Korean immigrant women`s physical activity experience_a situation-specific theory

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Research and Theory for Nursing Practice: An International Journal, Vol. 29, No. 1, 2015

Korean Immigrant WomensPhysical Activity Experience:A Situation-Specific Theory

Eun-Ok Im, PhD, MPH, RN, CNS, FAAN

School of Nursing, University of Pennsylvania

Sun Ju Chang, PhD, RN

School of Nursing, Chungbuk National University, South Korea

Giang Nguyen, MD, MPH, MSCE

School of Medicine, University of Pennsylvania

Lynn Stringer, PhD, RN, FAANWonshik Chee, PhD

School of Nursing, University of Pennsylvania

Eunice Chee, BS(c)

School of Engineering and Applied Science, University of Pennsylvania

To develop successful physical activity promotion programs for midlife immigrant

women, especially for Korean immigrant midlife women, concrete theoretical bases

are needed. However, virtually no theoretical frameworks and/or theories exist that

can explain the influences of immigration transition on the physical activity experi-

ence of midlife immigrant women in general or Korean immigrant midlife women

in specific. The purpose of this article is to present a situation-specific theory on

physical activity experience of Korean immigrant midlife women (SPAKIM) with its

development process. An integrative approach was used to develop the theory based

on the midlife womens attitudes toward physical activity (MAPA) theory, the transi-

tions theory, a review of the relevant literature, and two studies on midlife womens

attitudes toward physical activity. The proposed theory includes nature of transitions,

nonmodifiable and modifiable transition conditions, contexts of daily life, patterns


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The SPAKIM Theory 11

of response, and nursing therapeutics as major concepts, and each major concept

includes several related subconcepts. Because several concepts of the theory were

developed mainly based on the literature review, the major concepts and related

subconcepts need to be further developed and evaluated in future studies.

Keywords:nursing theory; midlife women; Asian American; immigrant;

physical activity

With an increasing number of immigrants across countries, immigration

has become a prominent international phenomenon throughout the

world (Gallup, 2013). Immigrants are vulnerable to various types of health

risks because they tend to earn less income, are more likely to be unemployed or

underemployed, are more likely to live in low-income situations, and are under

tremendous stress by immigration itself (Meyer, Torres, Cermeo, MacLean, &Monzn, 2003). Also, ethnic minority immigrants, including midlife Korean immigrant

women, have been reported to have an increased risk of cardiovascular diseases,

Type 2 diabetes, obesity, hypertension, and all-cause mortality, which frequently

results in health disparities among the populations (Eyler et al., 1999). Moreover,

midlife Asian immigrants including midlife Korean immigrant women tend to have

central obesity, which is frequently associated with Type 2 diabetes, cardiovascular

diseases, and increased mortality (Crespo, Yoo, & Hawkins, 2011).

Researchers have suggested that increasing physical activity would be a low-cost

way to prevent disease occurrence and the protective effects of physical activ-ity, especially for midlife immigrant women, would be greater than that for other

groups of women (U.S. Department of Health and Human Services [USDHHS],

2013). However, in comparison to nonimmigrants, immigrants are reported to

have much lower rates of participation in health promotion programs, includ-

ing physical activity promotion programs, because of multiple barriers including

language and communication barriers, cultural beliefs and traditions, and daily

socioeconomic challenges (Huh, Prause, & Dooley, 2007; Meyer et al., 2003). Thus,

researchers have pointed out the necessity of unique physical activity promotion

programs that effectively work for midlife immigrant women (Eyler et al., 1999;

USDHHS, 2009). To develop successful programs for midlife immigrant women,

especially for Korean immigrant midlife women, concrete theoretical bases are

needed. However, virtually no theoretical frameworks and/or theories exist that

can explain the influences of immigration transition on the physical activity

experience of midlife immigrant women in general or Korean immigrant midlife

women in specific.

