Development and psychometric testing of the Health Literacy Index for Female Marriage Immigrants (HLI-FMI) in Korea.

This study aimed to develop and examine the psychometric properties of the Health Literacy Index for Female Marriage Immigrants (HLI-FMI). Study participants were 282 women who migrated to Korea from Asian countries to marry and had a mean age of 33.24 years and had immigrated a mean of 5.58 years ago. Data were collected between March 2013 and May 2013. An initial 31 preliminary items were developed based on literature reviews and focus group interviews, including three constructs of health literacy: skills (print, numeracy), tasks (access, understand, appraise, apply), and health contexts (health promotion and disease prevention, health care maintenance and treatment, health system navigation). Exploratory factor analyses of the HLI-FMI yielded 12 items in two factors: Access-Understand Health Literacy (seven items) and Appraise-Apply Health Literacy (five items; Cronbach's alpha = 0.74). Criterion validity was supported through a significant correlation with the Rapid Estimate of Adult Literacy in Medicine-Short Form. Guided by a classical test theory and item response theory, item difficulty and discrimination were within acceptable ranges. HLI-FMI scores were positively associated with participant education and Korean proficiency. The HLI-FMI appears to be the first valid and reliable comprehensive health literacy measure for evaluating health literacy in Korean female marriage immigrants.

Assessment of healthy behaviors for metabolic syndrome among Korean adults: a modified information-motivation-behavioral skills with psychological distress.

BACKGROUND: Since the worldwide incidence of metabolic syndrome (Mets) has rapidly increased, healthy behaviors such as weight control, engaging in physical activity, and healthy diet have been crucial in the management of Mets. The purpose of this study was to examine healthy behaviors practice and factors that affect the practice in relation to Mets on the basis of a modified Information-Motivation-Behavioral skills model (IMB) with psychological distress, which is a well-known factor affecting healthy behaviors among individuals with Mets. METHODS: Study participants were 267 community dwelling adults (M age: 54.0 ± 8.1 years) with Mets who were attending public health centers located in Seoul, South Korea. A structured questionnaire was administered in the areas of information, motivation, behavioral skills, and practice of Mets healthy behaviors and levels of psychological distress from May 2014 to September 2014. Structural equation modeling was used to test the modified IMB model. RESULTS: The modified IMB model had a good fit with the data, indicating that motivation and behavioral skills directly influenced the practice of Mets healthy behaviors, whereas information and psychological distress directly influenced motivation and influenced the practice of healthy behaviors through behavioral skills. These components of the modified IMB model explained 29.8 % of the variance in healthy behaviors for Mets. CONCLUSION: Findings suggested that strengthening motivation and behavioral skills for healthy behaviors can directly enhance healthy behavior practice. Providing information about Mets related healthy behaviors and strategies for psychological distress management can be used as the first line evidence based intervention to systemically enhance motivation and behavioral skills among individuals with Mets.

The revised Stress Measurement of Female Marriage Immigrants in Korea: Evaluation of the psychometric properties.

The twenty-one item Stress Measurement of Female Marriage Immigrants (SMFMI) was developed to assess stress of female marriage immigrants in Korea. This study reports the psychometric properties of a revised SMFMI (SMFMI-R) for application with female marriage immigrants to Korea who were raising children. Participants were 190 female marriage immigrants from China, Vietnam, the Philippines, and other Asian countries, who were recruited using convenience sampling between November 2013 and December 2013. Survey questionnaires were translated into study participants' native languages (Chinese, Vietnamese, and English). Principal component analysis yielded nineteen items in four factors (family, parenting, cultural, and economic stress), explaining 63.5% of the variance, which was slightly better than the original scale. Confirmatory factor analysis indicated adequate fit for the four-factor model. Based on classic test theory and item response theory, strong support was provided for item discrimination, item difficulty, and internal consistency (Cronbach's alpha = 0.923). SMFMI-R scores were negatively associated with Korean proficiency and subjective economic status. The SMFMI-R is a valid, reliable, and comprehensive measure of stress for female marriage immigrants and can provide useful information to develop intervention programs for those who may be at risk for emotional stress.

Metabolic syndrome and its related factors among Asian immigrant women in Korea.

In this study, we examined the prevalence and risk factors of metabolic syndrome among Asian immigrant women in Korea based on sociodemographics and health behavior-related characteristics. The sample included 271 women from the Philippines, China, Vietnam, and other Asian countries through marriage. Data were collected using a structured questionnaire and health examination. Among 67 immigrants who had complete data for determination of metabolic syndrome, 1.5% reported having metabolic syndrome, and 44.4% of the entire sample had reduced high-density lipoprotein cholesterol, which is four times higher than their Korean-born counterparts. After controlling for age, there were significant differences in body mass index, depending on the country of origin, and weight change since immigration. Immigrants who had gained weight since immigration also had higher systolic blood pressure and triglycerides. As well as weight change, immigrants who always consumed high-fat diets were at risk of higher triglycerides. Immigrants living in urban areas had lower high-density lipoprotein cholesterol. In order to reduce the risk of metabolic syndrome, interventions should be directed toward the prevention of weight gain and lower fat intake after immigrating to Korea.

