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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Support Needs for Health Promotion of Community-Dwelling People with Disabilities: Perspectives of Operators Managing Disability Supportive Housing: Nam, Hye Jin , Lee, Haesun , Park, Han Nah , Lee, Sujin , Kim, Bohye , Yoon, Ju Young; J Korean Acad Nurs 2024;54(2):211-223. Published online May 31, 2024; DOI: https://doi.org/10.4040/jkan.23143

Abstract PDF: Purpose
Recent studies have focused on policies aimed at supporting the independence of individuals with disabilities in communities. As part of this initiative, supportive housing, integrated care, and residential spaces offer tailored services based on individual needs and autonomy. The attitudes and knowledge of the administrators supporting supportive housing residents regarding health management can influence the well-being of individuals with disabilities. Therefore, this study aimed to explore the challenges faced by supporting housing workers in enhancing the self-management skills of individuals with disabilities.
Methods
In this qualitative study, focus group interviews were conducted in August 2023 with nine administrators working to support housing in Seoul. Qualitative content analysis was used to analyze the interview data.
Results
The needs and challenges in enhancing the self-management skills of individuals with disabilities were as follows: (1) the complexity of health management challenges, (2) bidirectional strategies for strengthening health management capabilities, and (3) support for systematic health management. Additionally, eight subthemes were derived.
Conclusion
By investigating the difficulties experienced and identifying the necessary support requirements for supportive housing workers, this study seeks to uncover insights and identifies areas for improvement and strategies for health management. This study acknowledges the educational and institutional support necessary to improve the health and quality of life of individuals with disabilities residing in supportive housing.

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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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The Effects of Stress Vulnerability and Parental Burnout on Mental Health in Women with Early School-Age Children during the COVID-19 Pandemic: Mediating Effect of Spirituality: Yeom, Mijung , Kwon, Min; J Korean Acad Nurs 2024;54(1):106-117. Published online February 29, 2024; DOI: https://doi.org/10.4040/jkan.23150

Abstract PDF: Purpose
This study examined the effects of stress vulnerability and parental burnout on the mental health of women with early schoolaged children, with a focus on the mediating role of spirituality.
Methods
A survey was conducted among 171 women with early schoolaged children in Gyeonggi Province, Gangwon Province, and Seoul. Data were collected from September to December 2022 using the Korean-Symptom Check List 95, the Parental Burnout Assessment, and the Spirituality Assessment Scale. The data were analyzed using structural equation modeling with SPSS/WIN 22.0 and AMOS 20.0.
Results
The study model demonstrated a good fit, explaining 40.5% of the variance in mental health through stress vulnerability, parental burnout, and spirituality. Spirituality had a significant direct impact on mental health. Additionally, participants’ spirituality directly influenced their mental health, while stress vulnerability and parental burnout indirectly affected their mental health and were mediated through spirituality.
Conclusion
Stress vulnerability and parental burnout are negatively associated with mental health, while spirituality partially mediates these effects. Implementing a program to promote spirituality is suggested to assist mothers in recognizing the value and meaning of parenting activities during nursing interventions for mental health.

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Structural Equation Modeling of Health Promotion Behavior on Migrant Workers: A Multi-Group Analysis Based on the Period of Residence: Jeong, Hanna , Kim, Youngsuk; J Korean Acad Nurs 2024;54(1):73-92. Published online February 29, 2024; DOI: https://doi.org/10.4040/jkan.23101

Abstract PDF: Purpose
This study developed and tested a hypothetical model of health promotion behavior on migrant workers based on the Health Promotion Model and the Health Literacy Skills Framework.
Methods
Data were collected from 298 migrant workers in 9 regions across the country from December 2020 to March 2021. The exogenous variables were e-health literacy, occupational stress, acculturation, and social support. The endogenous variables were perceived benefits of action, self-efficacy, and health promotion behavior. Data were analyzed using SPSS/WIN 25.0, AMOS 20.0, and R-4.0.3 program.
Results
The model fit was appropriate. Social support had the most significant direct impact on the health promotion behavior of migrant workers. Perceived benefits of action and self-efficacy played a mediating role in the relationship among e-health literacy, social support, and health promotion behavior. Based on multi-group analysis, the migrant worker group with less than 5 years of residency had a more statistically significant effect on the relationship between perceived benefits of action and health promotion behavior than those with over 5 years.
Conclusion
Providing social support as a critical administrative strategy to enhance the health promotion behavior of migrant workers is necessary. Furthermore, when developing an intervention program utilizing the internal mechanism between social support and health promotion behavior, a self-efficacy-enhancing strategy is considered to be more effective. Additionally, educating migrant workers with short-term residence of less than 5 years about the benefits of health behaviors is essential.

