cuteral diversity in nursing Assignment | Essay Help Services

Funds 176 Culture Assignment Leininger (1995) cites, “ There is a marked increase in migration of people within and between countries worldwide. Transcultural nursing is needed because of the growing diversity that characterizes our growing national and global populations.  Diversity refers to differences in race, ethnicity, national origin, religion, age, gender, sexual orientation, ability or disability, social and economic status, class education and other attributes.” The objective for this assignment is to recognize the different forms of culture.  These forms are not limited to ethnic or racial groups.  Exploration  of a cultural type will be decided by each student in their selection of a scholarly article from a journal selected from the EBSCO site.     The article chosen will be analyzed with a written 2 page report.  A copy of the article must accompanied the written assignment. 10 Points:  assignment presented on due date 20 points:   Brief synopsis of the article 10 points: Identification of 2 references sources used in the article 20 point:  1)   Explain how this article increased your knowledge by disproving myths and stereotypes that are commonly formed against this culture.  And  2.) How the information in the article affects the patient’s ability to cope   Examples of Cultural forms:  “gun culture”  “computer age”  “culture shock of 1st generation immigrant” Culture of New England,  “culture of violence in the media”  Amish culture, “the graying of America”_ 5._____________________ORIGINAL ARTICLE
Child Health Nurs Res, Vol.26, No.1, January 2020: 23-34
https://doi.org/10.4094/chnr.2020.26.1.23
ISSN(Print) 2287-9110
ISSN(Online) 2287-9129
CHNR
Factors Affecting Health Behaviors in Late School-aged Children from Multicultural
Families
Sangmi Lee
Associate Professor, Department of Nursing, Dongyang University, Yeongju, Korea
Purpose: This study was conducted to investigate factors affecting health behaviors in late school-aged children from multicultural
families. Methods: This study included 401 children (112 from multicultural families and 289 from non-multicultural backgrounds)
in grades 4~6 in 11 elementary schools. Data on health behaviors and related factors (school adjustment, the mother-child
relationship, self-efficacy, etc.) were collected from the children using self-reported questionnaires between May and June in 2019.
The collected data were analyzed through a univariate analysis and multiple regression analysis. Results: The health behavior score
of multicultural children was lower than that of non-multicultural children (t=3.32, p=.001). In multicultural children, school
adjustment (β=.55, p<.001), mother-child relationship (β=.25, p=.001), and perceived health status (very healthy=1; β=.19, p=.011)
were significant factors affecting their health behavior and explained 47.0%(F=30.93, p<.001) of the variance. Conclusion: Multicultural
late school-aged children are at risk to engage in a lower level of health behaviors than their non-multicultural
counterparts. More attention should be paid to ways of improving multicultural children’s perceptions of their health status,
maternal relationships, and school adjustment in order to promote health behaviors.
Key words: Health behavior; Child; Mother-child relations; Cultural diversity; Family
Copyright © 2020 Korean Academy of Child Health Nursing | 23
INTRODUCTION
1. Need for Study
The proportion of elementary, middle, and high school students
in Korea from multicultural families is steadily rising,
with an increase from 0.7% in 2012 to 2.2% in 2018; furthermore,
the majority of multicultural students (76.2%) are in
elementary school [1]. In the Korean context, multicultural
students refer to children who are from families where one or
both parents are foreigners. It has become common in Korea
for children to be born in the setting of an international marriage
between a foreign woman who emigrated for marriage
and a Korean man, due to numerous complex social phenomena,
such as recent economic developments, women’s high
educational attainment, the reduced marriage rate of women
linked to their social advancement, the higher proportion of
men than women among older unmarried people (over 40
years of age), and the low birthrate [1].
Multicultural couples are prone to conflict due to linguistic
and cultural differences, and since the male partners in these
relationships are often older or of low socioeconomic status,
there is also a high risk of conflict due to the generation gap
and financial problems; taken together, both these conflicts
Corresponding author Sangmi Lee
https://orcid.org/0000-0002-7611-670X
Department of Nursing, Dongyang University,
145 Dongyangdae-ro, Punggi-eup, Yeongju 36040, Korea
TEL +82-54-630-1712 FAX +82-54-630-1371
E-MAIL lsm95@dyu.ac.kr
*This study was supported by the research fund of Dongyang University in
2018.
Received Aug 28, 2019 Revised Sep 26, 2019 Accepted Sep 28, 2019
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-
Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted noncommercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.
24 | Factors Affecting Health Behaviors in Late School-aged Children from Multicultural Families www.e-chnr.org
CHNR Child Health Nurs Res, Vol.26, No.1, January 2020: 23-34
and their underlying causes may influence their children [2].
Furthermore, mothers in multicultural families tend to have
an insufficient understanding of child rearing and health care,
due to the expectation that they give birth to a child within a
short period after immigration, a problem exacerbated by the
tendency of the father or grandparents to raise children according
to traditional methods, which involve providing improper
health care to children and place them at a higher risk
of health problems [3]. In particular, most foreign mothers in
Korea are women who emigrate from underdeveloped regions
of Southeast Asia, such as Vietnam [1]. These mothers
may lack adequate education on concepts of personal and
public hygiene, increasing their risk of providing improper
health care, which may in turn also have effects on their children’s
health behaviors.
Health behaviors are essential factors for maintaining and
promoting health and preventing disease, and given that
health habits formed at an early age tend to affect one’s health
throughout the lifetime [4], desirable health behaviors during
childhood lay the foundation for ensuring optimal growth
and development and becoming a healthy adult. School age is
a period when through increased independence from their environment
and an improved ability to control their behavior
[5], children begin to independently perform health behaviors
that previously depended on parents or caregivers, a transition
that widens the gap between children in terms of health
behaviors. For this reason, research into the health behaviors
of school-age children in Korea has become more active in recent
years [6-10], with most studies targeting late school-aged
children (specifically in the fourth to sixth grades in elementary
school) who are able to give self-reports on their own behaviors
[6-9]. Some research has investigated children from
the vulnerable environment of low-income households, who
are at a higher risk of poor health performance, but few studies
