November 25, 2004
Perspectives on Physical Activity in the Lives of Korean Women
OBJECTIVE: The purpose of this study was to explore what physical activity means to Korean women and to identify what factors influenced their decisions to engage in exercise. METHODS: Individual interviews were conducted with five Korean women in South Korea. Each interview was audiotaped and transcribed for later review. The transcription of interview was reviewed line by line to identify themes. RESULTS: The findings indicated that the Korean women understood that physical activity was related to exercise, labor, daily activity, and body movement. They believed that only exercise had any health benefits. For these women, the main determinants of exercise were availability of time, family support, financial security, concerns about safety, and the availability of community facilities for exercise. CONCLUSIONS: The findings in this study provided a better understanding of what physical activity means to Korean women and helped set the foundation for the more extensive study on physical activity.
KEY WORDS: Health Benefits; Korean Women; Physical Activity.Physical activity, one of the most important of all health- promoting behaviours, has beneficial effects on the general functioning of both young and middle-aged women. For these women, a healthy lifestyle in their early years increases the likelihood that they will maintain good health and functional ability in later years. Studies show, however, that contemporary many Korean women lack the physical activity they need for good health. For example, among contemporary Korean females aged 15 years and older, 57.8 percent are regarded as sedentary (Lee, 1997). In comparison, only 30.5 percent of American women aged 18 and older had not engaged in any leisure-time physical activity in the previous month, as reported by the Behavioral Risk Factor Surveillance System (BRFSS) for Texas (U.S. Department of Health and Human Services, 2000). Although Korean and American women differ in many respects, it is clear that both groups activity must increased their levels of physical activity.
In any assessment of physical activity, it is important to take into account the cultural background of the individuals (Sternfeld, Cauley, Harlow, Liu, & Lee, 2000). For example, there are differences between Western and Asian cultures as to what "health" means. According to the more traditional Korean culture, health is considered immeasurable, because health reflects not only the individual's current emotional and mental state but more generally his or her adaptation to conditions in the natural world (Yang, 2000). For good health, a human must be in harmony-or equilibrium- with nature. Good health is a given fact when the person is well adjusted to daily life; it is not a goal to be pursued by planned efforts (Yang, 2000). This view of health may affect one's choices of health-promoting behaviors. For example, it may explain why Korean women are more likely to focus on symptom management rather than preventive management (Lum, 1995; Sarna, Tae, Kim, Brecht, & Maxwell, 2001). Korean women, however, are involved in physical activities, ranging from caring for the family at home to working at jobs outside the home. In fact, many Korean women insist that their household and occupational tasks give them a sufficient amount of activity (Shin & Shin, 1999) . The high rates of hypertension, heart disease, and diabetes mellitus that prevail among Korean women call (Korean National Statistical Office, 1998) for a radical change in the way Korean women perceive their current activity patterns.
Only a few studies have addressed what Korean women actually think of physical activity and its role in improving their health (Im & Choe, 2001). Yet, knowledge of their beliefs about physical activity could provide valuable insights into the choices Koreans women make regarding physical activity. Before those beliefs can be examined/however, there has to be some deeper understanding of what physical activity means to the women. Such an understanding, if it is to embrace a sufficient variety and richness of meanings, requires a more personal and direct approach to data gathering, that is, a more qualitative technique. Only by qualitative methods can we begin to interpret much of what we have learned from the plethora of statistically oriented studies.
The purpose of this study was to improve the understanding of what physical activity means to Korean women. The approach of the study was to gather insights from interviews with the women on how they perceive physical activity in their daily lives and to identify factors that determine whether or not they engage in physical activity and exercise. With this knowledge, perhaps we would be better prepared to promote healthy attitudes toward exercise within the larger population of Korean women.
The hermeneutic phenomenological approach used for this study is frequently employed to explore the meaning of particular human experiences within situational contexts (Kahn, 2000). In open-ended interviews and direct observations in natural settings, the researcher invites informants to share their thoughts, dreams, expectations, rationales, and habits regarding some aspect of their lives. The researcher interprets the shared information and builds a coherent picture which helps make sense of the informant's experience.
After the proposal for this study was approved by the Institutional Review Board of the University of Texas at Austin, eight informants were recruited through fliers posted inside a large apartment complex in South Korea and only five met the eligibility. To be eligible for this study, the informants had to be women, Korean nationals, native speakers of Korean, aged 25 to 65 years, free of chronic of illness or disabilities, and living independently in a home-based setting. Women were excluded from the study if they have severe disabilities or histories of cardiovascular disease. The researcher conducted an eligibility screening interviews with the informants by telephone. If the woman met the inclusion criteria, she and the researcher agreed to a time and place for a face-to- face interview.
