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.

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.

노인차별(ageism)의 사회경제적 관련요인과 건강영향

천희란(Chun, Heeran),김일호(Kim, Il-Ho) 한국노년학회 2013 한국노년학 Vol.33 No.3

현대사회에 들어서며 전통적으로 공경의 대상이었던 노인은 나이로 인한 부당한 대우 및 차별을 경험하게 되었다. 이 연구는 노인의 사회경제적 지위를 고려하여 노인차별경험의 관련요인을 파악하고, 차별경험으로 인한 건강 영향을 다각적으로 살펴보고자 하였다. 편의표집으로 추출된 60세-89세 345명을 대상으로 Palmore의 'The Ageism Survey' 도구를 사용하여, 노인차별경험을 측정하였다. 연구결과, 고령자의 약 45.8%가 한번 이상의 노인차별을 경험한 것으로 나타났다. 노인차별경험은 남자, 무배우자, 수입이 낮은 노인이 유의미하게 높았다. 또한 노인차별경험은 노년기 우울감과 유의미하게 높은 연관성을 보였으나, 주관적 건강수준과 고혈압과의 연관성은 보이지 않았다. 사회적 지지가 있는 경우, 노인차별경험이 크게 증가할수록 우울증상을 유의미하게 증가시키는 결과를 보였다. 이 연구결과는 한국사회의 노인차별에 대한 정책적 관심을 촉구하고, 사회적 관계를 고려한 노인차별과 건강영향 연구의 필요성을 제기하고 있다. This study aims to examine how Korean elders experience ageism, with a focus on the social determinants, and how those experiences relate to their subjective, physical and mental health. Data was gathered from a convenient sample of 345 people aged 60-89 via face-to-face interviews. Ageism was measured using a 20 item questionnaire from 'The Ageism Survey' by Palmore. Health outcomes included self-rated health, hypertension, and depressive symptom. Half of the respondents reported having experienced ageism 'more than once' in 20 listed situations. The prevalence of ageism and sub-group characteristics appeared to show a different picture compared to the results in the Palmore's US study in which higher levels of ageism were reported by men (vs. women), people without spouses (vs. with spouses), and people with lower income (vs. higher). Furthermore, the ageism experience increased the risk of having depressive symptoms, with the association still significantly consistent even after adjusting for socio-demographic characteristics by OR 1.18 (95%CI 1.09-1.28). The health effect of ageism was not observed in hypertension or self-rated health. Interestingly, for those who experienced higher levels of ageism, having social support appeared to increase the risk of depressive symptoms. Ageism and the harmful impact on health need to be better understood in social context.

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 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.

보건의료관련 학과에서 환자안전 교육에 대한 고찰

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

연구목적 : 졸업 후 환자를 바로 접하게 되는 보건의료 전공 학생들은 환자안전에 대한 올바른 개념과 지식 및 기술을 습득할 필요가 있다. 본 연구는 국내·외 보건의료인 교육과정 내 환자안전 교육에 대한 선행연구들을 검토하여 향후 국내 보건의 료전문직 관련 학과의 환자안전 교육과정을 개발하는데 기초자료를 제공하고자 한다. 연구방법 : 2000년 이후부터 2016년 4월까지 영어 검색용어는 “patient safety” AND “educational, medical” or “educational, nursing” or “educational, dental” or “educational, pharmacy” AND “curriculum management”, 국문 검색용어는 “환자안전” AND “의학 교육” 또는 “간호학 교육” 또는 “치의학교육” 또는 “약학교육” 등으로 6개의 국외 및 5개의 국내 전자문헌 database를 이용하여 체계적 문헌검색을 실시하였다. 검색된 총 12,561건의 논문이 가운데 1, 2차 문헌 선택 / 배제를 통해 본 연구 목적에 적합한 25개의 문헌이 최종적으로 선택되었다. 25건 가운데 10건이 의학, 7건이 간호학, 1건이 약학이고, 이외에 보건의료전문직 간 공동 교육프로그램은 7건이었다. 연구결과 : 문헌검토 결과, 교과과정 내 환자안전 교육방법은 강의, 소그룹토의, 역할극, 시뮬레이션, 문제기반학습 등 다양함을 알 수 있었으며, 교육내용도 환자안전에 대한 지식, 근본오류분석, 환자안전 사례, 팀협력, 의사소통 등 각 실시기관별로 차이가 있었다. 교육에 대한 평가는 주로 교육프로그램 실시 전과 후에 설문조사를 실시하였으며, 대부분 교육 후 학생들의 환자안전에 대한 지식, 태도 등이 향상되었음을 보고하였다. 결론 : 국내 보건의료 관련 학과의 환자안전 교육 과정 운영을 위해 우선적으로 실시 현황에 관한 조사가 필요하다. 다음으로 다학제적 접근으로 전공별 특성을 고려한 효과적인 방법, 필수적 교육 내용, 평가 방법 등을 포함하는 체계적인 환자안전 교육과정 개발이 필요하다. 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.