in Korea have conducted health behavior surveys among
multicultural children [11].
Individuals’ health behavior is affected by their internal
and environmental characteristics [12]. Low socioeconomic
status reduces perceptions and practices of health behaviors,
and health problems and degree of obesity are well-known internal
factors that negatively interact with health behaviors
such as physical activity, eating habits, and lifestyle [12]. In
addition, since self-efficacy is a direct predictor of one’s behaviors
and will, high self-efficacy has the effect of stimulating
behavioral change by strengthening self-control of one’s
behaviors, thereby ultimately promoting health behaviors
[13]. Thus, self-efficacy should be included in analyses of the
health behaviors of socially vulnerable children, who are more
likely to experience low self-efficacy.
Parents, as the shapers of children’s most intimate environment,
act as role models for health behaviors, as well as educators
and facilitators [14]. In other words, emotional support
and adequate supervision from parents improve children’s
quality of life, and also control inappropriate health behaviors
and promote proper behaviors. However, foreign mothers
and multicultural families may lack a full understanding of
their children, exposing them to a greater risk of low-quality
parent-child relations. Especially when their children become
elementary school students and begin to follow the regular
school curriculum, foreign mothers face difficulties in guiding
their children to learn due to their different sociocultural background,
the unfamiliarity of the curriculum, and their poor
Korean proficiency. The low parenting efficacy that stems
from mothers’ poor ability to guide their children’s learning
further disturbs their relationship with their children, and it
therefore may be easier for children to disregard their mothers
or demonstrate negative attitudes toward them [15]. This interrupts
the formation of the mother-child relationship and interfere
with mothers’ roles as the health behavior educators
and facilitators for their children.
Moreover, school is the environment where late schoolaged
children spend most of their time (in addition to home)
and are exposed to various influences, and their health behaviors
are correlated with their adaption to-and satisfaction
with-school life [7]. School adjustment is an inclusive concept
that refers to the overall school life of children, including their
attitudes toward academic performance, compliance with
school regulations, relationships with peers or teachers, and
satisfaction with school life [16]. Considering the magnitude
of school’s influence on school-aged children [4], school adjustment
can be a significant factor affecting children’s quality
of life and even lifestyle factors, such as health behaviors.
However, multicultural children may have difficulties making
friends of their own age due to their exotic appearance,
language problems, or underachievement in school, and they
are therefore susceptible to difficulties in school adjustment,
including experiences of psychological problems, refusal to
attend school due to bullying [15], and timidity stemming
from a sense of repulsion, humiliation, and isolation due to
their unusual family environment, which is different from
that of their peers [17]. In a large-scale longitudinal study of
3,808 first-grade elementary students in Korea [18], peer relationships
showed significant correlations with scores on the
Child Behavior Checklist, which is used to evaluate children’s
social adjustment, emotion, and behavioral problems, as well
as with emotional and behavioral problems measured using
the Youth Self Report in early adolescence (13~15 years of
age). These findings demonstrate the short- and long-term influence
of peer relationships of school-aged children on their
ability to achieve optimal social outcomes. Therefore, it is
www.e-chnr.org Sangmi Lee | 25
https://doi.org/10.4094/chnr.2020.26.1.23 CHNR
necessary to elucidate the relationships between health behaviors
and the internal and environmental characteristics of
multicultural children, which are likely to negatively influence
their health-related behaviors. Since recent health behavior-
related research on children from multicultural families in
Korea has only been carried out in adolescents to a limited extent
using Youth Health Behavior Online Survey data [11], it is
necessary to compare the health behavior status of multicultural
school-aged children and that of children from
non-multicultural families with the goal of identifying factors
related to health behaviors as a basis for developing strategies
for health behavior promotion in multicultural school-aged
children.
2. Purpose
This study aimed to investigate factors affecting health behaviors
in late school-aged children from multicultural families
and to explore factors affecting these behaviors. Its specific
goals were to compare health behaviors, the mother-child
relationship, school adjustment, and self-efficacy between late
school-aged multicultural children and their non-multicultural
peers; to identify correlations between health behaviors
and children’s general characteristics, the mother-child
relationship, school adjustment, and efficacy; and finally, to
analyze the factors affecting health behaviors of multicultural
children.
METHODS
1. Study Design
This is a descriptive research study aiming to investigate
health behaviors in late school-aged children from multicultural
families in comparison with children from non-multicultural
families and to analyze the factors affecting the health
behaviors of multicultural children.
2. Subjects
The subjects of this study were late school-aged children
from multicultural and non-multicultural families, including
all of the fourth- to sixth-grade students from a convenience
sample of 11 elementary schools in town and village units of
North Gyeongsang Province in which multicultural families
form a large percentage of the population. The subjects were
children who had enough Korean-language proficiency to fill
out the questionnaire on their own and provided written consent
to participate in the study. A total of 414 children participated,
including multicultural children with foreign mothers
and children from non-multicultural families where both parents
were Korean. The final analysis included 401 children
(112 multicultural children and 289 non-multicultural children)
after excluding 13 children with missing data for basic
information such as maternal nationality. The sample size exceeded
the necessary sample size of 85 multicultural children
determined using the G*Power 3.1 program with an intermediate
effect size of .14, a significance factor of .05, a power
of .80, and with four independent variables to be considered
in the multiple regression analysis.
3. Data Collection
Before data collection, we received approval to conduct the
research from the Institutional Review Board of the institution
to which the researcher of this study was affiliated (approval
number 1041495-201903-HR-03-01). The researcher then visited
the participating elementary schools and explained the
purpose and methods of the study to the head of the institution
(principal or vice-principal), after which data were
collected from May to June of 2019 from the institutions that
