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

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

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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.

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.

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

Urban-Rural Differences in Prevalence of Depressive Symptoms and Its Related Factors Among Older Adults: Findings from the Korean Longitudinal Study of Aging: Bongjeong Kim, Jinseub Hwang, Dohyang Kim, Soo Jin Kang; Res Community Public Health Nurs. 2024;35(1):51-63. Published online March 29, 2024; DOI: https://doi.org/10.12799/rcphn.2023.00388

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Abstract PDF: Purpose
Many studies exist on factors associated with depressive symptoms in urban and rural older adults; however, studies using a longitudinal design are scarce. This study aimed to determine whether there is a difference in the prevalence of depressive symptoms and their associated risk factors over time between urban and rural areas using a longitudinal sample of Korean older adults.
Methods
Data from the Korean Longitudinal Study of Aging (2006–2020) of older adult participants ≥65 years without depressive symptoms were analyzed. A generalized estimating equation model was employed for repeated measures analysis.
Results
As the time of living in the area increased, the prevalence risk of depressive symptoms in older adults increased in urban areas compared to rural areas in adjusted Model 2. In urban areas, less social contact with neighbors was significantly associated with a higher risk of depressive symptoms. In rural areas, occasional social contact with children was significantly associated with a lower risk of depressive symptoms. The prevalence of depressive symptoms was associated with five components of successful aging with some variations observed based on urban and rural residential areas.
Conclusions
Our findings suggest that understanding the longitudinal impact of residence on depressive symptoms provides valuable insights into the relationship between urban/rural areas and depressive symptoms. This study highlights the need for nursing intervention efforts aimed at promoting successful aging and increasing social contact with children or neighbors.

Assessment of Metabolic Syndrome Risk Based on Body Size Phenotype in Korean Adults: Analysis of Community-based Cohort Data: Ji Young Kim, Youngran Yang; Res Community Public Health Nurs. 2023;34(2):158-170. Published online June 30, 2023; DOI: https://doi.org/10.12799/rcphn.2023.00101

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Abstract PDF: Purpose
Body size phenotypes can be regarded as an indicator of cardiovascular incidence risk factors. The aim of this study was to investigate the incidence of metabolic syndrome among metabolically healthy adults according to body size phenotype using Korean Genome & Epidemiology Study [KoGES]-community based cohort from 2001-2002 to 2014.
Methods
A prospective population-based cohort including 5,068 adults aged 40-69 years free from metabolic syndrome was included and divided into three phenotypes: metabolically healthy normal weight (MHNW), metabolically healthy overweight (MHOW), and metabolically healthy obesity (MHO). The time dependent Cox’s proportional hazards regression model was used to estimate the incidence of the metabolic syndrome after a follow-up 14 years.
Results
In the demographic, health related variables-adjusted model (Model 3), the hazard ratio of the metabolic syndrome was 1.92 (CI 1.54-2.40) for MHOW, 2.88 (CI 2.32-3.58) for MHO among males, 1.89 (CI 1.51-2.37) for MHOW, 2.34 (CI 1.88-2.90) for MHO for females compared to MHNW, respectively.
Conclusion
In conclusion, MHOW and MHO in both males and females increased the risk of metabolic syndrome compared to MHNW. Obesity management should be considered even in the absence of metabolic syndrome. Programs and resources should be provided for prevention of cardiovascular diseases and better quality of life.

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.

Influencing Factors for Work Engagement of COVID-19 Response Workers in Public Health Centers: Based on the Job Demands-Resources Model: Songran Park, Yeongmi Ha; Res Community Public Health Nurs. 2024;35(1):64-75. Published online March 29, 2024; DOI: https://doi.org/10.12799/rcphn.2023.00346

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Abstract PDF: Purpose
This study aimed to identify the influencing factors for work engagement of COVID-19 response workers in public health centers based on the JD-R model.
Methods
The participants were 119 civil servants and professionals of 20 public health centers with at least 6 months of work experience and have experience of COVID-19 response tasks in cities, districts and counties. The collected data were analyzed by descriptive statistics, t-test, ANOVA, Pearson’s correlation coefficient and multiple regression using IBM SPSS 27.0.
Results
The factors influencing work engagement were age, career development opportunity, and person-job fit. The explanatory power of these variables was 61%.
Conclusion
In order to enhance the work engagement of public health center workers in responding to future infectious disease outbreaks, it is necessary to develop various strategies such as assigning job roles that aligned with individual characteristics, providing career growth opportunities even during infectious disease outbreaks, and designing tasks by taking into account age.

