Journal of Korean Academy of Nursing

Examination of Predicting Factors for COVID-19 Vaccination Behaviors of University Students Utilizing the Theory of Planned Behavior: Heo, Yeon Jeong , Hyun, Hye-Jin; J Korean Acad Nurs 2024;54(2):178-192. Published online May 31, 2024; DOI: https://doi.org/10.4040/jkan.24020

Abstract PDF: Purpose
This study aimed to examine the predictive factors of COVID-19 vaccination behavior by evaluating the moderating effect of perceived behavioral control on the theory of planned behavior.
Methods
Data were collected from August 6 to August 31, 2022 from 235 college students (aged 20~29 years) across 12 universities using a structured web-based survey. Statistical analyses were conducted using the SPSS and AMOS software.
Results
Attitudes toward COVID-19 vaccination, subjective norms, and intention to be vaccinated significantly influenced COVID-19 vaccination behavior. Attitudes and subjective norms indirectly affected COVID-19 vaccination behavior through intention to vaccinate, whereas intention to vaccinate had a direct effect. The moderating effect of perceived behavioral control on the relationship between subjective norms and intention to vaccinate was significant.
Conclusion
Interventions that foster a positive attitude toward COVID-19 vaccination and bolster subjective norms and perceived behavioral control can boost the intention to be vaccinated and facilitate the uptake of COVID-19 vaccination.

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Development of the Hospital Nurses’ Silence Behavior Scale: Chung, Soojin , Hwang, Jee-In; J Korean Acad Nurs 2024;54(2):279-295. Published online May 31, 2024; DOI: https://doi.org/10.4040/jkan.23138

Abstract PDF: Purpose
This study aimed to develop a scale to measure hospital nurses’ silence behavior and examine its validity and reliability.
Methods
A total of 52 preliminary items on hospital nurses’ silence behavior were selected using a content validity test by seven experts on 53 candidate items derived from a literature review and in-depth interviews with 14 nurses. A total of 405 hospital nurses participated in a psychometric testing. Data analysis comprised item analysis, exploratory and confirmatory factor analyses, and convergent and discriminant validity tests. Pearson’s correlation coefficient was used for assessing concurrent validity, and Cronbach’s alpha was used for the reliability test.
Results
The final scale consisted of nine factors with 31 items, exhibiting acceptable model fit indices, convergent validity, and discriminant validity. The score of the entire scale was positively correlated with the ‘Organizational Silence Scale (OSS)-the issues on which nurses remain silent’ (r = .60, p < .001) and ‘OSS-the reasons why nurses remain silent’ (r = .68, p < .001). Cronbach’s α of the scale was .92, and α of each subscale ranged from .71 to .90.
Conclusion
The Hospital Nurses’ Silence Behavior Scale is a useful tool for assessing multifaceted silence behavior among nurses. It can provide basic data for developing better communication strategies among nurses and other hospital staff.

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Influence of Illness Uncertainty on Health Behavior in Individuals with Coronary Artery Disease: A Path Analysis: Jeong, Hyesun , Lee, Yesul , Park, Jin Sup , Lee, Yoonju; J Korean Acad Nurs 2024;54(2):162-177. Published online May 31, 2024; DOI: https://doi.org/10.4040/jkan.23136

Abstract PDF: Purpose
This study aimed to investigate the influence of uncertainty-related factors on the health behavior of individuals with coronary artery disease (CAD) based on Mishel’s uncertainty in illness theory (UIT).
Methods
We conducted a cross-sectional study and path analysis to investigate uncertainty and factors related to health behavior. The study participants were 228 CAD patients who visited the outpatient cardiology department between September 2020 and June 2021. We used SPSS 25.0 and AMOS 25.0 software to analyze the data.
Results
The final model demonstrated a good fit with the data. Eleven of the twelve paths were significant. Uncertainty positively affected danger and negatively affected self-efficacy and opportunity. Danger had a positive effect on perceived risk. Opportunity positively affected social support, self-efficacy, perceived benefit and intention, whereas it negatively affected perceived risk. Social support, self-efficacy, perceived benefit and intention had a positive effect on health behavior. We found that perceived benefit and intention had the most significant direct effects, whereas self-efficacy indirectly affected the relationship between uncertainty and health behavior.
Conclusion
The path model is suitable for predicting the health behavior of CAD patients who experience uncertainty. When patients experience uncertainty, interventions to increase their self-efficacy are required first. Additionally, we need to develop programs that quickly shift to appraisal uncertainty as an opportunity, increase perceived benefits of health behavior, and improve intentions.

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Effects of a Health Partnership Program Using Mobile Health Application for Male Workers with Cardiovascular Risk Factors in Small and Medium Enterprises: A Randomized Controlled Trial: Kim, Eun Jin , Hwang, Seon Young; J Korean Acad Nurs 2024;54(1):44-58. Published online February 29, 2024; DOI: https://doi.org/10.4040/jkan.23090

Abstract PDF: Purpose
This study aimed to apply a health partnership program using commercially available mobile health apps to improve cardiovascular risk factors in male employees and verify its effectiveness.
Methods
Using a randomized control group pretest-posttest design, male employees with cardiovascular risk factors from five small and medium-sized workplaces were randomly assigned to an experimental group (n = 32) and a control group (n = 31). The experimental group was encouraged to use three mobile health apps for 12 weeks to acquire the necessary cardiovascular disease-related information and practice strengthening training, walking, and diet management appropriate to their level. They also received feedback on their weekly activities and motivational text messages from health partners. Hypotheses were tested using the SPSS WIN 22.0.
Results
The experimental group showed a significant difference compared to the control group in terms of their perception of mobile health app (p < .05), self-efficacy for exercise and diet, self-management partnership, and cardiovascular disease prevention health behavior (p < .001). In particular, there were significant decreases in the body mass index, ratio, serum fasting blood sugar, total cholesterol, and triglyceride in the experimental group (p < .001); however, there was no significant difference in high-density lipoprotein-cholesterol.
Conclusion
Intervention using mobile apps based on partnership with health managers is effective in improving the objective cardiovascular risk index in male employees; therefore, such intervention should be continuously used as a useful lifestyle modification strategy in the workplace.

