTS: Multilevel modelling indicated that professionalism (ß = 0.02, p < 0.001) and foreign language fluency (ß = 0.25, p = 0.012) were significant individual-level predictors. Education on foreign patient care was marginally significant at p = 0.069. At the organisational level, nurse-to-patient ratio (ß = 0.37, p = 0.038) and organisational cultural competence (ß = 0.02, p < 0.001) were significant predictors. In addition, hospital ownership and work environment were marginally significant at p = 0.054 and p = 0.050, respectively. Furthermore, there was a significant cross-level interaction between professionalism and hospital ownership (ß = 0.03, p = 0.003). CONCLUSION: To provide culturally competent care, nurse leaders should recognise the importance of organisational-level factors, such as nurse staffing and organisational cultural competence, and create an environment that is inclusive of diverse patients, as well as promote professionalism among individual nurses.

The influences of socio-individual determinants and health information seeking on health-promoting behaviors among migrant women: A cross-sectional study.

AIM: This study aimed to examine the effects of socio-individual and health information-seeking variables on health-promoting behaviors among migrant women living in Korea. METHODS: A descriptive, cross-sectional design was used. A convenience sample comprising 190 Filipino marriage-migrant women from G City and J province, South Korea, were recruited between November and December 2015. Participants completed self-report surveys examining health-promoting behaviors, health information seeking, and socio-individual determinants. RESULTS: The most popular health information sources were healthcare professionals (39.0%), family or friends (31.6%), and the Internet (28.9%). Most respondents (90.5%) possessed smart devices; 55.8% used them to seek health information, while 9.5% used health-related applications. The health information that migrant women searched for online mainly concerned their health, diet/nutrition, and physical activity. Education (ß = .15, p = .008), health status (ß = -.10, p = .038), and smart device possession (ß = .20, p = .032) were factors influencing health-promoting behaviors. CONCLUSIONS: Considering the high use of smart devices among migrant women in Korea, these findings suggest the need for an accessible, reliable, and easily understandable Internet-based health information source to facilitate their health-promoting behaviors.

Agreement on Core Components of an E-Learning Cultural Competence Program for Public Health Workers in South Korea: A Delphi Study.

PURPOSE: This study aimed to seek agreement on the core components of an e-learning cultural competence program for Korean public health workers (PHWs) while prioritizing educational content areas. METHODS: A two-round Delphi study was performed with 16 Korean experts from five disciplines. Data were collected between August 30 and November 24, 2017. A questionnaire was developed from literature reviews and previous focus group interviews concerning PHWs. The panel members were asked to rate the importance and urgency of educational content areas and the effectiveness of teaching-learning methods and gave opinions on their appropriate frequency, duration, and target audience. Responses were analyzed using descriptive statistics. A median of 4.0 or greater or a rate of agreement of 75% or greater was considered a "consensus" for the purposes of this study. RESULTS: All consenting participants responded to two-round surveys. Participants reached consensus on thirty-one educational content areas. Of these, the highest priorities were "necessity of cultural competence of PHWs," "health characteristics according to race and ethnicity," and "establishing trusting relationships with migrants." The most effective teaching-learning method was case-based learning, with seven to eight sessions of training and duration of fewer than 30 minutes per session. CONCLUSION: Multidisciplinary experts proposed 12 prioritized educational content areas and effective teaching-learning methods as well as their frequency, duration, and target audiences, reflecting Korea-specific multicultural phenomena and the nature of the work of PHWs. These findings can contribute to preparing PHWs to provide culturally competent services to migrants in their communities.

Organisational cultural competence needed to care for foreign patients: A focus on nursing management.

AIM: This study aimed to explore the organisational level of the cultural competence needed to care for foreign patients from the Korean clinical registered nurses' perspective. BACKGROUND: Owing to the increasing foreign resident population in Korea, health care organisations face challenges arising from cultural differences. However, there is a lack of research on the impact of these changes on nursing care and management. METHOD: Participants were 16 clinical registered nurses from six general hospitals. Data were collected through individual in-depth and focus group interviews. Transcribed data were analysed by deductive content analysis. RESULTS: Data were classified into three categories: information, resources and incentives. Information included a systematic staff training programme and clear practice guidelines. Resources included convenient and credible interpretation services and adequate tools and materials, and incentives were referred to managerial support. CONCLUSION: Korean registered nurses perceived a lack of organisational support for caring for foreign patients. System-wide support and active unit-level intervention of nursing managers are essential for successful transformation towards a culturally competent organisation. IMPLICATION FOR NURSING MANAGEMENT: Registered nurses should play leadership roles to establish a dedicated nursing team or committee to create a supportive working environment and implement a monitoring system so that their organisations move towards greater cultural competence.

Development and Cross-Validation of the Short Form of the Cultural Competence Scale for Nurses.

PURPOSE: To develop and validate the short form of the Korean adaptation of the Cultural Competence Scale for Nurses. METHODS: To shorten the 33-item Cultural Competence Scale for Nurses, an expert panel (N = 6) evaluated its content validity. The revised items were pilot tested using a sample of nine nurses, and clarity was assessed through cognitive interviews with respondents. The original instrument was shortened and validated through item analysis, exploratory factor analysis, convergent validity, and reliability using data from 277 hospital nurses. The 14-item final version was cross-validated through confirmatory factor analysis, convergent validity, discriminant validity, known-group comparisons, and reliability using data from 365 nurses belonging to 19 hospitals. RESULTS: A 4-factor, 14-item model demonstrated satisfactory fit with significant factor loadings. The convergent validity between the developed tool and transcultural self-efficacy was significant (r = .55, p < .001). The convergent validity evaluated using the Average Variance Extracted and discriminant validity were acceptable. Known-group comparisons revealed significant differences in the mean scores of the groups who spent more than one month abroad (p = .002) were able to communicate in a foreign language (p < .001) and had education to care for foreign patients (p = .039). Cronbach's α was .89, and the reliability of the subscales ranged from .74 to .91. CONCLUSION: The Cultural Competence Scale for Nurses-Short Form demonstrated good reliability and validity. It is a short and appropriate instrument for use in clinical and research settings to assess nurses' cultural competence.

Experience of migrant care and needs for cultural competence training among public health workers in Korea.

OBJECTIVE: This study explored the experiences of public health workers (PHWs) providing health care for migrants living in Korea and clarified needs for cultural competence training. DESIGN AND SAMPLE: Twenty-six PHWs from five public health centers in Gwangju city, South Korea, participated in this exploratory qualitative study. METHODS: Five semi-structured focus group interviews of PHWs were conducted from September to December 2016. A directed content analysis approach was conducted using four categories: perceived characteristics of migrants, interaction between PHWs and migrants, interaction between PHWs and organizations/systems, and cultural competence training needs. RESULTS: PHWs perceived that migrants lacked autonomy in health decisions and awareness of health behaviors. PHWs experienced difficulties in communicating and in establishing trusting relationships. They found clients hard to reach and easy to miss, a lack of continuity in health care programs, and inadequate human and material resources. They preferred passive teaching methods to activity-based simulation. PHWs believed essential training should be provided through e-learning to all PHWs, including management. CONCLUSION: PHWs reported experiencing multiple challenges from a lack of preparedness for culturally competent care and their clients' vulnerability. Development of cultural competence training is suggested through e-learning that reflects the PHWs' experiences and provides systematic support.