Research in Community and Public Health Nursing

Original Articles

Patterns of Adolescent Substance Use: A Comparative Study among the United States, Canada, England, and South Korea from 2014-2021: Chaehee Kim, Kihye Han, Jieun Kim, Alison M. Trinkoff, Sihyun Park, Hyejin Kim; Res Community Public Health Nurs. 2024;35(2):179-193. Published online June 28, 2024; DOI: https://doi.org/10.12799/rcphn.2024.00535

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Abstract PDF: Purpose
This study aimed to identify the cross-national estimates of substance use, explore problematic substance use patterns among adolescents across countries and over time, and examine the relationship of individual characteristics on substance use patterns.
Methods
This study employed a time-series secondary data analysis spanning from 2014 to 2021 across four countries (United States, Canada, England, and South Korea). We analyzed the usage of five substances (alcohol, binge drinking, cigarettes, electronic cigarettes, and illicit drugs) alongside demographic characteristics. A descriptive analysis was performed to identify estimates of substance use across countries. Latent class analysis was employed to examine adolescents’ substance use patterns across time and countries. A multinomial logistic regression model was fit to assess the relationship between latent class and demographic characteristics.
Results
Adolescents in the United States and Canada had the highest substance use, while Korean adolescents had the lowest, particularly concerning drugs. Latent class analysis revealed two classes (light-user and heavy-user), with the addition of a third class (moderate-user) in some instances. The substance use patterns, while differing significantly among nations, exhibited consistency over time. During COVID-19, a decrease in heavy-substance users was observed across countries. Male or older participants were more likely to belong to the heavy-user class.
Conclusion
This research offers valuable insights into the variations in substance use patterns between nations and over time. A tailored approach is essential to prevent adolescents from becoming heavy-substance users. This approach should consider country regulations and demographics for a targeted and comprehensive preventive strategy.

Experience of Nurses Responding to the COVID-19 Outbreak at a Long-term Care Hospital in Korea: Eun Jo Kim, JaHyun Kang; Res Community Public Health Nurs. 2024;35(2):168-178. Published online June 28, 2024; DOI: https://doi.org/10.12799/rcphn.2023.00409

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Abstract PDF: Purpose
The COVID-19 pandemic uncovered the fundamental vulnerability of Long-term Care Hospitals (LTCHs) regarding infection control. This study aimed to describe the experiences of nurses who responded to the COVID-19 outbreak on the front lines while working at a LTCH.
Methods
This qualitative study was conducted with nine nurses. The data from in-depth individual interviews using semi-structured questions was analyzed thematically.
Results
Three themes and 11 sub-themes were extracted. The first theme, “the sudden onset of the outbreak,” included finding themselves desensitized to COVID-19 as the pandemic persisted; embarrassed by the unavoidable occurrence; and worried about becoming a spreader and aggravating the outbreak. The second theme, “physically and mentally worn out,” involved increased fatigue from overtime work; exhaustion from responding to inquiry calls pouring in; tension while monitoring and controlling infection control compliance among nursing assistants, caregivers, and elderly patients with cognitive impairment; and increased discomfort while taking on all the extra work with stifling personal protective equipment. The third theme, “awakened perspectives while responding to the outbreak,” covered increased compassion for patients; paying attention to infectious diseases and having confidence in infection control principles; realization of the need for isolation rooms, supplies, and a full-time infection control nurse; and pride as an LTCH nurse who responded to the COVID-19 pandemic.
Conclusion
To enhance the level of prevention and response to infectious disease outbreaks in LTCHs in the future, it is necessary to establish infection control infrastructure, including personnel, isolation facilities, supplies, and continuing education for the LTCHs’ nursing workforce.

