Introduction

Background

Healthy lifestyle habits formed in childhood can be maintained through adulthood and affect health in adulthood, and thus are very important in the prevention of chronic diseases and mental health problems [1]. Among health problems in childhood, obesity is associated with an increased risk of developing complex chronic diseases such as obesity, diabetes, and cardiovascular disease in adulthood, and it can also lead to negative body image and low self-esteem, causing psychosocial problems [2]. Meanwhile, the prevalence of overweight and obesity in children increased from 23.9% to 31.4% during the COVID-19 pandemic, compared to the prevalence before the pandemic [3], and during the pandemic, there were negative changes in children’s health behaviors, including decreased physical activity time [4], increased screen time, and the increased sugar-sweetened beverage intake level [4]. These findings indicate that the COVID-19 pandemic environment was a socio-environmental factor that negatively affected children’s health-related behaviors due to social distancing and lockdown during the pandemic [4].

The concept of health empowerment is based on Rogers’ Science of Unitary Human Beings (SUHB) theory [6]. According to Rogers’ SUHB theory, health empowerment is affected by the principle of an integrated or unitary view of human beings, which is the notion that humans are integrated with the environment in their daily lives and health experiences [6]. From this viewpoint, health empowerment refers to the process of gaining autonomy by enabling people to have control over decisions that affect their lives and well-being [7]. It also refers to the process by which people in vulnerable situations due to environmental risks actively change their unfavorable situations by recognizing their potential or abilities and thereby gaining autonomy and control [8]. Therefore, health empowerment is an important factor in promoting health in the daily lives of children who are in vulnerable situations due to the COVID-19 pandemic.

Recently, many countries around the world have been presenting child empowerment as a policy agenda for the promotion of children’s health and well-being [9]. In addition, the Organization for Economic Cooperation and Development (OCED) suggests that since social inequalities caused by COVID-19 have been undermining children’s health and empowerment [9], child empowerment should be a key area of national policies to provide equitable health outcomes for all children [9]. It has been reported that self-esteem is the intrapersonal factor that plays the most important role in the empowerment of children [10,11]. Self-esteem is an individual’s subjective evaluation of himself or herself, and refers to the degree to which an individual considers himself or herself valuable [12]. It has been reported that self-esteem may not only directly affect children’s physical and mental health but also indirectly influence children’s health as a mediator between children’s health and environmental and behavioral variables [11].

Meanwhile, children’s social support refers to children’s cognitive evaluation of positive resources they can obtain from others through social relationships [13], and children’s main social relationships are known to be family, friends, and teachers [13]. In particular, it has been reported that parental support and friend support are related to health behaviors [14,15]. More specifically, a higher level of parental support has been shown to be associated with a higher level of physical activity, which is a behavior for preventing obesity and less consumption of fast foods [14]. In addition, it has been found that a higher level of friend support is linked to performing sufficient physical activity every day [15].

Meanwhile, family empowerment refers to the state or ability of the family to cooperate with elements outside the scope of their life through controlling their own life in order to raise a child with problems [16,17]. Family empowerment is divided into three dimensions: family system, service system, and community/political system [16,18]. First, the dimension of family system refers to the parents’ ability to manage children’s problems in everyday ordinary situations [16,18]. Next, the dimension of service system refers to the parents’ ability to actively cooperate and communicate with organizations providing services for children and professionals in the process of receiving services necessary for their children [16,18]. Lastly, the dimension of community/political system refers to parents’ advocacy activities aimed at legislative bodies, policymakers, agencies, and community members in order to improve services for their own children as well as other children [16,18]. The above definitions of the three dimensions of family empowerment clearly show that family empowerment is an important factor in helping the families of children to effectively utilize services for the promotion of children’s health and increase the ability to cooperate with others in order to overcome children’s problems in a situation where children are experiencing many restrictions in their daily lives due to the COVID-19 pandemic.

