4. 기본연구보고서 2015-04 : 지역기반 환경보건정책 지원 방안 연구(1) -한국형 CARE 프로그램을 중심으로-

배현주,신용승,간순영,임유라,임종한 한국환경정책평가연구원 2015 기본연구보고서 Vol.2015 No.-

본 연구에서는 지역사회의 다양한 환경유해인자로 인한 환경보건문제들을 진단하고 이를 해결하기 위하여 국내 환경보건문제 현황과 국외의 지역기반 환경보건정책 지원수단의 절차와 방법론에 대해서 살펴보고, 이를 토대로 우리나라에 적용 가능한 지역기반 환경보건 정책지원 프로그램의 기본 틀과 도입 타당성을 제시하였다. 국내 환경보건문제 현황을 파악하기 위해 우리나라 지역사회 환경보건 이슈, 환경유해인자의 분포, 환경유해인자 노출인구의 특성, 건강영향의 지역적 분포 등 환경보건 현황을 살펴보고, 이를 토대로 지역기반 환경보건정책 지원수단의 필요성을 도출하였다. 또한 선진국에서 수행하고 있는 지역기반 환경보건정책 지원수단으로 미국 환경보호청의 CARE 프로그램, 세계보건기구의 지역 환경보건실행계획, 호주의 지방정부 환경보건 위해관리 절차를 면밀하게 검토하였다. 국외 지역기반 환경보건 정책수단 중에서 가장 체계화되어 있는 미국 환경보호청의 CARE 프로그램의 단계별 절차, 지침서, 정보, 지역 환경보건문제 우선순위 선정 방법론, 지역사회 실행 방안 등을 집중적으로 분석하였다. 이를 토대로 국내 여건을 고려한 한국형 CARE 프로그램인 지역기반 환경보건 정책지원 프로그램의 기본 원칙과 기본 틀을 제시하였다. 지역 환경보건정책 지원을 위한 한국형 CARE 프로그램은 기본적으로 ``지역사회 참여형``, ``중앙정부 주도의 하향식 형태와 지역사회 중심의 상향식을 결합한 하이브리드(hybrid) 방식``, ``지역사회 역량 및 파트너십 강화``, ``과학에 기반한 정책 수단``, ``수용체 중심의 건강영향에 근거한 지역사회 환경보건정책 수립`` 등 5가지 원칙을 토대로 구축할 필요가 있다. 한국형 지역기반 환경보건 정책지원 프로그램의 기본 틀은 환경보건정책 지원방안 계획 단계, 환경보건 현황 분석단계, 환경보건 이슈 우선순위 선정단계, 위해저감 계획 및 실행단계, 이행과정 사후 모니터링 단계로 구축하였다. 또한 지역기반 환경보건 정책지원 프로그램을 도입하기 위해서는 향후 환경보건 조사·평가기술, 취약성 평가 및 우선순위선정기술, 위해저감 및 위해소통기술에 대한 개발과 표준화가 필요하다. 지역기반 환경보건 정책지원 프로그램은 현재 환경보건문제인 환경유해인자와 건강영향의 인과관계를 명확하게 규명하기 어려운 한계점에 대해 오염원, 매체, 노출, 건강영향까지 문제를 포괄적으로 파악하고, 환경오염으로 인한 건강영향을 단계별로 관리할 수 있다. 또한 지역 내에서 문제를 일으킨 원인 제공자와 그로 인해 영향을 받는 당사자들을 참여시켜 지역에서 발생된 환경문제를 더욱 효과적으로 해결하는 데 기여할 수 있을 것으로 기대된다. This study diagnosed environmental health issues of local communities caused by various environmentally hazardous factors and reviewed the measures devised by other countries to support community-based environmental health policies. Based on the research results, this study proposed a framework and feasibility of the community-based environmental health supporting programme by taking into account the characteristics of Korea`s system. To analyze the status of domestic environmental health issues, this study identified Korea`s community environmental health issues, regional distribution of environmentally hazardous factors, characteristics of the population exposed to environmentally hazardous factors and regional distribution of health impacts. Based on the results, the need for the means to support community-based environmental health policies was derived. Also, this study reviewed the means of supporting community-based environmental health policies employed by the US EPA, the World Health Organization and the Australian government. A comprehensive analysis was conducted on the US EPA CARE programme which is the most systematic among the means of supporting environmental health policies. Based on the findings, this study proposed a framework and principle on policy support programme of community-based environmental health by considering the characteristic of Korea`s system. The policy support programme of community-based environmental health should be established based on the following principles: (1) engagement of local communities; (2) combination of government-led top-down system with community-based bottom-up approach; (3) strengthening the capacity and partnership of local communities; (4) science-based policy tools; and (5) health-based risk with focus on the receptors. The framework of Korea`s policy support programme of community-based environmental health suggested the following steps: (1) establish plans for supporting environmental health policy; (2) analyze the status of communities` environmental health; (3) define the priority among environmental health issues; (4) develop and execute risk reduction plan; and (5) evaluate progress and plan for the future. To introduce the community-based environmental health supporting programme, environmental health investigation and evaluation technology, vulnerability assessment and priority-setting technology and risk reduction and risk communication technology should be developed and standardized. The difficulty of explaining the causal relationship between environmentally hazardous factors and health impacts can be addressed by comprehensively identifying the issues ranging from pollution source, media, exposure and health impact through the community-based environmental health supporting programme. Also, health impact can also be managed step-by-step. This will contribute to effectively addressing environmental risks through the collaborative partnership between business owners and managers and local residents.

