Age and Gender Differences in Fall-Related Factors Affecting Community-Dwelling Older Adults.

BACKGROUND: Falls are one of the major adverse events affecting older adults that can result in serious injuries. Hospitalizations and deaths because of fall-related injuries have been increasing. Nevertheless, there is a dearth of studies examining the physical condition and current exercise habits of older adults. Moreover, studies analyzing the role of factors related to fall risk by age and gender in large populations are also scarce. PURPOSE: This study was designed to investigate the prevalence of falls among community-dwelling older adults and elucidate the effects of age and gender on the related factors using a biopsychosocial model. METHODS: This cross-sectional study utilized data from the 2017 National Survey of Older Koreans. On the basis of the biopsychosocial model, the biological factors related to falls included chronic diseases, number of medications, visual difficulties, activity of daily living (ADL) dependence, lower-limb muscle strength, and physical performance; psychological factors included depression, cognitive ability, regular smoking, alcohol consumption, nutritional status, and exercise; and the social factors included educational level, annual income, living conditions, and instrumental ADL dependence. RESULTS: Of the 10,073 older adults surveyed, 57.5% were women and approximately 15.7% had experienced falls. The results of the logistic regression showed that, in men, falls were significantly associated with taking more medications and being able to climb 10 stair steps; in women, falls were significantly associated with poor nutritional status and instrumental ADL dependence; and in both genders, falls were significantly associated with greater depression, ADL dependence, and the presence of more chronic diseases and negatively associated with physical performance. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The results suggest that practicing kneeling and squatting is the most effective strategy for reducing fall risk in older adult men and that improving nutritional status and strengthening physical ability is the most effective strategy for reducing fall risk in older adult women.

The Influence of Social Structure on Cancer Pain and Quality of Life.

The aim of this study was to investigate whether social structure is associated with cancer pain and quality of life using the Social Structure and Personality Research Framework. This study was a secondary analysis of data from 480 cancer patients. The measurements included socioeconomic variables, self-reported cancer pain using the McGill Pain Questionnaire-Short Form (MPQ-SF), and quality of life measured using the Functional Assessment of Cancer Therapy Scale (FACT-G). The data were analyzed using moderated multiple regression. Cancer pain and quality of life differed significantly with income. The associations between income and pain and quality of life were significant only for the high education group (≥ partial college), and these associations were greater for Caucasians than for their counterparts ( p < .05). When developing interventions, nurses should consider the influence of socioeconomic variables on pain and quality of life while considering possible moderating factors such as education.

Factors Associated With Medication Adherence Among Medical-Aid Beneficiaries With Hypertension.

The purpose was to examine factors associated with medication adherence among medical-aid beneficiaries with hypertension using the Expanded Behavioral Model of Health Services Utilization. A cross-sectional study was conducted with a convenient sample of 289 patients. The instruments included scales to measure medication adherence, health literacy, general self-efficacy, and pros and cons of chronic disease management. Data collection was performed between February and March 2011. A hierarchical regression analysis was performed. The study found that 25.6% to 34.6% had low motivation and low knowledge regarding medication adherence. Those with higher health literacy and higher self-efficacy scores were more likely to have higher medication adherence, whereas widowed and those who perceived more cons of chronic disease management were more likely to have lower medication adherence than their counterparts (p < .05). Interventions incorporating significant factors associated with medication adherence are required to enhance medication adherence and to prevent complications associated with medication non-adherence.

Racial/Ethnic Differences in Cardiovascular Symptoms in Four Major Racial/Ethnic Groups of Midlife Women: A Secondary Analysis.

Ethnic minority midlife women frequently do not recognize cardiovascular symptoms that they experience during the menopausal transition. Racial/ethnic differences in cardiovascular symptoms are postulated as a plausible reason for their lack of knowledge and recognition of the symptoms. The purpose of this study was to explore racial/ethnic differences in midlife women's cardiovascular symptoms and to determine the factors related to these symptoms in each racial/ethnic group. This was a secondary analysis of the data from a larger study among 466 participants, collected from 2006 to 2011. The instruments included questions on background characteristics, health and menopausal status, and the Cardiovascular Symptom Index for Midlife Women. The data were analyzed using inferential statistics, including Poisson regression and logistic regression analyses. Significant racial/ethnic differences were observed in the total numbers and total severity scores of cardiovascular symptoms (p < .01). Non-Hispanic Asians had significantly lower total numbers and total severity scores compared to other racial/ethnic groups (p < .05). The demographic and health factors associated with cardiovascular symptoms were somewhat different in each racial/ethnic group. Further studies are needed about possible reasons for the racial/ethnic differences and the factors associated with cardiovascular symptoms in each racial/ethnic group.

