Journal of Korean Academy of Nursing

Factors Influencing Psychosocial Well-Being in Family Caregivers of People with Amyotrophic Lateral Sclerosis: Hyeon Sik Chu, Young Ran Tak, Seung Hyun Kim; J Korean Acad Nurs 2018;48(4):454-464. Published online January 15, 2018; DOI: https://doi.org/10.4040/jkan.2018.48.4.454

Abstract Purpose

The purpose of this study was to identify factors influencing psychosocial well-being in family caregivers of patients with amyotrophic lateral sclerosis (ALS).

Methods

A descriptive correlational design was used. The transactional model of stress and coping was used to investigate the psychosocial well-being of 137 family caregivers of patients with ALS. Data were collected through self-reported questionnaires from January to November 2016. Data were analyzed using an independent t-test, one-way ANOVA, Pearson's correlation, and hierarchical multiple regression analysis with the SPSS WIN 21.0 program.

Results

The regression model had an adjusted R² of .49, which indicated that meaning-focused coping, social support, ALS patient-family caregiver relationship (especially a spousal relationship), and tracheostomy were significant predictors of caregivers’ psychosocial well-being.

Conclusion

Meaning-focused coping and social support significantly influenced caregivers’ psychosocial well-being. Therefore, interventions to improve caregivers’ psychosocial well-being must focus on increasing meaning-focused coping and social support resources.

Citations

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Educational Intervention for the Management of Nonspecific Lower Back Pain in Nonprofessional Caregivers (TRANSFE Program): A Quasi-Experimental Study
Víctor Ortiz-Mallasén, Eloy Claramonte-Gual, Águeda Cervera-Gasch, Desirée Mena-Tudela, María Jesús Valero-Chillerón, Laura Andreu-Pejó, Irene Llagostera-Reverter, Víctor Manuel González-Chordá
Nursing Reports.2024; 14(3): 1570. CrossRef
Analysing the influencing factors on caregivers’ burden among amyotrophic lateral sclerosis patients in China: a cross-sectional study based on data mining
Ling Lian, Minying Zheng, Ruojie He, Jianing Lin, Weineng Chen, Zhong Pei, Xiaoli Yao
BMJ Open.2022; 12(9): e066402. CrossRef
Evaluación de la efectividad de un programa de intervención en cuidadores no profesionales de personas dependientes en el ámbito de la atención primaria
Víctor Ortiz-Mallasén, Eloy Claramonte-Gual, Águeda Cervera-Gasch, Esther Cabrera-Torres
Atención Primaria.2021; 53(1): 60. CrossRef
Family Caregiver Suffering in Caring for Patients with Amyotrophic Lateral Sclerosis in Korea
Juyeon Oh, Jung-A Kim, Min Sun Chu
International Journal of Environmental Research and Public Health.2021; 18(9): 4937. CrossRef
Psychometric properties of the Korean version of the positive aspects of caregiving scale for family caregivers of people with amyotrophic lateral sclerosis
Hyeon Sik Chu, Young Ran Tak
Palliative and Supportive Care.2020; 18(6): 699. CrossRef
Theme 13 Clinical management and support

Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration.2019; 20(sup1): 327. CrossRef

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A study on the Experience of the Life of Caregivers with Mentally Ill Children: Kyoung Soon Lee; Journal of Nurses Academic Society 1997;27(4):953-960. Published online March 30, 2017; DOI: https://doi.org/10.4040/jnas.1997.27.4.953

Abstract: The purpose of this study was to explore and describe the experience of caregivers with mentally ill children. The sample consists of 4 participants who care for their children with mentally ill. They were asked open-ended questions in order for them to talk about their experiences. With permission of the subjects, the interviews were recorded and transcribed. The methodology utilized was the Colaizzi's phonomenological approach. The interview data was organized by themes into 5 categories : anguish, positive emotion, maturation, acceptance of the disease, and seeking information. These 5 themes were further categorized into 4 main groups : emotional impact, spiritual maturation, adapting to the illness, and seeking support needs. The results of this study have clinical and theoretical implications not only for psychiatric nursing in Korea but also for all clinicians working with the families of the mentally ill.

