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Abstract

This study is a secondary analysis of data collected in a previous study that consisted of 354 older adults, including 226 living in South Korea and 128 South Korean immigrants living in the United States. The aim of this study was to identify the moderating effects of social networks on health-promoting behaviors among Korean older adults with chronic illnesses. Using moderated mediation analyses, we found that the interaction effect between U.S. residency, the number of chronic illnesses, age, and education level accounted for 25% of the social networks. Our findings highlight the importance of social networks in promoting health behaviors and the need to strengthen social networks to improve the health of Korean older adults with chronic illnesses living in the United States. These results also emphasize the need for distinct approaches to health promotion, as health-promoting behaviors vary based on the number of chronic illnesses and country of residence.

Plain language summary

Older adult immigrants are at risk of suffering from chronic diseases compared to those born in the country. Health-promoting behavior is a way that could reduce the risk of this chronic disease. Several experts are looking for approaches to enhance health-promoting behavior in immigrants, including the existence of social networks. This study aims to find whether social networks have an effect on health-promoting behavior in Korean older adults with chronic illnesses. The study used data from previous research involving 354 Korean older adults, including 226 living in South Korea, and 128 South Korean immigrants living in the United States. The results of this study indicate that social networks has contribute a 25% interaction effect between living in the United States and the number of chronic illnesses, age, and level of education. Health-promoting behavior varies based on the number of chronic illnesses and the country in which they reside. In this study, it is whether they live in South Korea or in the United States. This difference in residence necessitates a different approach to improving health promotion behavior for Korean older adults in the two countries. Therefore, in our study, we explain the importance of social networks on health-promoting behavior and the need to strengthen social networks to improve the health of Korean older adult immigrants with chronic illnesses in the United States.

Keywords

aging chronic illness health promotion social networking

In the United States, approximately 80% of older adults have at least two chronic illnesses and multiple chronic diseases account for two-thirds of all health care costs (National Council on Aging, 2022). The average number of chronic diseases among older adults in Korea was 1.9, with 84% of this group experiencing more than one chronic diseases (Baek et al., 2021). Chronic diseases are responsible for seven out of 10 deaths each year, and treating individuals with chronic diseases accounts for a significant portion of the United States’ healthcare costs (Centers for Disease Control and Prevention, 2022). The avoidable mortality rate of chronic illnesses has greatly decreased as older adults’ interest in health management has increased. However, the overall mortality due to chronic illnesses is increasing as lifestyles that promote health are not keeping pace with the additional life expectancy (Korea Centers for Disease Control and Prevention, 2018). According to the Organization for Economic Co-operation and Development (OECD) health statistics from 2023, the life expectancy for Americans is 77 years old, while for Koreans, it is 83.5 years old. Additionally, Korea’s current health expenditure is 8.8% of its Gross Domestic Product (GDP), and it has the fastest rate of increase in medical expenses among OECD member countries. In contrast, health expenditure in the U.S. was 17.8% in 2021, which is slightly more than twice the average spending of OECD countries (OECD, 2023).

Care for older adults who have chronic illnesses cannot focus only on the treatment of illnesses but should also emphasize active participation in health-promoting behaviors that can help maintain health and forestall illnesses (J. H. Oh & Park, 2017; Sung et al., 2018). Countries with high growth of elderly population shift their strategies to focus on promoting the health and well-being of older adults, enabling them to work longer in better health and potentially reducing the demand for health care services (United Nations, 2023). According to World Health Organization (n.d.), “health promotion is the process of enabling people to increase control over and to improve, their health.” Health strategies for older adults have three aims that include (1) maintaining and increasing functional capacity, (2) maintaining or improving self-care (De Friese & Ory, 1998), and (3) stimulating one’s social network (Dean & Holstein, 1998). Social bonds and social activities such as doing professional work, learning activities, and maintaining a social network are essential for healthy aging (Golinowska et al., 2016; MOPACT, n.d.). The social network includes relatives, friends, and acquaintances, who are key people in the lives of older adults (Bahramnezhad et al., 2017).

Social networks have positive effects on the quality of life (Bahramnezhad et al., 2017; Bincy et al., 2022) and healthy behaviors including management of cardiovascular disease, access to healthcare facilities, maintenance of physical and mental health (Jeon & Park, 2022), and a decrease in overall mortality (M. Lee et al., 2013; Lei et al., 2016). Studies have found that the number of individuals in a person’s social network and frequency of contact are significant factors influencing older adults’ health-promoting behaviors (H. K. Lee & Kim, 2017; Sung et al., 2016; Yang & Nam, 2020). Older adult immigrants who live in the United States have larger social networks and practice more health-promoting behaviors compared to older adults who live in South Korea (Hong et al., 2018).

