Research in Community and Public Health Nursing

Original Articles

Association between Hearing Difficulty, Masticatory Difficulty, and Risk of Cognitive Impairment: Analysis of the Korean Longitudinal Study of Aging Data (2006-2020): Sook Hee Choi, Yun Hee Kim; Res Community Public Health Nurs. 2024;35(4):434-448. Published online December 30, 2024; DOI: https://doi.org/10.12799/rcphn.2024.00745

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Abstract PDF: Purpose
This study aimed to identify the association between hearing difficulty, masticatory difficulty, and cognitive impairment using data from the Korean Longitudinal Study of Aging.
Methods
This secondary data analysis included 6939 Korean adults aged 45 or older with no cognitive impairment at baseline. Self-reported questionnaires measured hearing and masticatory difficulty, and cognitive impairment were assessed using the Korea Mini-Mental State Examination (K-MMSE). Cox models were used to estimate the risk of cognitive impairment associated with the coexistence of hearing and masticatory difficulty.
Results
People who coexisted with hearing and masticatory difficulty were 2.4%. The incidence rate of cognitive impairment was 37.7% for the study sample and higher in females than males. Compared to people without hearing and masticatory difficulty, the total study sample with the coexistence of hearing and masticatory difficulty had a higher risk of cognitive impairment (HR: 1.26, 95% CI: 1.03–1.56), females with the coexistence of hearing and masticatory difficulty had a greater risk of cognitive impairment (HR :1.52 95% CI: 1.11–2.09).
Conclusion
Coexistence of hearing and masticatory difficulty increased females' cognitive impairment risk. It is recommended to check hearing and masticatory function in a timely, which may be effective in detecting individuals at high risk of cognitive impairment.

Factors Influencing Participation in Hypertension Management Education Among Diagnosed Hypertensive Patients in Busan: Utilizing the 2021 Community Health Survey: Hye Jung Jun, Kyoung Mi Kim; Res Community Public Health Nurs. 2024;35(4):424-433. Published online December 30, 2024; DOI: https://doi.org/10.12799/rcphn.2024.00759

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Abstract PDF: Purpose
This study investigated the completion rate of hypertension management education and its influencing factors among adults in the Busan region, utilizing data from the 2021 Community Health Survey.
Methods
The study included 3,660 adults aged 19 years or older who had been diagnosed with hypertension. Data were analyzed using SAS 9.4, focusing on demographic, socioeconomic, and health status characteristics.
Results
The results indicated that 22.1% of participants had completed hypertension management education. Key influencing factors varied by region: in the Western region, age, income, education level, marital status, and life satisfaction were significant factors associated with participation in hypertension management education. In the Southern region, income and education level were identified as relevant factors. Additionally, in the Central and Eastern regions, education level was a significant determinant.
Conclusion
Therefore, tailored hypertension management education programs that consider age, income, marital status, and life satisfaction are essential for residents in the Western region of Busan. Moreover, it is critical to enhance access to hypertension management education for low-income populations in the Southern region. Educational programs should also be designed to align with the educational levels of Busan residents to ensure effective hypertension management education.

Effects of Virtual Reality Cardiopulmonary Resuscitation Practice on the Knowledge, Skills, and Attitudes of Nursing Students: A single-blind randomized controlled trial (RCT): Jui Kim, Jung-Hee Song, Young-Ok Ha; Res Community Public Health Nurs. 2024;35(4):415-423. Published online December 30, 2024; DOI: https://doi.org/10.12799/rcphn.2024.00689

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Abstract PDF: Purpose
This study aimed to assess the effects of virtual reality (VR) cardiopulmonary resuscitation (CPR)—as compared to those of face-to-face Basic Life Support (BLS) education—on nursing students’ knowledge, skills, and attitudes.
Methods
Forty-four participants were recruited from nursing schools in Gyeonggi-do, Republic of Korea, and randomized into two groups: VR CPR (experimental group) and BLS (control group). The participants’ CPR knowledge, cardiac compression quality, self-efficacy, confidence, and attitudes toward education were evaluated.
Results
At enrollment, the control and experimental groups showed similar results for all the variables. After the intervention, results showed that the cardiac compression score and the hand position accuracy in the experimental group were significantly higher than in the control group. Meanwhile, knowledge, self-efficacy, and confidence were improved in both groups, though there was no significant difference between the two groups.
Conclusion
The study results showed that VR CPR education is just as effective as face-to-face BLS training for nursing students. Therefore, developing high-quality VR educational content in the future is necessary.

