Research in Community and Public Health Nursing

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Original Articles

The Burden Experience of Family Caregiver of Older Adults with Chronic Illness: Nova Yustisia, Titin Aprilatutini, Tuti Anggriani Utama, Mahmasoni Masdar; Res Community Public Health Nurs. 2023;34(2):85-95. Published online June 30, 2023; DOI: https://doi.org/10.12799/rcphn.2022.00304

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Purpose
This study aims to find out further about the burden on families in undertaking caregiving for the elderly with chronic illnesses.
Methods
A qualitative study was developed using in-depth interviews with 12 family caregivers selected by purposive sampling in July 2022. The thematic analysis was then carried out using the Colaizzi method, and N-Vivo 12 Qualitative Data Analysis Software was used to assist with the content analysis.
Results
The result from the experience interview analysis of caregivers participating in this study were 54 codes which were categorized into thirteen categories. Then, they were derived into four themes, as follows: 1) Physical burden of the caregivers for the elderly with chronic illness, 2) Psychological burden of the caregivers for the elderly with chronic illness, 3) Obstacle of caregivers for the elderly with chronic illness, 4) The state of caregivers who perform caregiving for the elderly with chronic illness.
Conclusion
The experience of caregivers in undertaking caregiving for the elderly with chronic disease has many obstacles, such as physical, psychological, and economic burdens. Caregivers often find positive aspects of their experiences while caregiving for the elderly, although their burden also constantly increases. Health facilities should pay serious attention to family caregivers and facilitate programs that can help reduce the burden on family caregivers.

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Relationship between Care Burden and Health Anxiety in the Family Caregivers of the Older Adults with Alzheimer’s Disease
Mohammad Sadegh Sargolzaei, Daniyal Kohestani, Tahereh Alsadat Khoubbin Khoshnazar, Hossein Asghari Asl
Ageing International.2024; 49(2): 280. CrossRef

Factors Related to Health-Related Quality of Life across the Life Cycle in One-Person Households among Korean Adults: Myung-Ock Chae; Res Community Public Health Nurs. 2024;35(2):125-139. Published online June 28, 2024; DOI: https://doi.org/10.12799/rcphn.2023.00304

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Abstract PDF: Purpose
This study is to identify factors related to health-related quality of life in one-person households across the life cycle by analyzing data from the 2021 Korean National Health and Nutrition Examination Survey.
Methods
The subjects of one-person households were divided into 195 young adults, 273 middle-aged people, and 490 elderly people according to life cycle. Data were analyzed by complex sample cross tabulation, complex sample t-test, complex sample ANOVA, and complex sample multiple regression analysis using IBM SPSS 26.0.
Results
In young adults, subjective health status, daily activity limitation, and stress level explained 41% of health-related quality of life, and in middle age, income level, education level, occupation, marital status, subjective health status, stress level, and depression had a 60% explanatory power. In old age, education level, subjective health status, daily activity limitation, stress level, and depression explained 53% of health-related quality of life.
Conclusion
In order to effectively improve the health-related quality of life of one-person households, it is necessary to establish a customized program considering the influencing factors across the life cycle and systematically manage it according to the flow of the life cycle.

Factors influencing dementia preventive behaviors of older adults at high risk of dementia: Application of extended health belief model: So Hee Jung, Mee Ock Gu; Res Community Public Health Nurs. 2024;35(1):22-36. Published online March 29, 2024; DOI: https://doi.org/10.12799/rcphn.2023.00402

