• Journal of Korean Public Health Nursing
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• v.3 no.1
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• pp.74-100
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• 1989

Inspite of the lots of studies on the harmfulness of cigarette smoking to the body published by many researchers since 1950, cigarette smoking people are increasing in number especially, cigarette smoking by young and women causes a serious problem. Examining the physiological motives of youth shows that, impulse which the youth want to immitate the adults, alluring curiousity, and defiant physiology of escaping from the norm of traditional groups which has been banned are cooperated well compoundly. As the period of the youth is the one which they accumulate knowledge and charactor by learning as well as the period of growth mentally, and physically they should be rightly educated about smoking before they addicted to smoking and it is desirable for us to make the youth to understand how harmfully the smoking is to effect to their growth and mental soundness simply not as a social norm which they should not smoke. The main motive of this study on the attitude of smoking by the youth is to give basic materials related on this field. For this study, 647 questionnaires were used as studying material which were able to analyze among 720 questionnaires of 2 classes of each grade of 3 high schools among the high schools of boys, girls and co-educated in Seoul from Oct. 21, 1988 through Oct. 26, 1988. Study Instrument are graded in Likert's 5 point from 40 questions which are 20 questions m affirmations and 20 questions in negations after analyzing the factors on 60 simple sentence questions which the students showed in preliminary studies. And these are systemized to be measured from 1 point which means they think smoking IS very bad to 5points which means they think smoking is really good. In these collected materials, technical statistics of frequency. percentage, average, standard deviation are used for general character and smoking attitude, $X^2-test$ for examinning Independant variables of physical. emotional, ethical and other areas pearson's coefficient of correlation for related direction and degree" and step­regression analysis for the degree of relative contribution of all variables which effect smoking attitude. The results of this study are as follows; 1. The smoking attitude of high school boys and girls showed average of 1.78 in physical area, 2.63 in emotional area, 2.61 in ethical area, 2.29 in other area respectively in a negative attitude generally also the negative attitude are expressed most strongly in physical area. I've can also say by this results that smoking is harmful to their health and further more it can be judged that this proves the youth in the period of preparation be adults have a strong curiousity in the emotional, ethical and other areas. 2. The most influential variables in each field as related factors effecting smoking attitude of the student can be explained from 13.2 in physical area the lowest experienced variables to 25.2 in emotional area the highest of degree of smoking experience. The fact that the more the smoking experienced students are increasing in number the higher tendency which accept the' smoking tells as the importance of health education about the population of latest student's smoking as important variables shown equally in each area. Those of grade, age, numbers of smoking people in house are showed meaningful in pure interrelation. Those related to the acceptance of teacher's smoking, sex, mothors education are shown meaningful in opposite interrelations. This means that the' increasing number' of smoking people in grade age, the number of smoker in family have a affirmative attitude. And people who are not interested in teacher's smoking wants to quit it, and whose mother's education is higher have a negative attitude. 3. The most negatively answered questions of the smoking attitude In physical, emotional, ethical and other areas are as belows; Firstly too much smoking is harmful to our health is 1.12 point. Secondly smoking have a ill-effect on pregnancy and embryo is 1.13 point. Thirdly smoking is harmful· to our health is 1.27 point. Fourthly smoking in crowed area with the people such as In a bus or subway should be prohibited is 1.27point. Fifthly smoking can ruin lungs is 1.31 point. And the most affirmatively answered questions are also as below; Firstly we showed smoke depending on time and place is 3.96 points. Secondly smoking is just habit is 3.83 points. Thirdly smoking people seem to be unable and deplorable is 3.69 point. Fourthly smoking should be prohibited by law is 3.56 points. Fifthly high school student's smoking is immitation of adults is 3.52 points.