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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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The Effects of the Infant Health Promotion Program for Mothers with Their Firstborn Infants: Yoon, Chae-Min , You, Mi-Ae; J Korean Acad Nurs 2023;53(6):666-677. Published online December 31, 2023; DOI: https://doi.org/10.4040/jkan.23056

Abstract PDF: Purpose
This study was intended to evaluate the effects of an Infant Health Promotion Program (IHPP) for mothers with their firstborn infants.
Methods
This study employed a non-equivalent control group pretest-posttest design. The participants consisted of 17 mothers with their firstborn infants in the experimental group and 17 in the control group from two women’s hospitals. The experimental group received eight sessions of the program for four weeks. The collected data were analyzed using the chi-square test and repeated-measures ANOVA using an SPSS/WIN ver. 22.0.
Results
The experimental group receiving the program had statistically significant higher levels of infant health promotion knowledge (F = 22.91, p < .001), social support (F = 27.64, p < .001), maternal role confidence (F = 8.25, p = .005) and health promotion behavior for infants (F = 16.85, p < .001) than the control group. The experimental group had a statistically significant lower level of parenting stress than the control group (F = 29.93, p < .001).
Conclusion
The study’s findings indicate that the IHPP is effective in improving health promotion knowledge, social support, and maternal role confidence and decreasing parenting stress among mothers with their firstborn infants. A method of delivering intervention, focused on readily accessible online platforms, coupled with intervention strategies grounded in the theory of self-efficacy, proves to be an advantageous approach for this particular target group.

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A Caring Program for Health Promotion among Women Who Have Experienced Trauma: A QuasiExperimental Pilot Study: Kim, Goun , Kim, Heejung , Park, Jeongok , Kang, Hee Sun , Kim, Soojin , Kim, Sunah; J Korean Acad Nurs 2023;53(5):500-513. Published online October 31, 2023; DOI: https://doi.org/10.4040/jkan.22120

Abstract PDF: Purpose
Women are more vulnerable to post-traumatic stress (PTS) than men, causing several health problems. Nurses should understand and work with women who have experienced trauma and provide interventions to promote their physical, social, and mental health.
Methods
This quasi-experimental pilot study used a one-group pre-test/post-test design. Data were collected from 14 women recruited between December 2019 and May 2020 from a self-sufficiency support center in South Korea for sexually-exploited women who had experienced trauma. The program consisted of six one-on-one intervention sessions per week for six weeks. Each session averaged 60~120 minutes. Participants were assessed at pre-test, post-test, and one-month follow-up. Changes in outcome variables over time were analyzed using the Wilcoxon signed-rank and Friedman tests.
Results
The caring program for health promotion was divided into six sessions: understanding the self, sharing traumatic events and negative emotions, reframing the meaning of traumatic events, identifying thoughts and physical and emotional responses, developing health promotion activities, and maintaining a positive attitude during the process of change. As a result of the caring program, PTS (F = 36.33, p < .001), depression (F = 24.45, p < .001), health-promoting behaviors (F = 7.06, p = .004), and self-esteem (F = 19.74, p < .001) among the participants differed significantly at pre-test, post-test, and follow-up.
Conclusion
This study provides foundational information for the implementation of a theory-driven program by nurses in clinical and community settings to provide comprehensive care for women who have experienced trauma.

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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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Internal Structure of the Health-Related Quality of Life Instrument with 8-Items in a Nationally Representative Population: Lee, Eun-Hyun; J Korean Acad Nurs 2023;53(3):359-369. Published online June 30, 2023; DOI: https://doi.org/10.4040/jkan.23007