지역사회정신보건 재활간호사업이 만성정신질환자의 일상생활기술향상에 미치는 영향

이경순,김윤희 대한간호학회정신간호학회 1997 정신간호학회지 Vol.6 No.2

The purpose of this study was to develop an instrument to check daily living skills for chronic mentally ill, to analyze the effectiveness of a community-based mental health program on the improvement of daily living skills for the chronic mentally ill, to find out the difference of their daily living skill levels according to the duration of their participation in the community-based mental health program. The research design was a form of single group pre-post experimental design. The subjects for this study were 26 chronic mentally ill who lived with their family members in the community, and participated in community-based mental health program of Sonbuk Health Promoting Center. The data were gathered from August 1, 1996 to August 31, 1997, and analyzed suing paired t-test and one way ANOVA with SPSS pc. The results of this study were as follows : Main hypothesis : The hypothesis, "there will be a difference in the scores of daily living skills of chronic mentally ill according to the duration of their participation in the community-based mental health program", was supported(the mean at 0 month : 2.66, the mean after 6 months : 2.93, the mean after 12 months : 3.18, F=3.29, p=.0425). Subhypothesis 1 : The subhypotesis, "there will be a difference in the scores of before(0 month) and after(6 months) participating in the community-based mental health program", was supported(the mean at 0 month : 2.66, the mean after 6 months : 2.93, t=-3.15, p=0.004). After the participation in program, the chronic mentally ill get higher scores of their daily living skills than before the participation in the program. Subhypothesis 2 : The subhypothesis, "there will be a difference in the scores of after 6 months and 12 months after the participation in the program", was supported(the mean after 6 months : 2.93, the mean after 12 months : 3.18, t=-2.41, p=.023). Subhypothesis 3 : The subhypothesis, "there will be a difference in the scores of before(0 month) and after 12 months participation in the program", was supported (the mean at 0 month : 2.66, the mean after 12 months : 3.18, t=-4.14, p=.000). After the participation in the program, the chronic mentally ill get higer scores of their daily living skills than before the participation the program. The people who participated in the community-based mental health program for a longer period, showed the more improvement in their daily living skills.

