The Validity and Reliability of the Korean Version of the Stigma Scale for Chronic Illness 8-Items (SSCI-8) in Patients with Neurological Disorders.

PURPOSE: The aim of this study was to develop a Korean version of the Stigma Scale for Chronic Illness 8-items (SSCI-8) and then assess its reliability and construct validity among patients with neurological conditions. METHOD: Patients diagnosed with stroke, Parkinson's disease, epilepsy, multiple sclerosis, myasthenia gravis, and amyotrophic lateral sclerosis were recruited. Reliability was assessed for internal consistency with Cronbach's alpha coefficient. Exploratory factor analysis (EFA) was used to extract potential factors of Korean SSCI-8. Convergent validity was assessed by correlating scores on the Korean SSCI-8 with scores for depression using the Beck Depression Inventory, anxiety using Spielberger's State-Trait Anxiety Inventory, and functional ability using the Korean modified Barthel Index (K-MBI), respectively. RESULTS: Of the total 202 patients enrolled in this study, 119 (58.9 %) were recruited with stroke, 33 (16.3 %) with Parkinson's disease, and 29 (14.4 %) with epilepsy. The Korean SSCI-8 had a high internal consistency (Cronbach's alpha = 0.90). The Korean SSCI-8 retrieved one factor from eight items by the EFA, and all factor loading scores were above 0.70 (0.71-0.84). The Korean SSCI-8 was correlated positively with depression (r = 0.74, p < 0.001) and anxiety (r = 0.61, p < 0.001), and negatively with the K-MBI (r = -0.48, p < 0.001). CONCLUSION: This study shows that the Korean SSCI-8 is a unidimensional model, even though it includes items of both enacted and internalized stigma. It is both reliable and valid for assessing stigma among Korean patients with neurological disease.

[Development and Effects of Smartphone App-Based Exercise Program for Hemodialysis Patients].

PURPOSE: To examine the effects of a smartphone application-based exercise program on self-efficacy expectations (SEE) and outcome expectations regarding exercise (OEE), physical fitness, activity level, physiological indices, and health-related quality of life in a sample of hemodialysis patients. METHODS: A quasi-experimental control group pre-test post-test design was used. Subjects were recruited from two university hospitals in G city. The subjects were assigned randomly by coin toss: 33 participants to the experimental group and 30 to the control group. A literature review and the self-efficacy theory were used to develop the smartphone program. Experts designed and verified the program to be userfriendly and in consideration of user interaction. Data were collected through a self-report pre-test post-test questionnaire and online medical records. RESULTS: In the experimental group, the levels of physical fitness and physical activity were significantly improved post-test, but the scores on health-related quality of life and the physical indices did not improve. In the experimental group, the SEE and OEE post-test scores were also significantly higher than the pre-test scores, but the control group's scores did not change. CONCLUSION: The smartphone application-based exercise program based on self-efficacy theory significantly improved the level of physical fitness and activity, SEE, and OEE for hemodialysis patients. The use of this application-based exercise program for hemodialysis patients might be an effective nursing intervention tool for improving SEE, OEE, level of physical fitness, and physical activity.

[Structural Equation Modeling of Self-Care Behaviors in Kidney Transplant Patients Based on Self-Determination Theory].

PURPOSE: The purpose of this study was to test a hypothesis explaining direct and indirect relationships among the factors affecting self-care behaviors of kidney transplant patients, based on self-determination theory. METHODS: Data were collected from 222 outpatients with kidney transplantation. The endogenous and exogenous variables of the hypothetical model consisted of healthcare provider's autonomy support, duration after kidney transplantation, basic psychological need satisfaction, autonomous and controlled motivation, depression, and self-care behaviors. Collected data were analyzed using SPSS/WIN 24.0 and AMOS 24.0. RESULTS: The hypothetical model demonstrated a good fit: RMSEA=.06, SRMR=.04, TLI=.94, CFI=.97. Statistically significant explanatory variables for the self-care behaviors of kidney transplant patients were duration after transplantation and basic psychological need satisfaction. Healthcare provider's autonomy support was indirectly significant, while autonomous motivation, controlled motivation and depression were not statistically significant for self-care behaviors. The variables accounted for 59.5% of the self-care behaviors of kidney transplant patients. CONCLUSION: It is necessary to develop an autonomy support program for healthcare providers to enhance the self-care behaviors of kidney transplant patients. Preventing the deterioration of self-care behaviors will be possible by conducting this program at one year and six years post-transplantation. In addition, the results suggest the need to developing personalized autonomy support programs for healthcare providers that can meet the basic psychological need satisfaction of kidney transplant patients.

