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Hwa-Byung(HB) has been categorized as a Korean culture-bound syndrome that is prevalent in married women of low socioeconomic status.

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PURPOSE: This study was designed to construct a structural model for health promoting behavior of patients with chronic disease. The hypothetical model was developed based on the literature review and Pender's health promotion model.
METHOD
Data was collected by questionnaires from 1748 patients with chronic disease in General Hospital from December 1999 to July 2000 in Seoul. The disease of subject were cardiac disease included hypertension peptic ulcer, pulmonary disease included COPD and asthma, DM, and chronic kidney disease. Data analysis was done with SAS 6.12 for descriptive statistics and PC-LISREL 8.13 Program for Covariance structural analysis.
RESULTS
1. The fit of the hypothetical model to the data was moderate, it was modified by excluding 4 path and including free parameters to it. The modified model with path showed a good fitness to the empirical data (x2=591.83, p<.0001, GFI=0.97, AGFI= 0.94, NNFI=0.95, RMSR=0.01, RMSEA=0.05). 2. The perceived benefits, perceived barriers, self-efficacy, self-esteem, and the plan for action were found to have significant direct effect on health promoting behavior of chronic disease. 3. The health concept, health perception, emotional state, social support were found to have indirect effects on health promoting behavior of chronic disease.
CONCLUSION
The derived model in this study is considered appropriate in explaining and predicting health promoting behavior of patients with chronic disease. Therefore, it can effectively be used as a reference model for further studies and suggested implication in nursing practice.

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• Factors affecting the health promoting behaviors of office male workers during the COVID-19 pandemic: Using Pender’s health promotion model
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• The intervention effects of the Clean Diet program on the health promotion attitudes and the physiological indices of an elderly
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• A Predictive Model of Health Promotion Behavior in Obese School-Age Children
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• Testing and Developing the Health Promotion Model in Low-Income, Korean Elderly Women
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• Exercise self-efficacy, exercise benefits and barriers, and commitment to a plan for exercise among Korean women with osteoporosis and osteoarthritis
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• Test of the health promotion model as a causal model of commitment to a plan for exercise among Korean adults with chronic disease
  YunHee Shin, SangKyun Yun, Nola J. Pender, HeeJung Jang
  Research in Nursing & Health.2005; 28(2): 117.     CrossRef

PURPOSE: This study was designed to construct a structural model for health promoting behavior in patients with chronic respiratory disease. A hypothetical model was developed based on the literature review. METHOD: Data was collected by questionnaires from 235 patients with chronic respiratory disease in a General Hospital in Seoul. Data analysis was done using SAS 6.12 for descriptive statistics and the PC-LISREL 8.13 Program for Covariance Structural Analysis. RESULT: The results are as follows : 1. The fit of the hypothetical model to the data was moderate. It was modified by excluding 2 path and including free parameters and 3 path to it. The modified model with path showed a good fitness to the empirical data(X2=80.20, P=0.05, GFI=0.95, AGFI=0.88, NNFI=0.95, NFI=0.96, RMSR=0.01, RMSEA =0.06). 2. The perceived benefits, self-efficacy, and a plan of action were found to have significant direct effects on the health promoting behavior in patients with chronic respiratory disease. 3. The health perception, self-esteem, and activity related to affect were found to have indirect effects on the health promoting behavior in patients with chronic respiratory disease. CONCLUSION: The modified model of this study is considered appropriate in explaining and predicting health promoting behavior in patients with chronic respiratory disease. Therefore, it can effectively be used as a reference model for further studies and suggested direction in nursing practice.

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• A Predictive Model of Health Promotion Behavior in Obese School-Age Children
  Mi Suk Jeon, Hyeon-Ok Kim
  Journal of Korean Academy of Nursing.2010; 40(2): 264.     CrossRef
• Exercise self-efficacy, exercise benefits and barriers, and commitment to a plan for exercise among Korean women with osteoporosis and osteoarthritis
  Yun Hee Shin, Hea Kung Hur, Nola J. Pender, Hee Jung Jang, Moon-Sil Kim
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• Test of the health promotion model as a causal model of commitment to a plan for exercise among Korean adults with chronic disease
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  Research in Nursing & Health.2005; 28(2): 117.     CrossRef
• Using methodological triangulation for cultural verification of commitment to a plan for exercise scale among Korean adults with chronic diseases
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This study was designed to construct a structural model for quality of life of chronic gastric disease. The hypothetical model was developed based on the literature review and Pender's health promotion model. Data were collected by questionnaires from 459 patients with chronic gastric disease in a General Hospital from July 1999 to August 2000 in Seoul. Data analysis was done with SAS 6.12 for descriptive statistics and PC-LISREL 8.13 Program for Covariance structural analysis. The results are as follows : 1. The fit of the hypothetical model to the data was moderate, thus it was modified by excluding 1 path and including free parameters and 2 path to it. The modified model with path showed a good fitness to the empirical data (Chi2=934.87, p<.0001, GFI=0.88, AGFI=0.83, NNFI=0.86, RMSR =0.02, RMSEA=0.07). 2. The perceived barrier, health promoting behavior, self-efficacy, and self-esteem were found to have significant direct effects on the quality of life. 3. The health concept, health perception, emotional state, and social support were found to have indirect effects on quality of life of chronic gastric disease. In conclusion, the derived model in this study is considered appropriate in explaining and predicting quality of life of chronic gastric disease. Therefore it can effectively be used as a reference model for further studies and suggested direction in nursing practice.

