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Research Papers
An Investigation of the Cumulative Effects of Depressive Symptoms on the Cognitive Function in Community-Dwelling Older Adults: Analysis of the Korean Longitudinal Study of Aging
Kim, Eunmi , Oh, Jinkyung , Huh, Iksoo
J Korean Acad Nurs 2023;53(4):453-467.   Published online August 31, 2023
DOI: https://doi.org/10.4040/jkan.23018
AbstractAbstract PDF
Purpose
This study investigated the cumulative effects of depressive symptoms on cognitive function over time in community-dwelling older adults. Methods: Data were investigated from 2,533 community-dwelling older adults who participated in the Korean Longitudinal Study of Aging (KLoSA) from the 5th (2014) to the 8th wave (2020). The association between cumulative depressive symptoms and cognitive function was identified through multiple regression analysis. Results: When the multiple regression analysis was conducted from each wave, the current depressive symptoms scores and cognitive function scores were negatively associated, regardless of the waves (B5th = - 0.26, B6th = - 0.26, B7th = - 0.26, and B8th = - 0.27; all p < .001). Further, when all the previous depressive symptoms scores were added as explanatory variables in the 8th wave, the current one (B8th = - 0.09, p < .001) and the previous ones (B5th = - 0.11, B6th = - 0.09, and B7th = - 0.13; all p < .001) were also negatively associated with the cognitive function score. The delta R2 , which indicates the difference between the model’s R2 with and without the depressive symptoms scores, was greater in the model with all the previous and current depressive symptoms scores (6.4%) than in the model with only the current depressive symptoms score (3.6%). Conclusion: Depressive symptoms in older adults have a long-term impact. This results in an accumulated adverse effect on the cognitive function. Therefore, to prevent cognitive decline in older adults, we suggest detecting their depressive symptoms early and providing continuous intervention to reduce exposure to long-term depressive symptoms.
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Influence of Social Capital on Depression of Older Adults Living in Rural Area: A Cross-Sectional Study Using the 2019 Korea Community Health Survey
Jung, Minho , Kim, Jinhyun
J Korean Acad Nurs 2022;52(2):144-156.   Published online April 30, 2022
DOI: https://doi.org/10.4040/jkan.21239
AbstractAbstract PDF
Purpose
This study aimed to investigate the influence of social capital on the depression of older adults living in rural areas.
Methods
Data sets were obtained from the 2019 Korea Community Health Survey. The participants were 39,390 older adults over 65 years old living in rural areas. Indicators of social capital included trust, reciprocity, network, and social participation. Depression—the dependent variable—was measured using the Patient Health Questionnaire-9 (PHQ-9). Hierarchical ordinal logistic regression was conducted to identify factors associated with depression after adjusting the data numbers to 102,601 by applying the Synthetic Minority Oversampling Technique (SMOTE).
Results
The independent variables—indicators of social capital—exhibited significant association with the depression of older adults. The odds ratios of depression were higher in groups without social capital variables.
Conclusion
To reduce depression, we recommend increasing social capital. Factors identified in this study need to be considered in older adult depression intervention programs and policies.
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Development of a Diabetic Foot Ulceration Prediction Model and Nomogram
Lee, Eun Joo , Jeong, Ihn Sook , Woo, Seung Hun , Jung, Hyuk Jae , Han, Eun Jin , Kang, Chang Wan , Hyun, Sookyung
J Korean Acad Nurs 2021;51(3):280-293.   Published online June 30, 2021
DOI: https://doi.org/10.4040/jkan.20257
AbstractAbstract PDF
Purpose
This study aimed to identify the risk factors for diabetic foot ulceration (DFU) to develop and evaluate the performance of a DFU prediction model and nomogram among people with diabetes mellitus (DM).
Methods
This unmatched case-control study was conducted with 379 adult patients (118 patients with DM and 261 controls) from four general hospitals in South Korea. Data were collected through a structured questionnaire, foot examination, and review of patients’ electronic health records. Multiple logistic regression analysis was performed to build the DFU prediction model and nomogram. Further, their performance was analyzed using the Lemeshow–Hosmer test, concordance statistic (C-statistic), and sensitivity/specificity analyses in training and test samples.
Results
The prediction model was based on risk factors including previous foot ulcer or amputation, peripheral vascular disease, peripheral neuropathy, current smoking, and chronic kidney disease. The calibration of the DFU nomogram was appropriate (χ2 = 5.85, p = .321). The C-statistic of the DFU nomogram was .95 (95% confidence interval .93~.97) for both the training and test samples. For clinical usefulness, the sensitivity and specificity obtained were 88.5% and 85.7%, respectively at 110 points in the training sample. The performance of the nomogram was better in male patients or those having DM for more than 10 years.
Conclusion
The nomogram of the DFU prediction model shows good performance, and is thereby recommended for monitoring the risk of DFU and preventing the occurrence of DFU in people with DM.
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Comparison of the Prediction Model of Adolescents’ Suicide Attempt Using Logistic Regression and Decision Tree: Secondary Data Analysis of the 2019 Youth Health Risk Behavior Web-Based Survey
Lee, Yoonju , Kim, Heejin , Lee, Yesul , Jeong, Hyesun
