Impact of English Proficiency on Health Literacy in Older Korean Immigrants: Mediating Effects of Social Support and Acculturation.

Limited English proficiency (LEP) is one of the most influencing factors of personal health literacy (PHL) in the older immigrant population. Over the years, the proportion of older Korean immigrants with LEP has not improved and it is still noted as a major barrier to PHL. Therefore, organizational approaches are needed to enhance the PHL of older immigrants with LEP. This study aims to find the mediating effect of social support and acculturation between LEP and PHL by conceptualizing social support and acculturation as an organizational health literacy strategy. Data from 244 older Korean immigrants living in the states of Alabama and Georgia, USA, were used to conduct the study. Korean version of the Multidimensional Scale of Perceived Social Support (MSPSS), East Asian Acculturation Measure (EAAM), and Health Literacy Survey-12 Questionnaires (HLS-Q12) were used to measure the variables. The path analysis was conducted to find the serial mediation effects of social support and acculturation. The results showed that 77.5% of the participants reported not having fluent English proficiency. English proficiency (ß =- 0.21, p = 0.007), social support (ß = 0.17, p = 0.004), and acculturation (ß = 0.18, p = 0.011) significantly predicted the PHL, and social support (ß = 0.04, p = 0.028) and acculturation (ß = 0.14, p < 0.001) mediated the relationship between LEP and PHL. Discussion: Health-related organizations and communities are encouraged to provide external social support and acculturation opportunities to enhance PHL in older Korean immigrants with LEP.

Korean women's perceptions of traumatic childbirth: a qualitative descriptive study.

BACKGROUND: Previous studies have established that negative or traumatic childbirth can create childbirth-related post-traumatic stress disorder (CB-PTSD). Because of the negative implications of CB-PTSD for mothers, children, and families, global qualitative research on traumatic or negative childbirth has risen in recent years. However, few studies have been conducted in South Korea. This study aims to explore women's various perceptions of traumatic childbirth in South Korea. METHODS: This qualitative descriptive study examined nine women who were at high risk of PTSD (IES-R-K > 24) at the time of the interview, between 1 and 11 years after childbirth. Semi-structured interviews were conducted. Interview transcripts were subjected to thematic analysis. RESULTS: The analysis identified two themes with six subthemes, as follows: (1) person-centred factors (pain, guilt, maternal identity conflict, and damaged femininity); (2) society-centred factors (threatened dignity and disrupted relationships). These findings may be attributed to Korean culture (excessive motherhood and lookism), as well as unbearable pain, disrespectful childbirth environments, lack of spouse's support, loss of their lifestyle, and unrealistic expectations. CONCLUSIONS: This study demonstrates various negative consequences, ranging from psychological damage to conflict in women's relationships with their spouses, and others. This highlights the various perceptions stemming from traumatic childbirth and emphasizes the significance of clinical intervention. Therefore, healthcare professionals' greater understanding of women's perceptions and increased concern about childbirth and respectful childbirth environments are required. In addition, based on our findings, there is a need to develop interventions that can alleviate CB-PTSD and further improve women's mental health, particularly through women-centred interventions.

Food Intake, Source, and Planning and Shopping Behavior Differences Among Hispanic, White, Black, and Asian Females.

BACKGROUND: Abdominal obesity remains a high public health concern. Within the United States, there are noted disparities among different ethnic/racial groups in relation to obesity, especially for females. PURPOSE: The purpose of this secondary analysis project was to examine the differences in nutritional intake, food sources, and meal planning and food shopping between Hispanic, White, Black, and Asian females by abdominal obesity level in the United States. METHODS: The 2017-2018 National Health Nutrition Examination data was used. Major variables included race/ethnicity, waist circumference (WC), nutritional intake, food source, and food shopping and meal planning behaviors. Descriptive statistics, correlational analyses, a series of two-way factorial analysis of variance, and odds ratio analyses were conducted to address research questions. FINDINGS: When comparing nutritional intake and food source by different racial/ethnic groups and abdominal obesity level, there were no interaction effects for all categories across groups. However, for the racial/ethnic main effects and obesity main effects, significant differences among groups were noted for nutritional intake and food source categories. There were no differences in food shopping and meal preparation between abdominal obesity and non-obese participants in each racial/ethnic group. CONCLUSIONS: Similarities and differences were noted between racial/ethnic groups for nutritional intake and sources of food. However, no significant differences were noted between racial/ethnic groups for food shopping and meal preparation behaviors. More research should be done to confirm these findings and further understand food shopping and meal preparation behaviors.

Problematic smartphone use and functional somatic symptoms among adolescents: Mediating roles of depressive symptoms and peer relationships by gender.

This study explored the relationship between problematic smartphone use and depressive symptoms, peer relationships, and functional somatic symptoms with a representative sample of Korean male and female adolescents using serial multiple mediation models. The results identified the mediating effect of depressive symptoms and peer relationships for males in the association between problematic smartphone use and FSS. The serial mediating effect of the two mediators was also verified in the model for males. However, in the model for females, only depressive symptoms mediated the relationship between problematic smartphone use and FSS. The findings suggest that parents and professionals should assess adolescents with problematic smartphone use for the risk of FSS when depressive symptoms develop. Schools should also provide programs to build positive peer relationships to reduce FSS.

The Effects of Smartphone Use on Life Satisfaction in Older Adults: The Mediating Role of Depressive Symptoms.