지역사회 정신보건재활간호가 재가 만성정신질환자의 자기관리활동에 미치는 영향

양수,유숙자,이광자 대한간호학회정신간호학회 1998 정신간호학회지 Vol.7 No.2

The health care system's rapid transformation from one in which the hospital plays a major role to one in which the hospital is no longer central to the delivery of health care has had a tremendous impact on psychiatric nursing, In Korea, the community mental health system has just begun to take root. In these days, psychiatric nurse specialists have come to take an interest in rehabilitation, caring for the psychiatric patients, community mental health. However, the developmental state of the community mental health system is rudimentary and the studies which are supposed to restore the psychosocial function of the chronic mentally ill patients and insufficient. Following this requirement, this study was designed to test the effects of community-based mental health nursing program on self-care activities of mentally ill patients. The sample of this study consisted of 26 patients who were registered with certain health center in Seoul and attending this program. This study was conducted for 18 months from the beginning of Aug. 1996 to the end for Feb. of 1998. The program required a client's meeting 5 times a week and family counsellor once a week, and was consisted of home visiting and day care program. Data by using Self-care performance scale were collected four times : right after participation, and in month six, and twelve, eighteen, and analyzed by the statistical methods of Repeated Measures ANOVA. The results of this study were as follows : 1. The was a significant difference in the scores of self-care activities of chronic mentally ill according to the duration of their participation in this program in all categories except eating and sleeping activities. 2. There was a statistically significant difference between before and the 6 months after the participation in the program in the eating, individual hygiene, dressing, leisure activities. At 12-month after participating the program, the subjects showed statistically significant improvement in all categories except sleeping, home life, leisure activities. Also, there was a statistically significant difference between before and 18-month after treatment in all categories expect eating and social life activities. 3. There was no significant difference in the score of self-care activities between 6-month and 12-month after participating program. Thus, both of patients and nursing care givers are apt to be tired of their work at these time. 4. At 18-month after the participation in this program, the scores of leisure activities, social activities were significantly different from those of 6-month and 12-month. In the light of these results, community-based mental health nursing program can improve self-care activities by helping them to continue their life and to function as a good support system for the chronic mentally ill. The researchers, therefore, propose that this program should be extended to the other place and be supported by local and central government.

지역사회 기반 참여형 학교 건강증진 프로그램 개발: 인도네시아 반다아체 초등학생 적용 사례

권은주 ( Eunjoo Kwon ),나은희 ( Eunhee Nah ),정헌우 ( Heon Woo Jeong ),정후근 ( Hoo Gn Jeoung ) 대한보건협회 2016 대한보건연구 Vol.42 No.1

연구목적 : 본 연구의 목적은 지역사회 기반 참여형 학교 건강증진 프로그램을 개발하고, 인도네시아 반다아체 지역에 적용된 과정을 확인하는 것이다. 연구방법 : 2012~2014년 한국국제협력단의 지원으로 진행된 “인도네시아 반다아체 초등학생 건강증진 및 보건교육 사업”을 대상으로 하며, 프로그램 개발 및 적용과정에 지역사회 참여형 연구(CBPR)의 기본 개념이 적용되었다. 연구결과 : 지역사회 기반 참여형 학교 건강증진 프로그램은 CBPR의 원칙에 따라 개발되고, 인도네시아 반다아체 지역에 적용되었다. 개발된 프로그램은 인도네시아 반다아체 아동의 건강한 성장에 영향을 미쳤다. 결론 : 교사를 비롯한 지역사회 구성원의 참여와 협력, 역량강화는 개발도상국의 학교 건강증진 프로그램에서 중요한 부분이다. 후속 연구를 통해 개발된 프로그램의 중재 효과를 깊이 있게 파악해야 할 것이다. Objective: This study was conducted to develop and implement a community-based participatory school health program for elementary school children. Methods: This study describes how Community-Based Participatory Research(CBPR) principles were applied to the international cooperation health project entitled “School Health Promotion and Education Project in Banda Aceh, Indonesia(2012-2014)” sponsored by Korea International Cooperation Agency(KOICA). Results: A community-based school health program was developed and made progress along the principles of CBPR successfully. A program had effect on securing right to health of the children in Banda Aceh, Indonesia. Conclusion: The cooperative participation and capacity building of community members are positively necessary in the school health program for developing countries. Further studies are required to confirm and discuss intervention effects of school health program in-depth.