Im and Meleis (1999) proposed situation-specific theories as a new type of theo-

ries that could be ready-to-wear in nursing practice and research. Despite some

argument on the typology of situation-specific theories, situation-specific theories

are the theories that focus on specific populations or to particular fields of practice;that consider sociopolitical, cultural, and historical contexts of nursing encounters;


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12 Im et al.

physical activity experience of midlife Korean immigrant women and that could

be used to guide the development of physical activity promotion programs for this

specific population, we aimed to develop a situation-specific theory. The purpose

of this article is to present the situation-specific theory on physical activity experi-

ence of Korean immigrant midlife women (SPAKIM) that we developed using the

integrative approach by Im (2005). In this article, the term of Korean immigrant

womenrestrictively refers to immigrant women having origins in South Korea.

First, the methods used to develop the SPAKIM are briefly explained. Then, the

multiple sources of theorizing used to develop the theory are described. Finally,

the major concepts and subconcepts of the SPAKIM theory and the relationships

among the concepts are presented with the evidence from the reasoning and

theorizing process.

METHODS: THE INTEGRATIVE APPROACH

The development process of the SPAKIM theory followed the integrative approach

by Im (2005). The integrative approach includes several steps that could be cyclic:

(a) checking assumptions for theorization, (b) initiating theorization through

multiple sources, (c) reasoning through critical analyses, (d) documenting theo-

rization, and (e) reporting and sharing theorization. We followed these steps in

our theoretical development of the SPAKIM. First, the assumptions for the theory

development were clarified as suggested in the approach. Then, the phenomenon(physical activity experience of Korean immigrant midlife women) was explored

using multiple sources of theorizing. Based on the sources, reasoning through criti-

cal analyses and theorizing were done to conceptualize the major concepts and to

ascertain the relationships among the concepts. Because more refinement of the

theory would be needed, this article could be the first step in reporting, sharing,

and validating that could be the last step suggested in the integrative approach.

The following sections are organized by these steps suggested in the integrative

approach (Im, 2005).

CLARIFICATION OF THE ASSUMPTIONS

The first assumption of this theorizing process was that diversities and complexities

could exist within the phenomenon of Korean immigrant womens physical activity

experience, and the proposed theory would represent only a part of the diversities

and complexities of the phenomenon. Second, the theory development process was

assumed to be cyclical and evolutionary and occur in specific sociopolitical con-

texts, which would subsequently limit the application of the SPAKIM theory. Third,

it was also assumed that the uniqueness of Korean immigrant womens physicalactivity experience could come from the womens continuous interactions with


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activity experience was assumed to be influenced by ethnicity, race, gender, and

social class that would provide the basis to structure the womens relationships

with others.

THE MULTIPLE SOURCES OF THEORIZING

Korean immigrant womens physical activity experience was explored through

multiple sources: (a) existing theories, (b) an integrated literature review, and

(c) two research studies.

EXISTINGTHEORIES

The midlife womens attitudes toward physical activity (MAPA) theory by Im,Stuifbergen, and Walker (2010) and the transitions theory by Meleis, Sawyer, Im,

Messias, and Schumacher (2000) were used as a source for developing the SPAKIM

theory. The MAPA theory is a situation-specific theory that was developed based

on a midrange theorythe attitude, social influence, and self-efficacy (ASE) model

by de Vries, Dijkstra, and Kuhlman (1988), an integrative literature review, and the

findings of a research project called the MAPA study (Im, Chee, Lim, Liu, & Kim,

2008). Because the MAPA theory aimed to explain the relationships between midlife

womens attitudes toward physical activity and their actual participation in physi-

cal activity, it would provide a comprehensive theoretical framework that could

explain all the related factors that might influence the physical activity experience

of Korean immigrant midlife women. The transition theory, a midrange theory,

was also developed through continuous theoretical works related to transitions,

an integrative literature review, and five research studies. The midrange transitions

theory was chosen for this theoretical work because physical activity experience of

Korean immigrant midlife women would be directly linked to the situational transi-

tion that they would experience as a result of their immigration from South Korea

to the United States.