The Relation among Uncertainty, Social Support, Care Burden of Mothers having Children with Developmental Disabilities: Kyoung Eun Jeong, Min Hyun Suk; Res Community Public Health Nurs. 2023;34(2):117-126. Published online June 30, 2023; DOI: https://doi.org/10.12799/rcphn.2022.00346

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Abstract PDF

Purpose
This descriptive correlation study aimed to confirm the relation among uncertainty, social support, care burden of mothers having children with developmental disabilities.
Methods
The participants were 111 mothers having children with autistic spectrum disorder or intellectual disability. The collected data were analyzed by descriptive statistics, t-test, ANOVA, Pearson’s correlation coefficient and multiple regression using IBM SPSS 23.0 in the study.
Results
Uncertainty and social support were significantly correlated to caregiver burden. As a result of multiple regression analysis, the factors affecting caregiver burden were children’s age, the expense for caring, the period suspected child disabilities, and uncertainty. These factors accounted for 40.8% of caregiver burden.
Conclusion
In order to reduce the burden of caring for mothers with children with developmental disabilities, it is necessary to establish a system that can detect children with developmental disabilities early and to develop and provide an integrated guide suitable for the growth and development stage of children with developmental disabilities.

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Spousal support, parent–nurse partnership and caregiver burden among parents of children with chronic diseases: A cross‐sectional study
Jihye Kim, Heemin Chae, Yoonjung Kim
Journal of Clinical Nursing.2024; 33(7): 2649. CrossRef

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

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.

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

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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.

Latent Classes of Depressive Symptom Trajectories of Adolescents and Determinants of Classes: Eun Joo Kim; J Korean Acad Community Health Nurs. 2022;33(3):299-311. Published online September 30, 2022; DOI: https://doi.org/10.12799/jkachn.2022.33.3.299

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Abstract PDF

Purpose
Untreated depression in adolescents affects their entire life. It is important to detect and intervene early depression in adolescence considering the characteristics of adolescent’s depressive symptoms accompanied by internalization and externalization. The aim of this study was to identify latent classes of depressive symptom trajectories of adolescents and determinants of classes in Korea. Methods: The three time-point (2018~2020) data derived from the Korean Children and Youth Panel Survey 2018 were used (N=2,325). Latent Growth Curve Modeling (LGCM) was conducted to explore the depressive symptom trajectories in all adolescents, and Latent Class Growth Modeling (LCGM) was conducted to identify each latent class. Multinomial logistic regression analysis was performed to confirm the determinants of each latent class. Results: The LGCM results showed that there was no statistically significant change in all adolescents' depressive symptoms for 3 years. However, the LCGM results showed that four latent classes showing different trajectories were distinguished: 1) Low-stable (intercept=14.39, non-significant slope), 2) moderate-increasing (intercept=19.62, significantly increasing slope), 3) high-stable (intercept=26.30, non-significant slope), and 4) high-rapidly decreasing (intercept=26.34, significantly rapidly decreasing slope). The multinomial logistic regression analysis showed that the significant determinants (i.e., gender, self-esteem, aggression, somatization, peer relationship) of each latent class were different. Conclusion: When screening adolescent’s depression, it is necessary to monitor not only direct depression symptoms but also self-esteem, aggression, somatization symptoms, and peer relationships. The findings of this study may be valuable for nurses and policy makers to develop mental health programs for adolescents.

Citations

Citations to this article as recorded by

How final year high school students’ depression develop during COVID-19 in China? A latent class growth modeling analysis
Xinyu Zhang, Guangdong Zhou
Current Psychology.2024; 43(13): 12221. CrossRef
What differentiates suicidal ideation from depressive symptoms amongst Korean young adults aged 20–39 years?
Jiwon Kang, Soong-nang Jang, Hyun-soo Kim
International Review of Psychiatry.2024; : 1. CrossRef
Factors Influencing Depression in Adolescents Focusing on the Degree of Appearance Stress
Mihye Lim, Myoungjin Kwon
Nursing Reports.2023; 13(1): 518. CrossRef

Risk Perceptions of Noncommunicable Diseases among Cambodian Adults: A Cross-Sectional Study: Sung Heui Bae, Ok Nam Hwang, Ji Eun Jeong, Young Ran Yang; J Korean Acad Community Health Nurs. 2022;33(2):259-268. Published online June 30, 2022; DOI: https://doi.org/10.12799/jkachn.2022.33.2.259

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Purpose
In Cambodia, noncommunicable diseases (NCDs) account for 64% of all deaths. A lack of risk perception of NCDs leads to poor measures of their prevention and management. This study aimed to investigate Cambodians’ risk perceptions of NCDs based on the health belief model. Methods A cross-sectional design was used, and using convenience sampling, participants included 200 Cambodians aged 40 years or older. A face-to-face administered structured questionnaire was used to assess demographic characteristics, health behaviors, and risk perceptions of NCDs. Results Of the constructs of NCD risk perception, perceived severity (88.2%) and benefits (86.3%) were high, but relative to these, perceived cues to action (64.1%), barriers (63.5%), and self-efficacy (58.1%) were low. Conclusion It is important to improve perceived self-efficacy in government health promotion, outreach, and improvement programs and to reduce perceived barriers through medical tests either by facility-based delivery or via outreach health services in Cambodia.

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Under-utilisation of noncommunicable disease screening and healthy lifestyle promotion centres: A cross-sectional study from Sri Lanka
Thilini Herath, Manuja Perera, Anuradhani Kasturiratne, Pracheth Raghuveer
PLOS ONE.2024; 19(4): e0301510. 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.

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