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Chen Y, Yuan J, Shi L, Zhou J, Wang H, Li C, Dong E, Zhao L. Understanding the Role of Technology Anxiety in the Adoption of Digital Health Technologies (DHTs) by Older Adults with Chronic Diseases in Shanghai: An Extension of the Unified Theory of Acceptance and Use of Technology (UTAUT) Model. Healthcare (Basel) 2024; 12:1421. [PMID: 39057564 PMCID: PMC11275594 DOI: 10.3390/healthcare12141421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Revised: 07/05/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
The unprecedented rapid growth of digital health has brought new opportunities to the health field. However, elderly patients with chronic diseases, as an important potential beneficiary group, are affected by the digital divide, leading to unsatisfactory usage of digital health technologies (DHTs). Our study focused on the factors influencing the adoption of DHTs among this vulnerable group. To extend the UTAUT theory, technology anxiety and several demographic predictors were included to address the age characteristics of the respondents. An on-site survey was conducted in general, district, and community hospitals in Shanghai (n = 309). Facilitating conditions negatively influenced technology anxiety. Technology anxiety hindered behavioural intention. Social influence had a significant but negative impact on behavioural intention. Education, whether older adults have had experience with DHTs and previous smartphone usage experiences were significantly associated with technology anxiety. The findings provide valuable information for multiple stakeholders, including family members of elderly users, product designers, and policymakers. Ameliorating facilitating conditions, improving devices' usage experience, encouraging attempts and focusing on groups with lower educational levels can help to reduce technology anxiety and promote DHT acceptance and use in older age groups.
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Affiliation(s)
- Yunhao Chen
- School of Public Health, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Jiajun Yuan
- Shanghai Engineering Research Center of Intelligence Pediatrics (SERCIP), Shanghai 200127, China
- Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Lili Shi
- Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Jiayun Zhou
- School of Economics, Shanghai University of Finance and Economics, Shanghai 200433, China
| | - Hansong Wang
- Shanghai Engineering Research Center of Intelligence Pediatrics (SERCIP), Shanghai 200127, China
- Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Chengjin Li
- School of Public Health, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Enhong Dong
- School of Nursing and Health Management, University of Medicine and Health Sciences, Shanghai 200237, China
- Institute of Healthy Yangtze River Delta, Shanghai Jiao Tong University, Shanghai 200052, China
| | - Liebin Zhao
- School of Public Health, Shanghai Jiao Tong University, Shanghai 200025, China
- Shanghai Engineering Research Center of Intelligence Pediatrics (SERCIP), Shanghai 200127, China
- Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
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Zawada SJ, Ganjizadeh A, Hagen CE, Demaerschalk BM, Erickson BJ. Feasibility of Observing Cerebrovascular Disease Phenotypes with Smartphone Monitoring: Study Design Considerations for Real-World Studies. SENSORS (BASEL, SWITZERLAND) 2024; 24:3595. [PMID: 38894385 PMCID: PMC11175199 DOI: 10.3390/s24113595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Revised: 05/28/2024] [Accepted: 05/31/2024] [Indexed: 06/21/2024]
Abstract
Accelerated by the adoption of remote monitoring during the COVID-19 pandemic, interest in using digitally captured behavioral data to predict patient outcomes has grown; however, it is unclear how feasible digital phenotyping studies may be in patients with recent ischemic stroke or transient ischemic attack. In this perspective, we present participant feedback and relevant smartphone data metrics suggesting that digital phenotyping of post-stroke depression is feasible. Additionally, we proffer thoughtful considerations for designing feasible real-world study protocols tracking cerebrovascular dysfunction with smartphone sensors.
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Affiliation(s)
- Stephanie J. Zawada
- Mayo Clinic College of Medicine and Science, 5777 E. Mayo Boulevard, Scottsdale, AZ 85054, USA
| | - Ali Ganjizadeh
- Mayo Clinic AI Laboratory, 200 1st Street SW, Rochester, MN 55902, USA; (A.G.); (B.J.E.)
| | - Clint E. Hagen
- Mayo Clinic Division of Biomedical Statistics and Informatics, 200 1st Street SW, Rochester, MN 55902, USA;
| | - Bart M. Demaerschalk
- Mayo Clinic Center for Digital Health, 5777 E. Mayo Boulevard, Scottsdale, AZ 85054, USA;
| | - Bradley J. Erickson
- Mayo Clinic AI Laboratory, 200 1st Street SW, Rochester, MN 55902, USA; (A.G.); (B.J.E.)
