Healthy life of Korean patients with chronic kidney failure undergoing hemodialysis: A situation-specific nursing theory.

PURPOSE: This study explored to develop a situation-specific theory explaining the healthy life of Korean patients with chronic kidney failure undergoing hemodialysis. BACKGROUND: Chronic kidney failure (CKF) patients have to reorganize their lives around their hemodialysis sessions for their survival. Nursing interventions based on specific theories may promote their health-related behaviors and outcomes. However, few theoretical frameworks or theories are available to guide hemodialysis patients on how to construct their lives under various constraints, while considering their experiences and sociocultural contexts. METHODS: An integrated approach was used to develop the situation-specific theory based on the network episode model (NEM), a review of related literature, and four of the authors' studies on hemodialysis patients' lives. RESULTS: The major concepts in the proposed theory include sociocultural context, social networks, individual-level factors, illness experiences, health-related behaviors, and health outcomes. Each major concept includes several relevant subconcepts. CONCLUSIONS: We used this theory to identify factors involved in shaping the illness experiences, health-related behaviors, and outcomes of Korean CKF patients undergoing hemodialysis. By exploring the links between these factors, we explained the healthy life that considers the uniqueness of Korean patients' sociocultural context, social network, and individual-level factors. Nurse and other healthcare professionals could integrate the proposed situation-specific theory into the development of nursing interventions based on this theory to promote health-related behaviors and outcomes of Korean CKF patients undergoing hemodialysis.

Awareness, knowledge, social norms, and vaccination intentions among Khmer mother-daughter pairs.

Cervical cancer is caused by human papillomavirus (HPV) infection, which can be prevented by vaccination. Mothers play an important role in promoting vaccination and health education. However, Cambodian American mothers reported to have challenges to play a role as primary health educators due to lack of health knowledge and language and cultural gaps. Therefore, this study aims to understand the Cambodian American daughters' and mothers' awareness, knowledge and social norms of HPV vaccination and their health communication and vaccination decision-making.We conducted a pilot randomized clinical trial to promote HPV vaccination. In this study, we have only reported findings from baseline data examining individual, interpersonal and social determinants of HPV vaccination behavior among 19 dyads of Cambodian American mothers and daughters.Both mothers and daughters demonstrated low levels of awareness and knowledge. A significant relationship was found between the daughters' HPV vaccine decisions and their perception of their mothers' intention on HPV vaccination for them.Culturally and linguistically appropriate communication strategies such as storytelling or visual presentation approaches may be more effective than the current practice of using information-based written materials to promote HPV vaccination and health education among Cambodian Americans.

Overview of human papillomavirus vaccination policy changes and its impact in the United States: Lessons learned and challenges for the future.

BACKGROUND: The HPV vaccination is effective and safe for preventing HPV infection and HPV attributable cancers. Despite this fact, the uptake rate of the vaccination in the United States has remained below the national target of 80%. Health policy focused on allocating resources and creating vaccine-promoting environments can influence HPV vaccination coverage rates. There is a scarcity of information about the HPV vaccination-related health policy and its impact on the outcome of vaccine uptake. METHOD: We conducted a comprehensive review of HPV vaccination-related health policies at the federal, state, and professional organization levels and examined their impact on population health by reviewing national data on HPV vaccination uptake rates. RESULTS: The review revealed that (a) HPV vaccination recommendations, which serve as the federal-level HPV vaccination policy, have changed frequently in terms of gender, age criteria, and dosing schedule, and (b) the frequent changes of the policy have resulted in low uptake rates among male and young adult populations. DISCUSSION: The uptake rate should be continuously followed to evaluate the impact of recent changes to the federal-level HPV vaccination policy. State-level policies and healthcare professionals, including nurses, are important to the promotion of HPV vaccinations and decreasing HPV vaccination disparities.

Vitamin D deficiency and associated factors in south Korean childbearing women: a cross-sectional study.