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Health Promotion Behavior, Self-Efficacy and the Role Stress of Family Caregivers Who Care for Hospitalized Cancer Patients: Hye Sook Jang, Jeong Ran Lee, Moung Sil Lee, Yeon Sun Yun, Young Hee Kim; Journal of Korean Academy of Nursing 2000;30(2):402-412. Published online March 29, 2017; DOI: https://doi.org/10.4040/jkan.2000.30.2.402

Abstract PDF

The purpose of this study is to identify health promotion behavior, self-efficacy and role stress of family caregivers who care for hospitalized cancer patient, The results would be used to provide the necessary basic data for promoting healthy behavior of the family caregivers to the cancer patient. The results were as follow : 1) The level of health promotion behavior was significantly different depending on the existence of care givers religion and type of help from family members. There was a positive relationship between the performance level of health promotion behavior and perceived health status or age. There was a negative correlation between the performance level of health promotion behavior and time cared for. 2) The level of self-efficacy was significantly different depending on gender and if the subject was employed. There was a positive relationship between perceived health status and intimacy with patient. 3) The level of role stress was significantly different in genders and relationships with patients. 4) There was a positive relationship between health promotion behavior and self-efficacy.

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The Effect of Self-efficacy and Depression on Sense of Family Coherence in Cancer Patients Undergoing Chemotherapy and Primary Caregivers in Day Care Wards: Using the Method Actor-partner Interdependence Model
Eun-Hee Do, Eun Joung Choi
Asian Oncology Nursing.2019; 19(4): 214. CrossRef
The Lived Experience of Suffering of Family with Cancer Patients: Parse’s Human Becoming Research Method
Ye-Sook Choi
The Korean Journal of Hospice and Palliative Care.2016; 19(2): 127. CrossRef

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A Model for Quality of Life of Family Caregivers with a Chronically Ill Patient: Eun Sook Park, Sook Ja Lee, Young Joo Park; Journal of Korean Academy of Nursing 1998;28(2):344-357. Published online March 29, 2017; DOI: https://doi.org/10.4040/jkan.1998.28.2.344

Abstract PDF: This study was designed to construct a model that predicts the quality of life of family caregivers with a chronically ill patient. The hypothetical model wad developed based on the findings from past studies on quality of life and on the family with a chronically ill patients. Data were collected by self-reported questionnaires from 200 family caregivers in Seoul and Kyung Gi-Do, from May 1 to July 21, 1997. Data were analyzed using descriptive statistics and correlation analysis. The Linear Structural Relationship(LISREL) modeling process was used to find the best fit model which predicts causal relationships among variables. The results are as follows: 1. The overall fit of the hypothetical model to the data was moderate [X2=31.54(df=23, p=.11), GFI=.96, AGFI=.91, RMR=.04]. 2. Paths of the model were modified by considering both its theoretical implication and the statistical significance of the parameter estimates. Compared to the hypothetical model, the revised model has become parsimonious and had a better fit to the data expect chi-square value(GFI=.95, AGFI=.91, RMR=.04). 3. Some of predictive factors, especially economic status, physical ability to perform daily-life activity, period after disease-onset, social support and fatigue revealed indirect effect on the quality of life of family caregivers with a chronically ill patient. 4. The factors, burden and role satisfaction revealed significant direct effects on the quality of life of family caregivers with a chronically ill patient. 5. All predictive variables of quality of life of family caregivers with a chronically ill patient, especially economic status, physical ability to perform daily-life activity, period after disease-onset, social support, fatigue, burden and role satisfaction explained 38.0% of the total variance in the model. In conclusion, the derived model in this study is considered appropriate in explaining and predicting quality of life of family caregivers with a chronically ill patient. Therefore it can effectively be used as a reference model for further studies and suggests direction in nursing practice.

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The Effects of a Support Group Intervention on the Burden of Primary Family Caregivers of Stroke Patients: Eun Kwang Yoo, Sanghee Jeon, Jeong Eun Yang; Journal of Korean Academy of Nursing 2007;37(5):693-702. Published online March 28, 2017; DOI: https://doi.org/10.4040/jkan.2007.37.5.693

