보건교육건강증진학회지 (Korean Journal of Health Education and Promotion)

  • 제24권5호
  • /
  • Pages.23-37
  • /
  • 2007
  • /
  • 1229-4128(pISSN)
  • /
  • 2635-5302(eISSN)
한국보건교육건강증진학회 (Korean Society for Health Education and Promotion)
권호 표지

일개 지역사회 여성 주민의 자궁경부암 조기검진 수검에 관한 행동변화단계별 교육 프로그램의 효과

Effectiveness of stages-matched educational program for cervical cancer screening among adult women in a community

  • 발행 : 2007.12.30
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

연구 배경: 자궁경부암은 조기검진을 통해 사망률과 의료비 부담을 감소시킬 수 있는 질환으로, 아직까지 우리나라에서는 자궁경부암이 여성암 중 높은 발생률을 보이고 있으나, Pap test를 통해 자궁경부암을 조기에 발견하고, 치료할 수 있는 것으로 알려져 있다. 연구 목적: 이 연구는 자궁경부암 조기검진 수검행동에 영향을 미치는 인지-행동적 요인을 고려하여 행동변화단계별 교육 프로그램을 개발하였고, 이를 40세 이상의 여성 주민에게 적용해봄으로써 행동변화단계별 맞춤형 교육 프로그램의 효과를 평가하고자 하였다. 연구 방법: 이 연구는 서울시 서초구에 거주하는 40세$\sim$59세 사이의 여성 주민을 대상으로 2003년 9월 1일부터 11월 14일까지 자료를 수집하였으며, 서초구의 5개 지역(동)에서 교육 중재군(162명)과 대조군(121명)을 선정하였다. 또한 행동변화단계별 교육 프로그램은 범이론적모형(TTM)을 활용하여 개발되었고, 교육 중재군의 교육내용 전달방법으로 인터넷 서비스와 우편 서비스가 활용되었다. 연구 결과: 조사대상자중 88.9%가 일생 중 1번 이상, 65.4%가 최근 2년 동안 1번 이상 자궁경부암 조기검진을 수검한 것으로 나타났다. 행동변화단계별 교육 프로그램의 효과를 살펴보면, 교육 후 인지 행동적 요인 중 태도와 변화의 과정이 통계적으로 유의하게 높아졌고, 행동변화단계 중 유지단계가 가장 많이 증가하였다. 교육내용 전달 방법은 인쇄된 교육자료를 활용한 우편 서비스가 인터넷 서비스보다 효과적인 것으로 나타났고, 행동변화단계별 전환 양상에서도 우편 서비스 중재군이 인터넷 서비스 중재 군보다 긍정적인 변화를 나타내었다. 한편 행동변화단계별 교육 프로그램에 관한 만족도 평가에서는 전달방법에 따른 유의한 차이가 없는 것으로 나타났다. 결론: 이 연구는 지역사회 여성 주민의 자궁경부암 조기검진에 관한 수검 행동을 증진시키기 위해 행동변화단계에 따른 맞춤형 교육 프로그램을 개발하여 적용하였고, 그 결과, 행동변화단계별 교육 프로그램이 자궁경부암 조기검진의 수검 행동을 증진시키는데 효과적인 것으로 나타났다.

Background: Even though cervical cancer poses a significant global cancer burden, successful implementations for early detection offer an opportunity to prevent deaths and reduce the cancer burden. In Korea, cervical cancer is the most prevalent type of cancer among adult women, but it is one of the few cancers in which a consensus-approved screening test exists for early diagnosis, Pap test, that can be combined with highly efficacious treatment regimens for early-stage disease. Purpose: This study was carried out to identify the cognitive-behavioral factors associated with cervical cancer screening behavior among adult women, aged 40 to 59, and to develop tailored messages and to evaluate the effectiveness of stage-matched educational program. Method: A total of 283 women who aged 40 years or older was recruited in Seoul, from September, 1st to November, 14th, 2003. The intervention group (N=162) and the control group (N=121) were selected from five sub-districts in Seocho-gu, Seoul. Building on the TTM, a quasi-experimental study was conducted to test the effectiveness of stages-matched intervention addressed at the five stages of cervical cancer screening behavior. Women in the intervention group were randomly assigned to one of two conditions, internet or postal services. Results: In our results, 88.9% of participants had received a Pap test at least once in their life-time, and 65.4% had got it in the past two years. With regard to cognitive-behavioral factors, the stages-matched educational program increased attitude and process of change for cervical cancer screening. The percentage changed was the largest in maintenance stage. With regard to delivery methods for tailored messages, the print materials were more effective at increasing screening adherence than the e-mail. Whereas the postal service group showed remarkable the change of behavior stage, the internet service group did not. Also it was not shown any difference of the satisfaction with stages-matched educational program between internet and postal service groups. Conclusion: This study suggested that cervical cancer screening behavior could be changed by tailored messages which had developed with cognitive-behavioral factors. The stages-matched educational program was effective to promote the screening adherence for cervical cancer.

