Utilization of Orem's Self-Care Deficit Nursing Theory in Self-Care Among Older Korean Immigrants With Diabetes in the United States.

Background: Diabetes is a chronic illness and increasing among older populations. Self-care is a critical element in managing diabetes. Orem's Self-Care Deficit Nursing Theory (SCDNT) has been used and applied in nursing to explain significant self-care concepts. Although older Korean immigrants are marginalized in maintaining optimal health status and accessing adequate health services, related studies are still lacking. Utilization of Orem's SCDNT allows nurses to better understand associated factors in self-care among older Korean immigrants with diabetes. Purpose: The first aim is to explain the significant concepts of SCDNT. The second aim is to examine basic conditioning factors on self-care among older Korean immigrants with diabetes based on Orem's SCDNT. Methods: Each concept and structure of Orem's SCDNT was described with a table and figure. The 10 basic conditioning factors in self-care among older Korean immigrants with diabetes were investigated based on the previous literature and discussed in terms of Orem's SCDNT. Results: By exploring the 10 basic conditioning factors among older Korean immigrants, nurses can identify related factors in the self-care of this minority immigrant group and initiate the development of culturally tailored and age-specific nursing interventions. Implications for Nursing Practice: This study provides an understanding of related self-care factors among older Korean immigrants with diabetes. Additionally, the findings will help nurses to develop customized effective interventions and implement appropriate diabetes care for this minority group.

Loneliness as a Mediator in the Association Between Social Isolation and Psychological Distress: A Cross-Sectional Study With Older Korean Immigrants in the United States.

The present study explored the role of loneliness in the association between social isolation and psychological distress, using a cross-sectional sample of older Korean immigrants in the U.S. Considering structural (unmarried and living alone) and relational (isolation from family and friends) social isolation, we hypothesized that (1) both types of social isolation would be associated with loneliness and psychological distress and (2) their effect on psychological distress would be mediated through loneliness. Data came from the Study of Older Korean Americans (SOKA), a multisite survey of Korean immigrants aged 60 and older (n = 2,150). The multivariate analyses demonstrated that older individuals with structural and relational isolation reported higher levels of loneliness and psychological distress. Loneliness was found to mediate the effect of both types of social isolation on psychological distress. The intervening role of loneliness suggests strategies to alleviate the mental health consequences of social isolation in older immigrants.

The Role of Ethnic Community Social Capital in the Association between Acculturation and Psychological Distress among Older Korean Americans.

Guided by the theories of social capital and stress-buffering, we examined how the association between low acculturation and poor mental health among older immigrants would be modified by social capital in ethnic communities (social cohesion, social engagement, perceived ethnic density, and the quality of social interaction). Using data from the Study of Older Korean Americans (N = 2,150, Mean age = 73.4), direct and interactive effect models were examined. Lower acculturation was associated with a greater level of psychological distress, and their link was modified by social cohesion (ß = .19, p < .01) and negative social interactions (ß = - .97, p < .01). Findings suggest that the mental health risk associated with low acculturation could be intensified when older immigrants perceive low sense of cohesion in their ethnic communities or have negative interactions with ethnic community members.

Perceptions of Health Insurance Among Self-employed Korean Immigrants From South Korea in the United States.

Korean Americans in the United States are more likely than other Asian ethnic groups to lack health insurance despite their high education and economic prosperity. According to the model of health service selection, immigrants' perceptions of the health care system and health care behaviors in their host country are affected by sociocultural referents including premigration health care experience in the country of origin. This study explored Korean immigrants' perceptions of health insurance and their intentions to purchase and maintain health insurance in the United States. We conducted in-depth interviews with 24 self-employed Korean immigrants who migrated from South Korea and were living in the Greater Los Angeles area in 2015. Participants generally had negative perceptions of U.S. health insurance in terms of cost, benefits, simplicity, and accessibility. Coupled with their positive experiences with the single-payer, universal health insurance in South Korea, respondents evaluated U.S. health insurance as not worth purchasing, and indicated they would not maintain health insurance once the individual mandate of the Affordable Care Act was abolished. On the contrary, respondents who immigrated prior to the establishment of the Korean universal health insurance in South Korea were relatively satisfied with U.S. health insurance and had maintained health insurance for substantial periods of time. Korean immigrants' premigration health care experiences appeared to influence their decisions to purchase health insurance in the United States and their intention to maintain health insurance. The study findings highlight the necessity of tailored health education that takes into account sociocultural determinants of health coverage among immigrants.

