Hangeoreum: A Self-Paced Web-Based Program for Loneliness and Connectedness Among Korean Immigrants Aged 50 and Older

Older Korean immigrants in the United States may experience loneliness and limited social connectedness due to cultural and language barriers, limited social support, and challenges associated with immigration and aging. They may also face barriers to accessing culturally and linguistically appropriate mental health resources. Hangeoreum is a research-developed, culturally tailored, self-paced, web-based acceptance and commitment therapy (ACT) program designed to address loneliness and promote meaningful connections and psychosocial well-being among Korean immigrants aged 50 and older. The program was developed based on the ACT psychological flexibility model and findings from a prior qualitative study involving 21 Korean immigrants aged 50 and older. This is a one-group, pretest-posttest mixed-methods pilot study conducted fully online. Approximately 40 Korean immigrants aged 50 and older who experience loneliness will participate. All enrolled participants will receive access to the Hangeoreum program. The study will evaluate preliminary changes in loneliness and other psychosocial outcomes, assess feasibility and user experience, and identify recommendations for program improvement. Hangeoreum includes six culturally tailored, self-paced weekly ACT modules delivered in Korean through the University of South Florida (USF) Canvas learning management system. Each module takes approximately 15-20 minutes to complete and includes brief educational materials, audio recordings, images, worksheets, culturally relevant examples, reflection questions, and ACT skills training exercises. The modules focus on recognizing responses to loneliness, stepping back from unhelpful thoughts, making space for difficult emotions, developing present-moment awareness, identifying personal values and meaningful connections, and taking small, values-based actions to promote connectedness and engagement in daily life. Recruitment will occur through Korean community organizations and networks across the United States, including Korean churches and social service organizations. Interested individuals will contact the study team or complete an online eligibility screening survey. Eligible individuals will complete electronic informed consent and pretest questionnaires online. After completing baseline procedures, participants will receive access to the Hangeoreum program using study-specific login credentials. Participants will be encouraged to complete approximately one module per week over 6-7 weeks. After completing the program modules, participants will complete posttest questionnaires online and participate in a one-time individual interview. Interviews will be conducted in Korean and recorded using the HIPAA-compliant version of Microsoft Teams. Interviews are expected to last approximately 40 minutes. Pretest and posttest questionnaires will be used to explore changes in loneliness, social connectedness, depressive symptoms, anxiety, perceived stress, and ACT-related processes, including psychological flexibility, experiential avoidance, cognitive fusion, and values-based engagement. Posttest implementation measures will assess perceived acceptability, appropriateness, feasibility, and usability. Feasibility will be evaluated using recruitment, retention, and adherence indicators, including program completion rates and reasons for ineligibility and dropout. The Canvas course will capture program engagement metrics, such as course access, time spent, and module completion, as well as responses to in-program activities for research purposes. Qualitative interviews will be used to understand participants' experiences, perceived benefits, cultural relevance, usability challenges, and recommendations for refining the program and study procedures. Analyses will focus on feasibility and descriptive characterization of program engagement. Pre-to-post changes in psychosocial outcomes and ACT-related processes will be explored to identify preliminary patterns of change. Interview data will be analyzed to identify common experiences, perceived benefits, barriers, and suggestions for program improvement. Because this is a single-group pilot study without a comparison group, findings related to psychosocial changes will be considered preliminary rather than definitive evidence of intervention effectiveness. All data will be collected electronically using university-approved secure platforms, including Qualtrics, the Hangeoreum program hosted on USF Canvas, and HIPAA-compliant Microsoft Teams. Hangeoreum is not publicly available and will be accessible only to enrolled participants using study-specific login credentials. Identifying information will be collected only as needed for study-related communication and administrative purposes and stored separately from research data. Study data will be stored in secure, access-controlled USF systems, including USF Box, with access restricted to authorized study personnel. Only de-identified findings, including anonymized interview quotations, will be used in presentations and publications.

Participants will complete the Hangeoreum program, a culturally tailored, Korean-language, self-paced, web-based acceptance and commitment therapy (ACT) program consisting of six weekly online modules over approximately 6-7 weeks.

Behavioral: Hangeoreum

Six culturally tailored, self-paced weekly ACT modules delivered in Korean, approximately 15-20 minutes each, focusing on psychological flexibility and meaningful connectedness.

Plazo: From the start of recruitment through completion of enrollment, up to 6 months.

The enrollment rate will be calculated as the number of participants who provide informed consent and complete the baseline assessment divided by the number of eligible individuals invited to participate in the study.

Plazo: Baseline through post-intervention (approximately 6-7 weeks)

Retention will be defined as the proportion of enrolled participants who complete the post-intervention assessment.

Plazo: Baseline through post-intervention (approximately 6-7 weeks)

Web-based module completion will be defined as the number of Hangeoreum modules completed by each participant (range 0-6 modules). Module completion will be determined based on completion of the module completion survey at the end of each module, as recorded in Canvas.

Plazo: Post-intervention (approximately 6-7 weeks)

Acceptability will be assessed using the Acceptability of Intervention Measure (AIM). AIM includes four items rated on a 5-point Likert scale (1 = completely disagree to 5 = completely agree). Mean scale scores range from 1 to 5, with higher scores indicating greater perceived acceptability.