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Development of Nursing Clinical Judgment Scale: Kwon, Shi Nae , Park, Hyojung; J Korean Acad Nurs 2023;53(6):652-665. Published online December 31, 2023; DOI: https://doi.org/10.4040/jkan.23042

Abstract PDF: Purpose
This study aimed to develop a nursing clinical judgment scale (NCJS) and verify its validity and reliability in assessing the clinical judgment of nurses.
Methods
A preliminary instrument of the NCJS comprising 38 items was first developed from attributes and indicators derived from a literature review and an in-depth/focus interview with 12 clinical nurses. The preliminary tool was finalized after 7 experts conducted a content validity test based on a data from a preliminary survey of 30 hospital nurses in Korea. Data were collected from 443 ward, intensive care unit, emergency room nurses who voluntarily participated in the survey through offline and online for the verification of the construct validity and reliability of the scale.
Results
The final scale comprised 23 items scored on a 5-point Likert scale. Six factors – integrated data analysis, evaluation and reflection on interventions, evidence on interventions, collaboration among health professionals, patient-centered nursing, and collaboration among nurse colleagues – accounted for 64.9% of the total variance. Confirmatory factor analysis supported the fit of the measurement model, comprising six factors (root mean square error of approximation = .07, standardized root mean square residual = .04, comparative fit index = .90). Cronbach’s α for all the items was .92.
Conclusion
The NCJS is a valid and reliable tool that fully reflects the characteristics of clinical practice, and it can be used effectively to evaluate the clinical judgment of Korean nurses. Future research should reflect the variables influencing clinical judgment and develop an action plan to improve it.

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Adolescents’ Experiences of Non-Suicidal Self-Injury: An Interpretative Phenomenological Analysis Study: Ko, Jung A , Kim, Ji Young; J Korean Acad Nurs 2023;53(5):538-555. Published online October 31, 2023; DOI: https://doi.org/10.4040/jkan.23075

Abstract PDF: Purpose
This qualitative study used interpretative phenomenological analysis and photovoice methods to explore the meaning of non-suicidal self-injury experienced by adolescents.
Methods
Participants were adolescents enrolled in middle and high schools in Gyeonggi-do and Jeollabuk-do who were selected through snowball sampling. Six participants had repeatedly engaged in self-injurious behavior for over a year. Data were collected through in-depth interviews and the photovoice method between November 2020 and July 2021. The collected data were analyzed using six steps of interpretative phenomenological analysis.
Results
The results yielded 5 main themes and 18 subthemes. The main themes were ‘a silent cry to an indifferent world’, ‘a heartache that one endures with scars’, ‘an inescapable cycle’, ‘filling the space in one’s heart’, and ‘healing the wounds’. The study findings revealed that the self-injurious behavior of adolescents began as a consequence of feeling lost and struggling with conflicts at home and school, which helped them relieve tension and pain. Nonetheless, inflicting self-injury only left signs of regret and remorse, which became a trace that the participants wanted to hide. However, the wounds healed after receiving attention and support from others. They were determined to stop engaging in repeated self-injurious behaviors and made efforts to do so.
Conclusion
This study can be used as a basis for the development of educational programs to prevent non-suicidal self-injury in adolescents. Additionally, it can inform nursing interventions that focus on building support systems to help adolescents who attempt self-injury.

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Exploring Spatial Variations and Factors associated with Walking Practice in Korea: An Empirical Study based on Geographically Weighted Regression: Kim, Eunjoo , Lee, Yeongseo , Yoon, Ju Young; J Korean Acad Nurs 2023;53(4):426-438. Published online August 31, 2023; DOI: https://doi.org/10.4040/jkan.23045

Abstract PDF: Purpose
Walking practice is a representative indicator of the level of physical activity of local residents. Although the world health organization addressed reduction in prevalence of insufficient physical activity as a global target, the rate of walking practice in Korea has not improved and there are large regional disparities. Therefore, this study aimed to explore the spatial variations of walking practice and its associated factors in Korea.
Methods
A secondary analysis was conducted using Community Health Outcome and Health Determinants Database 1.3 from Korea Centers for Disease Control and Prevention. A total of 229 districts was included in the analysis. We compared the ordinary least squares (OLS) and the geographically weighted regression (GWR) to explore the associated factors of walking practice. MGWR 2.2.1 software was used to explore the spatial distribution of walking practice and modeling the GWR.
Results
Walking practice had spatial variations across the country. The results showed that the GWR model had better accommodation of spatial autocorrelation than the OLS model. The GWR results indicated that different predictors of walking practice across regions of Korea.
Conclusion
The findings of this study may provide insight to nursing researchers, health professionals, and policy makers in planning health programs to promote walking practices in their respective communities.

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Factors Affecting Radiation Protective Behaviors in Perioperative Nurses Applying the Theory of Planned Behavior: Path Analysis: Jang, Se Young , Kim, Hee Sun , Jeong, Seok Hee , Kim, Young Man; J Korean Acad Nurs 2023;53(2):222-235. Published online April 30, 2023; DOI: https://doi.org/10.4040/jkan.22099

Abstract PDF: Purpose
The aim of this study was to identify the factors explaining protective behaviors against radiation exposure in perioperative nurses based on the theory of planned behavior.
Methods
This was a cross-sectional study. A total of 229 perioperative nurses participated between October 3 and October 20, 2021. Data were analyzed using SPSS/WIN 23.0 and AMOS 23.0 software. The three exogenous variables (attitude toward radiation protective behaviors, subjective norm, and perceived behavioral control) and two endogenous variables (radiation protective intention and radiation protective behaviors) were surveyed.
Results
The hypothetical model fit the data (χ2/df = 1.18, SRMR = .02, TLI = .98, CFI = .99, RMSEA = .03). Radiation protective intention (β = .24, p = .001) and attitude toward radiation protective behaviors (β = .32, p = .002) had direct effects on radiation protective behaviors. Subjective norm (β = .43, p = .002) and perceived behavior control (β = .24, p = .003) had direct effects on radiation protective intention, which explained 38.0% of the variance. Subjective norm (β = .10, p = .001) and perceived behavior control (β = .06, p = .002) had indirect effects via radiation protective intention on radiation protective behaviors. Attitude toward radiation protective behaviors, subjective norm, and perceived behavioral control were the significant factors explaining 49.0% of the variance in radiation protective behaviors.
Conclusion
This study shows that the theory of planned behavior can be used to effectively predict radiation protective behaviors in perioperative nurses. Radiation safety guidelines or education programs to enhance perioperative nurses’ protective behaviors should focus on radiation protective intention, attitude toward radiation protective behaviors, subjective norm, and perceived behavioral control.