In view of the above findings, this analysis aimed to identify the relationships between self-esteem, social support, family empowerment, and health empowerment among children in a health-vulnerable environment due to the COVID-19 pandemic in order to provide basic data for developing intervention measures to strengthen health empowerment for the promotion of children’s health. Among the factors considered in this study, self-esteem is an intrapersonal factor, and social support and family empowerment are interpersonal factors surrounding children.

Aims

The main aim of this study was to clarify the relationships between self-esteem, social support, family empowerment, and health empowerment among children in the social disaster situation of the COVID-19 pandemic.

Methods

Study design

This study is a descriptive correlational study to identify the relationships between self-esteem, social support, family empowerment, and health empowerment among children in a health-vulnerable environment due to the COVID-19 pandemic.

Participants

The participants of this study were fifth- and sixth-grade elementary school students and their parents. The children who participated in this study were selected from 241 fifth- and sixth-grade students attending an elementary school in Gangwon Province, Korea by a convenience sampling method, and a health survey was conducted with the children and their parents. Data collection was conducted in November 2021. Out of the 241 elementary school students in grades 5 and 6, 120 children (49.8%) agreed to participate after they were given explanations about the study including the purpose and procedure of the study. However, 5 children withdrew from the study during the health survey. Regarding the parent participants paired with child participants, among the parents of the 115 children who were the final survey participants, the parents of 99 children understood the purpose and explanations of this study and agreed to participate. In other words, 86.1% of the parents of child participants agreed to participate, but one parent withdrew from the study during the health survey. Therefore, 98 child-parent pairs were finally included in the analysis. Regarding the specific criteria for selecting research participants, children were selected from 5th- and 6th-grade elementary school students, and for the parents of child participants, the parents who were blood relatives of children were primarily selected in selecting the participants. If a child did not live with one or both of the parents or if both the parents were not alive, the adult who was raising the child and had legal custody of the child was selected instead of a parent. The parents who finally participated in the study consisted of 85 mothers (86.7%) and 13 fathers (13.3%).

Regarding the sample size of this study, the sample size for simple linear regression analysis was computed as follows. In regression analysis, the predictor variables entered one by one into each regression model were as follows: self-esteem, social support (friend support, family support, and teacher support), family empowerment (family system, service system, community/political system], age, gender, perceived academic achievement, perceived economic status, parent’s education level, family structure type. The sample size was computed using the G*power (version 3.1.9.7) program, based on the expected effect size value of 0.15 for the outcome variable (health empowerment), a power of 80%, and a significance level of ⍺=.05. As a result, the minimum sample size was calculated as 89 people, and the sample size was finally determined as 98 people, considering a dropout rate of 10%. Therefore, 98 child-parent pairs in this study were a sufficient sample size to secure statistical power.

Measures

1. General characteristics

Among the general characteristics of the participants, the following variables were measured through the survey responses of child participants: age, gender, perceived academic achievement (excellent, good, average, slightly poor, very poor), and perceived economic status (very high, high, average, low, very low). However, the parents’ education level (college or higher, high school or lower) and family structure type (both parents, single parent) were examined through the responses of children’s parents. Perceived academic achievement was categorized into ‘good’ and ‘bad’ by grouping ‘excellent’ and ‘good’ into ‘good’ and grouping ‘average’, ‘slightly poor’ and ‘very poor’ into ‘bad.’ Perceived economic status was categorized into ‘good’ and ‘bad’ by grouping ‘very high’ and ‘high’, and ‘average’ into ‘good’ and grouping ‘low’ and ‘very low’ into ‘bad.’ The education level of the parents of children was measured by examining the education levels of both parents (college or higher, high school or lower). Then, if at least one parent had the education level of college or higher, the education level of the child’s parents was classified as ‘college or higher.’

2. Self-esteem

The level of self-esteem among children was measured using the Korean version of the Self-Esteem Scale developed by Rosenberg [12]. The Korean version used was developed by Jon [19] through the translation and adaptation of the original scale. This scale consists of a total of 10 items rated on a 4-point Likert scale (1 point=‘Hardly’, 2 points=‘Sometimes’, 3 points=‘Most of the time’, 4 points=‘Always’). Negative items were reverse-scored, and the scores for each item were added up to calculate a mean (range: 1-4 points). A higher mean score indicates a higher level of self-esteem. As to the reliability of this tool, the value of Cronbach’s ⍺ was .79 in a previous study [20] and .87 in this study.