ANINTEGRATEDLITERATUREREVIEW

In the development of the SPAKIM theory, an integrative literature review was also

conducted by searching multiple databases including PubMed, PsycINFO, and the

Cumulative Index to Nursing and Allied Health Literature (CINAHL). The criteria for

the articles that were included in the literature review were (a) written in English,

(b) published in the past 10 years, and (c) data-based publications. When we searched

the literature related to immigration transition of Korea midlife women using the

keywordsmidlife,Korean, women,immigration, and/or transition, 255 articles, all

in English, were retrieved and 33 articles met the inclusion criteria. The literature

on factors influencing the physical activity experience of midlife women in gen-eral was also searched and included in this review because very few studies were


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14 Im et al.

immigrant, 122 articles were retrieved. Only 69 of these articles met the inclusion

criteria. Thus, 102 articles were included in the literature review. Then, the articles

were sorted according to the major foci of the theory development process. The

major findings of the articles were then analyzed to support specific associations

of various factors to the physical activity experiences of Korean/Asian American

immigrant midlife women.

TWOSTUDIES

To develop the SPAKIM theory, we also used the findings from two studies: (a) one

study on attitudes toward physical activity in a diverse sample of American women

in midlife (Study 1; Im et al., 2012) and (b) the other study on Korean immigrant

midlife womens needs for and attitudes toward physical activity (Study 2; Im &

Choe, 2001). The major goal of Study 1 was to explore ethnic differences in attitudestoward physical activity among four major ethnic groups of midlife women in the

United States, including Whites, Hispanics, African Americans, and Asians. Study

2 aimed to explore womens own needs for and attitudes toward physical activity

among Korean immigrant women in the United States using feminist approach

and transition theory. More detailed information on the two studies can be found

elsewhere (Im et al., 2012; Im & Choe, 2001).

REASONING AND THEORIZING: THE SPAKIM THEORY

The proposed SPAKIM theory includes the nature of transitions, modifiable tran-

sition conditions, nonmodifiable transition conditions, contexts of daily life, pat-

terns of response, and nursing therapeutics as major concepts (Figure 1). All these

major concepts basically came from the midrange transitions theory (Meleis et al.,

2000) and were further developed based on the findings from the multiple sources

described earlier.

NATUREOFTRANSITIONS

The nature of transitions includes the types, patterns, and properties of transi-

tions as in the middle-range transitions theory. The transitions that the women

are experiencing include immigration, menopausal, and healthillness transitions.

In the literature, it was also clear that the women were experiencing significant

challenges because of their immigration transition and indicated changes in cultural

norms, socioeconomic status, language, and living environment (Afable-Munsuz,

Ponce, Rodriguez, & Perez-Stable, 2010; Yang et al., 2007). However, other tran-

sitions that Korean American midlife women might experience simultaneously

were rarely explored, and little is known about the properties of their transitions

(e.g., awareness of their transitions, their engagement during the transition, etc.).In Study 2, Korean American midlife women were experiencing immigration


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Figure

1.TheSPAKIMt

heory.

Note.S

PAKIMs

ituation-specific

theoryonphysicalactivitye

xperienceofKoreanimmigrantmidlifewomen;BMIbodymass

ndex.

Healthillness

transition

Menopausal

tra

nsition

Immigration

transition

NatureofTransitions

TransitionConditions

PatternsofRes

ponse

ContextsofDailyLife

Nonmodifiabletransitionconditions

Backgroundcharacteristics

Healt

h/diseasestatusand

meno

pausalstatus

KoreanAmericanm

idlife

womensphysicalactivity

experience

Types,amount,fr

equency,

andintensityofp

hysical

activity

Needsforphysicalactivity

Otherrelatedoutcomes

Perceivedhealth

BMI

Modifiabletransitionconditions

Attitu

destowardphysicalactivity

Self-efficacy

Barriers

Socia

linfluences

Nursin

gtherapeutics:

Evidence-basedsocialmarketingapproaches

TheE

nglishasasecondlanguage(ESL)cu

rricula-basedprograms

Web-

basedprograms

Types

Patterns

Properties


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16 Im et al.

same time. For example, many of these women were experiencing their menopausal

transitions, and some of them were experiencing a healthillness transition because

of a diagnosis of a chronic disease such as diabetes, hypertension, and so on.