J Korean Acad Nurs 2021;51(1):40-53.   Published online February 28, 2021
DOI: https://doi.org/10.4040/jkan.20207
AbstractAbstract PDF
Purpose
The purpose of this study was to develop and compare the prediction model for suicide attempts by Korean adolescents using logistic regression and decision tree analysis. Methods: This study utilized secondary data drawn from the 2019 Youth Health Risk Behavior web-based survey. A total of 20 items were selected as the explanatory variables (5 of sociodemographic characteristics, 10 of health-related behaviors, and 5 of psychosocial characteristics). For data analysis, descriptive statistics and logistic regression with complex samples and decision tree analysis were performed using IBM SPSS ver. 25.0 and Stata ver. 16.0.
Results
A total of 1,731 participants (3.0%) out of 57,303 responded that they had attempted suicide. The most significant predictors of suicide attempts as determined using the logistic regression model were experience of sadness and hopelessness, substance abuse, and violent victimization. Girls who have experience of sadness and hopelessness, and experience of substance abuse have been identified as the most vulnerable group in suicide attempts in the decision tree model.
Conclusion
Experiences of sadness and hopelessness, experiences of substance abuse, and experiences of violent victimization are the common major predictors of suicide attempts in both logistic regression and decision tree models, and the predict rates of both models were similar. We suggest to provide programs considering combination of high-risk predictors for adolescents to prevent suicide attempt.
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Original Articles
Scale Development and Model Validation for the Process of Exercise Engagement for People with Prediabetes
Chang, Shu-Chuan , Yeh, Hsiu-Chen , Kuo, Yu-Lun
J Korean Acad Nurs 2020;50(2):298-312.   Published online April 30, 2020
DOI: https://doi.org/10.4040/jkan.2020.50.2.298
AbstractAbstract PDF
Purpose
This study had two objectives: 1) to develop a scale for the process of exercise engagement (SPEE) for prediabetic individuals (PDIs); 2) to validate a structural model for the process of exercise engagement for PDIs.
Methods
A cross-sectional survey with simple random sampling was conducted from September 2013 to December 2015 (in Taiwan). A total of 310 PDIs were enrolled for scale development and model validation via item analysis, factor analyses, and structural equation modeling. The Kuo model was used as the basis for developing the Chinese version of the SPEE for PDIs.
Results
The SPEE contains five subscales with a total of twenty-one items that account for 54.9% to 65.9% of the total variance explained for assessing participants’ process of engagement during exercise. For Kuo model validation, the model measures indicated goodness of fit between the Kuo model and sample data. Analysis further revealed a direct effect between the creating health blueprints (CHB) stage and the spontaneous regular exercise (SRE) stage (b=.60).
Conclusion
The SPEE includes five subscales for assessing the psychological transition and behavioral expression at each stage of the process of exercise engagement for PDIs. The SPEE for people with prediabetes provides deeper insights into the factors of behavioral change stages that are required to initiate long-term health care outcomes and avoid developing diabetes. These insights are significant as they allow for patient- specific mapping and behavior modification to effect exercise.
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Prediction Models of Mild Cognitive Impairment Using the Korea Longitudinal Study of Ageing
Park, Hyojin , Ha, Juyoung
J Korean Acad Nurs 2020;50(2):191-199.   Published online April 30, 2020
DOI: https://doi.org/10.4040/jkan.2020.50.2.191
AbstractAbstract PDF
Purpose
The purpose of this study was to compare sociodemographic characteristics of a normal cognitive group and mild cognitive impairment group, and establish prediction models of Mild Cognitive Impairment (MCI).
Methods
This study was a secondary data analysis research using data from “the 4th Korea Longitudinal Study of Ageing” of the Korea Employment Information Service. A total of 6,405 individuals, including 1,329 individuals with MCI and 5,076 individuals with normal cognitive abilities, were part of the study. Based on the panel survey items, the research used 28 variables. The methods of analysis included a c2-test, logistic regression analysis, decision tree analysis, predicted error rate, and an ROC curve calculated using SPSS 23.0 and SAS 13.2.
Results
In the MCI group, the mean age was 71.4 and 65.8% of the participants was women. There were statistically significant differences in gender, age, and education in both groups. Predictors of MCI determined by using a logistic regression analysis were gender, age, education, instrumental activity of daily living (IADL), perceived health status, participation group, cultural activities, and life satisfaction. Decision tree analysis of predictors of MCI identified education, age, life satisfaction, and IADL as predictors.
Conclusion
The accuracy of logistic regression model for MCI is slightly higher than that of decision tree model. The implementation of the prediction model for MCI established in this study may be utilized to identify middle-aged and elderly people with risks of MCI. Therefore, this study may contribute to the prevention and reduction of dementia.
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The Structural Analysis of Variables Related to Posttraumatic Growth among Psychiatric Nurses
Hyun Ju Yeo, Hyun Suk Park
J Korean Acad Nurs 2020;50(1):26-38.   Published online January 31, 2020
DOI: https://doi.org/10.4040/jkan.2020.50.1.26
AbstractAbstract PDF
Abstract Purpose:

