• Title/Summary/Keyword: validity-reliability

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A Development and Validation Study of the Web-based Korean Version of the Eating Disorder Diagnostic Scale DSM-5 (웹 기반 한국판 섭식장애진단척도 DSM-5의 개발 및 타당화 연구)

  • Lee, Hye Rin;Kwag, Kyung Hwa;Lee, You Kyung;Han, Soo Wan;Kim, Youl-Ri
    • Korean Journal of Psychosomatic Medicine
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    • v.28 no.2
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    • pp.185-193
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    • 2020
  • Objectives : The aim of this study was to develop and to verify the Korean version of the Eating Disorder Diagnosis Scale DSM-5 (K-EDDS) as a web-based diagnostic system, which enables rapid diagnosis of patients for early intervention. Methods : A total of 119 persons participated in the study, including patients with eating disorders (n=38) and college students (n=81). Along with the paper-and-pencil SCOFF, all participants completed the web-based K-EDDS, the Eating Disorder Examination-Questionaire (EDE-Q), and the Clinical Impairment Assessment Questionnaire (CIA). The semi-structured interview using the Eating Disorder Examination Interview (EDE) was conducted for participants with two or more SCOFF scores. Within two weeks, the web-based K-EDDS, the EDE-Q, and the CIA were re-tested. Results : In the exploratory factor analysis, four factors were extracted : body dissatisfaction, binge behaviors, binge frequency and compensatory behaviors. The four subscales of the web-based K-EDDS had significant correlation with each of the four subscales of the EDE-Q. The internal consistency of the web-based K-EDDS was highly satisfactory (Cronbach's alpha=0.93). The diagnostic agreement between the web-based K-EDDS and the EDE was excellent (96.83%), and the web-based K-EDDS's test-retest diagnostic agreement was fairly good (92.86%). The web-based K-EDDS and the CIA also showed significant differences between patients and general population, supporting discriminant validity. Conclusions : This study suggested that the web-based K-EDDS is a valid tool for assisting diagnosis of eating disorders based on DSM-5 in clinical and research fields.

Development and Validation of Classroom Problem Behavior Scale - Elementary School Version(CPBS-E) (초등학생 문제행동선별척도: 교사용(CPBS-E)의 개발과 타당화)

  • Song, Wonyoung;Chang, Eun Jin;Choi, Gayoung;Choi, Jae Gwang;ChoBlair, Kwang-Sun;Won, Sung-Doo;Han, Miryeung
    • Korean Journal of School Psychology
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    • v.16 no.3
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    • pp.433-451
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    • 2019
  • This study aimed to develop and validate the Classroom Problem Behavior Scale - Elementary School Version (CPBS-E) measure which is unique to classroom problem behavior exhibited by Korean elementary school students. The focus was on developing a universal screening instrument designed to identify and provide intervention to students who are at-risk for severe social-emotional and behavioral problems. Items were initially drawn from the literature, interviews with elementary school teachers, common office discipline referral measures used in U.S. elementary schools, penalty point systems used in Korean schools, 'Green Mileage', and the Inventory of Emotional and Behavioral Traits. The content validity of the initially developed items was assessed by six classroom and subject teachers, which resulted in the development of a preliminary scale consisting of 63 two-dimensional items (i.e., Within Classroom Problem Behavior and Outside of Classroom Problem Behavior), each of which consisted of 3 to 4 factors. The Within Classroom Problem Behavior dimension consisted of 4 subscales (not being prepared for class, class disruption, aggression, and withdrawn) and the Outside of Classroom Problem Behavior dimension consisted of 3 subscales (rule-violation, aggression, and withdrawn). The CPBS-E was pilot tested on a sample of 154 elementary school students, which resulted in reducing the scale to 23 items. Following the scale revision, the CPBS-E was validated on a sample population of 209 elementary school students. The validation results indicated that the two-dimensional CPBS-E scale of classroom problem behavior was a reliable and valid measure. The test-retest reliability was stable at above .80 in most of the subscales. The CPBS-E measure demonstrated high internal consistency of .76-.94. In examining the criterion validity, the scale's correlation with the Teacher Observation of Classroom Adaptation-Checklist (TOCA-C) was high and the aggression and withdrawn subscales of the CPBS-E demonstrated high correlations with externalization and internalization, respectively, of the Child Behavior Checklist - Teacher Report Form CBCL-TRF). In addition, the factor structure of the CPBS-E scale was examined using the structural equation model and found to be acceptable. The results are discussed in relation to implications, contributions to the field, and limitations.