3. Social support

Social support was measured using the perceived social support scale developed by Han & Yoo [13] with the permission of the authors, and the level of social support was rated by children. This tool consists of 24 items in three subdomains, and each item is rated on a 5-point Likert scale (1 point=‘Totally disagree’, 2 points=‘Disagree’, 3 points=‘Neutral’, 4 points=‘Agree’, 5 points=‘Totally agree’). The items in three subdomains consist of 8 items on friend support, 8 items on family support, and 8 items on teacher support. Negative items were reverse-scored, and the mean score (range: 1-5 points) was calculated after adding up the scores for each item. A higher mean score indicates a higher level of social support. The value of Cronbach’s ⍺ was .86 for friend support, .84 for family support, and .87 for teacher support in a previous study [13]. In this study, the value of Cronbach’s ⍺ was .92 for friend support, .92 for family support, and .92 for teacher support.

4. Family empowerment

Family empowerment was measured using a Korean version of the Family Empowerment Scale (FES) developed by Koren et al. [16]. The Korean version was developed as a short-form scale and validated by Jung [18], and it was used in this study with the author’s permission. The level of family empowerment was rated by children’s parents. This scale consists of three subdimensions and 15 items in total: 5 items on family system, 5 items on service system, and 5 items on community∙politics system. Each item is rated on a 5-point Likert scale (1 point=‘Totally disagree’, 2 points=‘Disagree’, 3 points=‘Neutral’, 4 points=‘Agree’, 5 points=‘Totally agree’). For this scale, the mean score (range: 1-5 points) was calculated by adding up the scores of each item, and a higher mean score indicate a higher level of family empowerment. The value of Cronbach’s ⍺ was .76 for family system, .79 for service system, and .79 for community∙politics system in a previous study [18], and .84 for family system, .82 for service system, and .83 for community∙politics system in this study.

5. Health empowerment

Health empowerment was assessed using the Korean Health Empowerment Scale (K-HES) developed by Park & Park [21] with the permission from the authors, and the level of health empowerment was rated by children. This scale consists of a total of 8 items, and each item is rated on a 5-point Likert scale (1 point=‘Hardly’, 2 points=‘A little’, 3 points=‘Average’, 4 points=‘Somewhat’, 5 points=‘Very much’). For this tool, the mean score (range: 1-5 points) is calculated by adding up the scores of each item, and a higher mean score indicates a higher level of health empowerment. The value of Cronbach’s ⍺ was reported as .80 in a previous study [21] and calculated as .85 in this study.

Data collection

This study was conducted after receiving approval from the Institutional Review Board of Catholic Kwandong University (IRB No.: CKU-21-01-0110), and research data were collected from November 8, 2021 to November 30, 2021 during the COVID-19 pandemic. Before conducting this study, we obtained consent from the principal, school nurse, and homeroom teachers, and provided the school nurse with sufficient explanations on the research method and tools to ask for cooperation in data collection. Only for the classes that agreed to cooperate and participate in the study, we posted participant recruitment posters on the bulletin boards of each classroom and the school nurse’s office, and sent a recruitment notice through a school newsletter.

In order to conduct a survey of children, the corresponding author and other researchers visited each classroom directly after school hours and distributed questionnaires to the children. They were first asked to respond to the survey questions by a self-administered survey method, but when students asked questions, the researcher read the relevant part or item of the questionnaire loud standing next to the students and gave them sufficient explanations to ensure that the children understood the content before responding to the survey questions. Only when the parents of child participants submitted the written informed consent form, the participant information sheet, a copy of the written informed consent form (including the participation agreement), and a copy of the questionnaire were sent in an envelope together with a school newsletter to each parent by delivering the envelope to each student. The completed questionnaires were collected by asking the parents to put them back into the envelopes and putting the envelopes into a sealed box placed in the school nurse’s office. In the process of obtaining agreement and consent to participate in this study from the participants, the contact information of the corresponding author and other researchers was provided through a school newsletter to allow the participants to make inquiries at any time, and responses to inquiries were given in a clear and easily understandable manner by phone or in person at any time.