The purpose of this study was to explain a structural model of posttraumatic growth among psychiatric nurses based on existing models and a literature review and verify its effectiveness.

Methods:

Data were collected from psychiatric nurses in one special city, four metropolitan cities, and three regional cities from February to March 2016. Exogenous variables included hardiness and distress perception, while endogenous variables included self-disclosure, social support, deliberate rumination, and posttraumatic growth. Data from 489 psychiatric nurses were analyzed using IBM SPSS Statistics 19.0 and AMOS 20.0.

Results:

The modified model was a good fit for the data. Tests on significance of the pathways of the modified model showed that nine of the 14 paths were supported, and the explanatory power of posttraumatic growth by included variables in the model was 69.2%. For posttraumatic growth among psychiatric nurses, deliberate rumination had a direct effect as the variable that had the largest influence. Indirect effects were found in the order of hardiness, social support, and distress perception. Self-disclosure showed both direct and indirect effects.

Conclusion

A strategy to improve deliberate rumination is necessary when seeking to improve posttraumatic growth among psychiatric nurses. Enhancing psychiatric nurses’ hardiness before trauma would enable them to actively express negative emotions after trauma, allowing them to receive more social support. This would improve deliberate rumination and consequently help promote psychological growth among psychiatric nurses who have experienced trauma.