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1 Web of Science

Moderating the Effects of Health Behaviors on Sexual Intercourse among Adolescents: A CrossSectional Study Using the 2020 Adolescent Health Behavior Survey: Lee, Eunmi , Yang, Youngran; J Korean Acad Nurs 2022;52(5):499-510. Published online October 31, 2022; DOI: https://doi.org/10.4040/jkan.22080

Abstract PDF: Purpose
This study investigated the association between adolescent health behaviors (drinking, smoking, and drug use) and sexual intercourse, as well as the moderating effects of economic status, cohabitation with parents, and school type, among adolescents in Korea.
Methods
Secondary data from the 16th Adolescent Health Behavior Survey (2020) were used. A total of 395 schools and 54,948 middle and high school students participated in the study. Complex sample frequency analysis, the Rao–Scott test, and complex sample logistic regression analyses were performed.
Results
Sexual intercourse rates for men and women were 5.8% and 3.3%, respectively. Approximately 7.3% of high school students and 1.8% of middle school students reported having had sexual relations. Drinking (odds ratio [OR] = 3.15, 95% confidence interval [CI] = 2.82~3.52), smoking (OR = 6.75, 95% CI = 5.90~7.71), and drug use (OR = 3.03, 95% CI = 2.23~4.11) significantly increased the risk of sexual intercourse. Economic status and school type had moderating effects on the association between drinking and sexual intercourse.
Conclusion
Adolescent drinking, smoking, and drug use are associated with a higher risk of sexual experience. Thus, to reduce this risk, controlling alcohol consumption, smoking, and drug use is necessary. In addition, programs for healthy lifestyles and sexual intercourse should be differentiated according to the school type and the economic conditions of the adolescents’ households.

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The Influence of Parental Self-Esteem on Late School-Aged Children’s Media Device Addiction: The Mediating Effect of Marital Conflict and Children’s Self-Esteem: Heo, Dayeon , Kim, Suk-Sun; J Korean Acad Nurs 2022;52(4):421-434. Published online August 31, 2022; DOI: https://doi.org/10.4040/jkan.22036

Abstract PDF: Purpose
This study aimed to examine the effect of parental self-esteem on late school-aged children’s media device addiction by mediating marital conflict and children’s self-esteem.
Methods
This study used data from the 11th (2018) Panel Study on Korean Children. The participants consisted of 1,082 family triads (fathers, mothers, and children). Data were collected using the Rosenberg Self-Esteem Scale, Marital Conflict Scale, and K-Internet Addiction Scale. The data were analyzed using structural equation modeling with SPSS/WIN 27.0 and Mplus 8.7.
Results
The final model showed a good fit for the data. Children’s media device addiction was directly related to mothers’ self-esteem, mothers’ marital conflict, and children’s self-esteem. Fathers’ self-esteem had a significant indirect effect on children’s media device addiction by mediating both fathers’ and mothers’ marital conflict. In addition, mothers’ self-esteem had a significant indirect effect on children’s media device addiction by mediating mothers’ marital conflict.
Conclusion
The findings indicates that self-esteem and marital conflict for both fathers and mothers have a significant effect on children’s media device addiction. It suggests that more attention might be given to fathers and mothers in developing interventions to prevent children’s media device addiction.

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Development and Evaluation of an Integrated Health Management Program for Psychiatric Patients with Metabolic Syndrome: Kwak, Yun Bock , Kim, Ji Young; J Korean Acad Nurs 2022;52(3):261-277. Published online June 30, 2022; DOI: https://doi.org/10.4040/jkan.21222

Abstract PDF: Purpose
This study developed an integrated health management program for metabolic syndrome in psychiatric patients and examined its effects on self-efficacy, healthy lifestyle, physiological indicators, knowledge of metabolic syndrome, attitudes toward healthy behavior, and social support.
Methods
A non-equivalent control group pretest posttest design was used. The participants were 65 psychiatric patients with metabolic syndrome in psychiatric rehabilitation centers, with 33 in the experimental group and 32 in the control group. The experimental group participants engaged in daily mobile application and walking exercises three times a week for more than 40 minutes over 8 weeks, while those in the control group were provided education booklets. The outcomes were measured using self-report questionnaires, anthropometrics, and blood analyses. Intervention effects were analyzed using the independent t-test, Mann—Whitney U test, ANCOVA, and Ranked ANCOVA.
Results
The experimental group showed a significant increase in self-efficacy (F = 8.85, p = .004, η_p2 = .13) and knowledge of metabolic syndrome (t = 2.60, p = .012, d = 0.60) compared to the control group. Additionally, the experimental group demonstrated a significant decrease in waist circumference (Z = - 2.34, p = .009, d = 0.58) and body mass index (Z = - 1.91, p = .028, d = 0.47) compared to the control group.
Conclusion
The integrated health management program for psychiatric patients with metabolic syndrome is effective in improving self-efficacy and knowledge of metabolic syndrome and decreasing physiological indicators such as waist circumference and body mass index.