• Asia pacific journal of information systems
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• v.24 no.1
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• pp.31-50
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• 2014

The ubiquitous accessibility of information through mobile devices has led to an increased mobility of workers from their fixed workplaces. Market researchers estimate that by 2016, 350 million workers will be using their smartphones for business purposes, and the use of smartphones will offer new business benefits. Enterprises are now adopting mobile technologies for numerous applications to increase their operational efficiency, improve their responsiveness and competitiveness, and cultivate their innovativeness. For these reasons, various organizational aspects concerning "mobile work" have received a great deal of recent attention. Moreover, many CIOs plan to allocate a considerable amount of their budgets mobile work environments. In particular, with the consumerization of information technology, enterprise mobile applications (EMA) have played a significant role in the explosive growth of mobile computing in the workplace, and even in improving sales for firms in this field. EMA can be defined as mobile technologies and role-based applications, as companies design them for specific roles and functions in organizations. Technically, EMA can be defined as business enterprise systems, including critical business functions that enable users to access enterprise systems via wireless mobile devices, such as smartphones or tablets. Specifically, EMA enables employees to have greater access to real-time information, and provides them with simple features and functionalities that are easy for them to complete specific tasks. While the impact of EMA on organizational workers' productivity has been given considerable attention in various literatures, relatively little research effort has been made to examine how EMA actually lead to users' job performance. In particular, we have a limited understanding of what the key antecedents are of such an EMA usage outcome. In this paper, we focus on employees' perceived job performance as the outcome of EMA use, which indicates the successful role of EMA with regard to employees' tasks. Thus, to develop a deeper understanding of the relationship among EMA, its environment, and employees' perceived job performance, we develop a comprehensive model that considers the perceived-fit between EMA and employees' tasks, satisfaction on EMA, and the organizational environment. With this model, we try to examine EMA to explain how job performance through EMA is revealed from both the task-technology fit for EMA and satisfaction on EMA, while also considering the antecedent factors for these constructs. The objectives of this study are to address the following research questions: (1) How can employees successfully manage EMA in order to enhance their perceived job performance? (2) What internal and/or external factors are important antecedents in increasing EMA users' satisfaction on MES and task-technology fit for EMA? (3) What are the impacts of organizational (e.g. organizational agility), and task-related antecedents (e.g., task mobility) on task-technology fit for EMA? (4) What are the impacts of internal (e.g., self-efficacy) and external antecedents (e.g., system reputation) for the habitual use of EMA? Based on a survey from 254 actual employees who use EMA in their workplace across industries, our results indicate that task-technology fit for EMA and satisfaction on EMA are positively associated with job performance. We also identify task mobility, organizational agility, and system accessibility that are found to be positively associated with task-technology fit for EMA. Further, we find that external factor, such as the reputation of EMA, and internal factor, such as self-efficacy for EMA that are found to be positively associated with the satisfaction of EMA. The present findings enable researchers and practitioners to understand the role of EMA, which facilitates organizational workers' efficient work processes, as well as the importance of task-technology fit for EMA. Our model provides a new set of antecedents and consequence variables for a TAM involving mobile applications. The research model also provides empirical evidence that EMA are important mobile services that positively influence individuals' performance. Our findings suggest that perceived organizational agility and task mobility do have a significant influence on task-technology fit for EMA usage through positive beliefs about EMA, that self-efficacy and system reputation can also influence individuals' satisfaction on EMA, and that these factors are important contingent factors for the impact of system satisfaction and perceived job performance. Our findings can help managers gauge the impact of EMA in terms of its contribution to job performance. Our results provide an explanation as to why many firms have recently adopted EMA for efficient business processes and productivity support. Our findings additionally suggest that the cognitive fit between task and technology can be an important requirement for the productivity support of EMA. Further, our study findings can help managers in formulating their strategies and building organizational culture that can affect employees perceived job performance. Managers, thus, can tailor their dependence on EMA as high or low, depending on their task's characteristics, to maximize the job performance in the workplace. Overall, this study strengthens our knowledge regarding the impact of mobile applications in organizational contexts, technology acceptance and the role of task characteristics. To conclude, we hope that our research inspires future studies exploring digital productivity in the workplace and/or taking the role of EMA into account for employee job performance.