Priorities of Family Caregivers in Preserving Functional Abilities of Individuals with Alzheimer's Disease Living at Home: A Best-Worst Scaling Approach: Eunhye Cho, Youngran Yang, Hyun Kyung Kim, Hye Young Kim; Res Community Public Health Nurs. 2024;35(2):156-167. Published online June 28, 2024; DOI: https://doi.org/10.12799/rcphn.2024.00556

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Abstract PDF Supplementary Material: Purpose
The decline in cognitive abilities among individuals with Alzheimer’s disease significantly impacts their Activities of Daily Living (ADLs), creating challenges and stress for their caregivers. This study aimed to investigate the priorities of family caregivers of community-dwelling individuals with Alzheimer's disease concerning the preservation of their loved ones' ADLs.
Methods
We employed a cross-sectional design with a best-worst scaling approach (BWS), and developed a BWS questionnaire utilizing the 10 daily living items from the Disability Assessment for Alzheimer’s Disease scale. This questionnaire was administered to 132 caregivers of individuals with Alzheimer's disease. Data analysis was conducted using SPSS WIN 21.0 and the R statistical program.
Results
The results revealed that "using the toilet without accidents" emerged as the top-ranked ADL that family caregivers preferred to preserve for the longest duration among individuals with Alzheimer's disease living at home. In contrast, "Managing money appropriately" was identified as a daily living activity considered relatively less critical to preserve. The study further indicated a preference among caregivers for preserving physical ADLs over instrumental ADLs.
Conclusion
This research provides clinical evidence shedding light on the priorities of family caregivers in preserving the functional abilities of individuals with Alzheimer's disease within the community.

Prediction model of health checkup and cancer screening experience of elderly population using 2021 Community Health Survey: Myeunghee Han; Res Community Public Health Nurs. 2024;35(2):140-155. Published online June 28, 2024; DOI: https://doi.org/10.12799/rcphn.2024.00500

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Abstract PDF: Purpose
This study was conducted to build a decision tree model composed of factors that predict whether or not the elderly population underwent health or cancer screening using the 2021 community health survey.
Methods
This study included 74,434 and 74,417 subjects who answered for experience of health checkup or cancer screening, respectively. This study used Chi-squared test, independent t-tests, and decision tree analysis to analyze the data.
Results
Regarding the health checkup, 78.1% of women received a health checkup, and among women, those aged 65-74 years who were not recipients of the basic livelihood service showed the highest participation rate of 85.0%. In case of men, those who were married and had no problems in daily activity showed the highest participation rate of 81.4%. In the case of cancer screening, for women, those who were 65-74 years old and were nonrecipients of basic livelihood benefits showed the highest participation rate of 75.3%. For men, the cancer screening rate was the highest at 74.3% in those who had no problems with mobility and were married.
Conclusion
It was found that the general and health characteristics of the elderly had a great influence on the health checkup and cancer screening. In order to develop a more improved screening system, screening rates and effects should be continuously observed and studied.

Factors Related to Health-Related Quality of Life across the Life Cycle in One-Person Households among Korean Adults: Myung-Ock Chae; Res Community Public Health Nurs. 2024;35(2):125-139. Published online June 28, 2024; DOI: https://doi.org/10.12799/rcphn.2023.00304

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Abstract PDF: Purpose
This study is to identify factors related to health-related quality of life in one-person households across the life cycle by analyzing data from the 2021 Korean National Health and Nutrition Examination Survey.
Methods
The subjects of one-person households were divided into 195 young adults, 273 middle-aged people, and 490 elderly people according to life cycle. Data were analyzed by complex sample cross tabulation, complex sample t-test, complex sample ANOVA, and complex sample multiple regression analysis using IBM SPSS 26.0.
Results
In young adults, subjective health status, daily activity limitation, and stress level explained 41% of health-related quality of life, and in middle age, income level, education level, occupation, marital status, subjective health status, stress level, and depression had a 60% explanatory power. In old age, education level, subjective health status, daily activity limitation, stress level, and depression explained 53% of health-related quality of life.
Conclusion
In order to effectively improve the health-related quality of life of one-person households, it is necessary to establish a customized program considering the influencing factors across the life cycle and systematically manage it according to the flow of the life cycle.