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Patel S, Sreelal B, Kalyani S, Joy SG, Pravalika T, Ramya T, Khan S, Archana V, Gandhi AP. Digital health literacy among the ageing population: A comparative cross-sectional study between rural and urban Telangana, India. Med J Armed Forces India 2024; 80:313-319. [PMID: 38799990 PMCID: PMC11117001 DOI: 10.1016/j.mjafi.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/07/2023] [Indexed: 05/29/2024] Open
Abstract
Background Digital health literacy (DHL) is the confluence where health literacy meets digital literacy. DHL has been labelled as one of the digital determinants of health by the World Health Organization. The present study estimated and compared the DHL between Telangana's urban and rural ageing adults, and their potential determinants. Methods A cross-sectional study was undertaken among 318 of the ageing individuals (≥45 years) of Hyderabad, visiting the primary health centres in the rural and urban field practice during March 2023. A Telugu version of the eHealth literacy scale (eHEALS) and health literacy scale tools were administered by the interviewers. Adjusted analysis was conducted by multiple linear regression method. Results Overall, 20.4% of the study participants had good DHL, with a similar proportion between rural and urban areas (rural-20.1% and urban-20.8%, p value-0.889). The median eHealth literacy score among the study participants was 8. While 36.5% and 45.9% had smartphones and standard analogue phones, respectively in urban areas, only 19.5% and 38.4% had smartphones and standard analogue phones, respectively in rural areas. Computer usage in the past month, higher educational qualification, and ownership of mobile phones were significant determinants of DHL. A mild but significant correlation between DHL and health literacy screening scores was found. Conclusion Considering the low DHL among the ageing population, enabling environment with enhanced access to mobile phones/smartphones and familiarity with information and communication technology gadgets must be established to improve their DHL.
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Affiliation(s)
- Sunil Patel
- Intern (Community Medicine), ESIC Medical College & Hospital, Sanathnagar, Hyderabad, India
| | - B.S. Sreelal
- Intern (Community Medicine), ESIC Medical College & Hospital, Sanathnagar, Hyderabad, India
| | - Sriramoju Kalyani
- Intern (Community Medicine), ESIC Medical College & Hospital, Sanathnagar, Hyderabad, India
| | - Sona G. Joy
- Intern (Community Medicine), ESIC Medical College & Hospital, Sanathnagar, Hyderabad, India
| | | | - Thatikonda Ramya
- Intern (Community Medicine), ESIC Medical College & Hospital, Sanathnagar, Hyderabad, India
| | - Somiya Khan
- Intern (Community Medicine), ESIC Medical College & Hospital, Sanathnagar, Hyderabad, India
| | - Vadithya Archana
- Intern (Community Medicine), ESIC Medical College & Hospital, Sanathnagar, Hyderabad, India
| | - Aravind P. Gandhi
- Assistant Professor (Community Medicine), ESIC Medical College & Hospital, Sanathnagar, Hyderabad, India
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Marsden AM, Hann M, Barron E, McGough B, Murray E, Valabhji J, Cotterill S. The effectiveness of digital delivery versus group-based face-to-face delivery of the English National Health Service Type 2 Diabetes Prevention Programme: a non-inferiority retrospective cohort comparison study. BMC Health Serv Res 2023; 23:1434. [PMID: 38110926 PMCID: PMC10729322 DOI: 10.1186/s12913-023-10365-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 11/22/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Face-to-face group-based diabetes prevention programmes have been shown to be effective in many settings. Digital delivery may suit some patients, but research comparing the effectiveness of digital with face-to-face delivery is scarce. The aim was to assess if digital delivery of the English National Health Service Diabetes Prevention Programme (NHS DPP) is non-inferior to group-based face-to-face delivery in terms of weight change, and evaluate factors associated with differential change. METHODS The study included those recruited to the NHS DPP in 2017-2018. Individual-level data from a face-to-face cohort was compared to two cohorts on a digital pilot who (i) were offered no choice of delivery mode, or (ii) chose digital over face-to-face. Changes in weight at 6 and 12 months were analysed using mixed effects linear regression, having matched participants from the digital pilot to similar participants from face-to-face. RESULTS Weight change on the digital pilot was non-inferior to face-to-face at both time points: it was similar in the comparison of those with no choice (difference in weight change: -0.284 kg [95% CI: -0.712, 0.144] at 6 months) and greater in digital when participants were offered a choice (-1.165 kg [95% CI: -1.841, -0.489]). Interactions between delivery mode and sex, ethnicity, age and deprivation were observed. CONCLUSIONS Digital delivery of the NHS DPP achieved weight loss at least as good as face-to-face. Patients who were offered a choice and opted for digital experienced better weight loss, compared to patients offered face-to-face only.