For our research, we used the Health Promotion Model by Pender et al. (2002) as a conceptual framework. The model describes the factors that influence health-promoting behavior in three areas: individual characteristics and experiences, behavior-specific cognitions and affect, and behavioral outcomes. In the model, interpersonal influences including social support becomes a modifying factor for health behavior. It is possible that the health-promoting behavior might vary depending on the social support provided through the social network (So & Jeong, 2017; Wu & Sheng, 2019). Furthermore, according to a survey on the proportion of social networks among the elderly in OECD countries, the proportion of social networks among the elderly in Korea was the lowest among OECD countries, at 60.9%, while the U.S. accounted for 91.5%, higher than the OECD average of 87.1% (OECD, 2016). Our study investigates the effect of social networks on the health of older adults with chronic illnesses.

Objective and Hypotheses

We focused our study on comparing older adults living in the U.S. with Korean immigrants, who represent one of the largest Asian immigrant populations in the U.S. (Migration Policy Institute, 2019). Our hypothesis was that social networks would mediate the relationship between the number of chronic illnesses and health-promoting behaviors, and that this effect would vary based on the country of residence for older adults.

Materials and Methods

Study Design and Data Source

This study was a secondary analysis of data collected in a previous study (Hong et al., 2018). The parent study was a cross-sectional, comparative research design consisting of 354 older adults including 226 living in South Korea and 128 South Korean immigrants living in the U.S. The required sample size was calculated using the G*Power 3.1 program, with a significance level of 5%, a power of test of 80%, and a medium effect size for a two-tailed test, which resulted in 139 subjects. The respondents were selected using a convenience sampling technique, and the eligibility criteria included Koreans and U.S. immigrants from South Korea who were older than 65 years old, and able to speak, read, and understand Korean. Data collection was carried out from July 2015 to April 2016 in the Busan and Kyeongsang provinces of South Korea and in the state of North Carolina in the U.S. The data was collected at churches, a senior citizen center, and community events (Hong et al., 2018).

Measurement

Sociodemographic characteristics were measured that includes age, gender, marital status, cohabitation status, driving status, education level, religion, social activity frequency, employment, income sources, and numbers and types of chronic illnesses.

The Lubben Social Network Scale-6 (Lubben, 1988) was used to measure the size of social networks that included family, friends, and neighbors. The scale consists of six items and is scored on a scale ranging from 0 to 30, with a higher score indicating a stronger social network. The reliability of the original scale was Cronbach’s α = .83. In the current study, reliability was measured as Cronbach’s α = .84 for Korean immigrants in the U.S. and Cronbach’s α = .92 for South Korean residents.

Considering the various definitions of health-promoting behaviors, we focused on six health domains from the measurement of Health-promoting Behavior Lifestyle Profile (HPLP) II (Seo & Hah, 2004; Walker et al., 1995). The Health-promoting Behavior Lifestyle Profile (HPLP) II assesses health-promoting lifestyle behaviors and consists of 52 items in six domains (i.e., spiritual growth, nutrition, health responsibility, physical activity, interpersonal relationships, and stress management). Each domain uses a 4-point Likert scale from 1 to 4. A higher score indicates a higher level of adherence to a health-promoting lifestyle. The reliability of the original scale was Cronbach’s α .92. In this study, reliability is measured as Cronbach’s α = .92 for Korean immigrants in the United States and Cronbach’s α = .97 for South Koreans.

Data Analysis

We analyzed the data using SPSS version 25.0. The mean and standard deviation (SD) were used for the social network scale and the health-promoting behaviors scale. Given that health-promoting behaviors may vary depending on the social support provided through social networks (So & Jeong, 2017), we developed a conceptual model for older adults’ health-promoting behaviors using moderated mediation analyses (Figure 1). To examine the multivariate relationship between, residency, social network, and health-promoting behaviors, we conceptualized the relationship as one in which social network might mediate the relationship between residency and health-promoting behaviors. To test this conceptual model, we employed both unconditional and conditional mediation models using the SPSS process macro provided by Hayes and Andrew (2018).

Figure 1.

The conceptual model for older adults HPLP moderated mediation analyses.

Ethical Considerations

The current study was reviewed and declared exempt by a University Institution Review Board (Study # 17-0570).

