The Science of Diabetes Self-Management and Care 2025, Vol. 51(6) 578–588 © The Author(s) 2025 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/26350106251378720 journals.sagepub.com/home/tde
Abstract
Purpose: The purpose of the study was to evaluate the validity and reliability of a short-form Revised Lifestyle Evaluation Scale for Metabolic Syndrome (RLES-MS)–Korean.
Methods: A cross-sectional survey was administered to 211 people with diabetes who were taking medication for metabolic syndrome and attending an outpatient clinic at a university-affiliated hospital in Suwon, Korea. Structured questionnaires were used for the psychometric evaluation. The RLES-MS validity was examined using exploratory factor analysis, and reliability was assessed using Cronbach’s alpha and McDonald’s omega.
Results: The interitem correlation analyses identified 2 low-correlation items, resulting in a 15-item scale. Factor analysis identified 4 dimensions of the RLES-MS: healthy eating and being active, monitoring and managing target goals, healthy coping, and awareness and taking medication. The 4-factor model explained 58.65% of the total variance. Item 8 (taking medication) scored the highest, and Item 2 (healthy eating) scored the lowest, followed by Item 13 (monitoring and managing the target values). Overall, Cronbach’s alpha and McDonald’s omega were .864 and .866, respectively. The RLES-MS showed significant associations with quality of life (r = .426, P < .001), self-efficacy (r = .530, P < .001), depressive symptoms (r = −.430, P < .001), and A1C (r = −.163, P = .018).
Conclusions: The RLES-MS showed good validity and moderate reliability, supporting its clinical use for evaluating lifestyle behaviors in Korean people with diabetes and metabolic syndrome.
People with diabetes are at an increased risk of developing metabolic syndrome. According to the worldwide consensus criteria, metabolic syndrome was defined as a clustering condition of risks such as abdominal obesity, high fasting glucose, high blood pressure, high triglycerides, and low high-density lipoprotein cholesterol. The global prevalence of metabolic syndrome has increased because of the population aging and unfavorable lifestyles.1,2 Metabolic syndrome, especially when combined with diabetes, can further exacerbate the risk of micro- and macrocardiovascular complications and can increase mortality.3,4 Globally, the prevalence of metabolic syndrome varies (approximately 12.5%-31.4%) geographically and economically.5 In Korea, the prevalence of metabolic syndrome is 24.9% among adults aged ≥19 years and 47.0% among those aged ≥65 years, according to the metabolic syndrome fact sheet.6
Factors associated with the prevalence of metabolic syndrome include income, education, and lifestyle habits. Notably, the prevalence of metabolic syndrome was high in smokers, high-risk drinkers, and those who did not regularly exercise. Over the past 15 years, the incidence of metabolic syndrome in Korea has consistently increased across all age groups, with the highest prevalence observed in men and women in their 70s.7 Furthermore, the prevalence of metabolic syndrome has increased since the coronavirus disease 2019 pandemic, with a particularly notable and significant increase in abdominal obesity.6
Therapeutic lifestyle modification (TLM) plays a key role in managing metabolic syndrome. TLM is an essential component and a cost-effective strategy for reducing morbidity and mortality.8,9 The cardiometabolic benefits of TLM for metabolic syndrome are well documented.10 Despite these benefits, comprehensive instruments to assess TLM are lacking in people with diabetes at risk for metabolic syndrome. Instruments such as the Health Promoting Lifestyle Profile,11 Health Habits Scale,12 and Perceived Health Competence Scale13 have been used; however, they are insufficient for therapeutic purposes, such as guiding the design of lifestyle interventions, identifying individual needs, or evaluating changes following health promotion programs. Specifically, these instruments were primarily developed to assess general lifestyle or health behaviors, and they lack the specificity required to identify behavioral targets or monitor changes over time. As such, their utility is limited when it comes to developing and evaluating individualized interventions in clinical or community settings. In addition, few instruments have been developed specifically to evaluate TLM in people with metabolic syndrome.