Plazo: Post-intervention (approximately 6-7 weeks)

Appropriateness will be assessed using the Intervention Appropriateness Measure (IAM). IAM includes four items rated on a 5-point Likert scale (1 = completely disagree to 5 = completely agree). Mean scale scores range from 1 to 5, with higher scores indicating greater perceived appropriateness.

Plazo: Post-intervention (approximately 6-7 weeks)

Perceived feasibility will be assessed using the Feasibility of Intervention Measure (FIM). FIM includes four items rated on a 5-point Likert scale (1 = completely disagree to 5 = completely agree). Mean scale scores range from 1 to 5, with higher scores indicating greater perceived feasibility.

Plazo: Post-intervention (approximately 6-7 weeks)

Usability will be assessed using the System Usability Scale (SUS). SUS includes 10 items rated on a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree). Responses will be scored using standard SUS procedures to generate a total score ranging from 0 to 100, with higher scores indicating better perceived usability.

Plazo: Baseline to post-intervention (approximately 6-7 weeks)

The UCLA Loneliness Scale Version 3 (UCLA-LS) is a 20-item self-report questionnaire assessing subjective feelings of loneliness and social isolation. Items are rated on a 4-point scale (1 = never to 4 = often). After appropriate reverse scoring, total scores range from 20 to 80, with higher scores indicating greater loneliness.

Plazo: Baseline to post-intervention (approximately 6-7 weeks)

The Social Connectedness Scale-Revised (SCS-R) is a 20-item self-report questionnaire assessing individuals' sense of interpersonal closeness and connectedness with others. Items are rated on a 6-point scale (1 = strongly disagree to 6 = strongly agree). After appropriate reverse scoring, total scores range from 20 to 120, with higher scores indicating greater social connectedness.

Plazo: Baseline to post-intervention (approximately 6-7 weeks)

The PHQ-9 is a nine-item self-report questionnaire assessing depressive symptoms over the past two weeks. Items are rated from 0 (not at all) to 3 (nearly every day). Total scores range from 0 to 27, with higher scores indicating greater severity of depressive symptoms.

Plazo: Baseline to post-intervention (approximately 6-7 weeks)

The GAD-7 is a seven-item self-report questionnaire assessing anxiety symptoms over the past two weeks. Items are rated from 0 (not at all) to 3 (nearly every day). Total scores range from 0 to 21, with higher scores indicating greater anxiety symptoms.

Plazo: Baseline to post-intervention (approximately 6-7 weeks)

The PSS-10 is a 10-item self-report questionnaire assessing perceived stress over the past month. Items are rated from 0 (never) to 4 (very often). After appropriate reverse scoring, total scores range from 0 to 40, with higher scores indicating greater perceived stress.

Plazo: Baseline to post-intervention (approximately 6-7 weeks)

The BEAQ is a 15-item self-report questionnaire assessing experiential avoidance, or the tendency to avoid unwanted thoughts, feelings, and experiences. Items are rated on a 6-point scale (1 = strongly disagree to 6 = strongly agree). Total scores range from 15 to 90, with higher scores indicating greater experiential avoidance.

Plazo: Baseline to post-intervention (approximately 6-7 weeks)

The CFQ-7 is a seven-item self-report questionnaire measuring cognitive fusion, or the extent to which individuals become entangled with their thoughts. Items are rated from 1 (never true) to 7 (always true). Total scores range from 7 to 49, with higher scores indicating greater cognitive fusion.

Plazo: Baseline to post-intervention (approximately 6-7 weeks)

The ELS-9 is a nine-item self-report questionnaire assessing values-based living, including clarity of personal values and engagement in meaningful activities. Items are rated on a 5-point scale (1 = completely disagree to 5 = completely agree). Total scores range from 9 to 45, with higher scores indicating greater values-based engagement.

Plazo: Baseline to post-intervention (approximately 6-7 weeks)

The MPFI-24 is a 24-item self-report questionnaire assessing multidimensional psychological flexibility and inflexibility processes. Items are rated on a 6-point scale (1 = never true to 6 = always true). Psychological flexibility and psychological inflexibility are represented by separate composite scores, with higher scores indicating greater levels of the respective construct.

Plazo: Post-intervention (approximately 6-7 weeks)

Individual semi-structured interviews (approximately 40 minutes) will be conducted in Korean via videoconference after program completion. Interviews will explore participants' experiences with Hangeoreum, perceived changes in loneliness and connectedness, cultural relevance, program usability and accessibility, perceived benefits, and suggestions for program improvement. Interview data will be analyzed using thematic analysis.

Plazo: Post-intervention (approximately 6-7 weeks)

Twelve additional program feedback items will assess participants' perceptions of the weekly modules, including clarity, ease of use, cultural relevance, visual design, engagement, perceived usefulness, manageability, and overall satisfaction. Items are rated on a 5-point Likert scale (1 = completely disagree to 5 = completely agree). Item-level ratings will be summarized descriptively, with higher scores indicating more favorable perceptions.

Hangeoreum Program: A Pilot Study of a Self-Paced, Web-Based Program to Address Loneliness and Connectedness Among Korean Immigrants Aged 50 and Older