BACKGROUND: Adequate levels of vitamin D are important for women of childbearing age as vitamin D helps maintain the pregnancy and ensures proper maternal and fetal bone metabolism and fetal skeletal development. However, vitamin D deficiency is a health problem prevalent in women of all ages, worldwide. This study aimed to determine the current status of serum vitamin D levels and the risk factors for vitamin D deficiency among South Korean nurses of childbearing age. METHODS: Serum levels of 25-hydroxyvitamin D (25[OH]D) were measured in 1594 registered nurses aged 20 to 45 years who are participants in an ongoing prospective cohort study of the Korean Nurses' Health Study initiated in 2013. The participants completed surveys about demographic and occupational characteristics and physical and psychological health. We examined associations with vitamin D deficiency through multivariable logistic regression analysis. RESULTS: The average blood 25(OH) D concentration of the participants was 12.92 ng/mL (4.0-63.4 ng/mL), while the prevalence of vitamin D deficiency (< 20 ng/mL) was 89% (1419/1594). Multivariable logistic regression showed that significant risk factors for vitamin D deficiency included month of sampling (there was a lower level of vitamin D deficiency in winter than in spring, summer, or fall), age (women in their 20s had a lower vitamin D level than those in their 30s and 40s), and stress symptoms. Vitamin D levels were not associated with body mass index, physical activity, and depressive symptoms. CONCLUSIONS: This study showed a high prevalence of vitamin D deficiency in Korean female nurses. Serum levels of vitamin D were associated with age and season. Vitamin D deficiency should be recognized as one of the primary health concerns among young women. More proactive actions, such as vitamin D supplements and food fortification, are needed to improve vitamin D deficiency in high-risk groups.

Development and acceptability of a peer-paired, cross-cultural and cross-generational storytelling HPV intervention for Korean American college women.

Although Korean American women have a higher risk of developing cervical cancer, currently there are limited culturally relevant intervention strategies for improving primary prevention of cervical cancer by promoting HPV vaccination in this population. This study reports the development of a cross-cultural, cross-generational storytelling HPV intervention using a peer-paired method, in which two storytellers interactively share their stories, as a particular innovation that might resonate with Korean American young women. The acceptability of the intervention was assessed by self-reported satisfaction and endorsement with the intervention in a pilot randomized control trial (RCT). We compared participants' responses to the intervention by their generation and cultural identity. One hundred and four Korean college women between the ages of 18-26 were recruited from the Northeastern US Participants randomized to the intervention group received a storytelling video (n = 54); the comparison group received written information (n = 50). The acceptability of the intervention was measured immediately post-intervention. The intervention group had significantly greater satisfaction than the comparison group (P < 0.05). Participants reported greater endorsement for videos that reflected their cultural and generational experiences. Future study is needed to examine the impact of such interventions on objective follow-up on HPV vaccination in a large-scale RCT.

HPV Vaccination and Korean American College Women: Cultural Factors, Knowledge, and Attitudes in Cervical Cancer Prevention.

Human papillomavirus (HPV) is the most prevalent sexually transmitted infection that leads to nearly all cervical cancers in the United States (U.S.), which could be prevented with the HPV vaccine. Korean American women experience a high burden of cervical cancer, but little is known about their awareness, knowledge, attitudes, sociocultural factors and social network/support related to intention to obtain the HPV vaccine. This study reports baseline characteristics of 104 Korean American college women aged 18-26 and who have not been previously vaccinated against HPV, as part of a pilot randomized controlled trial testing feasibility, acceptability, and preliminary effectiveness of an HPV storytelling intervention. Data were analyzed including descriptive statistics, bivariate analysis, and multivariate logistic regression. Multivariate logistic regression was performed to understand the relationship between independent predictors of intention to receive HPV vaccination. Overall, 34.6% of participants intended to obtain the vaccine. Positive predictors of intention to receive HPV vaccine were: years in the U.S., academic major, awareness of HPV and HPV vaccine, knowledge, and HPV recommendation by healthcare provider and parents. The multivariate logistic model showed that intention to receive the HPV vaccine was significantly associated with HPV vaccine recommendation by parents (OR 4.58, 95% CI 1.37-15.36) and knowledge (OR 1.11, 95% CI 1.11-1.22). These findings suggest a need for development of interventions that are not only culturally tailored but also acculturation-sensitive to promote HPV vaccination among Korean American college women. This may play a significant role in cervical cancer prevention among Korean American college women.