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• Exercise self-efficacy, exercise benefits and barriers, and commitment to a plan for exercise among Korean women with osteoporosis and osteoarthritis
  Yun Hee Shin, Hea Kung Hur, Nola J. Pender, Hee Jung Jang, Moon-Sil Kim
  International Journal of Nursing Studies.2006; 43(1): 3.     CrossRef
• Structural Model for Quality of Life of Patients With Chronic Cardiovascular Disease in Korea
  Kuem Sun Han, Sook Ja Lee, Eun Sook Park, Young-Joo Park, Kang Hyun Cheol
  Nursing Research.2005; 54(2): 85???96.     CrossRef
• Test of the health promotion model as a causal model of commitment to a plan for exercise among Korean adults with chronic disease
  YunHee Shin, SangKyun Yun, Nola J. Pender, HeeJung Jang
  Research in Nursing & Health.2005; 28(2): 117.     CrossRef
• Factors Influencing Quality of Life in People with Chronic Illness in Korea
  KuemSun Han, PyoungSook Lee, SookJa Lee, EunSook Park
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• Using methodological triangulation for cultural verification of commitment to a plan for exercise scale among Korean adults with chronic diseases
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The purpose of this study was to study how nurses interpreted the meaning of Hwa-Byung. It was carried through a review of literature, and the result is expected to explore ways that nursing intervention can promote the understanding of Hwa-Byung. The literature review focused on cultural psychology and psychiatrists' views toward Hwa-Byung. After that, it was reconfirmed concept of Hwa-Byung in nursing devived from historical analysis of the examples of Hwa-Byung from a true record of the Cho-Sun Dynasty(CD ROM, 1997). Characteristics of patients with Hwa-Byung include 'Hwa', an aspect of somatization, and self-diagnosing. It also could find that Hwa-Byung is characterized as 'Hwa', 'somatization' and 'self-diagnosis(subjectiveness)' according to a true record of the Cho-Sun Dynasty(CD ROM, 1997). The conceptual definition of 'Hwa', 'somatization' and 'self-diagnosing (subjectiveness)' are as follows. The core concept of Hwa-Byung, 'Hwa,' has the property of 'fire', and equals the feeling of injustice. Hwa-Byung means congestion of 'Hwa'. Therefore Hwa-Byung is the accumulation of being mistreated and mortified. The feeling of mistreatment comes from subjective experiences, which cannot be in harmony with the values, beliefs and rights of the patients. The situations that they have to endure again and again, though they are the sufferers, connote suppressed aggression and powerlessness endured over time. Suppressed aggression subordinated hostility, hatred and revengeful thoughts; powerlessness subordinates frustration, resignation, and fatalism. Somatization is another form of expressing 'Hwa' through physical symptoms. The somatization of clients with Hwa-Byung plays a role in expressing non-verbalized and suppressed emotions within themselves. The clients who experiences Hwa-Byung think that they know the cause of their illness and self-diagnose their problem as Hwa-Byung. Therefore, the feeling of unfairness which is the premise of Hwa-Byung infers 'subjectiveness' In conclusion, nursing's concept of Hwa-Byung is the accumulation of feelings of being mistreated and mortified. Hwa-Byung is the internalized 'Hwa' from enduring again and again. The feeling of being mistreated comes from subjective judgements about unfairness that cannot be harmonized with the clients' values, beliefs and rights. Those who can express their 'Hwa' only through their bodies imply suppressed aggression and powerlessness.

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• Clinical Correlates of Hwa-Byung and a Proposal for a New Anger Disorder
  Sung Kil Min
  Psychiatry Investigation.2008; 5(3): 125.     CrossRef

This study was done to investigate the lives of the daughters- in- law caring for parents with dementia and participate in their lives through having quality time with them. Data were collected by depth interviews and interpreted through the hermeneutic circle as follows. These daughters-in-law have conflict between social custom and subjective self. They had ambivalence toward their demented partents-in- law and were fighting a battle between rationality and emotions in their mind. These daughters-in law and mothers-in- law did not get along and the parents' dementia aggravated the relationships. They were alienated from their family by the parents with dementia. The indifference of their family especially their husbands, made these subjects live in misery. They cared for the demented mother-in-law with hatred. Even though they had this yoke, there daughters- in-law were not able to throw off the shackles of convention.

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