Reliability and Validity of the Korean Version of the Coping and Adaptation Processing Scale-Short-Form in Cancer Patients.

PURPOSE: This study was conducted to assess the reliability and validity of the Korean version of the Coping and Adaptation Processing Scale-Short-Form in patients with cancer. METHODS: The original scale was translated into Korean using Brislin's translation model. The Korean Short-Form and the Functional Assessment Cancer Therapy-General were administered to 164 Korean patients with cancer using convenience sampling method. The collected data were analyzed using SPSS 23.0 and AMOS 23.0. Construct validity, criterion validity, test-retest reliability, and internal consistency reliability of the Korean Coping and Adaptation Processing Scale-Short-Form were evaluated. RESULTS: Exploratory factor analysis supported the construct validity with a four-factor solution that explained 60.6% of the total variance. Factor loadings of the 15 items on the four subscales ranged .52~.86. The four-subscale model was validated by confirmatory factor analysis (Normed χ²=1.38 (p =.013), GFI=.92, SRMR=.02, RMSEA=.05, TLI=.94, and CFI=.95), and criterion validity was demonstrated with the Functional Assessment Cancer Therapy-General. Cronbach's alpha for internal consistency of the total scale was .83 and ranged .68~.81 for all subscales, demonstrating sufficient test-retest reliability. CONCLUSION: The Korean version showed satisfactory construct and criterion validity, as well as internal consistency and test-retest reliability.

[Effects of a pruritus intervention program on pruritus and sleep satisfaction for hemodialysis patients].

PURPOSE: The purpose of this study was to analyze the effects of a pruritus intervention program on pruritus and sleep satisfaction in patients undergoing hemodialysis. METHOD: This study was designed for a nonequivalent control group repeated measures quasi-experimental study. Hemodialysis patients were recruited from a kidney center at a university hospital located in G city, Korea. The subjects consisted of 43 patients 21 for the experimental group and 22 for the control group. The 2-week pruritus intervention program was given to the experimental group only.. An analytical survey was done before and after the pruritus intervention program. RESULT: There was a significant decrease in pruritus and increase in sleep satisfaction in the experimental group compared to the control group. There was significant improvement in clinical symptoms and sleep satisfaction after completing the pruritus intervention program in the experimental group. CONCLUSION: Pruritus intervention program in hemodialysis patients decreased pruritus severity and increased sleep satisfaction, which can be used as an efficient nursing intervention for hemodialysis patients.

Reliability and Validity of the Korean Version of the Cancer Stigma Scale.

PURPOSE: In this study the reliability and validity of the Korean version of the Cancer Stigma Scale (KCSS) was evaluated. METHODS: The KCSS was formed through translation and modification of Cataldo Lung Cancer Stigma Scale. The KCSS, Psychological Symptom Inventory (PSI), and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Core 30 (EORTC QLQ-C30) were administered to 247 men and women diagnosed with one of the five major cancers. Construct validity, item convergent and discriminant validity, concurrent validity, known-group validity, and internal consistency reliability of the KCSS were evaluated. RESULTS: Exploratory factor analysis supported the construct validity with a six-factor solution; that explained 65.7% of the total variance. The six-factor model was validated by confirmatory factor analysis (Q (χ²/df)= 2.28, GFI=.84, AGFI=.81, NFI=.80, TLI=.86, RMR=.03, and RMSEA=.07). Concurrent validity was demonstrated with the QLQ-C30 (global: r=-.44; functional: r=-.19; symptom: r=.42). The KCSS had known-group validity. Cronbach's alpha coefficient for the 24 items was .89. CONCLUSION: The results of this study suggest that the 24-item KCSS has relatively acceptable reliability and validity and can be used in clinical research to assess cancer stigma and its impacts on health-related quality of life in Korean cancer patients.

