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Nursing Open. 2 0 1 8;1–1 0 .
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wileyonlinelibrary.com/journal/nop2
1 | INTRODUCTION
Researchers have reported that a range of social and environ‐
mental factors were associated with adolescent and young adult
health risk behaviours such as smoking, drinking, and sexual be‐
haviour. Adolescence and young adulthood are critical periods for
tobacco control in that most smokers initiate smoking during ado‐
lescence and continue the behaviour during young adulthood (U.S.
Department of Health & Human Services, 2012). Those popula‐
tions would be exposed to harmful effec ts of tobacco consumption
throughout the rest of their lives if smoking is not quitted. Recently,
researchers documented that environmental determinants such as
exposure to advertisements of and accessibility to tobacco produc ts
were related to smoking initiation among adolescents (Gwon, Yan,
Huang, & Kulbok, 2018; Paynter & Edwards, 2009) and that tobacco
marketing mainly targeted young adults (Ling & Glantz, 20 02). In a
similar vein, alcohol use was reported to be associated with various
environmental factors such as the location and densit y of alcohol re‐
tailers among adolescents (Truong & Sturm, 2009; West et al., 2010)
and young adults (Scribner et al., 2008). Adolescents’ risky sexual
behaviours (having intercourse with multiple partners, consuming
alcohol or drugs while having intercourse, and anal intercourse) and
attitudes were associated with exposure to sexually explicit web‐
sites (Braun‐Courville & Rojas, 2009).
A question arises. Why are adolescent s and young adults im‐
pressionable to health risk behaviours? Given that Kinder and Sears
(1985) used impressionable years indicating that adolescents and
young adults are vulnerable to change, it is considered that youths are
Received:12April2 018
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Accepted:29May2018
DOI: 10.1002/nop2.170
RESEARCH ARTICLE
Concept analysis of impressionability among adolescents and
young adults
Seok Hyun Gwon1 | Suyong Jeong2
This is an op en acces s article unde r the terms of the Cre ative Commons At tribu tion License, which permits use, distr ibutio n and reproduc tion in any medium,
provide d the original wor k is prope rly cite d.
© 2018 The Aut hors. Nursing Open publishe d by John Wiley & Sons Ltd.
1College of Nursing , Univer sity of
Wisconsin‐Milwaukee,Milwaukee,
Wisconsin, USA
2College of N ursing, Resea rch Inst itute of
Nursing Science, Seoul N ational University,
Seoul, Korea
Correspondence
Suyong Jeong, College of Nu rsing, Research
Instit ute of Nursing Scie nce, Seoul Natio nal
University, Seoul, Korea.
Email: suyongjeong@gmail.com
Funding Information
This research received no s pecific grant f rom
any fundi ng agenc y in the pu blic.
Abstract
Aim: To report a concept analysis of impressionability among adolescents and young
adults.
Background: Adolescence and young adulthood are critical periods to establish
health behaviour. Environmental determinants are associated with youth health risk
behaviours. These populations are impressionable to a range of social and physical
environmental factors.
Design: Concept analysis.
Methods:Weselected17studiestoreviewfromPsychINFO,ERIC,MEDLINE,and
Google Scholar as well as the University of Virginia library. We did not apply date
limits. We included search terms: “adolescent”; “youth”; “young adult”; “impression‐
ability”; and “impressionable.”
Results: The defining attributes of impressionability among youths were a state where:
(a) one is able to be susceptible to external stimuli; (b) one is incapable of reasonable
judgement; and (c) one has a changeability to accept or modify one’s attitude and be‐
haviour. We identified antecedents, consequences, and cases of impressionability.
KEYWORDS
adolescent, commercial, concept analysis, impressionability, or not‐for‐profit sectors, youth
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sensitive and easily reactive to external environments and these char‐
acteristics may influence the formation of attitudes and behaviours.
