• 보건교육건강증진학회지
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• 제22권2호
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• pp.97-110
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• 2005

Objectives: Recent studies have shown that tailored messages for cancer screening to the beliefs and stage of cancer screening behavior of individual women increases the take-up probability. Many studies on cancer screening have used the Transtheoretical Model (TTM) to identify variables associated with cancer screening behavior. This study was carried out to identify the cognitive-behavioral factors associated with stomach cancer screening among women aged 40 years and over, and to develop and evaluate a tailored educational program for stomach cancer screening by stages of change. Methods: Building on the TTM constructs, we conducted a quasi-experimental study(N=283) to test the effectiveness of a tailored educational program for endoscopic stomach cancer screening. We carried out pre and post tests in the experimental group(N=162) and the control group(N=121), and the experimental group was subdivided into an on-line group(N=81) and an off-line group(N=81) by educational methodology using e-mail and the postal service. We used the chi-square test, trend test, and paired t-test to test the effectiveness of the program for stomach cancer using a tailored stage-matched messages. Results: To examine the effectiveness of the program for stomach cancer screening by the tailored stage-matched messages, the stage-matched materials were offered to the experimental group(N=162) four times for 4 weeks. The stage-matched materials consisted of the four types for stomach cancer. The tailored message was effective in changing the cognitive-behavioral factors, such as experience process, behavior process, con opinion for stomach cancer, self-efficacy, and the behavioral stages for stomach cancer screening. The stomach cancer screening adherence was higher for the stage-matched materials using postal mail than for those using e-mail. Conclusion: To improve the stomach cancer screening rate, the use of tailored messages for stomach cancer screening will be generated using an expert system. Therefore the implementation of tailored educational program will be supported a partnership between public and private health organizations and increasing awareness of the necessity of community-based interventions.

• 보건교육건강증진학회지
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• 제24권5호
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• pp.23-37
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• 2007

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.

• 지역사회간호학회지
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• 제13권2호
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• pp.205-215
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• 2002

Objectives: This study was designed to develop and evaluate a stage matched exercise intervention program to effectively increase exercise behaviors in urban elders. Methods: The study included three phases: preliminary descriptive data collection, program development, and program evaluation. The data for the preliminary descriptive phase were collected between May and June 2001. The study participants were 89 urban elders who responded a questionnaire that included general characteristics, exercise related experiences, stage, and process of change in exercise behaviors. Data were analyzed using descriptive statistics, $x^2$-test, and content analysis. Development of the program was based on the preliminary data. and a literature review, and was guided by the tran theoretical model. It consisted of strategies to facilitate the process of changes used in each stage. Evaluation of the program was achieved from October to December 2001, using a case study method, in which eight urban female elders participated. Interviews were conducted on a weekly basis in the form of either an individual interview, or group discussion. Each elder subject received education in accordance with the program strategies and education materials. In the case that a subject's stage of change moved into another one, the scores for the process of change were re-measured. The data were analyzed using the content analysis technique. Results: The results were as follows: 1. Elders who participated in the preliminary data collection phase were over 75 years of age, and the majority of them were women. They had a higher educational level, and fewer number of illnesses than the subjects in other studies. Their stage of change was divided into pre-contemplation and maintenance. The social liberation scores were the highest across all stages of change. There was no difference between men and women on scores for processes of change in each stage. 2. The stage matched exercise intervention program that was developed in this study consisted of one counseling type program and three distinguished educational booklet materials. 3. The results of the case studies are as follows: 1) The study participants were 8 women between 75 and 87 years of age. At the first interviews, all of them were in the pre-contemplation stage. All of them reached the action stage before the 7th week. The scores for processes of change that were the focus in each stage increased more than the scores for other processes of change. During the early stages of change, experimental processes increased more than behavioral processes. However. this pattern was reversed during later stages of change. 2) Characteristics of the subjects in each stage were identical as presented at the tran theoretical model. The intervention strategies were effective in the transition occurred in any stage. 3) Barriers for exercise included unwillingness to exercise, fatigue, shortness of breath, and pain. Ways to overcome these barriers were 'learning an alternative exercise method that can be done at home', 'self-promising/ exercise-promising', and 'use of cues to exercise'. 4) The factors that affected the application of the program were consideration of age and personal preference in selecting an exercise pattern, individualized intervention, and use of education materials appropriate to elders. Women over 80 years of age preferred muscle strengthening and stretching exercise, because they can be easily done at home. They also preferred individualized interventions, materials that were easy to read, and education contents appropriate for elders. Conclusion: In conclusion, the stage matched exercise intervention program that considered the characteristics of the elders was effective to facilitate exercise behaviors of the elders.

• Nutrition Research and Practice
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• 제11권4호
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• pp.319-326
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• 2017

BACKGROUND/OBJECTIVE: Effective weight reduction remains a challenge throughout the world as the prevalence of obesity and its consequences are increasing. This study aimed to determine the effects of an individualized nutrition counseling program (IC) matched with a transtheoretical model (TTM) for overweight and obese subjects. SUBJECTS/METHODS: Fifty overweight and obese subjects aged 19-60 years with a body mass index ${\geq}23kg/m^2$ were enrolled in the weight reduction study. They were randomized into two groups: Intervention group received an IC matched with a TTM; control group received an educational handbook. Body weight (BW), body fat (BF), waist circumference (WC), waist to height ratio (WHtR), stages of change (SOC), processes of change (POC), food intake, and physical activity (PA) were assessed at baseline and at 4, 8, and 12 weeks after program initiation in both groups. All data were analyzed by intention-to-treat, using SPSS software for hypothesis testing. RESULTS: Forty-five female subjects were included in the 12-week trial at Ramkhamhaeng Hospital, Bangkok, Thailand. The results showed significant weight loss ($1.98{\pm}1.75kg$; 3% loss of initial weight) in the intervention group at 12 weeks, compared to a $0.17{\pm}1.67kg$ loss in the control group. There were significant differences between intervention and control groups in BF mass ($-1.68{\pm}1.78$, $-0.04{\pm}1.62kg$); percentage BF ($-1.54{\pm}2.11$, $0.08{\pm}2.05$); WC ($-5.35{\pm}3.84$, $0.13{\pm}3.23cm$); WHtR ($-0.0336{\pm}0.02$, $-0.0004{\pm}0.02$), and energy consumption ($-405.09{\pm}431.31$, $-74.92{\pm}499.54kcal/day$) in the intervention and control groups, respectively. Intragroup SOC was improved in both groups. The POC for the weight management action (WMA) process was significantly different with POC scores increasing by $16.00{\pm}11.73$ and $7.74{\pm}14.97$ in the intervention and the control groups, respectively. PA level did not change in either group. CONCLUSIONS: The IC matched with a TTM resulted in reductions in BW, BF, and WC, thus reducing likely health risks by decreasing energy intake and inducing positive behavior changes while enhancing the WMA process.