Trajectories of Depressive Symptoms among Multicultural Middle and High School Adolescents: A Longitudinal Study Using Latent Class Growth Model: Sujin Lee, Soo Jin Lee, Hyanglan Kim; Res Community Public Health Nurs. 2024;35(4):401-414. Published online December 30, 2024; DOI: https://doi.org/10.12799/rcphn.2024.00696

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Abstract PDF: Purpose
This study aimed to identify latent classifications based on trajectories of change in depressive symptoms among multicultural adolescents in middle and high school and to identify factors that influence classification.
Methods
This study used six time-point data from the Multicultural Adolescents Panel Study (MAPS) conducted by the National Youth Policy Institute (NYPI). We longitudinally analyzed data from 2014 to 2019, which corresponds to the participants' middle and high school years. Latent Growth Curve Modeling (LGCM) was used to analyze the depressive developmental trajectories of multicultural youth in middle and high school. Latent Class Growth Modeling (LCGM) was used to determine the number and shape of latent classes according to the type of depression among multicultural adolescents. We applied multinomial logistics regression analysis to explore the predictors of each class.
Results
A model with three latent classes was identified: (1) low-decreasing class (intercept=13.34, slope=-0.07, 37.9%), (2) moderate-increasing class (intercept=17.76, slope=0.41, 47.6%), (3) high-increasing class (intercept=23.22, slope=0.44, 14.5%). Multinomial logistic regression showed multicultural adolescents who were male, experienced high acculturative stress and social withdrawal, and had low self-esteem, life satisfaction, and family support tended to belong to either the moderate-increasing or high-increasing class.
Conclusion
These findings suggest that preliminary assessments of gender, acculturation stress, self-esteem, life satisfaction, social withdrawal, and family support among multicultural adolescents may be valuable for developing tailored mental health programs.

Digital Health Literacy and Associated Factors Among Older Adults Living Alone in South Korea: A Cross-Sectional Study: Minhwa Hwang, Gahye Kim, Seonghyeon Lee, Yeon-Hwan Park; Res Community Public Health Nurs. 2024;35(4):389-400. Published online December 30, 2024; DOI: https://doi.org/10.12799/rcphn.2024.00766

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Abstract PDF: Purpose
This study aimed to examine the level of digital health literacy and identify factors associated with digital health literacy among older adults living alone in South Korea.
Methods
A cross-sectional study was conducted on 140 older adults aged 65 and above who live alone. Descriptive statistics and non-parametric methods were used to explore the relationship between digital health literacy and independent variables. A generalized linear model was used to identify factors associated with digital health literacy.
Results
Among 140 smartphone-owning older adults living alone, 52.1% were using the Internet via digital devices, and the participants’ average digital health literacy score was 6.64±7.46. Univariate analysis results showed significant differences in digital health literacy according to age, education level, and multimorbidity. The factors associated with digital health literacy were identified as gender (B=−0.36, p=.031), age (B=−0.06, p<.001), education level (B=0.12, p<.001), and sleep problems (B=−0.06, p=.006).
Conclusion
Despite widespread Internet and smartphone use, older adults living alone with chronic diseases showed low levels of digital health literacy, which were significantly associated with gender, age, education level, and sleep problems. Enhancing digital health literacy among vulnerable populations is crucial for the effective implementation of digital health services. Collaborative efforts, including tailored digital health interventions to enhance the digital health literacy of vulnerable populations and supportive policies, are essential to bridge the digital divide and promote health equity.

