Research
Social media based Trailblazer Optimizing Population health
Publications
Navigating healthier beverage consumption in adolescents using the “R-Ma Bot” chatbot: A usability and evaluation study
Objective: This pilot study aimed to evaluate the usability and effectiveness of a behavior change technique (BCT)-based chatbot developed to promote healthier beverage consumption among adolescents.
Methods: The Read and Manage your health roBot (“R-Ma Bot”), designed with 13 BCTs, was tested with 42 adolescents (13 men, 29 women, mean age 15.0 ±0.7) for 2 weeks. Usability was assessed after the 2-week intervention using a chatbot usability questionnaire, recruitment, retention, participation, and engagement. Scores above 70 out of 100 were considered high usability. Qualitative data from open-ended questions were collected for evaluation. Effectiveness was measured by changes in knowledge, use and impact of nutrition labels, and weekly consumption of sugar, sodium, and caffeine from carbonated and/or energy drinks before and after the 2-week intervention.
Results: The score of R-Ma Bot’s usability averaged 74.7, with participants addressing it useful, friendly, and easy to use, though they suggested improving unnatural conversation flow. All participants engaged with the chatbot for at least 13 out of 14 days, with over half using it daily for the entire period. After intervention, awareness of nutrition labels increased from 64.3% to 92.9%, and nonreaders decreased from 42.9% to 16.7%. Weekly sugar intake from beverages significantly
decreased by 60%, from 13.1 ±20.1 mg to 7.9 ±12.8 mg.
Conclusions: R-Ma Bot’s high usability contributed to high retention and behavioral changes, significantly reduced sugar consumption from beverages and improved awareness of nutrition labels. We suggest integrating strategies that enhance knowledge, motivation, and opportunities through BCTs with youth-friendly design elements in the development of interventions for adolescents.
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Reciprocal relationship between multicultural adolescents’ depression and life satisfaction: a random intercept cross‑lagged panel model for 3‑wave panel data
Multicultural adolescents (MA) in Korea experience higher depression and lower life satisfaction compared to Korean native adolescents. To consider appropriate interventions, this study investigates the cross-lagged effect between life satisfaction and depression among these adolescents. Secondary data from the Multicultural Adolescents Panel Survey, which is a nationally representative sample, was analyzed. Data from the 3rd (T1, elementary school), 5th (T2, middle school), and 7th (T3, high school) waves (2013–2017) were used. Altogether, 1,239 MA were included in the sample for analysis; the mean age at T1 was 11.97 (± 0.36) years. The ten-item Depression Scale Questionnaire was used to measure depression, and the three-item Happiness Scale was used to measure life satisfaction. The random intercept cross-lagged panel model was conducted to estimate within-person autoregressive and cross-lagged effects. Life satisfaction and depression had a reciprocal relationship from T1 to T2, while only life satisfaction had a lagged effect from T2 to T3. Life satisfaction’s lagged effect dominated that of depression. The cross-lagged effect size of depression from T1 to T2 was larger than that from T2 to T3, and that of life satisfaction from T2 to T3 was larger than that from T1 to T2. Low life satisfaction in MA continues over time. Depression is not persistent, but if experienced in elementary school, it leads to low life satisfaction in middle school and depression in high school. The findings suggest that early intervention for depression in elementary school can reduce its negative effect MA’s life satisfaction. Read All
코로나19 전후 다문화 청소년의 건강관리와 일상생활 변화: 혼합연구방법
Objectives: This study aims to explore the lifestyle and health management changes during the COVID-19 pandemic and its influence on the health of multicultural adolescents in Korea.
Methods: Using an exploratory sequential mixed-methods design, secondary data analysis was conducted. Focus Group Interview’s analysis was conducted using a content analysis method and the quantitative data were analyzed with SPSS/WIN 26.0.
Results: The main categories were “distorted health lifestyle patterns, complaining about difficulties caused by daily life changes, and
adaptation to social distancing”. The main findings were supported by the results of quantitative research showing that decreased physical activity, increased sedentary lifestyle, and BMI decreased the subjective health status of multicultural adolescents. On the positive side, the rate of practicing hands’ hygiene activities for prevention of infection increased.
