Research in Community and Public Health Nursing

Original Articles

Malnutrition Risk in Community-Dwelling Older Adults with Dual Sensory Declines: Focusing on Social Determinants of Health: Ha Na Jeong; Res Community Public Health Nurs. 2024;35(4):325-338. Published online December 30, 2024; DOI: https://doi.org/10.12799/rcphn.2024.00675; Funded: Konyang University

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Abstract PDF: Purpose
As the number of older adults with dual sensory declines is increasing, they face a higher risk of malnutrition compared to those without these declines. Although social determinants of health can influence malnutrition, there has been limited research on this population. This study aimed to explore the association between malnutrition risk and social determinants of health among older adults with dual sensory declines.
Methods
The study is a cross-sectional analysis using data from the 2020 National Survey of Older Koreans. Binomial logistic regression analysis was conducted to examine the association between malnutrition risk and social determinants of health. These determinants include structural determinants, social capital, and intermediary determinants among older adults with dual sensory declines.
Results
1,771 with dual sensory declines were included in the analysis. Among the structural determinants, women (odds ratio [OR]=1.75, 95% confidential interval [CI] 1.19~2.57) and national basic livelihood security system recipients (OR=1.87, 95% CI 1.13~3.07) were significantly associated with malnutrition risk. In social capital, social non-participation (OR=1.33, 95% CI 1.03~1.73) and social network size (OR=0.95, 95% CI 0.92~0.98), Among intermediary determinants, living dissatisfaction (OR=1.61, 95% CI 1.16~2.23), environmental satisfaction (OR=0.95, 95% CI 0.92~0.99), household debt (OR=1.59, 95% CI 1.02~2.49) and comorbidity (OR=3.85, 95% CI 2.98~4.97) were significantly related to malnutrition risk.
Conclusion
These findings highlight the critical need to address key social determinants of health to enhance nutritional outcomes for older adults with dual sensory declines.

Digital Health Literacy and Associated Factors Among Older Adults Living Alone in South Korea: A Cross-Sectional Study: Minhwa Hwang, Gahye Kim, Seonghyeon Lee, Yeon-Hwan Park; Res Community Public Health Nurs. 2024;35(4):389-400. Published online December 30, 2024; DOI: https://doi.org/10.12799/rcphn.2024.00766; Funded: National Research Foundation of Korea, Ministry of Science and ICT

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Abstract PDF: Purpose
This study aimed to examine the level of digital health literacy and identify factors associated with digital health literacy among older adults living alone in South Korea.
Methods
A cross-sectional study was conducted on 140 older adults aged 65 and above who live alone. Descriptive statistics and non-parametric methods were used to explore the relationship between digital health literacy and independent variables. A generalized linear model was used to identify factors associated with digital health literacy.
Results
Among 140 smartphone-owning older adults living alone, 52.1% were using the Internet via digital devices, and the participants’ average digital health literacy score was 6.64±7.46. Univariate analysis results showed significant differences in digital health literacy according to age, education level, and multimorbidity. The factors associated with digital health literacy were identified as gender (B=−0.36, p=.031), age (B=−0.06, p<.001), education level (B=0.12, p<.001), and sleep problems (B=−0.06, p=.006).
Conclusion
Despite widespread Internet and smartphone use, older adults living alone with chronic diseases showed low levels of digital health literacy, which were significantly associated with gender, age, education level, and sleep problems. Enhancing digital health literacy among vulnerable populations is crucial for the effective implementation of digital health services. Collaborative efforts, including tailored digital health interventions to enhance the digital health literacy of vulnerable populations and supportive policies, are essential to bridge the digital divide and promote health equity.

