• Asia-Pacific Journal of Business Venturing and Entrepreneurship
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• v.14 no.3
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• pp.97-110
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• 2019

This study analyzed various factors of influence affecting the will to start a business and established and empirically analyzed a research model to see which factors significantly affect the will to start a business. To this end, we investigated the general characteristics and experiences of individuals, conducted a study on the will to start a business, and analyzed the entrepreneurship passion for startups, the ability to find business opportunities, and the ability to connect with partner companies. The intent to start a business survey was investigated in a recertive style with a 7 point scale, and the reliability and feasibility review were analyzed through the PLS analysis method, which enables the implementation of a measurement model and a structural model. To collect valid data, the survey was conducted using an entrepreneurial curriculum class hours to collect and analyze 421 data. In summary, the results are as follows: First, college students have many opportunities to develop their capabilities through competitions held by universities and support institutions, and by utilizing them, they have no fear of starting a business. Second, the ability of students to discover product clients themselves has been improved by fostering entrepreneurship in the special lectures on startup in universities. Third, it can be seen that it has received various information on startups from support agencies to enhance its commitment to startups. The implications are as follows. First, they should foster entrepreneurship among college students by offering practical oriented courses that can broaden their understanding of startups. Second, it needs to be improved from entrepreneurial enthusiasm to a program that can grow into a company that can collaborate with partner companies and confirm its commitment to corporate establishment and product development and determine market opportunities. Third, it is necessary to establish an ecosystem of start-ups that can carry out systematic planning and performance management as it is weak to carry out projects with will to startups.

• Korean Journal of Environmental Biology
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• v.39 no.1
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• pp.100-107
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• 2021

Along with an increase in the frequency of high-concentration fine particulate matter in Korea, interest and research on ammonia (NH₃) are actively increasing. It is obvious that agriculture has contributed significantly to NH₃ emissions. However, studies on the long-term effect of fertilizer use on the ambient NH₃ concentration of agricultural land are insufficient. Therefore, in this study, NH₃ concentration in the atmosphere of agricultural land was monitored for 11 months using a passive sampler. The average ambient NH₃ concentration during the total study period was 2.02 ㎍ m^-3 and it was found that the effect of fertilizer application on the ambient NH₃ concentration was greatest in the month immediately following fertilizer application (highest ambient NH₃ concentration as 11.36㎍ m^-3). After that, it was expected that the NH₃ volatilization was promoted by increases in summer temperature and the concentration in the atmosphere was expected to increase. However, high NH₃ concentrations in the atmosphere were not observed due to strong rainfall that lasted for a long period. After that, the ambient NH₃ concentration gradually decreased through autumn and winter. In summary, when studying the contribution of fertilizer to the rate of domestic NH₃ emissions, it is necessary to look intensively for at least one month immediately after fertilizer application, and weather information such as precipitation and no-rain days should be considered in the field study.

• Asia Marketing Journal
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• v.13 no.3
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• pp.25-53
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• 2011

This study probes the effect of loyalty program on the customer retention based on the real transaction data(n=2,892) acquired from education service industry. We try to figure out the outcomes of reward program through more than 1 year-long data gathered and analyzed according to quasi-experimental design(i.e., before and after design). We adopt this kinds of research scheme in regard that previous studies measured the effect of loyalty program by dividing the customers into two group(i.e., members vs. non-members) after the firms or stores had started the program. We believe that it might not avoid the self-selection bias. The research questions of this study could be explained such as: First, most research said that the loyalty programs could increase the customer loyalty and contribute to the sustainable growth of company. But there are little confirmation that this promotional tool could be justified in terms of financial perspective. Thus, we are interested in both the retention rate and financial outcomes caused by the introduction of loyalty programs. Second, reward programs target mainly current customer. Especially CRM(customer relationship management) said that it is more profitable for company to build positive relationship with current customer instead of pursuing new customer. And it claims that reward program is excellent means to achieve this goal. For this purpose, we check in this study whether there is a interaction effect between loyalty program and customer type in retaining customer. Third, it is said that dis-satisfied customers are more likely to leave the company than satisfied customers. While, Bolton, Kannan and Bramlett(2000) claimed that reward program could contribute to minimize the effect of negative service by building emotional link with customer, it is not empirically confirmed. This point of view explained that the loyalty programs might work as exit barrier to current customer. Thus, this study tries to identify whether there is a interaction effect between loyalty program and service experience in keeping customer. To achieve this purpose, this study adopt both Kaplan-Meier survival analysis and Cox proportional hazard model. The research outcomes show that the average retention period is 179 days before introducing loyalty program but it is increased to 227 days after reward is given to the customers. Since this difference is statistically significant, it could be said that H1 is supported. In addition, the contribution margin coming from increased transaction period is bigger than the cost for administering loyalty programs. To address other research questions, we probe the interaction effect between loyalty program and other factors(i.e., customer type and service experience) affecting it. The analysis of Cox proportional hazard model said that the current customer is more likely to engage in building relationship with company compared to new customer. In addition, retention rate of satisfied customer is significantly increased in relation to dis-satisfied customer. Interestingly, the transaction period of dis-satisfied customer is notably increased after introducing loyalty programs. Thus, it could be said that H2, H3, and H4 are also supported. In summary, we found that the loyalty programs have values as a promotional tool in forming positive relationship with customer and building exit barrier.