Results

General Characteristics of Participants

A total of 334 older adults participated in the study, including 128 Korean immigrants living in the U.S. and 206 older adults living in South Korea. Sociodemographics are shown in Table 1. The mean age of participants was 73 (SD = 6.40, 65–96 years of age). Half of all participants were in marital status living with a spouse. Approximately 15% of immigrants lived alone, and 40% of resident South Koreans lived alone. The education level was higher for immigrants. More than 51% of immigrants attended social gatherings more than once a week, whereas only 25% of South Korean residents did so. More than 28% of immigrants had full- or part-time jobs, while only 19% of South Korean participants worked. For both groups, high blood pressure, arthritis, and diabetes were common chronic illnesses. About 81% of South Korean older adults reported more than one chronic illness, compared to nearly half of the immigrants. The mean of social network was 14.87 (6.87) (range 0–30) in older South Koreans, 16.41 (5.92) in Korean immigrants in the U.S.; the mean of HPLP score was 2.35 (0.68) (range 1–4) in older adults in South Korea and 2.68 (0.44) in Korean immigrants in the U.S.

Table 1.

Socio-Demographic Characteristics of South Korean Older Adults and Korean Older Adult Immigrants in the United States (n = 354).

Characteristics	Categories	United States (n = 128)	South Korea (n = 226)	${{\bf{x}}^2}$ (df)	p
Characteristics	Categories	n (Column %)	n (Column %)	${{\bf{x}}^2}$ (df)	p
Age (year)	≤74	83 (64.8)	106 (46.9)	10.57 (1)	.001**
Age (year)	≥75	45 (35.2)	120 (53.1)	10.57 (1)	.001**
Gender	Male	43 (33.6)	65 (28.8)	0.900 (1)	.343
Gender	Female	85 (66.4)	161 (71.2)	0.900 (1)	.343
Marital status	Married	85 (66.4)	115 (50.9)	27.25 (3)	.000***
	Widow	28 (21.9)	102 (45.1)
	Separated/divorced	5 (3.9)	7 (3.1)
	Other	10 (7.8)	2 (.9)
Living with	No one	18 (14.1)	91 (40.2)	31.73 (3)	.000***
	Spouse	80 (62.5)	86 (38.1)
	Children	20 (15.6)	23 (10.2)
	Other (spouse and children)	10 (7.8)	26 (11.5)
Driving	No	19 (14.8)	178 (78.8)	135.28 (1)	.000***
Driving	Yes	109 (85.2)	48 (21.2)	135.28 (1)	.000***
Education	No schooling	5 (3.9)	56 (24.8)	118.33 (4)	.000***
	Elementary school	13 (10.2)	64 (28.3)
	Middle school	13 (10.2)	41 (18.1)
	High school	36 (28.1)	57 (25.2)
	University	61 (47.4)	8 (3.5)
Religion	None	7 (5.5)	57 (25.2)	77.64 (4)	.000***
	Christian	112 (87.5)	93 (41.2)
	Catholic	6 (4.7)	26 (11.5)
	Buddhist	0 (0.0)	45 (19.9)
	Other	3 (2.3)	5 (2.2)
Social activities	None	12 (9.4)	59 (26.1)	28.05 (3)	.000***
	Once a month	29 (22.7)	55 (24.3)
	2–3/month	22 (17.2)	54 (23.9)
	At least once a week	65 (50.8)	58 (25.7)
Gathering with children	1–2/month	23 (24.5)	80 (45.5)	13.84 (3)	.003**
	1–2/week	19 (20.2)	34 (19.3)
	More than 3/week	9 (9.6)	15 (8.5)
	Other	43 (45.7)	47 (26.7)
Employment	No	92 (71.9)	183 (81.0)	3.90 (1)	.048*
Employment	Yes	36 (28.1)	43 (19.0)	3.90 (1)	.048*
Income source	Work	31 (24.2)	83 (36.7)	83.85 (3)	.000***
	Adult children	12 (9.4)	98 (43.4)
	Property income	49 (38.3)	21 (9.3)
	Other	36 (28.1)	24 (10.6)
Chronic Illness	Hypertension	57 (44.5)	110 (48.7)
	Cardiac	7 (5.5)	43 (19.0)
	Hepatic	2 (1.6)	14 (6.2)
	Diabetes	21 (16.4)	54 (23.9)
	Arthritis	23 (18.0)	100 (45.6)
	Hearing	7 (5.5)	27 (11.9)
	Stroke	1 (0.8)	13 (5.8)
	Respiratory	3 (2.3)	16 (7.1)
	GI	15 (11.7)	46 (20.4)
	Renal	6 (4.7)	21 (9.3)
	Dental	15 (11.7)	62 (27.4)
	Optic	13 (10.2)	53 (23.5)
	Incontinence	9 (7.0)	16 (7.1)
	Neuralgia	10 (7.8)	66 (29.2)
	Other	5 (3.9)	8 (3.5)
# Chronic illness	0	61 (47.7)	43 (19.0)	52.76 (5)	.000***
	1	41 (32.0)	57 (25.2)
	2	12 (9.4)	43 (19.0)
	3	7 (5.5)	40 (17.7)
	4	5 (3.9)	20 (8.8)
	5 or more	2 (1.6)	23 (10.2)