The Lifestyle Evaluation Scale for Metabolic Syndrome (LES-MS) was initially developed in Korea to evaluate TLM in people with metabolic syndrome.14 The original 36-item scale used a 4-point Likert response format (1 = never, 2 = sometimes, 3 = very often, 4 = always). The total score ranged from 36 to 144, with higher scores indicating healthier lifestyle practices. Based on international guidelines and the literature, the LES-MS comprises 6 subscales with items related to physical activity/weight control (Items 1-8), dietary pattern (Items 9-24), alcohol/smoking (Items 25-27), stress (Items 28-30), sleep and rest (Items 31 and 32), and medication/regular doctor visits (Items 33-36). The original LES-MS was designed as an inventory to rate people’s adherence to various regimenrelated behaviors, with both content and clinical validity verified through a literature review by a multidisciplinary expert team and people with metabolic syndrome, respectively.
The LES-MS has been adapted to measure adherence to various treatment regimens and lifestyle activities for other chronic conditions. Studies using the original tool have verified its effectiveness in various contexts, including identifying factors influencing healthy lifestyle habits in people at risk for metabolic syndrome15; exploring the relationship between metabolic syndrome lifestyle and type D personality16; examining the relationship between metabolic syndrome, lifestyle, and nutrition among Chinese office workers17; investigating the relationship between social support and metabolic syndrome prevention behavior in college students18; and assessing lifestyle risk factors in workers with high risk for metabolic syndrome.19 Despite its widespread application, the 36-item long form of LES-MS has not yet been revised or tested in a shorter form to enhance its clinical feasibility.
A short version of the scale is beneficial because it can measure the lifestyle habits of people with diabetes at risk for metabolic syndrome using a small number of questions, thereby reducing the burden on both research staff and research participants in busy clinical settings. However, ensuring that the abbreviated scale adequately reflects the original scale is essential. A short version requires systematic verification for validity and reliability.
In this context, this study aimed to revise the LES-MS, adapt a short version to measure adherence to TLM for metabolic syndrome in people with diabetes, and evaluate the psychometric properties of the short version. Specifically, this study focuses on (1) structural validity, (2) hypothesis testing for construct validity, and (3) reliability of the Revised LES-MS (RLES-MS).
A cross-sectional survey design evaluated the psychometric properties of the RLES-MS using convenience sampling. People with diabetes who visited the endocrinology outpatient clinic at a university-affiliated hospital in Suwon, South Korea, were initially recruited. The inclusion criteria included being diagnosed with diabetes, aged 19 years or older, taking one or more oral hypoglycemic agents for the past 6 months, and/or taking medication for metabolic syndrome according to the National Cholesterol Education Program Adult Treatment Panel III criteria. The exclusion criteria included the presence of major psychological disorders or impaired cognition. Of the 230 individuals who agreed to participate, 211 completed the questionnaires and performed the A1C test, yielding a response rate of 91.7%.
The sample size was calculated to ensure an adequate factor analysis, so the moderate factor structure ratio between the sample and variable was 10:1.20 Thus, the 17-item scale version required a minimum of 170 respondents. The Kaiser-Meyer-Olkin (KMO) measure (.866) of sampling adequacy supported this sample size.
On May 12, 2022, the authors obtained written permission from the developer of the original scale to revise the LES-MS and verify the psychometric properties of the short version. Based on previous research approaches,14 the 36-item LES-MS was independently reviewed and scored by two nursing professors with expertise in health behavior and scale development. Each item was evaluated for clarity, relevance, and potential redundancy. Through a series of iterative discussions, consensus was reached on retaining 17 core items that best represented the original constructs. The research team further reviewed these 17 items to ensure semantic consistency and conceptual fidelity. The developer of the original scale verified the accuracy of the terminology used. An expert panel composed of one scale development expert, two metabolic syndrome experts, and two nurses who educate people with diabetes about TLM for metabolic syndrome conducted a content validity analysis to assess the comprehensibility, applicability, and appropriateness of the RLES-MS. The original LES-MS used a 4-point scale, ranging from 1 (no) to 4 (always), to measure adherence to lifestyle behaviors. During expert panel discussions, scoring “no” as 1 was considered inaccurate. A consensus was reached to revise the scale to a 4-point range from 0 to 3, with 0 representing no adherence to lifestyle behaviors and 3 representing always adherence to lifestyle behaviors. The pretest version of the RLES-MS was adopted for psychometric testing using item analysis. Two items (Items 16 and 17) were removed because of low item-total correlations (<.30; .254 and .234, respectively), indicating that these items were not strongly related to the scale. A pilot study of 10 people with diabetes at risk for metabolic syndrome was performed at the data collection site to assess the comprehensibility and feasibility of the RLES-MS. Participants verbally confirmed that they understood all the questions and had no difficulty answering them.
