충청북도 대사 이상 보유자를 위한 모바일 헬스케어 중재 효과 분석 : 건강행태 및 대사 지표를 중심으로 = Effectiveness of Mobile Healthcare Interventions for Individuals with Metabolic Abnormalities in Chungcheongbuk-do: Focusing on Health Behaviors and Metabolic Indicators

다국어 초록 (Multilingual Abstract)

Effectiveness of Mobile Healthcare Interventions for Individuals with Metabolic Abnormalities in Chungcheongbuk-do: Focusing on Health Behaviors and Metabolic Indicators Yeon je-ok Department of Bio-Wellness Convergence, Specialization in Nutritional Science Graduate School of Konkuk University This study evaluated the effectiveness of ICT-based mobile healthcare interventions in improving metabolic health indicators and dietary practices among Korean adults with one or more metabolic risk factors, The intervention was first implemented through public health centers in Chungju-si (2021–2023), and later expanded to rural and urban regions of Chungcheongbuk-do Province (2019 and 2023), allowing for a comparative analysis before and after the COVID-19 pandemic. A total of 1,986 participants were included in the study—244 from Chungju, 1,204 from rural areas, and 538 from urban areas—who had at least one of the following risk factors: abdominal obesity, hypertension, elevated fasting blood sugar (FBS), or dyslipidemia, as identified through national health screening data. The analysis focused on sex- and age-specific differences in health outcomes and behavioral change across intervention periods. Health indicators examined included body mass index (BMI), waist circumference (WC), systolic and diastolic blood pressure (SBP and DBP), fasting blood suger (FBS), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG). Dietary behavior was evaluated through breakfast consumption rate, sodium-reduction practice, nutrition label awareness, and a composite dietary practice score measured through self-reported adherence and mobile counseling records. Results from Chungju showed a significant decrease in BMI from 25.32 to 23.98 kg/m² (p = 0.003), WC from 89.42 to 84.83 cm (p = 0.001), and DBP from 85.34 to 76.71 mmHg (p < 0.001). In rural areas, males in their 50s experienced notable reductions in SBP (133.6 to 128.4 mmHg, p = 0.012) and DBP (85.2 to 79.1 mmHg, p = 0.007), while females in their 50s and 60s also showed statistically significant improvements in blood pressure. Similarly, in urban areas, older females saw SBP decline from 134.7 to 128.5 mmHg (p = 0.015) and DBP from 84.5 to 78.2 mmHg (p = 0.008). While FBS levels in Chungju remained stable, rural females in their 60s experienced a significant decrease from 111.2 to 103.5 mg/dL (p = 0.010), and urban females in their 50s showed a reduction from 108.4 to 101.7 mg/dL (p < 0.05). These findings underscore the strong receptiveness and engagement among middle-aged female participants in adhering to mobile health interventions. Cholesterol profiles also improved