• Journal of Preventive Medicine and Public Health
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• v.20 no.1 s.21
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• pp.165-203
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• 1987

This project was a service-cum-research effort with a quasi-experimental study design to examine the health benefits of an integrated Family Planning (FP)/Maternal & Child health (MCH) Service approach that provides crucial factors missing in the present on-going programs. The specific objectives were: 1) To test the effectiveness of trained nurse/midwives (MW) assigned as change agents in the Health Sub-Center (HSC) to bring about the changes in the eight FP/MCH indicators, namely; (i)FP/MCH contacts between field workers and their clients (ii) the use of effective FP methods, (iii) the inter-birth interval and/or open interval, (iv) prenatal care by medically qualified personnel, (v) medically supervised deliveries, (vi) the rate of induced abortion, (vii) maternal and infant morbidity, and (viii) preinatal & infant mortality. 2) To measure the integrative linkage (contacts) between MW & HSC workers and between HSC and clients. 3) To examine the organizational or administrative factors influencing integrative linkage between health workers. Study design; The above objectives called for quasi-experimental design setting up a study and control area with and without a midwife. An active intervention program (FP/MCH minimum 'package' program) was conducted for a 2 year period from June 1982-July 1984 in Seosan County and 'before and after' surveys were conducted to measure the change. Service input; This study was undertaken by the Soonchunhyang University in collaboration with WHO. After a baseline survery in 1981, trained nurses/midwives were introduced into two health sub-centers in a rural setting (Seosan county) for a 2 year period from 1982 to 1984. A major service input was the establishment of midwifery services in the existing health delivery system with emphasis on nurse/midwife's role as the link between health workers (nurse aids) and village health workers, and the referral of risk patients to the private physician (OBGY specialist). An evaluation survey was made in August 1984 to assess the effectiveness of this alternative integrated approach in the study areas in comparison with the control area which had normal government services. Method of evaluation; a. In this study, the primary objective was first to examine to what extent the FP/MCH package program brought about changes in the pre-determined eight indicators (outcome and impact measures) and the following relationship was first analyzed; b. Nevertheless, this project did not automatically accept the assumption that if two or more activities were integrated, the results would automatically be better than a non-integrated or categorical program. There is a need to assess the 'integration process' itself within the package program. The process of integration was measured in terms of interactive linkages, or the quantity & quality of contacts between workers & clients and among workers. Intergrative linkages were hypothesized to be influenced by organizational factors at the HSC clinic level including HSC goals, sltrurture, authority, leadership style, resources, and personal characteristics of HSC staff. The extent or degree of integration, as measured by the intensity of integrative linkages, was in turn presumed to influence programme performance. Thus as indicated diagrammatically below, organizational factors constituted the independent variables, integration as the intervening variable and programme performance with respect to family planning and health services as the dependent variable: Concerning organizational factors, however, due to the limited number of HSCs (2 in the study area and 3 in the control area), they were studied by participatory observation of an anthropologist who was independent of the project. In this observation, we examined whether the assumed integration process actually occurred or not. If not, what were the constraints in producing an effective integration process. Summary of Findings; A) Program effects and impact 1. Effects on FP use: During this 2 year action period, FP acceptance increased from 58% in 1981 to 78% in 1984 in both the study and control areas. This increase in both areas was mainly due to the new family planning campaign driven by the Government for the same study period. Therefore, there was no increment of FP acceptance rate due to additional input of MW to the on-going FP program. But in the study area, quality aspects of FP were somewhat improved, having a better continuation rate of IUDs & pills and more use of effective Contraceptive methods in comparison with the control area. 2. Effects of use of MCH services: Between the study and control areas, however, there was a significant difference in maternal and child health care. For example, the coverage of prenatal care was increased from 53% for 1981 birth cohort to 75% for 1984 birth cohort in the study area. In the control area, the same increased from 41% (1981) to 65% (1984). It is noteworthy that almost two thirds of the recent birth cohort received prenatal care even in the control area, indicating that there is a growing demand of MCH care as the size of family norm becomes smaller 3. There has been a substantive increase in delivery care by medical professions in the study area, with an annual increase rate of 10% due to midwives input in the study areas. The project had about two times greater effect on postnatal care (68% vs. 33%) at delivery care(45.2% vs. 26.1%). 