[Effects of aerobic exercise using a flex-band on physical functions & body image in women undergoing radiation therapy after a mastectomy].

PURPOSE: This study examined the effects of aerobic exercise using a flex band on the improvement of physical functions & body image in breast cancer women undergoing radiation therapy after a mastectomy. METHOD: Women with breast cancer(n = 26) were assigned to an experimental group(EG, n = 15) and control group(CG, n = 11). The E.G. participated in an aerobic exercise program with a 60% to 80% intensity of maximal heart rate for 25 minutes during the main exercise, 3 times per week, for 6 weeks. The EG did not exercise regularly for 3 months before participating in this program. The CG received no exercise treatment during the research period. Data were analyzed using the chi(2)-test and Mann-Whitney U test by the SPSS version 11.0 program at a 5% significant level. RESULTS: Group analysis revealed that the EGwomen had significantly more improved cardiopulmonary functions, ROM of the affected shoulder joint, and body image compared to the CG. CONCLUSION: Aerobic exercise using a flex band may be an effective rehabilitative measure for mastectomy women with respect to cardio-pulmonary functions, ROM, & body image. Further studies are recommended to study early rehabilitation programs within 10 days post-operatively.

[Effects of a structured drug education program on knowledge and medication compliance for hemodialysis patients].

PURPOSE: The purpose of this study was to analysis the effects of a structured drug education program on knowledge and medication compliance for hemodialysis patients. METHOD: Hemodialysis patients were recruited from a kidney center, at a university hospital located in G city, Korea. Thirty subjects in the control group received no intervention and 30 subjects in the experimental group received a structured drug education program. RESULT: There were significant increases in medication knowledge and medication compliance in the experimental group compared to the control group. CONCLUSION: According to the above results, this education program for hemodialysis patients increased knowledge and medication compliance. These findings suggest that a structured drug education program can be used as an efficient nursing intervention for hemodialysis patients.

[Factors Influencing Changes in Quality of Life in Patients undergoing Hematopoietic Stem Cell Transplantation: A Longitudinal and Multilevel Analysis].

PURPOSE: This study was a prospective longitudinal study to identify changes in quality of life in patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT). It was based on Roy's adaptation model. METHODS: The questionnaires were administered before HSCT, 30 and 100 days after HSCT. Of the 48 potentially eligible patients, 44 (91.7%) participated in the study and 40 (90.9%) completed the questionnaires at 100 days after HSCT. Multilevel analysis was applied to analyze changes in quality of life. RESULTS: Overall, quality of life showed a decreasing tendency from pre-HSCT to 100 days after HSCT. The adaptation level of participants was compensatory. Type of conditioning was the significant factor influencing quality of life before HSCT (ß00=79.92, p<.001; ß01=-12.64, p<.001) and the change rate of quality of life (ß10=-1.66, p=.020; ß11=2.88, p=.014). Symptom severity (ß20=-1.81, p=.004), depression (ß30=-0.58, p=.001), social dependency (ß40=-0.35, p=.165), and loneliness (ß50=-0.23, p=.065) had a negative effect on changes in quality of life. Symptom severity and depression were statistically significant factors influencing changes in quality of life. CONCLUSION: According to the results of this study, the development of nursing intervention is needed to improve quality of life in patients undergoing allogeneic hematopoietic stem cell transplantation in the early immune reconstruction period. The interventions should include programs to enhance coping capacity and programs to help control symptom severity and depression. Also these interventions need to be started from the beginning of HSCT and a multidisciplinary approach would be helpful.

[Model development of an elderly health promotion center: the effect of a social support program at a community health center].