지역기반 주민참여 건강사업의 사례 비교 연구: 지역 맥락에 따른 연합체계 형성과 다부문 협력의 차이

허현희,손인서 한국보건사회연구원 2020 保健社會硏究 Vol.40 No.1

본 연구의 목적은 지역기반 주민참여 건강사업에 참여하는 다양한 지역 자원들 간의 협력 체계 형성과정과 연합활동에 지역맥락이 미치는 영향을 분석하고자 한다. 국내 네 개 지역의 주민참여 건강사업을 이해관계자 대상 인터뷰 자료(n=19)와 보고서 및 논문 등 이차자료(n=12)를 활용해 비교 분석했다. 심층 인터뷰는 2017년 10월부터 12월까지 수행되었으며, ‘지역사회 연합활동 이론’을 활용해 범주화하고 분석하였다. 연구결과, 최근 10여년 진행된 지역기반 주민참여 건강사업의 협력 체계의 구성과 방식은 지역 맥락과 특성에 따라 달랐다. 농촌은 지역자원이 부족한 상태이므로 사업 초기에 하향식 방법으로 주민건강위원회를 만드는 경우가 많았고 지역 엘리트에게 의존하는 경향을 보였다. 이러한 접근법은 사업 초기에는 지역민들에게 건강사업을 홍보하기에 적합하고, 다수의 관심을 이끌어내는 데 효과적이었다. 이에 반해, 상대적으로 지역자원이 풍부한 도시에서는 처음부터 상향식의 방법으로 주민을 조직하려는 경향을 보였고, 보건소의 협력 태도와 경험, 주민건강활동가의 역량 등에 따라 결과 차이를 보였다. 연구결과는 지역사회 맥락적 요인이 주민참여 건강사업의 협력주체 선정 및 연합활동에 미치는 영향을 경험적으로 규명하였다. 이 연구는 지역 특성에 따라 차별화된 사업 주체 교육, 사업평가지표의 개발, 그리고 행정지원의 개선을 제안한다. The purpose of the study is to examine how community contexts shape coalition formation and affect its implementation in community-based participatory health programs (CBPHP) of South Korea. Using a comparative case study approach, four cases were studied by drawing upon in-depth interview data and archival documents. A total of 19 stakeholders were interviewed from October to December, 2017. The Community Coalition Action Theory was used to analyze the data. Findings reveal that the collaboration strategies differ according to community contexts. Since the rural area lacks human resources and social networks, public health centers tend to rely on local elites to build health committees and implement the program. This approach is useful for publicizing the program and attracting people at an early stage. In contrast, in the urban areas, where resources are relatively abundant, community organizing tends to occur with a bottom-up approach. Its success differs by public health centers’ attitudes towards intersectoral action and lay health workers’ capacity. Community contexts have significant impact on the choices of collaborators and strategies. It is suggested to consider community contexts when training staffs, developing, and evaluating the program.

키르키즈스탄 이주민 마을 지역사회기반 영유아 건강증진 예비사업 평가

신현숙,이유나,이숙정,장윤경 한국아동간호학회 2019 Child Health Nursing Research Vol.25 No.4

Purpose: Children in migrant villages in Kyrgyzstan have a high incidence of anemia and need effective health promotion programs. The purpose of this study was to evaluate a pilot study of a health promotion project for infants and toddlers based on community participation. Methods: This was a retrospective study conducted to evaluate the effectiveness of the project. The project was carried out by nurses at a public health center, community health workers, and local residents in a migrant village. After the operational system of the project was established, health assessments, child-care education, provision of vouchers for iron supplements, and activities to improve residents' awareness were conducted during 6 months among 100 children, of whom 85 were finally analyzed. Results: In international health projects, close cooperation of the project team with community residents and health workers is important. Access to the community-based program was feasible in the socially and economically poor migrant village, and improvements were shown in children's anemia and awareness of health care. Conclusion: By focusing on the effective aspects of this preliminary project, plans to utilize community health workers and promotion strategies can be added to the main project to improve health promotion among children in this area.

