Social Support, Acculturative Stress, and Health-Promoting Lifestyle of North Korean Refugees

Background:There has been a long debate about the effect of social support on health: main effect model versus buffering (moderating) effect model. While health conditions of North Korean refugees (NK refugees) are significantly influence their successful adaptation, there is a dearth of research on the factors affecting their health behaviors and health promotion, which are also related to increased longevity. This study aims to examine the roles of social support in the relationship between acculturative stress and health-promoting lifestyle of NK refugees by testing the main effect model and the buffering effect model.  

Method:A sample of 202 NK refugees in South Korea was recruited October 2010 to March 2011 from two local agencies, two NGOs, and one job training center. Data were collected using a self-administered survey. Health-promoting lifestyle was measured by Health Promotion Lifestyle Profile which consists of six sub-domains: self-actualization, exercise, nutrition, health responsibility, supportive relationship, and stress management. Acculturative stress and social support were measured by multi-item scales designed for NK refugees. Analysis was conducted by two steps. First, main effect model and buffering effect model were tested to examine the roles of social support associated with the effects of acculturative on overall health-promoting lifestyle. After that, the direct effects of social support and acculturative stress on each sub-domain of health-promoting lifestyle were examined.

Results: The results supported the main effect model indicating that social support (b=.18, p<.01) is positively associated with overall health-promoting lifestyle regardless of the level of acculturative stress while acculturative stress (b=-0.14, p<.05) has negative association with overall health-promoting lifestyle controlling social support. The buffering effect of social support were not found in this study (b=-.00, p=.07). The results of examining the direct effects of social support and acculturative stress on the sub-domains of health-promoting lifestyle showed that controlling for all other variables in the model, social support was positively associated with self-actualization (b=.07, p<.001), exercise (b=.03, p<.05), and health responsibility (b=.05, p<.01). On the other hand, acculturative stress was negatively associated with self-actualization (b=-.05, p<.01), exercise (b=-.03, p<.05), and supportive relationship (b=-.03, p<.05).

Discussion: This study has important implications for designing interventions for health promotion of NK refugees. This study indicates that regardless of stress level, social support can play a significant role as a protective factor in promoting healthy lifestyle. Specifically, NK refugees who perceived more social support show more positive attitudes toward their lives, more exercise, and more responsible behaviors for their health. On the other hand, social support is not associated with healthy diet and stress management. These results support the necessity of provision of services related to healthy food and stress management in addition to the intervention for health promotion using social support. Furthermore, given that NK refugees who experience more acculturative stress show less engagement in social relationships, interventions with enhancing social support and managing stress may have synergic effects for health promotion for NK refugees.