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4 Web of Science

Effect of Virtual Reality Program for Alleviating Behavioral and Psychological Symptoms of Dementia Patients: Park, Seon-Min , Choi, Seung-Yi , Kim, Jung-Hee; J Korean Acad Nurs 2022;52(2):121-133. Published online April 30, 2022; DOI: https://doi.org/10.4040/jkan.22008

Abstract PDF: Purpose
This study examined the impact of a virtual reality intervention program based on psychological needs on behavioral and psychological symptoms, apathy, and quality of life (QOL) in patients with dementia or mild cognitive impairment living in nursing facilities.
Methods
This study is nonequivalent control group pretest-posttest design of quasi-experimental study. The study collected data from November 18, 2020 to July 24, 2021 from patients with dementia or mild cognitive impairment (30 in the experimental group and 30 in the control group) at three nursing facilities in G city using self-reporting and caregiver-informant reporting methods. The analysis employed the chi-square test, Fisher’s exact test, paired t-test, independent t-test, Wilcoxon signed rank test, Mann–Whitney U, repeated measures ANOVA, GEE, using SPSS/WIN 27.0.
Results
The severity of behavioral and psychological symptoms (Wald χ2 = 2.68, p = .102) and the care burden of caregivers (Wald χ2 = 1.72, p = .190) were not significant and was no significant time and group interaction effect (Wald χ2 = 0.63, p = .426, Wald χ2 = 0.52, p =. 471). The difference in apathy and QOL score were statistically significant for the group-time interaction (F = 43.65, p < .001; F = 4.35, p= .041).
Conclusion
The virtual reality intervention program of this study shows a positive effect on the apathy reduction and QOL of patients with dementia or mild cognitive impairment residing in nursing facilities.

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3 Web of Science

A Prediction Model of Exercise Level in Patients with Ankylosing Spondylitis: Kim, Moon Ja , Lee, Eun Nam; J Korean Acad Nurs 2022;52(2):157-172. Published online April 30, 2022; DOI: https://doi.org/10.4040/jkan.21238

Abstract PDF: Purpose
This study aimed to construct and test a hypothetical model to explain the predictive factors and causal pathways for exercise levels in patients with ankylosing spondylitis based on the self-determination theory. A conceptual framework was constructed assuming that autonomy support by health care providers would satisfy the three basic psychological needs of patients, which would increase their autonomous motivation for exercise, resulting in its initiation and continuation.
Methods
This cross-sectional study included 221 patients with ankylosing spondylitis who were visiting rheumatology clinics in two tertiary hospitals. Health Care Climate Questionnaire-exercise regularly, Basic Psychological Needs Satisfaction scale, Behavior Regulation in Exercise Questionnaire-2, and exercise level were used to collect data.
Results
The fitness of the hypothetical model met the recommended level (χ2/df ≤ 3, SRMR ≤ .08, RMSEA ≤ .08, GFI ≥ .90, AGFI ≥ .85, NFI ≥ .90, TLI ≥ .90, CFI ≥ .90). The model effect analysis revealed that autonomy support by health care providers had a positive effect on patients' autonomy, competence, relatedness, autonomous motivation, and exercise level. Competence and relatedness had positive effects on autonomous motivation and exercise level, respectively. Autonomous motivation had a positive effect on exercise level.
Conclusion
The predictive factors of exercise level in patients with ankylosing spondylitis were autonomous motivation, health care providers' autonomy support, competence, and relatedness. Considering these factors, we recommend the development of an effective program for improving exercise levels in these patients.

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Validity and Reliability of the Korean Version of the Climate, Health, and Nursing Tool: Jeong, Da Woon , Kim, Gwang Suk , Park, Min Kyung; J Korean Acad Nurs 2022;52(2):173-186. Published online April 30, 2022; DOI: https://doi.org/10.4040/jkan.21211

Abstract PDF: Purpose
Climate change has various negative effects on human health, which has resulted in increased burden on the health care system. Nurses contribute significantly to assessing climate-related health risks and creating a healthy environment. This study aimed to evaluate the reliability and validity of the Korean version of the Climate, Health, and Nursing Tool (K-CHANT) to measure nurses’ awareness, motivation, concern, and behaviors at work and at home regarding climate change and health.
Methods
The 22 items of English CHANT were translated into Korean with forward-backward translation techniques. Internal consistency reliability, test-retest reliability, and construct validity using confirmatory factor analysis were performed using SPSS WIN (25.0) and AMOS (26.0). Survey data were collected from 220 master’s, doctoral, and post-doctoral nursing students.
Results
The K-CHANT consists of 20 items across 5 domains.Two items of the original CHANT were excluded because of low content validity index and standardized regression weights. The internal consistency reliability of the K-CHANT, assessed by Cronbach’s αá was .81, with an intraclass correlation coefficient of .66~.90. The five subscales model was validated by confirmatory factor analysis (SRMR < .08, RMSEA < .08, AGFI > .70, CFI > .70).
Conclusion
The K-CHANT has satisfactory construct validity and reliability to measure nurses’ awareness, motivation, concern, and behaviors at work and at home regarding climate change and health. Future research should examine nurses’ perceptions and behaviors related to the health effects of climate change and develop an action plan to improve it.

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9 Web of Science

Effects of Second Victim Experiences after Patient Safety Incidents on Nursing Practice Changes in Korean Clinical Nurses: The Mediating Effects of Coping Behaviors: Jeong, Seohee , Jeong, Seok Hee; J Korean Acad Nurs 2021;51(4):489-504. Published online August 31, 2021; DOI: https://doi.org/10.4040/jkan.21089

Abstract PDF: Purpose
This study was investigated the mediating effect of coping behaviors in the relationship between the second victim experiences after patient safety incidents and the nursing practice changes.
Methods
A cross-sectional survey was performed using structured questionnaires. Participants were 218 clinical nurses in general tertiary hospitals in South Korea. Data were collected through an online survey and snowball sampling from August 11 to September 6 2020. Data were analyzed using SPSS 23.0 program. A mediation analysis was performed using multiple regression and a simple mediation model applying the PROCESS macro with 95% bias-corrected bootstrap confidence interval.
Results
The mean scores of second victim experiences was 3.41/5. Approach coping (β = .55, p < .001) and the avoidant coping (β = - .23, p = .001) showed mediation effects in the relationship between second victim experiences and constructive change in nursing practice. Avoidant coping (β = .29, p < .001) showed a mediation effect in the relationship between second victim experiences and defensive change in nursing practice.
Conclusion
Coping behaviors has a mediating effect on the relationship between second victim experiences and nursing practice changes. To ensure that nurses do not experience second victim, medical institutions should have a culture of patient safety that employs a systematic approach rather than blame individuals. They also need to develop strategies that enhance approach coping and reducing avoidant coping to induce nurses’ constructive practice changes in clinical nurses in experiencing second victims due to patient safety incidents.