• Journal of Hospice and Palliative Care
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• v.13 no.3
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• pp.169-180
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• 2010

Purpose: This study was to identify the death recognition, meaning in life, and death attitude of participants in the death education program. Methods: A survey was conducted, and 205 data were collected. Descriptive statistics, ${\chi}^2$-test, ANOVA, and Duncan test were used. Results: 1) The followings were the characteristics of death recognition shown by the participants. Over half of the participants said that they had given some thoughts on their deaths, that they had agreeable view on death acceptance, and that diseases and volunteer works made them think about their deaths. Moreover, suffering, parting with family and concerns for them, etc. were the most common reasons for the difficulty of accepting death. As for 'the person whom I discuss my death with', spouse, friend, and son/daughter were the most chosen in this order. Lastly, the funeral type that most of the participants desired was cremation. 2) The means of meaning in life and death attitude were $2.92{\pm}0.29$ and $2.47{\pm}0.25$, respectively. There were significant differences between health status, meaning in life and death attitude. 3) A significant positive corelationship was found between meaning in life and death attitude (r=0.190, P=0.001). Conclusion: For an effective death education program that would fit each individual's situation, an educational content that can make a person understand the meaning of his or her life and death, includes knowledge to lessen the fear and anxiety of death, and helps a person heal from the loss of a family member is absolutely necessary.

• Asia-Pacific Journal of Business Venturing and Entrepreneurship
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• v.16 no.5
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• pp.31-47
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• 2021

The purpose of this study is to demonstrate the moderating effect of technology development activities in the relationship between independent variables such as entrepreneurial orientation and technology innovation capabilities and dependent variables. As a result of analyzing the causal relationship between research variables, it was found that the higher the innovation and initiative among the sub-factors of entrepreneurial orientation, the more positive the technical commercialization performance and product completion. Among the sub-factors of entrepreneurial orientation, risk-taking was found to have a significant effect only on product completion. It was found that the higher the technology commercialization capability and technology convergence capability, the higher the technology commercialization performance, the technology commercialization performance. As a result of analyzing the moderating effect of technology development activities, it was found that technology development management ability, a sub-factor of technology development activities, controls the influence relationship between innovation and risk sensitivity and technology performance. In addition, it was found that the involvement in technology development planning controls the influence relationship between technology convergence capability and technology performance among sub-factors of technology innovation capability. Based on the above analysis results, this study made three suggestions as follows. First, the achievements of technology commercialization to achieve the superiority of corporate competition depend on progressive innovation and risk-taking based on entrepreneurial orientation. It is necessary to find a way to build entrepreneurial orientation from within the organization. Second, due to the nature of the ICT industry, which has a fast pace of technological development and changes in market acceptance, technology commercialization performance will be positive when the capabilities, technology, knowledge, and resources that can quickly lead to product production can be organically linked. Finally, corporate CEOs need to further promote innovation and risk-taking through phased and continuous research activities for technology development. In addition, it is necessary to establish a corporate culture that tolerates various strategies and failures so that understanding of technology convergence can lead to technological performance.

• Journal of Global Scholars of Marketing Science
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• v.20 no.2
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• pp.188-198
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• 2010