• Asia-Pacific Journal of Business Venturing and Entrepreneurship
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• v.17 no.2
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• pp.15-31
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• 2022

This study was conducted to suggest a start-up policy that includes start-up education and support for active seniors with various careers who try to change their careers before and after retirement. From this point of view, this study divided the factors affecting the entrepreneurial will of active seniors into entrepreneurship organizational and functional competency and identified the effect of these competencies on entrepreneurial efficacy and entrepreneurial intention. In the proposed model, start-up competency is divided into organizational competency (leadership, creativity problem-solving, communication, decision-making) and functional competency (management strategy, marketing, business plan). And this study examined the mediating role of entrepreneurial efficacy in the relationship between entrepreneurial competency factors and entrepreneurial intention. Meanwhile, PLS-POS analysis was performed to uncover the heterogeneity and pattern in the proposed structural model. The survey was conducted with the help of an online survey company from November 27 to December 15, 2020 for the active senior age group from 40 to under 65 years old. Data were collected from a total of 433 panelists and analyzed using SPSS 22.0 and SmartPLS 3.3.7 programs. The findings are as follows. First, the finding shows that the entrepreneurial organizational and functional competencies of active seniors had significant positive(+) effects on entrepreneurial efficacy. Second, the result shows that entrepreneurial organizational and functional competencies of active seniors had significant positive(+) effects on entrepreneurial intention. Third, the findings show that entrepreneurship efficacy had a significantly positive(+) effect on entrepreneurial intention. The findings of PLS-POS show that entrepreneurship education needs to be carried out by identifying the needs that require entrepreneurial organizational and functional competency when training for entrepreneurship competency. In summary, the findings of the current study are to determine what the competency factors are for the government (local government) to increase the policy direction necessary for establishing and implementing entrepreneurship education and training programs to develop policies to enhance the economic activity participation rate of active seniors.

• Journal of Intelligence and Information Systems
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• v.25 no.3
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• pp.117-140
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• 2019

