Research in Community and Public Health Nursing

Original Articles

Factors Associated with Homosexual Adolescents in South Korea: Jong Gun Kim; Res Community Public Health Nurs. 2024;35(3):207-215. Published online September 30, 2024; DOI: https://doi.org/10.12799/rcphn.2023.00332; Funded: Hoseo University

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Abstract PDF: Purpose
The purpose of this study was to investigate factors related to homosexual adolescents in South Korea.
Methods
Using statistics from the 12th (2016) Korea Youth Risk Behavior Web-based Survey, hierarchical logistic regression analysis was conducted. The study sample comprised 65,528 middle and high school students aged 12 to 18 years.
Results
The significant predictors of homosexual intercourse were gender, attempted suicide, bullying at school experience, ever drinking, ever smoking, habitual or purposeful drug use, cohabitation with family, weekly allowance, and mother’s education levels.
Conclusions
The results suggest that gender-related interventions should be considered in school health education programs and that sexual health interventions for high-risk groups may be needed, given the factors predicting homosexual intercourse.

Developing a community-based, multicultural-friendly prenatal education pilot program: EunSeok Cha, Sojung Lee, Gui-Nam Kim, Byung Hun Kang, Minsun Jeon; Res Community Public Health Nurs. 2024;35(3):226-239. Published online September 30, 2024; DOI: https://doi.org/10.12799/rcphn.2024.00507; Funded: Chungnam National University

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Abstract PDF: Purpose
The purpose of this study was to examine the acceptability, availability and sustainability of a pilot prenatal program developed by an interdisciplinary team.
Methods
Out of 19 multicultural women participated in the 6-session prenatal program, 6 women took part in an exit- focus group interview as a part of formative evaluation. The verbatim transcriptions of semi-structured interview data were analyzed using conventional content analysis.
Results
In general, the participants expressed high satisfaction with program content, educators and education methods. A hybrid model including health professionals and community health workers and using online and offline education modes was suggested as a way to disseminate the program at a national level. Interventions using aesthetic approaches such as music and an integrated method such as the introduction of available social services in pregnancy and during the postpartum period may play a role as the facilitator of the program participation of multicultural women. These approaches may also help them develop healthy coping skills, problem solving skills and empowerment in multicultural childbearing women who need to adjust to life in a new country simultaneously taking a new role as a mother.
Conclusion
An interdisciplinary prenatal program using a holistic approach contributes to enhancing multicultural women’s empowerment to become a mother in a new country.

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; Funded: Ministry of Education of the Republic of Korea, National Research Foundation of Korea

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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.

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; Funded: Gangneung-Wonju National University

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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

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; Funded: Dong Yang University

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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.

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; Funded: Seoul National University, National Research Foundation of Korea, Ministry of Education

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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.

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; Funded: National Research Foundation of Korea, Ministry of Education, Center for Human-Caring Nurse Leaders for the Future

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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.

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; Funded: National Research Foundation of Korea, Ministry of Education

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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.

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; Funded: Ministry of Education of the Republic of Korea, National Research Foundation of Korea

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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.

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; Funded: Jeju National University

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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.

A Multi-component Living Lab on Health Engagement for Advancing Self-care Agency among Migrant Workers in South Korea: A mixed methods study: Youlim Kim, Hyeonkyeong Lee, Sookyung Kim, Junghee Kim; Res Community Public Health Nurs. 2023;34(4):281-293. Published online December 29, 2023; DOI: https://doi.org/10.12799/rcphn.2023.00199; Funded: National Research Foundation of Korea, College of Nursing, Yonsei University

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Abstract PDF Supplementary Material: Purpose
Migrant workers battle to access health services and adapt to a new culture. Self-care agency can be essential for health self-management. This study examines the effects of a health engagement program to improve self-care agency using a living lab approach among migrant workers living in South Korea.
Methods
This study used a mixed-methods design, including a non-equivalent pre-post-test control group and three focus group interviews. Participants included 42 migrant workers from nine countries recruited via flyers, posters, and internet bulletins posted by a migrant community organization. During the 12 weeks, only the intervention group participants received four workshops addressing healthy physical activity, healthy dietary habits, effective cultural adaptation, stress management, and two outdoor cultural activities. They also participated in focus group interviews after the second, third, and fourth group activities and discussed the benefits of healthy behaviors and specific ways to implement them in real life.
Results
Participants in the intervention group showed an increase in self-care agency, health literacy, and acculturation after the 12- week intervention. Themes were derived based on the lessons from living lab activities, barriers to health behavior practices, and methods to overcome these.
Conclusion
This study demonstrated that multi-component intervention using a living lab effectively increased migrants’ participation in health promotion activities by strengthening health in their self-care agency. The qualitative and living lab approach effectively obtained comprehensive results on strategies to enhance healthy behavior engagement.

Factors affecting cultural adaptation stress by gender among multicultural adolescents in Korea: Seungwoo Han; Res Community Public Health Nurs. 2023;34(4):320-331. Published online December 29, 2023; DOI: https://doi.org/10.12799/rcphn.2023.00276; Funded: Kwangju Women`s University

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Abstract PDF: Purpose
This paper is a descriptive survey research to identify factors that affect acculturation stress in multicultural adolescents, and provide basic information that can be used to develop ways to improve their mental health.
Methods
This study used the data of the 2nd multicultural adolescents panel study provided on December 30, 2022 by the National Youth Policy Institute. The subjects of this study were 1,520 multicultural adolescents in the fourth grade of elementary school and the survey period was from July to November 2020. The dependent variable was acculturation stress, and the explanatory variables were as follows: mother’s and father’s country of origin, region size, home economic conditions, academic achievement, experience of discrimination, mother’s level of education, father’s level of education, and number of close friends. Data analysis involved calculation of descriptive statistics, analysis of differences in the level of acculturative stress and general characteristics between male and female adolescents, and multiple regression analysis.
Results
This study found that there are gender differences in significant influencing factors for acculturation stress among multicultural adolescents. For males, factors influencing acculturation stress were identified as regional size, mother's education level, parental support, and teacher support. For females, they were regional size, experience of discrimination, number of close friends, parental support, and self-esteem.
Conclusion
The results of this study suggest that psychiatric nurses should provide psychiatric nursing and counseling to multicultural adolescents in addition to clinical psychiatric nursing. Various mental health programs should be developed for multicultural adolescents, with a focus on counseling, education, and family therapy.