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Abstract PDF: Purpose
The purpose of this study was to identify the factors influencing dementia preventive behaviors of older adults at high risk of dementia based on extended health belief model.
Methods
The subjects were 140 older adults at high risk of dementia living in H-gun, Gyeongsangnam-do, Republic of Korea. The data was collected from April 21 to May 28, 2021 by using structured questionnaires. The data was analyzed using t-test, ANOVA, Scheffé test, Pearson’s correlation coefficient, and hierarchical multiple regression by SPSS/WIN 24.0 program.
Results
The mean score of dementia preventive behaviors of older adults at high risk of dementia was 3.47±0.49 (range 1-5). The factors influencing dementia preventive behaviors were self-efficacy (β=.82, p<.001), cues to action(β=.17, p=.013), ages 75-79 (β=0.35, p=.003; reference: ages 65-69), ages ≥80 (β=0.27, p=.021; reference: ages 65-69), which together explained 82.0% of total variance in dementia preventive behaviors (F=25.21, p<.001).
Conclusion
Based on the results of this study, it is highly recommended to develop and apply the dementia prevention program that can increase self-efficacy and cues to action for improving dementia preventive behavior of older adults at high risk of dementia.

Patterns of Adolescent Substance Use: A Comparative Study among the United States, Canada, England, and South Korea from 2014-2021: Chaehee Kim, Kihye Han, Jieun Kim, Alison M. Trinkoff, Sihyun Park, Hyejin Kim; Res Community Public Health Nurs. 2024;35(2):179-193. Published online June 28, 2024; DOI: https://doi.org/10.12799/rcphn.2024.00535

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Abstract PDF: Purpose
This study aimed to identify the cross-national estimates of substance use, explore problematic substance use patterns among adolescents across countries and over time, and examine the relationship of individual characteristics on substance use patterns.
Methods
This study employed a time-series secondary data analysis spanning from 2014 to 2021 across four countries (United States, Canada, England, and South Korea). We analyzed the usage of five substances (alcohol, binge drinking, cigarettes, electronic cigarettes, and illicit drugs) alongside demographic characteristics. A descriptive analysis was performed to identify estimates of substance use across countries. Latent class analysis was employed to examine adolescents’ substance use patterns across time and countries. A multinomial logistic regression model was fit to assess the relationship between latent class and demographic characteristics.
Results
Adolescents in the United States and Canada had the highest substance use, while Korean adolescents had the lowest, particularly concerning drugs. Latent class analysis revealed two classes (light-user and heavy-user), with the addition of a third class (moderate-user) in some instances. The substance use patterns, while differing significantly among nations, exhibited consistency over time. During COVID-19, a decrease in heavy-substance users was observed across countries. Male or older participants were more likely to belong to the heavy-user class.
Conclusion
This research offers valuable insights into the variations in substance use patterns between nations and over time. A tailored approach is essential to prevent adolescents from becoming heavy-substance users. This approach should consider country regulations and demographics for a targeted and comprehensive preventive strategy.

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

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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.

Factors Affecting the Performance of Infection Control of Multi-drug Resistant Organisms in Intensive Care Unit Nurses of General Hospitals based on the Theory of Planned Behavior: The Mediating Effect of Intention: Nam-Sook Kim, So-Eun Choi; Res Community Public Health Nurs. 2023;34(3):183-195. Published online September 27, 2023; DOI: https://doi.org/10.12799/rcphn.2023.00150

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Abstract PDF

Purpose
The purpose of this study is to analyze the factors that affect the performance of infection control of multidrug-resistant organisms (MDROs) by nurses in intensive care units (ICU) in general hospitals.
Methods
Participants were 105 ICU nurses from 6 general hospitals. The questions for the survey performed were based on the theory of planned behavior, such as attitude towards infection control of MDROs, subjective norms, perceived behavioral control, intention, and performance.
Results
In the relationship between subjective norms towards infection control of MDROs and performance, intention showed a significant complete mediating effect; and in the relationship between perceived behavioral control and performance, intention showed a partial mediating effect. The attitude towards infection control of MDROs was excluded from the mediating effect verification because there was no significant correlation between intention and performance.
Conclusion
The results of this study suggest that department atmosphere and perceived behavior control promotion programs should be developed to enhance subjective norms in order to promote the performance of infection control of MDROs.