재가노인을 위한 지역사회 중심의 집중건강관리프로그램의 개발과 적용

송미숙(Song, Mi-Sook),송현종(Song, Hyun Jong) 한국노년학회 2009 한국노년학 Vol.29 No.1

본 연구는 노인의 질병과 기능상태가 악화되는 것을 예방하기 위해 재가노인을 대상으로 이들의 건강문제를 집중적으로 관리하는 프로그램을 개발하는 것을 목적으로 하였다. 경기도 G시에 거주하는 재가노인을 대상으로 4주간 프로그램을 실시하였으며 실시 전후에 대상자의 건강상태를 비교하였고 프로그램에 대한 주관적인 만족도를 조사하였다. 집중 건강관리 프로그램은 만성질환 관리를 위한 진료와 간호 및 상담, 근력강화와 균형감각증진 및 관절가동범위 증진을 위한 운동, 통증관리를 위한 물리치료, 미세운동과 인지기능을 강화하기 위한 작업치료, 영양관리, 사회성 증진을 위한 치료레크레이션, 그리고 주 1회 의사의 검진으로 구성하였다. 신경정신과전문의, 재활의학과전문의, 가정의학과전문의에 의해 각각의 세부 중재 내용에 대한 검토를 받아 프로그램의 내용타당도를 확보하였다. 최종 연구대상자는 69명이었으며 대상자의 기능 및 건강수준을 영역별로 판단하기 위하여 동경도 노인종합연구소에서 개발하여 검증된 Otasha-Kensin도구를 한국보건사회연구원에서 한국어로 번역한 도구를 사용하였다. 본 연구팀이 개발한 집중 건강관리 프로그램은 노년증후군의 진행을 억제하는데 부분적으로 효과가 있었다. 특히 허약, 낙상, 영양부족 영역에서는 프로그램 중재 전에 위험군이었던 대상자가 프로그램 중재 후에 정상군으로 이동하였으나 요실금, 경증 인지기능장애 영역은 통계학적으로 유의한 차이를 보이지 않아 중재효과가 상대적으로 적었다. The purpose of the present study was to develop a community-based intensive health care program for the community dwelling elderly to strength their functional status and to verify the effect on their geriatric syndrome. A one-group pretest-posttest design was used for the study. A total of 69 frail elderly, who lived in the area within 20 minutes by car, were committed themselves to the day care center(Sangikjae), and had the ability of verbal communication were selected from G city in Kyunggi province. The participants completed a set of questionnaires to measure the sub-score of frailty, fall, urinary incontinence, malnutrition, and mild cognitive disorder domain, using the Otasha-Kensin through the physical examinations and interviews. After 4 weeks of intervention, the outcome was measured to evaluate the effects of the program, and the data obtained were analyzed using descriptive statistics, paired t-test and McNemar test. The results showed that the sub-score of frailty, fall, urinary incontinence, and malnutrition domain were statistically significantly decreased after intervention except those of urinary incontinence and mild cognitive disorder domain, implying that the risk of frailty, fall, and malnutrition was decreased. These findings indicated that community-based the intensive health care program is effective for relieving geriatric syndrome of the community dwelling elderly.

지역주민참여 보건프로그램에 대한 비판적 접근: 파라과이 뎅기열 예방 프로그램 ‘밍가 암비엔탈’의 사례

구경모 부산외국어대학교 중남미지역원 2019 이베로아메리카 Vol.21 No.2

본 연구는 지역주민참여 보건 프로그램이 정치, 경제적 요인에 의해 실천되는 과정을 파라과이 뎅기열 예방 프로그램인 밍가 암비엔탈을 통해 분석한 것이다. 비판적 의료인류학 분야에서는 보건 의료 프로그램의 실천이 해당 질병의 예방과 퇴치라는 본연의 목적 이외에 사회문화 및 정치경제적 요인이 주요 변수로 작용될 수 있음을 설명하고 있다. 같은 맥락에서 본 연구도 지역 공동체 기반의 보건프로그램이 다양한 외적 요인에 의해 어떻게 작동되는가를 분석하였다. 그 결과 밍가 암비엔탈 프로그램은 뎅기열 퇴치라는 보건 프로그램으로서 실효성에 대한 우려에도 불구하고 국가와 지역사회의 정치인, 기업 등 다양한 이해관계 집단에 의해 실천되는 경향을 보이고 있다. 이 사례를 통해 본 연구는 지역주민참여 보건 프로그램이 그 본래의 목적과 다르게 정치경제적 관계에 의해 작동될 수 있음을 파악하였다. This study analyzes how the health program is implemented by political and economic factors in the case of Minga Ambiental program in Paraguay. In the field of critical medical anthropology, the practice of health care programs explains that socio-cultural and political and economic factors can be the main variables besides the primary purpose of preventing and eradicating the disease. In the same vein, this study also analyzed how community-based health programs operate by various external factors. As a result, the Minga Ambiental program is a health program called Dengue Fever, which has been tended to be sustained and expanded by various actors, including politicians and corporations in countries and communities, despite concerns about effectiveness. In this case, this study found that health programs can be operated by political and economic relations different from their original purpose, and are intertwined in various social contexts by various actors in constructing health programs.