agreed for students to participate. In accordance with the circumstances
of the specific institutions, either the researcher or
a class teacher who fully understood the purpose and methods
of the study visited fourth- to sixth-grade classrooms to
inform them of the purpose and methods of the study and
their choice between voluntary participation or refusal, and
then collected data from the subjects who provided written
consent to participate. In this study, all information except for
physical measurement values (weight, height) were gathered
by a 4-page questionnaire survey on A4 paper, which took 20
minutes to fill out. For the weight and height of the subjects,
measurement values to the first decimal place were collected
at a medical clinic (for fourth-graders) or stadiometers in the
school (for fifth- and sixth-graders) as part of student health
check-ups that took place from April to May 2019. The subjects
were also each provided with a small reward.
4. Study Tools
The dependent variable of this study was health behavior,
and the predictors of the dependent variable were general
characteristics (gender, grade, adiposity, perceived health status,
perceived economic status, etc.), their mother-child relationship,
school adjustment, and self-efficacy.
1) Health behaviors
To investigate the health behaviors of elementary school
students, we used (with approval) the tool that was developed
by Kim, Yang, Jeong, and Lee [19] and then modified and sup26
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CHNR Child Health Nurs Res, Vol.26, No.1, January 2020: 23-34
plemented on the basis of health guidelines by Park [9]. This
tool consists of a total of 53 questions in 6 subcategories, including
10 questions on individual hygiene, 9 on eating habits,
6 on exercise, 10 on mental health, 10 on disease prevention,
and 8 on accident prevention. The items were scored
on a 4-point Likert scale, with ‘never’ as 1 point and ‘always’
as 4 points, implying that the higher the total score, the higher
the level of health promotion behaviors. The reliability of the
tool-represented by Cronbach’s ⍺-was .94 for the entire tool
and .75~.83 for the sub-dimensions in Park’s study [9], and .93
for the entire tool and .68~.81 for the sub-dimensions in our
study.
2) Body mass index and adiposity
Body mass index (BMI) is calculated by dividing weight
(kg) by height squared (m2), and adiposity was defined according
to the classification criteria of the 2017 Pediatric
Growth Chart [20]. Underweight was defined as an age-specific
weight under the 5th percentile, overweight as an agespecific
BMI greater than the 85th percentile and less than the
95th percentile, and obesity as an age-specific BMI greater
than or equal to the 95th percentile.
3) Perceived health status
Perceived health status was evaluated by a single question
regarding the subject’s own opinion of his or her current
health status, as has been done in previous studies to determine
participants’ subjective health status [6,11]. The question
was answered using a Likert scale, with ‘very unhealthy’
as 1 point and ‘very healthy’ as 4 points, meaning that the
higher the total score, the better the perceived health status.
4) Mother-child relationship
In order to evaluate the mother-child relationship among
late school-aged children, the tool developed by Lee and Kim
[21] was used. This tool uses the same questions to evaluate a
child’s perceived relationship with his or her mother or father,
although it was utilized in this study to investigate specifically
mother-child relationships. The tool consists of 30 questions
distributed among 5 subcategories, with 10 questions on
intimacy/support, 7 on authority/control, 5 on the parental
relationship, 4 on great expectations, and 4 on permissiveness.
The responses were on a 5-point Likert scale, with ‘absolutely
not true’ as 1 point and ‘very true’ as 5 points, meaning that
the higher the total score, the higher the quality of the parent-
child relationship. Cronbach’s ⍺, as an indicator of the
reliability of the tool, was .89 for the entire tool and .73~.87 for
the sub-dimensions in Lee and Kim’s study [21], while the corresponding
values were .89 for the entire tool and .79~.92 for
the sub-dimensions in this study.
5) School adjustment
The tool developed by Joe and Doh [16] was used with the
author’s approval to evaluate school adjustment in the late
school-aged children. This tool consists of 30 questions in 4
subcategories, with 9 questions on academic attitudes and
rule observance, 7 on relationships with peers, 8 on relationships
with teachers, and 6 on school satisfaction. The items
were answered on a 4-point Likert scale, with ‘almost never’
as 1 point and ‘very true’ as 4 points, implying that the higher
the total score, the greater the school adjustment. Cronbach’s ⍺, as an indicator of the reliability of the tool, was .91~.93 for
the sub-dimensions in Joe and Doh’s study [16], while its values
were .96 for the entire tool and .86~.92 for its sub-dimensions
in this study.
6) Self-efficacy
The Korean Adaptation of the General Self Efficacy Scale
[22], which was developed by Schwarzer and Jerusalem [23],
was utilized to evaluate self-efficacy. This tool is allowed to be
used through the original developer’s official website (http://
userpage.fu-berlin.de/~health/korean.htm) without special
approval. This tool, consisting of 10 questions, was scored using
a 4-point Likert scale with ‘absolutely not true’ as 1 point
and ‘very true’ as 4 points, meaning that the greater the total
score, the higher the self-efficacy. Cronbach’s ⍺, reflecting the
reliability of this tool, was .75 in Schwarzer and Jerusalem’s
study [23] and .92 in our study.
5. Data Analysis
The data collected from this study were analyzed by SPSS
Statistics 23 for Windows (IBM Corp., Armonk, NY, USA), the
skewness and kurtosis of the major variables (health behaviors,
perceived health status, mother-child relationship, school
adjustment, self-efficacy) for multicultural children were in
the range of -2 to +2, which enabled us to assume a normal distribution
and to analyze the data using parametric tests. The
general characteristics, health behaviors, perceived health status,
mother-child relationship, school adjustment, and self-efficacy
of multicultural and non-multicultural children were
analyzed using descriptive statistics (average, standard deviation,
frequency, and percentage), while the independent
t-test and x2 test were used to compare major variables between
the two groups. Health behaviors were analyzed according
to the general characteristics of multicultural children
using the independent t-test and one-way analysis of variance,
and Pearson correlation coefficients were used to determine
the correlations of health behaviors with major
variables. The factors affecting subjects’ health behaviors
were analyzed using multiple regression analysis.
www.e-chnr.org Sangmi Lee | 27
https://doi.org/10.4094/chnr.2020.26.1.23 CHNR
RESULTS
1. Comparison of General Characteristics and Major Variables
between Multicultural and Non-multicultural
Children
Multicultural children made up 27.9% of the 401 total subjects,
and the majority of the mothers of the multicultural children
were Vietnamese (78.6%), followed by 8.0% Filipinas,
and 7.1% Chinese. Among the participants’ general characteristics,