NONMODIFIABLETRANSITIONCONDITIONS

Nonmodifiable transition conditions influencing Korean immigrant womens physical

activity experience include (a) background characteristics and (b) health/disease

status and menopausal status.

Background Characteristics. The background characteristics that might influence

Korean immigrant womens physical activity experience include age, marital status,

high education, high income, length of stay in the United States, and English profi-

ciency. In Yang et al.s (2007) study, educational level was significantly associated

with less occupational activity and more sport/exercise activity, and marital statuswas significantly associated with more sports/exercise activity. In Wang, Quan,

Kanaya, and Fernandezs (2011) study, the more acculturated group was more likely

to be physically active. In August and Sorkins (2011) study, both English-proficient or

limited English-proficient Asian/Pacific Islanders aged 4564 years were less likely to

be engaged in moderate and vigorous physical activity. The literature was also clear

that socioeconomic factors and social norms change from one generation to the next

might lead to higher or lower levels of physical activity (Afable-Munsuz et al., 2010).

In the qualitative interviews included in Study 1, the overarching theme of the

racial/ethnic commonalities in midlife womens physical activity experience wasgender disparities. Because of their gender, the women had certain unique physi-

cal activity experience. For instance, a common theme labeled not encouraged

showed gender disparities in physical activity experience. In the womens patriarchal

cultures, womens physical activities were discouraged to preserve their energy for

childbearing and childrearing. In Study 2, Korean American midlife womens needs

for physical activity were significantly different according to several sociodemo-

graphic characteristics including family income, education, health/disease status,

language preference, ethnic origin of close friends, self-reported ethnic identity,

and the length of stay in the United States (p.05).

Health/Disease Status and Menopausal Status. The other nonmodifiable transi-

tion condition would be health/disease status and menopausal status. In the study

by Parikh, Fahs, Shelley, and Yerneni (2009), higher physical health scores were

positively associated with physical activity. Also, they reported that better mental

health status was positively associated with greater physical activity. In the study by

Ceria-Ulep, Serafica, and Tse (2011), physical limitations related to diseases such as

hypertension, peripheral vascular disease, arthritis, and diabetes were associated

with physical activity.

In Study 1, the number of menopausal symptoms had a direct effect on physical

activity scores only in Asians including Korean immigrant midlife women (p.01).The paths from number of menopausal symptoms to physical activity scores were


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activity were significantly different according to health/disease status (p.02).

Also, in the qualitative interviews of Study 1, it was obvious that some of the women

participated in physical activity because of their family histories of specific diseases.

MODIFIABLETRANSITIONCONDITIONS

The modifiable transition conditions that may influence Korean immigrant womens

physical activity experience include (a) attitudes toward physical activity, (b) self-efficacy,

(c) perceived barriers, and (d) social influences.

Attitudes Toward Physical Activity. The literature supported that attitudes toward

physical activity could influence physical activity of Korean American midlife women.

Pham, Harrison, and Kagawa-Singer (2007) reported that cultural attitudes toward

physical activity influenced physical activity. The participants considered physical

activity and exercise to be beneficial to the overall health of individuals throughincreasing energy and strength, improving physical and mental well-being, promoting

weight loss, and preventing illness. However, physical activity was perceived to

include not only common sports and games but also cooking, household chores,

and yard work. In a study among Korean immigrant midlife women, attitudes toward

physical activity predicted the intention of leisure time physical activity, although

they did not significantly predict the leisure time physical activity (Lee & Im, 2010).

In Study 1, controlling background characteristics and perceived health and

menopause status, the attitudes scores (partial R2 .05, p.01) significantly

influenced the physical activity scores as well. In path analyses, direct paths fromattitudes scores (p.01) to physical activity scores were statistically significant. In

Asian Americans, attitudes scores (p.05) were identified to influence the physical

activity scores when controlling background characteristics and perceived health

and menopause status. In the qualitative part of Study 1, all the women across ethnic

minority groups including Korean immigrant midlife women considered physical

activity a luxury because of lack of time and overburdened family responsibilities,

which negatively influenced their actual participation in physical activity.