Abstract PDF

PURPOSE: The purpose of this study was to develop and evaluate the effects of a support group intervention on the burden of primary family caregivers of stroke patients. METHOD: A nonequivalent control group pretest-posttest design was used. The subjects were 36 primary family caregivers of stroke patients [experimental(N=18) and control(N=18) groups] in a neurosurgery ward of a university hospital. The experimental group members participated in six sessions of a support group intervention for two weeks and the degree of their caregiving burden was evaluated. Data was analyzed by Chi-square tests, t-tests, and paired t-tests using SPSS 10.0. RESULT: The experimental group had a significantly lower total burden score (t=2.061, p= .047)and sub-scales of emotional(t=-3.319, p= .002), time-dependent(t=-2.045, p= .049) and developmental(t=-2.656, p= .012) burden scores than the control group, while no significant differences were found in physical, social or financial burden scores between the two groups. Within the experimental group, there was a significant decrease in physical(t=2.507, p= .023), emotional(t=4.754, p= .000), social(t=2.932, p= .009), time- dependent(t=5.015, p= .000) and developmental(t=7.541, p= .000) burden scores but not the financial burden score. CONCLUSION: The results suggest that a support group intervention can be utilized as an effective nursing program to reduce the burden of primary family caregivers of stroke patients.

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Comparison Between Comprehensive Nursing Care Ward and Private Care Ward on Functional Recovery in Stroke Patients
Yang Rok Hur, Woo Sup Song, Kyung Min Kim, Ki Hun Hwang
Brain & Neurorehabilitation.2022;[Epub] CrossRef
The Development and Evaluation of Navigation Program for Caregivers of Stroke Patients Admitted to a Rehabilitation Centers: A Pilot Study
Nam Hee Kim, Young Sook Tae
Korean Journal of Adult Nursing.2018; 30(3): 277. CrossRef
Effects of a Footbath Program on Heart Rate Variability, Blood Pressure, Body Temperature and Fatigue in Stroke Patients
Yu Lim Son, Myung Sook Yoo
Journal of Korean Biological Nursing Science.2016; 18(1): 51. CrossRef
The Effect of Post-Stroke Depression on Rehabilitation Outcome and the Impact of Caregiver Type as a Factor of Post-Stroke Depression
Dong-Heun Ahn, Yung-Jin Lee, Ji-Hun Jeong, Yong-Rok Kim, Jong-Bum Park
Annals of Rehabilitation Medicine.2015; 39(1): 74. CrossRef
Effects of a Telephone-based Support Group Program for Family Caregivers Providing Long-term Care for Elders
Eun-Young Kim, Jeong Ok Kwon
Journal of Korean Gerontological Nursing.2014; 16(1): 38. CrossRef

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A Study on the Related Factors of the Wellbeing of Family Caregivers in Elderly with Stroke: Yeon Hwan Park, Su Jeong Yu, Shin Mi Kim, Yun Jung Lee; Journal of Korean Academy of Nursing 2006;36(2):373-380. Published online March 28, 2017; DOI: https://doi.org/10.4040/jkan.2006.36.2.373

Abstract PDF: Purpose
The purpose of this study was to identify the factors related to the wellbeing of the family caregivers of the elderly with a stroke.
Methods
The subjects of this study were 199 elderly treated in four oriental hospitals in Korea, and their primary family caregivers. The data was collected by interviewsand a self reported questionnaire, during the period from October, 2003 to April, 2004.
Results
The results of this study were as follows. The mean score of wellbeing of family caregivers was 60.6412.63. The factors related to wellbeing of family caregivers were sex, age, education, depression, illness severity, ADL, paralysis, and speech disability in elderly characteristics. Among family caregivers characteristics, education, relation, and burden were significantly related. In situational variables, family income and the previous relationship between the elderly and family caregivers were related to wellbeing. Stepwise multiple regression analysis revealed that the most powerful predictor of wellbeing was the burden of family caregivers. A combination of the depression of elderly and age of family caregivers accounted for 50.3% of the variance of wellbeing.
Conclusions
On developing the nursing intervention for improving wellbeing of family caregivers, many factors should be considered, especially caregiver burden, and elderly depression.

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The Effects of the Day Care Service Program for the Elderly and Family with the Stroke: Compared with the Elderly and Family in Home: Yeon Hwan Park; Journal of Korean Academy of Nursing 2003;33(7):990-998. Published online March 28, 2017; DOI: https://doi.org/10.4040/jkan.2003.33.7.990

Abstract PDF

Purpose

The purpose of this study was to identify the effects of the day care service for the elderly and family with the stroke.