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A Structural Equation Model for Happiness in Mothers with Young Children
Mijung Yeom, Soo Yang
J Korean Acad Nurs 2019;49(3):241-253.   Published online January 15, 2019
DOI: https://doi.org/10.4040/jkan.2019.49.3.241
AbstractAbstract PDF
Abstract Purpose

This study aimed to develop and test a model of the happiness of mothers with young children based on the stress-coping-adaptation model of Lazarus and Folkman.

Methods

The data collection period was from May to July 2016. A self-report questionnaire was used to collect data from 210 mothers with children under 5 years of age living in Seoul, Gyeonggi, and Gangwon provinces. The exogenous variable was parenting stress, and the endogenous variables were parenting alliance, depression, optimism, ways of coping, and happiness. Data from 201 questionnaires were analyzed using the SPSS 22.0 and AMOS 20.0 programs. Data analyses included descriptive statistics, factor analysis, and structural equation modeling.

Results

The final modified model showed a reasonable fit to the data, and out of 25 paths, 13 were statistically significant. This model explained 78.4% of the variance in the happiness of mothers with young children and confirmed that depression, optimism, parenting alliance, and social support-focused coping have a direct effect on the subject's happiness. Parenting stress also influenced happiness through parenting alliance, depression, and optimism.

Conclusion

In order to bolster the happiness of mothers with young children, positive psychological interventions that can minimize psychological vulnerabilities, such as depression, and that can enhance their strengths, such as optimism, may serve as effective ways of coping with and adapting to stress.

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Testing a Model to Predict Problem Gambling in Speculative Game Users
Hyangjin Park, Suk-Sun Kim
J Korean Acad Nurs 2018;48(2):195-207.   Published online January 15, 2018
DOI: https://doi.org/10.4040/jkan.2018.48.2.195
AbstractAbstract PDF
Abstract Purpose

The purpose of the study was to develop and test a model for predicting problem gambling in speculative game users based on Blaszczynski and Nower's pathways model of problem and pathological gambling.

Methods

The participants were 262 speculative game users recruited from seven speculative gambling places located in Seoul, Gangwon, and Gyeonggi, Korea. They completed a structured self-report questionnaire comprising measures of problem gambling, negative emotions, attentional impulsivity, motor impulsivity, non-planning impulsivity, gambler's fallacy, and gambling self-efficacy. Structural Equation Modeling was used to test the hypothesized model and to examine the direct and indirect effects on problem gambling in speculative game users using SPSS 22.0 and AMOS 20.0 programs.

Results

The hypothetical research model provided a reasonable fit to the data. Negative emotions, motor impulsivity, gambler's fallacy, and gambling self-efficacy had direct effects on problem gambling in speculative game users, while indirect effects were reported for negative emotions, motor impulsivity, and gambler's fallacy. These predictors explained 75.2% problem gambling in speculative game users.

Conclusion

The findings suggest that developing intervention programs to reduce negative emotions, motor impulsivity, and gambler's fallacy, and to increase gambling self-efficacy in speculative game users are needed to prevent their problem gambling.

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A Structural Model for Premenstrual Coping in University Students: Based on Biopsychosocial Model
Myung-Ock Chae, Hae Ok Jeon, Ahrin Kim
J Korean Acad Nurs 2017;47(2):257-266.   Published online April 28, 2017
DOI: https://doi.org/10.4040/jkan.2017.47.2.257
AbstractAbstract PDF
Purpose

The aims of this study were to construct a hypothetical structural model which explains premenstrual coping in university students and to test the fitness with collected data.

Methods

Participants were 206 unmarried women university students from 3 universities in A and B cities. Data were collected from March 29 until April 30, 2016 using self-report structured questionnaires and were analyzed using IBM SPSS 23.0 and AMOS 18.0.