Traumatic chain: Korean-American immigrants' transgenerational language and racial trauma in Native Speaker.

The premise of this study is to look at the intergenerational transferal of language and racial trauma of Asian immigrants in general and Korean-American immigrants in particular to a western country, the United States of America. This study investigates trauma from a psychological standpoint, based on Chang-Rae Lee's novel Native Speaker. In describing a marker of citizenship, the novel's title also points to who is the native language speaker and who is a native of a country, and why one who is not may be excluded. The Korean immigrants' vulnerability to the English language and racial differences highlights their status as minority "others," and they suffer from transgenerational trauma. As a result of transgenerational traumatic effects, Henry (the protagonist) has various traumatic side effects such as dysphasia, aphasia, and parasomnia and finally leaves no stone unturned to recuperate from trauma. The Trauma of the Unspeakable theory by Michelle Balaev is used in this article to show how trauma affects people's minds.

Changing the Landscape of an American Town: Immigrantrification of a Korean Ethnoburb and Its Cultural and Economic Consequences.

This study focuses on the social, cultural, and physical transformations-referred to as immigrantrification (gentrification by immigrants)-initiated by Korean immigrants in Palisades Park, a well-known Koreatown in New Jersey, in the first two decades of the twenty-first century. It draws on data collected from ethnographic field research conducted in 2019-2020, including 67 interviews. Gentrification initiated as a profitable investment strategy of middle-class, entrepreneurial Korean immigrants has followed the town's revitalization brought about by the population and economic growth and the expansion of amenities during the establishment of the Korean ethnoburb. While many residents complain about overcrowding, pollution, land-use intensity, and parking problems, Guatemalan immigrants-active participants in labor-intensive gentrification who have established their sub-enclave, gradually supplanting White residents-express fear of being priced out of the immigrantrified town. Thus, this study addresses two issues underrepresented in the gentrification discourse - third-world immigration and ethnic minority gentrification - by expanding the research on Korean gentrifiers.

Comparative Study on Volunteering among Older Korean Immigrants in the United States and Older Koreans in South Korea.

This study aimed to determine the most important factors that influence the prevalence of volunteering among older Koreans in the United States and in Korea and to identify sociodemographic resources, cultural resources, and social resources that are correlated with volunteering. The data were gathered from older Koreans aged 60 or over from the two countries (n = 480). The prevalence of volunteering was 23.3% for older Korean immigrants in the United States versus 14.7% for the older Koreans in Korea. This study found that there was a significant relationship between human capital (individual resources) and volunteering in both countries. Education and financial status had a positive relationship with volunteering among older Koreans in both countries. Cultural resources and social resources were the only important predictors of volunteering among older Korean immigrants in the United States. Regarding types of volunteering, older Koreans in both countries were more likely to participate in informal volunteering than formal volunteering. These findings differ somewhat from those reported by previous studies. This study was the first attempt to examine older adults from these two countries with a focus on the correlation between cultural factors, social resources, and volunteering.

Understanding the role of ethnic online communities during the COVID-19 pandemic: A case study of Korean immigrant women's information-seeking behaviors.

The rule of social distancing, coupled with the closing down of ethnic enclaves, has led immigrants to become isolated from their ethnic groups. In this study, we investigate the increasing role of ethnic online communities in immigrants' information-seeking behaviors during the COVID-19 pandemic. An analysis of 726 posts in MissyUSA reveals how an ethnic online community helps Korean immigrant women deal with the pandemic, reflecting the essence of a community amid societal lockdown. The findings suggest that these online communities supplement immigrant women's medical knowledge, build non-medical knowledge helpful to disadvantaged immigrants, and offer transnational knowledge regarding medical systems, products, and travel. These results provide evidence of how ethnic online communities promote immigrants' ongoing incorporation into society through the development of domestically and transnationally engaged medical and non-medical knowledge.

When home becomes classroom: The shifting roles of Korean immigrant mothers in the management of children's education during COVID-19 in the US.