In Study 2, Korean immigrant womens attitudes toward physical activity were

also found to influence their physical activity experience, and three themes reflecting

the womens attitudes toward physical activity were reported. The themes were

(a) physical activity is certainly different from exercise, (b) full of physical activity

but lack of exercise, and (c) no physical activity during menstruation. The women

perceived that physical activity was a broad term that even included breathing, eating,

and every human activity, and exercise was regarded as a type of physical activity with

an intentional purpose. Subsequently, they described that their daily lives were full

of physical activities such as cooking, cleaning, and laundry; childrearing activities;

educating Korean language and customs; and their work outside the home. However,

the women thought that their work occupied all their time and left them no time for

exercise. Their new work experience outside the home made them overburdenedand did not allow any time for exercise. Finally, Korean American midlife women did


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Physical Activity Self-Efficacy. Physical activity self-efficacy could be another

modifiable transition condition that might influence Korean immigrant midlife

womens physical activity experience. In the study by Yang et al. (2007), self-efficacy

was a significant predictor of physical activity among Korean immigrant midlife

women in the United States. Also, in the study by Choi, Wilbur, and Kim (2011),

self-efficacy was a predictor of the time spent in leisure time physical activity.


menopause status, the self-efficacy scores (partialR2.06,p.01) significantly

influenced the physical activity scores of midlife women from four ethnic groups. In

the hierarchical multiple regression analyses in Asians including Korean immigrant

midlife women, self-efficacy scores (p.05) significantly influenced the physical

activity scores when controlling background characteristics and perceived health

and menopause status. Direct paths from self-efficacy scores (p.01) to physical

activity scores were statistically significant across four ethnic groups. Also, pathsfrom attitudes scores to physical activity scores were mediated partially by self-

efficacy scores (p.01). In addition, self-efficacy scores fully mediated the relation-

ship between level of acculturation and physical activity scores and fully mediated

the relationship between total number of menopausal symptoms and physical

activity scores (p.01). According to the path analyses in Asians including Korean

immigrant midlife women, self-efficacy scores had direct effects on physical activity

scores (p.05).

Perceived Barriers. In the literature, perceived barriers to physical activity were

significant factors that influenced physical activity of Korean immigrant midlifewomen. Brownson, Baker, Housemann, Brennan, and Bacak (2001) reported that

lack of time, feeling tired, feeling that they were active enough at their jobs, and

lack of motivation influenced womens participation in physical activity. Melillo et al.

(2001) also reported barriers such as fear and a feeling of inappropriateness. Pham

et al. (2007) also reported that, as major barriers to physical activity and exercise,

their research participants cited lack of time and money, language barriers, lack of

information, safety issues, and the lack of space and organized sports programs.


menopause status, the barrier scores (partialR2.04,p .01) significantly influ-

enced the physical activity scores. In the hierarchical multiple regression analyses

in Asians, the barrier scores were a significant factor that influenced the physical

activity scores. Direct paths from barrier scores (p.05) to physical activity scores

were statistically significant. Also, paths from attitudes scores to physical activity

scores were mediated partially by barrier scores (p.05). Barrier scores also fully

mediated the relationship between total number of menopausal symptoms and

physical activity scores (p.01).

Social Influence. Social influence would consist of the opinion of family, friends,

colleagues, and health professionals but also the general opinion of society (Im et al.,

2010). The influence of family and friends was repeatedly reported to have apositive influence on physical activity behavior in healthy people. Wallace, Raglin,


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without spouses. Taylor et al. (2008) reported the importance of peer pressure,

mutual support, and the encouragement of friends in adhering to regular physical

activity regimens among Chinese immigrants.

In the quantitative part of Study 1, however, social influences were not a significant

predictor of midlife women across all ethnic groups, and paths from social influence

scores to physical activity scores were not significant. Only in White women, the

social influence scores were a significant factor that influenced the physical activity

scores (p.05). Considering Asian cultural heritage that emphasizes family as a

central unit of their society, this finding needs to be further investigated though.

