Seunghyun Yoo

Collaborative community empowerment: an illustration of a six-step process.

This article illustrates a method used in a community empowerment project where community members and university facilitators collaborated to increase the capacity of the community. The method may have practical uses in collaborations with community groups. The six-step process enabled the community groups to accomplish their short-term community goals: developing effective after-school programs and resolving problems of damaged homes and blighted properties in a relatively short time and continuing on their collaborative work. Having a social ecological model as a conceptual framework was helpful for the community to assess their status and develop action plans. Consistent community meetings, open communication, focused community leadership, community networking, and collaboration of community organizations and a university were the factors that reinforced the empowerment process. Challenges such as maximizing limited resources and generating more participation from the community need to be resolved while the reinforcing factors are cultivated.

Applying comprehensive community-based approaches in diabetes prevention: rationale, principles, and models.

The literature regarding the prevention of diabetes provides few standards for community-based initiatives. The present article offers four principles for engaging communities in comprehensive community approaches to diabetes prevention including (1) facilitating meaningful and central roles for communities, (2) giving primary attention to participatory processes rather than to best practices, (3) emphasizing cultural relevance in designing interventions particularly in racial and ethnic communities, and (4) incorporating social ecology approaches that are holistic and that address larger environmental influences rather than individual behavioral change alone. In order that community public health practitioners may operationalize the principles, models are provided for each.

Improvements in the Metabolic Syndrome and Stages of Change for Lifestyle Behaviors in Korean Older Adults

Objectives This study aims to examine the effectiveness of a 6-month lifestyle modification program on the improvement in metabolic syndrome (MetS) status and in stages of change for lifestyle behaviors associated with MetS among Korean older adults. Methods A lifestyle modification program was developed based on the transtheoretical model. The program consisted of health counseling, education classes, a self-management handbook, newsletters and a health diary. Older adults aged ≥60 (n = 480) with MetS were randomly assigned to the intervention group (IG) or the comparison group (CG). The IG received a comprehensive 6-month lifestyle modification intervention, while the CG received minimal information on MetS and lifestyle modification. Health examination and selfadministered survey were conducted before and after the intervention to determine the effectiveness of the program. Results After the intervention, the prevalence of MetS decreased to 38.1% in the IG and 52.4% in the CG (p = 0.046). The IG improved abdominal obesity (p = 0.016), blood pressure (p = 0.030), and triglyceride (p = 0.005) more than the CG did. The IG demonstrated significant improvements in the behavioral stages for portion control (p = 0.021), balanced diet (p < 0.001) and adequate intake of fruits and vegetables (p = 0.012). The IG reduced the prevalence of abdominal obesity (OR = 2.34) and improved MetS status (OR = 1.79) better than the CG. The IG were more likely to advance from preaction stages at baseline to action stage at post-intervention for portion control (OR = 3.29) and adequate intake of fruits and vegetables (OR = 2.06). Conclusion Lifestyle modification can improve the MetS status and behavioral stages in older adults.

Heterogeneity in Obesity Status and Cardiovascular Risks in Multiethnic Asian Female Immigrants in South Korea

The present study investigated the prevalence of obesity and the associated health conditions of multiethnic Asian female immigrants in Korea. Data were collected from 2246 immigrant wives in 7 largest ethnic groups in a national health examination program. The mean body mass index was 21.9 ± 3.3 kg/m2. Prevalence of obesity (body mass index ≥25 kg/m2) among immigrant women was 15.4%. Age-adjusted prevalence of obesity varied among groups by native country (from 10.4% for Japanese to 36.3% for Thai women). The likelihood of obesity significantly increased with years of residence in Korea (odds ratio [OR] = 1.44 for 5.0-9.9 years; 1.85 for ≥10 years), physical inactivity (OR = 1.84), and eating spicy and/or salty food (OR = 1.45). Prevalence of chronic health conditions also differed by country of origin. Significant associations were observed between obesity and elevated blood pressure (OR = 1.87), obesity and elevated cholesterol level (OR = 2.83), and obesity and prediabetes/diabetes (OR = 2.44) after adjusting for age, country of origin, and years of residence in Korea.