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 건강정보이해능력(Health Literacy) 측정도구 타당화

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

연구목적: “건강정보이해능력은 개인이 보건의료 관련 의사결정을 스스로 하는데 충분한 건강정보와 보건의료서비스를 제대로 얻고 처리하고 이해하는 능력”으로 정의된다. 고령자는 건강정보이해능력이 특히 취약한 인구집단이다. 이 연구는 Chew 등이 개발한 척도를 적용하여 우리나라 고령자의 건강정보이해능력을 측정하기 위한 도구의 신뢰도와 타당도를 검증하였다. 연구방법: 자료는 단면조사로 수집된 2016년 ‘서울 고령자 건강과 기능조사’ 60~79세 725명 응답자를 대상으로 분석하였다. 대상자를 무작위로 두 표본으로 나누어 표본 A (n=400)는 탐색적 요인분석과 척도의 타당화를 위한 분석에 사용하고, 표본 B (n=325)는 확증적 요인분석을 위해 사용하였다. 설문지는 번역-역번역, 전문가 교차검토 등을 통해 최종 12문항으로 구성하였고, 내적신뢰도 분석을 통해 최종 8문항을 선택하였다. 연구결과: 연구결과 8개 설문문항은 2개의 요인 구조를 보였고, 탐색적 요인분석 결과 신뢰도와 타당도가 높았다(KMO=.872, Bartlett's χ²=2431.248, df= 28, p<.001). 확증적 요인분석은 추출된 이 두 요인 구조(건강정보 “이해” 와 건강정보 “활용”)의 구성타당도가 충족되는 결과를 보였다(χ²=53.386/df=19, GFI=.960, CFI=.979, TLI=.969, RMSEA= 0.075). 결론: 본 연구는 이 도구가 고령자의 건강정보이해능력을 측정하는 도구로 타당도가 있음을 증명한다. 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

고령자의 건강리터러시에서 사회적 격차

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

연구목적: 이 연구는 사회경제적 불평등에 주목하며, 고령자의 건강리터러시와 관련된 사회적 요인을 파악하고자 한다. 연구방법: 본 연구는 단면연구이며 자료는 다단계확률추출 표집으로 서울시 각 구별 60-79세 고령자 725명을 면담한 설문 조사 결과이다. 건강리터러시 측정도구는 Chew등 연구의 16문항을 수정하여 국내 고령자를 대상으로 타당도가 입증된 8문항을 사용하였다. 대상 인구집단의 건강리터러시 수준의 높고 낮음 구분은 중위수 32점 기준으로 나누었다. 사회경제적 요인으로 교육수준은 초졸 이하, 중졸, 고졸이상 등 세 그룹으로, 기타 사회인구학적 독립변수로 연령(60대, 70대), 성별, 배우자 유무, 사회적지지, 소득이 있는 일 유무, 주관적 경제수준 및 용돈 수준 등을 고려하였다. 로지스틱 회귀분석을 사용하여 낮은 건강리터러시 수준 관련요인을 분석하고, 사회경제적 불평등을 비교하였다. 결과: 연구 결과, 참여자의 연령은 68.5세(±5.6) 이고 여자가 55%였다. 단변량 분석 결과, 고려한 모든 사회경제적 변수와 건강리터러시의 관련성이 관찰되었다. 연령보정 오즈비로 계산한 건강리터러시의 격차는 교육불평등 지표에서 두드러졌다(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). 다변량 분석 결과, 고령자, 여성, 낮은 교육수준 그룹 등이 낮은 건강리터러시의 유의한 관련 요인으로 나타났다. 결론: 본 연구결과는 우리나라 고령자의 건강리터러시 정책에서 사회경제적 불평등에 대한 관심과 특히 교육 불평등을 고려한 접근의 필요성을 제시한다. 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.