Social Network Analysis of Adults’ Obesity-Related Health Behaviors According to Life Cycle Stage: Seung-bin Park, Insoon Kang; Res Community Public Health Nurs. 2024;35(4):375-388. Published online December 30, 2024; DOI: https://doi.org/10.12799/rcphn.2024.00738

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Abstract PDF: Purpose
This secondary data analysis study examined adults’ levels and networks of obesity-related health behaviors according to the life cycle stage.
Methods
Participants included 5,203 adults aged 19–79 years who participated in the third year of the eighth Korea National Health and Nutrition Examination Survey (2021). Life cycle stages were divided into young, middle-aged, and older adult groups. Obesity status was classified based on a body mass index of 25 kg/m2. Selected obesity-related health behaviors included alcohol abstinence, not smoking, proper sleep, eating breakfast, fruit intake, vegetable intake, not eating out, aerobic physical activity, walking, and weight training. Obesity-related health behavior networks were analyzed for density, inclusiveness, degree, and degree/closeness/betweenness centrality using social network analysis.
Results
Participants’ obesity rate was 37.6%, with the highest rate observed in the older adult group (39.2%). In all life cycle stages, the non-obese group had a higher density and average degree in the obesity-related health behavior network than the obese group. The young adult group showed higher centrality for vegetable intake, not smoking, alcohol abstinence, and proper sleep. The middle-aged group generally had higher centrality for health behaviors, whereas the older adult group had lower overall centrality for health behaviors, especially proper sleep and physical activity-related behaviors.
Conclusion
There were differences in the levels and network structures of obesity-related health behaviors according to the life cycle stage, indicating a need for differentiated obesity-management strategies according to the life cycle stage.

Effects of a School-Based Health Education for Cardiovascular Disease Prevention Among High School Girls: Minah Kang, Jina Choo; Res Community Public Health Nurs. 2024;35(4):363-374. Published online December 30, 2024; DOI: https://doi.org/10.12799/rcphn.2024.00647

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Abstract PDF: Purpose
We aimed to evaluate effects of a school-based health education for cardiovascular disease (CVD) prevention among high school girls.
Methods
Non-randomized cluster trial was conducted by recruiting two female high schools located in Seoul and allocating one school as a cluster to an experimental group and the other school as the other cluster to a control group. Participants were 169 first-year female high school students in two clusters. Of the participants, 84 were recruited in the experimental group and 85 in the control group. An intervention was an eight-week "School-based Health Education for CVD prevention". The experimental group received the intervention, while the control group received a CVD prevention handout. Measures were knowledge, self-efficacy, and health behaviors for CVD prevention. The pre-test and post-test were conducted.
Results
The experimental group participating in "School-Based Health Education for CVD Prevention" had significantly higher changes in knowledge, self-efficacy scores to prevent CVD, and health behaviors than the control group over eight weeks.
Conclusions
The "School-based Health Education for CVD Prevention" program may improve high school students' knowledge and self-efficacy as determinants of health behaviors as well as health behaviors to prevent cardiovascular disease.

Reliability and Validity of the Korean Version of 8-item Health Literacy Assessment Tool (K-HLAT-8): Mirae Jo, Eun-mi Kwak; Res Community Public Health Nurs. 2024;35(4):351-362. Published online December 30, 2024; DOI: https://doi.org/10.12799/rcphn.2024.00682

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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 Health Literacy Assessment Tool (K-HLAT-8) for Korean adults.
Methods
The survey was conducted from April 1, 2020 to May 30, 2020 at a university hospital, a university, and one community picnic area with adults who understood the purpose of the study and voluntarily agreed to participate. A total of 220 adults participated in this study. After forward and backward translation of the original version of the Health Literacy Assessment Tool 8 (HLAT-8) into Korean, construct validity (confirmatory factor analysis), convergent validity, and reliability were evaluated. Convergent validity was confirmed through the correlation between the K-HLAT-8 and the Self-As Carer Inventory (SCI).
Results
Construct validity, evaluated using confirmatory factor analysis, showed good fit. The K-HLAT-8 showed a positive correlation with the SCI score. In terms of internal consistency, Cronbach’s α of the K-HLAT-8 was 0.85. For test-retest reliability, the intraclass correlation coefficient (ICC) was .99 (95% CI: 0.97~0.99).
Conclusion
The reliability and validity were confirmed, so K-HLAT-8 can be applied to evaluate the health literacy of Korean adults. Furthermore, these assessment results should be used as basic data to implement programs that can improve health literacy.