Review Article

Optimistic bias: Concept analysis: Miseon Shin, Juae Jeong; Res Community Public Health Nurs. 2024;35(1):112-123. Published online March 29, 2024; DOI: https://doi.org/10.12799/rcphn.2023.00360

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Abstract PDF: Purpose
The purpose of this study was to analyze and clarify the concept of ‘optimistic bias.’
Methods
A review of the literature was conducted using several databases. The databases were searched using the following keywords: optimistic bias, optimism bias, and concept analysis. The literature on optimistic bias was reviewed using the framework of Walker and Avant’s conceptual analysis process.
Results
Optimistic bias can be defined by the following attributes: 1) underestimation of personal risk, 2) vague confidence, 3) positive future prediction and 4) lack of risk recognition. The antecedents of optimistic bias are as follows: 1) risk perception, 2) self-efficacy, and 3) risk controllability. The consequences of optimistic bias are as follows: 1) reduced anxiety, 2) providing emotional stability, 3) negative consequences for preventive health behavior, 4) lack of attention to risk-related information, and 5) negative consequences for self-protection behavior.
Conclusion
The definition and attributes of optimistic bias identified by this study can provide a common understanding of this concept and help to develop a nursing intervention program effective in preventing, protecting, and improving health of subjects in the field of nursing practice.

Original Articles

Illness Experience of Glaucoma Patients: Hyeon ae Lee, Seon Nyeo Kim, Hwa Young Kim, Sue Kyung Sohn; Res Community Public Health Nurs. 2024;35(1):99-111. Published online March 29, 2024; DOI: https://doi.org/10.12799/rcphn.2024.00458

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Abstract PDF: Purpose
The purpose of this study was to understand and describe the experiences of patients with glaucoma.
Methods
Data were collected from March to April in 2023, through individual in-depth interviews with 10 glaucoma patients. Verbatim transcripts were analyzed using Colaizzi’s phenomenological analysis.
Results
Six theme clusters were extracted that described patients’ experiences: 1) The frightening disease unexpectedly discovered; 2) A dismal life gradually trapped in darkness; 3) Fear of the unseen; 4) Following treatment without any other options; 5) Grateful for the help but feeling miserable; 6) Realizing the importance of eyes and health.
Conclusion
The results of this study provide a deep understanding and insight into the experience of Glaucoma patients. Glaucoma patients experienced physical, mental, and social pain through the disease process. Therefore, psychological nursing interventions are needed to understand and reduce mental pain along with medical treatment to relieve physical symptoms in glaucoma patients. Furthermore, it will be necessary to prepare institutional support measures to minimize various social restrictions.

Smartphone dependency latent profile classification and association with emotional and behavioral difficulties among high school students in Korea: Eunjoo Kim, Min Kyung Song; Res Community Public Health Nurs. 2024;35(1):84-98. Published online March 29, 2024; DOI: https://doi.org/10.12799/rcphn.2024.00465

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Abstract PDF: Purpose
The pervasive integration of smartphones into adolescents’ daily lives has resulted in a concerning upsurge in smartphone dependency among high school students. Due to the diverse types and severity levels of smartphone dependency, there is a critical need for research to explore its heterogeneity. This study aimed to identify latent profile of smartphone dependency in high school students based on the four subdomains of smartphone dependency: disturbance of adaptive functions, virtual life orientation, withdrawal, and tolerance. In addition, we explored how emotional and behavioral difficulties differ according to the profiles.
Methods
We used data from 2,195 Korean high school students from the Korean Children and Youth Panel Survey 2018. Latent profile analysis (LPA) was performed to identify smartphone dependency latent profile. Statistical analysis including chi-square test, Analysis of Variance (ANOVA), and ranked Analysis of Covariance (ANCOVA) confirmed differences in smartphone use characteristics and emotional-behavioral difficulties according to the classified latent profile.
Results
LPA identified four distinct latent profiles of smartphone dependency among high school students; 1) Underdependent type, 2) Moderate type, 3) Habitual user type, and 4) Virtual space dependent type. The results of ranked ANCOVA, controlling for gender, geographical location, economic status, parental smartphone dependency, and relational variables, revealed that habitual user type exhibited significantly higher rates of attention deficit hyperactivity disorder, social withdrawal, and depressive symptoms compared to other types.
Conclusion
The identification of these profiles provides a foundation for developing tailored intervention programs for adolescents with different levels and patterns of smartphone dependency.