As the aging phenomenon accelerates and various social problems related to the elderly of the vulnerable are raised, the need for effective elderly care solutions to protect the health and safety of the elderly generation is growing. Recently, more and more people are using Smart Toys equipped with ICT technology for care for elderly. In particular, log data collected through smart toys is highly valuable to be used as a quantitative and objective indicator in areas such as policy-making and service planning. However, research related to smart toys is limited, such as the development of smart toys and the validation of smart toy effectiveness. In other words, there is a dearth of research to derive insights based on log data collected through smart toys and to use them for decision making. This study will analyze log data collected from smart toy and derive effective insights to improve the quality of life for elderly users. Specifically, the user profiling-based analysis and elicitation of a change in quality of life mechanism based on behavior were performed. First, in the user profiling analysis, two important dimensions of classifying the type of elderly group from five factors of elderly user's living management were derived: 'Routine Activities' and 'Work-out Activities'. Based on the dimensions derived, a hierarchical cluster analysis and K-Means clustering were performed to classify the entire elderly user into three groups. Through a profiling analysis, the demographic characteristics of each group of elderlies and the behavior of using smart toy were identified. Second, stepwise regression was performed in eliciting the mechanism of change in quality of life. The effects of interaction, content usage, and indoor activity have been identified on the improvement of depression and lifestyle for the elderly. In addition, it identified the role of user performance evaluation and satisfaction with smart toy as a parameter that mediated the relationship between usage behavior and quality of life change. Specific mechanisms are as follows. First, the interaction between smart toy and elderly was found to have an effect of improving the depression by mediating attitudes to smart toy. The 'Satisfaction toward Smart Toy,' a variable that affects the improvement of the elderly's depression, changes how users evaluate smart toy performance. At this time, it has been identified that it is the interaction with smart toy that has a positive effect on smart toy These results can be interpreted as an elderly with a desire to meet emotional stability interact actively with smart toy, and a positive assessment of smart toy, greatly appreciating the effectiveness of smart toy. Second, the content usage has been confirmed to have a direct effect on improving lifestyle without going through other variables. Elderly who use a lot of the content provided by smart toy have improved their lifestyle. However, this effect has occurred regardless of the attitude the user has toward smart toy. Third, log data show that a high degree of indoor activity improves both the lifestyle and depression of the elderly. The more indoor activity, the better the lifestyle of the elderly, and these effects occur regardless of the user's attitude toward smart toy. In addition, elderly with a high degree of indoor activity are satisfied with smart toys, which cause improvement in the elderly's depression. However, it can be interpreted that elderly who prefer outdoor activities than indoor activities, or those who are less active due to health problems, are hard to satisfied with smart toys, and are not able to get the effects of improving depression. In summary, based on the activities of the elderly, three groups of elderly were identified and the important characteristics of each type were identified. In addition, this study sought to identify the mechanism by which the behavior of the elderly on smart toy affects the lives of the actual elderly, and to derive user needs and insights.

• Journal of Global Scholars of Marketing Science
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• v.19 no.4
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• pp.1-10
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• 2009