Table 1. Interview Questions
The face-to-face interview with each woman took place in a quiet and comfortable setting, and it typically lasted about 40 minutes. The interview began with the researcher explaining the purpose and method of the study and obtaining the participant's written informed consent before proceeding. Each interview was audiotaped and later transcribed. The principal question in the interview was what physical activity meant to the informant, but the informant was also asked to identify factors that influenced her decision whether or not to engage in exercise, a specific form of physical activity. The interview questions used in each interview are shown in Table 1.
As soon as possible after meeting with the informant, the researcher reviewed the Korean-language transcription of the interview line by line several times. The purpose of these repeated reviews was to identify, bracket, and label distinct but emergent topics (Kahn, 2000). Those topics in turn were grouped into main themes. In addition, the informants' definitions and examples were carefully examined. These definitions and examples were used to develop categories of physical activity.
After the analysis of the Korean transcripts, the transcript was translated from Korean into English. To ensure that the Korean and English versions corresponded closely in meaning and to reduce any bias in interpretation (Brislin, 1970; Dimmitt, 1996), two bilingual graduate students compared the versions for equivalence of content. The graduate students were given no demographic information or other indicators by which to identify the informants.
Of the eight Korean women who responded to the flyers, only five were eligible to participate in the study and five Korean women, whose ages ranged from 34 to 59 (mean 45.8 years), finished the interview. Five was an acceptable number of participants for this pilot study since the researcher was getting no new information by the fifth interview. Four were married, two were college educated, and two worked outside the home. Only one of the women was currently engaged in exercise. From the interviews with these Korean women and from the repeated analyses of the transcriptions, the researcher was able to obtain a clearer understanding of how the participants defined physical activity and what factors determined their decisions to take up an exercise program. These definitions and factors are discussed in the following sections.
Definition of physical activity
In general, the definition of "physical activity" given by these women was at odds with the concept of physical activity that prevails in the West. The Korean written character for "physical activity" derives from the Chinese character combining ideograms for "body" and "movement." As a result, to the Korean women, physical activity was any movement of the body. This definition differs from that commonly taken for granted in academic studies in the West, which conceive of physical activity as leisure-time, occupational, or household activity (Bouchard & Shephard, 1994).
The Western view of ph\ysical activity seemed to be new to the women in this study. Whereas they defined "physical activity" broadly as daily activity and/or body movement, they made strong distinctions between daily activity, body movement, and labor, on one hand, and exercise, on the other hand. Note, for example, the distinctions made by the participants during their interviews:
YH: Daily activity? Regular and natural living . . . wake up in the morning, make breakfast, help my husband go to work, make box lunches for my children . . . .
MY: I think it is about household activity and volunteering in church.
SJ: Labor is a kind of obligation. I have to work. But it is not all for me. I have to work for my company, carry out household activities for my family, as well as for myself.
KS: From my experience, labor is not exercise, and it is not good for my health. I used to engage regularly in exercise at a health club, but sometimes I couldn't go there because of personal reasons. Then I would try to compensate for the missed day. At my workplace, I would purposely clean the floor to exercise my arms. Or I would climb stairs many times for leg exercise. Guess what? I spent the same amount of time doing those things as when I exercised at the health club. I was sweating, too. But I never felt the rush of good feeling that came after my regular exercise. I just felt some muscle pains. I just felt like soaked cotton [a limp rag]. I think household work is included in labor.
KS: From doing work, I can feel some sense of accomplishment, but I also feel the burden of having to continue to accomplish as time passes. I would call it stress. So I can't say that labor is positively related to health. I teach children. People say my occupation is related more to the brain than the body. When I am teaching, I use my arm to write something on the blackboard, and I stand for a long time. I feel physically drained and exhausted at the end of the day. I feel some joy in teaching my students, but it easily fades away as I grow tired each day.
SJ: Exercise is a part of physical activity. I do exercise for my health with a constructive and optimistic mind. Physical activity, however, is just a part of my life. It is just for living. I don't think my health is related to physical activity. I can enjoy exercising, though . . . .
EY: Exercise . . . is something for myself. I exercise for my health, for a better life, and for a better quality of later life. I think, however, it is a matter of priority in my life when I think of it, comparing it with other ordinary physical activity. I love to exercise I believe that, if I am healthy, it would be good for everyone around me, though.