Data analysis

The collected data was analyzed IBM SPSS Ver 26.0 (IBM Co. Armonk, NY, USA). The general characteristics of and the levels of self-esteem, social support, family empowerment, and health empowerment of the participants were analyzed using descriptive statistics such as real numbers and percentages, means, and standard deviations. A simple linear regression analysis was conducted to examine relationships between health empowerment and general characteristics, such as age, gender [female=1, male=0], perceived academic achievement [1=good, 0=bad], perceived economic status [1=good, 0=bad], parental education level [1=college or higher, 0=high school or lower]), and family structure type [1=both parents, 0=single parent]). In addition, the relationships between self-esteem, social support, family empowerment, and health empowerment among the participants were analyzed using simple linear regression analysis. The Cronbach's ⍺ coefficient was calculated to verify the reliability of the tool used in the study.

Results

General characteristics

The mean age of the children who participated in this study was 11.38±0.60 years, and in gender, girls (57 people, 58.2%) accounted for a larger proportion than boys (41 people, 41.8%) (Table 1). As to perceived academic achievement, 49 children (50.0%) rated their academic achievement as good. Regarding perceived economic status, 34 people (34.7%) reported their family’s economic status as good. As for the level of education of the children’s parents, 14 parents (14.3%) responded that one or both of the parents of the child had the education level of college or higher. Regarding family structure type, 81 children (86.2%) lived with a single parent, and 13 children (13.8%) lived with both parents.

Levels of self-esteem, social support, family empowerment, and health empowerment

The mean score for self-esteem among the children who participated in this study was 2.91±0.63 points, and the mean score for social support among the children was 3.86±0.59 points. The mean scores for each subdomain of social support were 3.72±0.76 points for friend support, 4.09±0.79 points for family support, and 3.79±0.87 points for teacher support (Table 2). The mean score for family empowerment perceived by the children’s parents was 3.50±0.55 points, and the mean scores for each sub-dimension of family empowerment were 3.50±0.55 points for family system, 3.69±0.66 points for service system, and 3.00±0.74 points for community∙politics system. The mean score for children’s health empowerment was 3.55±0.83 points.

Relationships between general characteristics and health empowerment

In the analysis of relationships between the general characteristics of the study participants and health empowerment, the level of health empowerment in children was found to be significantly higher associated with younger age (B=-0.31, SE=0.14, β=-0.23, t=-2.26, p=.026), male gender (B=-0.35, SE=0.17, β=-0.21, t=-2.06, p=.043), a higher level of perceived academic performance (B=0.39, SE=0.16, β=0.24, t=2.40, p=.018), and a higher level of perceived economic status (B=0.36, SE=0.17, β=0.21, t=2.05, p=.043) (Table 3). Parents’ education level and family structure type did not have a statistically significant relationship with children’s health empowerment.

Relationships between self-esteem, social support, family empowerment, and health empowerment

In this study, relationships between self-esteem, social support, family empowerment, and health empowerment were analyzed using a simple linear regression analysis. In the simple linear regression model, self-esteem was statistically significantly linked to health empowerment (B=0.61, SE=0.12, β=0.46, t=5.11, p<.001), and a higher level of self-esteem was associated with a higher level of health empowerment (Table 3). With respect to the relationship between social support and health empowerment, health empowerment showed a significant relationship with the overall social support (B=0.66, SE=0.13, β=0.47, t=5.16, p<.001), friend support (B=0.39, SE=0.10, β=0.36, t=3.73, p<.001), family support (B=0.46, SE=0.10, β=0.44, t=4.79, p<.001), and teacher support (B=0.23, SE=0.10, β=0.24, t=2.43, p=.017). A higher level of social support was significantly linked to a higher level of health empowerment. As for family empowerment, the overall family empowerment had a statistically significant relationship with health empowerment (B=0.40, SE=0.15, β=0.27, t=2.70, p=.008). Among the subdimensions of family empowerment, service system (B=0.30, SE=0.13, β=0.24, t=2.37, p=.020) and community/political system (B=0.30, SE=0.11, β=0.26, t=2.68, p=.009) had a significantly association with health empowerment. A higher level of family empowerment was significantly associated with higher levels of health empowerment, but among the subdimensions of family empowerment, family system did not have a statistically significant relationship with health empowerment.