The context of perceived and desired social support among Korean older adults.

Social support has multiple dimensions, the context of which can be explored by qualitative methods. In this study, face-to-face interviews were conducted with 21 local senior center members (9 men and 12 women aged 65 and older) in Seoul, South Korea, in order to explore how they perceive and desire social support in an aging society. The qualitative methods in this study also included thematic analysis and constant comparison to identify three main themes: “no or denied support,” “not to be greedy and shameless,” and “justification and hopelessness.” In the interviews, perceived and desired support did not emerge immediately as the participants were reluctant to share personal concerns with or to seek support from others. Nevertheless, they would turn to spouses and children for both emotional and instrumental support when in dire need. A shared norm among the participants was that seeking support would be an embarrassing and shameless act for themselves and a burden to others. They justified the discrepancy between the perceived and desired support as part of aging and felt hopelessness about it. The findings of this study have implications that implicit, individual social support may be effective than explicit, group support activities for those who are passive in recognizing the need for and seeking social support. In assessing and interpreting social support in old age, both perceived and desired support should be included and contextual approaches can be useful in so doing. The senior centers should be a more active advocate of successful aging that would offset hopelessness, negative attitude toward life, and social disconnection. Future research should focus on identifying effective strategies to bridge the gap between perceived and desired social support in older adults in this society of changing values and social norms.

Clustering Patterns and Correlates of Multiple Health Behaviors in Middle-aged Koreans with Metabolic Syndrome

Objectives: The objective of the study was to examine the clustering patterns and correlates of multiple health behaviors (MHBs) in middle-aged Koreans with metabolic syndrome (MetS). Methods: Data on sociodemographics, clinical characteristics, health behaviors (vegetable intake, physical activity, cigarette smoking, and alcohol consumption), and psychological characteristics were collected by a self-reported survey and medical examination from 331 individuals with MetS. Clustering of MHBs was examined by measuring 1) the ratios of observed and expected prevalence of MHBs, and 2) the prevalence odds ratios. A binomial logistic regression were conducted. Results: Men were more likely than women to engage in multiple unhealthy behaviors. Clustering of smoking and heavy drinking was exhibited in the participants. Women with high vegetable intake were more likely to be physically inactive, and those with inadequate vegetable intake were more likely to be physically active. Those with lower self-regulation were more likely to engage in unhealthy behaviors. Conclusions: The findings support the multiple health behavior approach as opposed to the individual health behavior approach. Emphasis of self-regulation is necessary in developing multiple behavior intervention for individuals with MetS.

Composition of Metabolic Syndrome Among Korean Adults in a Lifestyle Modification Intervention

Objectives The aim of this study was to examine the composition of metabolic syndrome (MetS) components among middle-aged and older Koreans. Methods A total of 263 participants (age 40 + years) in a lifestyle modification intervention program who met the MetS definition of National Cholesterol Education Program (NCEP) – Adult Treatment Panel (ATP) III criteria were included in the study. The frequent patterns and clustering of MetS components were investigated. Clustering of changes in individual components, through a lifestyle modification intervention, was also identified. All characteristics were stratified by and compared between sexes. Results Approximately 80% of the participants had three of five MetS risk factors at baseline. The prevalence of each risk differed by sex. MetS composition patterns that do not include low high-density lipoprotein (HDL) cholesterol were more noticeable in men because of the low prevalence of low HDL cholesterol. In women, with higher prevalence of low HDL cholesterol, more patterns that include low HDL cholesterol were observed. The most common combination was “elevated blood pressure + abdominal obesity + impaired fasting glucose” in both sexes. Clustering of MetS risks was also found with most of the frequent combinations of MetS components. Through the lifestyle intervention, the greatest change was observed in HDL cholesterol among men and blood pressure among women. Triglycerides and HDL cholesterol were likely to be improved with blood pressure in men and abdominal obesity in women. Conclusion Differences in the prevalent patterns of MetS compositions were observed prior to and after the intervention, along with during-intervention changes. It is recommended that intervention strategies and guidelines for MetS management consider the MetS composition patterns for effectiveness.