4. The study area had better reproductive efficiency (wanted pregancies with FP practice & healthy live births survived by one year old) than the control area, especially among women under 30 (14.1% vs. 9.6%). The proportion of women who preferred the 1st trimester for their first prenatal care rose significantly in the study area as compared to the control area (24% vs 13%). B) Effects on Interactive Linkage 1. This project made a contribution in making several useful steps in the direction of service integration, namely; i) The health workers have become familiar with procedures on how to work together with each other (especially with a midwife) in carrying out their work in FP/MCH and, ii) The health workers have gotten a feeling of the usefulness of family health records (statistical integration) in identifying targets in their own work and their usefulness in caring for family health. 2. On the other hand, because of a lack of required organizational factors, complete linkage was not obtained as the project intended. i) In regards to the government health worker's activities in terms of home visiting there was not much difference between the study & control areas though the MW did more home visiting than Government health workers. ii) In assessing the service performance of MW & health workers, the midwives balanced their workload between 40% FP, 40% MCH & 20% other activities (mainly immunization). However, $85{\sim}90%$ of the services provided by the health workers were other than FP/MCH, mainly for immunizations such as the encephalitis campaign. In the control area, a similar pattern was observed. Over 75% of their service was other than FP/MCH. Therefore, the pattern shows the health workers are a long way from becoming multipurpose workers even though the government is pushing in this direction. 3. Villagers were much more likely to visit the health sub-center clinic in the study area than in the control area (58% vs.31%) and for more combined care (45% vs.23%). C) Organization factors (admistrative integrative issues) 1. When MW (new workers with higher qualification) were introduced to HSC, it was noted that there were conflicts between the existing HSC workers (Nurse aids with less qualification than MW) and the MW for the beginning period of the project. The cause of the conflict was studied by an anthropologist and it was pointed out that these functional integration problems stemmed from the structural inadequacies of the health subcenter organization as indicated below; i) There is still no general consensus about the objectives and goals of the project between the project staff and the existing health workers. ii) There is no formal linkage between the responsibility of each member's job in the health sub-center. iii) There is still little chance for midwives to play a catalytic role or to establish communicative networks between workers in order to link various knowledge and skills to provide better FP/MCH services in the health sub-center. 2. Based on the above findings the project recommended to the County Chief (who has power to control the administrative staff and the technical staff in his county) the following ; i) In order to solve the conflicts between the individual roles and functions in performing health care activities, there must be goals agreed upon by both. ii) The health sub·center must function as an autonomous organization to undertake the integration health project. In order to do that, it is necessary to support administrative considerations, and to establish a communication system for supervision and to control of the health sub-centers. iii) The administrative organization, tentatively, must be organized to bind the health worker's midwive's and director's jobs by an organic relationship in order to achieve the integrative system under the leadership of health sub-center director. After submitting this observation report, there has been better understanding from frequent meetings & communication between HW/MW in FP/MCH work as the program developed. Lessons learned from the Seosan Project (on issues of FP/MCH integration in Korea); 1) A majority or about 80% of the couples are now practicing FP. As indicated by the study, there is a growing demand from clients for the health system to provide more MCH services than FP in order to maintain the achieved small size of family through FP practice. It is fortunate to see that the government is now formulating a MCH policy for the year 2,000 and revising MCH laws and regulations to emphasize more MCH care for achieving a small size family through family planning practice. 2) Goal consensus in FP/MCH shouBd be made among the health workers It administrators, especially to emphasize the need of care of 'wanted' child. But there is a long way to go to realize the 'real' integration of FP into MCH in Korea, unless there is a structural integration FP/MCH because a categorical FP is still first priority to reduce the rate of population growth for economic reasons but not yet for health/welfare reasons in practice. 3) There should be more financial allocation: (i) a midwife should be made available to help to promote the MCH program and coordinate services, (in) there should be a health sub·center director who can provide leadership training for managing the integrated program. There is a need for 'organizational support', if the decision of integration is made to obtain benefit from both FP & MCH. In other words, costs should be paid equally to both FP/MCH. The integration slogan itself, without the commitment of paying such costs, is powerless to advocate it. 4) Need of management training for middle level health personnel is more acute as the Government has already constructed 90 MCH centers attached to the County Health Center but without adequate manpower, facilities, and guidelines for integrating the work of both FP and MCH. 5) The local government still considers these MCH centers only as delivery centers to take care only of those visiting maternity cases. The MCH center should be a center for the managment of all pregnancies occurring in the community and the promotion of FP with a systematic and effective linkage of resources available in the county such as i.e. Village Health Worker, Community Health Practitioner, Health Sub-center Physicians & Health workers, Doctors and Midwives in MCH center, OBGY Specialists in clinics & hospitals as practiced by the Seosan project at primary health care level.