This study attempts to examine the influence that negative WOM (NWOM) has in an online context. It specifically focuses on the impact of the service failure description and the perceived intention of the communication provider on consumer evaluations of firm competence, attitude toward the firm, positive word of mouth and behavioral intentions. Studies of communication persuasiveness focus on "who says what; to whom; in which channel; with what effect (Chiu 2007)." In this research study, we examine electronic web posting, particularly focusing on two aspects of "what": the level of service failure communicated and perceived intention of the individual posting. It stands to reason electronic NWOM that appears to be trying to damage a product’s or firm's reputation will be viewed as more biased and will thus be considered as less credible. According to attribution theory, people search for the causes of events especially those that are negative and unexpected (Weiner 2006). Hennig-Thurau and Walsh (2003) state "since the reader has only limited knowledge and trust of the author of an online articulation the quality of the contribution could be expected to serve as a potent moderator of the articulation-behavior relationship. We therefore posit the following hypotheses: H1. Subjects exposed to electronic NWOM describing a high level of service failure will provide lower scores on measures of (a) firm competence, (b) attitude toward the firm, (c) positive word of mouth, and (d) behavioral intention than will subjects exposed to electronic NWOM describing a low level of service failure. H2. Subjects exposed to electronic NWOM with a warning intent will provide lower scores on measures of (a) firm competence, (b) attitude toward the firm, (c) positive word of mouth, and (d) behavioral intention than will subjects exposed to electronic NWOM with a vengeful intent. H3. Level of service failure in electronic NWOM will interact with the perceived intention of the electronic NWOM, such that there will be a decrease in mean response on measures of (a) firm competence, (b) attitude toward the firm, (c) positive word of mouth, and (d) behavioral intention from electronic NWOM with a warning intent to a vengeful intent. The main study involved a2 (service failure severity) x2 (NWOM with warning versus vengeful intent) factorial experiment. Stimuli were presented to subjects online using a mock online web posting. The scenario described a service failure associated with non-acceptance of a gift card in a brick-and-mortar retail establishment. A national sample was recruited through an online research firm. A total of 113 subjects participated in the study. A total of 104 surveys were analyzed. The scenario was perceived to be realistic with 92.3% giving the scenario a greater than average response. Manipulations were satisfactory. Measures were pre-tested and validated. Items were analyzed and found reliable and valid. MANOVA results found the multivariate interaction was not significant, allowing our interpretation to proceed to the main effects. Significant main effects were found for post intent and service failure severity. The post intent main effect was attributable to attitude toward the firm, positive word of mouth and behavioral intention. The service failure severity main effect was attributable to all four dependent variables: firm competence, attitude toward the firm, positive word of mouth and behavioral intention. Specifically, firm competence for electronic NWOM describing high severity of service failure was lower than electronic NWOM describing low severity of service failure. Attitude toward the firm for electronic NWOM describing high severity of service failure was lower than electronic NWOM describing low severity of service failure. Positive word of mouth for electronic NWOM describing high severity of service failure was lower than electronic NWOM describing low severity of service failure. Behavioral intention for electronic NWOM describing high severity of service failure was lower for electronic NWOM describing low severity of service failure. Therefore, H1a, H1b, H1c and H1d were all supported. In addition, attitude toward the firm for electronic NWOM with a warning intent was lower than electronic NWOM with a vengeful intent. Positive word of mouth for electronic NWOM with a warning intent was lower than electronic NWOM with a vengeful intent. Behavioral intention for electronic NWOM with a warning intent was lower than electronic NWOM with a vengeful intent. Thus, H2b, H2c and H2d were supported. However, H2a was not supported though results were in the hypothesized direction. Otherwise, there was no significant multivariate service failure severity by post intent interaction, nor was there a significant univariate service failure severity by post intent interaction for any of the three hypothesized variables. Thus, H3 was not supported for any of the four hypothesized variables. This study has research and managerial implications. The findings of this study support prior research that service failure severity impacts consumer perceptions, attitude, positive word of mouth and behavioral intentions (Weun et al. 2004). Of further relevance, this response is evidenced in the online context, suggesting the need for firms to engage in serious focused service recovery efforts. With respect to perceived intention of electronic NWOM, the findings support prior research suggesting reader's attributions of the intentions of a source influence the strength of its impact on perceptions, attitude, positive word of mouth and behavioral intentions. The implication for managers suggests while consumers do find online communications to be credible and influential, not all communications are weighted the same. A benefit of electronic WOM, even when it may be potentially damaging, is it can be monitored for potential problems and additionally offers the possibility of redress.

• Asia pacific journal of information systems
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• v.19 no.4
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• pp.125-148
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• 2009