Perceived urban neighborhood environment for physical activity of older adults in Seoul, Korea: A multimethod qualitative study.

This study assessed the attributes of a perceived urban neighborhood environment for the physical activity (PA) of older adults by applying a qualitative multimethod approach to collect both descriptive and spatial information. Conducted in a northern community of Seoul, Korea, from April 2014 to November 2015, data collection methods included 90 walking tours by researchers, 46 face-to-face, semi-structured interviews combined with qualitative mapping with senior residents aged 65+, 19 guided tours with the interviewees, and 3 focus groups with 12 community service providers. Thematic analysis and pattern finding were performed on the data. Walking was the main type of PA of the older adults. Nine attributes of perceived neighborhood environment for PA were identified under three themes: daily living (everyday life activities, mobility, social opportunities, diverse destinations); the multidimensionality of accessibility (physical, economic, psychosocial), and attractiveness and pleasantness (maintenance, aesthetics). The subcategories of the attributes included proximity, access to public transportation, walkability, cost-worthiness, low or no cost, familiarity, sense of welcoming, sociocultural appropriateness, fair access, order and upkeep, safety, openness, cleanliness, and interestingness. Strategies to generate more movement and activities in the everyday routine of the elderly should be a core task for health promotion and neighborhood design. A strategic application of multiple qualitative methods can create an opportunity to build contextual understanding and to generate ideas in interactions with the community.

Routine Screening and Consultation Facilitate Improvement of Metabolic Syndrome

This randomized controlled trial study aimed to investigate the effects of a lifestyle intervention on metabolic syndrome (MetS) among middle-aged Koreans. A total of 243 middle-aged Koreans with MetS were randomly assigned to either of 2 types of lifestyle intervention for MetS and followed for 12 months. Health examinations and interventions were implemented at 16 regional branch facilities of a Korean medical institution from 2010, following the NCEP-ATP III criteria and recommendations. Lifestyle intervention (LI) group (n = 137) participated in a 12-week multi-component intervention including individual counseling, group sessions, and self-help materials. Basic usual intervention (BI) group (n = 106) was provided with one-page health information sheet on MetS and MetS management at baseline. Prevalence of MetS and each of MetS components, except for low HDL-cholesterol, in both groups were significantly reduced and maintained after the intervention. Notably, prevalence of hypertension and abdominal obesity continued to improve during the follow-up period. Between-group differences in results were not found. Both interventions were effective when they were accompanied with repeated check-ups and notification of MetS status. It is recommended to design clear guidelines for the notification of MetS after MetS screening and to encourage checking MetS status periodically for effective MetS management (KCT 0000446). Graphical Abstract

Mobile health for community participation: Research patterns and directions

Objectives: This study aims to examine the trends of mobile-health research in terms of community participation. Methods: A set of 24 peer-reviewed articles were identified for review. Two authors independently reviewed the articles using a literature review matrix and reexamined as a team. Review categories include: general characteristics, research methods, levels and ranges of community participation, and research topics. Results: Most of the articles were published in 2013-2014, including one domestic paper. Multidisciplinary approaches were used in 65% of the studies. Community participation was at low or mid-levels of Arnstein’s participation model. In mobile-health research so far, the level of participation tends to improve as more diverse stakeholders participate in health promotion initiatives with mobile-health. The review yielded five types of mobile-health research for community health promotion: improving the quality of primary healthcare through the community health workers’capacity enhancement; improving the data collection capabilities; facilitating exchanges of community information and resources; reinforcing community identity; and monitoring physical environment of the communities. Conclusions: Although at an early stage of research development, application of mobile-health to community health promotion via participation has a potential. Multi-disciplinary approaches should be fostered for further development.