grade, perceived economic status, and cohabiting family
members showed statistically significant differences between
multicultural and non-multicultural children. The multicultural
children were predominantly fourth-graders, while
the non-multicultural children were mostly sixth-graders
(x2=9.21, p=.010), and the multicultural children had a higher
proportion of self-perceived ‘average’ or ‘difficult’ economic
status than the non-multicultural children (x2=17.77, p<.001).
Additionally, a higher proportion of multicultural children
lived together with their father (x2=6.58, p=.009) and grandparents
(x2=49.49, p<.001), but a lower percentage lived with
their mothers (x2=23.10, p<.001) and older siblings (x2=22.79,
p<.001) (Table 1).
The overall average score for health behaviors (t=3.32, p=
.001), the mother-child relationship (t=6.75, p<.001), school
adjustment (t=2.30, p=.022), and self-efficacy (t=2.05, p=.041)
were all significantly lower in multicultural children than in
non-multicultural children (Table 1). Differences in health behavior
scores between the two groups were analyzed according
to grade, perceived economic status, and cohabitation with
the mother, which are general characteristics that showed significant
differences between multicultural and non-multicultural
children. The analysis showed that the health behavior
scores analyzed according to each of those three variables
were consistently lower for multicultural children than for
their non-multicultural counterparts. In particular, among
sixth-graders (t=2.07, p=.040), those with a ‘prosperous’ economic
status (t=2.26, p=.026), and those who cohabited with
their mothers (t=2.37, p=.018), multicultural children showed
statistically significantly lower health behavior scores than
non-multicultural children (Table 2).
2. Differences in Health Behaviors among Multicultural
Children in Relation to Their General Characteristics
The overall average score for multicultural children’s health
behaviors showed a significant difference (F=8.81, p<.001) in
relation to their perceived health status, and was statistically
significantly higher in the ‘very healthy’ group than in the
‘healthy’ and ‘unhealthy’ groups, as confirmed by a post-hoc
test (Scheffé test). Disease prevention-one of the health behavior
subcategories-showed a significant difference in relation
to adiposity (F=6.54, p=.002), and the Scheffé test confirmed
that the average score was significantly lower in underweight
respondents than in normal, overweight, or obese respondents,
while mental health was significantly higher among
participants who had older siblings than among those who
did not (t=2.31, p=.023) (Table 3).
3. Correlations between Health Behaviors, School Adjustment,
Parent-Child Relationship, and Self-efficacy in Multicultural
Children
The overall score for health behaviors showed a statistically
significant positive correlation with the mother-child relationship
(r=.37, p<.001), school adjustment (r=.62, p<.001), and
self-efficacy (r=.44, p<.001), but no statistically significant relationship
with body mass index (Table 4).
4. Factors Affecting the Health Behaviors of Multicultural
Children
In order to identify factors affecting multicultural children’s
health behaviors, we carried out multiple regression
analysis using the overall score for health behaviors as the dependent
variable. Perceived health status, the mother-child
relationship, school adjustment, and self-efficacy, which
showed statistically significant (p<.050) correlations with
the overall score for health behaviors in the univariate analysis,
were chosen as independent variables and entered into
the regression model in a stepwise method. Perceived health
status, which is a categorical variable, was converted into a
dummy variable with responses of ‘less than healthy’ set as 0
and ‘very healthy’ as 1. The analysis included 102 subjects
who had no missing values for the included variables, and
the Durbin-Watson index of the model was 1.77, meaning that
there was no autocorrelation among the independent variables.
The tolerance limit was over .1 (.8~.9) and the variance inflation
factor was lower than 10 (1.0~1.1), proving that there was no
multicollinearity. The variables that exerted a significant influence
on health behaviors were-in descending order-school adjustment
(β=.55, p<.001), the mother-child relationship (β=
.25, p=.001), and perceived health status (‘very healthy’=1; β=
.19, p=.011). The model was statistically significant (F=30.93,
p<.001), with an explanatory power of 47.0% (Table 5).
DISCUSSION
The late-school period is a time when the gap in health behaviors
among children can widen, as the independence of
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CHNR Child Health Nurs Res, Vol.26, No.1, January 2020: 23-34
Table 1. Differences in General Characteristics and Main Variables between Multicultural and Non-multicultural Children (N=401)
Variables Categories
Total
Range
Multicultural
children (n=112)
Non-multicultural
children (n=289) x2 or t (p)
n (%) or M±SD n (%) or M±SD n (%) or M±SD
Gender Male
Female
192 (47.9)
209 (52.1)
53 (47.3)
59 (52.7)
139 (48.1)
150 (51.9)
0.02 (.912)
Grade 4th
5th
6th
129 (32.2)
124 (30.9)
148 (36.9)
48 (42.8)
33 (29.5)
31 (27.7)
81 (28.0)
91 (31.5)
117 (40.5)
9.21 (.010)
BMI* 19.9±3.9 12.6~33.3 19.2±4.0 20.1±3.9 1.90 (.059)
Adiposity* Underweight
Normal
Overweight or obese
25 (7.4)
218 (64.1)
97 (28.5)
10 (10.7)
58 (62.4)
25 (26.9)
15 (6.1)
160 (64.8)
72 (29.1)
2.20 (.334)
Perceived
health status
≤Unhealthy
Healthy
Very healthy
35 (8.7)
238 (59.4)
128 (31.9)
9 (8.0)
75 (67.0)
28 (25.0)
26 (9.0)
163 (56.4)
100 (34.6)
3.93 (.140)
Perceived
economic
status
Prosperous
Moderate
Poor
123 (30.7)
269 (67.1)
9 (2.2)
18 (16.0)
89 (79.5)
5 (4.5)
105 (36.3)
180 (62.3)
4 (1.4)
17.77 (＜.001)
Maternal
nationality
Korea
Vietnam
Philippines
China
Other†
289 (72.1)
88 (22.0)
9 (2.2)
8 (2.0)
7 (1.7)
0 (0.0)
88 (78.6)
9 (8.0)
8 (7.1)
7 (6.3)
289 (100.0)
0 (0.0)
0 (0.0)
0 (0.0)
0 (0.0)
401.00 (＜.001)
Cohabiting
with family
members‡
Father
Mother
Grandparents
Older siblings
Younger siblings
348 (86.8)
344 (85.8)
133 (33.3)
178 (44.0)
198 (49.5)
105 (93.8)
81 (72.3)
67 (59.8)
28 (25.0)
63 (56.3)
243 (84.1)
263 (91.0)
66 (22.9)
148 (51.4)
135 (46.9)
6.58 (.009)
23.10 (＜.001)
49.49 (＜.001)
22.79 (.＜001)
2.84 (.096)
Health
behaviors
Personal hygiene
Eating habits
Exercise
Mental health
Disease prevention
Injury prevention
Total
30.1±5.1
25.0±4.3
15.9±3.6
30.8±5.0
29.7±5.4
24.0±4.7
155.5±22.3
10~40
12~34
6~24
14~40
14~40
8~32
84~208
28.6±4.8
24.4±4.0
15.3±3.4
30.0±4.9
28.2±5.1
23.6±4.2
150.0±19.5
30.7±5.2
25.3±4.4
16.1±3.7
31.1±5.0
30.3±5.4
24.1±4.9
157.6±23.0
3.87 (＜.001)
1.91 (.057)
2.00 (.046)
1.99 (.047)
3.54 (＜.001)
0.97 (.335)
3.32 (.001)
Mother-child
relationship
Intimacy/support
Authority/control
Parental relationship
Great expectations
Permissiveness
Total
38.5±9.2
27.2±5.7
18.0±5.2
15.3±3.8
14.7±3.5
113.7±18.8
10~50
7~35
5~25
4~20
4~20
50~150
35.2±8.6
25.6±5.1
16.6±5.0
13.7±4.0
14.0±3.2
104.5±15.7
39.8±9.1
27.8±5.4
18.7±5.1
15.9±3.6
15.0±3.6
117.1±18.7
4.48 (＜.001)
3.67 (＜.001)
3.69 (＜.001)
5.32 (＜.001)
2.50 (.013)
6.75 (＜.001)
School
adjustment
Academic attitude/
rule observance
Relationships with peers
Relationships with teachers
School satisfaction
Total
27.3±4.8
23.4±4.0
25.8±4.4
18.9±3.9
