Research in Community and Public Health Nursing

Volume 35 (1); March 2024

Original Articles

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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