Effect of Service Convenience on the Relationship Performance in B2B Markets: Mediating Effect of Relationship Factors (B2B 시장에서의 서비스 편의성이 관계성과에 미치는 영향 : 관계적 요인의 매개효과 분석)

  • Han, Sang-Lin;Lee, Seong-Ho
    • Journal of Distribution Research
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    • v.16 no.4
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    • pp.65-93
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    • 2011
  • As relationship between buyer and seller has been brought closer and long-term relationship has been more important in B2B markets, the importance of service and service convenience increases as well as product. In homogeneous markets, where service offerings are similar and therefore not key competitive differentiator, providing greater convenience may enable a competitive advantage. Service convenience, as conceptualized by Berry et al. (2002), is defined as the consumers' time and effort perceptions related to buying or using a service. For this reason, B2B customers are interested in how fast the service is provided and how much save non-monetary cost like time or effort by the service convenience along with service quality. Therefore, this study attempts to investigate the impact of service convenience on relationship factors such as relationship satisfaction, relationship commitment, and relationship performance. The purpose of this study is to find out whether service convenience can be a new antecedent of relationship quality and relationship performance. In addition, this study tries to examine how five-dimensional service convenience constructs (decision convenience, access convenience, transaction convenience, benefit convenience, post-benefit convenience) affect customers' relationship satisfaction, relationship commitment, and relationship performance. The service convenience comprises five fundamental components - decision convenience (the perceived time and effort costs associated with service purchase or use decisions), access convenience(the perceived time and effort costs associated with initiating service delivery), transaction convenience(the perceived time and effort costs associated with finalizing the transaction), benefit convenience(the perceived time and effort costs associated with experiencing the core benefits of the offering) and post-benefit convenience (the perceived time and effort costs associated with reestablishing subsequent contact with the firm). Earlier studies of perceived service convenience in the industrial market are none. The conventional studies that have dealt with service convenience have usually been made in the consumer market, or they have dealt with convenience aspects in the service process. This service convenience measure for consumer market can be useful tool to estimate service quality in B2B market. The conceptualization developed by Berry et al. (2002) reflects a multistage, experiential consumption process in which evaluations of convenience vary at each stage. For this reason, the service convenience measure is good for B2B service environment which has complex processes and various types. Especially when categorizing B2B service as sequential stage of service delivery like Kumar and Kumar (2004), the Berry's service convenience measure which reflect sequential flow of service deliveries suitable to establish B2B service convenience. For this study, data were gathered from respondents who often buy business service and analyzed by structural equation modeling. The sample size in the present study is 119. Composite reliability values and average variance extracted values were examined for each variable to have reliability. We determine whether the measurement model supports the convergent validity by CFA, and discriminant validity was assessed by examining the correlation matrix of the constructs. For each pair of constructs, the square root of the average variance extracted exceeded their correlations, thus supporting the discriminant validity of the constructs. Hypotheses were tested using the Smart PLS 2.0 and we calculated the PLS path values and followed with a bootstrap re-sampling method to test the hypotheses. Among the five dimensional service convenience constructs, four constructs (decision convenience, transaction convenience, benefit convenience, post-benefit convenience) affected customers' positive relationship satisfaction, relationship commitment, and relationship performance. This result means that service convenience is important cue to improve relationship between buyer and seller. One of the five service convenience dimensions, access convenience, does not affect relationship quality and performance, which implies that the dimension of service convenience is not important factor of cumulative satisfaction. The Cumulative satisfaction can be distinguished from transaction-specific customer satisfaction, which is an immediate post-purchase evaluative judgment or an affective reaction to the most recent transactional experience with the firm. Because access convenience minimizes the physical effort associated with initiating an exchange, the effect on relationship satisfaction similar to cumulative satisfaction may be relatively low in terms of importance than transaction-specific customer satisfaction. Also, B2B firms focus on service quality, price, benefit, follow-up service and so on than convenience of time or place in service because it is relatively difficult to change existing transaction partners in B2B market compared to consumer market. In addition, this study using partial least squares methods reveals that customers' satisfaction and commitment toward relationship has mediating role between the service convenience and relationship performance. The result shows that management and investment to improve service convenience make customers' positive relationship satisfaction, and then the positive relationship satisfaction can enhance the relationship commitment and relationship performance. And to conclude, service convenience management is an important part of successful relationship performance management, and the service convenience is an important antecedent of relationship between buyer and seller such as the relationship commitment and relationship performance. Therefore, it has more important to improve relationship performance that service providers enhance service convenience although competitive service development or service quality improvement is important. Given the pressure to provide increased convenience, it is not surprising that organizations have made significant investments in enhancing the convenience aspect of their product and service offering.