Economic differences in risk factors for obesity among overweight and obese children.

The purpose of the study was to identify the economic differences in familial, physiological, psychological, and lifestyle characteristics associated with overweight and obese children in South Korea. A total of 407 overweight and obese children participated in the study. The obesity rate was 69.0% and the prevalence of metabolic syndrome (MS) was 33.3% in the low-income bracket, and the prevalence of MS was 27.2% for the population. The children in the low-income group were more prone to have poor eating behavior and more likely to spend more than 2 hr viewing television. They also were more likely to have lower self-esteem and more depressive symptoms. School nurses should understand that risk factors for childhood obesity are more prevalent in low-income groups, which will eventually aggravate health disparities between socioeconomic status groups. Therefore, prevention programs for childhood obesity, which target high-risk groups of such children need to be developed and prioritized.

Factors associated with screen time among school-age children in Korea.

The purpose of this study was to investigate the association of sociodemographic, psychosocial, and behavioral characteristics with screen time among school-age children in Korea. This study employed a nonexperimental, cross-sectional study design. A total of 370 children attending four elementary schools participated in the study. Self-report method was used, and instruments included screen time (time spent on TV/video/computer/video games), sleep duration, eating behavior, pros and cons of exercise, and exercise self-efficacy. According to the results, 45.7% of the children had screen time of 1-2.9 hr/day and 8.9% had 3 or more hr/day. Increased screen time showed an association with gender (boy), higher body mass index, fast food consumption, higher cons of exercise, having a working mother, and attendance at a school in an inner city area (p < .05). Understanding the factors associated with screen time may provide useful information in the development of health promotion programs aimed at decreasing sedentary behaviors.

Perception and needs in health education curriculum among school nurses as health teachers in Korea.

The study investigated perceived effectiveness and perceived barriers to health education curriculum targeting school nurses as health teachers in Korea. A total of 741 health teachers participated. The questionnaire included perceived effectiveness and perceived barriers to health education curriculum, future roles of health teachers, and needs for in-service training programs. The most frequently selected perceived barrier was a lack of personnel to serve in the health clinic when the nurse was teaching, although 60.9-61.7% wanted to continue both duties of health education and school health services. Perceived effectiveness of health education was positively associated with duration of teaching career (p < .05). Elementary school health teachers had higher perceived effectiveness than those in middle and high schools, while those with bachelor's degrees had lower perceived effectiveness than those with master's degrees (p < .05). In-service training and efforts to decrease the perceived barriers would help to offer effective health education.

[Validation of a needs assessment tool for case management in Korean medical aid beneficiaries].

PURPOSE: The purpose of this study was to validate the Needs Assessment Tool for Case Management (NATCM) for use with Korean medical aid beneficiaries. METHODS: Psychometric testing was performed with a sample of 645 Korean medical aid beneficiaries, which included 41 beneficiaries who were selected using proportional sampling method, to examine intraclass correlation coefficients (ICC). Data were evaluated using item analyses, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), Cronbach's alpha, and ICC. RESULTS: Through psychometric testing the final version of NATCM was found to consist of two subscales: 1) Appropriateness of Health Care Utilization (5 items) and 2) Self Care Ability (6 items). The two subscale model was validated by CFA (RMSEA=.08, GFI=.97, and CFI=.93). Internal consistency measured by Cronbach's alpha was .82, and subscale reliability ranged from .79 to .84. The ICC of the NATCM between case managers was .73 and between case managers and health care professionals. .82. CONCLUSION: This study suggests that the final version of NATCM is a brief, reliable, and valid instrument to measure needs of Korean medical aid beneficiaries. Therefore, the NATCM can be effectively utilized as an important needs assessment as well as outcome evaluation tool for case management programs in Korea.

Multilevel analysis of health care service utilization among medical aid beneficiaries in Korea.

PURPOSE: The current study was done to identify individual- and group-level factors associated with health care service utilization among Korean medical aid beneficiaries by applying multilevel modeling. METHODS: Secondary data analysis was performed using data on health care service reimbursement and medical aid case management progress from 15,948 beneficiaries, and data from 229 regions were included in the analysis. RESULTS: Results of multilevel analysis showed an estimated intraclass correlation coefficient (ICC) of 18.1%, indicating that the group level accounted for 18.1% of the total variance in health care service utilization, and that beneficiaries within the region are more likely to share common features with regard to health care service utilization. At the individual level, existence of disability and types of medical aid beneficiaries showed a significant association, while, at the group level, social deprivation index, and the number of beneficiaries and case managers within the region showed a significant association with health care service utilization. CONCLUSION: The significant influence of group level variables in health care service utilization found in this study indicate a need for group level approaches, such as policy change and/or promotion of community awareness.