UGC(User Generated Contents) is emerging as the center of e-business in the web 2.0 era. The trend reflects changing roles of users in production and consumption of contents on websites and helps us to understand new strategies of websites such as web portals and social network websites. Nowadays, we consume contents created by other non-professional users for both utilitarian (e.g., knowledge) and hedonic values (e.g., fun). Also, contents produced by ourselves (e.g., photo, video) are posted on websites so that our friends, family, and even the public can consume those contents. This means that non-professionals, who used to be passive audience in the past, are now creating contents and share their UGCs with others in the Web. Accessible media, tools, and applications have also reduced difficulty and complexity in the process of creating contents. Realizing that users create plenty of materials which are very interesting to other people, media companies (i.e., web portals and social networking websites) are adjusting their strategies and business models accordingly. Increased demand of UGC may lead to website visits which are the source of benefits from advertising. Therefore, they put more efforts into making their websites open platforms where UGCs can be created and shared among users without technical and methodological difficulties. Many websites have increasingly adopted new technologies such as RSS and openAPI. Some have even changed the structure of web pages so that UGC can be seen several times to more visitors. This mainstream of UGCs on websites indicates that acquiring more UGCs and supporting participating users have become important things to media companies. Although those companies need to understand why general users have shown increasing interest in creating and posting contents and what is important to them in the process of productions, few research results exist in this area to address these issues. Also, behavioral process in creating video UGCs has not been explored enough for the public to fully understand it. With a solid theoretical background (i.e., theory of implementation intentions), parts of our proposed research model mirror the process of user behaviors in creating video contents, which consist of intention to upload, intention to edit, edit, and upload. In addition, in order to explain how those behavioral intentions are developed, we investigated influences of antecedents from three motivational perspectives (i.e., intrinsic, editing software-oriented, and website's network effect-oriented). First, from the intrinsic motivation perspective, we studied the roles of self-expression, enjoyment, and social attention in forming intention to edit with preferred editing software or in forming intention to upload video contents to preferred websites. Second, we explored the roles of editing software for non-professionals to edit video contents, in terms of how it makes production process easier and how it is useful in the process. Finally, from the website characteristic-oriented perspective, we investigated the role of a website's network externality as an antecedent of users' intention to upload to preferred websites. The rationale is that posting UGCs on websites are basically social-oriented behaviors; thus, users prefer a website with the high level of network externality for contents uploading. This study adopted a longitudinal research design; we emailed recipients twice with different questionnaires. Guided by invitation email including a link to web survey page, respondents answered most of questions except edit and upload at the first survey. They were asked to provide information about UGC editing software they mainly used and preferred website to upload edited contents, and then asked to answer related questions. For example, before answering questions regarding network externality, they individually had to declare the name of the website to which they would be willing to upload. At the end of the first survey, we asked if they agreed to participate in the corresponding survey in a month. During twenty days, 333 complete responses were gathered in the first survey. One month later, we emailed those recipients to ask for participation in the second survey. 185 of the 333 recipients (about 56 percentages) answered in the second survey. Personalized questionnaires were provided for them to remind the names of editing software and website that they reported in the first survey. They answered the degree of editing with the software and the degree of uploading video contents to the website for the past one month. To all recipients of the two surveys, exchange tickets for books (about 5,000~10,000 Korean Won) were provided according to the frequency of participations. PLS analysis shows that user behaviors in creating video contents are well explained by the theory of implementation intentions. In fact, intention to upload significantly influences intention to edit in the process of accomplishing the goal behavior, upload. These relationships show the behavioral process that has been unclear in users' creating video contents for uploading and also highlight important roles of editing in the process. Regarding the intrinsic motivations, the results illustrated that users are likely to edit their own video contents in order to express their own intrinsic traits such as thoughts and feelings. Also, their intention to upload contents in preferred website is formed because they want to attract much attention from others through contents reflecting themselves. This result well corresponds to the roles of the website characteristic, namely, network externality. Based on the PLS results, the network effect of a website has significant influence on users' intention to upload to the preferred website. This indicates that users with social attention motivations are likely to upload their video UGCs to a website whose network size is big enough to realize their motivations easily. Finally, regarding editing software characteristic-oriented motivations, making exclusively-provided editing software more user-friendly (i.e., easy of use, usefulness) plays an important role in leading to users' intention to edit. Our research contributes to both academic scholars and professionals. For researchers, our results show that the theory of implementation intentions is well applied to the video UGC context and very useful to explain the relationship between implementation intentions and goal behaviors. With the theory, this study theoretically and empirically confirmed that editing is a different and important behavior from uploading behavior, and we tested the behavioral process of ordinary users in creating video UGCs, focusing on significant motivational factors in each step. In addition, parts of our research model are also rooted in the solid theoretical background such as the technology acceptance model and the theory of network externality to explain the effects of UGC-related motivations. For practitioners, our results suggest that media companies need to restructure their websites so that users' needs for social interaction through UGC (e.g., self-expression, social attention) are well met. Also, we emphasize strategic importance of the network size of websites in leading non-professionals to upload video contents to the websites. Those websites need to find a way to utilize the network effects for acquiring more UGCs. Finally, we suggest that some ways to improve editing software be considered as a way to increase edit behavior which is a very important process leading to UGC uploading.