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Development of Work-related Musculoskeletal Disorder Questionnaire Using Receiver Operating Characteristic Analysis (Receiver Operating Characteristic 분석법을 이용한 업무관련성 근골격계질환 설문지 개발)

  • Kwon, Ho-Jang;Ju, Yeong-Su;Cho, Soo-Hun;Kang, Dae-Hee;Sung, Joo-Hon;Choi, Seong-Woo;Choi, Jae-Wook;Kim, Jae-Young;Kim, Don-Gyu;Kim, Jai-Yong
    • Journal of Preventive Medicine and Public Health
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    • v.32 no.3
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    • pp.361-373
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    • 1999
  • Objectives: Receive Operating Characteristic(ROC) curve with the area under the ROC curve(AUC) is one of the most popular indicator to evaluate the criterion validity of the measurement tool. This study was conducted to develop a standardized questionnaire to discriminate workers at high-risk of work-related musculoskeletal disorders using ROC analysis. Methods: The diagnostic results determined by rehabilitation medicine specialists in 370 persons(89 shipyard CAD workers, 113 telephone directory assistant operators, 79 women with occupation, and 89 housewives) were compared with participant's own replies to 'the questionnair on the worker's subjective physical symptoms'(Kwon, 1996). The AUC's from four models with different methods in item selection and weighting were compared with each other. These 4 models were applied to 225 persons, working in an assembly line of motor vehicle, for the purpose of AUC reliability test. Results: In a weighted model with 11 items, the AUC was 0.8155 in the primary study population, and 0.8026 in the secondary study population(p=0.3780). It was superior in the aspects of discriminability, reliability and convenience. A new questionnaire of musculoskeletal disorder could be constructed by this model. Conclusion: A more valid questionnaire with a small number of items and the quantitative weight scores useful for the relative comparisons are the main results of this study. While the absolute reference value applicable to the wide range of populations was not estimated, the basic intent of this study, developing a surveillance fool through quantitative validation of the measures, would serve for the systematic disease prevention activities.

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The Relationship of Organizational and Job Characteristics, Empowerment, Job Satisfaction and Organizational Commitment Perceived by Hospital Administrative Staffs (병원 행정인력이 인지하는 조지.직무특성, 임파워먼트, 직무만족 및 조직몰입간의 관련성)