Development and Evaluation of Eating Traits Scale for Adult in Republic of Korea: Youngwon Kim, Eunok Park; Res Community Public Health Nurs. 2024;35(4):339-350. Published online December 30, 2024; DOI: https://doi.org/10.12799/rcphn.2024.00521

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Abstract PDF: Purpose
The purpose of this study was to develop eating traits scale for Korean adults and verify its validity and reliability.
Methods
The initial items were developed based on the literature reviews. The first preliminary scale has consisted of 78 items and the second preliminary scale consisted of 50 items selected by 13 experts who were formed to evaluate the content validity. To review whether they could understand the questionnaires at their reading level, 27 sixth-grade elementary school students were asked to be involved in this study. The questionnaire was revised through the consultation of Korean language teachers, and the final preliminary scale was composed of 50 items. Data were collected from 329 adults aged 19 to 65 years to test validity and reliability of the scale The item analysis and exploratory factor analysis were applied.
Results
Exploratory factor analysis showed 5 factors of 35 items. The factors (No. of items) were ‘Mood states (6)’, ‘Pursuit of health (6)’, ‘Stimulation of food (9)’, ‘Social situations (5)’, ‘Desire satisfaction (9)’. These 5 factors explained 55.04% of the total variance. Eating traits scale developed in this study was established construct validity. The reliability of the scale, Cronbach's alpha coefficient was .92 and the factor’s ranged from .77 to .87.
Conclusions
Eating traits scale developed in this study was verified by content validity, construct validity and reliability. It is expected to be useful measuring eating traits of Korean adults in clinical practice and research.

Malnutrition Risk in Community-Dwelling Older Adults with Dual Sensory Declines: Focusing on Social Determinants of Health: Ha Na Jeong; Res Community Public Health Nurs. 2024;35(4):325-338. Published online December 30, 2024; DOI: https://doi.org/10.12799/rcphn.2024.00675

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Abstract PDF: Purpose
As the number of older adults with dual sensory declines is increasing, they face a higher risk of malnutrition compared to those without these declines. Although social determinants of health can influence malnutrition, there has been limited research on this population. This study aimed to explore the association between malnutrition risk and social determinants of health among older adults with dual sensory declines.
Methods
The study is a cross-sectional analysis using data from the 2020 National Survey of Older Koreans. Binomial logistic regression analysis was conducted to examine the association between malnutrition risk and social determinants of health. These determinants include structural determinants, social capital, and intermediary determinants among older adults with dual sensory declines.
Results
1,771 with dual sensory declines were included in the analysis. Among the structural determinants, women (odds ratio [OR]=1.75, 95% confidential interval [CI] 1.19~2.57) and national basic livelihood security system recipients (OR=1.87, 95% CI 1.13~3.07) were significantly associated with malnutrition risk. In social capital, social non-participation (OR=1.33, 95% CI 1.03~1.73) and social network size (OR=0.95, 95% CI 0.92~0.98), Among intermediary determinants, living dissatisfaction (OR=1.61, 95% CI 1.16~2.23), environmental satisfaction (OR=0.95, 95% CI 0.92~0.99), household debt (OR=1.59, 95% CI 1.02~2.49) and comorbidity (OR=3.85, 95% CI 2.98~4.97) were significantly related to malnutrition risk.
Conclusion
These findings highlight the critical need to address key social determinants of health to enhance nutritional outcomes for older adults with dual sensory declines.