Validity and Reliability of the Korean Version of the Diabetes Acceptance and Action Scale (DAAS-K): Kawoun Seo; Res Community Public Health Nurs. 2024;35(1):76-83. Published online March 29, 2024; DOI: https://doi.org/10.12799/rcphn.2023.00430

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Abstract PDF: Purpose
The purpose of this study was to evaluate the validity and reliability of the Korean version of the Diabetes Acceptance and Action Scale-Revised (DAAS-R) for Korean patients with type 2 diabetes.
Methods
The survey was conducted from September 1, 2021, to September 30, 2021, through a survey institution for patients diagnosed with diabetes who understood the purpose of the study and voluntarily agreed to participate. A total of 231 individuals with type 2 diabetes participated in this study. After performing forward and backward translations of the original version of the Diabetes Acceptance and Action Scale-Revised (DAAS-R) into Korean, its constructive validity (confirmatory factor analysis), concurrent validity and reliability were assessed. Concurrent validity was confirmed through the correlation between acceptance and action, quality of life, diabetes self-stigma, and experiential avoidance.
Results
Construct validity, measured using confirmatory factor analysis, showed a good fit. The DAAS-K was positively correlated with acceptance and action, quality of life, and negatively correlated with diabetes self-stigma and experiential avoidance. As for internal reliability, the Cronbach’s α of the DAAS-K was .95.
Conclusion
The DAAS-K can be applied to assess diabetes acceptance and action in Korean patients with type 2 diabetes and to compare the levels of psychological flexibility of patients with diabetes internationally.

Influencing Factors for Work Engagement of COVID-19 Response Workers in Public Health Centers: Based on the Job Demands-Resources Model: Songran Park, Yeongmi Ha; Res Community Public Health Nurs. 2024;35(1):64-75. Published online March 29, 2024; DOI: https://doi.org/10.12799/rcphn.2023.00346

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Abstract PDF: Purpose
This study aimed to identify the influencing factors for work engagement of COVID-19 response workers in public health centers based on the JD-R model.
Methods
The participants were 119 civil servants and professionals of 20 public health centers with at least 6 months of work experience and have experience of COVID-19 response tasks in cities, districts and counties. The collected data were analyzed by descriptive statistics, t-test, ANOVA, Pearson’s correlation coefficient and multiple regression using IBM SPSS 27.0.
Results
The factors influencing work engagement were age, career development opportunity, and person-job fit. The explanatory power of these variables was 61%.
Conclusion
In order to enhance the work engagement of public health center workers in responding to future infectious disease outbreaks, it is necessary to develop various strategies such as assigning job roles that aligned with individual characteristics, providing career growth opportunities even during infectious disease outbreaks, and designing tasks by taking into account age.

Urban-Rural Differences in Prevalence of Depressive Symptoms and Its Related Factors Among Older Adults: Findings from the Korean Longitudinal Study of Aging: Bongjeong Kim, Jinseub Hwang, Dohyang Kim, Soo Jin Kang; Res Community Public Health Nurs. 2024;35(1):51-63. Published online March 29, 2024; DOI: https://doi.org/10.12799/rcphn.2023.00388