• Journal of Korean Academy of Nursing
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• v.22 no.1
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• pp.81-115
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• 1992

The problem addressed by this study was to determine the effect of nurse - patient agreement on the means to achieve nursing goals in the early postpartum period of primiparous mothers. It was hypothesized that the experimental treatment would result in hegher self-confidence and satisfaction in maternal role performance. This purpose was to contribute to the planning of nursing care to enhance self- confidence and satisfaction in maternal role performance and to the development of relevant nursing theory. Especially, the early postpartum period is crucial toward in recovery from childbirth and attainment of the maternal role. Maternal role attaintment is a complex social and cognitive process of stimulus -response accomplished by learning. Most women attain the maternal role sucessfully. But, some primiparous mothers experience difficultites in attainment of the maternal role due to lack of experience and knowledge. Self-confidence and satisfaction in maternal role performance are important factors in attainment and adjustment to the maternal role (Mercer, 1981a, 1981b ; Lederman, Weigarten, and Lederman, 1981 :Bobak and Jensen, 1985). Nursing is defined as behaviors of nurses add patients that attain nursing goals through action, reaction, interaction, and transaction. For attainment of nursing goals, active participating transactions must occur by agreement on the means to achieve those goals through nurse -patient mutual goal setting and establishment of their active relationships(King, 1981, Ha, 1977). Based on King's theory of goal attainment (1981), this stuy was planned as a non-equivalent control group, non -synchronized quasi -experimental design using agreement on the means to achieve nursing goals in early postpartum as the experimental treatment. The data were collected from July 20 to Sep. 1, 1991 by questionnaires with 60 primiparous mothers planing to breast feed after normal deliveries at W hospital in Pusan, Korea. The subjects were divided into a control group(conventional group) -those admitted from July 20 to Aug. 12, and an experimental group(agreement group) - those admitted from Aug. 13 to Sep. 1. The instument for agreement on the means to nursing goals in the early postpartum period included five steps - identification of disturbances of problems through action, reaction, and interaction with primiparous mothers : mutual early postpartal nursing goal setting : exploration of the means to achieve goals ; agreement on the means (self- care, ealry maternal -infant contact, performance of mothering behavior, and communicating about the infant's behavior and health condition) : implementation of the means. This instrument was developed on the basis of King's elements that lead to transactions in nurse-patient interactions. Lederman et al's (1981) scale for Confidence in ability to cope with tasks of motherhood and Lederman et al's(1981) scale for Mother's satisfaction with motherhood and infant care were used to measure self-confidence and satisfaction in maternal role performance ·with the subjects immediately after admission and on the day of discharge. Self-care performance in the experimental group was measured by self -evaluation tool developed by the investigator from the literature concerned. The tools to measure Pelf-confidence and satisfaction in maternal role performance, and the tool to measure self-evaluation of self-care performance were tested for internal reliability. Cronbach's Alphas were 0.94, 0.94, and 0.63. The data were analysed by using in S.P.S.S. computerized program and included percentage, x²-test, t-test, ANOVA, and Pearson Correlation Coefficient. The conclusions obtained from this study are summerized as follows : 1. The degree of self-confidence in maternal role performance of the total subjects group measured before the experimental treatment was above average with a mean score of 2.77(range 2.14-3.64). Out of 14 items, those with relatively high mean scores were ‘I would like to be a better mother than I am’(3.95), and ‘I have my doubts about whether I am a good mother’(2.87). Those with low mean scores were ‘I know that my baby wants most of the times’(2.28), ‘When the baby cries, I can tell what she /he wants’(2.37), and ‘I have confidence in my ability to