Conclusion: Through the results, we confirmed that the COVID-19 pandemic has had negative influences on behaviors associated with obesity, and on adolescents’ sociality because of social distancing. In contrast, some positive changes have been found in adapting to the lockdown, washing hands, and ventilation to prevent infection. In crisis, health-related service support should be sought with more attention to the physical and mental health of multicultural adolescents exposed to a more vulnerable environment.
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Association of Smoking Media Literacy with Vietnamese and South Korean Adolescents’ Susceptibility to Smoking
Studies on how smoking media literacy (SML) is associated with susceptibility to smoking among adolescents in South Korea and Vietnam are scarce. Thus, we examined the association of SML with susceptibility to smoking among adolescents in these countries to initiate a collaborative global health program. In total, 460 adolescents (Vietnam: 277, South Korea: 183) aged 15–18 completed an online cross-sectional survey. SML was measured using the 15-item SML scale. Susceptibility to smoking was measured by three questions on future smoking and if offered a cigarette by a friend. A multiple logistic regression model explored the association of SML with susceptibility to smoking. The study revealed that higher SML was significantly associated with lower susceptibility to smoking among Vietnamese, but not South Korean adolescents. Further studies to identify pathways between other factors associated with SML and susceptibility to smoking are needed to develop culture-specific intervention strategies for smoking prevention. Read All
Social Support for Acculturative Stress, Job Stress, and Perceived Discrimination Among Migrant Workers Moderates COVID-19 Pandemic Depression
Objectives: This study aimed to investigate the practical moderating effect of social
support on the relationship between acculturative stress, job stress, and perceived
discrimination, and depression among migrant workers during the coronavirus disease-19 pandemic as a vulnerable group susceptible to mental health problems.
Methods: Data for this cross-sectional descriptive study were collected using an online survey from 214 Vietnamese and Cambodian migrant workers, who are among the largest migrant groups residing in South Korea. Participants were asked to report on acculturative stress, job stress, perceived discrimination, depression, and social support through questionnaires in their native languages.
Results: The findings showed that acculturative stress affected depression, and this effect was moderated by social support. The impact of acculturative stress on depression was significant in the group with low mean scores of social support. However, the effect of the interaction of social support on the relationship of job stress and perceived discrimination to depression was not statistically significant.
Conclusion: Our findings suggest the need for differentiated strategies to improve the mental health of migrant workers based on the level of social support.
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Living labs for a mobile app-based health program: effectiveness of a 24-week walking intervention for cardiovascular disease risk reduction among female Korean-Chinese migrant workers: a randomized controlled trial
Background: The risk of Cardiovascular disease (CVDs) among adult populations is influenced by environmental factors, and immigrant populations tend to be more vulnerable. This study examined the effectiveness of a 24-week walking program based on social-cognitive determinants through mobile app for CVD risk reduction among female Korean-Chinese middle-aged workers.
Methods: This study used a parallel randomized controlled trial. Participants were recruited by distributing posters and flyers and randomly assigned to either the standard treatment (ST, n=22) or enhanced treatment group (ET, n=28). Participants were provided with a mobile app linked to Fitbit Alta for 24weeks and instructed to walk at least 30 minutes five times a week and moderate-intensity physical activity. The ET group had additional interventions that enhanced social-cognitive determinants such as self-efficacy, social support. All participants were guided to voluntary physical activity during the 12-week maintenance period. Data were analyzed by the Mann Whitney U-test and a generalized estimating equation.
Results: There were significant between-group differences regarding the number of steps (B=1.295, P<.001) and moderate physical activity time (OR=6.396, P=.030) at week 12. ET group had significant changes in high-density lipoprotein cholesterol (B=10.522, P=.007), low-density lipoprotein cholesterol (B=-16.178, P=.024), total cholesterol (B=-20.325, P=.039), fasting blood sugar (B=−8.138, P=-.046). In addition, there was a significant reduction of 10-year CVD risk for the ET group over 12weeks compared to the ST group (B=-0.521, P<. 001).
Conclusions: Long-term studies are needed to reduce the risk of cardiovascular disease in large-scale migrant workers and to confirm the direct and indirect effects of social-cognitive determinants on health outcomes.