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6 Web of Science

Effects of a Cognitive Behavior Therapy Program for Patients with Fibromyalgia Syndrome: A Randomized Controlled Trial: Kong, Kyoung Ran , Lee, Eun Nam; J Korean Acad Nurs 2021;51(3):347-362. Published online June 30, 2021; DOI: https://doi.org/10.4040/jkan.21025

Abstract PDF: Purpose
This study developed a cognitive behavioral therapy program aimed at altering the physical condition, emotions, and behaviors of fibromyalgia patients, and confirmed the program’s clinical applicability. The program was developed by analyzing previous studies conducting in-depth interviews with fibromyalgia patients, drawing on cognitive behavior theory to establish the program contents, recruiting experts to test its validity, and conducting a preliminary survey.
Methods
To confirm the program’s effect, this study used a randomized controlled trial design. The participants were outpatients diagnosed with fibromyalgia in Dong-A University Hospital, Busan. The 30 patients in the experimental group took part in the program, which comprised 8 sessions (90 to 120 minutes) based on cognitive behavior theory, delivered over 8 weeks. Hypothesis testing was carried out using the repeated measures ANOVA.
Results
The analysis revealed significant differences between the experimental and control groups in positive automatic thoughts, pain, fatigue, depression, and interpersonal relationships. However, there was no significant difference between the groups in terms of sleep disorders and negative automatic thoughts.
Conclusion
This program is a positive effect on physical condition, emotions, and behaviors. It is thus expected to be used to help fibromyalgia patients improve their disease conditions.

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Influences of Autonomic Function, Salivary Cortisol and Physical Activity on Cognitive Functions in Institutionalized Older Adults with Mild Cognitive Impairment: Based on Neurovisceral Integration Model: Suh, Minhee; J Korean Acad Nurs 2021;51(3):294-304. Published online June 30, 2021; DOI: https://doi.org/10.4040/jkan.20282

Abstract PDF: Purpose
This study aimed to investigate objectively measured physical activity (PA) in institutionalized older adults with mild cognitive impairment (MCI) and to elucidate the influence of autonomic nervous function, salivary cortisol, and PA on cognitive functions based on neurovisceral integration model.
Methods
Overall cognitive function was evaluated using the mini-mental state examination (MMSE) and executive function was evaluated using semantic verbal fluency test and clock drawing test. Actigraph for PA, HRV and sAA for autonomous function, and the geriatric depression scale for depression were used. Saliva specimens were collected in the morning for sAA and cortisol.
Results
Ninety-eight older adults from four regional geriatric hospitals participated in the study. They took 4,499 steps per day on average. They spent 753.93 minutes and 23.12 minutes on average in sedentary and moderate-to-vigorous activity, respectively. In the multiple regression analysis, lower salivary cortisol level (β = - .33, p = .041) and greater step counts (β = .37, p = .029) significantly improved MMSE score. Greater step count (β = .27, p = .016) also exerted a significant influence on verbal fluency, and greater sAA (β = .35, p = .026) was significantly associated with a better clock drawing test result.
Conclusion
Salivary cortisol, sAA and physical activity were significantly associated with cognitive functions. To prevent older adults from developing dementia, strategies are needed to increase their overall PA amount by decreasing sedentary time and to decrease salivary cortisol for cognitive function, and to maintain their sympathetic nervous activity for executive function.

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2 Web of Science

Effectiveness of Drinking Reduction Program Focused on Self-Determination Enhancement for College Students with Problematic Drinking: Ma, Jin-Kyoung , Yoo, Moon-Sook; J Korean Acad Nurs 2021;51(3):265-279. Published online June 30, 2021; DOI: https://doi.org/10.4040/jkan.20247

Abstract PDF: Purpose
This study examined the impact of a drinking reduction program on drinking motivation, drinking refusal self-efficacy, and problematic drinking behaviors in college students with problematic drinking habits.
Methods
This study incorporated a non-equivalent control group prepost-test design. Study participants included 58 college students who scored 12 or more in the AUDIT-K test (Alcohol Use Disorders Identification Test-Korean version) (experimental group: 30; control group: 28). The intervention consisted of eight sessions and was conducted once a week. It was designed to promote autonomy, competence, and relatedness-the three elements of basic psychological needs in self-determination theory. The participants were assessed before the intervention, immediately after, and four weeks post intervention. Data were collected from October 12 to December 31, 2017. The analysis employed the chi-square test, Fisher’s exact test, independent t-test, and repeated measures ANOVA using SPSS/WIN 22.0.
Results
The mean age of participants was 21.8 years. There were 30 men (51.7%) and 28 women (48.3%). The differences in drinking motivation, drinking refusal self-efficacy, and problematic drinking behaviors were statistically significant for the group by time interaction (F = 42.56, p < .001; F = 54.96, p < .001; F = 39.90, p < .001, respectively). Conclusion: The findings indicate that the intervention effectively decreases drinking motivation, increases drinking refusal self-efficacy, and decreases problematic drinking behaviors. It can be an efficient strategy for college students with problematic drinking habits to enhance their self-determination ability.

