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Theoretical Framework

According to Wilson (1992), a theoretical framework for a study is an “essay that places the study in the context of existing related theory based on the literature that has been reviewed”. The theoretical framework used for this study on health promoting behaviors among EKI (Elderly Korean Immigrants) living in the United States was the Pender’s Health-promotion model (HPM) (Pender, 1996). Specifically, this study was intended to explore the nature of health promotion among EKI. The HPM is based on personal responsibility for health, in which human health is viewed as a complex paradigm affected by personal, social, political, and environmental factors (Sohng &Yeom, 2002). The HPM consists of the following three conceptual components: (a) individual characteristics, (b) behavior-specific cognition, and (c) behavioral outcomes. Individual characteristics and behavior-specific cognition are viewed as predictors for healthy behaviors, while behavioral outcome is an action goal achieved by health-promoting behaviors.

Study Variables and Measurement Instruments

Self-efficacy and Perceived Health Status are the two variables of the study.  The study variable of self-efficacy was derived from the domain of behavior-specific cognition.  According to (Bandura, 1977), self-efficacy refers to a person’s belief in his or her ability to perform a certain task successfully. Self-efficacy expectancy is a powerful predictor of behavioral change because it prompts the initial decision to achieve a behavior (Bandura, 1982). Self-efficacy has been reported to have a strong positive impact on healthy behaviors including cigarette smoking cessation, weight control, contraception, alcohol abuse (Mudde Kok, & Strecher, 1995).

Self-efficacy was measured using The General Self-efficacy Scale (Sherer et al., 1982). The instrument consists of 17 items, including 6 positive statements and 11 negative ones. Subjects respond on a 5-point Likert scale in which higher scores indicated higher self-efficacy. Construct validity and internal consistency of 0.86 were reported in the original study for college students (Sherer et al., 1982). The scale has been used in elder population (Bosscher, & Smit, 1998). The alpha coefficient reliability of the scale was 0.89 in the current study.

On the other hand, perceived health status refers to the subjective self evaluation

of one’s own health (Pender Walker, Sechrist, & Frank-Stromborg, 1990). Perceived health status is positively related to health-promoting behaviors of elderly (Speake, Cowart, & Pellet, 1989), affecting diet and weight control (Pender, & Pender, 1986). Two questions were used to measure the perceived health status based on the questionnaire developed by Speake et al. (1989): What is your evaluation of your current health status? and, What is your present health status compared to others of your own age? The first item is self rated as: excellent, good, fair, poor, and very poor health. The response choices for the second question are: much better, better, same, worse, and much worse. Both questions were scored as a 5-point scale in which ‘‘excellent’’ and ‘‘much better’’ were rated as the highest point, respectively. The reliability of the tool was not tested since the scale had only two items, making it inappropriate as to measure internal consistency.

Results of the Study

The total HPLP (Health-Promoting Lifestyle Profile) score was positively correlated with self-efficacy, but weakly correlated with perceived health status. There also was a significant correlation between self-efficacy and perceived health status. There were significant differences on HPLP scores for level of education and economic status. Respondents who had more education (high school or more) showed significantly higher HPLP scores than those who had

less education (primary school or less). An additional test of association between education and the six subdimensions of the HPLP was done to find more clearly detailed significance differences found for education on health-promoting behaviors. The level of education was significantly associated with four of the six HPLP subscales. Respondents with higher education

showed higher scores in self-actualization, health responsibility, exercise, and nutrition. Post-hoc ANOVA revealed that those who reported their economic status as either ‘‘good’’ or ‘‘very poor’’ showed higher HPLP scores than those who reported their economic status as ‘‘average’’ or ‘‘poor’’. Examining the subscales of the HPLP, respondents who reported their economic status as very poor showed higher scores in interpersonal support than those who reported average or poor economic status. The exercise subscale revealed those with good economic status were more engaged in exercise than other economic status groups. Only education was significantly associated with self-efficacy. Respondents who were more educated showed higher self-efficacy scores than those who were less educated.

Conclusions and the Implications of the Study

As a conclusion, the subjects reported negative perceptions on their health. Hence, this study concluded that there exist poor practices of healthy lifestyles of elderly Korean immigrants. The health-promoting practice that was rated lowest by the EKI was exercise. Moreover, self-efficacy was positively correlated with health promoting behaviors of the EKI.  Increased self-efficacy may be therefore a useful strategy that can enhance engagement in health-promoting behaviors by EKI. In addition, this study showed the importance of education in engaging in health-promoting behaviors. Since education also was associated with self-efficacy in this study, the impact of formal years of schooling on private health practices

of the EKI should be acknowledged by health care professionals. Moreover, the socioeconomic status of the EKI was much lower than the general elder population in the United States. Since unequal income distribution is linked to negative health outcomes (Kennedy, Kawachi, Glass, & Prothrow-Stith, 1998), this disparity in income indicates a need for further discussion on easily accessible and cost-effective health services for EKI. In addition to the meager financial condition, language barriers limit accessibility of EKI to various community resources available to elderly residents in the community. None of them participated in community health programs,

and health information via media was hardly available to them because of their lack of English fluency. Feasible health educational programs by public health nurses with the cooperation from bilingual personnel are thereby considered to be imperative for better engagement of EKI in health-promoting behaviors.


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