Adaptation and validation of the health belief model scale for colorectal cancer screening.

Korea has the second highest incidence of colorectal cancer in the world. Instruments that are culturally and contextually sensitive, as well as valid and reliable, for determining health beliefs regarding colorectal cancer screening are essential for obtaining accurate information. The purpose of this study was to adapt and validate the health belief model scale for Koreans regarding colorectal cancer and fecal occult blood test utilization. Individual and cognitive interviews (also known as cognitive debriefing) with 33 Koreans, expert reviews with seven nursing practitioners and professors, and a pilot test with 18 Koreans were conducted to make the existing health belief model scale culturally and contextually sensitive. Subsequently, a cross-sectional survey with 728 Koreans aged >50 years was conducted. Exploratory and confirmatory factor analyses of the construct validity and internal consistency reliability supported the adapted health belief model scale. The adapted and validated health belief model scale in this study could contribute to the assessment of health beliefs regarding the fecal occult blood test among Koreans with a greater degree of accuracy with respect to Korean culture and context.

The Psychometric Validation of the EPDS-K Among Korean Women: Does It Only Measure Depressive Symptoms?

PURPOSE: The purpose of this study was to test the validity of the Edinburgh Postnatal Depression Scale-Korean (EPDS-K) and compare the specified models (one-, two-, three-factor model, and a model in the current study) in pregnant, first-trimester Korean women. DESIGN AND METHODS: The study consisted of two groups of 100 first-trimester Korean women recruited from maternity clinics in Korea. FINDINGS: The results show that the EPDS-K has depression, anxiety, and anhedonia factors, and that the validity of the EPDS-K with Korean women is questionable. PRACTICE IMPLICATIONS: Healthcare providers should test the psychometric properties of tools for screening accuracy, clinical decision-making, and understanding of a phenomenon within different cultural settings.

Posttraumatic growth and related factors of child protective service workers.

OBJECTIVES: The aim of the study is to measure the level of vicarious trauma, posttraumatic growth (PTG), and other factors affecting PTG among child protective service workers. METHODS: We include posttraumatic stress, social support, stress coping, and demographic data as independent variables. Data was collected from 255 full-time social workers from 43 child protective agencies as acomplete enumeration and 204 included in the final analysis. RESULTS: The major findings of the study were as follows: The mean score of PTG was 44.09 (SD:21.73). Hierarchical multiple regression was adopted and "pursuing social support as a way of coping with stress" was the strongest predictive factor (ß=0.319, p<0.001) of PTG. CONCLUSION: We suggest that child protective workers are vulnerable to posttraumatic stress and mental health services are indicated. We also recommend various types of training for stress coping program, especially strengthening the social support system of the child protective service workers in South Korea.

Depression in family caregivers of cancer patients: the feeling of burden as a predictor of depression.

PURPOSE: The purpose of this study was to explore the prevalence of and to identify the predictors of depression in family caregivers of cancer patients. PATIENTS AND METHODS: We enrolled 310 caregivers of cancer patients from the National Cancer Center, Korea, on this study and obtained demographic information for both patients and caregivers. To assess caregiver depression and its predictors, we used the Beck Depression Inventory (BDI), the Caregiver Quality of Life Index-Cancer, and the Family Impact Questionnaire. We used logistic regression analysis to identify independent predictors of caregiver depression. RESULTS: The majority (67%) of caregivers had high depression scores (BDI > 13), and 35% had very high depression scores (BDI > 21). In a multiple logistic regression model, caregivers who were women, the spouse of the patient, in poor health, feeling burdened, adapting poorly, unable to function normally, or caring for a patient with poor Eastern Cooperative Oncology Group performance status were more likely to experience depression (P < .01 for all values). CONCLUSION: Depression was highly prevalent among cancer patient family caregivers, and care burden was its best predictor. Interventions aimed at reducing the psychiatric effects of cancer should focus not only on the patient but also on the caregiver.

Predictors associated with the place of death in a country with increasing hospital deaths.