PURPOSE: The purpose of this study was to develop a model of an elderly health promotion center after witnessing the effect of a social support program on dependent variables in older adults at a local community health center. METHOD: The subjects were 60 female adults over 65 years dwelling in a rural area, and they were divided into experimental and control groups each with 30 people. A social support program was implemented 6 hours a day, 3 times a week, for 4 months in the experimental group. Included was health assessment, health education, counseling, consultation, exercise, physical & occupational therapy, primary care, recreation, lunch & transfer service. Data was collected from May 1st to September 14th, 2002 by questionnaires, and analyzed by x2-test, t-test, Pearson's correlation coefficient and stepwise multiple regression using SAS. RESULT: The social support program in the elderly was very effective on all dependent variables of physical health (t= 4.68, p= .001), health knowledge (t= 3.60, p= .001), life satisfaction (t= 8.65, p= .001), and health promoting behaviors (t= 5.23, p= .001). CONCLUSION: The Social Support Program at a Community Health Center was effective on health promoting behaviors in the elderly.

[Changes on Index Of Nausea, Vomiting, and Retching in hospitalized cancer patients undergoing chemotherapy].

PURPOSE: The purpose of this study was to determine the changes on Index of Nausea, Vomiting, & Retching (INVR) during a cycle of chemotherapy. METHODS: Forty-three patients hospitalized for chemotherapy at C University Hospital during a period of 5 days from March to May, 2003 were examined. Scores of INVR were measured once a day. Anxiety, anorexia, fatigue, and sleep satisfaction were measured before chemotherapy. Data was analyzed by repeated measures of ANOVA. RESULTS: The score of INVR increased over time during the days of hospitalization and showed a peak on the third day. The score was significantly higher on the third and consecutive cycles than on the first and second cycle. The score was significantly higher in patients in their forties and fifties rather than in their sixties. The score was higher in women than in men, and also increased as the sleep satisfaction decreased. CONCLUSION: These results suggested that specific interventions for relief of nausea & vomiting were needed in middle age, women, the third chemotherapy cycle, and the third day after chemotherapy.

[Validation of Quality of Life Index-Cancer among Korean patients with cancer].

PURPOSE: The purpose of this study was to validate Quality of Life Index-Cancer (Q.L.I.-C) developed by Ferrans (1990) among Korean cancer patients. METHOD: This study design was exploratory factor analysis methodology. Q.L.I.-C was translated into Korean and reverse-translated into English. The subjects were 357 Korean patients with various cancers. Data were collected by questionnaires from May to August, 2000 and was analyzed by descriptive statistics, Principal Component Analysis for construct validity and Cronbach's alpha coefficient for reliability. RESULT: The range of factor loadings was .446 approximately .841. The explained variance from the 5 extracted factors was 63.7% of the total variance. The first factor 'family' was 35.5%, and 'health & physical functioning', 'psychological', 'spiritual', and 'economic' factors were 11.5%, 6.9%, 5.6%, and 4.2% respectively. Because of cultural difference between Americans and Koreans, certain items such as sexuality, job status, and education were deleted from the extraction of factors in this study. The Cronbach's alpha coefficient was .9253 among the 28 items. CONCLUSION: Q.L.I.-C could be applied in measuring quality of life of Korean cancer patients. It also recommend to do further studies for validation of Q.L.I.-C American and Korean versions relating to cultural differences.

Reliability and validity of the Korean version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire to assess Chemotherapy-induced peripheral neuropathy.