Discussion

This study attempted to identify the relationships between self-esteem, social support, family empowerment, and health empowerment among children in the social disaster situation of the COVID-19 pandemic. The participants were 98 child-parent pairs, and the children were selected among 5th- and 6th-grade elementary school students attending an elementary school in Gangwon Province. In this study, a higher level of health empowerment in children was significantly associated with a higher level of self-esteem, social support (friend support, family support, teacher support) as well as a higher level of family empowerment (service system, community∙political system).

In this research, there was a significant relationship between children’s self-esteem and health empowerment, and a higher level of self-esteem was linked to a higher level of health empowerment among children. Meanwhile, in a previous study conducted with children and adolescents aged 12-23 years with intellectual disabilities in 2019 before the COVID-19 pandemic, an analysis of the relationships between empowerment, mental health problems, and self-esteem revealed that a higher level of self-esteem was significantly associated with a higher level of empowerment and with a lower level of mental health problems [22]. In addition, the study reported that a higher level of empowerment was linked to a lower level of mental health problems [22]. In addition, in a previous study on factors associated with empowerment among adolescents aged 13-14 years conducted in 2011, self-esteem, which is an intrapersonal factor, was found to be the most significant influencing factor for empowerment in adolescents [8]. Health empowerment is a factor that connects an individual’s strengths, capabilities, and proactive preventive behaviors to social policies and changes [23], and it has been reported that health-related empowerment among adolescents (aged 15-16 years old) is enhanced through the process of developing an individual’s self-esteem, and self-esteem itself can promote health [24]. Although it was not possible to directly identify the relationship between self-esteem and health empowerment in children through previous studies, it is thought that self-esteem, which is an intrapersonal factor of children, is a factor that can enhance health empowerment along with children’s growth even when they are not in a vulnerable situation due to environmental risks, and that the children’s health can be promoted in the process. Therefore, it is suggested that self-esteem is an essential factor as a strategic component of intrapersonal factors that can enhance health empowerment when developing intervention measures to promote health in daily life as well as in situations where children are in a health-vulnerable environment.

In this study, social support, an interpersonal factor of children, was found to have a significant association with health empowerment. A higher level of social support was significantly associated with a higher level of health empowerment in children. In particular, a higher level of social support, including friend support, family support, and teacher support, was linked to a higher level of health empowerment in children. A literature review revealed that although health empowerment and social support have been shown to be related to health behaviors [25,26], there has been no study to investigate the relationship between social support and health empowerment in children. However, social support perceived by children is defined as ‘a cognitive evaluation of positive resources, such as love, recognition, information, and material assistance, that can be obtained from others through social relationships’ [13]. In a previous study conducted in 2007 before the COVID-19 pandemic, the analysis of the relationship between social support and empowerment among 5th- and 6th-grade elementary school students using local child centers revealed that friend support and family support were related to empowerment [27], and friend support had a significant indirect effect on mental health (depression, anxiety) through empowerment [27]. Meanwhile, according to a previous study that was conducted using the data collected before the COVID-19 pandemic and was published in 2020, analysis results of the relationship between social support and health behavior (physical activity) of children (4th to 6th graders in elementary school) using local child centers revealed that health behavior showed a significant relationship with friend support but was not related to family support [15]. These findings show that among the subdomains of social support, friend support is an important variable affecting children’s health and health behaviors among children in a socioeconomically vulnerable environment. Therefore, social support perceived by children can be employed as a component of intervention strategies to improve the health empowerment of children in a vulnerable environment. In particular, it is considered necessary to utilize friend support, which is as an interpersonal factor, to improve health empowerment for the promotion of children’s health.