Method

Data were collected from September 2002 to March 2003 by self report questionnaires and interview. 50 elderlies and families(Gr I) who used day care center were compared with 51 elderlies and families (Gr II) who didn't used. The data were analyzed using independent sample t test and chi square test.

Result

The general characteristics, stressors, and situational variables related to outcome variables were homogeneous between two groups. The caregiver burden(t=-2.287, p=.024) score in the Gr I was significantly lower than in the Gr II. However there was no evidence of an effect day care center attendance on the depression of the elderly, the relationship between elderly and caregiver, and the family functioning.

Conclusion

Findings indicate that day care service was effective in reducing the caregiver burden of the elderly, however more day care service programs(elderly health management, rehabilitation...)will be added.

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The Long-term Care Utilization of the Elderly with Dementia, Stroke, and Multimorbidity in Korea
Boyoung Jeon, Soonman Kwon, Hongsoo Kim
Health Policy and Management.2013; 23(1): 90. CrossRef
Factors Influencing the Quality of Life of Caregiver using Day Care Service
Hyun Jeong No, Yeon Hee Choi
Journal of East-West Nursing Research.2013; 19(1): 1. CrossRef

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Effects of Home Care Services Use by Older Adults on Family Caregiver Distress: Jiyeon Kim, Hongsoo Kim; J Korean Acad Nurs 2016;46(6):836-847. Published online December 30, 2016; DOI: https://doi.org/10.4040/jkan.2016.46.6.836

Abstract PDF

Purpose

The purpose of this study was to examine the association between utilization of home care services under the national long-term care insurance system and family caregiver distress.

Methods

A secondary data analysis was conducted in this study using data collected in 2011 and 2012 from the Korean version of International Resident Assessment Instrument (interRAI) Home Care assessment system. The study sample included 228 clients receiving community based home care and their family caregivers in Korea. Descriptive statistics, χ² test, t-test, and Heckman selection model analysis were conducted using SAS 9.3.

Results

Presence of family caregiver distress was significantly associated with days of nurse visits (β=-.89, p=<.001) and home helper visits (β=-.53, p=.014). Level of caregiver distress was also significantly associated with days of nurse visits (β=-.66, p=.028). Other factors which were significantly associated with caregiver distress were depression, cognitive function, inadequate pain control, social support for older adult, and caregiver relationship to the older adult.

Conclusion

The results of this study show that visiting nurse service and appropriate support programs for Older Adults and family caregivers experiencing caregiver distress should be developed and provided to families based on the health care needs of older adults and their family caregivers for effective and sustainable home care.

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Minah Lee
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Effect of perceived chronic illness management support, health literacy, and social support on the care burden of families caring for older people with multiple chronic conditions at home: A cross-sectional study
Eun Sil Lee, Mi Young Kim
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Hye-Jin Kim, Jae-Young Lim, Soong-Nang Jang
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Use of Home Care Services Reduces Care-Related Strain in Long-Distance Caregivers
Francesca B Falzarano, Verena Cimarolli, Kathrin Boerner, Karen L Siedlecki, Amy Horowitz, Suzanne Meeks
The Gerontologist.2022; 62(2): 252. CrossRef
Comparing the Needs of Family Caregivers and Program Providers in Long-Term Care in Terms of Family Support Program
Myonghwa Park, Younghye Go, Miri Jeong, Eun-Jeong Han
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Development and Application of Cost Management Program for Visiting Nursing Centers Using Time-Driven Activity-Based Costing
Juhang Kim, Ji Young Lim
Journal of Korean Academy of Nursing.2019; 49(5): 586. CrossRef

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Structural Equation Model for Caregiving Experience of Families Providing Care for Family Members with Mental Disorders: In Ohg Oh, Sunah Kim; J Korean Acad Nurs 2015;45(1):97-106. Published online February 27, 2015; DOI: https://doi.org/10.4040/jkan.2015.45.1.97

Abstract PDF

Purpose

This study was done to develop and test a structural model for caregiving experience including caregiving satisfaction and caregiving strain in families providing care for family members with a mental disorder.

Methods

The Stress-appraisal-coping model was used as the conceptual framework and the structural equation model to confirm the path that explains what and how variables affect caregiving experience in these families. In this hypothesis model, exogenous variables were optimism, severity of illness and uncertainty. The endogenous variables were self efficacy, social support, caregiving satisfaction and caregiving strain. Data were collected using structured questionnaires.