The purpose of this study was to categorize the gap between coffee shop 'importance' (as perceived by customers before patronizing the coffee shop) and 'satisfaction' (perception of customers after patronizing the coffee shop) as positive or negative and to analyze the effect of these gaps on purchasing behavior. To do this, I used the gap between importance and satisfaction regarding the choice of a coffee shop as the explanatory variable and performed an empirical analysis of the direction and size of the effect of the gap on purchasing behavior (overall satisfaction, willingness-to-revisit) by applying the Ordered Probit Model (OPM). A previous study that used IPA to evaluate the effects of gaps estimated the direction and size of a quadrant but failed to analyze the effect of gaps on customers. In this study, I evaluated the effects of positive and negative gaps on customer satisfaction and willingness-to-revisit. Using OPM, I quantified the effect of positive and negative gaps on overall customer satisfaction and willingness-to-revisit. Per-head expenditure, frequency of visits, and coffee-purchasing place had the most positive effects on overall customer satisfaction. Frequency of visits, followed by per-head expenditure and then coffee-purchasing place, had the most positive impact on willingness-to-visit. Thus per-head expenditure and frequency of visits had the greatest positive effects on overall satisfaction and willingness-to-revisit. This finding implies that the higher the actual satisfaction (gap) of customers who spend KRW5,000 or more once or more per week at coffee shops is, the higher their overall satisfaction and willingness-to-revisit are. Despite the fact that economical efficiency had a significant effect on overall satisfaction and willingness-to-revisit, college and university students still use coffee shops and are willing to spend KRW5,000 because they do not only purchase coffee as a product itself, but use the coffee shop for other activities, such as working, meeting friends, or relaxing. College and university students also access the Internet in coffee shops via personal laptops, watch movies, and study; thus, coffee shops should provide their customers with the appropriate facilities and services. The fact that a positive gap for coffee shop brand had a positive effect on willingness-to-revisit implies that the higher the level of customer satisfaction, the greater the willingness-to-revisit. A negative gap for this factor, on the other hand, implies that the lower the level of customer satisfaction, the lower the willingness-to-revisit. Thus, the brand factor has a comparatively greater effect on satisfaction than the other factors evaluated in this study. Given that the domestic coffee culture is becoming more upscale and college/university students are sensitive to this trend, students are attentive to brands. In most upscale coffee shops in Korea, the outer wall is built out of glass that can be opened, the interiors are exotic with an open kitchen. These upscale coffee shops function as landmarks and match the taste of college/university students. Coffee shops in Korea have become a cultural brand. To make customers feel that coffee shops are upscale, good quality establishments and measures to provide better services in terms of brand factor should be instituted. The intensified competition among coffee shop brands in Korea as a result of the booming industry indicates that provision of additional services is needed to differentiate competitors. These customers can also use a scanner free of charge. Another strategy that can be used to boost brands could be to provide and operate a seminar room for seminars and group study. If coffee shops adopt these types of strategies, college/university students would be more likely to consider the expenses they incur worthwhile and, subsequently, they would be more likely to be satisfied with the brands of these coffee shops, with an associated increase in their willingness-to-revisit. Gender and study year had the most negative effects on overall satisfaction and willingness-to-revisit. Female students were more likely to be satisfied and be willing to return than male students, and third and fourth-year students were more likely to be satisfied and willing-to-return than first or second-year students. Students who drink coffee, read books, and use laptops alone at coffee shops are easily noticeable. High-grade students tend to visit coffee shops alone in order to use their time efficiently for self-development and to find jobs. The economical efficiency factor had the greatest effect on overall satisfaction and willingness-to-revisit in terms of a positive gap. The higher the actual satisfaction (gap) of students with the price of the coffee, the greater their overall satisfaction and willingness-to-revisit. Economical efficiency with a negative gap had a negative effect on willingness-to-revisit, which implies that a less negative gap will result in a greater willingness-to-revisit. Amid worsening market conditions, coffee shops located around colleges/universities are using strategies, such as a point or membership card, strategic alliances with credit-card companies, development of a set menu or seasonal menu, and free coffee-shot services to increase their competitive edge. Product power also had a negative effect in terms of a negative gap, which indicates that a higher negative gap will result in a lower willingness-to-revisit. Because there are many more customers that enjoy coffee in this decade, as compared to previous decades, the new generation of customers, namely college/university students, want various menu items in addition to coffee, and coffee shops should, therefore, add side menu items, such as waffles, rice cakes, cakes, sandwiches, and salads. For example, Starbucks Korea is making efforts to enhance product power by selling rice cakes flavored in strawberry, wormwood, and pumpkin, and providing coffee or cream free of charge. In summary, coffee shops should focus on increasing their economical efficiency, brand, and product power to enhance the satisfaction of college/university students. Because shops adjacent to colleges or universities enjoy a locational advantage, providing differentiated services in terms of economical efficiency, brand, and product power, is likely to increase customer satisfaction and return visits. Coffee shop brands should, therefore, be innovative and embrace change to meet their customers' desires. Because this study only targeted college/university students in Seoul, comparative studies targeting diverse regions and age groups are required to generalize the findings and recommendations of this study.

• Journal of Intelligence and Information Systems
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• v.22 no.3
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• pp.23-43
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• 2016