Factors associated with the overuse or underuse of health care services among medical aid beneficiaries in Korea.

PURPOSE: To compare and contrast demographic characteristics and health care service utilization between overusers and underusers of health care services and to identify factors associated with the overuse or underuse of health care services among the medical aid beneficiaries in Korea. METHODS: Secondary data analysis was performed using health care costs and medical aid case management progress data. Data on demographic characteristics, health-related quality of life (HRQoL), and inappropriate health care service user category (overuse or underuse) were provided by the Medical-Aid Case Management Center of Korea, and heath care service reimbursement data were provided by the Korea National Health Insurance Corporation (NHIC). Data on 22,697 beneficiaries were used for analysis, and logistic regression analysis was conducted to examine factors that are associated with overuse and underuse of health care services. RESULTS: The study results revealed that older individuals, women, unemployed individuals, type 1 medical aid beneficiaries, and those with higher education and disabilities were more likely to belong to the overuse group, but urban residents, compared to metropolitan residents, and those with higher HRQoL were more likely to belong to the underuse group (p < .05). CONCLUSIONS: Understanding factors associated with the overuse or underuse of health care services may help to provide tailored case management services to improve the HRQoL of the beneficiaries and optimize their use of health care services. CLINICAL RELEVANCE: Promoting appropriate use of health care services may enhance clients' quality of life and preserve resources for other essential services for medical aid beneficiaries.

Predictors of health-related quality of life among low-income midlife women.

The purpose of this study was to determine whether any of the sociodemographic, biomedical, psychosocial, and medical-care factors independently predict health-related quality of life (HRQoL) among low-income women. Cross-sectional data were used to predict factors that determine HRQoL. A survey was conducted targeting a convenience sample of 200 midlife women. Blood samples were drawn from all participants, who also received a physical examination. Hierarchical multiple regression analysis was used to test the independent effects of each factor. The study found that sociodemographic and psychosocial factors were independently associated with HRQoL. Compared to married women, widowed or divorced women had significantly lower HRQoL, whereas those with higher levels of stress perception and those not performing regular exercise had significantly lower HRQoL (p < .01). The full model accounted for 44.7% of the variance in HRQoL. The HRQoL of low-income midlife women was associated with multiple factors, with stress perception exerting the major influence.

Health promotion health center project.

OBJECTIVES: As part of a major government support for health promotion, a health promotion health center (HPHC) project was launched at the national level in Korea. The purpose of the study was to describe this 2-year HPHC project within the framework of the Ottawa Charter for Health Promotion and to evaluate the preliminary outcomes of the community residents. DESIGN: A cross-sectional design was used. SAMPLE: A total of 2,261 community residents participated in the survey, with 792 in HPHC sites and 1,469 in non-HPHC sites. MEASUREMENT: The instrument included questions on participants' demographic characteristics, awareness, participation, health behavior (smoking, exercise, meat consumption, and blood pressure checkup), and satisfaction with the health promotion programs. RESULTS: The 5 main health promotion strategies of the Ottawa Charter were evident in the HPHCs. HPHCs were successful in enhancing awareness, participation, and satisfaction through their health promotion programs, although health behaviors were not significantly different between the 2 groups, except exercise. CONCLUSION: Ottawa Charter strategies embedded within the practice of the community health promotion activities were effective in increasing the short-term outcomes (awareness, participation, and satisfaction with health promotion programs), which is a promising finding for the development of health promotion behaviors in the future.

Predictors of health services utilization by hypertensive patients in South Korea.

OBJECTIVES: The purpose of this study was to elucidate the factors that influence making contact with health care services after a diagnosis of hypertension and the volume of health services utilization by the hypertensive patients. METHODS: A secondary data analysis with 3 data sets, including health screening, health survey, and national health insurance reimbursement data. Data on 841,630 public servants aged between 21 and 65 years who underwent health screenings in 2000 and 2002 were provided by the National Health Insurance Cooperation. RESULTS: Of the 841,630 screened participants, 204,099 (24.25%) were hypertensives and 9,057 (1.08%) were newly diagnosed as having hypertension. Age, sex, systolic blood pressure, comorbidity, alcohol consumption, and tobacco use were significantly associated with making contact with health care services, while age, sex, place of residence, occupation, body mass index, systolic and diastolic blood pressure, comorbidity, alcohol consumption, and tobacco use were significantly associated with the volume of health services utilized by the hypertensive patients. CONCLUSIONS: Health professionals should devise strategies to encourage nonusers and inappropriate users of health services to obtain timely health services while considering the factors that influence making contact with health care services and the volume of health services utilization.

