Purpose North Korean refugee women face multiple vulnerabilities during pregnancy and early childrearing due to fragmented support and limited familiarity with Korea’s health and welfare systems. Existing research has examined isolated barriers. This study used a service design approach to explore their maternal–infant care experiences and identify structural discontinuities across the care pathway.
Methods Data were collected from North Korean refugee mothers and service providers from April to August 2024. A service design approach using user journey mapping, thematic analysis, and service blueprinting was employed to examine user actions, emotional trajectories, frontline interactions, and backstage and interagency processes.
Results Five structural issues were identified: fragmented information, cross-institutional access barriers, cultural and emotional isolation, discontinuity in interagency linkage, and provider resource constraints. These issues accumulated along the pathway, increasing emotional burden, delaying timely care, and reinforcing avoidance behaviors. Misalignment between user needs and multi-agency processes was also evident.
Conclusion Maternal and infant care challenges among North Korean refugee women stem from structural fragmentation rather than individual factors. Based on these findings, the NK Mom Care Navigator—a pathway-based, culturally responsive service design model—is proposed to strengthen continuity of care and enhance equitable maternal–infant support for vulnerable refugee families.
Purpose The purpose of this study was to explore the in-depth perceptions of newborn care among North Korean refugee women through focus group interviews. This research aims to provide foundational data for developing newborn care education programs tailored for North Korean refugee women preparing for motherhood.
Methods This qualitative study employed focus groups to investigate perceptions of neonatal care among North Korean refugee women of childbearing age (20–45 years old). Conducted from August to September 2022, the sessions included five non-pregnant women and four who were currently pregnant.
Results Both pregnant and non-pregnant women expressed ambivalent feelings, characterized by a blend of expectation and fear regarding childrearing. Pregnant women articulated specific parenting strategies and viewed childrearing as a more tangible responsibility in light of physical changes and social isolation. In contrast, non-pregnant women expressed vague aversion and anxiety about the lack of information and support systems, stating that they could only endure childrearing with adequate external support. Notably, pregnant women emphasized the psychological conflict stemming from disrupted self-realization and shifts in their identities as mothers.
Conclusion This study revealed differences in childrearing perceptions among North Korean refugee women based on their pregnancy status. It underscores the necessity for developing customized education programs that consider life stages and psychological readiness, as well as the importance of establishing social support systems.
Citations
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Service design for improving pregnancy, childbirth, and childcare competency among North Korean refugee women in South Korea: a qualitative service-design study In-Sook Lee Child Health Nursing Research.2026; 32(1): 52. CrossRef
Purpose The study investigated the relationships between key variables, including the level of parenting knowledge, acculturative stress, depression, and the strengths and difficulties associated with their children’s emotions and behavior, among North Korean refugee mothers who faced the challenging task of adapting to Korean society while raising their children.
Methods A descriptive study design was used. Data were collected from 130 North Korean refugee mothers between September and November 2023.
Results The participants had very limited parenting knowledge, and 82.3% of them scored 21 or higher on the depression scale used in community epidemiological studies. Higher levels of parenting knowledge and lower levels of depression were associated with lower levels of acculturative stress. Moreover, higher levels of depression were associated with more emotional and behavioral difficulties in children. Maternal depression, age, and employment status were identified as factors that influenced emotional and behavioral problems in preschool-aged children.
Conclusion These findings underscore the importance of providing parent education and mental health support programs for North Korean refugee families in order to improve parents' parenting skills and emotional well-being.
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Can we protect refugee children from mental health problems?— a scoping review of modifiable factors to inform preventive interventions Rita Gonçalves, M J Marques, Jordan Sibeoni, Sónia Dias BMC Medicine.2026;[Epub] CrossRef
A Phenomenological Study on the Perceived Quality of Life Among Older Female North Korean Refugees in South Korea Myeonghee Kim, Soochan Choi, Jeongsu Lim Journal of Immigrant & Refugee Studies.2025; : 1. CrossRef
Purpose The purpose of this study was to identify effects of parenting stress in North Korean refugee fathers on their parenting behavior.
Methods A descriptive study design was used. Data were collected during 2014 and 2015 in a settlement support center for North Korean refugees and 99 North Korean refugee fathers participated. Data were analyzed using SPSS 21.0.
Results Warmth․encouragement parenting behavior received the highest score. The score for parenting stress was 81.98 out of 180, and 32.3% of participants were found to need professional help (≥PSI 90). There were significant negative correlations between warmth․encouragement parenting behavior and parenting stress. There were also significant positive correlations between rejection․neglect parenting behavior and parenting stress. Predictors of warmth․encouragement behavior were parent-child dysfunctional interaction which explained 10.1% of the variance. Predictors of rejection․neglect behavior were parent-child dysfunctional interaction, number of children and wife’s education level which explained 33.4% of the variance.