Statistically significant at: *p < .05. **p < .01. ***p < .001.

Moderating Mediation effect of Social Networks

Using moderated mediation analyses, the interaction effect between U.S. residents and the number of chronic illnesses, age, and education explained social networks by 25% (see Table 2). The interaction effect between U.S. residents and the number of chronic illnesses was positively associated with social networks (β = 1.90, p < .001). After controlling for all variables in the model, a participant’s age increase predicted social networks decreased by 0.26 (β = −0.26, p < .001). After controlling for all variables in the model, one unit increase in education, predicted social networks increasing by 2.16 (β = 2.16, p < .003).

Table 2.

Moderated Mediation Analyses of Older Adult’s HPLP.

Model 2A	Outcome:	Social network			R ²	.25
Model 2A	β	SE	t	p	LLCI	ULCI
Constant	37.21	4.71	7.88	.000	27.93	46.49
US	−4.171	1.06	−3.93	.001	−6.26	−2.08
Chron 5	−1.84	0.28	−6.68	.000	−2.38	−1.30
US* Chron5	1.90	0.58	3.30	.001	0.77	3.03
Age	−0.26	0.05	−5.36	.000	−0.37	−0.17
Education	2.16	0.74	2.91	.003	0.71	3.62
Female	−0.35	0.74	−0.48	.631	−1.80	1.09
Occupation	−0.67	0.82	−0.82	.411	−2.28	0.94
Conditional effect of United States residence at values of the # chronic illness:
Chron 5 (n = 0)	−4.17	1.06	−3.93	.001	−6.26	−2.08
(n = 1)	−2.28	0.77	−2.96	.032	−3.78	−0.77
(n = 3)	−3.60	0.94	−3.80	.002	−5.47	−1.74
	Outcome:	HPLP			R ²	.40
Model 2B	β	SE	t	p	LLCI	ULCI
Constant	92.88	22.72	4.09	.000	48.19	137.58
SOCNET	2.24	0.23	9.65	.000	1.78	2.70
US	8.49	3.24	2.62	.009	2.12	14.86
Age	−0.13	0.24	−0.54	.586	−0.61	0.34
Female	2.75	3.41	0.80	.422	−3.97	9.47
Occupation	−5.69	3.60	−1.58	.115	−12.78	1.40
Education	1.71	3.38	0.50	.614	−4.94	8.35
Living with spouse	16.82	4.00	4.21	.000	8.95	24.68
Living with children	16.01	4.79	3.34	.000	6.59	25.44
Living with others	3.22	5.31	0.61	.545	−7.23	13.67
Direct effect	Effect	SE	t	p	LLCI	ULCI
US on HPLP (C′)	8.49	3.24	2.62	.009	2.12	14.86
Indirect effect (US → Social network → HPLP)	Effect	Boot SE	BootLLCI	BootULCI
#0 Chron	−9.34	2.75	−15.09	−4.25
#1 Chron	−5.09	1.86	−8.95	−1.66
#3 Chron	3.40	3.01	−2.41	9.41

Note. HPLP: Health-promoting behaviors.

Interaction effect.

Factors associated with health-promoting behaviors are a social network, U.S. residence, living with a spouse, and living with kids. The explanatory power (R ²) was 40% (see Table 2, Model 2B). After controlling for all variables in the model, a one-unit increase in social networks was associated with an increase of 2.24 health-promoting behaviors (β = 2.24, p < .001). After controlling for all variables in the model, immigrants demonstrated an 8.40-point increase in health-promoting behaviors compared to South Korean residents (β = 8.49, p < .009). There was a 16.82-point increase in health-promoting behaviors for participants living with a spouse (β = 16.82, p < .001), and a 16.01-point increase in health-promoting behaviors for participants who live with their adult children (β = 16.01, p < .001).