Abstract PDF: Purpose
This study evaluated the internal structure (structural validity, internal consistency, and measurement invariance) of the Health-Related Quality of Life Instrument with Eight Items (HINT-8), developed to measure Korean people’s health-related quality of life.
Methods
A secondary analysis was conducted using data from the Korea National Health and Nutrition Examination Survey, involving 6,167 adults aged over 18 years. The structural validity of the HINT-8 was assessed using exploratory graph analysis and confirmatory factor analysis. Internal consistency and measurement invariance were analyzed using McDonald’s omega (ω) and multigroup confirmatory factor analysis, respectively.
Results
The HINT-8 had a single dimension and good internal consistency (ω = .804). The one-dimension HINT-8 ex-hibited matric invariance but not scalar invariance across sociodemographic groups (sex, age, education, and marital status). Further, it exhibited scalar or partial scalar invariance across medical condition groups (hypertension, diabetes, depressive symptoms, and cancer).
Conclusion
The study finds that the HINT-8 demonstrated satisfactory structural validity and internal consistency, indicating its suitability for practice and research. However, the HINT-8 scores cannot be compared across different groups regarding sex, age, education, and marital status, as the interpretation varies within each sociodemographic category. Conversely, interpretation of the HINT-8 is consistent for individuals with and without hypertension, diabetes, depressive symptom, and cancer.

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1 Web of Science

Effects of Health Education Using Virtual Reality for Adolescents: A Systematic Review and MetaAnalysis: Park, SoMi , Chung, ChaeWeon , Kim, Gaeun; J Korean Acad Nurs 2023;53(2):177-190. Published online April 30, 2023; DOI: https://doi.org/10.4040/jkan.23003

Abstract PDF: Purpose
This study aimed to evaluate the effects of health interventions using virtual reality (VR) on improving knowledge, attitudes, and skills; and inducing behavioral change among adolescents.
Methods
This study is a systematic review and meta-analysis following PRISMA guidelines. We searched Cochrane, MEDLINE, Embase, CINAHL, Scopus, Web of Science, and Korean databases between database inception and April 10, 2021. Based on heterogeneity, a random- or fixed-effects model was used, as appropriate, to calculate effect sizes in terms of the standardized mean difference (SMD) and odds ratio (OR). Studies were selected if they verified the effects of health education using VR on adolescents; there was an appropriate control group; and if the effects of education were reported in terms of changes in knowledge, attitudes, skills, or behaviors.
Results
This analysis included six studies (n = 1,086). The intervention groups showed greater responses in knowledge and attitudes (SMD = 0.57, 95% confidence interval (CI) [0.12 to 1.02]), skills related to health behavior (SMD = -0.45, 95% CI [-0.71 to -0.19]), and behavioral change after 12 months (OR = 2.36, 95% CI [1.03 to 5.41]).
Conclusion
The results confirm the effectiveness of health interventions using virtual reality (VR). Although the analysis include a small number of studies, a case can be made for health interventions using VR to be utilized as educational methods and strategies to prevent risky behaviors among adolescents.

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1 Web of Science

Pathway Analysis on the Effects of Nursing Informatics Competency, Nursing Care Left Undone, and Nurse Reported Quality of Care on Nursing Productivity among Clinical Nurses: Yu, Mi , Kim, Se Young , Ryu, Ji Min; J Korean Acad Nurs 2023;53(2):236-248. Published online April 30, 2023; DOI: https://doi.org/10.4040/jkan.22110

Abstract PDF: Purpose
Nursing informatics competency is used to manage and improve the delivery of safe, high-quality, and efficient healthcare services in accordance with best practices and professional and regulatory standards. This study examined the relationship between nursing informatics competency (NIC), nursing care left undone, and nurse reported quality of care (NQoC) and nursing productivity. A path model for their effects on nursing productivity among clinical nurses was also established.
Methods
Data were collected using structured questionnaires answered by 192 nurses working in a tertiary hospital located in J city, Korea, and analyzed using SPSS/WIN 23.0 and AMOS 21.0 program.
Results
The fit indices of the alternative path model satisfied recommended levels χ2 = .11 (p= .741), normed χ2 (χ2/df) = .11, SRMR = .01, RMSEA = .00, GFI = 1.00, NFI = 1.00, AIC = 18.11. Among the variables, NIC (β = .44, p < .001), NQoC (β = .35, p < .001) had a direct effect on nursing productivity. Due to the mediating effect of NQoC on the relationship between NIC and nursing productivity, the effect size was .14 (95% CI .08~.24). Meanwhile, nursing care left undone through NQoC in the relationship between NIC and nursing productivity, has a significant mediation effect (estimate .01, 95% CI .00~.03). The explanatory power of variables was 44.0%.
Conclusion
Education and training for enhancing NIC should be provided to improve nursing productivity, quality of care and to reduce missed nursing care. Furthermore, monitoring the quality of nursing care and using it as a productivity index is essential.