COVID-19 has disrupted women's lives by increasing their childcare and household labor responsibilities. This has detrimentally affected immigrant women with limited resources, who invest in their children's education for upward mobility. Based on a content analysis of 478 posts on the MissyUSA website, this study explores the ways in which Korean immigrant mothers in the U.S. navigate the management of middle and high school children's online education during lockdown. Before the pandemic, mothers' tasks were largely limited to scheduling and coordinating private-paid after-school programs that occurred outside the home. However, the pandemic transformed mothers into active coordinators of public middle and high school classes and of private online tutoring, and de facto schoolteachers at home. This breakdown of boundaries between the home and tasks normally relegated to the outside world has burdened mothers with augmented roles managing the ordinary functioning of their children's education during the pandemic.

The beneficial role of family enmeshment among South Korean immigrants in the United States.

Enmeshment is considered inimical to healthy family dynamics among European Americans. However, recent studies have failed to show negative associations between family enmeshment and individual outcomes among Asian Heritage families. Using structural equation modelling and multiple group analysis, this study examined whether enmeshed relationships are dysfunctional in Korean immigrant families in the United States and whether degree of acculturation moderated the associations between enmeshment and children's socioemotional functioning and academic performance. The sample consisted of 98 South Korean immigrant families with children between 9 and 14 years of age residing in the Greater New York City Area. Results showed that enmeshed family relationships tended to be beneficial to child socioemotional functioning and the association became more evident with lower than higher degree of acculturation. Findings are discussed in terms of the meaning of enmeshment when working with Korean immigrant families in the United States.

The effects of acculturation and environment on lifestyle behaviors in Korean immigrants: the mediating role of acculturative stress and body image discrepancy.

OBJECTIVES: Despite high rates of cardiometabolic diseases in Korean immigrants (KIs), little is known about cultural and environmental factors contributing to lifestyle behaviors. The purpose of this cross-sectional study was to examine the relationships among acculturation, environment, and lifestyle behaviors (dietary behavior, physical activity, and sedentary behavior) through culturally sensitive psychological mediators, body image discrepancy and acculturative stress in middle-aged KIs. DESIGN: A cross-sectional study was conducted. KIs aged 30-65 years were recruited online and at Korean community centers and churches in the Northeastern US Participants completed validated measures of dietary behavior (the Nutrition Subscale of the Health Promoting Lifestyle Profile (HPLP) II), physical activity (the International Physical Activity Questionnaire (IPAQ) - short form), and sedentary behavior (the Sedentary Behavior Questionnaire). Acculturative stress was measured by the Acculturative Stress Index and body image discrepancy was measured by the Stunkard Figure Rating Scale. Acculturation was defined as a latent variable measured by Korean and American orientation (Vancouver Index of Acculturation), age of immigration to the US, length of residency in the US, and English proficiency. Data were analyzed with structural equation modeling (SEM). RESULTS: The sample included 361 KIs (mean age = 41.77 ± 10.28 years, 48.1% female, and 46.4% overweight or obese). In the SEM model, acculturation had significant indirect effects on dietary behavior, physical activity, and sedentary behavior through body image discrepancy. Acculturative stress mediated the relationship between acculturation and sedentary behavior. Greater environmental support for physical activity and better healthy food accessibility were related to higher levels of physical activity and healthier dietary behavior, respectively. CONCLUSION: In our study, acculturation and environmental support for physical activity and healthy food simultaneously influenced KIs' lifestyle behaviors. Addressing an unhealthy body image and acculturative stress may be additional strategies for lifestyle intervention programs to prevent cardiometabolic diseases in KIs.

Associations of Self-Reported Sleep Quality with Demographic and Other Characteristics in Older Korean Immigrants.

Poor sleep is common among older adults, affecting a wide range of health outcomes. However, little is known about sleep issues among older Korean immigrants, the fastest growing Asian American subgroup in the United States. We aimed to explore multiple factors associated with sleep among this group. We analyzed cross-sectional survey data from 43 older immigrants living in two large Korean communities in Southern California. Perceived sleep quality was significantly associated with gender, living arrangement, employment status, mental health, and sleep-related beliefs (all p-values < 0.05). Living with someone and being employed for wages were significantly uniquely associated with better sleep quality, accounting for demographic and health-related factors (R2 = 51.8%, adjusted R2 = 38.7%, p = 0.002). These findings suggest a potential role of sociocultural factors on sleep. Further studies are needed to confirm these findings and to inform a sleep intervention program tailored to the characteristics of older Korean immigrants.

Parental stress of Korean immigrants in the U.S.: Meeting Child and Youth's educational needs amid the COVID-19 pandemic.

