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Expanding the health belief model on dementia knowledge, fear, and preventive behaviors among older adults in Korea: a cross-sectional descriptive study

  • Jeong Eui Yun (Jeju Eastern Center for Dementia) ;
  • Suyoung Choi (College of Nursing, Health and Nursing Research Institute, Jeju National University)
  • 투고 : 2025.01.19
  • 심사 : 2025.02.03
  • 발행 : 2025.02.28

초록

Purpose: This study aimed to expand the health belief model by incorporating dementia knowledge and fear and to assess the effects of these variables on dementia prevention behaviors among older adults. Methods: In total, 199 elderly individuals from 10 senior centers in Korea completed a structured questionnaire assessing characteristics, dementia knowledge, fear, health beliefs, and prevention behaviors. Measures included the Alzheimer's Disease Knowledge Scale, the Korean version of the Fear of Alzheimer's Disease Scale, and the Korean version of the Motivation to Change Lifestyle and Health Behavior for Dementia. Hierarchical polynomial regression was conducted to examine the impact of integrating dementia knowledge and fear into the health belief model. Results: Hierarchical polynomial regression across four models revealed significant effects of various factors on dementia prevention behaviors, explaining 12%-36% of the variance. Perceived barriers significantly decreased dementia prevention behaviors, while higher levels of self-efficacy and cues to action had a positive influence. Additionally, a nonlinear relationship was identified between dementia knowledge and prevention behaviors, with the positive impacts of increased knowledge potentially diminishing beyond a certain point. Conclusion: Our findings underscore the necessity of modifying the health belief model to integrate dementia knowledge and fear, which play critical roles in shaping preventive behaviors among older adults. Future investigations should examine the optimal level of dementia knowledge to promote these behaviors and elucidate the intricate relationship between knowledge and actions.

키워드

과제정보

This manuscript is based on a part of the first author's master's thesis from Jeju National University.