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Causal Model of Factors Influencing Adherence to Standard Precautions Practices Among Chinese Emergency Nurses: A Cross-sectional Study
Yanfang Huang, Wanchai Lertwatthanawilat, Pimpaporn Klunklin, Akeau Unahalekhaka
Pacific Rim International Journal of Nursing Research.2024; 28(3): 525. CrossRef
Nurses in Iraq Show Alarmingly Low Infection Control Adherence
Alyaa H. Ali
Academia Open.2024;[Epub] CrossRef

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

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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.

Review Article

Optimistic bias: Concept analysis: Miseon Shin, Juae Jeong; Res Community Public Health Nurs. 2024;35(1):112-123. Published online March 29, 2024; DOI: https://doi.org/10.12799/rcphn.2023.00360

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Abstract PDF: Purpose
The purpose of this study was to analyze and clarify the concept of ‘optimistic bias.’
Methods
A review of the literature was conducted using several databases. The databases were searched using the following keywords: optimistic bias, optimism bias, and concept analysis. The literature on optimistic bias was reviewed using the framework of Walker and Avant’s conceptual analysis process.
Results
Optimistic bias can be defined by the following attributes: 1) underestimation of personal risk, 2) vague confidence, 3) positive future prediction and 4) lack of risk recognition. The antecedents of optimistic bias are as follows: 1) risk perception, 2) self-efficacy, and 3) risk controllability. The consequences of optimistic bias are as follows: 1) reduced anxiety, 2) providing emotional stability, 3) negative consequences for preventive health behavior, 4) lack of attention to risk-related information, and 5) negative consequences for self-protection behavior.
Conclusion
The definition and attributes of optimistic bias identified by this study can provide a common understanding of this concept and help to develop a nursing intervention program effective in preventing, protecting, and improving health of subjects in the field of nursing practice.

Original Articles

Priorities of Family Caregivers in Preserving Functional Abilities of Individuals with Alzheimer's Disease Living at Home: A Best-Worst Scaling Approach: Eunhye Cho, Youngran Yang, Hyun Kyung Kim, Hye Young Kim; Res Community Public Health Nurs. 2024;35(2):156-167. Published online June 28, 2024; DOI: https://doi.org/10.12799/rcphn.2024.00556

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Abstract PDF Supplementary Material: Purpose
The decline in cognitive abilities among individuals with Alzheimer’s disease significantly impacts their Activities of Daily Living (ADLs), creating challenges and stress for their caregivers. This study aimed to investigate the priorities of family caregivers of community-dwelling individuals with Alzheimer's disease concerning the preservation of their loved ones' ADLs.
Methods
We employed a cross-sectional design with a best-worst scaling approach (BWS), and developed a BWS questionnaire utilizing the 10 daily living items from the Disability Assessment for Alzheimer’s Disease scale. This questionnaire was administered to 132 caregivers of individuals with Alzheimer's disease. Data analysis was conducted using SPSS WIN 21.0 and the R statistical program.
Results
The results revealed that "using the toilet without accidents" emerged as the top-ranked ADL that family caregivers preferred to preserve for the longest duration among individuals with Alzheimer's disease living at home. In contrast, "Managing money appropriately" was identified as a daily living activity considered relatively less critical to preserve. The study further indicated a preference among caregivers for preserving physical ADLs over instrumental ADLs.
Conclusion
This research provides clinical evidence shedding light on the priorities of family caregivers in preserving the functional abilities of individuals with Alzheimer's disease within the community.