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Abstract PDF: Purpose
Many studies exist on factors associated with depressive symptoms in urban and rural older adults; however, studies using a longitudinal design are scarce. This study aimed to determine whether there is a difference in the prevalence of depressive symptoms and their associated risk factors over time between urban and rural areas using a longitudinal sample of Korean older adults.
Methods
Data from the Korean Longitudinal Study of Aging (2006–2020) of older adult participants ≥65 years without depressive symptoms were analyzed. A generalized estimating equation model was employed for repeated measures analysis.
Results
As the time of living in the area increased, the prevalence risk of depressive symptoms in older adults increased in urban areas compared to rural areas in adjusted Model 2. In urban areas, less social contact with neighbors was significantly associated with a higher risk of depressive symptoms. In rural areas, occasional social contact with children was significantly associated with a lower risk of depressive symptoms. The prevalence of depressive symptoms was associated with five components of successful aging with some variations observed based on urban and rural residential areas.
Conclusions
Our findings suggest that understanding the longitudinal impact of residence on depressive symptoms provides valuable insights into the relationship between urban/rural areas and depressive symptoms. This study highlights the need for nursing intervention efforts aimed at promoting successful aging and increasing social contact with children or neighbors.

Current Status and Associated Factors of Emotional Distress Due to COVID-19 Among People with Physical Disabilities Living in the Community: Secondary Data Analysis using the 2020 National Survey of Disabled Persons: Bohye Kim, Ju Young Yoon; Res Community Public Health Nurs. 2024;35(1):37-50. Published online February 29, 2024; DOI: https://doi.org/10.12799/rcphn.2023.00374

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Abstract PDF: Purpose
This study aimed to assess the current situation and factors associated with emotional distress due to COVID-19 among people with physical disabilities living in the community, using a Social-Ecological Model.
Methods
A secondary data analysis was performed using data from the 2020 National Survey of Disabled Persons. The study participants were 1,654 participants aged 19 years or older with physical disabilities. For data analysis, complex sample logistic regression was conducted to identify factors associated with emotional distress due to COVID-19 in people with physical disabilities.
Results
The results showed that 55.7% of people with physical disabilities living in the community experienced emotional distress due to COVID-19. This emotional distress was influenced by various factors, including intrapersonal factors (activities of daily living, difficulty in getting information about COVID-19, difficulty in obtaining and using equipment related to COVID-19), interpersonal factors (satisfaction with the number of friends), and community/policy factor (support related to COVID-19 from national and local governments).
Conclusion
It is recommended to develop tailored interventions to prevent mental health issues among people with physical disabilities by considering the factors related to their emotional distress in the event of future infectious disease disasters.

Factors influencing dementia preventive behaviors of older adults at high risk of dementia: Application of extended health belief model: So Hee Jung, Mee Ock Gu; Res Community Public Health Nurs. 2024;35(1):22-36. Published online March 29, 2024; DOI: https://doi.org/10.12799/rcphn.2023.00402

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Abstract PDF: Purpose
The purpose of this study was to identify the factors influencing dementia preventive behaviors of older adults at high risk of dementia based on extended health belief model.
Methods
The subjects were 140 older adults at high risk of dementia living in H-gun, Gyeongsangnam-do, Republic of Korea. The data was collected from April 21 to May 28, 2021 by using structured questionnaires. The data was analyzed using t-test, ANOVA, Scheffé test, Pearson’s correlation coefficient, and hierarchical multiple regression by SPSS/WIN 24.0 program.
Results
The mean score of dementia preventive behaviors of older adults at high risk of dementia was 3.47±0.49 (range 1-5). The factors influencing dementia preventive behaviors were self-efficacy (β=.82, p<.001), cues to action(β=.17, p=.013), ages 75-79 (β=0.35, p=.003; reference: ages 65-69), ages ≥80 (β=0.27, p=.021; reference: ages 65-69), which together explained 82.0% of total variance in dementia preventive behaviors (F=25.21, p<.001).
Conclusion
Based on the results of this study, it is highly recommended to develop and apply the dementia prevention program that can increase self-efficacy and cues to action for improving dementia preventive behavior of older adults at high risk of dementia.