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Determinants of Problem Drinking by Regional Variation among Adult Males in Single-Person Households: Geographically Weighted Regression Model Analysis: Ahn, Junggeun , Choi, Heeseung , Kim, Jiu; J Korean Acad Nurs 2023;53(1):101-114. Published online February 28, 2023; DOI: https://doi.org/10.4040/jkan.22131

Abstract PDF: Purpose
This study aimed to identify regional differences in problem drinking among adult males in single-person households and predict the determinants.
Methods
This study used data from the 2019 Community Health Survey. Geographically weighted regression analysis was performed on 8,625 adult males in single-person households who had been consuming alcohol for the past year. The Si-Gun-Gu was selected as the spatial unit.
Results
The top 10 regions for problem drinking among adult males in single-person households were located in the Jeju-do and Jeollanam-do areas near the southern coast, whereas the bottom 10 regions were located in the Incheon and northern Gyeonggi-do areas. Smoking, economic activity, and educational level were common factors affecting problem drinking among this population. Among the determinants of regional disparities in problem drinking among adult males in single-person households, personal factors included age, smoking, depression level, economic activity, educational level, and leisure activity, while regional factors included population and karaoke venue ratio.
Conclusion
Problem drinking among adult males in single-person households varies by region, and the variables affecting each particular area differ. Therefore, it is necessary to develop interventions tailored to individuals and regions that reflect the characteristics of each region by prioritizing smoking, economic activity, and educational level as the common factors.

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Factors Influencing Preventive Behaviors for COVID-19 in Undergraduate Nursing Students: A Cross-Sectional Descriptive Study: Choi, Jeong Sil , Kim, Kyung Mi; J Korean Acad Nurs 2022;52(6):554-563. Published online December 31, 2022; DOI: https://doi.org/10.4040/jkan.22047

Abstract PDF: Purpose
This study aimed to determine how undergraduate nursing students’ knowledge and health beliefs affected their COVID-19-related infection-prevention behaviors.
Methods
This study used a descriptive survey. A total of 188 undergraduate nursing students from two universities in South Korea participated in this study. The data were collected from June 2020 to August 2020. Factors influencing infection-prevention behaviors were identified using multiple regression analysis.
Results
The participants’ mean knowledge level regarding COVID-19 was 84.05 ± 11.78 out of 100. The average health belief score was 2.80 ± 0.32 points out of 5. COVID-19-related preventive health behaviors were correlated with experiences of searching for COVID-19 information (r = .22, p < .01), perceived severity (r = .24, p < .01), perceived benefits (r = .29, p < .01), cues to action (r = .30, p < .01), knowledge (r = .27, p < .01), and perceived barriers (r = - .19, p < .05). Factors that significantly affected COVID-19-related preventive health behaviors were the participants’ years of study, experiences regarding COVID-19 prevention education, perceived severity, perceived barriers, and cues to action.
Conclusion
COVID-19-related preventive health behaviors are promoted by increasing awareness about the disease and promoting COVID-19 education in nursing curriculums.

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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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A Longitudinal Study of the Reciprocal Relationship between Depression and Income among Korean Older Men and Women: Lee, Jeong , Jeon, Gyeong-Suk; J Korean Acad Nurs 2022;52(4):451-463. Published online August 31, 2022; DOI: https://doi.org/10.4040/jkan.22052

Abstract PDF: Purpose
This study examined the reciprocal relationships between depression and income, and gender differences in these relationships among older adults in South Korea.
Methods
Using 2015 to 2019 of the Korea Welfare Panel Study (KoWePS), we studied 6,070 older adults (2,394 men and 3,676 women) aged 60 years over in 2015. The generalized estimating equation was employed to explore the effect of an individual income on depression and the reverse causal link-that of depression on income.
Results
The study found the reciprocal relationships between income and depression. Income has a significant impact on depression. Higher-income was linked to decreased risks of the Center for Epidemiologic Studies Depression (CES-D) scores among older adults (B = - 0.121, p < 0.001). Estimates of the reverse causal link show that higher CES-D scores were also linked to income reduction among Korean older adults (B = - 0.007, p < 0.001). In addition, we also observed gender differences in the impact of income on depression but not in the reverse causal link. Income has more detrimental to psychological consequence for older men (B = - 0.108, p < 0.001) than older women (B = - 0.057, p < 0.001).
Conclusion
The finding implies that both psychological and social protection policies for the elderly are needed in view of gender perspective.