Factors Influencing Participation in Hypertension Management Education Among Diagnosed Hypertensive Patients in Busan: Utilizing the 2021 Community Health Survey: Hye Jung Jun, Kyoung Mi Kim; Res Community Public Health Nurs. 2024;35(4):424-433. Published online December 30, 2024; DOI: https://doi.org/10.12799/rcphn.2024.00759; Funded: Korea Disease Control and Prevention Agency

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Abstract PDF: Purpose
This study investigated the completion rate of hypertension management education and its influencing factors among adults in the Busan region, utilizing data from the 2021 Community Health Survey.
Methods
The study included 3,660 adults aged 19 years or older who had been diagnosed with hypertension. Data were analyzed using SAS 9.4, focusing on demographic, socioeconomic, and health status characteristics.
Results
The results indicated that 22.1% of participants had completed hypertension management education. Key influencing factors varied by region: in the Western region, age, income, education level, marital status, and life satisfaction were significant factors associated with participation in hypertension management education. In the Southern region, income and education level were identified as relevant factors. Additionally, in the Central and Eastern regions, education level was a significant determinant.
Conclusion
Therefore, tailored hypertension management education programs that consider age, income, marital status, and life satisfaction are essential for residents in the Western region of Busan. Moreover, it is critical to enhance access to hypertension management education for low-income populations in the Southern region. Educational programs should also be designed to align with the educational levels of Busan residents to ensure effective hypertension management education.

Association between Hearing Difficulty, Masticatory Difficulty, and Risk of Cognitive Impairment: Analysis of the Korean Longitudinal Study of Aging Data (2006-2020): Sook Hee Choi, Yun Hee Kim; Res Community Public Health Nurs. 2024;35(4):434-448. Published online December 30, 2024; DOI: https://doi.org/10.12799/rcphn.2024.00745; Funded: Youngsan University

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Abstract PDF: Purpose
This study aimed to identify the association between hearing difficulty, masticatory difficulty, and cognitive impairment using data from the Korean Longitudinal Study of Aging.
Methods
This secondary data analysis included 6939 Korean adults aged 45 or older with no cognitive impairment at baseline. Self-reported questionnaires measured hearing and masticatory difficulty, and cognitive impairment were assessed using the Korea Mini-Mental State Examination (K-MMSE). Cox models were used to estimate the risk of cognitive impairment associated with the coexistence of hearing and masticatory difficulty.
Results
People who coexisted with hearing and masticatory difficulty were 2.4%. The incidence rate of cognitive impairment was 37.7% for the study sample and higher in females than males. Compared to people without hearing and masticatory difficulty, the total study sample with the coexistence of hearing and masticatory difficulty had a higher risk of cognitive impairment (HR: 1.26, 95% CI: 1.03–1.56), females with the coexistence of hearing and masticatory difficulty had a greater risk of cognitive impairment (HR :1.52 95% CI: 1.11–2.09).
Conclusion
Coexistence of hearing and masticatory difficulty increased females' cognitive impairment risk. It is recommended to check hearing and masticatory function in a timely, which may be effective in detecting individuals at high risk of cognitive impairment.

Effects of a School-Based Health Education for Cardiovascular Disease Prevention Among High School Girls: Minah Kang, Jina Choo; Res Community Public Health Nurs. 2024;35(4):363-374. Published online December 30, 2024; DOI: https://doi.org/10.12799/rcphn.2024.00647; Funded: College of Nursing, Korea University, National Research Foundation of Korea, Ministry of Science and ICT

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Abstract PDF: Purpose
We aimed to evaluate effects of a school-based health education for cardiovascular disease (CVD) prevention among high school girls.
Methods
Non-randomized cluster trial was conducted by recruiting two female high schools located in Seoul and allocating one school as a cluster to an experimental group and the other school as the other cluster to a control group. Participants were 169 first-year female high school students in two clusters. Of the participants, 84 were recruited in the experimental group and 85 in the control group. An intervention was an eight-week "School-based Health Education for CVD prevention". The experimental group received the intervention, while the control group received a CVD prevention handout. Measures were knowledge, self-efficacy, and health behaviors for CVD prevention. The pre-test and post-test were conducted.
Results
The experimental group participating in "School-Based Health Education for CVD Prevention" had significantly higher changes in knowledge, self-efficacy scores to prevent CVD, and health behaviors than the control group over eight weeks.
Conclusions
The "School-based Health Education for CVD Prevention" program may improve high school students' knowledge and self-efficacy as determinants of health behaviors as well as health behaviors to prevent cardiovascular disease.