참고문헌

  1. World Health Organization. Risk reduction of cognitive decline and dementia: WHO guidelines [Internet]. Geneva: World Health Organization; 2019 [cited 2024 Dec 16]. Available from: https://www.who.int/publications/i/item/risk-reduction-of-cognitive-decline-and-dementia
  2. Central Dementia Center. Korean dementia observatory 2023 [Internet]. Seoul: Central Dementia Center; 2024 [cited 2024 Dec 24]. Available from: https://www.nid.or.kr/info/dataroom_view.aspx?bid= 284
  3. Shon C, Yoon H. Health-economic burden of dementia in South Korea. BMC Geriatrics. 2021;21(1):358–367. https://doi.org/10.1186/s12877-021-02526-x
  4. Ministry of Health and Welfare. The 4th comprehensive dementia management plan (2021–2025) [Internet]. Sejong: Ministry of Health and Welfare; 2020 [cited 2024 Dec 15]. Available from: https://www.mohw.go.kr/board.es?mid= a10401000000&bid= 0008&tag= &act= view&list_no= 360099
  5. Rosenstock IM. The health belief model and preventive health behavior. Health Education Monographs. 1974;2(4):354–386. https://doi.org/10.1177/109019817400200405
  6. Rosenstock IM, Stretcher VJ, Becker MH. Social learning theory and the health belief model. Health Education Quarterly. 1988;15(2):175–183. https://doi.org/10.1177/109019818801500203
  7. Champion VL, Skinner CS. The health belief model. In: Glanz K, Rimer BK, Viswanath K, editors. Health behavior and health education: theory, research, and practice. 4th ed. San Francisco, CA: Jossey-Bass; 2008. p. 45–65.
  8. Seyde E, Taal E, Wiegman O. Risk-appraisal, outcome and self-efficacy expectancies: cognitive factors in preventive behaviour related to cancer. Psychology & Health. 1990;4(2):99–109. https://doi.org/10.1080/08870449008408144
  9. Jung SH, Gu MO. Factors influencing dementia preventive behaviors of older adults at high risk of dementia: application of extended health belief model. Research in Community and Public Health Nursing. 2024;35(1):22–36. https://doi.org/10.12799/rcphn.2023.00402
  10. Li H, Zhang J, Wang L, Yang T, Yang Y. A health promoting-lifestyle prediction model for dementia prevention among chinese adults: based on the health belief model. BMC Public Health. 2022;22(1):2450. https://doi.org/10.1186/s12889-022-14828-9
  11. Eccleston C, Doherty K, Bindoff A, Robinson A, Vickers J, McInerney F. Building dementia knowledge globally through the understanding dementia massive open online course (MOOC). npj Science of Learning. 2019;4(1):1–6. https://doi.org/10.1038/s41539-019-0042-4
  12. Faul F, Erdfelder E, Buchner A, Lang AG. Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behavior Research Methods. 2009;41(4):1149–1160. https://doi.org/10.3758/BRM.41.4.1149
  13. Carpenter BD, Balsis S, Otilingam PG, Hanson PK, Gatz M. The Alzheimer's disease knowledge scale: development and psychometric properties. The Gerontologist. 2009;49(2):236–247. https://doi.org/10.1093/geront/gnp023
  14. Kim EJ, Jung JY. Psychometric properties of the Alzheimer's disease knowledge scale-Korean version. Journal of Korean Academy of Nursing. 2015;45(1):107–117. https://doi.org/10.4040/jkan.2015.45.1.107
  15. Garcia-Ribas G, Garcia-Arcelay E, Montoya A, Maurino J, Ballesteros J. Quantifying knowledge of Alzheimer's disease: an analysis of the psychometric properties of the Alzheimer's disease knowledge scale. Neurology and Therapy. 2021;10(1):213–224. https://doi.org/10.1007/s40120-021-00230-x
  16. Moon Y, Kim HJ, Choi H, Oh SI, Han SH. Validity of the Korean version of the fear of Alzheimer's disease scale for the assessment of anticipatory dementia. Journal of Korean Medical Science. 2014;29(3):411–415. https://doi.org/10.3346/jkms.2014.29.3.411
  17. French SL, Floyd M, Wilkins S, Osato S. The fear of Alzheimer's disease scale: a new measure designed to assess anticipatory dementia in older adults. International Journal of Geriatric Psychiatry. 2012;27(5):521–528. https://doi.org/10.1002/gps.2747
  18. Choi WH, Seo YM, Kim BR. Factors influencing dementia preventive behavior intention in the elderly people. Journal of East-West Nursing Research. 2019;25(2):138–146. https://doi.org/10.14370/jewnr.2019.25.2.138
  19. Kim S, Sargent-Cox K, Cherbuin N, Anstey KJ. Development of the motivation to change lifestyle and health behaviours for dementia risk reduction scale. Dementia and Geriatric Cognitive Disorders Extra. 2014;4(2):172–183. https://doi.org/10.1159/000362228
  20. Lim K, Kim J, Kim M. Development and testing of dementia prevention behaviors scale for seniors living at home. In: Poster session presented at: enhancing person-centered care environment: strengthening our basis safe and healthy 2018 Korean Society of Nursing Science fall academic conference. 2018 October 22; Seoul.
  21. Lee YW, Woo SM, Kim OR, Lee SY, Im HB. Relationships between dementia knowledge, attitude, self-efficacy, and preventive behavior among low income middle-aged women. Korean Journal of Adult Nursing. 2009;21(6):617–627.
  22. Ko SJ, Shin SH. Effects of dementia knowledge, self-efficacy and depression on dementia preventive behavior in elderly couples: dyadic data analysis. Journal of Korean Academy of Nursing. 2013;43(2):276–286. https://doi.org/10.4040/jkan.2013.43.2.276
  23. Iacobucci D, Schneider MJ, Popovich DL, Bakamitsos GA. Mean centering helps alleviate "micro" but not "macro" multicollinearity. Behavior Research Methods. 2016;48(4):1308–1317. https://doi.org/10.3758/s13428-015-0624-x
  24. Zhao M, Lv X, Lin X, You E, Zhang H, Ellis KA, et al. Dementia knowledge and associated factors among older Chinese adults: a cross-national comparison between Melbourne and Beijing. International Psychogeriatrics. 2021;33(10):1057–1067. https://doi.org/10.1017/S1041610221000053
  25. Hong JY, Jung D. The impact of dementia knowledge and attitude on caregiving appraisal among caregivers of older adults with dementia using dementia care centers. Journal of Korean Gerontological Nursing. 2020;22(4):348–357. https://doi.org/10.17079/jkgn.2020.22.4.348