As a result of the growth of Internet data and the rapid development of Internet technology, "big data" analysis has gained prominence as a major approach for evaluating and mining enormous data for various purposes. Especially, in recent years, people tend to share their experiences related to their leisure activities while also reviewing others' inputs concerning their activities. Therefore, by referring to others' leisure activity-related experiences, they are able to gather information that might guarantee them better leisure activities in the future. This phenomenon has appeared throughout many aspects of leisure activities such as movies, traveling, accommodation, and dining. Apart from blogs and social networking sites, many other websites provide a wealth of information related to leisure activities. Most of these websites provide information of each product in various formats depending on different purposes and perspectives. Generally, most of the websites provide the average ratings and detailed reviews of users who actually used products/services, and these ratings and reviews can actually support the decision of potential customers in purchasing the same products/services. However, the existing websites offering information on leisure activities only provide the rating and review based on one stage of a set of evaluation criteria. Therefore, to identify the main issue for each evaluation criterion as well as the characteristics of specific elements comprising each criterion, users have to read a large number of reviews. In particular, as most of the users search for the characteristics of the detailed elements for one or more specific evaluation criteria based on their priorities, they must spend a great deal of time and effort to obtain the desired information by reading more reviews and understanding the contents of such reviews. Although some websites break down the evaluation criteria and direct the user to input their reviews according to different levels of criteria, there exist excessive amounts of input sections that make the whole process inconvenient for the users. Further, problems may arise if a user does not follow the instructions for the input sections or fill in the wrong input sections. Finally, treating the evaluation criteria breakdown as a realistic alternative is difficult, because identifying all the detailed criteria for each evaluation criterion is a challenging task. For example, if a review about a certain hotel has been written, people tend to only write one-stage reviews for various components such as accessibility, rooms, services, or food. These might be the reviews for most frequently asked questions, such as distance between the nearest subway station or condition of the bathroom, but they still lack detailed information for these questions. In addition, in case a breakdown of the evaluation criteria was provided along with various input sections, the user might only fill in the evaluation criterion for accessibility or fill in the wrong information such as information regarding rooms in the evaluation criteria for accessibility. Thus, the reliability of the segmented review will be greatly reduced. In this study, we propose an approach to overcome the limitations of the existing leisure activity information websites, namely, (1) the reliability of reviews for each evaluation criteria and (2) the difficulty of identifying the detailed contents that make up the evaluation criteria. In our proposed methodology, we first identify the review content and construct the lexicon for each evaluation criterion by using the terms that are frequently used for each criterion. Next, the sentences in the review documents containing the terms in the constructed lexicon are decomposed into review units, which are then reconstructed by using the evaluation criteria. Finally, the issues of the constructed review units by evaluation criteria are derived and the summary results are provided. Apart from the derived issues, the review units are also provided. Therefore, this approach aims to help users save on time and effort, because they will only be reading the relevant information they need for each evaluation criterion rather than go through the entire text of review. Our proposed methodology is based on the topic modeling, which is being actively used in text analysis. The review is decomposed into sentence units rather than considering the whole review as a document unit. After being decomposed into individual review units, the review units are reorganized according to each evaluation criterion and then used in the subsequent analysis. This work largely differs from the existing topic modeling-based studies. In this paper, we collected 423 reviews from hotel information websites and decomposed these reviews into 4,860 review units. We then reorganized the review units according to six different evaluation criteria. By applying these review units in our methodology, the analysis results can be introduced, and the utility of proposed methodology can be demonstrated.

• Journal of Korean Home Economics Education Association
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• v.18 no.3 s.41
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• pp.1-22
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• 2006

The purpose of this study is that I should look for a desirous directions about home economics by studying the requirements and perception of the high school parents who have finished the course of home economics. It was about 600 parents whom I have searched Seoul-Pusan, Ganwon. Ghynggi province, Choongcheong-Gyungsang province, Cheonla and Jeju province of 600, I chose only 560 as apparently suitable research. The questions include 61 requirements about home economics and one which we never fail to keep among the contents, whenever possible and one about the perception of home economics aims 11 about the perception of home economics courses and management. The collections were analyzed frequency, percent, mean. standard deviation t-test by using SAS program. The followings is the summary result of studying of it. 1. All the boys and girls learning together about the Idea of healthy lives and desirous human formulation and knowledge together are higher. 2. Among the teaching purposes of home economics, the item of the scientific principle and knowledge for improvements of home life shows 15.7% below average value. 3. The recognition degree about the quality of home economics is highly related with the real life, and about the system. we recognize lacking in periods and contents of home economics field and about guiding content, accomplishment and application qualities are higher regardless of sex. 4. The important term which we should emphasize in the subject of home economics is family part. 5. Among the needs of home economic requirement in freshman, in the middle unit, their growth and development are higher than anything else, representing 4.11, and by contrast the basic principle and actuality is 3.70, which is lowest among them. 6. In the case of second grade requirement of home economics content for parents in the middle unit young man and consuming life is 4.09 highest. 7. In the case of 3rd grade requirement of economics contents in the middle unit the choice of coming direction and job ethics is highest 4.16, and preparing meals and evaluation is lowest 3.50.

• Journal of the Korean association of regional geographers
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• v.3 no.2
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• pp.163-193
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• 1997