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Information Resource Network Analysis of Factors Influencing Breastfeeding Planning and Duration: Lee, Eunyoung , Cho, Insook , Cho, Seong Jin , Lee, Eunju; J Korean Acad Nurs 2021;51(2):232-244. Published online April 30, 2021; DOI: https://doi.org/10.4040/jkan.20280

Abstract PDF: Purpose
This study aimed to identify the modifiable factors affecting breastfeeding planning and duration among healthy mothers and their use of breastfeeding information resources.
Methods
A cross-sectional survey was conducted in a community setting. Four hundreds participants were recruited at five pediatric clinics and three community health centers located in Paju-si and Goyang-si, Gyeonggi-do, between January and May 2019. Based on the breastfeeding decision-making model, driven by Martens and Young’s work, the survey items consisted of demographics, childbirth and breastfeeding characteristics, and breastfeeding information resources. In the analysis, 389 responses were used in the t-test, ANOVA, and logistic regression. Information resource networks were compared before and after childbirth including a subgroup analysis depending on the breastfeeding duration.
Results
The modifiable factors affecting breastfeeding planning and duration were antenatal and postpartum breastfeeding education and the provision of information in the hospital. The frequency of Internet use and websites visited were notable and potentially modifiable factors, which were also observed in the networks showing different relationship patterns according to participant subgroups and times. The childbirth event increased the centralization of the network in the planned group, while the network of the non-planned group was more diffused after childbirth. The network of the short-term breastfeeding group was characterized by a more centralized pattern and the resources of high betweenness centrality than the long-term group.
Conclusion
Breastfeeding education is a consistent factor that affects breastfeeding behavior. A well-designed internet-based approach would be an effective nursing intervention to meet the needs of women seeking breastfeeding information and changing their behaviors.

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1 Web of Science

Face Mask Usage, Knowledge and Behavior of Face Mask Usage in Older Adults Living Alone in the COVID-19 Era: Han, A-Reum , Park, Yeon-Hwan; J Korean Acad Nurs 2021;51(2):203-216. Published online April 30, 2021; DOI: https://doi.org/10.4040/jkan.20252

Abstract PDF: Purpose
This study analyzed the current status of face mask usage. It also identified factors related to the knowledge and behavior regarding the same among older adults living alone during the COVID-19 pandemic.
Methods
This descriptive study was conducted via a telephone survey involving 283 older adults living alone in S City from March to April 2020. Knowledge and behavior pertaining to face mask usage were measured using Hilda Ho’s Face Mask Use Scale; reliability of the measurement was Kuder-Richardson formula-20 = .62, Cronbach’s α = .92. Data were analyzed using descriptive analysis, independent t-test, Pearson’s correlation coefficient, and multiple linear regression.
Results
Older adults used one mask for 3.55 days on an average. The knowledge level was 9.97 (± 1.84) out of 12 and behavior level was 15.49 (± 1.55) out of 16. Level of education (β = - .31, p < .001), living region (β = .13, p = .017), personal income (β = .12, p = .041) significantly affected the face mask usage-related knowledge, and living region (β = .15, p = .010) significantly affected the face mask usage-related behavior.
Conclusion
Older adults living alone are aware of the effects of using face masks. However, their mask usage is inappropriate, for example, the prolonged use of the same mask. Considering the low level of face mask usage-related knowledge, it is necessary to develop customized education programs and infectious disease prevention strategies for older adults possessing low educational levels living alone in urban-rural complex areas.

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Effects of Program to Promote Obesity Prevention Behaviors on Pre-Schoolers: Focused on Kindergartener in Korea: Hwang, Inju , Bang, Kyung-Sook; J Korean Acad Nurs 2021;51(2):188-202. Published online April 30, 2021; DOI: https://doi.org/10.4040/jkan.20217

Abstract PDF: Purpose
This study aimed to develop a program to promote obesity prevention behaviors for pre-schoolers and to confirm the effectiveness of the program in Korea.
Methods
The program comprised 8 sessions for 4 weeks including combined classroom lectures and physical activities. A non-equivalent control group pre-post test study design was used, and seventy two children, aged 5 to 6 years (experimental group: 33, control group: 39) and their parents participated in the study. To examine the effectiveness of the program, children’s knowledge, intake of sugar-added beverages and fruits & vegetables, time of outdoor play and screen time, and parental self-efficacy were measured. Data were analyzed with SPSS/WIN ver. 22.0 and R 4.0.2, using descriptive analysis, chi-square test, Fisher’s exact test, the independent t-test, and Analysis of covariance (ANCOVA).
Results
The results showed that the experimental group reported significantly increased knowledge (p < .001) and longer time of outdoor play on weekends (p = .033). However, there were no significant differences in the intake of sugar-added beverages and fruits & vegetables, screen time, and parental self-efficacy in the two groups.
Conclusion
This study confirms the applicability of an obesity prevention intervention at kindergartens in Korea. The results can be used as basic data for the study of childhood obesity prevention in Korea.

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Factors Influencing Health Behavior Compliance in Adult Moyamoya Patients: Kim, Bo Eun , Song, Ju-Eun; J Korean Acad Nurs 2021;51(1):80-91. Published online February 28, 2021; DOI: https://doi.org/10.4040/jkan.20222

Abstract PDF: Purpose
The purpose of this study was to identify factors influencing health behavior compliance in adult patients with moyamoya.
Methods
A descriptive correlation study was conducted to investigate the factors influencing health behavior compliance. Participants were 142 adult patients diagnosed with moyamoya disease who were hospitalized or visited an outpatient clinic in the Gyeonggi province. Data were collected from December 16, 2019 to April 14, 2020 using self-report questionnaires and analyzed using the IBM SPSS 26.0 Win software.
Results
The hierarchical multiple regression analysis demonstrated that self-efficacy (β = .60, p < .001), social support (β = .13, p = .032), and age (β = .21, p = .005) affected the health behavior of adults with moyamoya disease. These 3 variables explained 62.0% of the variance of health behavior compliance, and the most influential factor was self-efficacy.
Conclusion
Based on the results of this study, it concludes that nursing interventions should be focused on self-efficacy and social support to improve health behavior compliance with adult patients diagnosed with moyamoya disease. For that, various strategies to enhance self-efficacy and social support should be developed and actively applied in the clinical setting for adult moyamoya patients.