Results

Physiological factor was identified as a significant predictor of premenstrual syndrome (t=6.45, p<.001). This model explained 22.1% of the variance in premenstrual syndrome. Psychological factors (t=-2.49, p=.013) and premenstrual syndrome (t=8.17, p<.001) were identified as significant predictors of premenstrual coping. Also this model explained 30.9% of the variance in premenstrual coping in university students. A physiological factors directly influenced premenstrual syndrome (β=.41, p=.012). Premenstrual syndrome (β=.55, p=.005) and physiological factor (β=.23, p=.015) had significant total effects on premenstrual coping. Physiological factor did not have a direct influence on premenstrual coping, but indirectly affected it (β=.22, p=.007). Psychological factors did not have an indirect or total effect on premenstrual coping, but directly affected it (β=-.17, p=.036).

Conclusion

These findings suggest that strategies to control physiological factors such as menstrual pain should be helpful to improve premenstrual syndrome symptoms. When developing a program to improve premenstrual coping ability and quality of menstrual related health, it is important to consider psychological factors including perceived stress and menstrual attitude and premenstrual syndrome.

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Identifying Latent Classes of Risk Factors for Coronary Artery Disease
Eunsil Ju, JiSun Choi
J Korean Acad Nurs 2017;47(6):817-827.   Published online January 15, 2017
DOI: https://doi.org/10.4040/jkan.2017.47.6.817
AbstractAbstract PDF
Abstract Purpose

This study aimed to identify latent classes based on major modifiable risk factors for coronary artery disease.

Methods

This was a secondary analysis using data from the electronic medical records of 2,022 patients, who were newly diagnosed with coronary artery disease at a university medical center, from January 2010 to December 2015. Data were analyzed using SPSS version 20.0 for descriptive analysis and Mplus version 7.4 for latent class analysis.

Results

Four latent classes of risk factors for coronary artery disease were identified in the final model: ‘smoking-drinking’, ‘high-risk for dyslipidemia’, ‘high-risk for metabolic syndrome’, and ‘high-risk for diabetes and malnutrition’. The likelihood of these latent classes varied significantly based on socio-demographic characteristics, including age, gender, educational level, and occupation.

Conclusion

The results showed significant heterogeneity in the pattern of risk factors for coronary artery disease. These findings provide helpful data to develop intervention strategies for the effective prevention of coronary artery disease. Specific characteristics depending on the subpopulation should be considered during the development of interventions.

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Factors Influencing Adolescent Lifetime Smoking and Current Smoking in South Korea: Using data from the 10th (2014) Korea Youth Risk Behavior Web-Based Survey
Seok Hyun Gwon, Suyong Jeong
J Korean Acad Nurs 2016;46(4):552-561.   Published online August 31, 2016
DOI: https://doi.org/10.4040/jkan.2016.46.4.552
AbstractAbstract PDF
Purpose

The purpose of this study was to investigate factors influencing lifetime smoking and current smoking among adolescents in South Korea.

Methods

Hierarchical logistic regression was conducted based on complex sample analysis using statistics from the 10th (2014) Korea Youth Risk Behavior Web-Based Survey. The study sample comprised 72,060 adolescents aged 12 to 18.

Results

The significant factors influencing adolescent lifetime smoking were female gender, older age, higher stress, higher weekly allowance, lower economic status, living apart from parents, parental smoking, sibling smoking, peer smoking, observation of school personnel smoking, and coed school compared to boys' school. The significant factors influencing adolescent current smoking were female gender, older age, higher stress, higher weekly allowance, both higher and lower economic status compared to middle economic status, living apart from parents, parental smoking, sibling smoking, peer smoking, observation of school personnel smoking, and coed school compared to boys' school.

Conclusion

Factors identified in this study need to be considered in programs directed at prevention of adolescent smoking and smoking cessation programs, as well as policies.

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A Structural Model for Primiparas' Breastfeeding Behavior
Hyun-Joo Yang, Ji-Min Seo
J Korean Acad Nurs 2013;43(3):399-408.   Published online June 28, 2013
DOI: https://doi.org/10.4040/jkan.2013.43.3.399
AbstractAbstract PDF
Purpose

The study was done to construct and test a structural model to explain primipara breastfeeding behavior.