The first analyses were conducted with an unconditional mediation model that included education, age, living situation, gender, and occupation as covariates of both the mediator (social network) and health outcomes (health-promoting behaviors). Further examination of the relationship between country of residence and social network size showed that this negative relationship was moderated by a total number of chronic illnesses. Thus, we anticipated a complex mediation relationship, and we undertook mediation analyses to explicate this relationship.

The indirect effect of the country on health-promoting behaviors mediated by social network size is negative and nonsignificant (in the interest of space requirements in this brief report, we do not report this model). Given the negative finding, we undertook a moderated mediation model that included the number of chronic conditions as a moderator of the relationship between country and social network (see Figure 1). The results of this analysis are provided in Table 2. For low levels of chronic illness (less than one), the mediation effect is negative and significant. However, for chronic illnesses of two or more, we find a positive indirect effect that is insignificant. Thus, we conclude that for those with few chronic illnesses, the relationship between country and social network is negative. For those with chronic illnesses greater than three, U.S. residents demonstrated more health-promoting activities, which mediated the effects of these illnesses by social networks. However, for those with high comorbidities, this mediation model is positive but nonsignificant.

Discussion

Health-promoting behaviors may vary based on the number of chronic illnesses and country of residence, which suggests a need for tailored approaches to health promotion. Compared to South Korean residents, immigrants to the U.S. engage in more health-promoting behaviors and have larger social networks. Furthermore, after controlling for all variables, health-promoting behaviors increased as the number of individuals in a social network increased. Although recent studies have explored the health-promoting behaviors of Korean immigrants in the U.S., to the best of our knowledge, this is the first paper to compare the role of social networks in health-promoting behaviors among South Korean older adults with chronic illnesses residing in their home country and those residing in the United States as immigrants.

Social network has been found to be associated with health maintenance (Sung et al., 2016), and it is considered a greater explanatory factor for maintaining health than nutrition or exercise (H. K. Lee & Kim, 2017). A recent systematic review indicated that social support is an effective intervention for enhancing health-promoting behaviors among older adult immigrants in terms of physical activity and good dietary habits (Jagroep et al., 2022). The social network of South Korean residents is more likely to include friends, neighbors, and acquaintances who live closer than their relatives, and the relationship between friends and neighbors is positively correlated with the level of physical activity (Hong et al., 2018). However, as individuals age, the frequency of social activities decreases, and social networks weaken (Jung et al., 2018).

Immigrants face challenges in adopting the language and culture of their destination country, which can lead to a lack of immediate resources and limited social networks (Park et al., 2015; Wu & Penning, 2015), increasing the risk of social isolation (Lai et al., 2020). Hawkins summarized the facilitators and barriers for older adult immigrants in the U.S., including access to healthcare, health insurance coverage, mental health, activity involvement, and English language proficiency (Hawkins et al., 2022). Immigrants have reported decreased or limited social support after moving to the U.S. (Hong et al., 2018). Other senior Asian immigrants have reported difficulty visiting hospitals or accessing public services due to language barriers (Liu et al., 2017). Linguistic and cultural differences mean that immigrants may receive fewer health benefits compared to native Americans (Flavin et al., 2018).

A 20-year literature review of health-related facilitators and barriers faced by older immigrant adults in the U.S. sheds light on the role of social networks, as social support, which includes social networks and social relationships, is one of the most commonly observed factors affecting health (Hawkins et al., 2022). Subsequently, social networks have emerged as a crucial source of emotional, economic, and practical support for older adult immigrants. On the other hand, social isolation has a negative impact on their health status, health behavior, and utilization of health services (World Health Organization, 2018). Our findings illustrate the importance of social networks in health-promoting behaviors and highlight the need for policies to strengthen social networks to improve the health of immigrants. While South Korean residents do not face the same challenges (Rhee, 2017), there is also a need for policy interventions on their behalf. According to the United Nation’s Madrid International Plan of Action on Aging, assisting older adults in continuing to live in familiar and safe communities should be a priority for countries with aging populations (World Health Organization, 2020).

We hypothesized that social networks play a mediating role between the number of chronic illnesses and health-promoting behaviors and that this effect would differ based on country of residence. Our hypothesis was partially supported, and thus Pender’s Health Promotion Model and the conceptual framework for this study have been partially explained. Specifically, the interaction effect between U.S. residence and the number of chronic illnesses was positively associated with social networks. These findings align with previous studies that found social networks decrease the risk of death for the elderly (Ali et al., 2018) and showed that chronic illnesses and social network size have an impact on social isolation (Bahramnezhad et al., 2017). Social isolation is detrimental to well-being (Hawkins et al., 2022), and at advanced ages, it becomes challenging to establish relationships with others due to limited physical and economic abilities (Jeon & Choi, 2015; Kristensen et al., 2019). Moreover, the social networks of immigrants are mainly composed of other immigrants who share linguistic and cultural traditions (Li et al., 2018), which may impede their attempts to assimilate and access community resources.