Results

Optimism and caregiving self-efficacy had significant direct and indirect effects on caregiving satisfaction. Optimism, severity of illness and uncertainty had significant direct and indirect effects on caregiving strain. The modified path model explained effects of optimism on caregiving self-efficacy with social support in the path structure as a mediator. Also, there were direct and indirect effects of optimism and uncertainty on caregiving satisfaction with social support and caregiving self-efficacy in the path structure as a mediators.

Conclusion

Results suggest the need to improve caregiving self-efficacy of these families, establish support systems such as a mental health professional support programs for caregiving self-efficacy. Optimism, severity of illness and uncertainty perceived by families need to be considered in the development of support programs in order to increase their effectiveness.

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Experience of Mental Healthcare Services by Family Caregivers of Patients With Mental Disorders
Ja-Yeon Nam, In-Seo Son, Tae-Hoon Kim, Yoon-Young Nam
Journal of Korean Neuropsychiatric Association.2024; 63(1): 38. CrossRef
Influence of Gratitude and Sense of Meaning in Life on Caregiving Self-Efficacy of Family Caregivers of Persons With Mental Illness
Won Hee Jun
Western Journal of Nursing Research.2023; 45(12): 1104. CrossRef
Development of Discharge Nursing Service Model for Heart Failure Patients
Sung Hye Park, Ju Hee Lee, Yeon Soo Jang, Soo Young Han, Young Ah Kim, Eui Geum Oh
Journal of Korean Academy of Nursing Administration.2023; 29(2): 141. CrossRef
Factors Influencing the Quality of Life of Family Caregivers of Stroke Patients: A Cross-Sectional Survey
Ji-Hye Lee, Mi Sook Jung
Journal of Korean Academy of Fundamentals of Nursing.2023; 30(4): 479. CrossRef
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Mijeong Park, Eunyoung E. Suh, Soo-Young Yu
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Suffering Experience of Primary Caregivers of People with Mental Disabilities in Community Dwellings
Eun Joung Choi, Hyun Mee Cho, Eun Ju Cho, Minkyung Lee
Journal of Korean Academy of psychiatric and Mental Health Nursing.2020; 29(3): 218. CrossRef
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Sung Hae Kim, Yoona Choi, Ji-Hye Lee, Da-El Jang, Sanghee Kim
The Open Nursing Journal.2018; 12(1): 26. CrossRef
Effects of Family Burden, Resilience and Spiritual Well-being on the Quality of Life of Primary Caregivers of People with Mental Illness
Hyun Mee Joe, Eun Joung Choi
Journal of Korean Academy of Psychiatric and Mental Health Nursing.2017; 26(3): 226. CrossRef
Experiences of Caring for a Spouse with Schizophrenia
Gong Ju Chai, Eun Sook Nam
Journal of Korean Academy of Psychiatric and Mental Health Nursing.2016; 25(2): 133. CrossRef

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The Experience of Adult Korean Children Caring for Parents Institutionalized with Dementia: Suhye Kwon, Young-Sook Tae; J Korean Acad Nurs 2014;44(1):41-54. Published online February 28, 2014; DOI: https://doi.org/10.4040/jkan.2014.44.1.41

Abstract PDF

Purpose

The purpose of the study was to explore and describe the experience of adult Korean children who are caregivers for parents institutionalized with dementia.

Methods

Participants were fourteen adult children caregivers of elders institutionalized with dementia. Data were collected through in-depth unstructured interviews with individual participants from August to November, 2012. Theoretical sampling was used to the point of theoretical saturation. Data were analyzed using Strauss and Corbin's Grounded Theory Method.

Results

From open coding, 67 concepts, 29 sub-categories, and 14 categories were identified. Analysis revealed that the core category of the experience of adult children caring for their parents institutionalized with dementia was 'enduring the role of a prop' consisting of four phases: initial turmoil, exploration, role adjustment, and acclimation. To manage the role of a prop, participants utilized various action/interactional strategies such as overcoming the unfamiliarity, overseeing the nursing home care, and counterbalancing the caring roles. As a result, participants experienced ambivalence towards the existence of parents with dementia, changes in family relationships, altered viewpoint towards nursing homes, and restructuring of life.

Conclusion

In-depth understanding of the experience will guide nurses to promote effective interventions in order to better support the Korean family caregivers of parents institutionalized with dementia.