care for the baby’(2;50). That is, the self - confidence of Primiparous mothers was considerably high in mothering, but rather low in activities concerning the infant care and understanding of the infant behavior. The degree of satisfaction in maternal role performance of the total subjects group measured before the experimental treatment was high with a mean score of 3.18(range 1.92-3.92). Out of 13 items, those with relatively high mean scores were ‘I am glad 1 had this baby now’(3.75), ‘I play with the baby between feedings when s/he is awake and quiet’(3.67), and ‘I enjoy being a mother’(3.27). Those with low mean scores were ‘I am upset about having too many responsibilities as a mother’(2.78), ‘It bothers me to get up for the baby at night’(2.82), and ‘I get annoyed if the baby frequently interrupts my activities’.(2.82), That is, the satisfaction of primiparous mothers was considerably high in mothering and infant care, but rather low in restraints in time or on the mother's self accomplishment and development. 2. Agreement on the means to achieve nursing goals in the early postpartum period included process of mutual goal setting, exploration of the means to achieve goals, and ahreement in concert means to achieve goals based on the mothers' condition, concerns, self-perception of the nurse - patient interactions. In the process of agreement, there was agreement that the means to achieve goals should be through trust and establishment of active relationships with the nurse through identification of problems according to planned nursing goals and active interaction, such as explanations, teaching, changing of opinions, acceptance or rejection of explanations, and proposing of questions. Therefore agreement on the means to achieve nursing goals in the early postpartum period appears to be an effective nursing intervention for primiparous mothers. 3. The degree of self- confidence in maternal role performance of the exprimental group was higher than that of the control group(t＝3.95, p＜0.01). Out of 14 items, those with higher score in the experimental group were ‘I would like to be a better mother than I am’(t＝1.93, p＜0.05), ‘I know that my baby wants most of the times’(t＝2.75, p＜0.01), ‘When the baby cries, 1 can tell what she/he wants’(t＝2.10, p＜0.05), ‘I have confidence in my ability to care for the baby’(t＝3.72, p＜0.01), ‘I trust my own judement in deciding how to care for the baby’(t＝1.96, p＜0.05), ‘I feel that I know my baby and what to do for him /her’(t＝2.44, p＜0.01), ‘I am concerned about being able to meet the baby's needs’(t＝2.87, p＜0.01), ‘I know what my baby likes and dislikes’(t＝3.26, p＜0.01), ‘I don't know to care for the baby as well as I should’(t＝2.07, p＜0.05), and ‘I am unsure about whether I give enough attention to the baby’(t＝3.04, p＜0.01), That is, the degree of self-confidence in mothering, activities concerning infant care, and understanding of infant behavior of the experimental group was higher than that of the control group. Therefore, the first hypothesis, that the degree of self-confidence in maternal role performance of the experimental group would be higher than that of the control group, was supported(t＝3.95, p＜0.01). 4. The degree of satisfaction in the maternal role performance of the exprimental group was higer than that or the control group(t＝2.31, p＜0.05). Out of 13 items, those with higher score in the experimental group were ‘I am glad I had this baby now’(t＝2.29, p＜0.05), ‘I enjoy taking care of the baby’(t＝2.4g, p＜0.01), ‘It is boring for me to care for the baby and do the same thing over and over’(t＝2.87, P＜0.01), ‘I am unhappy with the amount of time I have for activities other than childcare’(t＝2.51, p＜0.01), and ‘When bathing and diapering the baby, I would like to be doing something else’(t＝2.43, p＜0.01). That is, the degree of satisfaction in mothering, infant care, and restraints in time of on the mother's self accomplishment and development in the experimental group was higher than that of the control group. Therefore, the second hypothesis, that the degree of satisfaction in maternal role performance of the experimental group would be higher than that of the control group, was supported(t＝2.31, p＜0.05). 5. The third hypothesis, that the higher the degree of satisfaction in materenal role performance, the higher the degree of self-confidence in materenal role performance in the experimental group, was supported (r＝0.57, p＜0.01)

• 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.