Impressionability is a concept that has been used by researchers to
mean vulnerability and sensitivity to an environment and the concept
is found in li terature on environ ment and health ris k behaviours amon g
young people in various disciplines. Reviewing literature related to vul‐
nerability, researchers have attempted a concept analysis of vulnera‐
bility in older adulthood (Brocklehurst & L aurenson, 2008) and in early
childhood (Mattheus, 2010). Dorsen (2010)conceptualized the vul‐
nerability among homeless adolescents with a perspective stemming
from an evolutionary approach. Although vulnerability is applicable to
populations of any age, impressionabilit y is usually limited to adoles‐
cent and young adult populations. However, no researchers have yet
attempted to analyse the concept of impressionability during adoles‐
cence and early adulthood while differentiating it from vulnerability.
2 | BACKGROUND
Environment, one of four metaparadigm domains in nursing, is de‐
fined as “the entity that exists ex ternal to a person or to humanity,
conceived either as a whole or as that which contains many distinct
element s” (Kim, 2010). Nursing researchers have been interested in
the needs and activities of people, which dynamically interact with
the external world in multiple dimensions (Kim, 2010; Neuman,
1982). The domain of environment can include physical, social, sym‐
bolic, and holistic components (Kim, 2010).
Social learning theory demonstrates that individuals form atti‐
tudes and behaviours under the influence of other people nearby
(Ba nd ur a&McClelland,1977).Social ef fe ctisastrongfa ctorre lated
to youth health risk behaviours such as tobacco use (Gwon & Jeong,
2016;Gwon et al., 2018)andalcohol use (Nash, McQueen, &Bray,
2005). These days, young people are socially active in both of fline
and online settings (Huang, Unger, et al., 2014). According to Lenhart
et al. (2018), 94% of adolescents access the Internet using a mobile
device and 71% of those use more than one social media website.
Content about tobacco products, such as electronic cigarettes
(Huang, Kornfield, Szczypka, & Emer y, 2014; Luo, Zheng, Zeng, &
Leischow, 2014) and water pipes (Guidry, Jin, Haddad, Zhang, &
Smith, 2016), are widespread on social media settings these days.
The ecolo gical model of he alth behaviour p osits that indiv idual health
behaviour is determined by multiple levels of social and environmental
influence(McLeroy,Bibeau,Steckler,&Glanz,1988).Builtenvironment
(Sallis et al ., 2006), one of the environment al factors in th e ecological per‐
spective of health behaviour, may include marketing elements for drug
sales. Gwon, DeGuzman, Kulbok, and Jeong (2017) considered tobacco
marketing in retailers and geographic distribution of the retailers as a
built environmental factor related to adolescent tobacco use.
2.1 | Aims
To this end, we analysed the concept of impressionability using
a method devised by Walker and Avant (Walker & Avant, 20 05).
The objec tive of this study is to identify attributes that are es‐
sential to the concept of impressionabilit y among youths. By
examining the attributes of impressionability, we will provide
useful information for the development of theories, policies, and
practices for control over harmful environments related to health
risk behaviours and for capacity building for reasonable decision‐
making among youths.
2.2 | Data sources
We searched empirical literature in the following databases:
PsychINFO,ERIC ,MEDLINE,GoogleSch ola r,andtheonlinec ata‐
logue of the University of Virginia library. Search terms included:
“adolescent”; “youth”; “young adult”; “impressionable”; and “im‐
pressionability”. The search was conducted in 2017 and no date
limits were applied. A total of 388 articles was initially searched
for review. First, titles and abstracts of studies were reviewed for
appropriateness for concept analysis. This limited the number of
studies that appeared to match the aims of the concept analysis to
39. Full‐text articles were then assessed according to the inclusion
and exclusion criteria. Inclusion criteria were studies: (a) includ‐
ing adolescents or young adults; (b) using the concept of being
impressionable or impressionability; and (c) written in English. We
excluded studies focusing only on children given the scope of this
study. We manually included two studies from the University of
Virginia librar y. Finally, 17 studies were included for the review
(Figure 1).