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Eun Jeong Kim, Kyung Mi Sung
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Hwawoo Jeon, Yong Suk Choi, Yoonseob Lim
DIGITAL HEALTH.2023;[Epub] CrossRef
Time in the State of Dementia Caregiving in South Korea: When Care Becomes (Non-)Waiting
Jieun Lee
Culture, Medicine, and Psychiatry.2023; 47(4): 898. CrossRef
Depression, anxiety, and sleep quality of caregivers of children with spinal muscular atrophy
Almala Pinar Ergenekon, Zeynep Gümüş, Cansu Yilmaz Yegit, Muruvvet Cenk, Aynur Gulieva, Mine Kalyoncu, Merve Selcuk, Seyda Karabulut, Gulten Ozturk, Ela Erdem Eralp, Olcay Unver, Bulent Karadag, Yasemin Gokdemir
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Eun Kyoung Suh, Hye Ryoung Kim
Journal of Korean Gerontological Nursing.2020; 22(4): 335. CrossRef
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Hye-Young Jang, Eun-Ok Song
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Hye-Young Jang
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Annals of Rehabilitation Medicine.2015; 39(1): 74. CrossRef

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Experiences of Family Caregivers of Patients with Terminal Cancer: Eun Sook Choi, Keum Soon Kim; J Korean Acad Nurs 2012;42(2):280-290. Published online April 30, 2012; DOI: https://doi.org/10.4040/jkan.2012.42.2.280

Abstract PDF

Purpose

This study done to identify the experiences of families caring for patients with terminal cancer. The question was, "What is the caregiving experience of a family who has a member with terminal cancer?"

Methods

Grounded Theory was applied and in-depth interviews were done with 11 family members. Interviews were recorded with the interviewees' consent and were transcribed and analyzed. Participants' relationships to patients were 6 spouses, 4 daughters, and 1 mother. The ages of the participants were between 32 and 62, with an average of 47.5.

Results

The study showed "enduring with bonds" as the main category and the main factor affecting this category was the "patients' diagnosis of terminal cancer." The caregiving experience was divided into four stages: shock, confusion, struggle, and acceptance. Mediating factors were relationship with the patient, intimacy with the patient, social support, communication, and trust. Conclusively, participants underwent internal maturity, and changes occurred in family and social and personal life.

Conclusion

The families took care of the patients with responsibility and love. The study results should help with the understanding of a family with a member with terminal cancer and should be used to develop nursing, mediating, and consulting programs for these caregivers.

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Eunice E. Lee, Shin‐Young Lee
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Jihyeon Lee, Chiyoung Cha
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Ye-Sook Choi
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Youngshin Lee, Youngran Tak
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Evaluation of a Self-efficacy-based Basic Life Support Program for High-risk Patients' Family Caregivers: Kyunghee Kang, Insook Lee; Journal of Korean Academy of Nursing 2005;35(6):1081-1090. Published online October 31, 2005; DOI: https://doi.org/10.4040/jkan.2005.35.6.1081

Abstract PDF

Purpose

The purpose of this study was to evaluate a Self-efficacy-based Basic Life Support (SEBLS) program for high-risk patients' family caregivers on cardiac arrest. The SEBLS program was constructed on the basis of Bandura's self-efficacy resources as well as the International Liaison Committee on Resuscitation's “2000 Guidelines for CPR and ECC”.

Method

The effect of the SEBLS program on emergency response self-efficacy and emergency response behavior such as BLS(Basic Life Support) knowledge and BLS skill performance was measured by a simulated control group pretest-posttest design. Study subjects were38 high-risk patients' family caregivers(20 experimental subjects and 18 control subjects) whose family patients were admitted to a general hospital in Incheon, Korea.

Result

1. Emergency response self-efficacy was significantly higher in the experimental subjects who participated in the SEBLS program than in the control subjects. (t=8.3102, p=0.0001). 2. For emergency response behavior, BLS knowledge (t=5.6941, p=0.0001) and BLS skill performance (t=27.8281, p=0.0001) was significantly higher in experimental subjects than in control subjects.

Conclusion

A SEBLS program can increase emergency response self-efficacy and emergency response behavior, and could be an effective intervention for high-risk patient's family caregivers. Long-term additional studies are needed to determine the lasting effects of the program.

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Kyoung Sun Song, Kyung-Yeon Park
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