  • 박재산
    • Health Policy and Management
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    • v.14 no.1
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    • pp.65-88
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    • 2004
  • In general, empowerment is defined as the motivational concept of autonomy and self-efficacy. Recently, the concept of empowerment is applied to improve organizational staff's job satisfaction and organizational commitment in many organizations. Empower-ment in service organizations, i.e., hospitals, has certainly generated more publicity than any other organizations. The objectives of this study are, first, to measure the degree of hospital employees' empowerment using Spreitzer(1995)'s empowerment theory, second, to analyze the causal relationship of organizational and job characteristics, a degree of empowerment, and organizational performance(job satisfaction and organizational commitment), and third, to offer the strategy for the improvement of job satisfaction and organizational commitment. Spreitzer insists that the empowerment is composed of 4 dimensions(meaning, competence, self-determination, and impact). And he argues that various work-related characteristics is a direct cause of empowerment and the indirect cause of job satisfaction and organizational commitment, mediated by the empowerment latent variable. In order to perform this study, data were collected by self-administered questionnaires from hospital employees working in administrative department of 3 university hospitals in Inchon and Kyunggi-Do region. The number of cases is 181(response rate; 86%). The Collected data were analyzed with SPSS Ver. 10.0 and AMOSV Ver. 4.0. First, to test validity of variables, the factor analysis was used. Second, to test reliability, Cronbach's alpha coefficients was calculated. Cronbach's alpha of empowerment variable is 0.8323 showing that there's no problem in regard to the internal consistency. Also the Cronbach's alpha of other variables are 0.8301 of the degree of perceived control, 0.6705 of job characteristics, O.8787 of compensation, 0.9254 of job satisfaction, and 0.8389 of organizational commitment, respectively. Among the questions of job characteristics, two survey questions are deleted due to lowering the reliability. Third, to test multicollinearity and correlation of variables, the correlation analysis was performed. There was no problem of multicollinearity. Finally structural equation modelling (SEM) analysis was conducted to find the causal relationship of organizational and job Characteristics, empowerment, job satisfaction and organizational commitment. The 16 variables are included for the SEM analysis. The major results of this study are as follows: First, in the case of model fitness, the condition of x$^2$ statistic(92.187) is not fully satisfied, but the indices of GFI(0.912), AGFI(0.863), NFI(0.917) and CFI(0.928) are partially satisfied, which needs to upper 0.90. Second, in the result of hypotheses testing, all hypotheses are accepted and have a positive effect in 95% or 99% confidence interval(P<0.05 or P<0.001) except the effect of compensation variable on empowerment(P=0.082). Third, in regard to the direct, indirect, and total effect of variables, the direct effect of perceived control, task characteristics, and compensation on job satisfaction are 0.728, 2.264, 0.328 and on organizational commitment are 0.094, 1.411, 0.418, respectively. Also the indirect effect of perceived control, task characteristics, and compensation on job satisfaction are 0.311, 0.196, 0.028 and on organizational commitment are 0.210, 0.132, 0.019, respectively. Thus, these findings imply that various work-related factors are direct effect of empowerment and indirect effect of result variables, job satisfaction and organizational commitment. Also These results showed that the workplace empowerment is significant mediating factor of employee's job satisfaction and organizational commitment.

Application of HHIE-S(Hearing Handicap Inventory for the Elderly-Screening version) to screening test of noise-induced hearing loss (소음성 난청 선별검사에 HHIE-S(Hearing Handicap Inventory for the Elderly-Screening version)의 적용)

  • Lee, Mi-Young;Suh, Suk-Kwon;Lee, Choong-Won
    • Journal of Preventive Medicine and Public Health
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    • v.29 no.3 s.54
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    • pp.539-553
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    • 1996
  • The study was conducted from May to September in 1994 to investigate applicability of the Hearing Handicap Inventory for the Elderly-Screening version(HHIE-S) in parallel with the pure-tone audiometer to the initial screening test of noise-induced hearing loss(NIHL) in some noise-exposed workers. Subjects were selected by systemic sampling that took every 10th person from 6, 700 workers taking the annual occupational health examination by the department of Health Maintenance of Dongsan Hospital Keimyung University in Taegu. The authors administered the pure-tone audiometric test and self-reported questionnaire of HHIE-S including items of sociodemographic and job-related variables concurrently. The final subjects analysed were 1,019(488 males and 531 females) excluding fourteen persons who had many missing values in their questionnaires. The reliability coefficients of HHIE-S scale by Cronbach's alpha were 0.84. In the univariate analysis of hearing handicap measured by the HHIE-S, work duration, military service and the hearing threshold loss at 1KHz and 4KHz by the initial audiometer were significant in males while age, work duration and hearing threshold loss at 1KHz and 4KHz were significant in females. In the stepwise linear regression analysis, hearing threshold loss at 1KHz and 4KHz, was the only selected variable explaining the hearing handicap in males and hearing threshold loss at 1KHz and 4KHz, age, and work duration were selected in females. In ROC curves for HHIE-S scores against NIHL as gold standard which was defined by the follow-up audiogram as more than 30dB of the average of 0.5/1/2KHz and 50dB at 4KHz, the optimal cutoff for the parallel HHIE-S appeared to be 8. The results suggest that HHIE-S appeared to have some reliability and validity in this data and might be used in screening NIHL in parallel with pure-tone audiometer in noise-exposed workers.