2.3 | Concept analysis method
Walker and Avant (2005) introduced the strategies for concept
analysis. This method was derived from Wilson (1963) and initially
consisted of 11 stages, but it was simplified to eight steps. The
steps are: to (a) select a concept; (b) determine the aims or pur‐
poses of the analysis; (c) identify all uses of the concept; (d) deter‐
mine the defining attributes; (e) identif y a model case; (f) construct
additional cases; (g) identify antecedent s and consequences; and
(h) define the empirical referents. We chose this method because
our study aimed to identify attributes of impressionability among
adolescents and young adults. Moreover, this method provides
clear steps to follow and it has been evolved by several nursing
researchers for evidence‐based nursing practice and research
(Walker & Avant, 20 05;Weaver&Mitcham, 20 08). Because this
study did not obtain private identifiable information and patient
consent, Research Ethics Committee approval was not required.
3 | RESULTS
3.1 | Uses of concepts
The definitions of “impressionable” are present in dictionaries.
Oxford University Press (2017) defines impressionable as “easily in‐
fluenced,” and the American Heritage Dictionary (2017) defines it as
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“readily or easily influenced; suggestible or capable of receiving an
impression.” Cambridge Dictionaries Online (2017) states that “im‐
pressionable” describes a person as being “easily influenced by other
people, especially because you are young.” Synonyms for “impres‐
sionability” include: “sensitivity”; “impressibility”; “reactivity”; “recep‐
tiveness”; “sensitiveness”; “susceptibility”; “flexibility”; “perceptivity”;
“plasticity”; and “pliancy ” (Thesaurus.com, 2017). The word impres‐
sionable originated in the mid‐nineteenth century from French, from
impressionner, which came from the Latin noun impression, derived
from the verb imprimere (“press into”; Oxford University Press, 2017).
3.2 | Theoretical uses of the concept
Unfortunately, impressionability has not been found in any theo‐
ries. Although impressionabilit y is not a term used very frequently
in ordinar y dialogue, it has been widely used in academia to describe
the characteristics of youths. This concept was initially raised in
the context of the “impressionable years” to explain a social change
in psychology (Kinder & Sears, 1985; Krosnick & Alwin, 1989).
Psychologists coined the concept of impressionability to describe
the distinctiveness of late adolescence and early adulthood, which
symbolize flexibility and openness to change.
3.3 | Empirical uses of the concept
The concept of impressionability has been used in a range of dis‐
ciplines (Table 1). Researchers have at tempted to use impression‐
ability to depict features of adolescents and young adults in a
developmental context. Impressionabilit y tended to be used primar‐
ily in psychology to investigate charac teristics of these populations
FIGURE 1 Flow diagram of the literature selection process
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who are known to be interested in and easily influenced by current
social issues.
Psychologists were inclined to use impressionability as a dis‐
tinct and special characteristic of adolescent and early adult
years. In 1985, impressionability was found in Kinder and Sears’
(1985) study. They used “impressionable years” to refer to a flex‐
ible and vulnerable time to change attitudes among adolescents
and young adults. It implies that impressionability has a feature of
changeability. Krosnick and Alwin (1989) supported the concept
of impressionable years of young people and they demonstrated
that individuals in late adolescence and early adulthood are very
susceptible to political attitude change even though their suscep‐
tibility drops rapidly thereafter. Similarly, Tyler and Schuller (1991)
reported that impressionability is openness to attitude change
TABLE 1 Empirical uses of impressionability in disciplines
Authors (Year) Purpose Concept attributes
Psychology
Kinder and Sear s
(1985)
To provide an account of public opinion and political ac tion
congenial to social psychological tastes.
Flexibility and vulner abilit y in late adolescence and
early adulthood in which p eople tend to change
Krosnick and Alwin
(1989)
To test two hypotheses about the relation between age and
susceptibility to attitude change.