95.4±14.9
9~43
7~28
8~32
6~24
30~120
26.4±4.8
22.8±4.2
24.9±4.9
18.5±4.1
92.6±15.9
27.7±4.8
23.7±4.0
26.1±4.2
19.1±3.9
96.5±14.3
2.22 (.027)
2.03 (.043)
2.37 (.018)
1.36 (.174)
2.30 (.022)
Self-efficacy 29.2±5.7 10~40 28.2±4.8 29.5±6.0 2.05 (.041)
*N=340 in total, n=93 in multicultural children, n=247 in non-multicultural children; †Cambodia, Mongolia, Thailand; ‡Multiple choice item;
BMI=Body mass index (kg/m2).
www.e-chnr.org Sangmi Lee | 29
https://doi.org/10.4094/chnr.2020.26.1.23 CHNR
Table 2. Differences in Health Behaviors by Grade, Economic Status, and Cohabitation with Mother between Multicultural and Nonmulticultural
Children (N=401)
Variables Categories n
Multicultural children
(n=112)
Non-multicultural children
(n=289) t (p)
M±SD t or F (p) M±SD t or F (p)
Grade 4th
5th
6th
129
124
148
151.0±18.9
148.6±21.3
149.9±19.1
0.15 (.864) 156.6±24.6
157.5±24.8
158.3±20.5
0.14 (.874) 1.45 (.149)
1.83 (.070)
2.07 (.040)
Perceived
economic status
Prosperousa
Moderateb
Poorc
123
269
9
149.8±21.3
149.8±19.1
154.2±25.3
0.12 (.888) 162.7±22.6
154.2±22.8
174.0±13.4
5.73 (.004)
b＜c*
2.26 (.026)
1.69 (.093)
1.40 (.204)
Cohabiting with
mother
Yes
No
344
57
152.2±19.7
144.2±18.1
1.95 (.054) 158.7±22.2
146.2±27.6
2.24 (.033) 2.37 (.018)
0.31 (.757)
*Post hoc analysis=Scheffé test, p＜.050.
Table 3. Comparison of Health Behaviors According to Characteristics among Multicultural Children (N=112)
Variables Categories n
Total
health
behavior
Personal
hygiene
Eating
habits Exercise Mental
health
Disease
prevention
Injury
prevention
M±SD M±SD M±SD M±SD M±SD M±SD M±SD
Gender Male
Female
t (p)
53
59
146.6±21.0
153.0±17.8
1.72 (.087)
28.3±4.5
28.8±5.0
0.52 (.604)
23.8±4.3
24.9±3.7
1.36 (.176)
14.9±3.3
15.6±3.5
1.09 (.277)
29.4±5.2
30.5±4.7
1.22 (.226)
27.4±5.6
28.9±4.6
1.53 (.129)
22.8±4.5
24.3±3.7
1.95 (.054)
Grade 4th
5th
6th
F (p)
48
33
31
151.0±18.9
148.6±21.3
149.9±19.1
0.15 (.864)
27.5±4.8
29.6±4.1
29.2±5.1
2.32 (.103)
25.2±3.6
23.1±4.0
24.4±4.4
2.77 (.067)
15.2±3.4
15.1±3.4
15.7±3.5
0.23 (.796)
30.5±5.1
29.6±4.9
29.5±4.7
0.48 (.619)
28.3±5.1
28.4±5.4
27.7±4.9
0.16 (.852)
24.3±3.4
22.8±5.0
23.4±4.2
1.42 (.245)
Adiposity* Underweighta
Normalb
Overweight or
obesec
F (p)
10
58
25
138.4±17.4
149.8±19.9
155.8±16.7
3.11 (.050)
27.8±5.1
28.8±4.7
30.0±4.1
1.04 (.357)
22.7±4.2
24.2±4.2
25.2±3.7
1.37 (.261)
13.1±4.5
15.8±3.0
15.0±3.7
2.80 (.066)
28.8±4.7
29.6±5.3
31.2±3.4
1.39 (.254)
23.9±3.5
28.1±4.8
30.2±4.6
6.54 (.002)
a＜b, c†
22.1±4.9
23.3±4.2
24.2±4.1
0.93 (.398)
Perceived
health status
≤Unhealthya
Healthyb
Very healthyc
F (p)
9
75
28
142.4±22.5
146.2±17.6
162.4±18.7
8.81 (＜.001)
a, b＜c†
27.5±5.0
27.9±4.7
30.6±4.5
3.54 (.033)
b＜c†
23.8±4.1
23.7±3.8
26.4±3.9
5.23 (.007)
b＜c†
13.1±3.8
15.2±3.3
16.3±3.4
3.31 (.040)
a＜c†
29.1±4.6
29.2±4.4
32.3±5.7
4.37 (.015)
b＜c†
26.8±4.9
27.0±4.8
31.6±4.5
9.95 (＜.001)
a, b＜c†
22.1±5.3
23.2±4.0
25.2±4.0
3.05 (.051)
Perceived
economic
status
Prosperous
Moderate
Poor
F (p)
18
89
5
149.8±21.3
149.8±19.1
154.2±25.3
0.12 (.888)
28.8±4.5
28.3±4.8
31.8±4.5
1.26 (.287)
23.3±3.7
24.5±4.1
25.6±4.1
0.89 (.414)
15.2±3.2
15.3±3.5
15.8±3.9
0.06 (.943)
30.7±4.9
30.0±4.7
26.6±7.7
1.37 (.260)
28.2±6.0
28.1±4.9
29.4±5.9
0.16 (.855)
23.6±4.3
23.5±4.1
25.0±4.8
0.29 (.746)
Cohabiting
with mother
Yes
No
t (p)
81
31
152.2±19.7
144.2±18.1
1.95 (.054)
29.0±4.9
27.4±4.4
1.59 (.115)
24.7±4.1
23.5±3.8
1.46 (.148)
15.5±3.4
14.7±3.4
1.19 (.236)
30.5±4.6
28.6±5.5
1.83 (.070)
28.5±5.4
27.2±4.2
1.23 (.220)
23.9±4.1
22.8±4.2
1.21 (.228)
Cohabiting
with
grandparent
Yes
No
t (p)
67
45
151.1±17.9
148.2±21.9
0.77 (.442)
28.1±5.2
29.2±4.1
1.16 (.248)
24.9±3.6
23.6±4.5
1.78 (.077)
15.1±3.4
15.5±3.5
0.61 (.545)
30.5±4.9
29.2±4.9
1.45 (.151)
28.4±5.0
27.8±5.2
0.67 (.503)
24.0±3.4
23.0±5.0
1.14 (.259)
Older sister or
brother
Have
None
t (p)
28
84
152.1±19.8
148.7±18.8
0.81 (.422)
29.5±4.8
28.2±4.7
1.28 (.205)
23.8±4.1
24.5±3.9
0.74 (.463)
15.6±3.4
15.1±3.3
0.72 (.471)
31.7±4.5
29.3±4.8
2.31 (.023)
28.6±5.3
27.9±4.9
0.61 (.544)
22.8±4.0
23.8±4.1
1.05 (.298)
*n=93; †Post hoc analysis=Scheffé test, p＜.050.
30 | Factors Affecting Health Behaviors in Late School-aged Children from Multicultural Families www.e-chnr.org
CHNR Child Health Nurs Res, Vol.26, No.1, January 2020: 23-34
Table 4. Correlation among Health Behaviors and Main Variables among Multicultural Children (N=112)
Variables
Total
health
behavior
Personal
hygiene
Eating
habit Exercise Mental
health
Disease
prevention
Injury
prevention
r (p) r (p) r (p) r (p) r (p) r (p) r (p)
Mother-child relationship .37 (＜.001) .32 (.001) .24 (.015) .22 (.021) .39 (＜.001) .28 (.004) .19 (.053)
School adjustment .62 (＜.001) .38 (＜.001) .30 (.002) .24 (.015) .74 (＜.001) .44 (＜.001) .56 (＜.001)
Self-efficacy .44 (＜.001) .24 (.014) .18 (.063) .23 (.017) .52 (＜.001) .39 (＜.001) .40 (＜.001)
Body mass index* .19 (.067) .21 (.041) .19 (.073) .02 (.860) .05 (.609) .26 (.013) .08 (.471)
*n=93.
Table 5. Factors Affecting Health Behaviors in Multicultural Children (N=102)
Variables B SE β t p
(Constant) 53.17 12.91 7.09 ＜.001
Perceived health status (Ref.: ≤healthy) 8.03 3.11 .19 2.58 .011
Mother-child relationship 0.32 0.09 .25 3.40 .001
School adjustment 0.74 0.10 .55 7.35 ＜.001
Adj. R2=.47, F=30.93, p＜.001
Ref.=Reference.
children’s behavior from the surrounding environment becomes
stronger than previously. Since multicultural children
are likely to be in a vulnerable condition regarding health behavior
practices, this study investigated the health behaviors
of multicultural late school-aged children and the factors affecting
those behaviors by analyzing self-reported data from
fourth- to sixth-grade elementary students in rural areas with
a high proportion of multicultural students, and obtained the
following meaningful results.
First of all, multicultural children are at risk of having poor
health behavior practices. In this study, the overall score for
multicultural children’s health behaviors and the scores for all
the subcategories showed a tendency to be lower than the corresponding
scores of non-multicultural children. Due to their
vulnerable family characteristics, multicultural children have
a high risk of not being able to receive proper health care starting
early in their lives, which may also exert a negative influence
on children’s independent health behaviors subsequently
[3]. However, few domestic studies have investigated the
health behaviors of multicultural children, especially those of
late school-age children, and our study is therefore significant
in being a groundbreaking study demonstrating that multicultural
children constitute a health behavior-disadvantaged
group. Meanwhile, in Park’s study [9], which used the same
health behavior measurement tools as our study to investigate
297 fourth- through sixth-grade elementary students from
low-income families in Seoul, the total average score was
167.4±22.5, while our study obtained average scores of 150.0
±19.5 points for multicultural children and 155.5±22.3 points
for all subjects, including non-multicultural children, reflecting
a major difference from the findings of Park [9] (by more
than 10 points). Since the subjects of Park’s study [9] were children
from low-income families who were cared for at local
children’s centers in big cities, it is reasonable to infer that the
difference in health behavior scores between the subjects of
these two studies is related to differences between residential