Factors Associated with Homosexual Adolescents in South Korea: Jong Gun Kim; Res Community Public Health Nurs. 2024;35(3):207-215. Published online September 30, 2024; DOI: https://doi.org/10.12799/rcphn.2023.00332; Funded: Hoseo University

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Abstract PDF: Purpose
The purpose of this study was to investigate factors related to homosexual adolescents in South Korea.
Methods
Using statistics from the 12th (2016) Korea Youth Risk Behavior Web-based Survey, hierarchical logistic regression analysis was conducted. The study sample comprised 65,528 middle and high school students aged 12 to 18 years.
Results
The significant predictors of homosexual intercourse were gender, attempted suicide, bullying at school experience, ever drinking, ever smoking, habitual or purposeful drug use, cohabitation with family, weekly allowance, and mother’s education levels.
Conclusions
The results suggest that gender-related interventions should be considered in school health education programs and that sexual health interventions for high-risk groups may be needed, given the factors predicting homosexual intercourse.

Developing a community-based, multicultural-friendly prenatal education pilot program: EunSeok Cha, Sojung Lee, Gui-Nam Kim, Byung Hun Kang, Minsun Jeon; Res Community Public Health Nurs. 2024;35(3):226-239. Published online September 30, 2024; DOI: https://doi.org/10.12799/rcphn.2024.00507; Funded: Chungnam National University

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Abstract PDF: Purpose
The purpose of this study was to examine the acceptability, availability and sustainability of a pilot prenatal program developed by an interdisciplinary team.
Methods
Out of 19 multicultural women participated in the 6-session prenatal program, 6 women took part in an exit- focus group interview as a part of formative evaluation. The verbatim transcriptions of semi-structured interview data were analyzed using conventional content analysis.
Results
In general, the participants expressed high satisfaction with program content, educators and education methods. A hybrid model including health professionals and community health workers and using online and offline education modes was suggested as a way to disseminate the program at a national level. Interventions using aesthetic approaches such as music and an integrated method such as the introduction of available social services in pregnancy and during the postpartum period may play a role as the facilitator of the program participation of multicultural women. These approaches may also help them develop healthy coping skills, problem solving skills and empowerment in multicultural childbearing women who need to adjust to life in a new country simultaneously taking a new role as a mother.
Conclusion
An interdisciplinary prenatal program using a holistic approach contributes to enhancing multicultural women’s empowerment to become a mother in a new country.

Exploring the Prevalence and Influencing Factors of Sexually Explicit Internet Material (SEIM) Consumption among Adolescents and Young Adults in Cambodia: Hyunjeong Cheon, Youngran Yang; Res Community Public Health Nurs. 2024;35(3):284-296. Published online September 30, 2024; DOI: https://doi.org/10.12799/rcphn.2024.00633; Funded: Ministry of Education of the Republic of Korea, National Research Foundation of Korea

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Abstract PDF: Purpose
This study investigates the prevalence and factors associated with the consumption of sexually explicit Internet material (SEIM) among adolescents and young adults in Cambodia.
Methods
Utilizing a cross-sectional study design, data were collected through a survey administered to 1,271 participants. The survey focused on measuring SEIM consumption, sexual sensation seeking, perceived reality of SEIM, and sexual attitudes. Findings: The study revealed a SEIM prevalence of 27.2%, with notably higher rates among males (35.5%) than females (18.6%). Significant predictors of SEIM consumption included being male, having a father with a middle-level education, engaging in alcohol or substance consumption, spending more than five hours daily on electronic devices, having friends with sexual experience, frequent thoughts about sex, a heightened interest in sex compared to peers, perceiving SEIM as realistic, and maintaining a permissive attitude towards sex.
Conclusions
These findings underscore the importance of implementing education programs to address SEIM consumption and its potential risk factors. Such initiatives are crucial for preventing the use of SEIM among Cambodian youth, promoting a healthier understanding of sexuality, and fostering responsible online behavior.