Susceptibility to political attitude change during late
adolescence and early adulthood
Tyler and Schuller
(1991)
To examine the openness of people of varying ages to
attitude change.
Openness to attitude change among younger people
Alwin et al. (1992) To overview of political attitudes over the life span Malleabilityofattitudinalorientationsearlyinadultlife
Silvers tein et al.
(2001)
To assess how the attitudes of Americans towards
government programmes that serve older people changed
and how much of the shif t was due to intracohort change
and how much was due to cohort replacement.
Susceptibility to public concern among young adults
Mayetal.(20 04) To examine the effects of an office works tation ergonomics
intervention on employees’ perceptions of workstation,
and whether reac tions differed between younger and
older employees.
Being influenced among younger people
Education
Carr et al. (2013) To discuss developing first‐year students as scholars. Being ready to learn. Optimal state for new experi‐
ences among college students
Medicine
GlantzandMandel
(2005)
To discuss alternative methods for tobacco prevention
among adolescents.
Susceptibility among youth
Miller(2005) To report findings that neur al plasticity can be ex tended
into adulthood.
Malleability,adaptability,andplasticit ytonew
experiences into adulthood
Beghi et al. (2006) To introduce idiopathic generalized epilepsies of
adolescence.
Being easily distracted in adolescence
Kligman et al. (20 06) To review experimental studies on the nature of sensitive
skin.
Sensitivity to stimuli among female adults
Chuang et al. (2010) To discuss the role of the “hidden curriculum” in shaping t he
professional identify of doctors in training.
Absorbency in learning among medical students
Nursing
Hinkle and Kopp
(200 6)
To explore mentoring as a career development strategy for
nursing students, minority nurses, and nursing faculty.
Imitation and internalization of others’ characteristics
among college students
Fenush and Hupcey
(2008)
To investigate clinical unit choices of graduating baccalau‐
reate nursing students and to identify factors that
influence these decisions.
Being influenced by others among college students
Stretch et al. (2009) To seek the views of school nurses on vaccinating girls who
did not have parental consent.
Immaturity, being easily influenced, vulnerability, and
being incapable of making a clear and independent
judgement among 12–13 year olds
Walsh (2011) To review of narrative pedagogy and simulation for nursing
education.
Being distracted among college student s
Fenwick et al., 2012 To examine that individuals will transform into three
distinct types of decision‐makers using three dif ferent
styles of decision‐making in response to the problems
related to the experience of persistent pain.
Being easily influenced among individuals experiencing
pain
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among younger people in their study that examined attitude
changes with various age groups. Alwin, Cohen, and Newcomb
(1992) used impressionability to mean malleability of attitudinal
orientations early in adult life. Silverstein, Angelelli, and Parrott
(2001) used impressionability to mean susceptibility to public con‐
cern amongyoung adults and May,Reed,Schwoerer,andPotter
(2004) used the concept to mean the influence among younger
people. Carr et al. (2013) used impressionability to mean the op‐
timal state for new experiences among college students in an ed‐
ucation article.
Moreover, impressionability has been used in thedisciplines of
medicin e and nursing. G lantz and Man del (2005) use d it to mean
susceptibility among youths. Miller(2005) used it to mean mallea‐
bility, adaptabilit y, and plasticity to new experiences into adulthood.
Beghi, Beghi, Cornaggia, and Gobbi (2006) used it to mean easily
distracted in adolescence, whereas Kligman Sadiq Zhen and Crosby
(2006) used it to mean sensitivity to stimuli among female adults.
Chuang et al. (2010) used it to mean absorbency in learning among
medical students.
Hinkle and Kopp (2006) used impressionability to mean imitation
and internalization of others’ characteristics among college students.