키워드

참고문헌

  1. Ansell D, Lacey L, Whitman S, Chen E, Phillips C. A nurse-delivered intervention to reduce barriers to breast and cervical cancer screening in Chicago inner city clinics. Public Health Rep 1994;109: 104-111
  2. Ajzen I. The theory of planned behavior. Organ Behav Hum Dec Proc 1991; 50: 179-211
  3. Bandura A. Social foundations of thought and action: a social cognitive theory. Englewood Cliffs, NJ: Prentice-hall, 1986
  4. Bray F, Loos AH, McCarron P, Weiderpass E, Arbyn M, Moller H, Hakama M, Parkin DM. Trends in cervical squamous cell carcinoma incidence in 12 European countries: changing risk and the effects of screening. Cancer Epidemiol Biomarkers Prev 2005; 14(3):677-86 https://doi.org/10.1158/1055-9965.EPI-04-0569
  5. Carpenter V, Colwell B. Cancer knowledge, self-efficacy, and cancer screening behaviors among mexican-american women. J Gancer Educ 1995 ; 10 : 217-222
  6. CDC (National Center for Chronic Disease Prevention & Health Promotion). Behavioral Risk Factor Surveillance System. 2007. (http://apps.nced.cdc.gov/brfss)
  7. Davis DT, Bustamante A, Brawn CP, et al. The urban church and cancer control: a source of social influence in minority communities. Public Health Rep 1994; 109(4):500
  8. Godin G, Shepard RJ. Use of attitude-behavior models in exercise promotion. Sport Med 1990;10:103-21 https://doi.org/10.2165/00007256-199010020-00004
  9. Henson RM, Wyatt SW, Lee NC. The national breast and cervical cancer early detection program: a comprehensive public health response to two major health issues for women. J Public Health Manage Pract 1996;2(2):36-47
  10. KIHASA(Korean Institute for Health and Social Affairs). Measuring Health promotion behaviors in Seoul. Seoul: Korean Institute for Health and Social Affairs. 2002
  11. Kwak MS, Park EC, Bang JY, Sung NY, Lee JY, Choi KS. Factors associated with cancer screening participation, Korea. J Prev Med Public Health 2005;38(4):473-481
  12. Marcus AC & Crane LA. A review of cervical cancer screening intervention research: implications for public health program and future research. Prev Med 1998;27:13-31 https://doi.org/10.1006/pmed.1997.0251
  13. Meissner HI, Breen N, Coyne C. Legler JM, Green DT, Edwards BK. Breast and cervical cancer screening intervention: An assessment of the literature. Cancer Epidemiol Biomark Prev 1998;7:951-961
  14. National Cancer Center. Cancer information. 2004
  15. Prochaska JO, Velicer FV, Rossi JS, et al. Stages of change and decisional balance for 12 problem behaviors. Health Psychol 1994; 12:39-46
  16. Rimer BK. Mammography use in the U.S.: trends and the impact of intervention. Ann Behav Med 1994;16:317-326
  17. Saslow D, Castle PE, Cox JT, Davey DD, Einstein MH, Ferris DG, et al. American Cancer Society guideline for Human Papillomavirus(HPV) vaccine use to prevent cervical cancer and its precursors. CA Cancer J Clin 2007;57: 7-28 https://doi.org/10.3322/canjclin.57.1.7
  18. Satariano WA, Schwartz AG, Swanson GM. Screening for cervical cancer: results from several intervention stratefies. In: Issues in cancer screening communications. New York: A.R.Liss, 1982;275-83
  19. Solomon D, Breen N, McNeel T. Cervical cancer screening rates in the United States and the potential impact of implementation of screening guidelines. CA Cancer J Clin 2007;57:105-111 https://doi.org/10.3322/canjclin.57.2.105
  20. Suarez L, Nicholis DC, Brady CA. Use of peer role models to increase pap smear and mammogram screening in Mexican-American and black women. Am J Prev Med 1993;9:290-296 https://doi.org/10.1016/S0749-3797(18)30705-0
  21. Talyor VM, Hislop TG, Jackson JC, Tu SP, Yasui Y, Schwartz SM, The C, Kuniyuki A, Acorda E, Marchand A, Thompson B. A randomized controlled trial of intervention to promote cervical cancer screening among Chinese women in North America. J Natl Cancer Inst 2002;94:670-7 https://doi.org/10.1093/jnci/94.9.670