PURPOSE: This study was performed to assess the reliability and validity of the Korean version of European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Chemotherapy-induced peripheral neuropathy 20 items (EORTC QLQ-CIPN20) in patients receiving neurotoxic chemotherapy. METHODS: A convenience sample of 249 Korean cancer patients, previously or currently, being treated with peripheral neurotoxic chemotherapeutic agents were asked to fill in the questionnaire. Collected data were analyzed using SPSS 21.0 and AMOS 21.0. Construct validity, known-group validity, concurrent validity, and internal consistency reliability of the Korean version of the QLQ-CIPN20 were evaluated. RESULTS: Factor analysis confirmed 3 dimensions of CIPN: sensory, motor, and autonomic. The factor loadings of the 20 items on the 3 subscales ranged from .38 to .85. The 3 subscale-model was validated by confirmatory factor analysis (GFI=.90, AGFI=.86, RMSR=.05, NFI=.87, and CFI=.94), and concurrent validity was demonstrated with the EORTC QLQ-C30. Furthermore, the QLQ-CIPN20 established known-group validity. The Cronbach's alpha coefficients for internal consistency of the subscales ranged from .73 to .89. CONCLUSION: The Korean version of the EORTC QLQ-CIPN20 showed satisfactory construct, concurrent, and known-group validity, as well as internal reliability.

[A structural model for psychosocial adjustment in patients with early breast cancer].

PURPOSE: This study was done to propose a structural model to explain and predict psychosocial adjustment in patients with early breast cancer and to test the model. The model was based on the Stress-Coping Model of Lazarus and Folkman (1984). METHODS: Data were collected from February 18 to March 18, 2009. For data analysis, 198 data sets were analyzed using SPSS/WIN12 and AMOS 7.0 version. RESULTS: Social support, uncertainty, symptom experience, and coping had statistically significant direct, indirect and total effects on psychosocial adjustment, and optimism had significant indirect and total effects on psychosocial adjustment. These variables explained 57% of total variance of the psychosocial adjustment in patients with early breast cancer. CONCLUSION: The results of the study indicate a need to enhance psychosocial adjustment of patients with early breast cancer by providing detailed structured information and various symptom alleviation programs to reduce perceived stresses such as uncertainty and symptom experience. They also suggest the need to establish support systems through participation of medical personnel and families in such programs, and to apply interventions strengthening coping methods to give the patients positive and optimistic beliefs.

[Psychosocial adjustment of low-income Koreans with cancer].

PURPOSE: To describe psychosocial adjustment of low-income Koreans who have cancer. METHODS: Data were collected during 2008 using individual in-depth interviews with 18 Korean people with cancer. The income status of the participants was low, 11 were recipients of the National Basic Livelihood Protection program. Mean age was 58.3 yr and 11 were female. Five participants had stomach cancer, five, colorectal cancer, and four, breast cancer. Data were analyzed using grounded theory methodology. RESULTS: The core category emerged as 'bearing up alone with double suffering'. 'Poverty and cancer: A double suffering' emerged as a causal condition. The adjustment process consisted of three stages: 'forming a treatment will to live' ,'practicing for the cure',and 'restructuring self and repaying favors'. Each stage indicated action-interaction strategies which were employed to bear up alone with double suffering during the illness process. Self-reflection, parental responsibility, and support from the public sector played important roles in overcoming the double suffering. Two types of consequences were identified: Transcended life and strained life suppressed by poverty and cancer. CONCLUSION: The results provide insights into the psychosocial adjustment process for low income Korean with cancer and can be used in developing and implementing efficient home-care services for these people.

[A prediction model development on quality of life in kidney transplant recipients].

PURPOSE: The purpose of this study was to identify factors influencing quality of life in kidney transplant recipients and to understand the concrete pathway of influence and the power of each variable, so that integrated prediction model to promote the quality of life of kidney transplant recipients could be developed. METHODS: The sample was composed of 218 patients in follow-up care after a kidney transplant in one of 4 university hospitals in the Honam area. A structured questionnaire was used and the collected data were analyzed for fitness, using the LISREL program. RESULTS: This model was concise and extensive in predicting the quality of life of kidney transplant recipients. CONCLUSION: The research verified the factors influencing quality of life for kidney transplant recipients and it verified that direct factors such as perception of health state, compliance, self-efficacy, stress and indirect factors such as self-efficacy and social support can be important factors to predict the quality of life for recipients. Moreover, those variables represent 87% of variance in explaining quality of life in a prediction model so that the variables can be utilized to predict quality of life for kidney transplant recipients.