in key demographics. TC in rural females in their 60s decreased from 217.1 to 201.4 mg/dL, and LDL-C from 138.7 to 127.1 mg/dL. Among urban females in their 50s, TC fell from 211.6 to 199.5 mg/dL, and LDL-C from 136.4 to 124.9 mg/dL. HDL-C levels either remained stable or showed slight increases, particularly in female groups. For instance, rural females in their 50s had HDL-C improvements from 52.3 to 54.1 mg/dL, while men showed minimal changes. Behavioral improvements were also observed in dietary practices. In Chungju, breakfast consumption increased from 59.4% to 70.8%, and sodium-reduction practices improved from 28.1% to 44.8%. Rural males in their 50s reported an increase in breakfast consumption from 52.2% to 68.4%, and urban males in their 40s from 47.6% to 65.9%. Urban females in their 40s recorded the highest nutrition label awareness at 81.5%, suggesting a high level of health literacy and dietary awareness. The composite dietary practice score in Chungju showed significant improvements across all years of intervention. Scores increased from 2.77 to 3.98 in 2021, from 2.75 to 4.00 in 2022, and from 2.58 to 3.79 in 2023 (all p < 0.001). Male participants consistently achieved higher final-stage scores, with an average of 3.91 in 2023, reflecting greater adherence over time. While female participants demonstrated strong initial improvements, a slight decline was observed in later stages, highlighting the need for continued motivational strategies and gender-specific support to maintain behavior change. These findings provide empirical evidence supporting the effectiveness of mobile healthcare interventions delivered via public health centers and enhanced by ICT infrastructure. Despite the challenges posed by the COVID-19 pandemic, the interventions successfully improved both clinical and behavioral health outcomes across diverse regions. In particular, middle-aged female participants benefitted significantly from the program, reinforcing the importance of tailored intervention models. In conclusion, ICT-based mobile healthcare strategies present a scalable, sustainable approach to chronic disease prevention and health promotion in community settings. To maximize long-term impact, public health systems should implement sex- and age-specific interventions, integrate emotional and educational support mechanisms, develop user-friendly dietary guidance tools, and establish performance-based monitoring systems for broader regional expansion. These efforts are crucial in advancing health equity and strengthening preventive healthcare systems in the post-pandemic era. Key words: Mobile healthcare, ICT-based intervention, Metabolic syndrome, Dietary practice, COVID-19, Rural and urban comparison

목차 (Table of Contents)

• 제1장 서론 1
• 제1절 연구의 배경 1
• 제2절 연구의 목적 및 필요성 4
• 제3절 연구가설 5
• 제2장 이론적 배경 6
• 제1절 대사증후군의 정의 및 관리의 필요성 6
• 1.1 대사증후군 6
• 1.2 대사증후군의 주요 위험요인 9