Lifestyle behaviors: Revised Lifestyle Evaluation Scale for Metabolic Syndrome. The version of the 17-item RLES-MS was selected as the revised short version of the original 36-item LES-MS for evaluating the lifestyle behaviors and physical function levels of people with metabolic syndrome.14 Item scores were summed to produce an overall perceived RLES-MS score, with higher scores indicating more adherence to healthy behaviors. The Cronbach’s alpha for the LES-MS in people with metabolic syndrome was .92 in the original study,14 indicating acceptable internal consistency.
Self-efficacy: Chronic Disease Self-Efficacy Scale. The short version of the Chronic Disease Self-Efficacy Scale (CDSES-6) was used to measure self-efficacy in people with chronic diseases.21 The scale consists of 6 items rated on a 10-point Likert scale ranging from 1 (not at all confident) to 10 (totally confident), with a higher score indicating greater self-efficacy. A Cronbach’s alpha of .87 for the adapted 33-item scale has been reported.22 The Cronbach’s alpha for reliability of the scale for the total sample in the current study was .947.
Quality of life: World Health Organization Well-Being Index. Quality of life (QoL) was measured using the 5-item World Health Organization Well-Being Index (WHO-5), which evaluated subjective well-being in the previous 2 weeks.23 The total score ranges from 0 to 100 (absence of well-being to maximum well-being). After multiplying the raw sum of the 5 items by 4, a final score below 52 (raw score below 13) or a participant’s response of 0 or 1 to any of the 5 items indicates poor health-related QoL. The WHO-5 has demonstrated sufficient construct validity, predictive validity, and internal consistency in several populations.24 The Cronbach’s alpha coefficient for this scale was .892 in the current study.
Depressive symptoms: Center for Epidemiologic Studies-Depression Scale. Depressive symptoms were measured using the Center for Epidemiologic Studies-Depression Scale.25 A 20-item self-report scale was developed to assess the frequency of individual experiences of 20 events during the past 7 days, which comprised 16 negatively worded items assessing major affective components of depression and 4 positively worded items assessing the positive affect. The total score ranged from 0 to 60, with higher scores indicating greater depressive symptoms and a cutoff score greater than or equal to 16 indicating a risk of clinical depression. The Cronbach’s alpha for this scale was .85 in the original study25 and .941 in the current study.
A1C. A1C was measured using a NycoCard Reader II (Axis-Shield PoC, Oslo, Norway). The level of A1C was considered uncontrolled if it was greater than or equal to 7% (53 mmol/mol).26
Demographic and diabetes profile of the participants. All participants completed a questionnaire on demographic characteristics (sex, age, education, and economic status), and diabetes-related information was collected from their electronic medical records.
Approval was obtained from the Institutional Review Board of the authors’ institution (IRB No. SUR-2022-079). Each participant understood the study’s objective and voluntarily signed an informed consent form after stating their understanding of their rights to confidentiality, withdrawal, and protection of identifying details.
The data were analyzed using SPSS version 23.0 (IBM SPSS Statistics and AMOS for Windows, IBM Corporation, Armonk, NY) and Stata version 14.2 (STATACorp, College Station, TX). No data were missing. The authors confirmed that the data had a multivariate normal distribution.27 The distribution of RLES-MS scores was assessed using means, standard deviations, and floor or ceiling effects using the lowest or highest score; a frequency of less than 30% was considered acceptable.
The psychometric properties of the RLES-MS were established by examining its structural validity, construct validity, and internal consistency reliability. The authors calculated item-total correlations using Pearson’s correlation coefficients, where values of .30 to .80 indicated that items were related to the overall scale28; 2 items (Items 16 and 17) that showed correlations lower than .30 were removed.