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Affiliation(s)
- Antonia M Marsden
- Centre for Biostatistics, School of Health Sciences, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
| | - Mark Hann
- Centre for Primary Care and Health Services Research, School of Health Sciences, University of Manchester, Manchester, UK
| | | | | | - Elizabeth Murray
- Institute of Epidemiology & Health Care, University College London, London, UK
| | - Jonathan Valabhji
- NHS England, London, UK
- Imperial College Healthcare NHS Trust, London, UK
- Imperial College London, London, UK
| | - Sarah Cotterill
- Centre for Biostatistics, School of Health Sciences, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
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Amoako I, Srem-Sai M, Quansah F, Anin S, Agormedah EK, Hagan Jnr JE. Moderation modelling of COVID-19 digital health literacy and sense of coherence across subjective social class and age among university students in Ghana. BMC Psychol 2023; 11:337. [PMID: 37845753 PMCID: PMC10580498 DOI: 10.1186/s40359-023-01334-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 09/18/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND The study assessed the moderation modelling of digital health literacy and sense of coherence across subjective social class and age among university students in Ghana during the COVID-19 pandemic. METHODS A total of 1160 students were conveniently sampled from two universities namely, the University of Education, Winneba and University of Cape Coast, using the descriptive cross-sectional survey design. Preliminary analysis was performed using descriptive statistics, whilst multivariate multiple regression and moderation analyses (Haye's Model) were employed to analyze the main data. RESULTS The study revealed that COVID-19 digital health literacy is directly and positively associated with sense of coherence among university students. Further, higher subjective social class positively and strongly moderated the relationship between COVID-19 digital health literacy and sense of coherence among university students. Additionally, the relationship between COVID-19 digital health literacy and sense of coherence was indirectly prominent among relatively older university students than younger ones. CONCLUSIONS The findings have implications for university management/authorities and public health agencies to organize effective orientation and self-management training programmes for university students.
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Affiliation(s)
- Isaac Amoako
- Department of Education, Atebubu College of Education, Bono East, Ghana
- Department of Interdisciplinary Studies, Akenten Appiah-Minka University of Skills Training and Entrepreneurial Development, P. O. Box 1277, Kumasi, Ghana
| | - Medina Srem-Sai
- Department of Health, Physical Education, Recreation and Sports, University of Education, P. O. Box 25, Winneba, Ghana
| | - Frank Quansah
- Department of Educational Foundations, University of Education, P. O. Box 25, Winneba, Ghana
| | - Stephen Anin
- Department of Industrial and Health Sciences, Faculty of Applied Sciences, Takoradi Technical University, P.O. Box 256, Takoradi, WS000, Ghana
| | - Edmond Kwesi Agormedah
- Department of Business & Social Sciences Education, University of Cape Coast, PMB, Cape Coast, Ghana.