Using narrative intervention for HPV vaccine behavior change among Khmer mothers and daughters: A pilot RCT to examine feasibility, acceptability, and preliminary effectiveness.

PURPOSE: To develop a theory-guided culturally grounded narrative intervention to promote HPV vaccination behavior and examine the feasibility, acceptability, and preliminary effectiveness of the intervention among dyads of Cambodian American mothers and daughters. METHOD: The principles of community-based participatory research guided the development and evaluation and involved two phases: Phase 1: Development of storytelling narrative intervention videos which focused on a series of HPV vaccination-related messages and which integrated the narrative theory with the revised network episode model (rNEM); Phase 2: conducting the pilot RCT with 19 dyads of Khmer mothers and daughters aged from 14 to 17years to examine the feasibility and acceptability of the study. FINDINGS: Recruitment was completed in 7months with an overall retention of 84%. The acceptability of the intervention was high, as reflected by the number of positive comments on the narrative video. Preliminary data indicate that vaccine uptake at one-month follow-up was the same (2 vs. 2) between intervention and control groups. However, daughters in the narrative intervention group reported higher intention to receive HPV vaccination within one month compared to the control group (4 vs. 1). CONCLUSION: All the procedures to inform a full RCT were examined, including identification of eligible participants, recruitment, randomization, intervention adherence, and short-term follow-up. The positive preliminary outcomes and feedback support the feasibility and potential effectiveness of the theory-guided narrative intervention.

Factors Associated with HPV Vaccination among Cambodian American Teenagers.

OBJECTIVES: Parents have general influence over their children's health and health behavior. However, given the dearth of specific literature regarding knowledge level and social and cultural factors influencing HPV vaccination behaviors among Cambodian American (CA) parent, it is difficult to develop an effective, evidence-based public health HPV vaccination program. Therefore, the objectives of this study were to determine the HPV vaccine uptakes among CA teenagers and to examine factors influencing HPV vaccine uptakes. DESIGN AND SAMPLE: A descriptive, cross-sectional survey design and a combination of network and targeted sampling methods were used. RESULTS: CA mothers (n = 130) completed a health survey through face-to-face interviews in either English or Khmer language. Girls vaccination rates were 29% while that of boys was 16%. Awareness and knowledge of HPV among CA mothers was very low, and many believed that their daughters, who speak English and were educated in the U.S., had more knowledge about health than they did. Logistic regression analysis showed that CA girls had significantly higher odds of vaccination when their mothers possessed a higher level of English reading ability and had greater awareness and knowledge of HPV. CONCLUSIONS: The strikingly low rates of HPV vaccination among CA girls and boys underscore the need to improve vaccination outreach, education, and uptake. The findings can be used to develop targeted public health HPV vaccination programs for CAs, which will reduce cervical cancer disparities.

Storytelling/narrative theory to address health communication with minority populations.

PURPOSE: To explain the development and application of storytelling/narrative theory in health disparities intervention research as a way to promote health communication and behavior change among racial, ethnic, and minority populations. FINDINGS: The proposed storytelling theory helps explain that storytelling affects changes in attitude and health behavior of the viewer through realism, identification, and transportation. CONCLUSIONS: The proposed storytelling/narrative theory can be a guide to develop culturally grounded narrative interventions that have the ability to connect with hard-to-reach populations. CLINICAL RELEVANCE: Narrative communication is context-dependent because it derives meaning from the surrounding situation and provides situation-based stories that are a pathway to processing story content. Although storytelling is grounded in nursing practice and education, it is underutilized in nursing interventional research. Future efforts are needed to extend theory-based narrative intervention studies designed to change attitude and behaviors that will reduce health disparities among minorities.

Recognizing global disparities in health and in health transitions in the 21st century: what can nurses do?