Review Article

A Systematic Review of Questionnaire Measuring eHealth Literacy: Jung-Won Ahn, Mi Young Kim; Res Community Public Health Nurs. 2024;35(3):297-312. Published online September 30, 2024; DOI: https://doi.org/10.12799/rcphn.2024.00752; Funded: Gangneung-Wonju National University

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Abstract PDF: Purpose
This review aims to summarize the characteristics of currently used questionnaires measuring eHealth literacy and assess the quality of their psychometric properties in self-reported assessments within community settings.
Methods
The systematic analysis was conducted using the COnsensus-based Standards for the selection of health Measurement INstruments checklist to evaluate the methodological quality of studies on measurement properties.
Results
A total of 21 studies, including 19 questionnaires, were reviewed. The findings indicated that the quality of psychometric assessments for eHealth literacy was generally rated as 'good,' with most studies addressing multiple aspects of reliability and validity. Internal reliability, content validity, hypothesis testing, and responsiveness were particularly well-supported, each receiving over 10 sufficient ratings. However, there was limited evidence regarding measurement errors, test-retest reliability, criterion validity, and analyses of floor and ceiling effects.
Conclusion
This study contributes to the enhancement of eHealth literacy measurement tool selection and improves the reporting of their validity and reliability, thereby increasing the credibility of future research.

Original Articles

Prediction model of health checkup and cancer screening experience of elderly population using 2021 Community Health Survey: Myeunghee Han; Res Community Public Health Nurs. 2024;35(2):140-155. Published online June 28, 2024; DOI: https://doi.org/10.12799/rcphn.2024.00500; Funded: Dong Yang University

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Abstract PDF: Purpose
This study was conducted to build a decision tree model composed of factors that predict whether or not the elderly population underwent health or cancer screening using the 2021 community health survey.
Methods
This study included 74,434 and 74,417 subjects who answered for experience of health checkup or cancer screening, respectively. This study used Chi-squared test, independent t-tests, and decision tree analysis to analyze the data.
Results
Regarding the health checkup, 78.1% of women received a health checkup, and among women, those aged 65-74 years who were not recipients of the basic livelihood service showed the highest participation rate of 85.0%. In case of men, those who were married and had no problems in daily activity showed the highest participation rate of 81.4%. In the case of cancer screening, for women, those who were 65-74 years old and were nonrecipients of basic livelihood benefits showed the highest participation rate of 75.3%. For men, the cancer screening rate was the highest at 74.3% in those who had no problems with mobility and were married.
Conclusion
It was found that the general and health characteristics of the elderly had a great influence on the health checkup and cancer screening. In order to develop a more improved screening system, screening rates and effects should be continuously observed and studied.

Bidirectional Relationship Between Depression and Frailty in Older Adults aged 70-84 years using Random Intercepts Cross-Lagged Panel Analysis: Ji Hye Shin, Gyeong A Kang, Sun Young Kim, Won Chang Won, Ju Young Yoon; Res Community Public Health Nurs. 2024;35(1):1-9. Published online February 29, 2024; DOI: https://doi.org/10.12799/rcphn.2023.00381; Funded: Seoul National University, National Research Foundation of Korea, Ministry of Education