As the number of smartphone use by older adults increases, investigating the effects of smartphone use on health outcome become important in healthcare. This study aimed to investigate the effects of smartphone use on life satisfaction and the mediating role of depressive symptoms in older adults. This is a secondary data analysis study using the 2017 Korean Media Panel Survey. A total of 2071 respondents aged 65 years and older were analyzed to examine the effects of mobile phone type (no mobile phone/2G phone/smartphone) on life satisfaction. Among the respondents, data from 680 smartphone owners were analyzed to find the effects of the level of smartphone use on life satisfaction. The 2G mobile phone and smartphone owner groups showed significant positive effects on life satisfaction compared with the no mobile phone group, respectively. The level of smartphone use showed significant positive effects on life satisfaction. Depressive symptoms played a mediating role in both models. Smartphone use showed positive effects on life satisfaction in older adults. Nurses should promote the well-being of older adults and minimize the digital health gap in the future by increasing older adults' smartphone use through multi-level approaches.

Frailty trajectory among community-dwelling middle-aged and older adults in Korea: evidence from the Korean Longitudinal Study of Aging.

BACKGROUND: There is no study on the frailty trajectory including both middle-aged and older people, and the understanding of the long-term frailty trajectory is insufficient. This study aimed to identify the frailty trajectory, subgroups of the frailty trajectory, and the predictors that differentiate these subgroups among community-dwelling middle-aged and older adults. METHODS: The participants were 9,775 individuals aged 45 years and older who participated in the Korean Longitudinal Study of Aging (2006-2018). Frailty was measured using a frailty instrument comprising three items: grip strength weakness, exhaustion, and social isolation. Latent growth curve modeling and latent class growth modeling were performed to identify the frailty trajectory and latent classes of the trajectory. Multinomial logistic regression was used to confirm the predictors that classified the latent classes. RESULTS: Over 12 years, the slope of the frailty trajectory among the participants showed a gradual increase. In addition, there was a difference in the latent class of frailty trajectories among middle-aged and older adults. The middle-aged participants were divided into two groups: maintaining robustness and changing from pre-frailty to robustness. The older adults were divided into three groups: maintaining robustness, maintaining pre-frailty, and changing from the frailty to pre-frailty group. Regular exercise, cognitive dysfunction, and social participation were significant predictors that differentiated each latent class in both middle-aged and older adults; additionally, current smoking and the number of chronic diseases were significant predictors in middle-aged people. CONCLUSIONS: Various subgroups within the frailty trajectory existed among community-dwelling middle-aged and older adults. To reduce frailty, it is necessary to intervene with modifiable factors appropriate for each age group.

Social factors predicting improvement of frailty in community-dwelling older adults: Korean Frailty and Aging Cohort Study.

AIM: The study aimed to identify social factors predicting improvement of frailty in community-dwelling older adults after 2 years using a population-based cohort study. METHODS: We analyzed data from the 2016 and 2018 Korean Frailty and Aging Cohort Study. The participants of this study were 1428 community-dwelling older adults aged 70-84 years who were recruited from 10 medical centers across different regions. Frailty was measured using the five-item FRAIL scale, which evaluates fatigue, resistance, ambulation, illness and weight loss. Multilevel logistic regression analysis was used to examine baseline social factors that predict frailty improvement after 2 years by frailty status. RESULTS: In frail older adults, higher participation in social activities (odds ratio [OR] 1.17, 95% confidence interval [CI] 1.02-1.34) was significantly associated with frailty improvement. In pre-frail older adults, there were no significant social factors predicting the improvement of frailty status; however, other modifiable factors such as high and moderate levels of physical activity (OR 1.17, 95% CI 1.07-1.28, OR 1.13, 95% CI 1.03-1.25, respectively) and low depressive symptoms (OR 0.88, 95% CI 0.84-0.91) were associated with pre-frail improvements. High levels of physical activity (OR 1.16, 95% CI 1.02-1.33) were also associated with improvements of frailty. CONCLUSIONS: Different strategies depending on the level of frailty are necessary to improve frailty status. Timely and appropriate interventions can promote frailty improvement and prevent negative health outcomes in community-dwelling older adults. Geriatr Gerontol Int 2021; 21: 465-471.

The Cross-Lagged Panel Analysis between Frailty and Physical Activity among Community-Dwelling Older Adults by Age Groups.

Objectives: This study was to investigate the reciprocal relationship between frailty and physical activity among older adults by age group (middle-old: 70-79 years; oldest-old: 80-84 years) within 2 years using cross-lagged panel analysis. Methods: The study data were derived from the Korean Frailty and Aging Cohort Study, and a total of 1092 participants were included. Results: Frailty and high physical activity had significant reciprocal relationships in the middle-old group, which indicates that frailty was associated with less high physical activity, and high physical activity predicts less frailty after 2 years. In the oldest-old group, there was no statistically significant reciprocal relationship between frailty and any level of physical activity reference to low physical activity and vice versa after 2 years. Discussion: Further studies on the relationship between frailty and physical activity of the oldest-old population and specific physical activity guidelines for older adults are needed.

Pathways among Frailty, Health Literacy, Acculturation, and Social Support of Middle-Aged and Older Korean Immigrants in the USA.

Culturally and linguistically different immigrants in the U.S. are considered populations with low health literacy in general, thereby having a high risk of negative health outcomes such as frailty. The purpose of this study is to identify the effects of social support and acculturation on the relationship between health literacy and frailty of Korean immigrants in existing models of health literacy. A total of 244 Korean immigrants aged 50 years and older residing in Southern United States (Alabama and Georgia) were recruited. Path analysis was used to examine the pathways among variables, and the indirect effects of health literacy were analyzed. The results revealed that health literacy and social support directly influenced frailty; social support and acculturation were identified to influence health literacy. Health literacy had a partial mediating effect in the relationship between social support and frailty and a complete mediating effect in the relationship between acculturation and frailty. Therefore, to prevent frailty, it is necessary to consider enhancing immigrants' health literacy by elevating acculturation and social supports.