노년기 남녀의 주관적 건강 수준에 대한 생애과정적 고찰

천희란(Chun, Heeran),김정석(Kim, Cheong-Seok) 한국인구학회 2016 한국인구학 Vol.39 No.3

본 연구는 노년기 주관적 건강수준을 생애과정적 관점에서 논의해 보고자 한다. 노인들의 주관적 건강수준은 노년기 삶의 질을 대변하는 한편, 노년 사망의 주요 예측치로 알려져 있다. 노년기 건강은 노년기와 그 이전 삶의 단계에서의 사회경제적 지위에 따라 차이가 나며, 생애과정에 걸쳐 지속되고 누적되는 성격을 띠고 있다. 본 연구는 이에 주목하여 현재 노인들의 유년기, 청 · 장년기, 노년기 사회경제적 지위가 갖는 효과를 생애단계별로 구분해보고 이들이 어떤 방식으로 노년기의 건강수준에 이를 것인가를 고민하고 있다. 또한, 건강과 사회경제적 지위를 둘러싼 삶의 궤적은 남녀간에 차이를 보이는 것으로 알려져 있다. 따라서 생애단계별 사회경제적 지위의 효과를 성별로 살펴보는 작업이 동시에 요구된다. 경험적 분석을 위해 제4기 국민건강영양조사자료(2007~2009년)를 활용하였다. 이 자료에는 부모의 교육이나 직업 등 유년기 환경과 관련된 지표가 포함되어 있다. 주관적 불건강에 대한 로짓회귀분석 결과, 청·장년기와 노년기 현재의 사회경제적 위치 효과가 유년기의 효과를 대체 혹은 포괄하는 것으로 나타난다. 이는 유년기의 사회경제적 지위가 노년까지 직접적인 효과를 가지기 보다는 청장년기의 그것으로 이어지고 흡수된 결과로 이해된다. 이 패턴은 대체로 남녀에게 공통적으로 발견되기도 하지만, 여전히 성별에 따라 차별적인 모습도 보인다. 본 논문은 노년기의 건강상태를 현재의 시점에서 이루어지는 건강행위와 더불어 개인의 삶의 궤적을 통해 연구해야 할 필요성을 재확인시켜준다. This study approached health in old age through a life course perspective. Self-rated health is widely known to reflect one"s general health status and quality of life, as well as serve a valid predictor of mortality. Socioeconomic status not only affects health in later life, but the effect persists and accumulates through one"s life. In employing a life course approach, we focus on the effect of one"s socioeconomic status on health by life stages - early life, adult life, and old age. The socioeconomic impact on health is also determined by gender, so we conducted the analysis by gender separately. We utilized a representative sample of people aged 60 to 79 from the 4th Korea National Health and Nutritional Examination Survey, with variables for the early life environment such as parental education and occupation. Multivariate logistic analysis revealed that the early life effect appeared to be associated with adult socioeconomic status, not directly on the effect of health in later life. This also showed gender differential patterns in some associations. Our results highlight the importance of one"s life course trajectory, along with gender, to understand one"s health in later life.

보건의료관련 학과에서 환자안전 교육에 대한 고찰

천희란 ( Heeran Chun ),신은희 ( Eunhee Shin ) 대한보건협회 2016 대한보건연구 Vol.42 No.4

Objective : It is essential for students in the health care professional discipline to get enough education on patient safety regarding its concept, knowledge, and skills, as they are soon to work with patients upon completing graduation. We sought to systematically review the existing literature on patient safety programs in undergraduate and pre-registration courses, and also to provide evidence for future direction in developing school based curricula for health care professionals in South Korea. Methods : Various online databases were systematically reviewed from January 2001 to April 2016 which included 6 international DB sources (Ovid-Medline, Ovid-EMBASE, PubMed, Cochrane, ERIC, and Academic Search Premier) and 5 Korean DB sources (KoreaMed, KMbase, KISS, RISS, KisTi), with keywords of “patient safety” AND “educational, medical” or “educational, nursing” or “educational, dental” or “educational, pharmacy” AND “curriculum management”. For review, 25 papers were finally selected from the initial group of 12,561. Among the final 25 papers selected, 10 were from medical education, 7 were from the nursing area, 1 was from pharmacy education, and the remaining 7 papers were interdisciplinary. Results : We categorized the patient safety programs into methods, contents, and evaluation. Methods varied including lectures, small group discussions, role plays, simulations, and problem based learning(PBL). Contents were also varied including knowledge, medical error theory, root cause analysis, case studies, collaboration, and communication, etc. Evaluation was usually conducted by pre-post surveys, in which the improvement in knowledge and attitude of students on patient safety issues through the education was revealed. Conclusion : Our review suggests that we should identify the current status of patient safety courses and develop a national framework for undergraduate/pre-registration programs in South Korea, especially through an inter-professional team work approach.