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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

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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Experience of Peer Support Work among People with Mental Illness in the Community: A Grounded Theory Approach: Hyun, Myung Sun , Kim, Hyunlye , Nam, Kyoung A , Kim, Su Young; J Korean Acad Nurs 2022;52(2):187-201. Published online April 30, 2022; DOI: https://doi.org/10.4040/jkan.21208

Abstract PDF: Purpose
This study discovered a substantive theory of the experience and process of peer support work among people with mental illness.
Methods
The participants were members of community-based mental health facilities and had been working as peer supporters for more than six months. The data were collected through in-depth interviews with twelve participants and analyzed using Corbin and Strauss’s grounded theory approach.
Results
The core category was “becoming a healer going with patients in the journey of recovery,” and the core phenomenon was “identity confusion as a peer supporter.” The causal conditions were “starting peer support work without certainty” and “standing at the boundary between the therapist and patient.” The intervening conditions were “willingness to become a successful peer supporter,” “feeling a sense of homogeneity with the patient,” “accepting the mental illness,” and “support from people around.” The action and interaction strategies were “letting go of greed,” “being open about oneself,” “developing professional skills,” “maintaining wellness in the body and mind,” and “being with the patient.” The consequences were “becoming a useful person,” “changing attitude toward life,” “expansion of the sense of self-existence,” “recovering from mental illness,” and “discovering a role as peer supporter.” Finally, the substantive theory of “becoming a healer going with patients in the journey of recovery” was derived.
Conclusion
This study provides a holistic understanding of peer support work and the implications of interventions to help people with mental illness in a person-centered recovery process.

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2 Web of Science

Interorganizational Networks for Smoking Prevention and Cessation: A Blockmodeling Approach: Park, Eun-Jun , Kim, Hyeongsu , Lee, Kun Sei , Cho, Junghee , Kim, Jin Hyeong , Jeong, Ho Jin , Lee, Ji An; J Korean Acad Nurs 2022;52(2):202-213. Published online April 30, 2022; DOI: https://doi.org/10.4040/jkan.21192

Abstract PDF: Purpose
This study examined characteristics and patterns of interorganizational networks for smoking prevention and cessation in Korea.
Methods
We surveyed two community health centers, ninety-five hospitals or clinics, ninety- two pharmacies, and sixty-five health welfare organizations in two districts of Seoul in 2020. Data on the organizations’ characteristics of smoking cessation and interorganizational activities for information sharing, client referral, and program collaboration were collected and analyzed using network statistics and blockmodeling.
Results
Network size was in the order of information sharing, client referral, and program collaboration networks. Network patterns for interorganizational activities on information sharing, client referral, and program collaboration among four organizations were similar between the two districts. Community health centers provided information and received clients from a majority of the organizations. Their interactions were not unidirectional but mutual with other organizations. Pharmacies were involved in information sharing with health welfare organizations and client referrals to hospitals or clinics. Health welfare organizations were primarily connected with the community health centers for client referrals and program collaboration.
Conclusion
A community health center is the lead agency in interorganizational activities for smoking prevention and cessation. However, hospitals or clinics, pharmacies, and health welfare organizations also participate in interorganizational networks for smoking prevention and cessation with diverse roles. This study would be evidence for developing future interorganizational networks for smoking prevention and cessation.

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Willingness to Use and Appropriate Payable Cost for Visiting Nurse Service for the Elderly in the Community: Seo, Soyoung , Jang, Soong-nang; J Korean Acad Nurs 2022;52(1):105-119. Published online February 28, 2022; DOI: https://doi.org/10.4040/jkan.21193