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다문화 청소년과 어머니의 차별 경험이 다문화 청소년의 우울감에 미치는 영향
Purpose: Discrimination experienced in the early stages of life among ethnic minority adolescents is known to affect depression and also adversely affect health throughout adulthood and old age. The purpose of this study was to identify whether discrimination experienced by ethnic minority adolescents and their mothers and depression among mothers affect depression in ethnic minority adolescents according to gender.
Methods: This was a cross-sectional study using the data of 2018 National Multicultural Family Survey in Korea. The study sample comprised 2,446 ethnic minority adolescents aged 11~18 and their mothers. The data were analyzed using descriptive statistics, pearson correlation analysis, and ordinal logistic regression with SPSS/WIN 25.0 and STATA IC 16.
Results: 18.4% of the adolescents (boys: 15.1%, girls: 20.5 %) felt sad or frustrated sometimes or more often for at least two weeks during the past year. Also, 8.3% of the adolescents and 29.6% of their mothers experienced discrimination during the past year. Boys were influenced more than girls by bullying at school (OR=5.17, 95% CI: 2.85~9.38), academic performance (very bad’s OR=5.79, 95% CI: 1.54~21.63) and mother’s depression (often’s OR=2.31, 95% CI: 1.14~4.64). Girls were influenced more than boys by experience of discrimination (OR=2.72, 95% CI: 1.69~4.39).
Conclusion: The findings showed that discrimination experienced by ethnic minority adolescents and their mothers in Korean society increases depression in ethnic minority adolescents and has different effects by gender. Therefore, a gender-specific and mother-inclusive intervention is recommended to prevent depression in ethnic minority adolescents.
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Social Determinants of Health and Well-Being of Adolescents in Multicultural Families in South Korea: Social-Cultural and Community Influence
Objectives: Adolescents in multicultural families (AMFs) are exposed to numerous
stressors and face environmental vulnerability within the family, school, and community systems, which may affect their health and well-being. Concrete discussion on policies is lacking due to insufficient data on the levels of well-being of AMFs in South Korea. This study aimed to investigate social-cultural and community factors affecting their well-being.
Methods: A cross-sectional study was conducted with a convenience sample of
206 AMFs (aged 13–18 years) from 16 general schools and three multicultural schools across eight large cities. AMFs completed a self-administrative questionnaire assessing well-being, individual factors (acculturative stress, health behavior), social and community factors (social support, sense of community), and environmental factors (school type, economic status). Data were analyzed using structural equation modeling.
Results: Social support and sense of community significantly and directly affected
well-being. The economic status and type of school had an indirect effect on well-being, whereas the effect of acculturative stress was not significant. Factors significantly affecting adolescents’ well-being were social support, sense of community, economic status, and type of school.
Conclusion: Addressing well-being may be the strategy leading AMFs to grow
into healthy adults. These results could help educators, health professionals, and
policymakers to identify ways to enhance the well-being of AMFs.
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국내 다문화 청소년의 사회적 건강결정요인: 통합적 문헌고찰(2018~2020)
Purpose: This study is an integrated literature review to analyze health problems and social determinants of multicultural adolescents in South Korea.
Methods: An integrative review was conducted according to Whittemore & Knafl’s guideline. An electronic search that included publications from 2018 to 2020 in the PubMed, EMBASE, Cochrane Library, CINAHL, RISS, and KISS databases was conducted. Of a total of 67 records that were identified, 13 finally met full inclusion criteria. Text network analysis was also conducted to identify keywords network trends using NetMiner program.
Results: The health problems of multicultural adolescents were classified into mental health(depression, anxiety, suicide and acculturative stress) and health risk behaviors (smoking, risky drinking, smartphone dependence and sexual behavior). As social determinants affecting the health of multicultural adolescents, the biological factors such as gender, age, and visible minority, and the psychological factors such as acculturative stress, self-esteem, family support, and ego-resiliency were identified. The sociocultural factors were identified as family economic status, residential area, parental education level, and parents' country of birth. As a result of text network
analysis, a total of 41 words were identified.
Conclusion: Based on these results, mental health and health risk behaviors should be considered as interventions for health promotion of multicultural adolescents. Our findings suggest that further research should be conducted to broaden the scope of health determinants to account for the effects of the physical environment and health care system.