고령자의 헬스리터러시 관련 요인: HLS-EU-Q16 측정도구 활용

천희란(Heeran Chun),이주열(Ju Yul Lee) 한국보건교육건강증진학회 2020 보건교육건강증진학회지 Vol.37 No.1

Objectives: This study was performed to identify and investigate the factors associated with the level of health literacy among older adults in Seoul, using the European Health Literacy Survey Q16(HLS-EU-Q16) measure. Methods: Data were drawn from a cross-sectional study conducted in Seoul of older residents, aged 60~79. A total of 302 elderly were recruited according to gender, age, and geography. Health literacy was assessed using the short version of the HLS-EU-Q16. The comprehensive health literacy measure consists of three domains: health care, diseases prevention, and health promotion. For explanatory variables, demographic(gender, age, marital status), socioeconomic(education level, subjective economic status, National Basic Livelihood Act recipients), and health-related factors (self-rated health, number of chronic diseases and, medical check-ups) were considered. Descriptive statistics and multivariate linear regression models were used to identify variables associated with health literacy. Results: The mean score of health literacy was 11.4±3.7. Multivariate regression analyses found significant associations between health literacy and education, subjective economic status(higher), number of chronic diseases(over 3), and medical check-up(additional). Associated factors differed by domain-specific health literacy. Conclusion: Health promotion programs for elderly should pay more attention to vulnerable groups in regarding health literacy. The results call for further studies with utilizing longitudinal design and diverse measures.

고혈압 인지율의 평가와 연령별 특성

천희란(Heeran Chun),김일호(Il-Ho Kim) 한국보건교육건강증진학회 2016 보건교육건강증진학회지 Vol.33 No.5

Objectives: This study examines the awareness of hypertension and its age-specific characteristics among Korean adults. Methods: Data were derived from the fourth Korean National Health Examination and Nutrition Survey (KNHANES IV, 2007-2009) of 14,637 subjects aged 30 and older. Self-reported prevalence of hypertension (HTN) was compared with measured arterial systolic/diastolic blood pressure, employing Kappa index, sensitivity, and specificity. Multiple logistic regression analysis was used to determine factors in hypertension awareness by age groups. Results: Kappa agreement between self-reported and measured data in hypertension was high (0.70, 95% CI 0.68-0.71). Awareness by sensitivity was relatively high (65.3%) and specificity was very high (98.8%) for all ages. After age stratification, the results revealed the very lowest level of hypertension awareness among the youngest age group: 29.1% of adults aged 30-49 years, 57.5% of adults aged 45-59 years, and 76.9% of those aged ≥ 60 years. Predictors for awareness differed by age group. Among adults aged 30-49 years, men exhibited lower awareness to HTN than women. Among middle-aged adults, workers showed lower awareness than non-workers. Among those aged ≥ 60 years, men and the less educated showed lower awareness to HTN than their counterparts. Conclusions: Age-specific prevention strategies are needed for hypertension management.

고령자의 건강정보이해능력(Health Literacy) 측정도구 타당화

천희란 ( Heeran Chun ),조성일 ( Sung-il Cho ),김일호 ( Il-ho Kim ) 대한보건협회 2018 대한보건연구 Vol.44 No.4

Objective : Health literacy (HL) is, defined as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” Being old is one of the main risk factors with limited health literacy. This study aims to adapt Chew’s health literacy scale into the Korean language and validate the scale for the use of the elderly. Methods : Data were drawn from the ‘2016 Seoul Survey on Elderly Health and Functional Assessment, which includes a total of 725 people aged 60 to 79. The sample was randomly divided into two groups for reliability and validity tests of the modified Chew’s scale of 8 items. The Korean version of the questionnaire was developed by group translation, expert reviews, and forward-backward translation. Exploratory and confirmatory factor analyses were conducted to assess and validate the factor structure of the scale. Results : Results suggest the two-factor structure (“Understanding” and “Applying” of HL) with 8 items. Exploratory factor analyses of the first sample (n=400) revealed that the internal reliability of the scale was high (Cronbach`s α=.904). Principal axis factoring extracted two factors (“Understanding” and “Applying” of HL) and explained 78.3% of total variance (KMO=.872, Bartlett's χ²=2431.3, df= 28, p<.001). Confirmatory factor analysis of the second sample (n=325) was performed and the two-factor model was supported (GFI=.960, CFI=.979, TLI=.969, RMSEA= 0.075). Conclusions : This study provides evidence for adequate criterion and validity of the health literacy scale for the community dwelling elderly in Korea

중 · 고령인구에서 비만과 만성질환 관리를 위한 비만 측정 지표 비교

천희란(Heeran Chun),박은자(Eun-Ja Park),김일호(Il-Ho Kim),조성일(Sung-il Cho) 한국보건교육건강증진학회 2014 보건교육건강증진학회지 Vol.31 No.5