Abstract PDF: Purpose
This study aimed to measure willingness to use (WTU) and appropriate payable cost of visiting nurse service for the elderly and explore their impact factors.
Methods
The study included 752 participants selected from data that were completed in 2017 for the elderly aged over 60 nationwide. Logit and Tobit regression analysis were performed to confirm the influencing factors.
Results
The study found that 39.1% of the elderly in the community were WTU the visiting nurse service, and they reported that the cost per visit was 12,650 Korean Won. The factors influencing WTU were having less than moderate subjective health status (OR = 1.63, p = .011), being part of a social participating groups (OR = 1.50, p = .046), or participation in senior health promotion programs (SHPPs) (OR = 1.96, p = .003). The cost was also influenced by less than moderate subjective health status (β = 4.37, p = .021), being part of a social participating groups (β = 4.41, p = .028), or participation in SHPPs (β = 4.87, p = .023). Additionally, elderly people living alone who were used as covariates were highly WTU (OR = 2.20, p = .029).
Conclusion
This study provides evidence to predict demand for visiting nurse service and reflects consumer value in setting the service cost. This is the first study to derive cost from consumers' perspective regarding the service for the elderly. As it is the result of an open-ended survey, follow-up studies are needed to estimate more reliable and reasonable results.

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Development and Evaluation of Health Empowerment Scale for North Korean Women Defectors: Lim, Semi , Kang, Younhee; J Korean Acad Nurs 2022;52(1):80-91. Published online February 28, 2022; DOI: https://doi.org/10.4040/jkan.21174

Abstract PDF: Purpose
This study developed an instrument to evaluate the health empowerment of North Korean women refugees and examined its validity and reliability.
Methods
Through literature review and focused group interviews, 66 preliminary items with three constructs, including perceived control, perceived competence, and goal internalization were selected based on Menon’s psychological health empowerment model. A questionnaire survey was conducted with 239 North Korean women refugees in the community from August 31 to September 4, 2020. Content, construct, convergent, and discriminative validity were evaluated. Cronbach’s α was used to evaluate the reli-ability of scale.
Results
The final instrument consisted of 31 items with three factors that were identified through confirmatory factor analysis. The convergent validity showed that the correlation coefficient was .52 (p < .001), which confirmed the validity of the developed measurement tool. Cronbach’s α for all the items was .94, and Cronbach's α for the factors was .76~.91.
Conclusion
This health empowerment scale has been developed to include aspects of health empowerment, provide a conceptual framework, and offer objective indicators to evaluate the effectiveness of a health education program.

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Effectiveness of the Infectious Disease (COVID-19) Simulation Module Program on Nursing Students: Disaster Nursing Scenarios: Hwang, Won Ju , Lee, Jungyeon; J Korean Acad Nurs 2021;51(6):648-660. Published online December 31, 2021; DOI: https://doi.org/10.4040/jkan.21164

Abstract PDF: Purpose
This study aimed to develop an emerging infectious disease (COVID-19) simulation module for nursing students and verify its effectiveness.
Methods
A one-group pretest–posttest quasi-experimental study was conducted with 78 under-graduate nursing students. A simulation module was developed based on the Jeffries simulation model. It consisted of pre-simulation lectures on disaster nursing including infectious disease pandemics, practice, and debriefings with serial tests. The scenarios contained pre-hospital settings, home visits, arrival to the emergency department, and follow-up home visits for rehabilitation.
Results
Disaster preparedness showed a statistically significant improvement, as did competencies in disaster nursing. Confidence in disaster nursing increased, as did willingness to participate in disaster response. However, critical thinking did not show significant differences between time points, and neither did triage scores.
Conclusion
The developed simulation program targeting an infectious disease disaster positively impacts disaster preparedness, disaster nursing competency, and confidence in disaster nursing, among nursing students. Further studies are required to develop a high-fidelity module for nursing students and medical personnel. Based on the current pandemic, we suggest developing more scenarios with virtual reality simulations, as disaster simulation nursing education is required now more than ever.

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8 Web of Science

Validity and Reliability of the Korean Version of Assessment of Health Literacy in Breast and Cervical Cancer Screening: Shin, Hye Sook , Chi, Eunlim , Han, Hae-Ra; J Korean Acad Nurs 2021;51(6):769-781. Published online December 31, 2021; DOI: https://doi.org/10.4040/jkan.21108