Methods

The participants were 213 primiparas on postpartum wards. Data were analyzed using the PASW 18.0 and AMOS 19.0 programs.

Results

Fitness statistics for the hypothetical model were appropriate (χ2 =38.50, p=.070, GFI=.96, RMSEA=.05, AGFI=.93, NFI=.95, TLI=.97, CFI=.98, PNFI=.57, χ2/df=1.43). Breastfeeding behaviors were directly influenced by intention to breastfeed, perceived effectiveness of breastfeeding, and the amount of supplementary feeding. The amount of supplementary feeding had the largest direct impact on breastfeeding behavior. The largest total effect on breastfeeding behavior was intention to breastfeed. The environment of the maternity hospital indirectly influenced breastfeeding behavior. These factors explained 18.9% of variance in the primipara breastfeeding behavior.

Conclusion

The results of the study indicate that in order to promote primipara breastfeeding the amount of supplementary feeding immediately after the birth should be limited and an environment that encourages exclusive breastfeeding in the hospital should be provided. The results also suggest it is necessary to provide nursing interventions that increase the intention to breastfeed and the perceived effectiveness of breastfeeding.

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Maternal and Hospital Factors Impacting the Utilization of Rooming-in Care in South Korea: Secondary Analysis of National Health Data
Yunmi Kim, Eun-Young Kim
J Korean Acad Nurs 2011;41(5):593-602.   Published online October 31, 2011
DOI: https://doi.org/10.4040/jkan.2011.41.5.593
AbstractAbstract PDF
Purpose

Purpose: In this study analysis was done of utilization of rooming-in care in South Korean hospitals in order to examine the factors related to mothers and hospitals that affect rooming-in care.

Methods

With the involvement of 254,414 mothers who gave birth across 953 hospitals, the analysis used the health insurance qualification data of the National Health Insurance Corporations and Health Insurance Review and Assessment Service (2006). Factors associated with rooming-in care were analyzed using a GEE logistic regression analysis to consider factors related to both mothers and hospitals.

Results

Only 45.1% of the mothers used rooming-in care. The results of the regression analysis revealed that individual factors of the mothers were not associated with rooming-in care, whereas group factors of the hospitals were. Rooming-in care use was primarily related to small hospital, location of hospital, and higher nurse staffing level.

Conclusion

The findings of this study indicate that the utilization of rooming-in care is not associated with factors an individual mother, but rather with the group factors of the hospitals. Thus, a policy-based approach considering both of these types of factors is required to enhance the utilization of rooming-in care.

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Predictive Bayesian Network Model Using Electronic Patient Records for Prevention of Hospital-Acquired Pressure Ulcers
In Sook Cho, Eunja Chung
J Korean Acad Nurs 2011;41(3):423-431.   Published online June 13, 2011
DOI: https://doi.org/10.4040/jkan.2011.41.3.423
AbstractAbstract PDF
Purpose

The study was designed to determine the discriminating ability of a Bayesian network (BN) for predicting risk for pressure ulcers.

Methods

Analysis was done using a retrospective cohort, nursing records representing 21,114 hospital days, 3,348 patients at risk for ulcers, admitted to the intensive care unit of a tertiary teaching hospital between January 2004 and January 2007. A BN model and two logistic regression (LR) versions, model-I and -II, were compared, varying the nature, number and quality of input variables. Classification competence and case coverage of the models were tested and compared using a threefold cross validation method.

Results

Average incidence of ulcers was 6.12%. Of the two LR models, model-I demonstrated better indexes of statistical model fits. The BN model had a sensitivity of 81.95%, specificity of 75.63%, positive and negative predictive values of 35.62% and 96.22% respectively. The area under the receiver operating characteristic (AUROC) was 85.01% implying moderate to good overall performance, which was similar to LR model-I. However, regarding case coverage, the BN model was 100% compared to 15.88% of LR.

Conclusion

Discriminating ability of the BN model was found to be acceptable and case coverage proved to be excellent for clinical use.

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