This study investigates Korean immigrants' parental stress amid the COVID-19 pandemic, especially when they experience difficulties trying to meet their children's educational needs. Korean immigrant parents residing in the U.S. were invited to complete an online survey through purposive sampling. The final sample included a total of 341 Korean immigrant parents from 42 U.S. states. Three models of Ordinary Least Squares (OLS) regressions were conducted to examine the associations between parent-reported difficulties meeting the children's educational needs, parental stress, and the immigrant parents' resilience and social support. Findings indicate that parents' difficulties meeting their children's educational needs in general as well as language barriers were associated with increased parental stress. Moreover, parents' resilience and social support also significantly decreased parental stress levels. Implications for practice, policy, and future research are presented.

Caught in the middle: a thematic analysis of the experiences of Korean-Canadian caregiver-employees in the greater Toronto and Hamilton area.

BACKGROUND: The objective of this study was to investigate the experiences of caregiver-employees (CEs) from the Korean-Canadian community in the Greater Toronto and Hamilton Area. METHODS: Nine participants were recruited and invited to partake in data collection, which consisted of the completion of a sociodemographic questionnaire as well as a qualitative, semi-structured interview. The interview transcripts were thematically analyzed. RESULT: The thematic analysis revealed four primary themes, each of which had three sub-themes. The four primary themes are:: (i) tensions, (ii) adaptations to the dual role of being a CE, (iii) coping mechanisms, and (iv) desired changes to the status quo. CONCLUSION: The result of this study suggest that Korean-Canadian CEs, as a consequence of their position at the convergence of Korean and Western cultural values, would be best supported through the provision of culturally sensitive supports and greater workplace accommodation.

Korean Immigrants' Perception of Mental Well-Being and Help-Seeking Behaviors.

This article describes a study that investigated Korean immigrants' perception of mental well-being and help-seeking behaviors with particular focus on those with mental illness. Participants with probable diagnoses of anxiety or depression were more likely to recognize their mental health problems and their impact than those without such diagnoses. However, many of them did not acknowledge experiencing mental health problems and did not show high likelihood of seeking professional mental health services. The cultural beliefs and the lack of culturally competent mental health services appeared to contribute to the low levels of recognition of mental health problems and also the low rates of mental health service utilization. The participants listed mental health professionals' ability to communicate in the language of their preference, confidentiality, and affordability as significant factors in their decision to seek professional help. The study findings emphasize the great need of mental health educational programs within the Korean immigrant community. The findings also suggest that resources and infrastructures be secured for the provision of culturally competent mental health services for this population.

The Mediating Role of Pain Catastrophizing on the Association Between Depression and Pain Severity and Interference Among Elderly Asian Immigrants with Chronic Pain.

PURPOSE: The association between depression and chronic pain is well established. However, few studies have examined the pathways from depression to chronic pain. The present cross-cultural study aimed to test the mediating effects of pain catastrophizing on associations between depression and chronic pain (eg, pain severity, pain intensity) among Korean American elderly. PATIENTS AND METHODS: A total of 132 elderly Korean Americans with chronic pain were recruited from elderly daycare centers and Korean ethnic churches in the community. For mediation analyses, structural equation modeling with full information maximum likelihood estimation method was used. The bias-corrected bootstrap confidence interval (CI) method for inferential tests of the indirect effects was also conducted in mediation analysis. RESULTS: The results indicated that the proportion of comorbid depression and chronic pain was 45.7%. Elderly Korean Americans with depression scored higher in pain severity, pain interference, and pain catastrophizing than those without depression. Pain catastrophizing was found to have a significant mediating effect on the relationship between depression and pain severity (indirect effect = 0.147, Bootstrap 95% CI = [0.079, 0.226]), controlling for demographic covariates, comorbidities and pain area. Pain catastrophizing also mediated the relationship between depression and pain interference (indirect effect =0.164, Bootstrap 95% CI = [0.097, 0.244]), controlling for the covariates. CONCLUSION: These findings add to the literature by providing evidence that pain catastrophizing plays a role in high levels of pain severity and pain interference comorbid chronic pain and depression in Asian elderly immigrants. Appropriate culturally tailored programs to redirect pain catastrophizing cognitive process should be developed and provided for elderly Asian Americans to reduce chronic pain disparity.

Relationship between Employment Type and Self-Rated Health among Korean Immigrants in the US: Focusing on Gender and Number of Years in the US.