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The Sequential Mediating Effects of Dietary Behavior and Perceived Stress on the Relationship between Subjective Socioeconomic Status and Multicultural Adolescent Health
Studies have examined the impact of social determinants of health on the health behaviors and health statuses of ethnic minority adolescents. This study examines the subjective health of this population by examining the direct effects of multicultural adolescents’ subjective socioeconomic status (SES) and the sequential mediating effects of their dietary behaviors and perceived stress. We utilized secondary data of 500 middle school students from multicultural families who participated in the 15th Korean Youth Health Behavior Survey, 2019. Information about SES, perceived stress, subjective health status, and dietary behavior (measured by the breakfast intake frequency during the prior week) were utilized. For the relationship between the SES and the subjective health status, we confirmed the sequential mediating effects of breakfast frequency and perceived stress using SPSS 25.0 and PROCESS macro with bootstrapping. The results showed that SES had a direct effect on subjective health status and indirectly influenced subjective health status through the sequential mediating effect of breakfast frequency and perceived stress. However, SES had no direct effects on perceived stress. These findings emphasize that broadening the community-health lens to consider the upstream factor of SES when preparing health promotion interventions is essential to achieving health equity for vulnerable populations. Read All
Network Support Using Social Networking Services to Increase Exercise Adherence Among Korean-Chinese Middle-Aged Migrant Women: Mixed Methods Study
Background: Social networking services (SNSs) are recognized to be a promising approach to easily deliver health interventions and to enhance social support for exercise adherence. However, the patterns and aspects of social support through SNSs have not been reported and their influence on other social-cognitive factors remains inconclusive.
Objective: Our objective is to explore how social support delivered through SNSs impacts interactions among Korean-Chinese (KC) middle-aged women and to identify how this approach influences social-cognitive factors for exercise (eg, sense of community, self-efficacy for exercise, and social support for exercise).
Methods: A mixed methods design was used. Text analysis of SNS messages and text mining using the Korean Natural Language Application (KoALA) were conducted. Social-cognitive factors (eg, sense of community, self-efficacy for exercise, and social support for exercise) were assessed at baseline and after 12 weeks using a structured questionnaire. A comparison of social-cognitive factors at baseline and at 12 weeks was conducted to identify any potential significant changes, using the Wilcoxon signed-rank test.
Results: A total of 259 SNS messages were collected from 24 KC women, distributed among four chat groups, who participated in a 12-week walking intervention program between August and October 2018. The individual average frequency of chatting via the SNS was 10.79 (range 0-34) and the most frequent type of social support through the SNS was network support (172/259, 66.4%). The most common words extracted from the SNS were Health, Exercise, Participation, and We. Overall, the perceived levels of sense of community (P<.001) and social support for exercise (P=.002) were significantly increased at 12 weeks compared with baseline. Group 1 (P=.03) and Group 4 (P=.03), whose members demonstrated the highest frequency of network support, experienced a significant increase only in the level of sense of community.
Conclusions: By integrating these data and conducting a mixed methods analysis, we observed that among the types of social support, network support was a key point for the promotion of social-cognitive factors in increasing exercise adherence. Therefore, network support through SNS-based interventions should be considered as a useful strategy to help vulnerable migrant populations make changes to exercise behaviors.
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Development of a Living Lab for a Mobile-Based Health Program for Korean-Chinese Working Women in South Korea: Mixed Methods Study
Background: Korean-Chinese (KC) women make up the largest group of female migrants in South Korea. To prevent and manage chronic diseases in middle-aged KC women working full time, it is necessary to develop health promotion programs that utilize an online platform because such a platform would allow individuals to participate in health promotion interventions at their convenience.
Objective: This study aimed to develop a living lab for a mobile-based health (LLm Health) program focused on improving the physical activity and cultural adaptation of KC women workers.
Methods: We used a mixed methods design. Living lab principles were factored into the LLm Health program, including the use of multiple methods, user engagement, multistakeholder participants, real-life settings, and cocreation. The program was
developed using the 4 steps of the intervention mapping method: needs assessment, setting of objectives, identification of intervention strategies, and intervention design. Needs assessment was conducted through a literature review, focus group interviews with a total of 16 middle-aged KC women, and an online survey related to health promotion of migrant workers given to 38 stakeholders. KC middle-aged women participated in the early stages of program development and provided the idea of developing programs and mobile apps to enhance physical activity and acculturation. The mobile app developed in the program was validated with the help of 12 KC women and 4 experts, including 3 nursing professors and a professor of physical education. They were asked to rate each item based on content, interface design, and technology on a 4-point scale using a 23-item Smartphone App Evaluation Tool for Health Care.