districts (large cities vs. rural villages and towns). It is possible
for rural areas to have a more vulnerable physical environment
related to health behaviors, given a relative lack of public
sports facilities, parks, and access to healthcare than urban
areas; furthermore, the sparse availability of health teachers
due to the small number of students and limited administrative
manpower [1] might have had negative influences on perceptions
and practices of health behaviors by undermining
school health education programs. Moreover, a study that
compared marriage migrant women in urban and rural areas
[24] reported that compared to city-dwelling women, those in
rural areas had lower socioeconomic status and poorer levels
of adaptation to Korea, as reflected by their education levels,
monthly income, and Korean-language proficiency, as well as
the low education levels of their spouses. In other words, multicultural
children in rural communities are vulnerable due to
www.e-chnr.org Sangmi Lee | 31
https://doi.org/10.4094/chnr.2020.26.1.23 CHNR
family-related factors on top of regional disadvantages, putting
them at a double disadvantage in relation to health behaviors.
Therefore, further research should investigate the
health behavior gap between regions, as well as reinforcing
health behavior-promoting educational interventions for multicultural
children.
Multicultural children presented significantly lower scores
for the mother-child relationship and school adjustment than
non-multicultural students, in addition to their poorer scores
for health behaviors, suggesting that multicultural children’s
environmental support system may also be vulnerable. This
study supports the results of previous studies [15,25] that reported
poor-quality mother-child relationships in multicultural
families, due to the fact that mothers of multicultural
families immigrate at the time of marriage and, in a short time
frame, experience the drastic change of childbirth in addition
to facing the burden of child-rearing, a combination that contributes
to high parenting stress and low maternal identity,
placing them at a greater risk of difficulties in mother-child
bonding from the early stages of their children’s lives [25].
Subsequently, it becomes easier to use physical instead of verbal
punishment as the child grows and the mother’s Koreanlanguage
proficiency falls short compared to that of her child,
and school enrollment may cause mother-child conflicts due
to the child’s disrespect toward the mother, who is unfamiliar
with educational programs and culture in Korea [15]. Therefore,
to improve mother-child relationships in multicultural
families, an approach needs to be taken starting early in children’s
lives that utilizes practical strategies, such as the ongoing
operation of individual consultation programs, to resolve
mother-child conflicts and to promote attachment. Multicultural
children are unlikely to receive proper support even
at school, and a qualitative study [26] on the experiences of elementary
school teachers in guiding multicultural children
found that multicultural children had poor learning outcomes
due to their weak Korean writing ability, learning readiness,
and comprehension, and that teachers faced difficulties in
dealing with these children’s frequent behavioral problems
such as stealing, distractions, violence, and violations of school
regulations. Furthermore, parents’ ability to provide guidance
to multicultural children was hindered by the mothers’
communication problems, passive attitudes towards educating
their children, and poor understanding of their children
and school culture [26], and there were limits to the degree to
which teachers’ individual efforts alone could improve the
school adjustment of multicultural children. We suggest that a
more multidimensional approach incorporating a deeper connection
between the school and the local community for the
children and their families would be more effective for promoting
school adjustment in multicultural children.
A second major finding of this study is the health behaviors
of multicultural children showed correlations with some of
their internal characteristics, such as grade and adiposity. In a
study that targeted fifth- and sixth-graders in elementary
school [6,7], the health behavior score of fifth-graders was significantly
higher than that of sixth-graders, suggesting that
children in lower grades might have higher levels of health
behavior practices. There was no significant difference in
health behavior scores according to grade in this study, but
the difference in health behavior scores between multicultural
and non-multicultural children became more distinctive as
the students advanced through school, with multicultural
children in sixth grade showing a lower average score than
the non-multicultural children by about 8.4 points, which was
statistically significant. For this reason, health behavior education
for multicultural children should be reinforced starting
in the lower grades and repeated throughout the higher
grades to help these children to consistently practice and improve
health behaviors. Additionally, the health behavior
score of underweight children tended to be lower than that of
normal or overweight/obese children in our study, in contrast
to the findings of Oh’s study [6] in which underweight
children had higher health behavior scores than overweight
children. Being overweight or obese, which is likely the outcome
of inappropriate eating habits and physical activity,
should not be overlooked considering the various negative influence
of obesity on relationships with peers at school,
long-term social adjustment, and health problems. However,
since underweight children are over-represented at low socioeconomic
levels, and are susceptible to deficient care [27] as
much as obese children, healthcare policy should not overlook
the problems faced by underweight children, considering
the negative influence of nutritional deficiencies on children’s
learning ability, growth, and development.
As a third important finding, we discovered that the predictors
of multicultural children’s health behaviors were perceived
health status, the mother-child relationship, and school
adjustment. Many recent studies in Korea on late school-age
non-multicultural children [6-9] have consistently reported
that the more positively children assess their health status, the
higher their health behavior scores. Perceived health status
was likewise demonstrated to be a predictor of multicultural
children’s health behaviors (β=.19, p=.011) in our study,
proving that subjective health status is a quite reliable indicator
for predicting health behaviors in children, including
multicultural students, and can be used as an easy, simple tool
in various child care environments, ranging from clinics to
schools and local communities. In addition, the low perceived
health status and self-efficacy of multicultural children can be
considered as reflective of their tendency to give poor sub32
| Factors Affecting Health Behaviors in Late School-aged Children from Multicultural Families www.e-chnr.org
CHNR Child Health Nurs Res, Vol.26, No.1, January 2020: 23-34
jective evaluations of themselves. Since school-age children
show a strong dependence on aspects of their surroundings