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Abstract PDF: Purpose
Depression and frailty are common health problems that occur separately or simultaneously in later life. The two syndromes are correlated, but they need to be distinguished to promote successful aging. Previous studies have examined the reciprocal relationship between depression and frailty, but there are limitations in the methods or statistical analysis. This study aims to confirm the potential prospective bidirectional and causal relationship between depression and frailty.
Methods
We used data from 887 older adults aged 70 to 84 from the Korean Frailty and Aging Cohort Study (KFACS) in 2016, 2018, and 2020 (3 waves). We separated the within-individual process from the stable between-individual differences using the random intercepts cross-lagged panel model.
Results
Significant bidirectional causal effects were observed in 2 paths. Older adults with higher depression than their within-person average at T1 had a higher risk of frailty at T2 (β=.22, p=.008). Subsequently, older adults with higher-than-average frailty scores at T2 showed higher depression at T3 (β=.14, p=.010). Autoregressive effects were only significant from T2 to T3 for both constructs (Depression: β=.16, p=.044; Frailty: β=.13, p=.028). At the between-person level, the correlation was significant between the random intercepts between depression and frailty (β=.47, p<.001).
Conclusions
We find that depressed older adults have an increased risk of frailty, which contributes to the onset of depression and the maintenance of frailty. Therefore, interventions for each condition may prevent the entry and worsening of the other condition, as well as prevent comorbidity.

Current Status and Associated Factors of Emotional Distress Due to COVID-19 Among People with Physical Disabilities Living in the Community: Secondary Data Analysis using the 2020 National Survey of Disabled Persons: Bohye Kim, Ju Young Yoon; Res Community Public Health Nurs. 2024;35(1):37-50. Published online February 29, 2024; DOI: https://doi.org/10.12799/rcphn.2023.00374; Funded: National Research Foundation of Korea, Ministry of Education, Center for Human-Caring Nurse Leaders for the Future

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Abstract PDF: Purpose
This study aimed to assess the current situation and factors associated with emotional distress due to COVID-19 among people with physical disabilities living in the community, using a Social-Ecological Model.
Methods
A secondary data analysis was performed using data from the 2020 National Survey of Disabled Persons. The study participants were 1,654 participants aged 19 years or older with physical disabilities. For data analysis, complex sample logistic regression was conducted to identify factors associated with emotional distress due to COVID-19 in people with physical disabilities.
Results
The results showed that 55.7% of people with physical disabilities living in the community experienced emotional distress due to COVID-19. This emotional distress was influenced by various factors, including intrapersonal factors (activities of daily living, difficulty in getting information about COVID-19, difficulty in obtaining and using equipment related to COVID-19), interpersonal factors (satisfaction with the number of friends), and community/policy factor (support related to COVID-19 from national and local governments).
Conclusion
It is recommended to develop tailored interventions to prevent mental health issues among people with physical disabilities by considering the factors related to their emotional distress in the event of future infectious disease disasters.

Validity and Reliability of the Korean Version of the Diabetes Acceptance and Action Scale (DAAS-K): Kawoun Seo; Res Community Public Health Nurs. 2024;35(1):76-83. Published online March 29, 2024; DOI: https://doi.org/10.12799/rcphn.2023.00430; Funded: National Research Foundation of Korea, Ministry of Education

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Abstract PDF: Purpose
The purpose of this study was to evaluate the validity and reliability of the Korean version of the Diabetes Acceptance and Action Scale-Revised (DAAS-R) for Korean patients with type 2 diabetes.
Methods
The survey was conducted from September 1, 2021, to September 30, 2021, through a survey institution for patients diagnosed with diabetes who understood the purpose of the study and voluntarily agreed to participate. A total of 231 individuals with type 2 diabetes participated in this study. After performing forward and backward translations of the original version of the Diabetes Acceptance and Action Scale-Revised (DAAS-R) into Korean, its constructive validity (confirmatory factor analysis), concurrent validity and reliability were assessed. Concurrent validity was confirmed through the correlation between acceptance and action, quality of life, diabetes self-stigma, and experiential avoidance.
Results
Construct validity, measured using confirmatory factor analysis, showed a good fit. The DAAS-K was positively correlated with acceptance and action, quality of life, and negatively correlated with diabetes self-stigma and experiential avoidance. As for internal reliability, the Cronbach’s α of the DAAS-K was .95.
Conclusion
The DAAS-K can be applied to assess diabetes acceptance and action in Korean patients with type 2 diabetes and to compare the levels of psychological flexibility of patients with diabetes internationally.