To determine structural validity, the authors conducted exploratory factor analysis (EFA) with a principal component extraction method to identify the underlying structure of the short-form scale (RLES-MS). The KMO and Bartlett’s sphericity tests were used to determine data suitability for the EFA using the maximum likelihood estimation method with the correlation matrix.29 The authors also conducted confirmatory factor analysis (CFA) to evaluate the model of the short-form RLES-MS using the adequacy of the model fit indices to validate the model in alignment with theoretical expectations.30 This 2-step approach—first using EFA to explore the latent structure and then CFA to confirm it—is commonly used in scale development and validation to ensure both the empirical and theoretical soundness of the factor model.
To investigate the construct validity, the authors conducted hypothesis testing. Pearson’s correlation coefficients examined the a priori hypothesis that the RLES-MS score would be significantly associated with QoL, selfefficacy, depressive symptoms, and A1C.
The authors used Cronbach’s alpha and McDonald’s omega to determine the internal consistency and reliability of the RLES-MS. Statistical significance was set at 2-tailed P < .05.
Of the 211 participants, 126 (59.7%) were men, 184 (87.2%) had completed at least 10 years of education, 161 (76.3%) had a perceived moderate economic status, and 105 (49.8%) had diabetes for 10 or more years. The mean age was 56.08 years (SD = 8.80), mean duration of diabetes 11.20 years (SD = 7.94), and mean A1C level 7.13% (SD = 1.13); 112 participants (53.1%) had A1C greater than or equal to 7% (53 mmol/mol; Table 1), and approximately 30% of participants (n = 63) had A1C lower than 6.5%.
The RLES-MS is a 4-point scale with a score range of 1.31 to 2.74 points, with an average of approximately 1.80 points (SD = 0.54). The highest item score for the 15-item RLES-MS was 2.74 (out of 3) for Item 8 (take prescribed medication); the lowest item score was 1.31 for Item 2 (healthy eating), followed by Item 13 (monitor and manage the target values; Table 2).
The obtained KMO was 0.866, meeting the KMO criterion (≥0.60) and supporting data adequacy for the factor analysis (Table 2). Bartlett’s test of sphericity was statistically significant (P < .001), supporting the use of factor analysis. Factor analysis identified 4 dimensions of the RLES-MS, with the factors labeled as healthy eating and being active (6 items), monitoring and managing target goals (4 items), healthy coping (3 items), and awareness and taking medication (2 items). The factor loadings for the 15 items in this study were all ≥0.4. If the factor loading is ≥0.3, the loading is significant; if it is ≥0.5, it is a very high loading. Except for Item 12 (0.496), 14 items showed ≥0.5 (Table 2). The 4-factor model explained 58.65% of the variance (Table 3).
The model obtained by the EFA was evaluated using CFA. Modification indices were employed to improve the partially satisfactory model fit obtained from the initial model, with 1 covariance allowed for the CFA between the measurement error of Items 5 and 6. After this modification, the 4-factor model of the RLES-MS with 15 items adequately fit the data (Figure 1). The following indices estimated the adequacy of the model fit: χ2/df = 2.200 (P < .001), root mean square error of approximation = 0.068 (90% CI, 0.055-0.081), normed fit index = 0.862, relative fit index = 0.826, incremental fit index = 0.920, Tucker-Lewis index = 0.897, and comparative fit index = 0.918. Thus, the CFA partly supported the EFA findings, with the standardized regression coefficients ranging from 0.450 to 0.832, except for factor 4 (0.157, 0.274; Figure 1).
The mean scores of the RLES-MS showed significant associations with the scores for QoL (r = .426, P < .001), self-efficacy (r = .530, P < .001), depressive symptoms (r = −.430, P < .001), and A1C (r = −.163, P = .018), consistent with the a priori study hypotheses (Table 4).
The internal consistency reliability of the 15-item RLES-MS was high (Cronbach’s α = .864; McDonald’s ω = .866; Table 2).
This study attempted to develop a psychometrically robust short-form LES-MS.14 The 15-item RLES-MS was derived from the original 36-item scale. The newly developed RLES-MS is a valid and reliable scale for assessing lifestyle adherence to TLM among Korean adults with diabetes and metabolic syndrome. It can potentially be used as a concise and effective tool in clinical settings.