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An Exploratory Study on the Policy for Facilitating of Health Behaviors Related to Particulate Matter: Using Topic and Semantic Network Analysis of Media Text: Byun, Hye Min , Park, You Jin , Yun, Eun Kyoung; J Korean Acad Nurs 2021;51(1):68-79. Published online February 28, 2021; DOI: https://doi.org/10.4040/jkan.20213

Abstract PDF: Purpose
This study aimed to analyze the mass and social media contents and structures related to particulate matter before and after the policy enforcement of the comprehensive countermeasures for particulate matter, derive nursing implications, and provide a basis for designing health policies.
Methods
After crawling online news articles and posts on social networking sites before and after policy enforcement with particulate matter as keywords, we conducted topic and semantic network analysis using TEXTOM, R, and UCINET 6.
Results
In topic analysis, behavior tips was the common main topic in both media before and after the policy enforcement. After the policy enforcement, influence on health disappeared from the main topics due to increased reports about reduction measures and government in mass media, whereas influence on health appeared as the main topic in social media. However semantic network analysis confirmed that social media had much number of nodes and links and lower centrality than mass media, leaving substantial information that was not organically connected and unstructured.
Conclusion
Understanding of particulate matter policy and implications influence health, as well as gaps in the needs and use of health information, should be integrated with leadership and supports in the nurses’ care of vulnerable patients and public health promotion.

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Identifying Trajectories of Behavioral Problems in Children with Allergic Diseases: Secondary Data Analysis of the 5th to 7th Panel Study of Korean Children: Son, Miseon , Ji, Eunsun; J Korean Acad Nurs 2020;50(6):822-836. Published online December 31, 2020; DOI: https://doi.org/10.4040/jkan.20177

Abstract PDF: Purpose
This study aimed to identify latent classes of behavioral problem trajectories in children with allergic diseases and investigate their predictors.
Methods
This study used data from the 5th to 7th Panel Study of Korean Children. The participants included 840 children aged 4~6 years with allergic diseases. Statistical analyses were conducted using latent class growth analysis and multinomial logistic regression.
Results
The trajectories of both internalizing and externalizing behavioral problems in children with allergic diseases were classified into five groups, that is deteriorative, recovering, changing 1 (decreasing-increasing), changing 2 (increasing-decreasing), and low state persistent group. For the internalizing behavioral problems, predictors were temperament, father’s education, family interaction, and disconnection in peer interaction. For the externalizing behavioral problems, predictors child’s gender, temperament, marital conflict, parenting stress, family interaction, and parenting environment.
Conclusion
Deteriorative group has high-risk behavioral problems in children with allergic diseases. We suggest to provide interventions considering latent problem trajectories based on ecological environments for allergic children.

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Development of a Coping Scale for Infertility-Women (CSI-W): Kim, Miok , Ko, Jung-Mi; J Korean Acad Nurs 2020;50(5):671-685. Published online October 31, 2020; DOI: https://doi.org/10.4040/jkan.20038

Abstract PDF: Purpose
The purpose of this study was to develop a Coping Scale for Infertility-Women (CSI-W).
Methods
The initial items were based on an extensive literature review and in-depth interviews with seven infertile women. Forty-three items were derived from a pilot survey. Data were collected from 216 women who had experienced intrauterine insemination (IUI) and in-vitro fertilization (IVF) more than once. The data were analyzed to verify the reliability and validity of the scale.
Results
Seven factors containing 28 items (four factors containing 17 items for active coping and three factors containing 11 items for passive coping) were extracted from the exploratory factor analysis to verify the construct validity. The four factors of active coping were confrontation, self-control, seeking social support (spouse), and seeking social support (colleagues and experts). The three factors of passive coping were distancing, escape, and avoidance. These items were verified through convergent, discriminant, and concurrent validity testing. The internal consistency reliability was acceptable (active coping: Cronbach’s a = .78; passive coping: Cronbach’s a = .81).
Conclusion
As its validity and reliability have been verified through various methods, the CSI-W can contribute to assessing the coping strategies of infertile women.

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Effects of BeHaS Program on Health Behavior, Physiologic Index and Self-Esteem of the Elderly Living Alone with Metabolic Syndrome Based on Community Based Participatory Research: Kim, Jong Im , Kim, Sun Ae , Park, Keumok , Kim, Jiyoung , Lee, Lina , Choi, Si Wan , Ku, Bon Jeong; J Korean Acad Nurs 2020;50(4):571-582. Published online August 31, 2020; DOI: https://doi.org/10.4040/jkan.19261

Abstract PDF: Purpose
This study aimed to determine the effects of a 12-week metabolic syndrome BeHaS (Be Happy and Strong) program in elderly people with metabolic syndrome living alone, based on a community-based participatory research (CBPR).
Methods
A nonequivalent control group pre-posttest design was used, and the participants were 43 elderly people living alone (experimental group 24, control group 19). The experimental group received a one-hour program per week and two individual health consultations during 12 weeks. The control group received two sessions about the metabolic syndrome and two individual health consultations. The effects of health behavior, blood pressure, blood sugar levels, abdominal circumference, triglycerides, and self-esteem were evaluated. The data were analyzed using the independent t-test and Mann-Whitney U test.
Results
The health behavior with respect to the metabolic syndrome in the experimental group increased significantly (t = - 3.19, p = .002). Both diastolic blood pressure and abdominal circumference decreased in the experimental group (t = 2.00, p = .028 and t = 3.91, p < .001). No significant differences were observed between the groups in systolic blood pressure, fasting blood sugar levels, triglycerides, and self-esteem.
Conclusion
The 12-week metabolic syndrome BeHaS program using community resources improves the health of elderly people with metabolic syndrome living alone. Based on these findings, further studies on the effectiveness of the metabolic syndrome BeHaS program and the experiences of those who participated in the CBPR are warranted.