such as peers, teachers, and families, rather than autonomous
standards, for self-evaluation [5], it is essential that support
for multicultural children in families and schools be reinforced
even more.
Mothers still exert a major influence on school-aged children,
and we verified that the mother-child relationship independently
affected the health behaviors of multicultural
children (β=.25, p=.001). This result is in agreement with
those of previous studies, in which the relationship of parents
and vulnerable children between 6 and 12 years of age was
found to be correlated to dietary patterns such as the intake of
fast foods, sweetened drinks, and fruits and vegetables [10].
The findings of this study are also consistent with those of another
study in which parental attachment in fourth- to sixthgrade
elementary students, as evaluated by emotional intimacy
toward their parents, showed a positive correlation
with health behaviors, emerging as a factor affecting health
behaviors in multiple regression analysis [6]. The proportion
of multicultural children who cohabited with their mothers
was significantly lower than that of non-multicultural children,
which can be inferred to have resulted from divorce or
separation of the parents, as there is a high risk of family dissolution
resulting from conflicts between parents and family
members in multicultural households [2]. Nonetheless, cohabitation
with the mother did not show a significant correlation
with children’s health behaviors, indicating that the quality
of the relationship, rather than physical cohabitation with
the mother, is what strongly affects children’s behavior.
School adjustment, reflecting the fact that school is an intimate
environment for school-aged children (along with the
familial setting), was the strongest predictor of multicultural
children’s health behaviors (β=.55, p<.001). This is consistent
with the result of a study on late school-aged non-multicultural
children, in which those with higher satisfaction with
their school life had higher health behavior scores than children
with lower-than-average satisfaction [7]. Our study,
which included not only school satisfaction, but also attitudes
towards academic achievements, observance of regulations,
and relationships with peers and teachers in the evaluation of
school adjustment, demonstrated that school life as a whole
has important implications for multicultural children’s health
behaviors. In a previous study of third- to sixth-grade elementary
students [28], the entire range of school adjustment criteria-
including relationships with teachers and peers, learning
activities, school regulations, and school event participation-
was related to cell phone overuse, supporting the fact
that school adjustment is an important factor that influences
health behaviors. In particular, school adjustment showed the
strongest correlation with mental health behavior (r=.74, p<
.001) among the subcategories of health behaviors. This is similar
to the results of a study of fourth- to sixth-grade elementary
students [17], which showed that multicultural children
were more frequently bullied within their relationships with
school friends than non-multicultural children, and that bullying
led to negative mental states such as intimidation, anxiety,
and depression, underscoring the need to pay attention to
multicultural children’s school adjustment, especially successful
adaptation to school life in terms of peer relationships.
Furthermore, this study showed a significant correlation
between the self-efficacy of multicultural children and their
health behaviors in the univariate analysis, in parallel with
Jeon’s study [7], which confirmed that perceived behavior
control, a parameter conceptually similar to self-efficacy, affected
late school-aged children’s health behaviors (β=.38,
p<.001). However, unlike Jeon’s results [7], self-efficacy was
not identified as an independent factor affecting health behaviors
in this study through multiple regression analysis. Considering
that self-efficacy is a strong factor that stimulates certain
behaviors and is deeply related to health behavior performance
[15], the relationship between self-efficacy and
health behaviors might have been undervalued, as this study
evaluated self-efficacy in terms of convictions about one’s capability
to engage in ordinary behaviors, rather than direct
health behaviors. It is suggested that further studies explore
the relationship between health behaviors among multicultural
children and more direct measures of self-efficacy in
relation to health behaviors.
CONCLUSION
This study investigated the levels of health behaviors among
multicultural children in comparison with non-multicultural
children and analyzed the factors affecting multicultural children’s
health behaviors. Multicultural children were identified
as a disadvantaged group in terms of health behaviors
since their level of health behaviors was lower than that of
non-multicultural children, and the predictors of their health
behaviors were subjective health status perceived by children,
the mother-child relationship, and school adjustment. Subjective
health status was reconfirmed through this study as a
very useful tool for predicting children’s health behaviors.
Since mother-child relationships and school adjustment as
perceived by the children were lower for multicultural children
than for non-multicultural children, nursing intervention
strategies to promote these factors as a way of improving
health behaviors among multicultural children are warranted.
Most of the mothers of the subjects of this study were of
Vietnamese nationality (78.6%), followed by Filipina (8.0%)
www.e-chnr.org Sangmi Lee | 33
https://doi.org/10.4094/chnr.2020.26.1.23 CHNR
and Chinese (7.1%). This reflects the fact that students with
Vietnamese mothers tend to be dispersed more intensely
throughout towns and villages (i.e., in rural areas). Considering
that cities have greater proportions of students with
Chinese or Korean-Chinese mothers relative to students with
Vietnamese mothers [1], it is unreasonable to generalize the
results of this study, which was based on town and village
areas in a single province, to the entire group of multicultural
elementary students. Furthermore, the cross-sectional design
of this study means that there are limitations in determining
the cause-and-effect relationships between variables. Nevertheless,
this is a novel study that extensively explored the
health behaviors of school-aged multicultural children and
identified predictors of health behaviors, and it is significant
in that it provides the basic information needed to establish a
health behavior promotion strategy for multicultural children.
Conflict of interest
No existing or potential conflict of interest relevant to this
article was reported.
REFERENCES
1.Ministry of Education; Korean Educational Development Institute.
2018 Statistical yearbook of education [Internet]. Chungcheongbuk-
do: Korean Educational Development Institute; 2018 [cited
2019 August 27]. Available from:
https://kess.kedi.re.kr/publ/view?survSeq=2018&menuSeq=3894
&publSeq=2&itemCode=02&menuId=0&language=en#
2. Korean Women’s Development Institute. The national survey of
multicultural familes 2018. Study Report. Sejong: National Ministry
of Gender Equality and Family; 2019 March. Report No.: 2019-01.