Predictors of adherence to a skill-building intervention in dementia caregivers.

BACKGROUND: Treatment adherence is a widely recognized problem in health services but understudied in caregiver intervention research. This study examines caregiver sociodemographic and psychological characteristics, patient illness severity, and treatment implementation factors as predictors of caregiver adherence to a skills training intervention to help families manage dementia care problems at home. METHODS: The sample consisted of 105 caregivers randomized to the Home Environmental Skill-Building Program at the Philadelphia site of the National Institutes of Health (NIH) Resources for Enhancing Alzheimer's Caregiver Health (REACH I). The intervention, implemented by occupational therapists, consisted of education, problem solving, communication, environmental and task simplification techniques, and home modifications. Adherence was measured by a proportion score representing the percentage of strategies used by participants compared to the total number of strategies prescribed during intervention (Strategy Use). RESULTS: Regression analysis with intraclass correlation adjustment for interventionist effects revealed that caregivers with better physical health (p <.001), greater treatment exposure (p <.001), more problem areas addressed (p =.012), and for whom more active therapeutic techniques (role play) were used (p =.004) demonstrated greater adherence. Other caregiver characteristics, patient cognitive impairment, and troublesome behaviors were not significantly related to caregiver adherence. CONCLUSIONS: Modifiable caregiver and treatment implementation factors, including active engagement of caregivers, were associated with adherence, whereas patient characteristics were not. Caregivers with poor health may be at risk for not benefiting from intervention, suggesting that efforts, including instruction in preventive care and allocating time to attend to their own health care needs, be directed towards improving their health.

Analysis of Validity and Reliability of the Health Literacy Index for Female Marriage Immigrants (HLI-FMI).

The purpose of this study was to obtain an independent evaluation of the factor structure of the 12-item Health Literacy Index for Female Marriage Immigrants (HLI-FMI), the first measure for assessing health literacy for FMIs in Korea. Participants were 250 Asian women who migrated from China, Vietnam, and the Philippines to marry. The HLI-FMI was originally developed and administered in Korean, and other questionnaires were translated into participants' native languages. The HLI-FMI consisted of 2 factors: (1) Access-Understand Health Literacy (7 items) and (2) Appraise-Apply Health Literacy (5 items); Cronbach's α = .73. Confirmatory factor analysis indicated adequate fit for the 2-factor model. HLI-FMI scores were positively associated with time since immigration and Korean proficiency. Based on classical test theory and item response theory, strong support was provided for item discrimination and item difficulty. Findings suggested that the HLI-FMI is an easily administered, reliable, and valid scale.

Effects of Health Status and Health Behaviors on Depression Among Married Female Immigrants in South Korea.

PURPOSE: This study examined the effects of health status and health behaviors on depression in married female immigrants in South Korea. METHODS: Sampling 316 immigrant women from the Philippines, Vietnam, China, and other Asian countries, a cross-sectional research design was used with self-report questionnaires that assessed sociodemographic characteristics, health status, health behaviors, and depression. RESULTS: There were significant differences in stillbirth experience, induced abortion, morbidity, perceived health status, meal skipping, and physical activity between depressed and nondepressed immigrant women. After adjusting for sociodemographic variables, stillbirth experience, poorer perceived health status, more meal skipping, and less physical activity were associated with greater depressive symptoms. CONCLUSIONS: Both health status and health behaviors had significant impacts on depression, suggesting that development of nursing interventions and educational programs should be targeted towards improving maternal health, healthy lifestyle, and subjective health perception to promote married female immigrants' psychological well-being.

Prevalence and correlates of obesity and overweight among asian immigrant women in Korea.

This study examines the prevalence of obesity and overweight as well as associations between obesity and overweight and demographic, sociocultural, and lifestyle factors among Asian immigrant women in Korea. Data were collected from physical measurements and standardized questionnaires from 287 adult women from China, Vietnam, the Philippines, and other Asian countries. The mean BMI (body mass index) was 22.0 kg/m(2); 15.0% of the sample were obese (BMI ≥ 25.0), and 17.1% were overweight (23.0 ≤ BMI < 25.0). The highest obesity proportion was found in Filipino (22.0%) and the lowest in Vietnamese women (7.8%). Adjusted for demographic, sociocultural, and lifestyle variables, individuals with greater length of residence (5+ years; odds ratio = 3.22, P = .010) were more likely to be obese or overweight. For prevention of excess body weight, public health efforts need to be targeted to immigrants starting at arrival in Korea.