The first purpose of the study was to revise the LES-MS to serve as a measurement for adherence to TLM in patients with metabolic syndrome. The 4 factors in the RLES-MS were revealed after removing 2 items with correlations lower than .30 for theoretical and psychometric reasons: healthy eating and being active (6 items), monitoring and managing target goals (4 items), healthy coping (3 items), and awareness and taking medication (2 items). This structure does not align with the original 36-item LES-MS, which has 6 subscales14 : physical activity/weight control, dietary pattern, alcohol/smoking, stress, sleep and rest, and medication/regular doctor visits.
In the current study, 2 items of the original physical activity/weight control subscale and 4 items of the original dietary pattern subscale loaded on Factor 1: doing regular exercise (Item 5), increased daily physical activity (Item 6), regular meals every day (Item 1), enough amount of protein foods (Item 3), healthy eating (Item 2), and fresh fruits and vegetables per day (Item 4). Three items of the original medication/regular doctor visits subscale and 1 item of the “physical activity/weight control” subscale loaded on Factor 2: monitor and manage the target values (Item 13), regular self-monitoring at home (Item 7), awareness of unusual symptoms (Item 14), and monitor and manage target weight (Item 15). One item of each of the original stress, sleep and rest, and medication/regular doctor visits subscales loaded on Factor 3: cope to relieve stress (Item 10), sleep and rest (Item 11), and regular hospital visits (Item 12). One item each of the original stress and medication/regular doctor visits subscales loaded on Factor 4: take prescribed medication (Item 8) and awareness of stressors (Item 9).
The structural validity using EFA showed a total variance explanatory power of 58.65%, close to the total variance explanatory power of 60% for factor selection in social science,31 indicating that the scale effectively captures the intended constructs. In addition, 14 out of 15 items showed factor loadings of ≥0.5, and 1 item showed factor loadings of ≥0.4. This result indicates that when applying the criterion that factor loadings of ≥0.3 are significant and those of ≥0.5 are highly significant,28 the items showed a high correlation with the factors. However, the relatively lower standardized regression coefficients for Factor 4 (take prescribed medication = 0.157 and awareness of stressors = 0.274) may indicate that this subscale is less robust than the others. This result could be due to the limited number of items (only 2) in this factor or the possibility that medication adherence was influenced by external factors (eg, health care access and patient-provider communication) not fully captured by the scale. Future studies could consider expanding this subscale or exploring its relationship with other constructs, such as health literacy or health beliefs.
The construct validity of the RLES-MS was supported through hypothesis testing, which demonstrated a significant association between the RLES-MS scores and measures of QoL, self-efficacy, depressive symptoms, and glycemic control. The CDSES-6 and WHO-5 were selected as comparator instruments to verify positive correlations. In addition, depressive symptoms were selected as a concept distinct from that of the RLES-MS. For this analysis, the correlation with the Center for Epidemiologic Studies-Depression Scale was verified as a comparator instrument to show the inverse correlation. These results are the same as the inverse correlation observed when the relationship with depression was verified using the original instrument.14
The significant, albeit weaker, association with glycemic control (A1C levels) suggests that lifestyle behaviors, as measured using the RLES-MS, play a role in managing metabolic syndrome, although other factors (eg, taking medication, genetic predisposition) may also influence glycemic control. However, it is essential to note that the present study focused on people with diabetes taking medication for metabolic syndrome, and further comparisons with those not taking medication were not possible. Such comparisons could provide valuable insights into how lifestyle behaviors differentially affect glycemic control in these two groups, potentially providing tailored interventions for each population.
The RLES-MS demonstrated an internal consistency reliability of 0.86, which sufficiently satisfies the general standard of 0.70 or higher that can be adopted in the field of applied research suggested by Nunnally,32 securing high internal consistency of the scale. The consistency of responses for each item showed high reliability. The removal of 2 items (Items 16 and 17) because of low item-total correlations (<0.30) further strengthened the reliability of the scale. These findings suggest that the RLES-MS is a reliable tool for assessing lifestyle behaviors in patients with metabolic syndrome.
A lifestyle assessment tool for metabolic syndrome indicates that a higher score reflects a more desirable lifestyle. However, no cutoff score has been established to distinguish between the levels of lifestyle adherence. Further research, including receiver operating characteristic analysis, will be necessary to determine an appropriate cutoff score for clinical validity.