For immigrants who reported no chronic illness or only one, the impact of the social network was negatively significant. However, for immigrants with more than three chronic illnesses, social networks had a positive but not statistically significant effect on health behaviors. Despite a large number of deaths due to chronic illnesses, physical activity for health promotion is decreasing (Korea Centers for Disease Control and Prevention, 2018), which supports the results of this study. In relation to the COVID-19 pandemic, the lockdown caused a decrease in social contact (Rolandi et al., 2020). However, the pandemic caused families to become closer, and although there was a decrease in network size and emotional and practical support, an increase was seen in informational support (Steijvers et al., 2022). These findings formed the basis for the results of this study, where older adults living with partners and those living with their children showed an increase of 16.82 and 16.01 points, respectively, in health-promoting behavior.

During the pandemic, maintaining face-to-face contact is still more important than relying on social media to promote health behaviors. A study conducted in Europe and Israel found that face-to-face interaction during crises such as the pandemic can lessen depression and anxiety considerably, while electronic contact can significantly increase them (Litwin & Levinsky, 2022). A study in Iran conducted before the pandemic found that education and perceived social support explained changes in health-promoting behaviors among older adults (Khami et al., 2020). Additionally, older adults may be less familiar with communication technology, which can hinder their ability to maintain social connections (Rolandi et al., 2020). Immigrant older adults may face even greater challenges in using communication technologies due to poorer socioeconomic status, less language proficiency, and lower levels of social inclusion (Chen et al., 2021). Therefore, culturally-tailored applications and support from family members and the community are necessary to overcome these obstacles. Although social media and communication technology can be seen as an opportunity to maintain social networks, face-to-face contact should remain the primary method. Thus, social networks are essential for maintaining health-promoting behaviors among older adults in South Korea and immigrant populations in the U.S.

Limitations and Future Directions

Our study has several limitations. This research was conducted using a cross-sectional design, so we could not determine the causal relationship between social networks and health-promoting behaviors. Additionally, our findings may not be generalizable to other immigrant groups since the target population was specific to Koreans. Furthermore, social networks provide information and motivation necessary for health promotion (Jeon, 2017), but immigrants may face unique challenges in accessing these resources through traditional family and kinship relationships. Therefore, expanding the range of public services for immigrants with chronic illnesses who might have limited social networks is necessary. Longitudinal data are needed to determine causal relationships and strengthen our findings on the impact of social networks on health-promoting behaviors in adults with chronic illnesses. Further research can explore the role of cultural factors and institutional support in promoting health-promoting behaviors among immigrants with chronic illnesses.

Conclusions

The study highlights the importance of social networks in health-promoting behaviors and underscores the need to strengthen social networks to improve the health of immigrants. Our findings have two important clinical implications. First, when implementing health promotion programs for older adults with chronic illnesses, it is necessary to assess and actively utilize their social networks. Second, older adults with chronic illnesses who live in a foreign country may be vulnerable to a decline in health-promoting behaviors without adequate social networks. A culturally tailored approach may be beneficial for maintaining social networks among immigrants. Further research is needed to examine the effect of social networks on health-promoting behaviors among older adults with chronic illnesses in South Korea and immigrants in the US post-pandemic, in order to develop more appropriate health strategies for this population.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Institutional Review Board Statement

The study was conducted according to the guidelines of the Declaration of Helsinki. The institutional review board of the university where the corresponding author is affiliated deemed this study exempt (Study # 17-0570).

ORCID iD

Hyewon Shin

Data Availability Statement

The data presented in this study are available on request from the corresponding author.

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The Moderating Effect of Social Networks on Health-Promoting Behaviors Among Korean Older Adults

Abstract

Plain language summary

Keywords

Objective and Hypotheses

Materials and Methods

Study Design and Data Source

Measurement

Data Analysis

Ethical Considerations

Results

General Characteristics of Participants

Moderating Mediation effect of Social Networks

Discussion

Limitations and Future Directions

Conclusions

Footnotes

Declaration of Conflicting Interests

Funding

Institutional Review Board Statement

ORCID iD

Data Availability Statement

References