Experience of Nurses Responding to the COVID-19 Outbreak at a Long-term Care Hospital in Korea: Eun Jo Kim, JaHyun Kang; Res Community Public Health Nurs. 2024;35(2):168-178. Published online June 28, 2024; DOI: https://doi.org/10.12799/rcphn.2023.00409

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Abstract PDF: Purpose
The COVID-19 pandemic uncovered the fundamental vulnerability of Long-term Care Hospitals (LTCHs) regarding infection control. This study aimed to describe the experiences of nurses who responded to the COVID-19 outbreak on the front lines while working at a LTCH.
Methods
This qualitative study was conducted with nine nurses. The data from in-depth individual interviews using semi-structured questions was analyzed thematically.
Results
Three themes and 11 sub-themes were extracted. The first theme, “the sudden onset of the outbreak,” included finding themselves desensitized to COVID-19 as the pandemic persisted; embarrassed by the unavoidable occurrence; and worried about becoming a spreader and aggravating the outbreak. The second theme, “physically and mentally worn out,” involved increased fatigue from overtime work; exhaustion from responding to inquiry calls pouring in; tension while monitoring and controlling infection control compliance among nursing assistants, caregivers, and elderly patients with cognitive impairment; and increased discomfort while taking on all the extra work with stifling personal protective equipment. The third theme, “awakened perspectives while responding to the outbreak,” covered increased compassion for patients; paying attention to infectious diseases and having confidence in infection control principles; realization of the need for isolation rooms, supplies, and a full-time infection control nurse; and pride as an LTCH nurse who responded to the COVID-19 pandemic.
Conclusion
To enhance the level of prevention and response to infectious disease outbreaks in LTCHs in the future, it is necessary to establish infection control infrastructure, including personnel, isolation facilities, supplies, and continuing education for the LTCHs’ nursing workforce.

Factors Associated with Nurse Self-Leadership: A Cross-Sectional Study of Nurses Working at Public Health Centers and Primary Healthcare Posts: Saeryun Kim, Younkyoung Kim; Res Community Public Health Nurs. 2024;35(3):195-206. Published online September 30, 2024; DOI: https://doi.org/10.12799/rcphn.2024.00493

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Abstract PDF Supplementary Material: Purpose
This study aimed to analyze the factors influencing self-leadership among public health nurses as they implement health promotion projects in public health centers and primary healthcare posts.
Methods
The study sampled 120 public health nurses from 22 public health centers and their associated primary healthcare posts in J province. Data were collected from October 11 through October 25, 2022.
Results
Employment at a primary healthcare post instead of a public health center (β=.23, p=.012), was significantly associated with self-leadership in model 1 (adjusted R2=.17, F=4.56, p<.001). Furthermore, communicative competence (β=.48, p<.001) and nursing professionalism (β=.26, p=.001) were significantly associated with self-leadership in model 2 (adjusted R2=.51, F=14.77, p<.001).
Conclusion
Open and self-directed work environments, along with opportunities for education and training, are necessary to enhance communicative competence and nursing professionalism. These improvements may, in turn, strengthen self-leadership among nurses, facilitating the implementation of health promotion projects within public health institutions.

School Nurses’ Perception of Job Performance Difficulties, Job Stress, Job Identity and Job Satisfaction: Eun Kyo Cho, Hyun Jung Moon; Res Community Public Health Nurs. 2023;34(1):43-51. Published online March 31, 2023; DOI: https://doi.org/10.12799/rcphn.2023.00010

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Abstract PDF: Purpose
To examine school nurses' perception of job performance difficulties, stress, identity, and satisfaction, and to identify the factors that affect job satisfaction. Methods: Data were collected through online survey questionnaires distributed to 189 regular school nurses working in Metropolitan I. The self-report questionnaire consisted of three instruments and demographic questions. The data were collected from June 29 to July 31, 2020, and analyzed using frequency, percentage, mean and standard deviation, t-test, ANOVA, Pearson's correlation coefficient, and multiple regression statistical techniques. Results: Perception of job performance difficulties showed a significant positive correlation with job stress (r=.20. p=.007), job identity (r=-.55, p<.001) and job satisfaction (r=-.39, p<.001), and each showed a negative correlation. Job stress showed a negative correlation with job satisfaction (r=-.65, p<.001), and job satisfaction and job identity showed a positive correlation (r=.53, p<.001). Job stress (β=-.58, p<.001), job identity (β=.43, p<.001), school-level elementary school (β=.19, p<.001), and middle school (β=.13, p=.011) were found to have a significant effect on job satisfaction. Conclusion: As job stress, job identity, and school level are important factors influencing job satisfaction, interventions are needed to lower the job stress of school nurses and strengthen their job identity. In addition, since the job satisfaction of school nurses can have a great impact on the health and happiness of students as well as the quality of life of future generations, it is necessary to improve policies and systems to increase the job satisfaction of school nurses.

