Research in Community and Public Health Nursing

Original Articles

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.

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.

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.

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.

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.

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.

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

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.

Factors Associated with Nurse Self-Leadership: A Cross-Sectional Study of Nurses Working at Public Health Centers and Primary Healthcare Posts: Saeryun Kim, Younkyoung Kim; Res Community Public Health Nurs. 2024;35(3):195-206. Published online September 30, 2024; DOI: https://doi.org/10.12799/rcphn.2024.00493

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Abstract PDF Supplementary Material: Purpose
This study aimed to analyze the factors influencing self-leadership among public health nurses as they implement health promotion projects in public health centers and primary healthcare posts.
Methods
The study sampled 120 public health nurses from 22 public health centers and their associated primary healthcare posts in J province. Data were collected from October 11 through October 25, 2022.
Results
Employment at a primary healthcare post instead of a public health center (β=.23, p=.012), was significantly associated with self-leadership in model 1 (adjusted R2=.17, F=4.56, p<.001). Furthermore, communicative competence (β=.48, p<.001) and nursing professionalism (β=.26, p=.001) were significantly associated with self-leadership in model 2 (adjusted R2=.51, F=14.77, p<.001).
Conclusion
Open and self-directed work environments, along with opportunities for education and training, are necessary to enhance communicative competence and nursing professionalism. These improvements may, in turn, strengthen self-leadership among nurses, facilitating the implementation of health promotion projects within public health institutions.

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.

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.

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

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.

Relationships of Self-leadership, Working Environment, and Professionalism among School Health Teachers: Joohee Kim, Young Ko; Res Community Public Health Nurs. 2023;34(4):294-306. Published online December 29, 2023; DOI: https://doi.org/10.12799/rcphn.2023.00297

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Abstract PDF: Purpose
This study was conducted to examine the relationships of self-leadership, working environment, and professionalism, and to identify the factors that influence professionalism among school health teachers.
Methods
This study was a descriptive research study to identify the relationships of self-leadership, work environment, and professionalism among school health teachers. Data were collected from 198 people via an online survey using a structured questionnaire. The data were collected from February 7 to 24, 2023. The relationships of self-leadership, working environment, and professionalism were analyzed using multiple regression analysis.
Results
The score of self-leadership of school health teachers was 3.97 points out of 5, working environment was 3.28 points out of 5, and professionalism was 4.12 points out of 5. Professional accountability and competency development were influenced by behavioral strategies of self-leadership, cognitive strategies of self-leadership, and working environment. These variables explained 35.0% and 29.5% of professional accountability, respectively. Autonomy was influenced by age, cognitive strategy of self-leadership, and working environment, and these variables explained 19.2% of the variance of autonomy. Social recognition was influenced by behavioral strategy of self-leadership, and working environment, and these variables explained 28.0% of social recognition.
Conclusion
To enhance the professionalism of school health teachers, it is necessary to cultivate self-leadership that can overcome difficulties in work and properly self-criticize. Improving the working environment would help enhance the professionalism of school health teachers.

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