Home-based walking intervention for middle-aged migrant women using 360-degree virtual videos and a wearable activity tracker: A mixed-methods pilot study: Duckhee Chae, Keiko Asami, Jaseon Kim, Kukhyeon Kim, Jeeheon Ryu, Ardith Z. Doorenbos; Res Community Public Health Nurs. 2024;35(1):10-21. Published online March 29, 2024; DOI: https://doi.org/10.12799/rcphn.2023.00339

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Abstract PDF Supplementary Material: Purpose
To sustain behavior change, an intervention strategy that considers the contribution of affect to daily physical activity behavior regulation is needed. Although virtual reality-based physical activity interventions have the potential to improve emotional status, interventions using virtual reality videos in a free-living environment are lacking. This pilot study assessed the feasibility and preliminary efficacy of a home-based intervention using 360-degree virtual videos and wearable activity trackers to improve mood and physical activity.
Methods
A one-group pilot study of 12 middle-aged migrant women asked participants to watch virtual reality videos and perform moderate-intensity walking 5 days per week for 4 weeks, then complete surveys and focus group interviews. The intervention’s feasibility and preliminary efficacy were assessed by examining recruitment, retention, adherence, acceptability, mood, physical activity, and exercise self-efficacy.
Results
A word-of-mouth approach was effective for recruiting participants. Although the weekly intervention adherence rate ranged from 53.5% to 83.5%, retention (92.3%) and acceptability (91.7%) were high. Participants were satisfied with the “visual status indicators,” “sense of accomplishment and confidence,” “emotional engagement and sense of presence,” “joy from exercise,” “external motivation through supervision,” “easy to control virtual reality device,” and “extra benefits” of the intervention. Participants had significant decreases in negative affect (p=.016). Positive affect, physical activity, and exercise self-efficacy showed trends toward improvement.
Conclusion
This home-based intervention employing virtual reality videos and Fitbit activity trackers is feasible and shows preliminary efficacy in improving mood. Further research is warranted to evaluate its effectiveness in a more rigorous randomized controlled trial.

Bidirectional Relationship Between Depression and Frailty in Older Adults aged 70-84 years using Random Intercepts Cross-Lagged Panel Analysis: Ji Hye Shin, Gyeong A Kang, Sun Young Kim, Won Chang Won, Ju Young Yoon; Res Community Public Health Nurs. 2024;35(1):1-9. Published online February 29, 2024; DOI: https://doi.org/10.12799/rcphn.2023.00381

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Abstract PDF: Purpose
Depression and frailty are common health problems that occur separately or simultaneously in later life. The two syndromes are correlated, but they need to be distinguished to promote successful aging. Previous studies have examined the reciprocal relationship between depression and frailty, but there are limitations in the methods or statistical analysis. This study aims to confirm the potential prospective bidirectional and causal relationship between depression and frailty.
Methods
We used data from 887 older adults aged 70 to 84 from the Korean Frailty and Aging Cohort Study (KFACS) in 2016, 2018, and 2020 (3 waves). We separated the within-individual process from the stable between-individual differences using the random intercepts cross-lagged panel model.
Results
Significant bidirectional causal effects were observed in 2 paths. Older adults with higher depression than their within-person average at T1 had a higher risk of frailty at T2 (β=.22, p=.008). Subsequently, older adults with higher-than-average frailty scores at T2 showed higher depression at T3 (β=.14, p=.010). Autoregressive effects were only significant from T2 to T3 for both constructs (Depression: β=.16, p=.044; Frailty: β=.13, p=.028). At the between-person level, the correlation was significant between the random intercepts between depression and frailty (β=.47, p<.001).
Conclusions
We find that depressed older adults have an increased risk of frailty, which contributes to the onset of depression and the maintenance of frailty. Therefore, interventions for each condition may prevent the entry and worsening of the other condition, as well as prevent comorbidity.

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