• Journal of Preventive Medicine and Public Health
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• v.56 no.2
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• pp.128-144
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• 2023

Objectives: The health system reform process is highly political and controversial, and in most cases, it fails to realize its intended goals. This study was conducted to synthesize factors underlying the failure of health system reforms. Methods: In this systematic review and meta-synthesis, we searched 9 international and regional databases to identify qualitative and mixed-methods studies published up to December 2019. Using thematic synthesis, we analyzed the data. We utilized the Standards for Reporting Qualitative Research checklist for quality assessment. Results: After application of the inclusion and exclusion criteria, 40 of 1837 articles were included in the content analysis. The identified factors were organized into 7 main themes and 32 sub-themes. The main themes included: (1) reforms initiators' attitudes and knowledge; (2) weakness of political support; (3) lack of interest group support; (4) insufficient comprehensiveness of the reform; (5) problems related to the implementation of the reform; (6) harmful consequences of reform implementation; and (7) the political, economic, cultural, and social conditions of the society in which the reform takes place. Conclusions: Health system reform is a deep and extensive process, and shortcomings and weaknesses in each step have overcome health reform attempts in many countries. Awareness of these failure factors and appropriate responses to these issues can help policymakers properly plan and implement future reform programs and achieve the ultimate goals of reform: to improve the quantity and quality of health services and the health of society.

• Journal of Preventive Medicine and Public Health
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• v.34 no.3
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• pp.237-243
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• 2001

Objectives : To examine the screening rate of cervical cancer in women and to find out the predictive factors for participation in cervical cancer screening programs within their life-time and within the last two years. Methods : The data was based on self-reported questionnaires from 1,613 women whose ages ranged from 26 to 60 years; this survey was peformed between December 1999 and January 2000. This study analyzed the predictive factors for participation in cervical cancer screening programs within their life-time and within the last two years. A logistic regression analysis was performed in order to derive the significant variables from the predisposing factors(demographic factor, health promotion behavior, reproductive factor), intervention factors(information channel, relation with medical stan, and proximal factors(attitude, social influence, self-efficacy). All analyses were peformed by the PC-SAS 6.12. Results : Our analyses showed that the screening rate for the women who received a cervical cancer screening(Pap smear) more than once within their life-time was 56.1% while those who had received one within the last two years was 34.5%. The significant factors for participation in cervical cancer screening program within their life-time were their income, married age, health promotion score, relation with medical staffs, social influence, and self-efficacy. On the other hand, age, number of pregnancies, menarche age, relation with medical staffs, social influences, and self-efficacy were significant factors for those being screened within the last two years. The predictive power of the logit model within their life-time was 68.8% and that within the last two years was 66.6%. Conclusion : The predictive factors for participation in cervical cancer screening program within their life-time are different from those for within the last two years. and that women's relations with medical staffs and social influences were the critical factors impacting on cervical cancer screening rates.

• The Korean Journal of Emergency Medical Services
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• v.24 no.1
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• pp.7-24
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• 2020

Purpose: Emergency medical service (EMS) personnel are at high risk of spreading infection. In this study, we used the PRECEDE model to identify the knowledge, status, and barriers to infection control among Korean paramedics to provide basic infection control data. Methods: A total of 164 respondents were analyzed for the study. A questionnaire was administered and collected through an online self-response platform. Descriptive analysis, t-test, ANOVA, multiple regression, and logistic regression analyses were performed to determine infection control practices and associated factors using SAS 9.4. To identify the pathways and direct, indirect, total effects based on the PRECEDE model, we used AMOS 26.0. Results: Highly rated self-efficacy (OR 8.82, 95% CI: 3.23-24.09), awareness (OR 6.05, 95% CI: 2.06-17.72), and enabling factors (OR 3.23, 95% CI: 1.18-8.78) led to superior infection control. As a result of the structural model analysis, the highly rated enabling factors and awareness led to superior practice patterns. Conclusion: Practice is related to self-efficacy, awareness, and enabling factors; however, further research is needed to develop strategies for infection control. In particular, institutional arrangements are needed to improve the enabling factors. Improving infection control performance may lead to better infection control and enhanced protection of EMS personnel and patients against infection risks.