In summary, when participants were asked about physical activity, they frequently related it to "daily activity" or "body movements" that were integrated into their daily lives, which encompassed all leisure-time, occupational, and household activities. Thus, they related physical activity to what they felt were obligations. When defined in Western terms, physical activity seemed to represent a burden to the participants. Some participants recognized that exercise was a form of physical activity, but they differentiated exercise from all other physical activities in that exercise had health benefits.
To obtain equivalent data in cross-cultural studies, therefore, we might have to decompose physical activity into "daily activity" and "exercise." One fact is clear: the narrow and somewhat negative attitude of these five Korean women toward physical activity has implications for efforts to design any program to promote the health benefits of physical activity within this population.
DETERMINANTS OF EXERCISE
As mentioned, the women responded more specifically to the term "exercise" than to "physical activity" when discussing their purposes and effects on health. All five participants expressed their intention to exercise to improve their health in later life, to improve their mood, and to lose weight. Only one of the five informants, however, was actually engaged in exercise at the time of the interview.
The women identified several factors that influenced their decision whether to engage in exercise. These included availability of time, family support, safety, financial security, and availability of a facility for exercise. Each factor is discussed below.
Availability of Time
The women considered the lack of time because of family-care obligations as the main barrier to exercise. Family systems in Korea have been changing rapidly in recent decades, with an increase in the number of working mothers and a decrease in the number of extended traditional families (Kweon). It is common to see a third person, either a family member or a non-family member, taking care of children while the mother works outside the home. Therefore, compared to women in more traditional roles, working mothers tend to regret the time they must deny their children or other family members. If the working mothers have spare time, they feel obligated to spending those hours with their family to compensate for absence during their working hours.
SJ: I can't exercise . . . If I had free time, I would love to get some exercise with my husband. However, I have children and a mother-in-law to be taken care of. I have to work, so I have to ask someone else to take care of my children. My mother takes care of my daughter and my mother-in-law takes care of my son. Therefore, when I have a day off, I have to visit them. I believe if I had a strong enough resolution, I could probably make some time for myself, but it would be risky. It is not easy when I consider all the situations that involve my family and myself. Nobody's going to tell me that I should get exercise when she or he is taking care of my children. I would not be comfortable doing that. I don't know . . . I believe many people around me are so supportive of me generally, but I am still uncomfortable with the idea of taking the time to exercise.
YH: When I feel my health is beginning to fall apart, I think I need some exercise. Currently I am exercising everyday. However, when I lived with my parents-in-law, I couldn't do it. . . .
The participants felt that family support was important to their decision to engage in exercise. Because they lived close together, they needed assurance from their family members that they could take the time to exercise without feeling they were violating any family obligation.
MY: We live together, so someone else, like my husband or my mother-in-law, takes care of my household chores while I am getting exercise. If a family member helps me and gives me the time to get exercise, I can enjoy my exercise. The main reason I want to exercise is to be happy and refreshed . . . However, if I didn't get such warm support from them, I would not be comfortable exercising. In fact, it might be stressful . . . I can't make any time for my health . . . right now.
Concerns about Safety and Lack of Financial Security
One of the determinants was concern about safety while the women exercised. Interestingly, the participants had different opinions about using the same community facility. One woman reported that she felt safe there, and another woman reported that she did not. According to a participant's comments, the playground at the elementary school was open to the public, but if a person needed to use that facility, she still had to have exercise partners to feel safe.
In addition, the participants indicated that financial concerns were a main barrier to exercise, because a safe place to exercise, such as a private health center, would cost more than they could afford.
YH: I see many people running and walking in the playground of the nearby elementary school even between 8 and 10 p.m. Therefore I feel I can run there safely . . . .
EY: I prefer to exercise in the morning. I rarely go out after dark. I can't tell whether our neighborhood is safe or not. People need to have a partner when they want to get exercise.
EY: The school's playground is open to the public, but I see few people there. Recently I heard that some bad things have happened in that area. If a woman has children, she has to bring them with her. If a woman has friends for exercise, she should bring them with her, too.
SJ: If there is some spare time or any emotional space to get exercise, it means that the person must feel comfortable with her living condition and economic circumstances.
Availability of a Facility in the Community
Three participants indicated that there were few exercise facilities available in the nearby neighborhood. This lack of facilities could be a barrier to exercise, especially for those who felt unable financially to exercise in a safe place, like a private health center.
SJ: We don't have much ground in our neighborhood. All the roads around my neighborhood are paved in concrete, so my feet hurt after running. I prefer a health center . . . .
EY: These days there is a trend to make special courses available for jogging and to provide parks near large apartment complexes. However, there are not enough of these yet.