Results: The LLm Health program comprised a 24-week walking program using Fitbit devices, the mobile app, and social cognitive interventions. The mobile app contained 6 components: a step counter, an exercise timer, an online chat function, health information, level of cardiovascular risk, and health status. The cultural aspects and lifestyles of KC women were accommodated in the entire process of program development. The content validity of the mobile app was found to be 0.90 and 0.96 according to the 12 KC women and 4 experts, respectively.
Conclusions: The mobile app was found to be valid and acceptable for KC women. The living lab approach was a useful strategy for developing a culturally adaptive LLm Health program for KC women workers, leading to their active participation in the overall research process, including needs assessment, program composition, and pre-evaluation.
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Living labs for health: an integrative literature review
Background: Living labs are user-focused experimental environments in which users and producers co-create innovative solutions in real-life settings. The aim of this study was to review and synthesize health-related studies that used the living labs approach.
Methods: An integrative literature review of 15 studies was conducted on the application of living lab principles and their usefulness for investing health problems. Three reviewers independently used methodological assessment tools to evaluate the data quality.
Results: Twelve of 15 studies were published during the past 5 years, while 14 of the 15 studies were conducted in Europe. Older adults were the target population in 9 of the 15 studies. The research topics varied, including detecting and monitoring daily life, fall prevention and social support. All the studies applied multi-method approaches and a real-life setting. Use of the living lab approach appeared to improve the quality of life, physical and social health and cognitive function of the target populations.
Conclusions: The results showed that the living lab approach was more commonly used to investigate health problems in older adult populations. Living lab appears to be an appropriate method for developing innovative solutions to improve the health of vulnerable groups.
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Effect of a Pedometer-Based, 24-Week Walking Intervention on Depression and Acculturative Stress among Migrant Women Workers
Little research has examined exercise-based interventions meant to alleviate depressive symptoms among Korean-Chinese migrant women workers living in Korea. Thus, this study evaluated the effectiveness of a 24-week walking program on reducing depressive symptoms and acculturative stress levels in this population. This quasi-experimental sequential walking program was conducted with 132 Korean-Chinese women over a period of 24 weeks. Participants were divided into either a standard treatment group (n = 69) or enhanced treatment group (n = 63). All participants were instructed to walk using a pedometer. The enhanced treatment group also received mobile text messages designed to encourage walking adherence and improve acculturation. Participants were asked to complete two structured questionnaires, the Centre for Epidemiologic Studies Depression Scale and the Acculturative Stress Scale, to evaluate the intervention programs. At the end of the program, both groups exhibited decreased depression scores, but the decrease in the enhanced treatment group was more significant both at weeks 12 and 24. Acculturative stress was also found to have decreased at weeks 12 and 24. Our findings show the walking program reduced the depressive symptoms and acculturative stress levels among the Korean-Chinese women in this study. Further studies will be needed to analyze the relationship between walking step count and mental health considering exercise intensity. Read All
Mobile App-Based Health Promotion Programs: A Systematic Review of the Literature
This study investigated the features and usefulness of mobile app-based health promotion programs for the general population. A comprehensive bibliographic search of studies on health promotion programs using mobile apps in peer-reviewed journals published in English up to November 2017 was performed using the PubMed, Embase, and CINAHL databases. The inclusion criteria were (1) randomized control trial designs; (2) assessed mobile app-based interventions to promote adult health conditions; 12 studies were ultimately included. The most common topics were diet and physical activity (n = 8) and overall healthy lifestyle improvement (n = 4). The purpose of the apps included providing feedback on one’s health status (n = 9) and monitoring individual health status or behavior change (n = 9). Across all studies, health outcomes were shown to be better for mobile app users compared to non-users. Mobile app-based health interventions may be an effective strategy for improving health promotion behaviors in the general population without diseases. This study suggests that mobile app use is becoming commonplace for a variety of health-promoting behaviors in addition to physical activity and weight control. Future research should address the feasibility and effectiveness of using mobile apps for health promotion in developing countries. Read All