Abstract PDF: Purpose
Health literacy is a significant determinant of health and health behaviors such as cancer screening. Despite its significance, there are limited instruments available to assess health literacy targeting Koreans. The purpose of this study was to test the psychometric properties of Korean translation of a validated health literacy instrument in cancer screening—Korean version of assessment of health literacy in breast and cervical cancer screening (K-AHL-C).
Methods
A total of 555 women aged 20~65 participated in the online survey study. Of 52 items addressing five domains included in the original version, we focused on 36 items addressing three key domains closely associated with cancer screening: familiarity, health navigation, and comprehension.
Results
During content validation, two items from the health navigation domain were removed, yielding 34 items. Using Rasch analysis and confirmatory factor analysis, we found the evidence of construct validity of K-AHL-C. The Korean version was also significantly correlated with measures of Functional Health Literacy scale, cancer prevention behaviors, and subjective health status, suggesting convergent validities respectively. Finally, K-AHL-C had acceptable reliability coefficients (α) ranging from 0.71 to 0.92 for each domain and the total scale.
Conclusion
These psychometric properties support the K-AHL-C is a valid and reliable instrument for measuring Koreans’ health literacy in cancer screening. Also it is expected to use the instrument to detect breast and cervical cancer early and improve the screening rate, and ultimately to contribute to the promotion of women's health and women's health nursing practice.

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3 Web of Science

Knowledge Structure of Chronic Obstructive Pulmonary Disease Health Information on HealthRelated Websites and Patients’ Needs in the Literature Using Text Network Analysis: Choi, Ja Yun , Lim, Su Yeon , Yun, So Young; J Korean Acad Nurs 2021;51(6):720-731. Published online December 31, 2021; DOI: https://doi.org/10.4040/jkan.21086

Abstract PDF: Purpose
The purpose of this study was to identify the knowledge structure of health information (HI) for chronic obstructive pulmonary disease (COPD).
Methods
Keywords or meaningful morphemes from HI presented on five health-related websites (HRWs) of one national HI institute and four hospitals, as well as HI needs among patients presented in nine literature, were reviewed, refined, and analyzed using text network analysis and their co-occurrence matrix was generated. Two networks of 61 and 35 keywords, respectively, were analyzed for degree, closeness, and betweenness centrality, as well as betweenness community analysis.
Results
The most common keywords pertaining to HI on HRWs were lung, inhaler, smoking, dyspnea, and infection, focusing COPD treatment. In contrast, HI needs among patients were lung, medication, support, symptom, and smoking cessation, expanding to disease management. Two common sub-topic groups in HI on HRWs were COPD overview and medication administration, whereas three common sub-topic groups in HI needs among patients in the literature were COPD overview, self-management, and emotional management.
Conclusion
The knowledge structure of HI on HRWs is medically oriented, while patients need supportive information. Thus, the support system for self-management and emotional management on HRWs must be informed according to the structure of patients’ needs for HI. Healthcare providers should consider presenting COPD patient-centered information on HRWs.

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3 Web of Science

Job Analysis of Nurse Care Coordinators for Chronic Illness Management in Primary Care Settings: Using Developing a Curriculum Process: Hwang, Ju-Hee , Choi, Yong-Jun , Kim, Mi-Sook , Yi, Seng-Eun , Park, Yong-Soon , Kim, Ji-Hyang , Yoon, Ju-Young , Shin, Dong-Soo; J Korean Acad Nurs 2021;51(6):758-768. Published online December 31, 2021; DOI: https://doi.org/10.4040/jkan.21065

Abstract PDF: Purpose
This study aimed to conduct a job analysis of nurse carecoordinators and to identify the frequency, importance and difficulty of each task of their job.
Methods
A committee for developing a curriculum (DACUM) was formed and members of the committee defined nurse care coordinators’ jobs and enumerated the duties, tasks and task elements by applying the DACUM technique. Then nurse care coordinators enrolled in the pilot project evaluated the frequency, importance and difficulty of each task.
Results
From the job descriptions of nurse care coordinators, we identified 12 duties and 42 tasks. Each task comprised 1~5 task elements. Among tasks, ‘assess the patient’s general health status’ was carried out most frequently. Nurse care coordinators perceived that ‘check vital signs’ and ‘strengthen patient competence to promote health behaviors’ were more important than all other tasks. The most difficult task was ‘develop professionalism as a nurse care coordinator’.
Conclusion
The nurse care coordinators' roles developed in this study will serve as the key guidelines for human resource management of care coordinators. Further, job specifications for nurse care coordinators need to be developed, which is necessary for designing education and training programs. We also need to integrate primary health care as an essential component in nursing education.