The Effects of Adverse Childhood Experiences, Benevolent Childhood Experiences, and Community Integration on Resilience in Psychiatric Outpatients: Keum Ran Hong, Hye Kyung Lee; Res Community Public Health Nurs. 2024;35(4):313-324. Published online December 30, 2024; DOI: https://doi.org/10.12799/rcphn.2024.00598

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Abstract PDF: Purpose
The purpose of this study is to determine the impact of adverse childhood experiences, positive childhood experiences, and community integration on resilience in psychiatric outpatients.
Methods
The study subjects were 166 psychiatric outpatients in one general hospital in South Korea who were diagnosed with schizophrenia spectrum disorder, bipolar disorder, or depression disorder. The collected data were analyzed with the t-test, ANOVA, Pearson’s correlation coefficient, multiple regression analysis, using the SPSS/WIN 24 program.
Results
There were statistically significant differences in resilience in psychiatric outpatients according to age, religion, occupation, type of household, type of diagnosed disorder. In psychiatric outpatients, resilience showed a significant positive correlation with benevolent childhood experiences and community integration, but had a negative correlation with adverse childhood experiences. Multiple regression analysis for resilience in psychiatric outpatients revealed that the significant factors affecting resilience were community integration, benevolent childhood experiences, adverse childhood experiences, housing facilities (type of household), ages 40-49, and living alone (type of household). These factors explained 52.2% of the variance.
Conclusion
In order to improve the resilience of mentally ill people, a campaign is needed to increase the accessibility of community participation programs in mental health services for community integration and to publicize the influence of benevolent childhood experiences and adverse childhood experiences. Furthermore, it is necessary to identify individual factors such as residence type and age of mentally ill people, build a customized support system by considering their specific needs, and develop intervention programs to strengthen resilience.

Review Article

A Systematic Review of Questionnaire Measuring eHealth Literacy: Jung-Won Ahn, Mi Young Kim; Res Community Public Health Nurs. 2024;35(3):297-312. Published online September 30, 2024; DOI: https://doi.org/10.12799/rcphn.2024.00752

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Abstract PDF: Purpose
This review aims to summarize the characteristics of currently used questionnaires measuring eHealth literacy and assess the quality of their psychometric properties in self-reported assessments within community settings.
Methods
The systematic analysis was conducted using the COnsensus-based Standards for the selection of health Measurement INstruments checklist to evaluate the methodological quality of studies on measurement properties.
Results
A total of 21 studies, including 19 questionnaires, were reviewed. The findings indicated that the quality of psychometric assessments for eHealth literacy was generally rated as 'good,' with most studies addressing multiple aspects of reliability and validity. Internal reliability, content validity, hypothesis testing, and responsiveness were particularly well-supported, each receiving over 10 sufficient ratings. However, there was limited evidence regarding measurement errors, test-retest reliability, criterion validity, and analyses of floor and ceiling effects.
Conclusion
This study contributes to the enhancement of eHealth literacy measurement tool selection and improves the reporting of their validity and reliability, thereby increasing the credibility of future research.

Original Articles

Exploring the Prevalence and Influencing Factors of Sexually Explicit Internet Material (SEIM) Consumption among Adolescents and Young Adults in Cambodia: Hyunjeong Cheon, Youngran Yang; Res Community Public Health Nurs. 2024;35(3):284-296. Published online September 30, 2024; DOI: https://doi.org/10.12799/rcphn.2024.00633

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Abstract PDF: Purpose
This study investigates the prevalence and factors associated with the consumption of sexually explicit Internet material (SEIM) among adolescents and young adults in Cambodia.
Methods
Utilizing a cross-sectional study design, data were collected through a survey administered to 1,271 participants. The survey focused on measuring SEIM consumption, sexual sensation seeking, perceived reality of SEIM, and sexual attitudes. Findings: The study revealed a SEIM prevalence of 27.2%, with notably higher rates among males (35.5%) than females (18.6%). Significant predictors of SEIM consumption included being male, having a father with a middle-level education, engaging in alcohol or substance consumption, spending more than five hours daily on electronic devices, having friends with sexual experience, frequent thoughts about sex, a heightened interest in sex compared to peers, perceiving SEIM as realistic, and maintaining a permissive attitude towards sex.
Conclusions
These findings underscore the importance of implementing education programs to address SEIM consumption and its potential risk factors. Such initiatives are crucial for preventing the use of SEIM among Cambodian youth, promoting a healthier understanding of sexuality, and fostering responsible online behavior.