서울시 주민참여 건강생태계 조성사업의 성과와 한계

이도연,김창오,이요한,최민재,황민지,허현희,기명 한국보건사회연구원 2022 保健社會硏究 Vol.42 No.1

서울시 건강생태계 조성사업은 주민 스스로 지역의 건강 문제를 해결하기 위한 주민참여사업으로, 지역의 민간단체를 통해 주민참여의 기반을 조성한다는 특징을 가진다. 본 연구는 질적ㆍ양적분석을 통해 사업 성과를 평가하였다. 양적조사는 사업 참여주민 119명, 비참여주민 337명, 운영진 37명을 설문조사하였고, 질적조사는 관련 자료 분석과 활동가와 주민 각 9명, 관련 이해관계자 6명을 인터뷰하였다. 참여주민은 참여, 신뢰 등 사회적 자본 지표에서 비참여주민보다 높았으며, 운영진 설문은 주민참여 원칙이 지역에 정착하고 있고, 민관협력 구조가 만들어지고 있음을 보여주었다. 질적조사를 통해서도 비슷한 결과를 보여, 주민들의 지역보건에 대한 책임성, 새로운 주민조직(건강위원회)의 형성, 민간단체의 건강의제 기획력 강화 등의 성과를 확인하였다. 논의를 통해 서비스 제공 과정에 대한 참여와 정치적 과정(보건사업의 기획과 결정)에 대한 참여라는 양자의 관점에서 건강생태계 사업을 성과와 한계를 고찰하였다. 주된 논의는 지역보건 서비스와 연계하는 과정, 건강위원회 등의 주민자치력 강화, 민간단체를 통한 지역사회 참여 역량의 축적 가능성을 중심으로 진행하였다. Citizen participation has two traditions: one is participation in planning and decision making, and the other is participation as the part of health service providing. The Seoul Health Ecosystem Initiative is mainly characterized as a participatory project involving community-based organizations (CBOs) and activists. The initiative is also based on these two traditions and is an attempt to overcome them. The aim of this study is to evaluate the outcomes of this initiative with a view to enhancing the role of CBOs as a platform for community participation. Both quantitative and qualitative methods were used for the evaluation in the 9 communities where the initiative were carried out. Two separate quantitative surveys were conducted; 1) among 119 participants and age and gender matched 256 non-participants and among 37 activists or public health center officers. For qualitative study, investigation of document data, interviews with 18 activists or participants from 9 communities, and interviews with stakeholders were also carried out. The quantitative survey showed that the participants had higher level of social capital such as community participation and trust than non-participating residents. Results from activists or public health center officers also showed that the principle of community participation was being settled and public-private cooperation was being developed in the communities. The qualitative survey showed that communities strengthened community empowerment and built new community organizations (health committees) through health ecosystem projects.

성과기반 지역사회간호학실습 온라인 프로그램 개발과 운영 성과

안혜란,오수현 전남대학교 간호과학연구소 2023 Nursing and Health Issues(NHI) Vol.28 No.2

Purpose: The study aimed to evaluate the efficacy of an online program developed to improve community health nursing practice. Methods: After applying the online program, the achievement level of learning outcomes and satisfaction with content were evaluated. Results: A total of 124 students participated in this study. The achievement level of all 15 learning outcomes significantly increased after applying online program. in pre-post test. The mean score for learning outcomes ranged from the lowest of 4.33 to the highest of 4.76 out of 5, indicating a high overall level of achievement. The content that contributed the most towards achieving the learning outcomes was core nursing skills, scoring 4.70 out of 5. Lecture and pre-learning had the highest satisfaction rate at 72.6%, respectively. The area with the highest demand for improvement was practical education, which was 50.0%. Conclusion: In this study, the online program was effective in achieving learning outcomes. It is It is necessar y to consider the expanding and paralleling online practice that can contribute to the achievement of learning outcomes.