Fenush Jr. and Hupcey (2008) used impressionability to mean being
influenced by others among college students. Stretch et al. (2009)
used it to mean immaturity, being easily influenced, vulnerability,
and being incapable of making a clear and independent judgement
among 12–13 year olds. Walsh (2011) used it to mean being dis‐
tracted among college students and Fenwick, Chaboyer, and St John
(2012) used it to mean being easily influenced among individuals ex‐
periencing pain.
3.4 | Defining attributes
Based on uses of impressionability, we identified a list of poten‐
tial attributes of impressionabilit y during adolescence and young
adulthood:
1. Flexibility, susceptibility, openness, malleability, adaptability,
plasticity, and vulnerability to attitude and behaviour change
(Alwin e t al., 1992; Beghi et al. , 2006; Gla ntz & Mandel , 2005;
Kinder & Sears, 1985; Krosnick & Alwin, 1989; Miller, 2005;
Tyler & Schuller, 1991);
2. Susceptibility to public concerns (Silverstein et al., 2001);
3. Being easily influenced and distrac ted by an external environment
(Beghi et al., 2006; Fenush Jr & Hupcey, 2008; Fenwick et al.,
2012;Mayetal.,2004;Walsh,2011);
4. Absorbency of learning (Carr et al., 2013; Chuang et al., 2010);
5. Imitating others (Hinkle & Kopp, 2006);
6. Sensitivity to stimuli (Kligman et al., 2006);
7. Immaturity and being incapable of making a clear and independ‐
ent judgement (Stretch et al., 2009).
The identification of major at tributes is the core step for concept
analysis ( Walker & Avant, 2005). After reviewing the literature and
discussing potential attributes, the three defining attributes of im‐
pressionability were identified:
1. A state where one is able to be susceptible to ex ternal stimuli
(from 2, 3, and 6 above);
2. A state where one is incapable of reasonable thinking (from 7
above);
3. A state where one has changeability to accept a new attitude/
behaviour or change an existing attitude/behaviour (from 1, 4,
and 5 above)
3.5 | Model case
A model case is a paradigmatic exemplar that includes all defining at‐
tributes of the concept (Walker & Avant, 2005). The following model
case was constructed by the authors. A 15‐year‐old boy named Tim
lives with his parents and one brother. His father is a current ciga‐
rette user. Tim has a couple of close friends to spend spare time with.
One friend, Ben, began to use electronic nicotine delivery systems
(ENDS) two weeks ago. He described the positive feeling that ENDS
use (vaping) led to. Tim was curious about the use of ENDS. One
day, on the way home af ter a club activity, Tim saw Ben vaping. Ben
said, “Do you want to give it a try?” Tim answered, “Why not?” Tim
inhaled the ENDS for the first time in his life. He felt a warm vapour
filling his airway and lungs. It tasted kind of sweet and fruity. The
vaporization he exhaled was thick and beautiful. Whenever commut‐
ing to and from school, he would see a couple of vape shops that sell
ENDS. The shops posted adver tisements and messages that vaping is
not harmful to one’s health and not addictive at all. Tim believes that
ENDS use is much less harmful than cigarettes; even if it is not, the
harmful ef fects will not happen to him. He has a positive attitude to‐
wards vaping and want s to buy an ENDS some day from a vape shop.
All defining attributes of impressionability were found in this
model case. Tim had susceptibility to external stimuli (his peer who
vapes, his father who smokes, and messages from vape shops), inca‐
pability of reasonable judgement (wrong beliefs that harmful effects
of ENDS will not happen to him), and changeability to accept or mod‐
ify attitude or behaviour (positive attitude towards vaping).
Identif ying additional cases such as borderline and contrar y
cases is helpful to clarify the characteristics of the concept (Walker
& Avant, 2005).
