Korean Journal of Health Education and Promotion (보건교육건강증진학회지)

Korean Society for Health Education and Promotion (한국보건교육건강증진학회)
권호 표지

Intervention Effect on Health Efficacy and Knowledge in Cardiovascular Health Promotion Behaviors in Children

초등학생 대상의 건강 효능감과 지식을 중심으로 한 심혈관 건강증진 중재 효과

  • Tak, Young-Ran (Department of Nursing, College of Medicine, Hanyang University) ;
  • Yun, E-Hwa (Cancer risk appraisal & prevention brach, National Cancer Control Institute, National Cancer Center)
  • Received : 2009.11.21
  • Accepted : 2009.12.12
  • Published : 2009.12.30
Download PDF
⟨ Previous Next ⟩

Abstract

Objectives: This study was conducted to identify the intervention effects on health efficacy and health knowledge related to health behaviors for improving cardiovascular health in elementary school children. Methods: A repeated measure, pre-post-test design was used to identify the intervention effect on health efficacy and health knowledge among 5th grade school children. Intervention consisted of a curriculum classroom intervention and parent intervention. Health efficacy, health knowledge, and perceived parental monitoring were measured for testing intervention effect. A sample of 219 participants completed a baseline pre-test and two tests during intervention and after intervention from March to July 2004. Results: Mental health efficacy improved significantly from baseline test to the test after intervention (F = 32.88, p < 0.0001). Physical health efficacy also significantly increased during intervention (F = 50.51, p < 0.0001), but did not significantly change after parent intervention. Health knowledge increased significantly from baseline test to the test after education (F =10.23, p < 0.0001), but decreased after parent intervention. Perceived parental monitoring had a significant impact on mental health efficacy and physical health efficacy. Conclusion: The findings support school-based cardiovascular health promotion intervention as effective in improving health efficacy and health knowledge. Parental influence should also be considered to maintain improved health efficacy and health knowledge by thinking process in the intervention for elementary school children.

목적: 본 연구는 학령기 아동 대상의 건강 효능감과 지식을 중심으로 한 심혈관 건강증진 중재 효과를 확인하기 위해 수행되었다. 방법: 본 연구는 반복측정 설계를 적용한 단일군 사전사후 연구 설계로 219명의 초등학생들 대상으로 하고 있다. 심혈관 건강증진 중재는 학교 수업을 기반으로 하는 주1회, 4주 교육으로 구성된 1차 중재와 부모에게 1차 중재 내용을 가정통신문의 형태로 전달하여 학생들의 건강 생활습관 유지에 있어서 부모의 역할을 강조하는 2차 중재로 구성되어 있다. 건강 효능감, 지식, 아동이 지각하는 부모의 모니터링에 대해 중재 전 기초 조사를 실시하고, 1차 중재 및 2차 중재 후 각각 실시하였다. 결과: 정신 건강 자아 효능감은 조사 시점에 따라 유의하게 증가하였다 (F = 32.88, p < 0.0001). 1차 및 2차 중재 후 신체 건강 자아 효능감의 경우 사전 조사에 비해 유의하게 증가하였으나 (F = 50.51, p < 0.0001), 부모 중재 기간 동안에는 건강 자아 효능감에 유의한 변화가 없었다. 지식수준은 전반적으로 증가하는 경향을 보였으나 (F =10.23, p < 0.0001), 부모 중재 후에는 오히려 감소하는 경향을 보였다. 또한 전반적인 자아 효능감에 영향을 미치는 요인으로 아동이 지각한 부모 모니터링인 것으로 나타났다. 결론: 본 연구의 결과는 학교 기반의 심혈관 건강 증진 프로그램이 건강 자아 효능감과 지식수준을 향상시키는 데 있어서 효과적이라는 기존 연구 결과를 지지하고 있다. 이 외에 학령기 아동의 건강 생활 습관 유도를 목적으로 건강 자아 효능감과 지식수준 향상을 위한 중재를 수행하는 데 있어서 부모의 영향을 고려해야 함을 제시하고 있다.