This study demonstrates several significant strengths that enhance its credibility and applicability, as evaluated using Cronbach’s 5 perspectives on validity.33 First, it ensured strong content validity by developing a short-form RLES-MS that comprehensively captured the key dimensions of lifestyle behaviors relevant to metabolic syndrome. The tool was refined through expert reviews and pilot testing to ensure it adequately represented the multidimensional construct it aimed to measure. Second, the study establishes criterion-related validity by demonstrating that the tool’s scores correlate meaningfully with external measures, such as QoL, self-efficacy, depressive symptoms, and A1C, that align with theoretical expectations.
Third, the study confirms the construct validity through EFA, which identifies a clear 4-factor structure consistent with the theoretical framework of metabolic syndrome management. This structural validity underscores the tool’s ability to measure the intended multidimensional construct. Fourth, strong correlations between the tool and related constructs, such as QoL and self-efficacy, supported convergent validity. In contrast, discriminant validity was evidenced by its ability to distinguish between unrelated constructs, such as depressive symptoms.
Finally, this study adhered to rigorous methodological standards, including the COSMIN guidelines, further strengthening the RLES-MS’s validity and reliability. By controlling for multiple testing and prespecifying hypotheses, this study minimized bias and enhanced the robustness of its findings. Overall, this study advances the field by providing a validated short-form assessment tool and aligns with Cronbach’s emphasis on comprehensive validity evaluation to ensure the tool’s scientific and practical utility.33
Although this study provides robust evidence for the validity and reliability of the RLES-MS, some limitations should be acknowledged. First, using a convenience sample from a single Korean university-affiliated hospital may limit the generalizability and validity of our findings. The RLES-MS should be evaluated in more diverse populations and settings to ensure applicability across different cultural and health care contexts to enhance generalizability. Using the same sample may limit the structural validity of the RLES-MS. Future studies should test its psychometric properties with independent samples for EFA and CFA to further evaluate validity. Second, the RLES-MS relies on self-reported data, which may be subject to social desirability bias or recall inaccuracies. Future research could incorporate objective measures of lifestyle behaviors, such as accelerometers for physical activities and dietary logs, to complement self-reported data.
This study demonstrated that the RLES-MS among people with diabetes has good validity and reliability, as measured using Cronbach’s alpha and McDonald’s omega, and is clinically beneficial for monitoring therapeutic lifestyle modification. Our study contributes significantly to the literature because it contains findings that enhance our current knowledge of potentially effective strategies for managing metabolic syndrome.
The RLES-MS offers a concise and practical tool for health care providers to assess TLM in individuals with metabolic syndrome. Considering the time constraints and ethical considerations related to respondents, using too many dimensions and items could be a concern in busy hospital environments. The brevity of the RLES-MS (15 items) makes it feasible in clinical settings where time constraints often limit the administration of longer survey instruments. The sound psychometric properties of the scale also make it suitable for research purposes, particularly in studies evaluating the effectiveness of lifestyle interventions for metabolic syndrome. In addition, the practicality of the tool, both in terms of economic feasibility (time and cost efficiency) and convenience (clear implementation guidelines and simple procedures), further underscores its potential for widespread clinical application. The shortened version of the lifestyle assessment tool for metabolic syndrome developed in this study improves time efficiency in clinical settings. It offers the convenience of simple usage procedures, enabling the individuals to make easy, repetitive use. Furthermore, this tool can contribute to preventing diseases and complications through effective lifestyle evaluations.
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the National Research Foundation of Korea grant (No. 2021R1A2C2007858) funded by the Korea government (MSIT) and a 2023 research grant (No. M-2023-00037) from the Department of Nursing Science, Graduate School, Ajou University.
Chun-Ja Kim https://orcid.org/0000-0002-7594-5418
Elizabeth A. Schlenk https://orcid.org/0000-0001-7361-1951
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From University of Virginia School of Nursing, Charlottesville, Virginia (Dr Seo); College of Nursing and Research Institute of Nursing Science, Ajou University, Suwon, Korea (Dr Kim); Department of Nursing, Dongseo University, Busan, South Korea (Prof Kang); Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea (Dr Kim); University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania (Dr Schlenk).
Corresponding Author: Chun-Ja Kim, College of Nursing and the Research Institute of Nursing Science, Ajou University, 164 Worldcup-Ro, Yeongtong-Gu, Suwon 16499, South Korea. Email: ckimha@ajou.ac.kr