Interestingly, in the qualitative interviews of Study 1, a common barrier reported

by midlife women across the racial/ethnic groups was lack of encouragement and

support and environmental factors. The women reported that they were ready to

be engaged in physical activity if their barriers in their environments and social

influences had been eliminated/minimized.

CONTEXTSOFDAILYLIFE

The contexts of daily life would be another important factor that influences Korean

American midlife womens physical activity experience. Taylor et al. (2008) reported

that multiple contextual factors circumscribing immigrants daily life influenced their

physical activity experience (e.g., weather conditions and safety concerns, a lack of

familiarity with their new city, the location of facilities, a lack of organized sports and

leisure activities for immigrants, financial difficulties). Ceria-Ulep et al. (2011) alsoreported multiple contextual barriers to physical activity, which included multiple

competing role responsibilities in terms of family obligations, job constraints, and

community responsibilities.

In the qualitative part of Study 1, it was found that the womens daily cultural

contexts influenced midlife womens physical activity experience. Racial/ethnic

minority women including Korean immigrant midlife women were more family-

oriented compared to white women and did not participate in physical activity

because of heavy family responsibilities. Especially when Asian immigrant women

had spare time, they spent their time to complete household chores and childcare

rather than participating in leisure time physical activity. Also, in the qualitative

part of Study 1, it was found that Asian midlife women including Korean immi-

grant midlife women tended to share White womens ideals about beauty, which

heightened their interest in increasing their physical activity to have a slim body.

In Study 2, Korean American midlife womens physical activity experience was

influenced by their immigration experiences in the contexts of their daily life. Despite

a large number of exercise facilities and fitness centers in the United States, the

women rarely had an access to the facilities because of their busy daily lives as

immigrants, financial problems, lack of social support resources and lack of skills

in English, or marginalized social status. Like other immigrant women, KoreanAmerican women lacked social support resources; their extended families, close


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in regular exercise. Furthermore, their patriarchal cultural tradition emphasizing

womens roles as mothers rarely allowed them to leave their children behind for

their own physical activity needs.

PATTERNSOFRESPONSE: PHYSICALACTIVITYEXPERIENCEANDOTHER

RELATEDOUTCOMES

We conceptualized Korean immigrant midlife womens patterns of response related to

physical activity as physical activity experience and other related outcomes. Then,

the concept of physical activity experience was theorized with five subconcepts

including types, amount,frequency, andintensity of physical activityandneeds for

physical activity. In the literature, these subconcepts were frequently used to report

research participants patterns of response related to physical activity. In Wong,

Beth Dixon, Gilbride, Chin, and Kwans (2011) study, they used the type, amount,frequency, and intensity of physical activity to conceptualize physical activity expe-

rience and found that 89% of the participants met the recommendation of at least

30 min of moderately intense activity per day. In Crespo et al.s (2011) study, they

measured the total energy expenditure (kilocalories per week), total summary of

physical activity index per week, and total historical physical activity (hours per

year) to conceptualize physical activity experience.

In Study 1, types of physical activity were also important in determining ethnic

differences in physical activity experience of midlife women. The study findings

indicated no significant ethnic differences in the physical activity scores amongthe four ethnic groups as a whole. However, significant ethnic differences in the

occupational index of the physical activity scores were observed; Asian American

women had significantly lower occupational index scores than other ethnic groups

(p .05). Also, in the qualitative part of Study 1, racial/ethnic minority groups

including Korean immigrant midlife women preferred walking or other natural

physical activities over more organized or structured physical activities (e.g., going

to the gym). In Study 2, needs for physical activity were also operationalized as one

aspect of physical activity experience, and the 10 most frequently reported needs for

physical activity among Korean American midlife women were described. The most

frequently reported need was to maintain physical ability (91%), the second was

for leisure (78%), and the third was to increase body metabolism (78%).