PURPOSE: To examine changes in patterns of health and disease in global context between rich countries (USA, Korea, South Africa) and poor countries (Cambodia, Malawi) by using the framework of epidemiology theory developed by Orman (1971, 2005), and to raise awareness of global health disparities thereby prompting actions to reduce such disparities. FINDINGS: 1) Life expectancy has increased across all selected countries except South Africa; 2) Korea and the USA have substantially lower mortality rates than other countries; 3) Infant and maternal mortality are still high in the poor countries; 4) The major cause of mortality in the poor countries is still communicable disease with evidence of the onset of non-communicable disease; and 5) The health transition theory provides a description and explanation of the differences in progress in economic development between countries but fails to explain differences in health status within and between countries. CONCLUSIONS: Life expectancy and mortality are enormously different among the five selected countries. This excessive health disparity is primarily due to the higher risk of communicable diseases in low-income countries. Social determinants of health are mainly responsible for the health disparities observed within and between countries. CLINICAL RELEVANCE: Future health care development and global research priorities will not be the same for all countries because the pattern of health transitions in the developing countries is not the same as the developed countries. Actions to reduce global health disparities need to recognize the conditions and social context in which persons live. An effective strategic approach to global health equality should develop a shared system of values, priorities, and delivery infrastructures with the populations who are targeted, aligning delivery within the local social contexts.

HBV-related health behaviors in a socio-cultural context: perspectives from Khmers and Koreans.

PURPOSE: The aim of this study is to explore factors influencing health and health care within the sociocultural context of Cambodian Americans (CAs or Khmers) and Korean Americans (KA) and to examine intergroup similarities and differences between CAs and KAs, focusing on hepatitis B virus (HBV) and liver cancer prevention behaviors. METHODS: The study used a qualitative design guided by the revised Network Episode Model (NEM) and informed by ethnographic analysis. Focus group interviews with key informants among CA community health leaders (CHLs, n=14) and individual interviews with key informants of KA CHLs (n=9) were audiotaped and transcribed. RESULTS: Three categories that influenced HBV and liver cancer prevention emerged from both CAs and KAs: the socio-cultural, individual, and behavioral. Four additional subcategories (sub-themes) of sociocultural were identified as socio-history, socio-medicine, socio-linguistic, and socio-health resources. Both CAs and KAs, however, have low levels of knowledge and significant misunderstandings about HBV infection. CONCLUSIONS: The study identifies and compares the social-cultural determinant for HBV and liver cancer and highlights the factors of education, intercultural communication, and interactions within socio-cultural contexts of CA and KA subgroups. In general, conceptual overlaps are apparent between Khmers (from now on, the terms, CA and Khmer, will be used interchangeably) and Koreans except for the sub-theme of socio-history. However, differences in concept-specific attributes point to the need to account for differing conceptualizations and implications of specific ethnic groups' sociocultural contexts, and to design contextually-relevant outreach and educational interventions for targeted AAPI subgroups.

Asian flushing: genetic and sociocultural factors of alcoholism among East asians.

Alcohol use can lead to a cascade of problems such as increased chances of risky behavior and negative health consequences, including alcoholic liver disease and upper gastric and liver cancer. Ethanol is metabolized mainly by 2 major enzymes: alcohol dehydrogenase (ADH) and acetaldehyde dehydrogenase (ALDH). Genetic variations of genes encoding the 2 enzymes are very common among East Asians but relatively rare for most other populations. Facial flushing and other physical discomforts after alcohol drinking triggered by accumulation of acetaldehyde through defective genes for ADH and ALDH have been reported. Approximately 40% of East Asians (Chinese, Japanese, and Korean) show facial flushing after drinking alcohol, known as "Asian flush," which is characterized by adverse reactions on alcohol drinking in individuals possessing the fasting metabolizing alleles for ADH, ADH1B*2, and ADH1C*1, and the null allele for ALDH and ALDH2*2. Alcoholism is determined not only by the genetic deficiency but also by behaviors that involve complex interactions between genetic and sociocultural factors. The purpose of this article was to provide nurses with the most current information about genetic and sociocultural influences on alcoholism and alcohol-related health problems specifically for East Asians and implications of this knowledge to nursing practice. The physiological phenomenon of genes and genetics in relation to alcohol metabolism in this special population is emphasized.

Mobile health-delivered narrative intervention to increase cervical cancer screening among Malawian women living with HIV: A pilot randomized controlled trial.