3.6 | Borderline case
An 18‐year‐old woman, Kate, is a new freshman in a state uni‐
versity. She does not like the smell of cigarette smoke because
when she was a child her mother used cigaret tes for more than
10 years. Kate is an outgoing and social person. She knows that
recently vaping has had popularity among college students and
she sees many students using ENDS on campus. She enjoys con‐
necting to social media; whenever she gets on it, she frequently
sees posts and photos related to ENDS. She hangs out with friends
in shopping malls and she sees a lot of vape shops and vape stands
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that sell ENDS. She believes that ENDS use is not that bad for her
health and that is the reason many people use ENDS. She thinks
that ENDS use has nothing to do with addiction and it is easy to
quit. She has a negative attitude towards ENDS use and has no
plan to try it.
In this borderline case, only two attributes of impressionability
can be seen: susceptibility to external stimuli (people who use ENDS
and ENDS‐related content on social media) and incapability of rea‐
sonable judgement (misconception of harmful effects of ENDS).
3.7 | Contrary case
A 17‐year‐old adolescent , Jake, is visually impaired. He lives with
parents and one brother in a rural area of South Korea with few
tobacco retail stores, vapes shops, and brick and mort ar stores that
sell tobacco products. He goes to a school for the blind. After school,
he accesses the Internet to listen to video clips, music, and news and
he reads books in braille and assists with house chores. His parents
and friends are not smokers or ENDS users. Because advertising and
posting any tobacco and ENDS‐related content on the Internet is not
permitted, he is not exposed to tobacco or ENDS‐related promo‐
tions on the Internet. He took a health course from a licensed school
nurse in school and learned that any tobacco including ENDS causes
harmful ef fects on health. He has no interest in smoking and does
not plan to tr y it.
This contrary case does not contain any attributes of im‐
pressionability. Rather, this is the complete opposite to
impressionability.
FIGURE 2 Conceptual map of impressionability among adolescents and young adults
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3.8 | Antecedents
Antecedents are the events that happen before a phenomenon oc‐
curs, whereas consequences are the results of a phenomenon (Walker
& Avant, 2005). Prior to attainment of impressionability, one must
be: (a) exposed to an environment–all of the certain circumstances
that surround a person. This includes not only physical factors but
also invisible factors such as social values or culture (Silverstein et
al., 2001). The environment does not stand as it is, but rather exists
with the potential to influence a person; (b) Participation in activities
such as receiving an educational programme or new lesson is an‐
other antecedent to the appearance of impressionability (Carr et al.,
2013;Glantz&Mandel,2005);(c)Interpersonalfactorsarisepriorto
the induction of impressionability, including both obser vation of and
interaction with others (Fenush Jr & Hupcey, 2008; Hinkle & Kopp,
2006) (Figure 2).
3.9 | Consequences
Two consequences of impressionabilit y were identified: (a) the es‐
tablishment of a new attitude or behaviour; and (b) modification of
an existing attitude or behaviour. Here, at titude refers to a disposi‐
tion and perspec tive on an issue or behaviour. Behaviour refers to
the actual actions of a person.
3.10 | Empirical referents
According to Walker and Avant (2005), determining empirical ref‐
erences––the last stage of a concept analysis––is helpful for iden‐
tifying the existence of the concept in real life. In other words, it
proposes the standards by which to measure the concept. In many
cases, the attributes and empirical referents of a concept are the
same (Walker & Avant, 20 05).
In this analysis, none of authors of the previous literature used
empirical referents for the concept of impressionability. Reviewing
the investigated attributes of impressionability, (a) susceptibil‐
ity to external stimuli must be presented because the ability to
sense an external environment is essential for impressionability.