Home-based walking intervention for middle-aged migrant women using 360-degree virtual videos and a wearable activity tracker: A mixed-methods pilot study: Duckhee Chae, Keiko Asami, Jaseon Kim, Kukhyeon Kim, Jeeheon Ryu, Ardith Z. Doorenbos; Res Community Public Health Nurs. 2024;35(1):10-21. Published online March 29, 2024; DOI: https://doi.org/10.12799/rcphn.2023.00339; Funded: Ministry of Education of the Republic of Korea, National Research Foundation of Korea

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Abstract PDF Supplementary Material: Purpose
To sustain behavior change, an intervention strategy that considers the contribution of affect to daily physical activity behavior regulation is needed. Although virtual reality-based physical activity interventions have the potential to improve emotional status, interventions using virtual reality videos in a free-living environment are lacking. This pilot study assessed the feasibility and preliminary efficacy of a home-based intervention using 360-degree virtual videos and wearable activity trackers to improve mood and physical activity.
Methods
A one-group pilot study of 12 middle-aged migrant women asked participants to watch virtual reality videos and perform moderate-intensity walking 5 days per week for 4 weeks, then complete surveys and focus group interviews. The intervention’s feasibility and preliminary efficacy were assessed by examining recruitment, retention, adherence, acceptability, mood, physical activity, and exercise self-efficacy.
Results
A word-of-mouth approach was effective for recruiting participants. Although the weekly intervention adherence rate ranged from 53.5% to 83.5%, retention (92.3%) and acceptability (91.7%) were high. Participants were satisfied with the “visual status indicators,” “sense of accomplishment and confidence,” “emotional engagement and sense of presence,” “joy from exercise,” “external motivation through supervision,” “easy to control virtual reality device,” and “extra benefits” of the intervention. Participants had significant decreases in negative affect (p=.016). Positive affect, physical activity, and exercise self-efficacy showed trends toward improvement.
Conclusion
This home-based intervention employing virtual reality videos and Fitbit activity trackers is feasible and shows preliminary efficacy in improving mood. Further research is warranted to evaluate its effectiveness in a more rigorous randomized controlled trial.

Smartphone dependency latent profile classification and association with emotional and behavioral difficulties among high school students in Korea: Eunjoo Kim, Min Kyung Song; Res Community Public Health Nurs. 2024;35(1):84-98. Published online March 29, 2024; DOI: https://doi.org/10.12799/rcphn.2024.00465; Funded: Jeju National University

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Abstract PDF: Purpose
The pervasive integration of smartphones into adolescents’ daily lives has resulted in a concerning upsurge in smartphone dependency among high school students. Due to the diverse types and severity levels of smartphone dependency, there is a critical need for research to explore its heterogeneity. This study aimed to identify latent profile of smartphone dependency in high school students based on the four subdomains of smartphone dependency: disturbance of adaptive functions, virtual life orientation, withdrawal, and tolerance. In addition, we explored how emotional and behavioral difficulties differ according to the profiles.
Methods
We used data from 2,195 Korean high school students from the Korean Children and Youth Panel Survey 2018. Latent profile analysis (LPA) was performed to identify smartphone dependency latent profile. Statistical analysis including chi-square test, Analysis of Variance (ANOVA), and ranked Analysis of Covariance (ANCOVA) confirmed differences in smartphone use characteristics and emotional-behavioral difficulties according to the classified latent profile.
Results
LPA identified four distinct latent profiles of smartphone dependency among high school students; 1) Underdependent type, 2) Moderate type, 3) Habitual user type, and 4) Virtual space dependent type. The results of ranked ANCOVA, controlling for gender, geographical location, economic status, parental smartphone dependency, and relational variables, revealed that habitual user type exhibited significantly higher rates of attention deficit hyperactivity disorder, social withdrawal, and depressive symptoms compared to other types.
Conclusion
The identification of these profiles provides a foundation for developing tailored intervention programs for adolescents with different levels and patterns of smartphone dependency.

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