In this study, there was a significant association between health empowerment and family empowerment, which is an interpersonal factor of children. In other words, as the level of family empowerment perceived by children’s parents became higher, the level of health empowerment in children was increased. In particular, with respect to the subdimensions of family empowerment, a higher level of the service system and a higher level of the community/political system were significantly linked to a higher level of health empowerment. However, there was no significant correlation between the dimension of family system and the level of health empowerment of children. The process of enhancing empowerment can be considered from the perspectives at three different levels: the micro, meso, and macro perspectives. From a micro perspective, enhancing empowerment means that individuals’ empowerment is enhanced through changes in their thinking [28]. From a meso perspective, enhancing empowerment includes the level of enhancing group empowerment through changes in interpersonal relationships through interactions with others as well as the level of enhancing individuals’ empowerment [28]. Lastly, from a macro perspective, enhancing empowerment involves not only the dimension of increasing individuals’ empowerment and group empowerment, but also the level of building organizational empowerment through changes in social systems and structures [28]. In other words, the concept of family empowerment suggests that individuals and families act as the agents of changes through their interactions with each other, and that when there is a problem with some social phenomenon, individuals and families change it to form desirable conditions. Meanwhile, according to a systematic literature review on family empowerment for children’s growth and development [29], children’s growth and development are affected by environmental factors including the family environment and the local community, and in particular, family empowerment not only influences children’s growth and development, but also promotes positive outcomes in children’s health, such as nutritional intake and body weight [29]. In this context, it is indisputably clear that family empowerment promotes the positive health of children [29], and in particular, parents’ ability to cooperate and communicate with experts in the community and their policy-related advocacy activities to improve services for children [16,18] are important in enhancing the positive health of children.

In addition, family empowerment has been reported to be one of the indicators for evaluation of family nursing, which involves not only improving the quantity and quality of services for families raising children with problems but also providing comprehensive support for them from a holistic perspective so that such families will have the ability to cooperate with others while raising children [17]. This family empowerment has been reported to be related to the educational level of the primary caregivers of children, perception of community support resources, and family bond [17]. In addition, it has been reported that family strength is related to the empowerment of adolescents, and a higher level of family strength is associated with a higher level of empowerment [30]. These findings suggest that family empowerment should be considered when providing family nursing to improve children’s health empowerment.

Based on the results of this study, the following suggestions are presented regarding the application of study findings to community nursing. First, this study was conducted with fifth- and sixth-grade elementary school students attending an elementary school in Gangwon Province, so it is difficult to generalize the results to all children. In addition, during the health survey of this study, there was difficulty in recruiting children and their parents in child-parent pairs due to the COVID-19 pandemic situation. Thus, although the sample size requirement for securing statistical power was met at the time of the final data analysis, there were some difficulties in meeting the minimum sample size. Therefore, there is a need to conduct replication studies by expanding the research subjects and reflecting various community environments and children’s developmental characteristics of children. In particular, secondly, since this study was focused on the exploration of intrapersonal and interpersonal factors affecting children’s health empowerment, the present research has limitations in terms of the interpretation of the interrelationships between the various factors surrounding children. Therefore, further theory-based research is needed to identify multi-level factors based on theories. Third, since this study was conducted with children and their parents in the social disaster situation of the COVID-19 pandemic, there are limitations in applying the study findings to children and their parents in various health-vulnerable environments. Therefore, it is suggested that replication studies should be conducted with children in various health-vulnerable environments.

Conclusions

This study aimed to identify intrapersonal and interpersonal factors associated with children’s health empowerment among children and their parents during the COVID-19 pandemic in consideration of the fact that children were in a health-vulnerable environment due to the social disaster situation of the COVID-19 pandemic. The results of this study revealed that children’s intrapersonal factor (self-esteem) and interpersonal factors (social support, family empowerment) were significantly associated with children’s health empowerment. In particular, although self-esteem was found to be an important factor for improving health empowerment in children’s ordinary daily life, social support and family empowerment were identified as key factors for improving health empowerment in children in a health-vulnerable environment. Based on the study findings described above, it is considered a significant outcome of this research that this study presented basic data for the development of intervention programs utilizing health empowerment strategies to promote the health of children in health-vulnerable environments.