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Factors Influencing Health Behavior Related to Particulate Matter in Older Adults: Park, Min Kyung , Kim, Gwang Suk; J Korean Acad Nurs 2020;50(3):431-443. Published online June 30, 2020; DOI: https://doi.org/10.4040/jkan.19201

Abstract PDF: Purpose
This study aimed to investigate health behavior related to particulate matter (PM) in older adults and examine the factors affectingit.
Methods
A cross-sectional survey design was used. Data were collected from 150 voluntary older adult participants from Songpa-gu inSeoul. The survey questions measured service perception and experience related to PM, risk perception related to PM, attitude toward riskof PM, and health behavior related to PM.
Results
The average score for health behavior related to PM was 79.37, ranging from 51 to 115.There was a significant positive correlation between health behavior related to PM and risk perception related to PM (r=.58, p <.001) as wellas between health behavior related to PM and attitude toward risk of PM (r=.70, p<.001). Multiple linear regression revealed that healthbehavior related to PM was predicted by levels of the existence of disease related to PM (β=.14, p=.019), service experience related to PM(b=.20, p=.021), risk perception related to PM (b=.20, p=.019), and attitude toward risk of PM (b=.44, p<.001). The model including thesevariables accounted for 47.0% of health behavior related to PM.
Conclusion
Korean older adults have the low level of health behaviorrelated to PM. The findings of this study emphasize that risk perception and attitude toward risk of PM should be evaluated, and theunderlying diseases related to PM and their service experience should be considered in developing intervention to improve health behaviorrelated to PM.

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Parental Factors Associated with Smartphone Overuse in Preschoolers: A Systematic Review and Meta-Analysis: Lee, Gumhee , Kim, Sungjae , Yu, Heajin; J Korean Acad Nurs 2020;50(3):349-368. Published online June 30, 2020; DOI: https://doi.org/10.4040/jkan.19186

Abstract PDF: Purpose
This study aimed to identify parental factors associated with smartphone overuse in preschoolers.
Methods
A systematic reviewwas conducted according to PRISMA guidelines. Relevant studies published in peer-reviewed journals from 2009 to June 2019 were identifiedthrough systematic search in 10 electronic databases (PubMed, CINAHL, Cochrane Central, EMBASE, Web of Science, NDSL, KISS, KMbase,KoreaMed, and RISS). Standardized effect sizes were calculated to quantify the associations of parental factors with smartphoneoveruse in preschoolers using meta-analysis.
Results
A total of 30 cross-sectional studies involving 7,943 participants met the inclusioncriteria. The following were negatively correlated with smartphone overuse in preschoolers: mother’s parenting self-efficacy (r =-.35),mother-child attachment (r =-.28), mother’s positive parenting behavior (r =-.28), mother’s positive parenting attitude (r =-.25), and father’sparenting involvement (r =-.15). Further, maternal factors such as smartphone addiction tendency (r =.41), parenting stress (r =.40), negativeparenting behavior (r =.35), negative parenting attitude (r =.14), smartphone usage time (r =.26), employment status (r =.18), and age(r =.12) were positively correlated with smartphone overuse in preschoolers.
Conclusion
Several parental factors influence smartphoneoveruse in preschoolers. These findings emphasize the need to assess and enhance the parental factors identified in this study to preventsmartphone overuse in preschoolers. Accordingly, we recommend the development of preventive interventions to strengthen parent-relatedprotective factors and mitigate risk factors.

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Development and Effects of Smartphone App-Based Walking Exercise Program for Taxi Drivers: Based on Bandura’s Self Efficacy Theory: Choi, Yun Ha , Chae, Min-Jeong; J Korean Acad Nurs 2020;50(2):242-254. Published online April 30, 2020; DOI: https://doi.org/10.4040/jkan.2020.50.2.242

Abstract PDF: Purpose
The purpose of this study was to examine the effects of smart-phone app-based walking exercise programs for taxi drivers on self-efficacy and outcome expectations for exercise, health-related quality of life, walking as an exercise, and physiological indexes.
Methods
A nonequivalent control group with a pre-post-test design was used. The subjects were recruited in G metropolitan city. Subjects were assigned to the experimental (n=31) or control groups (n=30). The smart phone app-based walking exercise program consisted of educations via the app, twelve short message services, and one individual telephone counseling session, which was spread over 12 weeks.
Results
Self-efficacy, outcome expectations, and health-related quality of life had significantly higher pre-post test differences in scores in the experimental group. Additionally, blood pressure, body mass index, and waist circumference had significantly decreased prepost- test difference levels in the experimental group. Walking as an exercise (which consisted of days walked, number of steps walked, and amount of time walked) had significantly increased in the experimental group after 7~12 weeks in the period following the intervention program rather than 1~6 weeks after the program.
Conclusion
The smart phone app-based walking exercise program based on the self-efficacy theory demonstrates a significant effect on improving self-efficacy, outcome expectations physical activities, and health-related quality of life for taxi drivers. Therefore, it is recommended to actively use the program as a tool to promote self-efficacy, physical activities, and health behaviors in taxi drivers.

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Development of a Scale for Alcohol Drinking Prevention Behavior in Early Elementary School Based on Ajzen’s Theory of Planned Behavior: Kim, Younkyoung , Lee, Chong Mi , Kang, Seo Young; J Korean Acad Nurs 2020;50(2):210-227. Published online April 30, 2020; DOI: https://doi.org/10.4040/jkan.2020.50.2.210

Abstract PDF: Purpose
This study aimed to develop a scale to measure variables related to alcohol drinking prevention behavior in early elementary school, based on the theory of planned behavior.
Methods
A scale was developed to measure variables related to alcohol drinking prevention behavior. Initial items for direct evaluation were constructed through a literature review, and those for belief-based indirect measure were generated through interviews with 30 second- and third-grade elementary school students. The collected data from 286 third-grade elementary school students were then subjected to item analysis, exploratory and confirmative factor analysis, criterion-related validity testing, and internal consistency assessment.
Results
The final scale consisted of 35 items. Intention, attitudes, subjective norms, and perceived behavioral control explained 82.7% of the variance; behavioral beliefs, normative beliefs, and control beliefs explained 65.6% of the variance; and evaluation of outcome, motivation to comply, and power of control beliefs explained 72.8% of the variance. The confirmatory factor analysis indicated that the theoretical models had a satisfactory goodness of fit. Criterion-related validity was confirmed between the direct evaluation variables and the indirect measure variables (attitudes r=.64, p <.001; subjective norms r=.39, p <.001; perceived behavioral control r=.62, p <.001). Cronbach’s a was .89 for the direct evaluation variables and .93 for the indirect measure variables.
Conclusion
The scale developed in this study is valid and reliable. It could be used to measure and explain variables related to alcohol drinking prevention behavior in early elementary school.

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