Objectives: This study was to examine the associations between obesity level and major chronic diseases in older population in Korea, using different obesity indicators. Methods: Data was from the 2008 KloSA Biomarker pilot, a nationwide sample of 514 non-institutionalized subjects (age 63.6±9.8 years; women 57.2%). Anthropometric information was collected by home visiting nurses. Portable bioimpedence devices(Omran HBF359) were used for measuring fat mass. Obesity cut-offs used the Asian criteria of BMI≥25, WC≥90/85cm, and fat%≥ 25/35 for men and women. Chronic disease prevalence was defined by physician-diagnosed history of 8 specified diseases. Results: Prevalence of chronic diseases significantly increased with increment of obesity level by BMI, WC and fat %. Odds ratios of acquiring chronic diseases remained significant in the obese group (BMI OR 2.76, 95%CI 1.82-4.19; WC OR 2.73, 95%CI 1.81-4.11; Fat OR 1.87 95%CI 1.26-2.78), after adjusting for age, sex, marital status, education, work participation, household income, smoking, drinking, and exercise. Conclusions: Obesity measured by all three indicators, BMI, WC, and fat mass cannot be disregarded, accentuating the significant effect on increases in disease risks among older population. BMI and WC measure appeared better to assess the risks of chronic diseases.

우리나라 헬스리터러시 측정 도구의 연구 동향 분석: 주제범위 문헌고찰(Scoping review)

천희란(Heeran Chun),김수현(Su Hyun Kim),박은자(Eunja Park) 한국보건교육건강증진학회 2022 보건교육건강증진학회지 Vol.39 No.4

Objectives: This study aims to provide a descriptive review of the published health literacy measurement tools developed and validated in South Korea. Methods: Using Scoping Review methods, a literature review was conducted by scanning international and Korean databases (PubMed, CINAHL, Scopus, RISS, SCIENCEON, KoreaMed). Among the 181 articles explored, 26 were included in the review. Results: Of the 26 articles (27 tools) reviewed, 17 measured general health literacy, while nine were content/context specific. Among the 17 general health literacy measures, 12 tools were translated (from REALM, NVS, Chew, HLS-EU, and HL-SDHQ) and five were newly developed in the Korean context. Except for the REALM-family measures, all the general health literacy instruments apply multi-dimensional characteristics. Most health literacy measures had acceptable reliability (α=>.70) and reported a diverse validation process (81% of the 26 articles). Conclusion: Newly developed health literacy measures need to be validated in a cultural and language-specific context. Future health literacy measures should focus on specific information concerning health literacy measures, such as time for evaluating literacy status, representative sampling for testing, and understudied populations, such as young individuals. Future systematic reviews should be conducted with further rigorous quality assessment of the health literacy instruments in Korea.

여성의 건강리터러시와 건강행동

천희란 ( Chun Heeran ),박은자 ( Park En-ja ) 한국보건사회연구원 2023 보건복지포럼 Vol.321 No.-

This study aimed to assess women’s health literacy levels and health literacy characteristics from a life-course perspective, with a focus on the relationship between health literacy and eight health behaviors. Analysis using a single-item health literacy measure (SILS) revealed that 24.6% of Korean women had ‘limited’ health literacy, with significant variations observed across different age groups. The risk of low health literacy among Korean women notably increased after the age of 65 compared to the 16-64 age group, and among older adults aged 75 and above, approximately 60% experienced health literacy problems. The group with low health literacy showed lower subjective health levels and appeared to engage in poorer health behaviors across all age groups. The association between health literacy and health behaviors varied across different life stages, as evident in indicators such as current and past smoking, binge drinking, physical activity, HPV vaccination, cervical cancer screening, and breast cancer screening. Therefore, there is a need for evidence-based health literacy programs in various domains to promote health equity and improve women’s health.

대학생의 디지털 건강리터러시와 예방적 건강행동: 코로나19 백신접종 의향 및 방역 참여를 중심으로

천희란(Chun, Heeran),윤혜란(Yoon, Hye-ran),최슬기(Choi, Seul Ki),박은자(Park, Eun Ja) 한국인구학회 2021 한국인구학 Vol.44 No.2

고령자의 건강리터러시에서 사회적 격차

천희란 ( Heeran Chun ) 대한보건협회 2020 대한보건연구 Vol.46 No.1

Objective: This study aims to assess the associated factors in health literacy, focusing on the socioeconomic inequalities among older adults. Methods: Data were drawn from a cross-sectional design, which includes 725 non-institutionalized older Koreans aged 60-79 residing in Seoul, from a multistage probability sample. The health literacy measure of 8 questions was modified and validated from Chew’s 16 Questionnaire. The lower health literacy group was divided by the median score of health literacy 32(range 11-40). Education was classified by three groups; elementary school or lower, middle school, high school or over. Other independent variables included age, gender, marital status, social support, working status, subjective economic status, and pocket money. Logistic regression models were used to examine the relative inequality in low health literacy. Results: The mean age of the sample was 68.5(±5.6) of which 55% were women. Bivariate analysis demonstrated significant associations between all considered socioeconomic positions and health literacy. Educational disparity in health literacy was prominent, with the odds of getting lower health literacy increasing by the lower level of education (aOR 2.15 95%CI 1.45-3.19, and aOR 3.85 95%CI 2.38-6.23; RII 10.37 95%CI 5.57-19.32). Multivariate results showed that older age, women, and lower education were associated with lower health literacy. Conclusion: The finding calls for more attention to educational disparity in health literacy among older adults in Seoul.