References

• 1. Viner RM, Ross D, Hardy R, Kuh D, Power C, Johnson A, et al. Life course epidemiology: Recognising the importance of adolescence. Journal of Epidemiology and Community Health. 2015;69(8):719–720. https://doi.org/10.1136/jech-2014-205300ArticlePubMedPMC
• 2. Kumanyika SK, Obarzanek E, Stettler N, Bell R, Field AE, Fortmann SP, et al. Population-based prevention of obesity: The need for comprehensive promotion of healthful eating, physical activity, and energy balance: A scientific statement from American heart association council on epidemiology and prevention, interdisciplinary committee for prevention (formerly the expert panel on population and prevention science). Circulation. 2008;118(4):428–464. https://doi.org/10.1161/circulationaha.108.189702ArticlePubMed
• 3. Kang HM, Jeong DC, Suh BK, Ahn MB. The impact of the coronavirus disease-2019 pandemic on childhood obesity and vitamin D status. Journal of Korean Medical Science. 2021;36(3):e21. https://doi.org/10.3346/jkms.2021.36.e21ArticlePubMedPMC
• 4. Pietrobelli A, Pecoraro L, Ferruzzi A, Heo M, Faith M, Zoller T, et al. Effects of COVID-19 lockdown on lifestyle behaviors in children with obesity living in Verona, Italy: A longitudinal study. Obesity. 2020;28(8):1382–1385. https://doi.org/10.1002/oby.22861ArticlePubMedPMC
• 5. Beck AL, Huang JC, Lendzion L, Fernandez A, Martinez S. Impact of the coronavirus disease 2019 pandemic on parents’ perception of health behaviors in children with overweight and obesity. Academic Pediatrics. 2021;21(8):1434–1440. https://doi.org/10.1016/j.acap.2021.05.015ArticlePubMedPMC
• 6. Shearer NBC. Health empowerment theory as a guide for practice. Geriatric Nursing. 2009;30(2 Suppl):4–10. https://doi.org/10.1016/j.gerinursecArticlePubMed
• 7. Alquwez N, Cruz JP, Alshammari F, Alotaibi NSH. Psychometric properties of the health empowerment scale Arabic version for working women in Saudi Arabia. Inquiry : A Journal of Medical Care Organization, Provision and Financing. 2021;58:469580211056040. https://doi.org/10.1177/00469580211056040ArticlePubMedPMC
• 8. Namgoong ES, Shin YH. The factors affecting empowerment of adolescents -Focused on middle school students in urban areas of Jeonbuk province-. Journal of the Korean Society of Child Welfare. 2011;34:29–62.
• 9. Burns T, Gottschalk F. Education in the digital age: Healthy and happy children, educational research and innovation [Internet]. Paris: Organization for Economic Co-operation and Development(OECD). 2020 [cited 2024 Aug 19]. Available from: https://www.oecd-ilibrary.org/content/component/2af6f0b7-en
• 10. Yi SC, Park JH, Jo MA, Choi YS. Effect of empowerment on well-being of children: Focusing on the community center for children. Journal of School Social Work. 2013;(25):83–107.
• 11. Lim YM. Dual mediating effects of peer relationships and self-esteem on the relationships between obesity and interpersonal competence in adolescent girls. Korean Journal of Youth Studies. 2020;27(7):129–157. http://doi.org/10.21509/KJYS.2020.07.27.7.129Article
• 12. Rosenberg M. Society and the Adolescent Self-Image. Princeton NJ: Princeton University Press; 1965. 338 p.Article
• 13. Han MH, Yoo AJ. The relation of stress and perceived social support to problem behavior. Korean Journal of Child Studies. 1996;17(1):173–188.
• 14. Straughan PT, Xu C. How does parents’ social support impact children’s health practice? Examining a mediating role of health knowledge. Global Health Research and Policy. 2023;8(1):8. https://doi.org/10.1186/s41256-023-00291-5ArticlePubMedPMC