  26. Farrow M, Doherty K, McInerney F, Klekociuk S, Bindoff A, Vickers J. Improving knowledge and practice through massive open online dementia education: the understanding dementia and preventing dementia MOOCs. In: Poster session presented at: Alzheimer's Association International Conference. 2018 July 22; Chicago, IL.
  27. Bartlett L, Bindoff A, Doherty K, Kim S, Eccleston C, Kitsos A, et al. An online, public health framework supporting behaviour change to reduce dementia risk: interim results from the ISLAND study linking ageing and neurodegenerative disease. BMC Public Health. 2023;23(1):1886. https://doi.org/10.1186/s12889-023-16805-2
  28. Kim BR, Chang HK. Factors influencing fear of dementia among middle-aged and older adults. Research in Community and Public Health Nursing. 2020;31(2):156–165. https://doi.org/10.12799/jkachn.2020.31.2.156
  29. Cantegreil-Kallen I, Pin S. Fear of Alzheimer's disease in the French population: impact of age and proximity to the disease. International Psychogeriatrics. 2012;24(1):108–116. https://doi.org/10.1017/S1041610211001529
  30. Seo YM, Choi WH. Comparison of influencing factors of the intention to dementia preventive behaviors in adults by sex groups: applying the health belief model. Journal of the Korea Academia-Industrial Cooperation Society. 2021;22(8):374–383. https://doi.org/10.5762/KAIS.2021.22.8.374
  31. Lim KC, Kim M, Ko H. Factors influencing dementia prevention behaviors in older Koreans enrolled in senior welfare centers. The Journal of Korean Academic Society of Nursing Education. 2021;27(1):39–48. https://doi.org/10.5977/jkasne.2021.27.1.39
  32. Cho I. Lifestyle behaviors for the prevention of Alzheimer's disease in middle-aged and older adults. The Journal of Humanities and Social Sciences 21. 2019;10(2):455–468. https://doi.org/10.22143/HSS21.10.2.33
  33. Ha EH, Jeon MY. Factors associated dementia preventive behavior of older adults in a local community: application of the information-motivation-behavioral skills model: a cross-sectional study. Journal of Korean Gerontological Nursing. 2023;25(1):34–43. https://doi.org/10.17079/jkgn.2023.25.1.34
  34. Ok JS, Ko IS, Ryu KH. Affecting factors of health behavior adherence depending on the duration of the hypertension diagnosis. Korean Journal of Rehabilitation Nursing. 2017;20(2):151–163. http://doi.org/10.7587/kjrehn.2017.151
  35. Gaertner B, Fuchs J, Kuhnert R, Neuhauser H. Dementia risk factors and cognitive function in a nationwide population-based sample aged 65+. European Journal of Public Health. 2024;34(Supplement_3):ckae144.238. https://doi.org/10.1093/eurpub/ckae144.238 
  36. Wong MYC, Ou K, Chung PK. Healthy lifestyle behavior, goal setting, and personality among older adults: a synthesis of literature reviews and interviews. Geriatrics. 2022;7(6):131. https://doi.org/10.3390/geriatrics7060131
  37. Choi HJ, Kim HY. Effects of depression, sleep and self-esteem on dementia preventive behavior in rural elderly people. The Journal of the Korea Contents Association. 2021;21(5):970–980. https://doi.org/10.5392/JKCA.2021.21.05.970
  38. Croezen S, Avendano M, Burdorf A, Van Lenthe FJ. Social participation and depression in old age: a fixed-effects analysis in 10 European countries. American Journal of Epidemiology. 2015;182(2):168–176. https://doi.org/10.1093/aje/kwv015
  39. Park SH, Lee SH, Ham EM. The relationship between optimistic bias about health crisis and health behavior. Journal of Korean Academy of Nursing. 2008;38(3):403–409. https://doi.org/10.4040/jkan.2008.38.3.403
  40. Park H. Dementia fear and dementia preventive behaviors of elderly in the community [master's thesis]. Seoul: Korea University; 2020. p. 60–61.
  41. Seo YM, Je NJ, Lee ES. The factors influencing intention of dementia prevention behavior in adults with hypertension or diabetes. Journal of Korean Academy of Community Health Nursing. 2020;31(4):481–490. https://doi.org/10.12799/jkachn.2020.31.4.481
  42. Bandura A. The anatomy of stages of change. American Journal of Health Promotion. 1997;12(1):8–10. https://doi.org/10.4278/0890-1171-12.1.8
  43. Lee B, Shon Y, Lee S, Yoon M, Kim M, Kim C. An efficacy of social cognitive theory to predict health behavior. a meta-analysis on the health belief model studies in Korea. Korean Academic Society for Public Relations. 2014;18(2):163–206. https://doi.org/10.15814/jpr.2014.18.2.163
  44. Werner P. Factors influencing intentions to seek a cognitive status examination: a study based on the health belief model. International Journal of Geriatric Psychiatry. 2003;18(9):787–794. https://doi.org/10.1002/gps.921
  45. Zimmer‐Gembeck MJ. Coping flexibility: variability, fit and associations with efficacy, emotion regulation, decentering and responses to stress. Stress and Health. 2021;37(5):848–861. https://doi.org/10.1002/smi.3043
  46. Bandura A. The explanatory and predictive scope of self-efficacy theory. Journal of Social and Clinical Psychology. 1986;4(3):359–373. https://doi.org/10.1521/jscp.1986.4.3.359
  47. Lim SO, Jo HM. The effect of a dementia preventive program on dementia knowledge, depression, and cognitive function among elderly in community (Korean elderly apartment in Chicago). The Journal of the Korea Contents Association. 2017;17(5):182–191. https://doi.org/10.5392/JKCA.2017.17.05.182
  48. Petkus AJ, Reynolds CA, Wetherell JL, Kremen WS, Pedersen NL, Gatz M. Anxiety is associated with increased risk of dementia in older Swedish twins. Alzheimer's & Dementia. 2016;12(4):399–406. https://doi.org/10.1016/j.jalz.2015.09.008
  49. Smith BJ, Ali S, Quach H. The motivation and actions of Australians concerning brain health and dementia risk reduction. Health Promotion Journal of Australia. 2015;26(2):115–121. https://doi.org/10.1071/HE14111
  50. Bowen CE, Kessler EM, Segler J. Dementia worry in middle-aged and older adults in Germany: sociodemographic, health-related and psychological correlates. European Journal of Ageing. 2019;16(1):39–52. https://doi.org/10.1007/s10433-018-0462-7