| | - John Elvis Hagan Jnr
- Department of Health, Physical Education and Recreation, University of Cape Coast, PMB, Cape Coast, Ghana
- Neurocognition and Action-Biomechanics-Research Group, Faculty of Psychology and Sports Science, Bielefeld University, Postfach 10 01 31, 33501, Bielefeld, Germany
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Areias AC, Janela D, Molinos M, Moulder RG, Bento V, Yanamadala V, Cohen SP, Correia FD, Costa F. Managing Musculoskeletal Pain in Older Adults Through a Digital Care Solution: Secondary Analysis of a Prospective Clinical Study. JMIR Rehabil Assist Technol 2023; 10:e49673. [PMID: 37465960 PMCID: PMC10466151 DOI: 10.2196/49673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Aging is closely associated with an increased prevalence of musculoskeletal conditions. Digital musculoskeletal care interventions emerged to deliver timely and proper rehabilitation; however, older adults frequently face specific barriers and concerns with digital care programs (DCPs). OBJECTIVE This study aims to investigate whether known barriers and concerns of older adults impacted their participation in or engagement with a DCP or the observed clinical outcomes in comparison with younger individuals. METHODS We conducted a secondary analysis of a single-arm investigation assessing the recovery of patients with musculoskeletal conditions following a DCP for up to 12 weeks. Patients were categorized according to age: ≤44 years old (young adults), 45-64 years old (middle-aged adults), and ≥65 years old (older adults). DCP access and engagement were evaluated by assessing starting proportions, completion rates, ability to perform exercises autonomously, assistance requests, communication with their physical therapist, and program satisfaction. Clinical outcomes included change between baseline and program end for pain (including response rate to a minimal clinically important difference of 30%), analgesic usage, mental health, work productivity, and non-work-related activity impairment. RESULTS Of 16,229 patients, 12,082 started the program: 38.3% (n=4629) were young adults, 55.7% (n=6726) were middle-aged adults, and 6% (n=727) were older adults. Older patients were more likely to start the intervention and to complete the program compared to young adults (odds ratio [OR] 1.72, 95% CI 1.45-2.06; P<.001 and OR 2.40, 95% CI 1.97-2.92; P<.001, respectively) and middle-aged adults (OR 1.22, 95% CI 1.03-1.45; P=.03 and OR 1.38, 95% CI 1.14-1.68; P=.001, respectively). Whereas older patients requested more technical assistance and exhibited a slower learning curve in exercise performance, their engagement was higher, as reflected by higher adherence to both exercise and education pieces. Older patients interacted more with the physical therapist (mean 12.6, SD 18.4 vs mean 10.7, SD 14.7 of young adults) and showed higher satisfaction scores (mean 8.7, SD 1.9). Significant improvements were observed in all clinical outcomes and were similar between groups, including pain response rates (young adults: 949/1516, 62.6%; middle-aged adults: 1848/2834, 65.2%; and older adults: 241/387, 62.3%; P=.17). CONCLUSIONS Older adults showed high adherence, engagement, and satisfaction with the DCP, which were greater than in their younger counterparts, together with significant clinical improvements in all studied outcomes. This suggests DCPs can successfully address and overcome some of the barriers surrounding the participation and adequacy of digital models in the older adult population.
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Affiliation(s)
| | - Dora Janela
- Sword Health, Inc, Draper, UT, United States
| | | | - Robert G Moulder
- Sword Health, Inc, Draper, UT, United States
- Institute for Cognitive Science, University of Colorado Boulder, Boulder, CO, United States
| | | | - Vijay Yanamadala
- Sword Health, Inc, Draper, UT, United States
- Department of Surgery, Frank H Netter School of Medicine, Quinnipiac University, Hamden, CT, United States
- Department of Neurosurgery, Hartford Healthcare Medical Group, Westport, CT, United States
| | - Steven P Cohen
- Departments of Anesthesiology & Critical Care Medicine, Physical Medicine and Rehabilitation, Neurology, and Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
- Departments of Anesthesiology and Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Fernando Dias Correia
- Sword Health, Inc, Draper, UT, United States
- Neurology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
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Guarnera J, Yuen E, Macpherson H. The Impact of Loneliness and Social Isolation on Cognitive Aging: A Narrative Review. J Alzheimers Dis Rep 2023; 7:699-714. [PMID: 37483321 PMCID: PMC10357115 DOI: 10.3233/adr-230011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/28/2023] [Indexed: 07/25/2023] Open
Abstract
Social concepts such as loneliness and social isolation are fairly new factors that have been recently gaining attention as to their involvement in changes in cognitive function and association with dementia. The primary aim of this narrative review was to describe the current understanding of how loneliness and social isolation influence cognitive aging and how they are linked to dementia. Studies have shown that there is an association between loneliness, social isolation, and reduced cognitive function, in older adults, across multiple cognitive domains, as well as a heightened risk of dementia. Numerous changes to underlying neural biomechanisms including cortisol secretion and brain volume alterations (e.g., white/grey matter, hippocampus) may contribute to these relationships. However, due to poor quality research, mixed and inconclusive findings, and issues accurately defining and measuring loneliness and social isolation, more consistent high-quality interventions are needed to determine whether studies addressing loneliness and social isolation can impact longer term risk of dementia. This is especially important given the long-term impact of the COVID-19 pandemic on social isolation in older people is yet to be fully understood.