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Is it Possible to predict the Characteristics of Calcific Deposition in Calcific Tendinitis of Shoulder Joint? (단순 방사선 검사를 이용하여 석회성 건염에서 발생하는 석회 침착물의 성상에 대한 예측이 가능한가?)

  • Kim, Sung-Jae;Lee, Hee Jae;Lee, Kwang-Hyun;Park, Dong-Hyeok;Lee, Bong Geun
    • The Journal of Korean Orthopaedic Ultrasound Society
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    • v.7 no.2
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    • pp.77-83
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    • 2014
  • Purpose: The purpose of current study was to evaluate the validity of the existing radiological classifications as a diagnostic modality for predicting characteristics of calcific deposition in calcific tendinitis of the shoulder joint. For that purpose, we determined the inter-observer reliability for evaluating diagnostic precisions of the classification and also evaluated diagnostic accuracy of predicting the toothpaste type calcific deposition. Materials and Methods: We performed retrospective study with total 26 patients surgically treated with calcific tendinitis of the shoulder joint from March 2010 to October 2013. Two independent observers reviewed preoperative radiographs of shoulder joints, and classified the characteristics of calcific depositions according to the criteria of Gartner, DePalma and Patte. Cohen's kappa were calculated for each classifications to evaluate inter-observer reliability. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio were determined for type of calcific depositions with Gartner type III, DePalma type I, and Patte type II for predicting toothpaste type calcific deposition. Results: The values of Cohen's kappa were the highest in the classification of Patte, 0.62, and the values for the classifications of DePalma and Gartner were 0.56 and 0.36, respectively. The sensitivities for predicting toothpaste type calcific deposition in Gartner Type III, DePalma type I and Patte type II were 83.3%, 91.7%, and 58.3%, respectively. Specificities were 85.7% 50.0% and 64%, positive likelihood ratios were 5.833, 1.833 and 1.633, negative likelihood ratios were 0.194, 0.167 and 0.648, and diagnostic odds ratios were 30.00, 11.00 and 2.52, respectively. Conclusion: There were no radiologic classifications of calcific tendinitis which has both high precision and accuracy. Further studies with other diagnostic modalities such as ultrasonography are needed for predicting characteristics of calcific deposition in calcific tendinitis of the shoulder joint.

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Health-related Quality of Life Measurement with St. George's Respiratory Questionnaire in Post-tuberculous Destroyed Lung (결핵후 폐손상에서 한국어판 St. George's Respiratory Questionnaire를 이용한 건강 관련 삶의 질 평가)

  • Lee, Byoung Hoon;Kim, Young Sam;Lee, Ki Deok;Lee, Jae Hyung;Kim, Sang-Hoon
    • Tuberculosis and Respiratory Diseases
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    • v.65 no.3
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    • pp.183-190
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    • 2008
  • Background: The control of active pulmonary tuberculosis is still an issue in community medicine. But there are also considerable needs for supportive management of symptomatic patients with post-tuberculous destroyed lung. Few studies have evaluated clinical characteristics and health-related quality of life in patients with post-tuberculous destroyed lung. Methods: We evaluated lung function, exercise tolerance, HRCT and health-related quality of life measurements using the Korean version of St. George's Respiratory Questionnaire (SGRQ) in 22 patients with parenchymal damage to more than a half of one lung due to pulmonary tuberculosis. Results: In the pulmonary function test, mixed defects and obstructive defects were observed in 10 (45.0%) and 9 (40.9%) of patients, respectively. In the cardiopulmonary exercise test, the mean $VO_2max%$ predicted ($39.0%{\pm}10.9%$) and $O_2$ pulse% predicted ($61.3%{\pm}13.6%$) were markedly decreased. In the SGRQ, the impact score (mean $27.8{\pm}18.5$) was significantly lower than the symptom score (mean $53.9{\pm}20.9$) or activity score (mean $50.8{\pm}27.3$) (p<0.05, p<0.01). Cronbach's alpha coefficient value for reliability was more than 0.7 for each subscale and total score. The total score showed a significant negative correlation with $FEV_1%$ predicted (r=-0.46, p<0.05) and $SaO_2$ (r=-0.60, p<0.05). On HRCT, a median of 9 (range 5~15) bronchopulmonary segments were destroyed by less than half, which significantly correlated with SGRQ total score (r=-0.52, p=0.02). Conclusion: The reliability and validity of the Korean version of the SGRQ was acceptable for the measurement of health-related quality of life in patients with post-tuberculous destroyed lung.