OBJECTIVES: To evaluate the contribution of type of illness, socio-demographic factors, and area of residence to the place of death in a country with increasing hospital deaths. DESIGN: Descriptive study of hospital deaths using a 10-year death registration database from the Korean National Statistical Office. SETTING AND PARTICIPANTS: Through the National Vital Statistics System, 2,402,259 deaths were registered in Korea from 1992 to 2001. MEASUREMENT AND MAIN RESULTS: There was a significant trend toward an increase in the proportion of hospital deaths, from 16.6% in 1992 to 39.9% in 2001. The proportion of deaths at home decreased over that period, from 72.9 to 49.2%. The risk of hospital death versus home death was lower for those aged 75 years and over (adjusted odds ratio: 0.212; 95% confidence interval: 0.210-0.214) compared with those <55 years, and for people who were highly educated (2.04; 2.02-2.06), had white-collar jobs (1.55; 1.54-1.57), and resided in areas with more available hospital beds (2.46; 2.42-2.51). Compared with other causes of death, the risk of dying in hospital was higher for patients with ischaemic heart disease (1.83; 1.79-1.86), cancer (1.25; 1.23-1.26) and chronic lower respiratory disease (1.21; 1.18-1.23). CONCLUSIONS: Trends in place of death are influenced by available hospital beds, socio-demographic factors and the nature of the terminal disease, in a country with increasing hospital deaths. These associations should be viewed within the context of culture and local health care systems.

Korean version of the caregiver quality of life index-cancer (CQOLC-K).

OBJECTIVE: The aim of this study was to develop and evaluate the internal consistency and construct validity of a Korean version of the Caregiver Quality of Life Index-Cancer (CQOLC-K). METHODS: The CQOLC-K was administered to 270 caregivers, along with the Medical Outcomes Study Short Form-36 (SF-36) and the Beck Depression Inventory (BDI). RESULTS: Internal consistency of the CQOLC-K (0.90) and all inter-scale correlations were significant in the expected direction (p < 0.001). Convergent validity was supported with moderate to strong correlations between the CQOLC-K and the mental component scores of the SF-36 (r = 0.39-0.58), and between the CQOLC-K and the two BDI scores (r = 0.50 and 0.60). Divergent validity was supported by weaker or negligible correlations between the CQOLC-K and the physical component scores of the SF-36 (r = 0.16-0.30). Contrasting groups validity showed that the CQOLC-K was able to distinguish clearly between patients differing in treatment history (p < 0.005), performance status (p < 0.005), care area (p < 0.005), and length of time after diagnosis (p < 0.005). CONCLUSION: These findings support the internal consistency reliability and construct validity of the Korean version of the CQOLC-K. The instrument can be used to measure quality of life in caregivers of cancer patients in clinical and epidemiological research.

Economic burdens and quality of life of family caregivers of cancer patients.

OBJECTIVES: We conducted this study to identify factors influencing the burdens cancer brings to a patient's family and to evaluate the association between the burdens and the caregiver's quality of life (QOL). METHODS: Participants were drawn from the primary family caregivers of cancer patients at 6 university hospitals and the National Cancer Center in Korea. Of the 738 eligible caregivers, 704 (95.4%) completed the questionnaire packets (Family Impact Questions and Caregiver's QOL-Cancer). RESULTS: Caregivers, who were poor (OR, 2.11; 95% CI, 1.44-3.10), whose health status was poor (OR, 1.87; 95% CI, 1.29-2.70), who were married (OR, 1.75; 95% CI, 1.12-2.72), who provided care for a long time (OR, 2.29; 95% CI, 1.59-3.28), who cared for patients with poor performance status (OR, 1.35; 95% CI, 1.00-1.82), and who paid high medical expenses (OR, 1.70; 95% CI, 1.21-2.40), were more likely to lose their family savings. In multiple regression analysis, most burden variables--including requiring caregiving assistance, major life change, inability to function normally, loss of savings, loss of income, and altered educational plans--were associated with caregiver QOL. Loss of family income, which was related to economic issues, was most strongly associated with it (16.0%). CONCLUSIONS: Our study suggests that to improve caregiver QOL, we should give priority to decreasing the economic burden that cancer places on patient's family.