• Research in Community and Public Health Nursing
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• v.29 no.1
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• pp.1-10
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• 2018

Purpose: The purpose of this study was to examine the prevalence and risk factors of suicidal ideation among middle class Korean. Methods: Cross sectional study was designed for secondary data analysis. From the 8th Korea Health Panel survey (2008~2013), a total of 6,037 data was drawn and analyzed by developmental stage using descriptive statistics including frequency, percentage, $x^2$ test, and logistic regression analysis. Results: Across all age groups, high physical-mental stress, frustration, anxiety about the future and low self-perceived health status or social class were found to be the risk factors of suicidal ideation. Peer-compared subjective health status and frustration significantly influenced the adolescents. The young adults'suicidal ideation was mainly influenced by physical and mental stress, frustration and absence of economic activity. For the middle-aged, physical and mental stress, frustration, future anxiety, low peer-compared subjective health status were found to be the major influencing factors. The predominant risk factors for the elderly were frustration and low peer-compared subjective health status. Conclusion: Making comparisons to others significantly influence suicidal ideation throughout all life cycles. Improvement of mental health and suicide prevention can be enhanced by avoiding negative comparison to others.

• Health Policy and Management
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• v.26 no.1
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• pp.12-23
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• 2016

Background: Many studies have explained regional disparities in health by socioeconomic status and healthcare resources, focusing on differences between urban and rural area. However some cities in Korea have the highest cardiovascular mortality, even though they have sufficient healthcare resources. So this study aims to confirm three hypotheses. (1) There are also regional health disparities between cities not only between urban and rural area. (2) It has different regional risk factors affecting cardiovascular mortality whether it is urban or rural area. (3) Besides socioeconomic and healthcare resources factors, there are remnant factors that affect regional cardiovascular mortality such as health behavior and physical environment. Methods: The subject of this study is 227 local authorities (si, gun, and gu). They were categorized into city (gu and si consisting of urban area) and non-city (gun consisting of rural area), and the city group was subdivided into 3 parts to reflect relative different city status: city 1 (Seoul, Gyeonggi cities), city 2 (Gwangyeoksi cities), and city 3 (other cities). We compared their mortalities among four groups by using analysis of variance analysis. And we explored what had contributed to it in whole authorities, city and non-city group by using multiple regression analysis. Results: Cardiovascular mortality is highest in city 2 group, lowest in city 1 group and middle in non-city group. Socioeconomic status and current smoking significantly increase mortality regardless of group. Other than those things, in city, there are some factors associated with cardiovascular mortality: walking practice(-), weight control attempt(-), deficiency of sports facilities(+), and high rate of factory lot(+). In non-city, there are other factors different from those of city: obesity prevalence(+), self-perceiving obesity(-), number of public health institutions(-), and road ratio(-). Conclusion: To reduce cardiovascular mortality and it's regional disparities, we need to consider differentiated approach, respecting regional character and different risk factors. Also, it is crucial to strengthen local government's capacity for practicing community health policy.

• Health Policy and Management
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• v.30 no.1
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• pp.26-36
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• 2020

Background: The purpose of this study was to analyze the relationship between the regional characteristics and the age-adjusted cardio-cerebrovascular disease mortality rates (SCDMR) in 229 si·gun·gu administrative regions. Methods: SCDMR of man and woman was used as a dependent variable using the statistical data of death cause in 2017. As a representative index of regional characteristics, health behavior factors, socio-demographic and economic factors, physical environment factors, and health care factors were selected as independent variables. Ordinary least square (OLS) regression and geographically weighted regression (GWR) were performed to identify their relationship. Results: OLS analysis showed significant factors affecting the mortality rates of cardio-cerebrovascular disease as follows: high-risk drinking rates, the ratio of elderly living alone, financial independence, and walking practice rates. GWR analysis showed that the regression coefficients were varied by regions and the influence directions of the independent variables on the dependent variable were mixed. GWR showed higher adjusted R² and Akaike information criterion values than those of OLS. Conclusion: If there is a spatial heterogeneity problem as Korea, it is appropriate to use the GWR model to estimate the influence of regional characteristics. Therefore, results using the GWR model suggest that it needs to establish customized health policies and projects for each region considering the socio-economic characteristics of each region.