Keywords

References

  1. Bandura, A. 1997. Self-efficacy - The exercise of control. W.H. Freeman and Company NY: USA
  2. Bandura, A. 2004. Health promotion by social cognitive means. Health Education & Behavior 31(2):143-164 https://doi.org/10.1177/1090198104263660
  3. Berenson, G., Srinivasan, S., Bao, W., Newman, W., Tracy, R. & Wattigney W. 1998. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The New England Journal of Medicine 338(23):1650-1656 https://doi.org/10.1056/NEJM199806043382302
  4. Berenson, G. 2002. Childhood risk factors predict adult risk associated with subclinical cardiovascular disease: The Bogalusa Heart Study. American Journal of Cardiology 90(supp):3L-7L https://doi.org/10.1016/S0002-9149(02)02953-3
  5. Bronfenbrenner, U. 1979. The ecology of human development: experiment by nature and design. Cambridge: Harvard University Press
  6. DiClemente, R., Wingood, G., Crosby, R., Sionean, C., Cobb, B., Harrington, K., Davis, S., Hook, E. III & Oh M. 2001. Parental monitoring: Association with adolescents' risk behaviors. Pediatrics 107(6):1363-1368 https://doi.org/10.1542/peds.107.6.1363
  7. Dishman, R., Motl, R., Felton, G., Ward, D., Dowda, M. & Pate, R. 2004. Self-efficacy partially mediates the effect of a school-based physicalactivity intervention among adolescent girls. Preventive Medicine 38:628-636 https://doi.org/10.1016/j.ypmed.2003.12.007
  8. Edmunson, E., Parcel, G., Feldman, H., Elder, J.,Perry, C., Johnson, C., Williston, B., Stone, E., Yang, M., Lytle, L., Webber, L. The effects of the child and adolescent trial for cardiovascular health upon psychosocial determinants of diet and physical activity behavior. Preventive Medicine 1996;25:442-454 https://doi.org/10.1006/pmed.1996.0076
  9. Flynn, M., McNeil, D., Maloff, B., Mutasingwa, D., Wu, M., Ford, C. & Tough, S. 2006. Reducing obesity and related chronic disease risk in children and youth: A synthesis of evidence with ‘best practice’ recommendations. Obesity Review 7(Suppl. 1):7-66 https://doi.org/10.1111/j.1467-789X.2006.00242.x
  10. Frenn, M., Malin, S. & Bansal, N. 2003. Stage- based intervention for low-fat diet with middle school students. Journal of Pediatric Nursing 18(1): 36-45 https://doi.org/10.1053/jpdn.2003.6
  11. Froman, R. & Owen, S. 1991. High school student's perceived self-efficacy in physical and mental health. Journal of Adolescent Research 6: 181-196 https://doi.org/10.1177/074355489162003
  12. Froman, R. & Owen, S. 1999. American and Korean adolescent's physical and mental health selfefficacy. Journal of Pediatric Nursing 14(1):51-58 https://doi.org/10.1016/S0882-5963(99)80060-8
  13. Glowinska, B., Urban, M. & Koput, A. 2002. Cardiovascular risk factors in children with obesity, hypertension and diabetes: lipoprotein (a) levels and body mass index correlate with family history of cardiovascular disease. European Journal of Pediatrics 161:511-518 https://doi.org/10.1007/s00431-002-1040-7
  14. Golan, M., Weizman, A. & Fainaru, M. 1999. Impact of treatment for childhood obesity on parental risk factors for cardiovascular disease. Preventive Medicine 29:519-526 https://doi.org/10.1006/pmed.1999.0584
  15. Harrell, J., Gansky, S., McMurray, R., Bangdiwala, S., Frauman, A. & Bradley, C. 1998. Schoolbased interventions improve heart health in children with multiple cardiovascular disease risk factors. Pediatrics 102(2):371-380 https://doi.org/10.1542/peds.102.2.371
  16. Harrell, J., McMurray, R., Baggett, C., Pennell, M.,Pearce, P. & Bangdiwala, S. 2005. Energy costs of physical activities in children and adolescents. Medicine & Science in Sports and Exercise 37:329-336 https://doi.org/10.1249/01.MSS.0000153115.33762.3F