Researchers in studies on environmental determinants of youth
health risk behaviour used items asking participants about the
frequencies of exposure to harmful environmental factors such as
advertisements, Internet posts, and retailers in regard to youth
health risk behaviours (Gwon et al., 2018; Gwon, Yan, & Kulbok,
2017; Pokhrel et al., 2 018). For (b), inc apability of rea sonable judge‐
ment, the examination of the knowledge, or perception of harmful
effects of the health risk behaviours may be used. Specific age
ranges such as from 12‐18 and 19‐24 years old may also be used
to classify impressionable years. Researchers have used various
instruments to measure (c), changeability to accept or modify atti‐
tudes and behaviour. Hanson (1997) measured attitudes towards
smoking initiation and intention to smoke using the Fishbein/
Ajzen‐HansonQuestionnaire. Participantsratedattitudeandin‐
tention on three 7‐point semantic differential evaluative scales of
“pleasant/not pleasant”, “nice/awful”, “a lot of fun/not fun at all”
and three other scales of “true/false”, “likely/unlikely”, “probably/
prob abl yn ot ” wi thara ng eo fs co res fr om+3 ‐−3res pec tivel y.Th e
sum of the first three scores for attitude was considered as the
attitude towards smoking and the other three scores for intention
were considered as smoking intention.
4 | DISCUSSION
Concepts are essential par ts of theories. A concept analysis is a para‐
mount step prior to creating a nursing theory. If nursing theories ef‐
fectively manage to describe phenomena of interest to the extent
of predicting and controlling it, then nursing science will become a
far more persuasive discipline. Adolescents and young adults are the
primary target groups in population‐based community/public health
nursing. Preventing health risk behaviours may play a key role for
better health among youths because once a health behaviour is es‐
tablished, it is significantly hard to modify later in life.
The overarching goals of Healthy People 2020, the 10‐year
plan outlining major national health objectives, include: (a) attaining
high‐quality and longer lives free of preventable diseases, etc.; (b)
accomplishing health equity and eliminating disparities; (c) forming
healthy social and physical environments; and (d) promoting qual‐
ity of life and healthy behaviours among all age groups (Office of
Disease Prevention & Health Promotion, 2018). To this end, facilitat‐
ing healthy behaviour and preventing health risk behaviours of the
population are key components to improving health across the na‐
tion. Adolescence and young adulthood are critical periods in health
behaviou r intervention a nd policies. Ma ny youths are expos ed to
harmful environmental factors such as online advertisements, video
clips, and posts in regard to health risk behaviours and various phys‐
ical environments including vape shops and liquor stores. There is a
need to clearly understand and measure impressionability to evalu‐
ate the influence of harmful environments and susceptibilit y to the
environments among youths. Disparities in health may exist among
adolescents and emerging adults compared with general adult s in
that young populations are not mature enough to make right and
optimal decisions for better health. These disparities may occur be‐
tween homogeneous adolescent and young adult groups depending
on defining attributes of the impressionability.
Health risk behaviours among adolescents and young adults
have several special features such as being influenced by others (e.g.,
peers) and being easily susceptible to external environments (e.g.,
advertisements and content of tobacco products online as well as
retailers) and inappropriate decision‐making caused by incomplete
brain development (Dahl, 2004). Theories including social learning
theory (Bandura & McClelland, 1977),ecological perspec tives on
healthbehaviours(McLeroyetal.,1988;Sallisetal.,2006),andem‐
pirical research study findings (Gwon et al., (2018); Gwon & Jeong,
2016) support this explanation.
Flaskerud and Winslow (1998) conceptualized vulnerability
as the interaction between relative risk, resource availability, and
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health status in the vulnerable population model. Dorsen (2010)
added in health perception to this model. According to this model,
adolescents or young adults may be vulnerable populations because
of high risks in health b ehaviour, lack of resource s, and self‐perceived
vulnerability. However, these models did not indicate susceptibility
to environment and attitude and behaviour change.
Spiers (2000) demonstrated that the term vulnerability needs
to be viewed from etic and emic perspectives. Spiers (2000) re‐
ported that attributes of the etic perspective of vulnerability in‐
clude endangerment, functional capacity, external recognition,
measurable behaviour, etc. and those of the emic perspective of
vulnerability include integrity, perceived challenge, capacity for
action, multidimensionality, power, and mutuality. Although these
attributes of vulnerability are comprehensive, the number of attri‐
butes is high and it may be hard to conceptualize and measure all
of the constructs.
