School Nurses' Experiences and Needs in COVID-19 Pandemic Response: A Qualitative Study.

The coronavirus disease 2019 pandemic drastically shifted the public health burden onto the school health system. We, therefore, explored the school nurses' experiences and needs for confronting the pandemic in school settings across Korea. This qualitative investigation enrolled 30 participants after their written consent. A written interview conducted through email and focus group interviews using an online meeting application verified participants' opinions and experiences. Collected data were subjected to text-mining and content analysis. The school nurse was found to be responsible for many tasks, including education on preventive measures with unclear quarantine guidelines. Content analysis identified three key themes: "aggravated difficulties owing to lack of support resulted in burnout," "reflection on supportive resources; direct provisions were helpful," and "needs and suggestions to safeguard students' health in the event of another pandemic." Recommendations should all be considered to keep schools and students safe from future pandemics.

A Multidomain Intervention for Modifying Lifestyle Habits Reduces the Dementia Risk in Community-Dwelling Older Adults: A Single-Blinded Randomized Controlled Pilot Study.

We aimed to examine the feasibility and effectiveness of a multidomain intervention including intensive and maintenance programs for reducing the risk of dementia in at-risk older adults. Community-dwelling older adults (aged ≥60 years) without dementia but having several risk factors for dementia (N = 32; 89% female; mean age±standard deviation, 76.8±4.7 years) were assigned to three parallel programs: intensive plus maintenance (INT+MNT), intensive only (INT-only), and active control. Subjects in INT+MNT and INT-only groups participated in a 4-week intensive group-based lifestyle modification program that focused on physical activity, vascular risk factors, dietary habits, cognitive activities, and social engagement. INT+MNT participants underwent an additional 20-week maintenance program to consolidate modified habits. The modified Australian National University-Alzheimer's Disease Risk Index (ANU-ADRI) score was used as the primary outcome measure for dementia risk. The changes in ANU-ADRI scores exhibited a significant group-by-time interaction: the INT+MNT group showed significant improvement at 24 weeks (ß= -6.05; SE = 1.86; p = 0.002), while the INT-only group did not. Additional exploratory analyses showed that the reduction in ANU-ADRI scores was caused by changes in protective factors rather than in risk factors. The INT + MNT group also showed greater improvement in executive function at 4 and 24 weeks (both p = 0.044), whereas changes in global cognitive function did not reach significance (p = 0.055). A 24-week multidomain dementia prevention involving a maintenance strategy for sustaining modified lifestyle habits reduced the risk of dementia and improved executive function in at-risk older adults.

Development of a scale to measure diabetes self-management behaviors among older Koreans with type 2 diabetes, based on the seven domains identified by the American Association of Diabetes Educators.

AIM: The purpose of this study was to develop the Diabetes Self-Management Behavior for Older Koreans (DSMB-O). This scale is based on the seven relevant domains that have been identified by the American Association of Diabetes Educators (AADE) and is adjusted for sociocultural and age-related characteristics. METHODS: Four phases were used to develop of the DSMB-O as a criterion-referenced measure. In phases 1 and 2, the DSMB-O adopted the AADE's seven domains and established a self-report questionnaire using a small number of items that are applicable to older Koreans. In phase 3, the DSMB-O was formulated with 16 preliminary items, including seven subitems. By assessing the content validity, 14 items (including five subitems) were selected. The final phase involved evaluating the DSMB-O's psychometric properties, including test-retest reliability, content validity, and criterion-related validity, using data from 150 older Koreans with type 2 diabetes. RESULTS: The coefficients of agreement and Cohen's Kappa for the test-retest reliability test ranged from 0.32 to 1.0 and -0.07 to 1.0, respectively. For the content validity, the values of both the item- and scale-level content validity indices were 1.0. The scores from the DSMB-O were positively correlated with the scores from the Korean version of the Summary of Diabetes Self-Care Activities Questionnaire. CONCLUSION: The DSMB-O is short and easy for older Koreans to use, as well as having acceptable levels of reliability and validity. Hence, the DSMB-O can be a useful tool to evaluate diabetes self-management behaviors in older Koreans with type 2 diabetes.

Intervention mapping protocol for developing a theory-based diabetes self-management education program.

Development of behavior theory-based health promotion programs is encouraged with the paradigm shift from contents to behavior outcomes. This article describes the development process of the diabetes self-management program for older Koreans (DSME-OK) using intervention mapping (IM) protocol. The IM protocol includes needs assessment, defining goals and objectives, identifying theory and determinants, developing a matrix to form change objectives, selecting strategies and methods, structuring the program, and planning for evaluation and pilot testing. The DSME-OK adopted seven behavior objectives developed by the American Association of Diabetes Educators as behavioral outcomes. The program applied an information-motivation-behavioral skills model, and interventions were targeted to 3 determinants to change health behaviors. Specific methods were selected to achieve each objective guided by IM protocol. As the final step, program evaluation was planned including a pilot test. The DSME-OK was structured as the 3 determinants of the IMB model were intervened to achieve behavior objectives in each session. The program has 12 weekly 90-min sessions tailored for older adults. Using the IM protocol in developing a theory-based self-management program was beneficial in terms of providing a systematic guide to developing theory-based and behavior outcome-focused health education programs.

Strategies for enhancing information, motivation, and skills for self-management behavior changes: a qualitative study of diabetes care for older adults in Korea.

PURPOSE: To describe strategies for enhancing information, motivation, and skills related to changes in diabetes self-management behavior among community-dwelling older adults in Korea. PATIENTS AND METHODS: A total of five focus group interviews (three separate focus groups) were conducted with 12 older adults with type 2 diabetes and five diabetes educators. Qualitative content analysis was used. RESULTS: "One's own willingness and ability" emerged as a fundamental belief about the strategies for diabetes self-management. Six major themes under three categories were identified. Under the information category, the recurrent themes were: 1) repeatedly offering detailed knowledge regarding self-management, 2) providing information about current health status, and 3) identifying experiential knowledge of blood glucose control. The recurrent themes in the motivation category were: 1) ensuring a positive attitude regarding self-management, and 2) encouragement or feedback from significant others. Furthermore, in the skills category, we found that the following theme emerged: hands-on skills training with numerical standards. CONCLUSION: This study identified six tailored strategies for enhancing information, motivation, and skills for diabetes self-management behavior changes. These strategies can be used in the development of a culturally sensitive diabetes self-management program for older adults.

[Health related quality of life of women with disabilities and its affecting factors].

PURPOSE: The purpose of this study was to investigate the factors that influenced health related quality of life in women with disabilities. The other purpose was to examine the correlations of activities of these women's daily life, self esteem, and health promoting behavior with health related quality of life. METHOD: The subjects consisted of 120 adult disabled women. Data was collected from February to June 2004 using structured questionnaires. Spearman's correlation, and multiple regression were used to test the quality of life with K-ADL, self esteem, and health promoting behaviors by using SPSS 12.0 for windows. RESULT: The health related quality of life of women with disabilities was related to educational level, marital status, residential type, cause of acquired disability and disability of spouse. In addition, it was related to self esteem (r=.385, p=0.00), health promoting behaviors (r=.428, p=0.00), K-ADL (r=-.419, p=0.00) and K-IADL (r=-.439, p=0.00). Activities of daily life, self esteem and health promoting behaviors were significant predictors 37.3% (r=0.212, p=0.000) to explain quality of life in disabled women. CONCLUSION: The more self esteem, health promoting behaviors, K-ADL and K-IADL are positive, the more the health related quality of life is good. Further studies need to be done to investigate additional effects of health related quality of life and to investigate nursing approaches to improve their health related quality of life with significant predictors.