  17. Harrell, J., McMurray, R., Bangdiwala, S., Frauman, A., Gansky, S. & Bradley, C. 1996. Effects of a school-based intervention to reduce cardiovascular disease risk factors in elementaryschool children: The Cardiovascular Health in Children (CHIC) Study. Journal of Pediatrics 128(6):797-805 https://doi.org/10.1016/S0022-3476(96)70332-3
  18. Harrell, J., McMurray, R., Gansky, S., Bangdiwala, S. & Bradley, C. 1999. A public health vs. a risk-based intervention to improve cardiovascular health in elementary school children: The Cardiovascular Health in Children study. American Journal of Public Health 89(10): 1529-1535 https://doi.org/10.2105/AJPH.89.10.1529
  19. Harrell, J., Pearce, P., Markland, E., Wilson, K., Bradley, C. & McMurray, R. 2003. Assessing physical activity in adolescents: Common activities of children in 6th-8th grades. Journal of the American Academy of Nurse Practitioners 15:170-178 https://doi.org/10.1111/j.1745-7599.2003.tb00259.x
  20. Hayman, L., Williams, L., Daniels, S., Steinberger, J.,Pridon, S., Dennison, B. & McCrindle, B. 2004. Cardiovascular Health Promotion in the Schools: A Statement for Health and Education Professionals and Child Health Advocates From the Committee on Atherosclerosis, Hypertension, and Obesity in Youth (AHOY) of the Council on Cardiovascular Disease in the Young. American Heart Association. Circulation 110: 2266-2275
  21. Jones, E., Renger, R. & Kang, Y. 2007. Self- efficacy for health-related behaviors among deaf adults. Research in Nursing & Health 30: 185-102 https://doi.org/10.1002/nur.20196
  22. Klein-Hessling, J., Lohaus, A. & Ball, J. 2005. Psychological predictors of health-related behavior in children. Psychology, Health & Medicine 10(1):31-43 https://doi.org/10.1080/13548500512331315343
  23. Korean National Statistical Office. 2006. Annual Report on the Cause of Death Statistics 2006. Retrieved from: URL: http://www.nso.go.kr/nso2006/
  24. Labarthe, D. 1998. Epidemiology and prevention of cardiovascular disease: A global challenge. Aspen publishers, Maryland: USA
  25. Leupker, R., Perry, C., Osganian, V., Nader, P., Parcel, G., Stone, E., Webber, L. 1998. The child and adolescent trial for cardiovascular health (CATCH). Journal of Nutrition and Biochemistry 9:525-534 https://doi.org/10.1016/S0955-2863(98)00042-4
  26. Li, X., Feiglman, S. & Stanton, B. 2000. Perceived parental monitoring and health risk behaviors among urban low-income African-American children and adolescents. Journal of Adolescent Health 27:43-48 https://doi.org/10.1016/S1054-139X(99)00077-4
  27. Luepker, R.V. 1994. Primer in Preventive Cardiology. American Heart Association, Texas: USA
  28. Ma, G., Shive, S., Tan, Y., Toubbeh, J., Fang, C. & Edwards, R. 2005. Tobacco use, secondhand smoke exposure and their related knowledge, attitudes and behaviors among Asian Americans. Addictive Behaviors 30:725-740 https://doi.org/10.1016/j.addbeh.2004.08.018
  29. Macaulay, A., Griffin, K., Gronewold, E., Williams, C. & Botvin, G. 2005. Parenting practices and adolescent drug-related knowledge, attitude, norms and behavior. Journal of Alcohol & Drug Education 49(2):67-83
  30. Melnyk, B., Small, L., Morrison-Beedy, D., Strasser, A., Spath, L., Kreipe, R, Crean, H., Jacobson, D., Kelly, S. & O'Haver, J. 2007. The COPE healthy lifestyles TEEN program: Feasibility, preliminary efficacy, & lessons learned from an after school group intervention with overweight adolescents. Journal of Pediatric Health Care 21(5):315-322 https://doi.org/10.1016/j.pedhc.2007.02.009
  31. Milligan R., Burke V., Beilin L., Richard D., Dunbar D., Spencer M., Balde E. & Gracey M. 1997. Health-related behaviors and psycho-social characteristics of 18 year-old Australians. Social Science & Medicine 45(10):1549-1562 https://doi.org/10.1016/S0277-9536(97)00092-0