• Journal of Industrial Convergence
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• v.18 no.2
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• pp.1-7
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• 2020

This study was conducted to identify factors that affect subjective health in middle-aged with hypertension. Hypertension, a representative chronic disease, is a disease of increasing prevalence from middle age. To effectively manage hypertension from middle age, it is necessary to revise lifestyle based on subjective health awareness. The subjects of this study were 2,254 middle-age with hypertension who were 30-64 years of age among the 2014-17 national health and nutrition survey. Study variables consisted of general, physical, and psychological factors. For data analysis, compound statistics were made using SPSS 25.0 program and then complex statistics. The results of this study showed that the factors that significantly influenced the subjective health of the subjects were sex, age, economic level, number of households, home ownership, stress, quality of life, and their explanatory power was 20.4% (F = 12.58, p<.001). The results of this study can be used as a basis for the intervention to improve the subjective health of middle-aged with hypertension. Appropriate lifestyle modifications are needed to effectively manage hypertension based on good subjective health awareness.

• Journal of Korean Academy of Nursing
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• v.39 no.4
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• pp.480-489
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• 2009

Purpose: The purpose of this study was to identify the factors which influence health-related quality of life (HRQoL) in Korean Medicaid beneficiaries. The relationships among sociodemographic factors, health status, health behavior, and HRQoL were analyzed. Methods: Data from the 2007 survey on Health Services Use and Health Status of Medicaid Beneficiaries conducted by the Ministry for Health Welfare and Family Affairs were examined. To analyze the sample survey data, descriptive statistics, correlation and hierarchical multiple survey regression analysis with SAS 9.1.3 package were used with SURVEYMEANS and SURVEYREG procedures, which incorporate the sample design into the analyses in order to make statistically valid inference for the whole Medicaid population. Results: The HRQoL correlated with limitations in Activities of Daily Living (ADL) (r=-.509, p<.001), stress (r=-.387, p<.001), depression (r=-.385, p<.001), alcohol consumption (r=.216, p<.001), and exercise (r=.293, p<.001). Significant factors that affect HRQoL of Medicaid beneficiaries were gender, region, limitations in ADL, stress, depression, alcohol consumption, and regular exercise. These variables explained 44.6% of HRQoL (F= 215.00, p<.001). Conclusion: The results indicate that to improve the HRQoL of Medicaid beneficiaries it is important to develop nursing intervention programs that focus on psychological health and health behavior and to give consideration to differences in gender and region.

• Journal of the Korean Society of School Health
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• v.3 no.2
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• pp.88-95
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• 1990

In order to promote the Generalized Health Beliefs between the medical doctors and university students for more comprehensive health control, we researched the Generalized Health Beliefs invented by Dr. Cockburn and microsystemic enviromental factors. As a result, we obtained the following conclusion from the study: 1. Analytically possible answers were given by 525 students (92.6%), and among them, 356(67.8%) male students, and 196(32.2%) female students. 2. Items for Generalized Health Beliefs, Which were divided into 4 factors: 4 items for seriousness of health, 3 items for the barrier of medical utility, 4 items for the medical motivation, and 4 item for the control over illness. 3. Cronbach's alpha constant for respective analytic factors revealed that the seriousness of health; 0.92, the barrier of medical utility; 0.94, the medical motivation; 0.44, and the control over illness; 0.76. 4. The seriousness of health was influences by gender, origin of birth, residence, and frequency of visiting a doctor during one year period (<0.05). 5. The barrier of medical utility differs from origin of birth, residence, and frequency of visiting differs from origin of birth, residence, and frequency of visiting a doctor(<0.05). 6. Gender was found to be an influencing factor in the medical motivation, and gender and religion in the control over illness(<0.05).

• The Korean Journal of Health Service Management
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• v.9 no.2
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• pp.13-22
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• 2015

This study confirmed that the organizational health of nurses have an effect on customer orientation. This survey was conducted March 1 to 31, 2014 and a total of 210 questionnaires were used in the analysis. Descriptive statistics, t-test, ANOVA, factor analysis, and regression analysis were used to analyze the collected data in the SPSS software package. The findings are summarized as follows: First, the business environment and community-oriented organizations on health factors had an influence on customer orientation(p<.05, p<.001). Among the demographic factors, graduating from college as relevant to customer orientation. Seniority and rank in the lower tier showed that customer orientation is vulnerable. Second, when leadership was added to a conventional model, it had no significant effect on the dependent variables. The influence of community-oriented business environment factors on customer orientation was statistically significant(p<.01). In the result, we should apply proper organizational health factors to hospitals by investigating leadership, because there was difference in customer orientation according to type of leadership.