장애인의 건강관련 삶의 질에 대한 사회적 결정요인의 영향 = Impact of Social Determinants on Health-related Quality of Life among the Disabled People

국문 초록 (Abstract)

본 연구는 장애인 건강불평등의 결과지표로서 건강성과를 충실히 반영하고 있는 건강관련 삶의 질에 초점을 맞춰 이의 사회적 결정요인을 다차원적으로 접근하여 구조적 인과관계를 실증적으로 규명함으로써 장애인의 건강권 보장의 실효적 실천을 위한 단초를 제공하고자 하였다. 이를 위해 재가 장애인 420명을 대상으로 구조화된 설문지를 통해 자료를 확보하여 실증적 분석을 수행하였는바 연구모형은 Solar and Irwin이 제안한 건강의 사회적 결정요인 모형을 이론적 토대로 하여 설정하였다. 즉 환경요인, 행동요인, 심리사회요인을 주요 선행요인으로 적용하고, 의료접근성을 매개변인으로 하는 구조모형을 설정하여 구조방정식을 통해 분석하였다. 또한 구조요인으로서의 거주지역과 사회경제적 지위를 상황적 맥락의 조절변인으로 설정하여 인과모형상 경향의 조절효과를 다집단분석을 통해 검증하였다. 분석결과, 환경요인으로서의 주거환경의 질, 행동요인으로서의 건강증진행동, 심리사회요인으로서의 건강자기효능감은 모두 의료접근성 및 건강관련 삶의 질에 정(+)적인 영향을 미치는 것으로 확인되었고, 거주지역과 사회경제적 지위는 그 영향을 조절하는데 통계적으로 유의미함이 확인되었다. 이에 장애인의 건강관련 삶의 질 향상을 통한 건강불평등 해소를 위해 의료비지원 등의 단편적 지원을 넘어선 사회적 결정요인에 대한 체계적 관심과 개선이 요구됨을 전제로, 의료접근성의 조응적 고려와 지역별․사회경제적 지위별 편차 해소를 위한 의료자원 배분과 직조의 형평성 확보 노력에 대한 다양한 논의를 제언하였다.

다국어 초록 (Multilingual Abstract)

This study focuses on health-related quality of life, which faithfully reflects health outcomes as an outcome indicator of health inequalities for people with disabilities, and approaches its social determinants in a multidimensional manner to empirically identify structural causal relationships, thus improving the right to health of people with disabilities. The aim was to provide a starting point for effective practice of security. For this purpose, an empirical analysis was conducted by obtaining data through a structured questionnaire targeting 420 disabled people living at home. The research model was established based on the theoretical basis of the social determinants of health model proposed by Solar and Irwin. That is, environmental factors, behavioral factors, and psychosocial factors were applied as major antecedent factors, and a structural model with medical accessibility as a mediating variable was established and analyzed through structural equations modeling(SEM). In addition, residential area and socioeconomic status as structural factors were set as control variables of the situational context, and the moderating effect of the trend in the causal model was verified through multi-group analysis. As a result of the analysis, it was confirmed that the quality of the residential environment as an environmental factor, health protection behavior as a behavioral factor, and health self-efficacy as a psychosocial factor all have a positive influence on medical accessibility and health-related quality of life, and the residential area and socioeconomic status were confirmed to be statistically significant in controlling the impact. Based on these results, in order to resolve health inequality by improving the health-related quality of life of the disabled, systematic attention to and improvement in social determinants beyond fragmentary support such as medical expenses support is required, and harmonious consideration of medical accessibility and Various discussions were proposed on efforts to secure equity in medical resource distribution to resolve differences by region/socioeconomic status.