Conclusion Findings show that North Korean refugee fathers’ parenting stress significantly influenced warmth․encouragement and rejection․neglect parenting behavior indicating a need to identify ways to decrease parenting stress. Parenting education can guide North Korean refugee fathers to strengthen parent-child positive interactions and therefore promote their children’s growth and development.
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Ambiguous Loss, Continuing Bonds, and Post-Separation Growth in North Korean Defector Women Kyong Ah Kim, Richard M. Lee, Hyein Chang Journal of Loss and Trauma.2025; : 1. CrossRef
가족관계에서 탈북청년들의 신념변화에 관한 질적 연구: 부모-자녀관계에서 ‘좋은 부모’에 관한 인식을 중심으로* 주람 전, 일현 배, 지홍 배, 윤정 신 Journal of Family Relations.2024; 28(4): 93. CrossRef
Development and effects of the PARENT (Parenting Acceptable Real Empathy Nurture Training) program for mothers who defected from North Korea In-Sook Lee, Jung-Hee Jeon Applied Nursing Research.2024; 79: 151839. CrossRef
Research Trends on the Parenting Behavior of North Korean Defectors: A Scoping Review Ocksim Kim, Seongmi Choi, JiYeon Choi, Sang Hui Chu Journal of Korean Public Health Nursing.2024; 38(1): 55. CrossRef
Influence of parenting efficacy, parenting stress, and acculturation stress on parent-child relations among North Korean refugee mothers In-Sook Lee, Jung-Hee Jeon Child Health Nursing Research.2021; 27(2): 171. CrossRef
Stress e competenze genitoriali nelle separazioni giudiziarie. Analisi dei fattori protettivi e di rischio nelle relazioni parentali Daniela Pajardi, Monia Vagni, Valeria Giostra, Viviana La Spada, Tiziana Maiorano RICERCHE DI PSICOLOGIA.2019; (4): 693. CrossRef
Structural Equation Model for Psychosocial Adjustment in North Korean Adolescent Refugees Insook Lee Child Health Nursing Research.2018; 24(3): 287. CrossRef
Purpose The purpose of this study was to investigate the knowledge and attitude on tuberculosis by parents of North Korean refugees’ children.
Methods A descriptive study was conducted. Data were collected from July to November, 2014 in Hanawon and 74 North Korean refugee parents participated in the study. Data were analyzed using the SPSS 21.0.
Results The score for knowledge was 17.72 out of 30 points, for awareness in attitude, 49.34 out of 60 points and for prevention behavior in attitude, 48.39 out of 60 points. There were positive significant correlations among knowledge, attitude and health interest. There was also a significant positive correlation between awareness and prevention behavior in attitude, and between prevention behavior and health interest.
Conclusion North Korean refugee parents showed a low level of knowledge and a negative attitude. The implication of these results is an awareness of the need for education on the causes, transmission and importance of treatment for tuberculosis. This kind of education can guide North Korean refugee parents to obtain correct information and positive attitudes and therefore, be able to effectively practice appropriate health behaviors in tuberculosis management for their children.
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Systematic review of evidence on public health in the Democratic People’s Republic of Korea John J Park, Ah-Young Lim, Hyung-Soon Ahn, Andrew I Kim, Soyoung Choi, David HW Oh, Owen Lee-Park, Sharon Y Kim, Sun Jae Jung, Jesse B Bump, Rifat Atun, Hee Young Shin, Kee B Park BMJ Global Health.2019; 4(2): e001133. CrossRef
Army Soldiers’ Knowledge of, Attitude Towards, and Preventive Behavior Towards Tuberculosis in Korea Yun Choi, Geum Hee Jeong Osong Public Health and Research Perspectives.2018; 9(5): 269. CrossRef
Relationships between Knowledge, Attitude and Preventive Behavior about Tuberculosis in Service Workers Seung-Rang Kang, Eun-Young Kim Journal of the Korea Academia-Industrial cooperati.2016; 17(5): 354. CrossRef
A Study on Continuity of Knowledge, Attitude, and Preventive Behavior among Elementary School Students after Tuberculosis Prevention Education Gyeong Mi Kim, Heejin Kim, Chung Mo Nam, Sun Ha Jee Journal of the Korean Society of School Health.2016; 29(3): 209. CrossRef
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