Factors associated with physical inactivity among korean men and women.

OBJECTIVES: To identify the independently associating factors on physical inactivity in Korean men and women. METHODS: The data of 5554 men and women (18-74 years) were analyzed using national health and nutritional examination survey data that included questionnaires and physical examinations. RESULTS: Multiple logistic regression analyses showed that significant factors were low monthly income, low education, current smoking, increased waist-to-hip ratio, and low health concern among men; living in rural areas, low monthly income, low education, perceived poor health status, low health concern, and emotional stress among women. CONCLUSIONS: Health care providers should focus on education and counseling regarding the factors that influence physical inactivity.

Stages and processes of smoking cessation among adolescents.

The purpose of this study was to identify the stages and processes of change related to smoking cessation among vocational technical high school students to provide baseline data for smoking cessation programs. Cross-sectional data were collected in April and May, 2004, from 300 male students at three vocational technical high schools in Korean metropolitan areas. The survey instruments included: decisional balance; self-efficacy; nicotine dependence; stages and processes of change; and knowledge related to smoking. The results indicated that 31.7%, 39.2%, and 29.1% of current smokers were in the precontemplation, contemplation, and preparation stages, respectively, and that 42.6% and 57.4% of former smokers were in the action and maintenance stages, respectively. Decisional balance, self-efficacy, and nicotine dependence were significantly associated with the stages of change. Regarding the processes of change, only behavioral processes were significantly associated with the stages of change, with experiential processes showing no significant relationship. The study results suggest that smoking cessation programs should emphasize behavioral strategies to help students progress through the stages.

The intention of future mammography screening among Korean women.

The purpose of this study was to understand factors that influence future mammography intention and to differentiate significant factors influencing future mammography intention between those who have past mammography experience and those who do not. A cross-sectional study design was used to analyze characteristics and factors that influence the intention to have a mammogram among middle-aged Korean women. A total of 310 women, aged 30 and older, participated in the study. The study results indicated that a combination of the Health Belief Model and the Theory of Reasoned Action was effective in predicting mammography intention of Korean women. It found that knowledge, perceived benefits, self-efficacy, and the subjective norm were significant factors affecting mammography intention in women who have past mammography experience. For women who have never had a mammogram, age, knowledge, perceived benefits, and self-efficacy provided a significant contribution to predicting mammography intention. Thirty-three to 43% of the variability in mammography intention can be explained by the combined influence of these independent variables. The findings from this study can be used to guide the design and implementation of tailored health education and promotion programs for Korean women according to their mammography experience, so as to increase mammography screening.

Effects of a national health promotion project on knowledge, perception, and competency of health care workers in Korea.

The purpose of this study was to measure the effect of the demonstration health promotion projects on whether knowledge, perceptions, and competencies of health care workers in health centers improved as a result of participating in the health promotion projects. A total of 1,955 community health care workers were recruited for the study. Health care workers from 18 demonstration health centers (n = 728) were assigned to the study group. The remaining 1,227 health care workers from 36 health centers, who have not participated in the demonstration projects, were assigned to the control group. Mailed-out questionnaires were used to measure knowledge and perceptions related to health promotion programs, and competencies in carrying out health promotion programs of health care workers for both groups. The results indicated that knowledge, perception, and competency of health care workers who participated in the demonstration projects were significantly higher than those who had not; but at the same time, those participants of demonstration projects might be under stress due to the extra assignments required by the projects. For effective health promotion programs, there is a need to supplement the staff in the health centers to take charge of health promotion programs.

A comparison of smoking control strategies in Korea and the United States.

The purpose of this study was to compare smoking control strategies between Korea and the United States. Korea and other developing countries may learn from the experience of the United States in dealing with the growing epidemic of cigarettes. In particular, smoking control objectives, structures, laws and regulations, funds, programs and activities, research, and surveillance systems were compared. The comparison was conducted at the federal, states/provincial, and county levels of the two countries. The data were collected through various governmental websites, contact with people directly, and a literature review. Based on the comparison, seven recommendations for smoking control strategies were made primarily for Korea.