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4 Web of Science

Information and General Guidance for Healthcare Professionals in the Fourth Wave of COVID-19: Kim, Jeung-Im , Yu, Mi , Yu, Soyoung , Park, Jin-Hee; J Korean Acad Nurs 2021;51(4):395-407. Published online August 31, 2021; DOI: https://doi.org/10.4040/jkan.21137

Abstract PDF: The COVID-19 curve seesawed and reached the fourth pandemic in July 2021. Since the first three waves, the focus has been on achieving herd immunity through vaccination while a lot of manpower is used for quarantine. However, we have not been able to prevent the fourth wave. The causes are thought to be related to people who doubt the safety of the vaccine and refuse it or violate quarantine guidelines such as social distancing. This study examined guidelines for preventing and controlling COVID-19, the accuracy of vaccination-related information, and described quarantine measures including for those who completed vaccination. In conclusion, prevention and vaccination are the most effective countermeasures against COVID-19. We recommend people vaccination with self-quarantine. Also, it is necessary to make large investments to protect and support nurses in future pandemics.

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6 Web of Science

Development and Evaluation of Prenatal Education for Environmental Health Behavior Using Cartoon Comics: Kim, Hyun Kyoung , Kim, Hee Kyung , Kim, Mirim , Park, Seohwa; J Korean Acad Nurs 2021;51(4):478-488. Published online August 31, 2021; DOI: https://doi.org/10.4040/jkan.21083

Abstract PDF: Purpose
This study aimed to develop and examine the effects of a prenatal program on environmental health behavior using cartoon comics among Korean pregnant women.
Methods
This study used a non-equivalent control group pre-test/post-test design. The program used cartoon comics to explore environmental health behaviors during pregnancy. The program consisted of the following four components: environmental toxicants during pregnancy, avoiding particulate matter during pregnancy, environmental toxicants during baby care, and making a healthy environment for children. In total, 35 pregnant women participated in the study: 18 in the experimental group and 17 in the control group. Data collection and program adaptation were conducted between November 3, 2020 and January 19, 2021. The effect of the prenatal education program was evaluated by t-test and repeated measures ANOVA.
Results
Learning experience (t = - 2.35, p = .025), feasibility (t = - 2.46, p = .019), satisfaction (t = - 2.23, p = .032) were higher in the experimental group than in the control group in the first post-test. Feasibility (t = - 2.40, p = .022) was higher in the experimental group than in the control group in the second post-test. Repeated-measures ANOVA showed significant interactions between time and group in environmental susceptibility (F = 9.31, p < .001), self-efficacy (F = 3.60, p = .033), and community behavior (F = 5.41, p = .007).
Conclusion
This study demonstrates the need for a prenatal education program to promote environmental health perceptions and behavior during pregnancy. We suggest a prenatal class adopting the creative cartoon comics to promote the maternal environmental health behaviors.

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3 Web of Science

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

Sub-Health Status Survey and Influential Factor Analysis in Chinese during Coronavirus Disease 2019 Pandemic: Pan, Yanbin , Yan, Jianlong , Lu, Wanxian , Shan, Miaohang; J Korean Acad Nurs 2021;51(1):5-14. Published online February 28, 2021; DOI: https://doi.org/10.4040/jkan.20241

Abstract PDF: Purpose
This study aimed to investigate sub-health status (SHS) of people living in China during the Coronavirus disease 2019 (COVID-19) COVID-19 pandemic. COVID-19 is a severe acute respiratory syndrome coronavirus (SARS-CoV) infection-induced acute infectious disease, which is featured by universal susceptibility and strong infectivity, and SHS (a status of low quality health) refers to a status of low-quality health. COVID-19 has gradually developed into a global pandemic, making the public in a high stress situation in physiological, psychological and social states in the short term.
Methods
From March 6 to 11, 2020, a large-scale cross-sectional survey was conducted by convenient sampling, and SHS assessment scale was used in the questionnaire. The ordinal logistic regression analysis was used to identify the factors affecting SHS.
Results
In this study, 17,078 questionnaires were delivered with 16,820 effective questionnaires collected, and 10,715 subjects (63.7%) were found with SHS, with moderate SHS primarily. Physiological sub-scale scored the highest, followed by psychological and social sub-scales. Ordinal logistic regression analysis indicated that man, only-child, workers and farmers were risk factors of SHS. Protective factors of SHS included living in rural areas and townships, laid-off retirees and education degree.
Conclusion
It shows many people in China place in a poor health status during COVID-19 pandemic. It is necessary that relevant departments pay more attention to people with poor health such as men, only-child, urban people, workers and farmers, and groups with high education degree during and after pandemic stabilization.

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5 Web of Science

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