Objective: This study aimed to develop and evaluate a mobile health (mHealth)-delivered, theory-guided, culturally tailored storytelling narrative (STN) intervention to increase cervical cancer screening among Malawian women living with human immunodeficiency virus (HIV). Methods: This study involved two phases: Phase 1: development of a theory-guided and culturally adapted STN intervention and Phase 2: a pilot randomized controlled trial was conducted. Participants were randomly assigned to one of three arms: Arm 1: tablet-based video (mHealth) with STN (n = 60); Arm 2: mHealth with a video of nonnarrative educational materials (n = 59); and Arm 3: control group with only reading nonnarrative educational materials in person (n = 60). Cervical cancer screening was measured using visual inspection with acetic acid (VIA) uptakes by self-report and health passport record review at 2 and 6 months after intervention. Results: Both arms 1 and 2 had nearly twice the rate of VIA uptakes than those in Arm 3 (51.0% and 50.0%, respectively, vs. 35.0%, P = 0.01) at 2 months follow-up, but there were no differences among groups from 2- to 6-month follow-ups. All groups demonstrated significant improvement of knowledge about risk factors, intention, and VIA uptakes. Conclusions: The findings demonstrate the preliminary effectiveness of the intervention on cervical cancer screening behavior and the feasibility of the study regarding recruitment, retention, treatment fidelity, and acceptability of the single 30-min session. The feasibility and the preliminary results of the effectiveness of the proposed study indicate scaling up the STN intervention to a larger population of women to increase cervical cancer screening uptake to prevent deaths due to cervical cancer in Malawi.

Why isn't evidence based practice improving health care for minorities in the United States?

Achieving health equity by improving the health care of all racial/ethnic groups is one of the key goals of Healthy People 2020. The implementation of evidence based practice (EBP) has been a major recommendation to achieve health equity in hopes of eliminating the subjectivity of clinical decision making. However, health disparities among racial/ethnic minorities are persistent in spite of the adoption of standardized care based on evidence. The EBP with racial and ethnic minorities is often seen as a possible cause of health and health care disparities. Three potential issues of using EBP to reduce health disparities have been identified: (1) a lack of data for EBP with ethnic/racial minority populations; (2) limited research on the generalizability of the evidence based on a European-American middle-class; and (3) sociocultural considerations in the context of EBP. Using EBP to reduce disparities in health care and health outcomes requires that nurse professionals should know how to use relevant evidence in a particular situation as well as to generate knowledge and theory which is relevant to racial/ethnic minorities. In addition, EBP implementation should be contextualized within the sociocultural environments in which patients are treated rather than solely focusing on the health problems.

Using community-based geographical information system (GIS) to recruit older Asian Americans in an Alzheimer's disease study.

OBJECTIVE: This study aims to show the usefulness of incorporating a community-based geographical information system (GIS) in recruiting research participants for the Asian Cohort for Alzheimer's Disease (ACAD) study for using the subgroup of Korean American (KA) older adults. The ACAD study is the first large study in the USA and Canada focusing on the recruitment of Chinese, Korean and Vietnamese older adults to address the issues of under-representation of Asian Americans in clinical research. METHODS: To promote clinical research participation of racial/ethnic minority older adults with and without dementia, we used GIS by collaborating with community members to delineate boundaries for geographical clusters and enclaves of church and senior networks, and KA serving ethnic clinics. In addition, we used socioeconomic data identified as recruitment factors unique to KA older adults which was analysed for developing recruitment strategies. RESULTS: GIS maps show a visualisation of the heterogeneity of the sociodemographic characteristics and the resources of faith-based organisations and KA serving local clinics. We addressed these factors that disproportionately affect participation in clinical research and successfully recruited the intended participants (N=60) in the proposed period. DISCUSSION: Using GIS maps to locate KA provided innovative inroads to successful research outreach efforts for a pilot study that may be expanded to other underserved populations across the USA in the future. We will use this tool subsequently on a large-scale clinical genetic epidemiology study. POLICY IMPLICATION: This approach responds to the call from the National Institute on Aging to develop strategies to improve the health status of older adults in diverse populations. Our study will offer a practical guidance to health researchers and policymakers in identifying understudied and hard-to-reach specific Asian American populations for clinical studies or initiatives. This would further contribute in reducing the health and research disparity gaps among older minority populations.