Development of Theory of Uncertainty on COVID-19: Theory Derivation Based on Uncertainty in Illness Theory: Cho Ryok Kang, Sook Ja Yang; Res Community Public Health Nurs. 2024;35(3):272-283. Published online September 30, 2024; DOI: https://doi.org/10.12799/rcphn.2024.00577

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Abstract PDF Supplementary Material: Purpose
The purpose of this study is to develop the Theory of Uncertainty on COVID-19 using the strategy of theory derivation.
Methods
Theory derivation was carried out in the following steps: review the literature to explore the phenomena related to uncertainty on COVID-19; select a parent theory that provides valuable concepts and a useful structure for derivation, and identify the concepts and structure of the parent theory to use in derivation; modify and redefine the concepts and structure of the parent theory to create a derived theory. In the literature review process, relevant findings were synthesized to support the propositions of the derived theory.
Results
The Theory of Uncertainty on COVID-19 was derived from the Uncertainty in Illness Theory to make it relevant and applicable to a specific aspect of uncertainty on COVID-19, health-related uncertainty perceived by a person who has not contracted COVID-19. It is a middle-range theory targeting the general population and consists of a linear and unidirectional model centered on three themes: antecedents of uncertainty, appraisal of uncertainty, and coping with uncertainty.
Conclusion
The Theory of Uncertainty on COVID-19 will be able to contribute to efforts to manage perceived uncertainty on pandemic diseases and improve individual biopsychosocial health in the future.

Knowledge of Healthcare Workers Towards NIPAH Virus: A Cross-Sectional Study: Hadi Al Sulayyim, Manea Alsaleem, Ali Sherjab, Saleh Aldoghman, Husain Alyami, Abdulaziz Al Yami, Mohammad Almeshal, Mohammad Altheban, Dahen Alsinan, Obaid Altheban, Fares Al-Mansour; Res Community Public Health Nurs. 2024;35(3):264-271. Published online September 30, 2024; DOI: https://doi.org/10.12799/rcphn.2024.00619

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Abstract PDF: Purpose
To evaluate the healthcare workers’ (HCWs) knowledge towards Nipah virus and identify the associated variables with good knowledge.
Methods
A cross-sectional design was conducted in Najran, Kingdom of Saudi Arabia (KSA) to evaluate the knowledge of HCWs towards Nipah virus. A validated questionnaire was employed to collect the data of HCWs. It consisted of two parts: Socio-demographic characteristics of the participants and questions related to the knowledge towards Nipah virus. Percentages and median (Q1, Q3) were used to present the data and were compared by Mann–Whitney and Kruskal Wallis. The associated variables with good knowledge were identified by logistic regression.
Results
The study included 247 participants. The median (Q1, Q3) knowledge score was 45% (10%, 60%), reflecting poor knowledge. About 62% of the HCWs stated that the symptoms of Nipah virus infection could be acute respiratory distress, convulsions, and coma. Only 36.8% reported no available vaccine to prevent Nipah virus infection, and more than 50% identified the virus’s main reservoir (fruit bat) as the possibility of transmission from animal to human. Roughly 57% of them reported that the virus can be transmitted among people through droplets. Less than 40% stated the Nipah virus can cause AIDS. The significantly associated variable with good knowledge was only nationality.
Conclusion
The present study showed a poor knowledge of HCWs. Good knowledge was associated with nationality. Therefore, the implementation of education and training programmes are highly recommended throughout conducting prospective and interventional studies.

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