Impressionability is different from vulnerability for these rea‐
sons. First, impressionable individuals must be exposed to ex ternal
stimuli and they need to have susceptibilit y to the stimuli. For exam‐
ple, although the blind may be a vulnerable population because of a
lack of resources and high risk of injuries and diseases, they may not
be an impressionable population because of a lack of susceptibility
to external stimuli. Second, impressionability should entail change‐
ability to alter attitudes and/or behaviours. Vulnerabilit y does not
necessarily require attitude or action change. Impressionability
results in the transformation of attitudes or behaviour by being in‐
fluenced by and susceptible to various social and environment al fac‐
tors. The attitude and behaviour established during adolescence and
early adulthood hardly change late in adulthood.
We believe that the identification of attributes, antecedents,
consequences, and models of impressionabilit y in our study pro‐
vided foundational information that will be helpful to create con‐
ceptual models and theories for adolescent and early adult health
promotion and health behaviour modification. Policymakers, health
providers, and health researchers involved in youth health may need
to consider the findings of this study for the development and im‐
plementation of intervention programmes for healthy behaviours. If
studies for the measurement of impressionability are followed, im‐
pressionability will be useful to prioritize and evaluate policies for
the prevention of health risk behaviours and promotion of healthy
environments among youths.
4.1 | Limitations
This study has some limitations. First, this concept analysis used the
method suggested by Walker and Avant (2005). Even though this
method is widely used, it may be problematic in the use of concepts
and differentiation of contex ts (Yi et al., 20 06). Second, this concept
analysis focused only on adolescence and early adulthood. Further
examination of impressionability for other developmental stages
may provide more information that will be helpful to understand
the entire context of impressionabilit y. Third, we were not able
to find empirical referents for impressionability. Possible reasons
include an overlap in characteristics between vulnerability and im‐
pressionability, impressionability is only used for particular popula‐
tions, impressionability is somewhat ambiguous for researchers to
define, and measuring attributes of impressionabilit y is not easy.
It is impor tant to learn healthy behaviours and prevent health
risk behaviours during adolescence and young adulthood. There is a
need to examine additional perspec tives on impressionabilit y using
other concept analysis methods such as the hybrid model and evo‐
lutionary method and focus on other developmental stages such as
school ages. In addition, future studies need to develop an instru‐
ment or measures to evaluate impressionability for youths.
5 | CONCLUSION
This study was the first attempt to examine the concept of impres‐
sionability during adolescence and early adulthood. The concept
analysis was conducted in accordance with the method devised
by Walker and Avant (2005). The literature was reviewed in disci‐
plines of psycholog y, education, medicine, and nursing. A tot al of
three critical attributes of impressionability were identified including
susceptibility to external stimuli, incapability of reasonable judge‐
ment, and changeability to accept or modify attitude or behaviour.
Antecedents were exposure to environment, participation in activi‐
ties, and interpersonal factors. Consequences were the acquisition
of new attitudes and behaviours and the modification of existing at‐
titudes and behaviours.
CONFLICT OF INTEREST
No conflict of interest has been declared by the authors.
AUTHOR CONTRIBUTIONS
All authors have agreed on the final version and meet at least one of
the following criteria (recommended by the International Committee of
MedicalJournalEditors[https://www.icmje.org/recommendations/]):
• substantial contributions to conception and design, acquisition of
data, or analysis and interpretation of data;
• drafting the ar ticle or revising it critically for important intellec‐
tual content.
ORCID
Seok Hyun Gwon https://orcid.org/0000‐0002‐7578‐1986
Suyong Jeong http://orcid.org/0000‐0001‐8038‐7986
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How to cite this article: Gwon SH, Jeong S. Concept analysis
of impressionability among adolescents and young adults.
Nursing Open. 2018;00:1–10. https://doi.org/10.1002/
nop2.170