• 제2절 정보통신기술 기반 모바일 헬스케어의 개념 및 역할 12
• 2.1 정보통신기술(ICT)과 보건의료의 융합 12
• 2.2 모바일 헬스케어(mHealth)의 개념 및 발전 13
• 2.3 AI·IoT 기반 공공 헬스케어 13
• 2.4 스마트 헬스케어 효과와 건강관리 활용 방안 15
• 제3절 보건소 중심 건강관리사업과 모바일 헬스케어의 결합 17
• 3.1 COVID-19 팬데믹 이후 보건소 중심 건강 관리사업의 변화 17
• 3.2 보건소 모바일 헬스케어 사업 18
• 제3장 연구내용 및 방법 21
• 제1절 연구대상 및 자료수집 21
• 제2절 연구설계 및 분석방법 22
• 제3절 연구의 기대 효과 27
• 제4장 결과 및 고찰 28
• PARTⅠ(충주시 ) 28
• 제Ⅰ절 일반적인 특성 28
• 1.1 연구 참여자의 일반적인 특성 28
• 제2절 연도별 참여자의 건강위험요인과 식생활 분석 29
• 2.1 기초 건강위험요인 변화 29
• 2.2 아침식사 섭취율과 저염식 실천율 변화 30
• 2.3 다양한 식품군 섭취 변화 32
• 2.4 식생활 실천 총점 변화 35
• 2.5 영양표시 인지율 변화 36
• 제3절 COVID-19 팬데믹 시기와 이후 시기의 건강지표 비교 분석 38
• 3.1 체질량지수 Body mass index (BMI) 변화 분석38
• 3.2 허리둘레 Waist circumference (WC) 변화 분석 40
• 3.3 수축기혈압 Systolic blood pressure (SBP) 변화 분석 41
• 3.4 이완기혈압 Diastolic blood pressure (DBP) 변화 분석 44
• 3.5 공복혈당 Fasting blood sugar (FBS) 변화 분석 46
• 3.6 중성지방 Triglyceride (TG) 변화 분석 47
• 3.7 총콜레스테롤 Total cholesterol (TC) 변화 분석 49
• 3.8 HDL-콜레스테롤 변화 분석 51
• 3.9 LDL-콜레스테롤 변화 분석 53
• 제4절 모바일 헬스케어 중재에 따른 건강지표와 식생활 변화 56
• 4.1 중재 기간별 건강지표 변화 56
• 4.2 중재 시기별 식생활 변화 62
• 4.2.1 아침식사 섭취율과 저염식 실천율 변화(2021-2023) 62
• 4.2.2 다양한 식품군 섭취 변화(2021-2023) 70
• 4.2.3 식생활 실천 총점 연도별 변화(2021-2023) 78
• 4.2.4 영양표시 인지율 변화(2021-2023) 82
• 제5절 소결 87
• PART Ⅱ(충청북도 ) 89
• 제1절 일반적인 특성 89
• 1.1 연구대상자의 일반적인 특성 89
• 제2절 COVID-19 팬데믹 이전 남녀 건강지표와 식생활지표 91
• 2.1 농촌 참여자의 건강위험요인 91
• 2.2 농촌 참여자의 식생활 실천 93
• 2.3 중소도시 참여자의 건강위험요인 94
• 2.4 중소도시 참여자의 식생활 실천 97
• 2.5 2019 농촌과 중소도시의 건강위험요인 비교 98
• 제3절 COVID-19 팬데믹 이후 남녀 건강지표와 식생활지표 101
• 3.1 농촌 참여자의 건강위험요인 101
• 3.2 농촌 참여자 식생활 실천 104
• 3.3 중소도시 참여자의 건강위험요인 105
• 3.4 중소도시 참여자의 식생활 실천 108
• 3.5 2023 농촌과 중소도시의 건강위험요인 비교 109
• 제4절 모바일 헬스케어 중재에 따른 시기별 효과 113
• 4.1 농촌지역 참여자의 건강지표 비교 113
• 4.1.1 체질량 지수 Body mass index (BMI) 변화 113
• 4.1.2 허리둘레 Waist circumference (WC) 변화 114
• 4.1.3 수축기혈압 Systolic blood pressure (SBP) 변화 116
• 4.1.4 이완기혈압 Diastolic blood pressure (DBP) 변화 118
• 4.1.5 공복혈당 Fasting blood sugar (FBS) 변화 120
• 4.1.6 총 콜레스테롤 Total cholesterol (TC) 변화 121
• 4.1.7 HDL-콜레스테롤 변화 123
• 4.1.8 LDL-콜레스테롤 변화 125
• 4.1.9 식생활 실천 변화 126
• 4.2. 중소도시의 시기별 건강지표 비교 129
• 4.1.1 체질량 지수 Body mass index (BMI) 변화 129
• 4.2.2 허리둘레 Waist circumference (WC) 변화 130
• 4.2.3 수축기혈압 Systolic blood pressure (SBP) 변화 132
• 4.2.4 이완기혈압 Diastolic blood pressure (DBP) 변화 133
• 4.2.5 공복혈당 Fasting blood sugar (FBS) 변화 135
• 4.2.6 총 콜레스테롤 Total cholesterol (TC) 변화 137
• 4.2.7 HDL-콜레스테롤 변화 138
• 4.2.8 LDL-콜레스테롤 변화 140
• 4.2.9 식생활 실천 변화 141
• 제5절 2019년과 2023년 성별·연령별 건강지표 변화 144
• 5.1 농촌지역 BMI와 허리둘레 지표의 연령 및 성별 비교 144
• 5.2 중소도시 지역 BMI와 허리둘레 지표의 연령 및 성별 비교 147
• 5.3 농촌지역 SBP, DBP, FBS 지표의 연령 및 성별 비교 150
• 5.4 중소도시 지역 SBP, DBP, FBS 지표의 연령 및 성별 비교 153
• 5.5 농촌지역 TC, HDL, LDL 지표의 연령 및 성별 비교 155
• 5.6 중소도시 지역 TC, HDL, LDL 지표의 연령 및 성별 비교 157
• 5.7 농촌지역 식생활 실천 연령별 남녀 비교 160
• 5.8 중소도시 식생활 실천 연령별 남녀 비교 164
• 제6절 소결 168
• 제5장 결론 및 제언 171
• 참고문헌 174
• 부록 190
• 1. 보건소 모바일 헬스케어 건강행태 설문지 190
• 국문초록 195