• 15. Hong J, Choo J, Kim HJ, Jae SY. Gender-specific correlates of sufficient physical activity among vulnerable children. Japan Journal of Nursing Science. 2020;17(1):e12278. https://doi.org/10.1111/jjns.12278ArticlePubMed
• 16. Koren PE, DeChillo N, Friesen BJ. Measuring empowerment in families whose children have emotional disabilities: A brief questionnaire. Rehabilitation Psychology. 1992;37(4):305–321. https://doi.org/10.1037/h0079106Article
• 17. Wakimizu R, Fujioka H, Nishigaki K, Matsuzawa A. Family empowerment and associated factors in Japanese families raising a child with severe motor and intellectual disabilities. International Journal of Nursing Sciences. 2018;5(4):370–376. https://doi.org/10.1016/j.ijnss.2018.09.006ArticlePubMedPMC
• 18. Jung SY. Family empowerment scale: Factor validation of the original form and development of a short form. The Journal of the Korea Contents Association. 2013;13(7):214–227. http://doi.org/10.5392/JKCA.2013.13.07.214Article
• 19. Jon BJ. Self-esteem: A test of its measurability. Yonsei Journal. 1974;11(1):107–130.
• 20. Lee YJ. The role of social support and self-esteem in the relationship between stress and psychological maladjustment. Journal of Seoul Women’s University Graduate School. 1995;3:195–242.
• 21. Park C, Park YH. Validity and reliability of Korean version of health empowerment scale (K-HES) for older adults. Asian Nursing Research. 2013;7(3):142–148. https://doi.org/10.1016/j.anr.2013.07.004ArticlePubMed
• 22. Verberg F, Helmond P, Otten R, Overbeek G. Mindset and perseverance of adolescents with intellectual disabilities: Associations with empowerment, mental health problems, and self-esteem. Research in Developmental Disabilities. 2019;91:103426. https://doi.org/10.1016/j.ridd.2019.103426ArticlePubMed
• 23. Camerini L, Schulz PJ, Nakamoto K. Differential effects of health knowledge and health empowerment over patients’ self-management and health outcomes: A cross-sectional evaluation. Patient Education and Counseling. 2012;89(2):337–344. https://doi.org/10.1016/j.pec.2012.08.005ArticlePubMed
• 24. Spencer G. Young people and health: Towards a new conceptual framework for understanding empowerment. Health. 2014;18(1):3–22. https://doi.org/10.1177/1363459312473616ArticlePubMed
• 25. Lee KM, Lim SM. The effects of health empowerment and social support on health promotion behavior in older adults: A cross-sectional study. Journal of Korean Gerontological Nursing. 2022;24(4):433–440. http://doi.org/10.17079/jkgn.2022.24.4.433Article
• 26. Shearer NBC. Relationships of contextual and relational factors to health empowerment in women. Research and Theory for Nursing Practice. 2004;18(4):357–370. https://doi.org/10.1891/rtnp.18.4.357.64094ArticlePubMed
• 27. Lee HK. A study on the relationship among social support, empowerment, and psychosocial adjustment of children in community child center [dissertation]. [Seoul]: Sookmyung Women's University; 2007. 110 p.
• 28. Suh MJ, Lee SH, Sohn SH. The contents selection and organization of ‘Understanding of self as an adolescent’ unit to build adolescent empowerment: A comparison of home economics textbooks of Korea and America. Journal of Home Economics Education Association. 2016;28(4):21–43. http://doi.org/10.19031/jkheea.2016.12.28.4.21Article
• 29. Dewi RK, Sumarni S. Parenting style and family empowerment for children's growth and development: A systematic review. Journal of Public Health in Africa. 2023;14(s2):2582. https://doi.org/10.4081/jphia.2023.2582Article
• 30. Kim MJ, Ryu JA. An predictor of family strength and resilience on adolescents' empowerment. Korean Journal of Youth Studies. 2012;19(12):231–255.

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