• Journal of Global Scholars of Marketing Science
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• v.19 no.4
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• pp.11-23
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• 2009

HSDPA (High-Speed Downlink Packet Access) is a 3.5-generation asynchronous mobile communications service based on the third generation of W-CDMA. In Korea, it is mainly provided in through videophone service. Because of the diffusion of more powerful and diversified services, along with steep advances in mobile communications technology, consumers demand a wide range of choices. However, because of the variety of technologies, which tend to overflow the market regardless of consumer preferences, consumers feel increasingly confused. Therefore, we should not adopt strategies that focus only on developing new technology on the assumption that new technologies are next-generation projects. Instead, we should understand the process by which consumers accept new forms of technology and devise schemes to lower market entry barriers through strategies that enable developers to understand and provide what consumers really want. In the Technology Acceptance Model (TAM), perceived usefulness and perceived ease of use are suggested as the most important factors affecting the attitudes of people adopting new technologies (Davis, 1989; Taylor and Todd, 1995; Venkatesh, 2000; Lee et al., 2004). Perceived usefulness is the degree to which a person believes that a particular technology will enhance his or her job performance. Perceived ease of use is the degree of subjective belief that using a particular technology will require little physical and mental effort (Davis, 1989; Morris and Dillon, 1997; Venkatesh, 2000). Perceived pleasure and perceived usefulness have been shown to clearly affect attitudes toward accepting technology (Davis et al., 1992). For example, pleasure in online shopping has been shown to positively impact consumers' attitudes toward online sellers (Eighmey and McCord, 1998; Mathwick, 2002; Jarvenpaa and Todd, 1997). The perceived risk of customers is a subjective risk, which is distinguished from an objective probabilistic risk. Perceived risk includes a psychological risk that consumers perceive when they choose brands, stores, and methods of purchase to obtain a particular item. The ability of an enterprise to revolutionize products depends on the effective acquisition of knowledge about new products (Bierly and Chakrabarti, 1996; Rothwell and Dodgson, 1991). Knowledge acquisition is the ability of a company to perceive the value of novelty and technology of the outside (Cohen and Levinthal, 1990), to evaluate the outside technology that has newly appeared (Arora and Gambaradella, 1994), and to predict the future evolution of technology accurately (Cohen and Levinthal, 1990). Consumer innovativeness is the degree to which an individual adopts innovation earlier than others in the social system (Lee, Ahn, and Ha, 2001; Gatignon and Robertson, 1985). That is, it shows how fast and how easily consumers adopt new ideas. Innovativeness is regarded as important because it has a significant effect on whether consumers adopt new products and on how fast they accept new products (Midgley and Dowling, 1978; Foxall, 1988; Hirschman, 1980). We conducted cross-national comparative research using the TAM model, which empirically verified the relationship between the factors that affect attitudes - perceived usefulness, ease of use, perceived pleasure, perceived risk, innovativeness, and perceived level of knowledge management - and attitudes toward HSDPA service. We also verified the relationship between attitudes and usage intention for the purpose of developing more effective methods of management for HSDPA service providers. For this research, 346 questionnaires were distributed among 350 students in the Republic of Korea. Because 26 of the returned questionnaires were inconsistent or had missing data, 320 questionnaires were used in the hypothesis tests. In UK, 192 of the total 200 questionnaires were retrieved, and two incomplete ones were discarded, bringing the total to 190 questionnaires used for statistical analysis. The results of the overall model analysis are as follows: Republic of Korea x2=333.27(p=0.0), NFI=0.88, NNFI=0.88, CFI=0.91, IFI=0.91, RMR=0.054, GFI=0.90, AGFI=0.84, UK x2=176.57(p=0.0), NFI=0.88, NNFI=0.90, CFI=0.93, IFI=0.93, RMR=0.062, GFI=0.90, AGFI=0.84. From the results of the hypothesis tests of Korean consumers about the relationship between factors that affect intention to use HSDPA services and attitudes, we can conclude that perceived usefulness, ease of use, pleasure, a high level of knowledge management, and innovativeness promote positive attitudes toward HSDPA mobile phones. However, ease of use and perceived pleasure did not have a direct effect on intention to use HSDPA service. This may have resulted from the fact that the use of video phones is not necessary for everyday life yet. Moreover, it has been shown that attitudes toward HSDPA video phones are directly correlated with usage intention, which means that perceived usefulness, ease of use, pleasure, a high level of knowledge management, and innovativeness. These relationships form the basis of the intention to buy, contributing to a situation in which consumers decide to choose carefully. A summary of the results of the hypothesis tests of European consumers revealed that perceived usefulness, pleasure, risk, and the level of knowledge management are factors that affect the formation of attitudes, while ease of use and innovativeness do not have an effect on attitudes. In particular, with regard to the effect value, perceived usefulness has the largest effect on attitudes, followed by pleasure and knowledge management. On the contrary, perceived risk has a smaller effect on attitudes. In the Asian model, ease of use and perceived pleasure were found not to have a direct effect on intention to use. However, because attitudes generally affect the intention to use, perceived usefulness, pleasure, risk, and knowledge management may be considered key factors in attitude development from which usage intention arises. In conclusion, perceived usefulness, pleasure, and the level of knowledge management have an effect on attitude formation in both Asian and European consumers, and such attitudes shape these consumers' intention to use. Furthermore, the hypotheses that ease of use and perceived pleasure affect usage intention are rejected. However, ease of use, perceived risk, and innovativeness showed different results. Perceived risk had no effect on attitude formation among Asians, while ease of use and innovativeness had no effect on attitudes among Europeans.