  32. Nader, P.R., Stone, E.J., Lytle, L.A., Perry, C.L., Osganian, S.K. & Kelder, S., et al. 1999. Three-year maintenance of improved diet and physical activity. Archieves of Pediatrics & Adolescent Medicine 153(7):695-704 https://doi.org/10.1001/archpedi.153.7.695
  33. Nash, S., McQueen, A. & Bray, J. 2005. Pathways to adolescent alcohol use; family environment, peer influence, and parental expectations. Journal of Adolescent Health 37:19-28 https://doi.org/10.1016/j.jadohealth.2004.06.004
  34. Norman, P., Abraham, C. & Conner, M. 2000. Understanding and changing health behavior -from health beliefs to self-regulation. Harwood academic publishers, UK
  35. Norton, D., Forelicher, E., Waters, C. & Carrieri-Kohlman, V. 2003. Parental influence on models of primary prevention of cardiovascular disease in children. European Journal of Cardiovascular Nursing 2:311-322 https://doi.org/10.1016/S1474-5151(03)00072-0
  36. Rimal, R. 2001. Longitudinal influences of knowledge and self-efficacy on exercise behavior: Tests of a mutual reinforcement model. Journal of Health Psychology 6(1):31-46 https://doi.org/10.1177/135910530100600103
  37. Rinderknecht, K. & Smith, C. 2004. Social cognitive theory in an after-school nutrition intervention for urban Native American Youth. Journal of Nutrition Education and Behavior 36:298-304 https://doi.org/10.1016/S1499-4046(06)60398-9
  38. Rizzo, N., Ruiz, J., Hurtig-Wennof, A., Ortega, F. & Sjostrom, M. 2007. Relationship of physical activity, fitness, and fatness with clustered metabolic risk in children and adolescents: The European youth heart study. Journal of Pediatrics 150:388-394 https://doi.org/10.1016/j.jpeds.2006.12.039
  39. Rutter, D. & Quine, L. 2002. Changing health behavior: Intervention and research with social cognitive theory. Derek R. Rutter and Lyn Quine (Eds.). Open University Press, PA: USA
  40. Small, S. & Kerns, D. 1993. Unwanted sexual activity among peers during early and middle adolescence: incidence and risk factors. Journal of Marriage and the Family 55(4):941-952 https://doi.org/10.2307/352774
  41. Strong, J., Malcom, G., McMahan, C., Tracy, R., Newman III, W., Herderick, E. & Cornhill, J. 1999. Prevalence and extent of atherosclerosis in adolescents and young adults. The journal of the American Medical Association 281(8):727-735 https://doi.org/10.1001/jama.281.8.727
  42. Twisk, J. 2003. Applied longitudinal data analysis for epidemiology. Cambridge University Press, Cambridge: UK
  43. Vieno, A., Santinello, M., Pastore, M. & Perkins, D. 2007. Social support, sense of community in school, and self-efficacy as resources during early adolescence: an integrative model. American Journal of Community Psychology 39:177-190 https://doi.org/10.1007/s10464-007-9095-2
  44. Winters, E., Petosa, R. & Charlton, T. 2003. Using social cognitive theory to explain discretionary, 'leisure-time' physical exercise among High school students. Journal of Adolescent Health 32:436-442 https://doi.org/10.1016/S1054-139X(03)00046-6
  45. World Health Organization. 2002. The world health report: Reducing risks, Promoting healthy life. WHO, Geneva: Switzerland
  46. Wu, T. & Jwo, J. 2005. A prospective study on changes of cognitions, interpersonal influences, and physical activity in Taiwanese youth. Research Quarterly for Exercise and Sport 76:1-12
  47. Zebracki, K. & Drotar, D. 2004. Outcome expectancy and self-efficacy in adolescent asthma self-management. Children's Health Care 33(2):133-149 https://doi.org/10.1207/s15326888chc3302_4
  48. Zhou, B., Wu, Y., Yang, J., Li, Y., Zhang, H. & Zhao, L. 2002. Overweight is an independent risk factor for cardiovascular disease in Chinese populations. Obesity Review 3(3):147-156 https://doi.org/10.1046/j.1467-789X.2002.00068.x