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Affiliation(s)
- Jade Guarnera
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Eva Yuen
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Melbourne, VIC, Australia
- Centre for Quality and Patient Safety-Monash Health Partnership, Institute for Health Transformation, Deakin University, Melbourne, VIC, Australia
| | - Helen Macpherson
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
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Dong Q, Liu T, Liu R, Yang H, Liu C. Effectiveness of Digital Health Literacy Interventions in Older Adults: Single-Arm Meta-Analysis. J Med Internet Res 2023; 25:e48166. [PMID: 37379077 PMCID: PMC10365623 DOI: 10.2196/48166] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/23/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND In a world of rapid digital technology development, the lack of digital health literacy (DHL) among older people cannot be ignored. DHL is becoming an essential competency that can facilitate the health status and health management of older adults. DHL interventions that are feasible and appropriate can be implemented on a large scale through the health care system for older people. OBJECTIVE The purpose of this meta-analysis was to assess the effectiveness of DHL interventions for older adults. METHODS English publications in PubMed, Web of Science, Embase, and the Cochrane Library were searched from inception to November 20, 2022. Two reviewers independently completed the data extraction and quality assessment. Review Manager (version 5.4; Cochrane Informatics & Technology Services) software was used for all meta-analyses. RESULTS A total of 7 studies, including 2 randomized controlled trials and 5 quasi-experimental studies, involving 710 older adults were considered eligible. The main outcome was scores on the eHealth Literacy Scale, and secondary outcomes were knowledge, self-efficacy, and skills. Quasi-experimental studies compared baseline and postintervention outcomes, while randomized controlled trials compared pre- and postintervention outcomes in the intervention group. Of the 7 studies, 3 used face-to-face instruction, while 4 adopted web-based interventions. Among them, 4 of the interventions were conducted using theoretical guidance, while 3 were not. Intervention duration varied from 2 to 8 weeks. In addition, the studies included were all conducted in developed countries, mainly in the United States. Pooled analysis presented that DHL interventions had positive effects on eHealth literacy efficacy (standardized mean difference 1.15, 95% CI 0.46 to 1.84; P=.001). Subgroup analysis revealed that DHL interventions that chose face-to-face teaching (standardized mean difference 1.15, 95% CI 0.46 to 1.84; P=.001), were guided by a conceptual framework (standardized mean difference 1.15, 95% CI 0.46 to 1.84; P=.001), and were sustained over 4 weeks (standardized mean difference 1.1, 95% CI 0.46 to 1.84; P=.001) had a more significant effect. Moreover, the outcomes showed considerable gains in knowledge (standardized mean difference 0.93, 95% CI 0.54 to 1.31; P<.001) and self-efficacy (standardized mean difference 0.96, 95% CI 0.16 to 1.77; P=.02). No statistically significant effect was found for skills (standardized mean difference 0.77, 95% CI -0.30 to 1.85; P=.16). The small number of studies, variable study quality, and heterogeneity are some limitations of this review. CONCLUSIONS DHL interventions have positive effects on the health status and health management of older adults. Practical and effective DHL interventions are crucial for the use of modern digital information technology in managing the health of older people. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42023410204; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=410204.
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Affiliation(s)
- Qian Dong
- School of Nursing, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, Shandong Province, China
| | - Ting Liu
- School of Nursing, Qingdao University, Qingdao, Shandong Province, China
| | - Ran Liu
- Jinan Blood Center, Jinan, Shandong Province, China
| | - Hongxia Yang
- School of Nursing, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, Shandong Province, China
| | - Cuiping Liu
- School of Nursing, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, Shandong Province, China
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Kim HS, Sung JH. The influence of Digital Informatization Level, Self-efficacy, and Social Support on Digital Health Literacy in the Elderly with Cancer. ASIAN ONCOLOGY NURSING 2022. [DOI: 10.5388/aon.2022.22.4.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Hye Su Kim
- Nurse, Kosin University Gospel Hospital, Busan, Korea
| | - Ji Hyun Sung
- Assistant Professor, College of Nursing, Kosin University, Busan, Korea
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