Structural Relationships Among Factors to Adoption of Telehealth Service (원격의료서비스 수용요인의 구조적 관계 실증연구)

  • Kim, Sung-Soo;Ryu, See-Won
    • Asia pacific journal of information systems
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    • v.21 no.3
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    • pp.71-96
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    • 2011
  • Within the traditional medical delivery system, patients residing in medically vulnerable areas, those with body movement difficulties, and nursing facility residents have had limited access to good healthcare services. However, Information and Communication Technology (ICT) provides us with a convenient and useful means of overcoming distance and time constraints. ICT is integrated with biomedical science and technology in a way that offers a new high-quality medical service. As a result, rapid technological advancement is expected to play a pivotal role bringing about innovation in a wide range of medical service areas, such as medical management, testing, diagnosis, and treatment; offering new and improved healthcare services; and effecting dramatic changes in current medical services. The increase in aging population and chronic diseases has caused an increase in medical expenses. In response to the increasing demand for efficient healthcare services, a telehealth service based on ICT is being emphasized on a global level. Telehealth services have been implemented especially in pilot projects and system development and technological research. With the service about to be implemented in earnest, it is necessary to study its overall acceptance by consumers, which is expected to contribute to the development and activation of a variety of services. In this sense, the study aims at positively examining the structural relationship among the acceptance factors for telehealth services based on the Technology Acceptance Model (TAM). Data were collected by showing audiovisual material on telehealth services to online panels and requesting them to respond to a structured questionnaire sheet, which is known as the information acceleration method. Among the 1,165 adult respondents, 608 valid samples were finally chosen, while the remaining were excluded because of incomplete answers or allotted time overrun. In order to test the reliability and validity of the assessment scale items, we carried out reliability and factor analyses, and in order to explore the causal relation among potential variables, we conducted a structural equation modeling analysis using AMOS 7.0 and SPSS 17.0. The research outcomes are as follows. First, service quality, innovativeness of medical technology, and social influence were shown to affect perceived ease of use and perceived usefulness of the telehealth service, which was statistically significant, and the two factors had a positive impact on willingness to accept the telehealth service. In addition, social influence had a direct, significant effect on intention to use, which is paralleled by the TAM used in previous research on technology acceptance. This shows that the research model proposed in the study effectively explains the acceptance of the telehealth service. Second, the research model reveals that information privacy concerns had a insignificant impact on perceived ease of use of the telehealth service. From this, it can be gathered that the concerns over information protection and security are reduced further due to advancements in information technology compared to the initial period in the information technology industry, and thus the improvement in quality of medical services appeared to ensure that information privacy concerns did not act as a prohibiting factor in the acceptance of the telehealth service. Thus, if other factors have an enormous impact on ease of use and usefulness, concerns over these results in the initial period of technology acceptance may become irrelevant. However, it is clear that users' information privacy concerns, as other studies have revealed, is a major factor affecting technology acceptance. Thus, caution must be exercised while interpreting the result, and further study is required on the issue. Numerous information technologies with outstanding performance and innovativeness often attract few consumers. A revised bill for those urgently in need of telehealth services is about to be approved in the national assembly. As telemedicine is implemented between doctors and patients, a wide range of systems that will improve the quality of healthcare services will be designed. In this sense, the study on the consumer acceptance of telehealth services is meaningful and offers strong academic evidence. Based on the implications, it can be expected to contribute to the activation of telehealth services. Further study is needed to assess the acceptance factors for telehealth services, such as motivation to remain healthy, health care involvement, knowledge on health, and control of health-related behavior, in order to develop unique services according to the categorization of customers based on health factors. In addition, further study may focus on various theoretical cognitive behavior models other than the TAM, such as the health belief model.