Factors Related to Smoking Relapse Within Six-Months of Smoking Cessation Among Inpatients: Ji Eun Bae, Chul-Woung Kim, Seung Eun Lee, Myungwha Jang; Res Community Public Health Nurs. 2023;34(4):307-319. Published online December 29, 2023; DOI: https://doi.org/10.12799/rcphn.2023.00213; Funded: Ministry of Health and Welfare, Chungnam National University

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Abstract PDF: Purpose
The purpose of this study is to identify factors associated with smoking relapse within 6 months after quit attempts among inpatients of a university hospital.
Methods
The subjects of this study were 572 inpatients of the National University Hospitals in Daejeon & Sejong who had enrolled in the smoking cessation service provided by the Daejeon·Sejong Tobacco Control Center and attempted to quit smoking. The data used in the study were extracted from the Smoking Cessation Service Integrated Information System. The Kaplan-Meier method and Cox Proportional hazards model were used to identify variables associated with smoking relapse within 6 months.
Results
The smoking relapse rate within 6 months was 76.7%, and variables associated with relapse included the absence of supporters for quitting smoking (hazard ratio [HR]=1.42, 95% confidence interval [CI]=1.00-2.02), nicotine dependence (HR=1.09, 95% CI=1.03-1.15), the use of prescription medications (including varenicline or bupropion) (HR=3.99, 95% CI=1.83-8.71), and the number of consultations (HR=0.67, 95% CI= 0.63-0.70).
Conclusion
As a result of the study, the number of consultations showed the strongest correlation with abstinence within 6 months. This implies that it is necessary to increase the counseling participation rate of the subjects so that smoking cessation counseling can be continued after discharge, and it is also required to provide support education to guardians during hospitalization for effective smoking relapse prevention.

Gender Differences in Older Adults’ Muscle Strength and Depressive Symptoms: A Relationship Mediated Through Perceived Stress: Gyeong A Kang, Jihye Shin, Ju Young Yoon; Res Community Public Health Nurs. 2023;34(3):196-204. Published online September 27, 2023; DOI: https://doi.org/10.12799/rcphn.2023.00164; Funded: Seoul National University, Ministry of Education, National Research Foundation of Korea, Center for Human-Caring Nurse Leaders for the Future

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Abstract PDF: Purpose
Preventing the effects of physical vulnerability is a practical approach to improving older adults’ depressive symptoms. This study aims to examine the relationship between gender differences related to muscle strength and depressive symptoms mediated by perceived stress.
Methods
In this cross-sectional study, data from 2,705 older adults (65 years old or older) from the Korea National Health and Nutrition Examination Survey VII 2016 and 2018 were analyzed. The moderated mediation model was developed; the outcome, independent, mediation, and moderated mediation variables in the literature-based research model were depressive symptoms, muscle strength, perceived stress, and gender, respectively.
Results
Perceived stress had a mediating effect on the relationship between muscle strength and depressive symptoms. The indirect effect of muscle strength on depressive symptoms mediated by perceived stress was β = -.02 (95% CI:-0.03~-0.01). The moderated mediation model demonstrated that the interaction term of handgrip strength and gender negatively affected perceived stress, which indicated that gender moderated the mediating model of perceived stress on the association of muscle strength and depressive symptoms (β = -.01, p <.05). The conditional indirect effect model was insignificant in the male group (β = -.00, 95% CI:-0.01~0.01) but significant in the female group (β = -.01, 95% CI: -0.02~0.00). Conclusions: Perceived stress mediated the relationship between muscle strength and depressive symptoms. However, the effect differed by gender. A stress-mediated depressive symptoms intervention program for older adults should be developed to consider women’s needs.

Effects of Fatigue and Emotional Labor on Sleep Quality among Apartment Security Guards: Chul-Gyu Kim, Sujeong Jeong, Young Mi Ryu, Seungmi Park, Kyoungmi Moon, Yunjung Kwon, Sun-A Park, Hye Ok Park; Res Community Public Health Nurs. 2023;34(3):205-216. Published online September 27, 2023; DOI: https://doi.org/10.12799/rcphn.2023.00220; Funded: Chungbuk National University

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Abstract PDF: Purpose
This study aimed to identify the effects of fatigue and emotional labor on the quality of sleep among apartment security guards.
Methods
A total of 196 apartment security guards working in 10 different regions participated in the study between July and October 2022, completing questionnaire assessing fatigue (physical imbalance, exhaustion, mental fatigue, and nervous system disfunction), emotional labor, and sleep quality. Data were analyzed using descriptive statistics, independent t-test, Mann-Whitney U test, ANOVA including Scheffe’s post hoc, and regression analysis.
Results
183(93.4%) participants were poor sleeper. Regression analysis of the factors influencing sleep quality yielded a significant model (F= 21.56, p<.001) with an explanatory power of 25.0% in the order of fatigue(exhaustion) (β=.28, p<.001), emotional labor (β=.27, p<.001), and subjective economic status (β=.15, p=.017).
Conclusion
It is essential to develop nursing educational programs that reduce exhaustion and emotional labor for improving the quality of sleep.

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