Prevalence and Risk Factors of Diabetic Retinopathy in Diabetes People using Korean National Health and Nutrition Examination Survey VII: Ihn Sook Jeong, Chan Mi Kang; J Korean Acad Community Health Nurs. 2022;33(4):408-417. Published online December 31, 2022; DOI: https://doi.org/10.12799/jkachn.2022.33.4.408

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Abstract PDF: Purpose
This study aimed to investigate the prevalence and risk factors of diabetic retinopathy (DR) in people with diabetes mellitus (DM) using Korean National Health and Nutrition Examination Survey VII (2017~2018). Methods: DM was defined as in two ways; 1) doctor's diagnosis (Group 1, n=549), 2) one of doctor's diagnosis, medication, or hyperglycemia (Group 2, n=849). The DR prevalence was measured as the prevalence proportion (%). Risk factors for developing DR were analyzed using multiple logistic regression, and odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Results: The prevalence of DR was 25.87% in Group 1 and 20.14% in Group 2. Risk factors for DR were identified as insulin therapy (Group 1: OR=5.31, Group 2: OR=5.27), DM duration ≥10 years (Group 1: OR=2.20, Group 2: OR=3.10), and systolic blood pressure ≥140 mmHg (Group 1: OR=2.26, Group 2: OR=2.23) for both groups. Conclusion: Considering the DR prevalence, eye examinations education is highly recommended as part of a diabetes management programs in the community. It is also proposed to shorten the eye examination cycle for people with risk factors and establish a referral system to link between screening to treatment.

The Effects of Non-pharmacological Interventions on Sleep among Older Adults in Korean Long-term Care Facilities: A Systematic Review and Meta-analysis: Sun Ok Jung, Hye Young Kim, Eun Ju Choi; J Korean Acad Community Health Nurs. 2022;33(3):340-355. Published online September 30, 2022; DOI: https://doi.org/10.12799/jkachn.2022.33.3.340

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Abstract PDF: Purpose
This study aimed to examine the effects of non-pharmacological sleep intervention programs in improving sleep quality among older adults in long-term care facilities. Methods: A literature search and selection was performed on nine different databases using the guidelines of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Overall, 14 studies met the inclusion criteria and were systematically reviewed. For the metaanalysis, the effect size was estimated using the random-effects model in Review Manager (RevMan) desktop version 5.4 of the Cochrane Library. Results: The meta-analysis of overall non-pharmacological interventions obtained a total effect size of 1.0 (standardized mean difference [SMD]=1.0, 95% confidence interval [CI]: 0.64~1.35), which was statistically significant (Z=5.55, p<.001). The most frequently studied non-pharmacological intervention was aroma therapy, with an effect size of 0.61 (SMD=0.61, 95% CI: 0.14~1.08), which was statistically significant (Z=2.55, p=.010). In the subgroup analysis, group-based interventions, interventions for >4 weeks, and untreated control studies were more effective. Conclusion: This study confirms that non-pharmacological interventions are effective in improving sleep quality among older adults in long-term care facilities. However, the sample size was small and the risk of bias in assessing the interventions of individual studies was unclear or high, thereby limiting the generalizability of the results. Further reviews that evaluate randomized control trials, evidence-based interventions that consider older adult participants' physical activity levels, different intervention methods and durations, and different control group intervention types are needed to obtain more conclusive evidence.

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

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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.

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