A Diagnostic Study on High School Students' Health and Quality of Life - Based on the PRECEDE model - (고등학생의 건강 및 삶의 질에 대한 진단적 연구 - PRECEDE 모형을 근간으로 -)

  • Yoo Jae-Soon;Hong Yeo-Shin
    • The Journal of Korean Academic Society of Nursing Education
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    • v.3
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    • pp.78-98
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    • 1997
  • Health education, as the most fundamental concept for national health promotion, alms for developing the self-care ability of the general public. High school days are regarded as the period when most important physical, mental and social developments occur, and most health-related behaviors are formed. School health education is one of the major learning resources influencing health potential in the home and community as well as for the individual student. High school health education in Korea has a fundamental systemic flaw in that health-related subjects are divided and taught under various subjects areas at school. In order to achieve the goal of school health education, it is essential to make a systematic assessment of the learner's concerns connected with his health and life, and the factors affecting them. So far, most of the research projects that had been carried out for improving high school health education were limited in their concerns to a particular aspect of health. Even though some had been done in view of comprehensive school health education, they failed to Include a health assessment of the learner. Therefore, in this study the high school students' concerns related to health and life were investigated in the first place on the basis of the PRECEDE model, developed by Green and others for the purpose of a comprehensive diagnostic research on high school health education. This study was done in two steps : one was the basic study for developing research instrument and the other was the main one. The former was conducted at five high schools in Seoul and Cheongju for 2 months-beginning in March, 1996. The students were asked to respond to questions related to their health and lives in unstructured open-ended question forms. On the basis of analysis of the basic study, the diagnostic instruments for the quality of life, health problems, health behavior and educational factors were constructed to be used for the collection of data for main study. An expert panel and the pilot study were used to improve content validity and reliability of the instruments. The reliability of the instruments was measured at between .7697 and .9611 by the Cronbach $\alpha$. The data for this study were collected from the sample consisted of the junior and senior classes of twenty general and vocational high schools in Seoul and Cheongju for two months period beginning in July, 1996. In analyzing the data, both t-test and $X^2$-test were done by using SAS-$PC^+$ Program to compare data between the sexes of the high school students and the types of high school. A canonical correlation analysis was carried out to determine the relationships among the diagnostic variables, and a multivariate multiple regression analysis was conducted by using LISREL 8.03 to ascertain the influences of variables on the high school students' health and quality of life. The results were as follows : 1) The findings of the hypothesis tests (1) The canonical correlation between the educational diagnosis variables and behavioral, epidemiological, social diagnosis variables was .7221, which was significant at the level of p<.001. (2) The canonical correlation between the educational diagnosis variables and the behavior variables was .6851, which also was significant (p<.001). (3) The canonical correlation between the behavioral diagnosis variables and the epidemiological variables was 4295, which was significant (p<.001). (4) The canonical correlation between the epidemiological diagnosis variables and the social variables was .6005, which was also significant (p<.001). Therefore, the relationship between each diagnosis variable suggested by the PRECEDE model had been experimentally proven to be valid, supporting the conceptual framework of the study as appropriate for assessing the multi-dimensional factors affecting high school students' health and quality of life. Health behavior self-efficacy, the level of parents' interest and knowledge of health, and the level of the perception of school health education, all of which are the educational diagnostic variables, are the most influential variables in students' health and quality of life. In particular, health behavior self-efficacy, a causative factor, was one of the main influential variables in their health and quality of life. Other diagnostic variables suggested in the steps of the PRECEDE model were found to have reciprocal relations rather than a unidirectional causative relationship. The significance of this research is that it has diagnosed the needs of high school health education by the learner-centered assessment of variety of factors related to the health and the life of the students. This research findings suggest an integrated system of school health education to be contrived to enhance the effectiveness of the education by strengthening the influential factors such as self-efficacy to improve the health and quality of the lives of high school students.

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