Under the concept of patterns of response, the concept of other related out-

comes is also theorized with two subconcepts: perceived health and body mass

index (BMI). The MAPA model and the literature (Kahn et al., 2002; Simmons et al.,

1998) supported that enhancing attitudes toward physical activity, self-efficacy,

perceived barriers, and social influences would increase physical activity and would

subsequently enhance perceived health and BMI. For example, a Korean American

midlife woman whose incorrect cultural beliefs related to physical activity are

changed through the educational sessions of a physical activity promotion programcould experience changes in her attitudes toward physical activity, increase her


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NURSINGTHERAPEUTICS: PHYSICALACTIVITYPROMOTIONPROGRAMS

The final major concept of the SPAKIM theory, nursing therapeutics, is conceptual-

ized as physical activity promotion programs that can influence modifiable transition

conditions to improve physical activity experience of Korean immigrant women. In theliterature review, we could find three types of physical activity promotion programs

for Asian immigrants in the United States. One of them was evidence-based social

marketing approach suggested by Van Duyn et al. (2007). They found that evidence-

based strategies to increase physical activity would need to be adapted for cultural

relevance for each racial or ethnic group. Another type of physical activity promotion

program identified in the literature among Asian Americans was a health education

program that incorporated English as a second language (ESL) curricula (Taylor et al.,

2008). They chose the specific approach because the ESL environment could be ideal

for health education (because immigrants in the ESL classes would be motivated toimprove their knowledge) and the ESL classes could make immigrants obtain health

information within the context of their daily life. Finally, web-based physical activity

promotion programs were identified in the literature. Wanner, Martin-Diener, Braun-

Fahrlnder, Bauer, and Martin (2009) developed and tested a web-based physical

activity intervention in the general online population with positive results. Massoudi

et al. (2010) developed a personal health record application that delivered a highly

individualized, behaviorally based lifestyle physical activity intervention for sedentary

adults, also with positive findings. However, none of these programs was aimed at

Korean immigrant midlife women. Only the intervention that was identified to include

Asian immigrants was the one by Dunton and Robertson (2008), but their intervention

was not tailored to Asian immigrants including Korean immigrants (although they

included Asian immigrants in their study). In Studies 1 and 2, no physical activity

promotion programs were identified; they were descriptive cross-sectional studies

on physical activity experience of midlife women.

CONCLUSIONS

In this article, we presented the SPAKIM theory that could explain the associations

of multiple factors to the physical activity experiences of Korean immigrant midlife

women within the unique contexts of their daily life as immigrants in the United

States. Because of its specificity to Korean immigrant midlife women, the SPAKIM

theory could be easily linked to health care practice and/or research projects related

to physical activity experience of Korean immigrant midlife women. Especially,

the subconcepts of modifiable transition conditions in the SPAKIM could be easily

adopted and targeted in structuring physical activity promotion interventions for

Korean immigrant midlife women. For example, the womens cultural attitudes

toward physical activity (e.g., full of physical activity but lack of exercise) couldbe targeted in the intervention development by designing educational sessions


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22 Im et al.

The SPAKIM theory has several limitations. First of all, because the SPAKIM is a

situation-specific theory, it tends to have limitations in its applicability. Thus, this

theory cannot be easily applicable to other target populations without modification

and validation through research and practice in the target populations. Second,

because some concepts of the SPAKIM (e.g., nursing therapeutics) were developed

mainly based on the literature review, they need to be further developed and evalu-

ated in future studies. Through further refinement and validation in additional studies

or in health care practice with this specific population, the theory could be further

strengthened to provide blueprints for actions for promotion of physical activity

in this specific population. Finally, because of the inherent nature of a situation-

specific theory (applied to a specific time and place), this theory needs to be viewed

as an emerging theory that needs to be continuously developed and refined with

changes in time and place.

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Acknowledgments. The studies that were used for theorizing process were funded by the

National Institute of Health (NIH/NINR/NHLBI: R01NR010568) and the Sigma Theta Tau

International. No conflict of interest has been declared by the authors.

Correspondence for this article should be directed to Eun-Ok Im, PhD, MPH, FAAN, School

of Nursing, University of Pennsylvania, 418 Curie Boulevard, Philadelphia, PA 19104. E-mail:

[email protected]


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Korean immigrant women`s physical activity experience_a situation-specific theory