3. Kim HR. Health problems and policy implications in multicultural
families. Health·Welfare Issue and Focus. 2013;12:1-8.
4. Lally P, Gardner B. Promoting habit formation. Health Psychology
Review. 2013;7(sup1): S137-S158.
https://doi.org/10.1080/17437199.2011.603640
5. Hockenberry M, Wilson D. Wong’s nursing care of infant and
children. 10th ed. St. Louis: Mosby; 2014. p. 569-583.
6. Oh JA. Factors affecting the health behavior of elementary school
children at a late school age. Journal of Korean Academy of Community
Health Nursing. 2010:21(4);458-467.
7. Jeon GE, Kwon IS. Factors affecting health promotion behaviors of
upper grade elementary students. Child Health Nursing Research.
2017;23(3):319-328. https://doi.org/10.4094/chnr.2017.23.3.319
8. Jang BS, Kim DH. Health literacy and health behavior in late
school-age children. Journal of Korean Academy of Community
Health Nursing. 2015;26(3):199-208.
https://doi.org/10.12799/jkachn.2015.26.3.199
9. Park J. Predictors of health promoting behaviors among children
from low-income families: An ecological approach [dissertation].
Seoul: Yonsei University; 2014. p. 1-181.
10. Kim S, Choo J. Health Behaviors and health-related quality of life
among vulnerable children in a community. Journal of Korean
Academy of Community Health Nursing. 2015;26(3):292-302.
https://doi.org/10.12799/jkachn.2015.26.3.292
11. Kim EG, Yoo H. Health behaviors and health status by gender differences
of adolescents in multicultural families. Journal of the
Korean Society of School Health. 2018;31(1):10-17.
https://doi.org/10.15434/kssh.2018.31.1.10
12. Short SE, Mollborn S. Social determinants and health behaviors:
Conceptual frames and empirical advances. Current Opinion in
Psychology. 2015;5:78-84.
https://doi.org/10.1016/j.copsyc.2015.05.002
13. Schwarzer R, Luszczynska A. Perceived self-efficacy [Internet].
Washington, D.C: National Cancer Institute; 2008 [cited 2019
August 27]. Available from:
https://cancercontrol.cancer.gov/brp/research/constructs/self_
efficacy.html
14. Yee AZ, Lwin MO, Ho SS. The influence of parental practices on
child promotive and preventive food consumption behaviors: A
systematic review and meta-analysis. International Journal of Behavioral
Nutrition and Physical Activity. 2017;14(1):47.
https://doi.org/10.1186/s12966-017-0501-3
15. Song SH, An HJ. Experience of child-rearing of filipino married immigrant
women. Journal of Korean Academy of Psychiatric and
Mental Health Nursing. 2011;20(2):167-179.
https://doi.org/10.12934/jkpmhn.2011.20.2.167
16. Joe SJ, Doh HS. The development and validation of a school adjustment
scale for late school-aged children. Korean Journal of Child
Studies. 2018;39(2):95-111.
https://doi.org/10.5723/kjcs.2018.39.2.95
17. Oh I. Relations between school bullying victimization and psychological
problems among students from multicultural families: A
focus on mediation effect of psychological well-being. Asian Journal
of Education. 2014;15(4):219-238.
18. Shin KM, Cho SM, Shin YM, Park KS. Effects of early childhood
peer relationships on adolescent mental health: A 6- to 8-year follow-
up study in South Korea. Psychiatry Investigation. 2016;13(4):
383-388. https://doi.org/10.4306/pi.2016.13.4.383
19. Kim SJ, Yang SO, Jeong GH, Lee SH. Level of health promotion behavior
practice in elementary school students. Journal of Korean
Academy of Child Health Nursing. 2007;13(4):407-415.
20. Kim JH, Yun S, Hwang S, Shim JO, Chae HW, Lee YJ, et al. The
2017 Korean national growth charts for children and adolescents:
Development, improvement, and prospects. Korean Journal of
Pediatrics. 2018;61(5):135-149.
https://doi.org/10.3345/kjp.2018.61.5.135
21. Lee MK, Kim SH. Development of a parent-child relationships
34 | Factors Affecting Health Behaviors in Late School-aged Children from Multicultural Families www.e-chnr.org
CHNR Child Health Nurs Res, Vol.26, No.1, January 2020: 23-34
scale for upper grade elementary school students. Korea Journal
of Counseling. 2011;12(3):997-1017.
22. Lee YM, Schwarzer R, Jerusalem M. Korean adaptation of the general
self-efficacy scale [Internet]. United Kingdom: NFER-Nelson;
1994 [Cited 2019 April 20]. Available from:
http://userpage.fu-berlin.de/~health/korean.htm
23. Schwarzer R, Jerusalem M. The general self-efficacy scale [Internet].
United Kingdom: NFER-Nelson; 1993 [Cited 2019 April 20].
Available from:
http://userpage.fu-berlin.de/~health/engscal.htm
24. Nam IS, Ahn S. Comparison of stress, social support, and marital
satisfaction between married immigrant women in urban and rural
areas. Korean Journal of Women Health Nursing. 2011;17(2):
99-108. https://doi.org/10.4069/kjwhn.2011.17.2.99
25. Song JE, Roh EH, Park SM. Systematic review of quantitative research
related to maternal adaptation among women immigrants
by marriage in Korea. Korean Journal of Women Health Nursing.
2015;21(1):55-70. https://doi.org/10.4069/kjwhn.2015.21.1.55
26. Hwang HH. Current status and implication of multicultural students.
Issues Report. Seoul: National Assembly Research Service;
2018 November. Report No.: 131-20181114.
27. Pearce A, Rougeaux E, Law C. Disadvantaged children at greater
relative risk of thinness (as well as obesity): A secondary data analysis
of the England national child measurement programme and
the UK millennium cohort study. International Journal for Equity
in Health. 2015;14:61. https://doi.org/10.1186/s12939-015-0187-6
28. Lee KS, Ahn HR, Lee KH. Factors related to the overuse of mobile
phone in elementary school students. Journal of Korean Academy
of Psychiatric Mental Health Nursing. 2011;20(3):271-280.
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Funds 176 Culture Assignment

Leininger (1995) cites, “ There is a marked increase in migration of people within and between countries worldwide. Transcultural nursing is needed because of the growing diversity that characterizes our growing national and global populations.  Diversity refers to differences in race, ethnicity, national origin, religion, age, gender, sexual orientation, ability or disability, social and economic status, class education and other attributes.”

The objective for this assignment is to recognize the different forms of culture.  These forms are not limited to ethnic or racial groups.  Exploration  of a cultural type will be decided by each student in their selection of a scholarly article from a journal selected from the EBSCO site.

The article chosen will be analyzed with a written 2 page report.  A copy of the article must accompanied the written assignment.

10 Points:  assignment presented on due date

20 points:   Brief synopsis of the article

10 points: Identification of 2 references sources used in the article

20 point:  1)   Explain how this article increased your knowledge by disproving myths and stereotypes that are commonly formed against this culture.  And  2.) How the information in the article affects the patient’s ability to cope

Examples of Cultural forms:  “gun culture”  “computer age”  “culture shock of 1^st generation immigrant”

Culture of New England,  “culture of violence in the media”  Amish culture, “the graying of America”

Please return to me your group members’ names and in which role they will be in.

1.___________________

2.____________________

3.___________________

4.______________________

5._____________________