Effects of Social Networks on Health-Promoting Behaviors Among North Korean Refugees in South Korea

Background and Purpose: Poor health and health behaviors among North Korean refugees (NKRs) in South Korea are serious risk factors hindering successful resettlement and overall well-being. Nevertheless, little is known about factors affecting NKRs’ health-promoting behaviors. Research has shown that social relationships have positive effects on health behaviors and outcomes. Although social relationships consist of diverse dimensions including structural (i.e., social networks) and functional (i.e., perceived social support) elements, previous studies have predominantly focused on the functional element of social relationships when examining health behaviors. This approach, however, is very limited with respect to understanding the influences of social relationships on health behaviors, given the distinct nature of different network dimensions. Thus, the present study examined how social networks are associated with health-promoting behaviors while accounting for perceived social support.

Methods: 202 NKRs aged 20 years or older were recruited from five resettlement support agencies (two governmental resettlement support centers, two nongovernmental organizations, and one job training center) between October 2010 and March 2011. Health-promoting behaviors were measured by the Health Promotion Lifestyle Profile scale, consisting of six subdomains of health-promoting behaviors: self-actualization, health responsibility, exercise, nutrition, interpersonal support, and stress management. Social networks were measured by the sizes of supportive networks from which NKRs reportedly received social support, including family, North Korean friends, South Korean friends, social workers, and members of religious organizations. Multivariate linear regression analyses were conducted to examine the effects of supportive social networks on overall health-promoting behaviors as well as each subdomain of health-promoting behaviors, while controlling for covariates including perceived social support.

Results: Participants’ mean age was 38 years (SD=10.8) and their average length of residence in South Korea was 3.7 years (SD=2.4). Many participants were female (78.7%). The mean size of overall supportive networks was 2.43 (SD=3.39). North Korean friends was the largest group (M=3.43, SD=3.94), followed by South Korean friends (M=3.24, SD=8.20) and members of religious organizations (M=2.47, SD=5.29). Regression analyses showed that having more networks with religious members were positively associated with overall health-promoting behaviors (b=.17, p<.05). Specifically, more networks with religious members were positively associated with health responsibility (b=.04, p<.05), exercise (b=.03, p<.05), and nutrition (b=.04, p<.05). Having more South Korean friends was negatively associated with nutrition (b=-.02, p<.05).

Conclusions and Implications: Findings of this study indicated that social networks with people from religious groups can positively affect health behaviors of NKRs, whereas social networks with South Korean friends can negatively affect healthy dietary behaviors. Our findings suggest that social work health interventions utilizing network members within religious organizations may promote health behaviors among NKRs. This study highlights the importance of examining both the structural and functional components of social relationships to better understand correlates of health-promoting behaviors in refugee and immigrant populations. Future studies aiming for more comprehensive and in-depth understanding of social network effects on health behaviors are required to make innovative changes in health practices and policies for socially and culturally disadvantaged groups.