Medical services are a fundamental and essential service in all urban areas. The location and accessibility of medical service facilities and institutions are critical to the diagnosis, control and prevention of illness and disease. The purpose of this paper is to present the results of a study on the location of medical facilities in Kwangju and the utilization of these facilities by the inhabitants. The following information is a summary of the findings: (1) Korea, like many countries, is now witnessing an increase in the age of its population as a result of higher living standards and better medical services. Korea is also experiencing a rapid increase in health care costs. To ensure easy access to medical consultation, diagnosis and treatment by individuals, the hierarchical efficient location of medical facilities, low medical costs, equalized medical services, preventive medical care is important. (2) In Korea, the quality of medical services has improved significantly as evident by the increased number of medical facilities and medical personnel. However, there is still a need for not only quantitative improvements but also for a more equitable distribution of and location of medical services. (3) There are 503 medical facilities in Kwangju each with a need to service 2,556 people. This is below the national average of 1,498 inhabitants per facility. The higher locational quotient and satisfactory population per medical facility showed at the civic center. On the other hand, problem regions such as the traditional residential area in Buk-Gu, Moo-deung mountain area and the outer areas of west Kwangju still maintain rural characteristics. (4) In the study area there are 86 general medicine clinics which provide basic medical services. i. e. one clinic per every 14,949 residents. As a basic service, its higher locational quotient showed in the residential area. The lower population concentration per clinic was found in the civic center and in the former town center, Songjeong-dong. In recently build residential areas and in the civic center, the lack of general medicine clinics is not a serious medical services issue because of the surplus of medical specialists in Korea. People are inclined to seek a consultation with a specialist in specific fields rather than consult a general practitioner. As a result of this phenomenon, there are 81 internal medicine facilities. Of these, 32.1% provide services to people who are not referred by a primary care physician but who self-diagnose then choose a medical facility specializing in what they believe to be their health problem. Areas in the city, called dongs, without any internal facilities make up 50% of the total 101 dongs. (5) There are 78 surgical facilities within the area, and there is little difference at the locational appearance from internal medicine facilities. There are also 71 pediatric health clinics for people under 15 years of age in this area, represents one clinic per 5,063 people. On the quantitative aspect, this is a positive situation. Accessibility is the most important facility choice factor, so it should be evenly located in proportion to demander distribution. However, 61% of 102 dongs have no pediatric clinics because of the uneven location. (6) There are 43 obstetrical and gynecological clinics in Kwangju, and the number of residents being served per clinic is 15,063. These services need to be given regularly so it should increase the numbers. There are 37 ENT clinics in the study area with the lower concentration in Dong-gu (32.4%) making no locational differences by dong. There are 23 dermatology clinics with the largest concentration in Dong-Gu. There are 17 ophthalmic clinics concentrated in the residential area because of the primary function of this type of specialization. (7) The use of general medicine clinics, internal medicine clinics, pediatric clinics, ENT clinics by the inhabitants indicate a trend toward primary or routine medical services. Obstetrics and gynecology clinics are used on a regular basis. In choosing a general medicine clinic, internal medicine clinic, pediatric clinic, and a ENT clinic, accessibility is the key factor while choice of a general hospital, surgery clinic, or an obstetrics and gynecology clinic, thes faith and trust in the medical practitioner is the priority consideration. (8) I considered the efficient use of medical facilities in the aspect of locational and management and suggest the following: First, primary care facilities should be evenly distributed in every area. In Kwangju, the number of medical facilities is the lowest among the six largest cities in Korea. Moreover, they are concentrated in Dong-gu and in newly developed areas. The desired number of medical facilities should be within 30 minutes of each person's home. For regional development there is a need to develop a plan to balance, for example, taxes and funds supporting personnel, equipment and facilities. Secondly, medical services should be co-ordinated to ensure consistent, appropriate, quality services. Primary medical facilities should take charge of out-patient activities, and every effort should be made to standardize and equalize equipment and facility resources and to ensure ongoing development and training in the primary services field. A few specialty medical facilities and general hospitals should establish a priority service for incurable and terminally ill patients. (9) The management scheme for the inhabitants' efficient use of medical service is as follows: The first task is to efficiently manage medical facilities and related services. Higher quality of medical services can be accomplished within the rapidly changing medical environment. A network of social, administrative and medical organizations within an area should be established to promote information gathering and sharing strategies to better assist the community. Statistics and trends on the rate or occurrence of diseases, births, deaths, medical and environment conditions of the poor or estranged people should be maintained and monitored. The second task is to increase resources in the area of disease prevention and health promotion. Currently the focus is on the treatment and care of individuals with illness or disease. A strong emphasis should also be placed on promoting prevention of illness and injury within the community through not only public health offices but also via medical service facilities. Home medical care should be established and medical testing centers should be located as an ordinary service level. Also, reduced medical costs for the physically handicapped, cardiac patients, and mentally ill or handicapped patients should be considered.

• 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.