Even though the women in this study were not engaged in regular exercise, there was an important finding: the women compensated for their lack of formal exercise by resorting to various healthful practices in their daily routines. While they were busy in the many roles of their lives, they tried to improve their health in various ways even though they did not exercise, but they would not admit that labor was positively related to their good health.
SJ: When I clean my house, I don't squat down. I try to use the long handled dust mop. In doing so, I avoid getting severe back pains. Also, it gives me some arm exercise. So, while it doesn't bother my back, it would be good for my body. And it takes much less time than cleaning with my k\nees bent [that is, squatting herself down]. When I hang up washed clothes to dry, I purposely try to use my upper arms to give an article a good snap before hanging it up on the line. Sometimes I lie on the bed and put my baby on my legs and lift him up. It's fun for the baby and it gives me some leg exercise.
KS: I described household chores as labor, but there is some enjoyment even in household chores, because I feel good when I see a clean house. If I could do my household chores in a suitable amount of time, depending on my physical ability, I believe, I would enjoy housework more.
SJ: I walk with my baby. I push the stroller and I walk at the same time. I am not bored at all because I am with my baby. At work, I try to walk or move as much as I can. I try to use stairs. I park a good-walk distance away from my building, though sometimes that's not my intention, like when the parking lot is full of cars when I get there. Anyway, I walk pretty much.
In their interviews, the five Korean women, all live in South Korea, reported what physical activity meant to them. Several words appeared repeatedly in their descriptions of physical activity, such as exercise, labor, daily activity, and body movement. They often related physical activity to some form of obligation. In addition, the women believed that only exercise could have a positive influence on their health, even though numerous studies have shown the beneficial effects of physical activity in all its forms (U.S. Department of Health and Human Services, 1996). In light of this finding, researchers in cross-cultural studies should be aware that Korean women may not necessarily relate increased physical activity to better health. This difference in perceptions must be considered by researchers who attempt to compare physical activity data from Korea with data from Western cultures.
The Korean women indicated several determinants to exercise: availability of time, family support, financial security, concerns about personal safety, and the availability of community facilities for exercise. These determinants were similar to those of previous studies (Sherwood & Jeffery, 2000), even studies involving subjects from five different cultural groups. For example, a qualitative study (Eyler et al., 1998) of physical activity among minority women in the U.S. (Filipino Americans, Chinese Americans, American Indians, African Americans, and Mexican Americans) reported that the availability of time, environmental access, and safety issues were determinants to exercise. In contrast to the Eyler et al. study, however, the present study has focused on what physical activity means to Korea women living in their own culture.
Korean women regard physical activity through the prism of their cultural and social background. While they play the role of major caregivers in their families, they often feel they lack good judgment if they fail to take care of themselves properly. Thus, lack of time is a frustrating barrier to exercise, because Korean women also feel obligated to give that time to the care of children, parents, parents-in-law, and other family members. In addition, Korean women recognize that family support is important to their ability to engage in regular exercise. Without family support, they do not feel they would get any benefits from exercising, at least emotionally. This determinant could be related to the Korean concept of health, which is oriented mainly toward emotional and mental happiness and equilibrium with life's circumstances.
Only one of five participants was currently engaging in exercise, but some of the other participants tried to compensate for their sedentary lifestyles by modifying their lives to promote healthful daily physical habits. Based on this study's findings health professionals should advise Korean women to seek ways to incorporate physical activity into their daily activities as much as they can, to ensure better health.
For future studies, more interviews with more informants will be needed for a denser data field. With its small sample size, this exploratory study could do little more than suggest the attitudes of Korean women toward physical activity and exercise and to identify possible determinants for their engaging in exercise. Nevertheless, the findings in this study give us a better understanding of what physical activity means to Korean women and will help set the foundation for the more extensive study on physical activity. Most importantly, we can see the need for studies that take into account the cultural differences between Korean and Western populations. In addition, health professionals should advise Korean women of ways to incorporate physical activity into their daily activities and evaluate strategies to decrease factors that impede women's ability to engage in exercise.
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Kyeongra Yang, MPH, RN, Doctoral Candidate
ACKNOWLEDGEMENT: The author thanks the Korean women who participated in this study. The author thanks Professor, Shirley C. Laffrey and Ms. Mary King for their invaluable inputs in this manuscript.
Kyeongra Yang, MPH, RN, Doctoral Candidate, The University of Texas, Austin.
Copyright Riley Publications, Inc. Center for the Study of Multiculturalism and Health Fall 2004