Although Korean immigrants report worse self-rated health and a higher self-employment rate than other Asian immigrant groups, the relationship between their employment type and self-rated health is understudied. This study examines the relationship between employment type and self-rated health among Korean immigrants in the US. Survey data of 421 first-generation working-age (18-64 years old) Korean immigrants in the New York-New Jersey area were analyzed. The self-administrated survey questionnaire included 39 items (e.g., sociodemographic characteristics, self-rated health, and health insurance status). A logistic regression analysis was conducted to examine the relationship between the dependent variable-self-rated health (e.g., bad/not bad vs. good/very good)-and independent variable-employment type (e.g., work at non-ethnic firms, work at co-ethnic firms, self-employed, and unemployed)-by focusing on differences regarding gender and number of years living in the US. Self-employed and unemployed Korean immigrants were less likely to report good health compared to those working in non-ethnic firms. After controlling for sociodemographic characteristics (age, gender, marital status, education, health insurance status, membership in any Koran association, religion, and English proficiency), the relationship between employment type and self-rated health remained significant among female and recent Korean immigrants. More worksite interventions by occupational health nurses that target self-employed Korean immigrants, especially women and recent immigrants, are necessary.

The Effects of Protestant Christian Faith on Successful Living Transition Among South Korean Immigrants in the United States: A Qualitative Study.

Religious belief and participation may facilitate well-being and the transition to living in the United States for Korean immigrants. However, there is little known about how Korean immigrant young adults obtain social/emotional support from church involvement and benefit from spiritual networks. A qualitative study was conducted through in-depth interviews with 22 members of one Protestant church in the Washington, DC metropolitan area. According to our findings, all respondents were supported in their transition to living in the United States through the social support and well-being effects of religious belief/affiliation. They manifested their belief mainly in two different ways, either engaging in spiritual networks as a church leader or by focusing on their education and livelihoods with their religious belief as a powerful motivator. It is hoped that further study will elucidate more of the mechanisms linking religious belief to the living transition for Korean and other immigrants to the United States.

Integrating Culturally Competent Advance Care Planning for Korean Immigrants: An Integrative Review.

AIMS: This review aims to explore the extant literature on the current utilization of ACP in Kisin order to obtain a comprehensive understanding of their health disparities and to determineevidence-based best practices to integrate culturally-competent ACP for EOL care of KIs. DESIGN: A systematic integrative review of the literature Data Sources:  Four electronic databases including PubMed, the Cumulative Index of Nursing and Allied Health Literature, the Cochrane Library, and Embase. METHOD: The detailed search strategy for databases implicated a combination of MeSHkeywords and associated terms, which can be found in Table A.Results: Three themes emerged in relation to fundamental components in the integration of culturally-competent ACP for EOL of KIs: (1) cultural characteristics of KIs; (2) disparities in ethnic-oriented ACP and EOL care resources in KIs; and (3) KIs' perspectives on ACP. CONCLUSION: The findings of this review indicate that culturally-competent ACP resources for KIsare presently quite insufficient. It is determined that much future research is needed on howculturally-competent ACP can best augment the quality of EOL care for KIs, and on howspecific interventions can effectively implement ACP in community settings. Impact: Such ongoing research dedicated to the development of feasible culturally competent practice guidelines is anticipated to markedly reduce health disparities and promote ACP in KIs. The recommendations in this review may support Korean primary HCPs, Korean health care center administrators, Korean health maintenance organizations (HMOs), Korean advance care nurse practitioners in hospice and palliative care, and nurse researchers in their work.

Religion, Religious Heterogeneity, and Intimate Partner Violence Among Korean Immigrant Women.

This study examined the role of religious affiliations and frequency of religious service attendance-such as church, Bible studies, and temples-as well as religious heterogeneity between couples on intimate partner violence (IPV) among Korean immigrant women in the United States. Through a case-control design, this study compared 64 Korean immigrant IPV victims with 63 Korean immigrant non-IPV victims. This study's findings reveal that for Korean immigrant women, a high frequency of religious service attendance was associated with higher IPV victimization, while their partners' high religious service attendance was associated with lower IPV victimization. When women's partners were religious compared with when they were not religious, they were less likely to perpetrate IPV even when the partners' alcohol consumption frequency increased. Also, when there was a gap between couples regarding frequency of religious attendance, IPV victimization increased. This discussion concludes by suggesting some policy implications based on these findings.