Correlates of hepatitis B virus health-related behaviors of Korean Americans: a situation-specific nursing theory.

PURPOSE: The purpose of this article is to explain the evolution of a situation-specific theory developed to enhance understanding of health-related behaviors of Korean Americans (KAs) who have or are at risk for a chronic hepatitis B virus (HBV) infection. ORGANIZING CONSTRUCT: The situation-specific theory evolved from an integration of the Network Episode Model, studies of health-related behaviors of people with HBV infection, and our studies of and practice experiences with Asian American individuals with HBV infection. FINDINGS: The major concepts of the theory are sociocultural context, social network, individual-level factors, illness experience, and health-related behaviors. CONCLUSIONS: The major propositions of the theory are that sociocultural context, social network, and individual-level factors influence the illness experience, and that sociocultural context, social network, individual-level factors, and the illness experience influence health-related behaviors of KAs who have or are at risk for HBV infection. CLINICAL RELEVANCE: This situation-specific theory represents a translation of abstract concepts into clinical reality. The theory is an explanation of correlates of health-related HBV behaviors of KAs. The next step is to develop and test the effectiveness of a nursing intervention designed to promote behaviors that will enhance the health of KAs who have or are at risk for HBV infection, and that takes into account sociocultural context, social network, individual-level factors, and illness experience.

Examine Race/Ethnicity Disparities in Perception, Intention, and Screening of Dementia in a Community Setting: Scoping Review.

BACKGROUND: Delayed detection and diagnosis of Alzheimer's Disease and related dementia (ADRD) can lead to suboptimal care and socioeconomic burdens on individuals, families, and communities. Our objective is to investigate dementia screening behavior focusing on minority older populations and assess whether there are ethnic differences in ADRD screening behavior. METHODS: The scoping review method was utilized to examine ADRD screening behavior and contributing factors for missed and delayed screening/diagnosis focusing on race/ethnicity. RESULTS: 2288 papers were identified, of which 21 met the inclusion criteria. We identified six dimensions of ADRD screening behavior: Noticing Symptoms, Recognizing a problem, Accepting Screen, Intending Screen, Action, and Integrating with time. Final findings were organized into study race/ethnicity, theoretical background, the methods of quantitative and qualitative studies, description and measures of ADRD screening behavior, and racial/ethnic differences in ADRD screening behavior. CONCLUSIONS: A trend in ethnic disparities in screening for ADRD was observed. Our findings point to the fact that there is a scarcity of studies focusing on describing ethnic-specific ADRD screening behavior as well as a lack of those examining the impact of ethnicity on ADRD screening behavior, especially studies where Asian Americans are almost invisible.

Ethnicity, Social, and Clinical Risk Factors to Tooth Loss among Older Adults in the U.S., NHANES 2011-2018.

BACKGROUND: Many older adults suffer from poor oral health, including tooth loss, and disparities among racial/ethnic and socially disadvantaged populations continue to exist. METHODS: Data were obtained from the National Health and Nutrition Examination Survey among the adult population in the U.S. The prevalence of edentulism and multiple regression models were conducted on 15,821 adults, including Asians, Blacks, Hispanics, Whites, and others to assess the relationships between tooth loss and their predictors. RESULTS: The prevalence of complete tooth loss increased with age from 0.7% for ages 20-44 to 20.2% for ages 65 and over. There are disparities in complete tooth loss regarding race/ethnicity, with the highest percentages (9%) among Whites and Blacks and the lowest percentages among Asians (3%) and Hispanics (4%). After adjusting for predictors, their impact on tooth loss was not consistent within racial/ethnic groups, as Asians had more tooth loss from Model 1 (ß = -1.974, p < 0.0001) to Model 5 (ß = -1.1705, p < 0.0001). CONCLUSION: Tooth loss was significantly higher among older adults and racial/ethnic groups even after controlling for other predictors among a nationally representative sample. The findings point to the fact that subgroup-tailored preventions are necessary.