Research in Community and Public Health Nursing

Volume 14 (4); December 2003

Original Articles

The Effect of Case Management Program for Diabetic Patients in Korean Community: Eun Young Shin, Cheol Hwan Kim, Won Sob Yoo, Hee Girl Kim, Chang Yub Kim; J Korean Acad Community Health Nurs. 2003;14(4):559-567. Published online December 31, 2003

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Abstract PDF: BACKGROUND
We first launched the case management program for diabetic patients who were registered in NHIC (National Health Insurance Corporation) in Korea and conducted this study to assess the effectiveness of the program.
METHODS
During the period from October in 2002 to March in 2003, 30 case managers performed the program for 71 diabetic patients. We evaluated the effectiveness of the program based on the results of fasting blood sugar level, two hour post-prandial blood sugar level, knowledge for diabetes, difficulty index in diabetes management, and the health risk factor changes of them. We analyzed results related to these factors through chi2 test and paired t-test.
RESULTS
The average age of the subjects was 58.9, and the numbers of women and men were 43 and 28 respectively. The fasting blood sugar level and two hour post-prandial blood sugar level decreased from 164.3mg/dl to 146.5mg/dl and from 224.0mg/dl to 203.0mg/dl respectively. The knowledge for diabetes and difficulty index in diabetes management changed from 8.13 to 9.10 and from 3.52 to 2.91 respectively, and these changes were the positive. We observed improvement in self-test of sugar level, foot management, oral hygiene and proper medication but not in self-test of nutritional management.
CONCLUSIONS
This study revealed that the case management program for diabetic patients who were registered in NHIC is significantly effective. However, the program need to study further to understand its long-term effects.

Effects of Self Care Program on Hypertensive Control in Hypertensive Patient: Ok Ran Kim; J Korean Acad Community Health Nurs. 2003;14(4):568-578. Published online December 31, 2003

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Abstract PDF: This study was conducted to estimate the effects of self-care program on knowledge and symptoms related hypertension self-care and physiological index in essential hypertensive patients aged between 35~74 year. The subjects for the experiment group and the control group of this study were 70 men and women selected through random sampling from adults at Sangju Red Cross Hospital in Gyeongsanbuk-do, and the experiment was carried out during the period from the 15th of September to the 30th of April in 2002. This study measured systolic and diastolic blood pressure (SBP, DBP, the mean value of the two measures) and total cholesterol (TC) and surveyed the subjects' diet and life style in relation to hypertension using a self-report questionnaire. In order to study the significance of the effects of self-care program, the author carried out t-test, paired t-test, ANCOVA, chi-square analysis and effectiveness index (EI) analysis.
Results
of the study are as follows: The experiment group got higher mean scores than the control group in the degree of low sodium intake and the degree of high calcium and high potassium intake, and the difference was statistically significant (P<0.05). The effectiveness index of the self-care program in smoking was 0.797 at the 1st posttest and 0.601 at the 2nd posttest, and in physical activities 0.600 at the 1st posttest and 0.849 at the 2nd posttest. The rate of regular antihypertensive drugs intake of the experimental group was higher than that of the control group, and the effectiveness index of the self-care program was 0.715. The mean score of the systolic blood pressure of the experimental group was lower than that of the control group, and the difference was statistically significant (P<0.05). In conclusion, these findings support usefulness of self-care programs in reducing systolic blood pressure and in promoting self-care related to diet and life style for treating and preventing hypertension.

Evaluation research on the application of Problem-Based Learning program in community health nursing: Chung Yul Lee, Won Jung Cho, Margaret J Storey, Eui Sook Kim, Kyung Hee Lee, Sun Hyoung Bae, Gwang Suk Kim, Ku Min Seo, Ok Kyung Ham; J Korean Acad Community Health Nurs. 2003;14(4):579-586. Published online December 31, 2003

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Abstract PDF: The goal of community health nursing courses is to prepare student nurses so that they become able to perform a variety of nursing roles in community. To achieve this goal, programs for community health nursing must develop students' abilities to function independently as community health nurses. This study evaluated the effectiveness of Problem-based Learning(PBL) as a teaching method in programs for community health nursing at four-year colleges of nursing. The subjects of this study were senior students at Y University. The study was designed as a descriptive & comparative survey. To determine the effectiveness of PBL, the author analyzed the process and results of teaching. The PBL teaching method was found to be significantly effective in building critical thinking abilities and increasing knowledge. The results also showed that the 43 students who were taught by both PBL and lecture teaching methods got a significantly higher knowledge score than the other 28 students who were taught only by lectures. As for the future direction of community health nursing courses, a teaching strategy involving both PBL and lectures is recommended.

An Estimation on the Need and Supply for Visiting Nursing Services of Health Center in Seoul: Ho Sihn Ryu, Jae Il Myoung, Na Il Hwang; J Korean Acad Community Health Nurs. 2003;14(4):587-597. Published online December 31, 2003

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Abstract PDF: PURPOSE
The purpose of this study was to estimate the demand and supply of visiting nursing services provided by health centers in urban area, aiming at strengthening infrastructure, which may improved the quality of life and health status of vulnerable population in the community.
METHODS
This study was conducted through nominal group discussion, focus group study. The demand and supply of visiting nursing were estimated by health economists based on the secondary analysis data from 25 health centers in Seoul.
RESULT
Primary targets for the visiting nursing must be people who are homebound in the community. They can be classified into: a group of Level I: chronic patients who need visiting nursing care at least once a week; and a group of Level II: vulnerable families that need management periodically e. g. twice a month. Based on the estimation of demand for visiting nursing services in the community, the estimated supply required was 651~770 visiting nurses including home health nurses in visiting nursing programs based on health centers in Seoul.
CONCLUSIONS
The estimated demand and supply of visiting nursing are expected to provide basic data for establishing alternative policies on visiting nursing infrastructure that might be accomplished through demand-based visiting nursing programs by districts.

The Effects of Sophrologic Prenatal Education Program in Community Health Centers: Jung Soon Kim, Myoung Soo Kim, Yoon Hee Kim, Young Seon Kim, Bock Ja Kim, Jung Hee Lee; J Korean Acad Community Health Nurs. 2003;14(4):598-607. Published online December 31, 2003

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Abstract PDF: PURPOSE
The purpose of this study was to identify the effects of the Sophrologic Prenatal Education Program.
METHOD
The subjects of this study were 16 antepartum women who had been registered at community health centers at S-gu in Pusan. Data were collected from women who visited for antenatal care during the period from the 7th of May to 28th of June in 2003. Participants were evaluated before and on completion of the 8 weeks' educational program using 3 instruments: Breast-feeding knowlege, Maternal-fetal attachment and Antenatal stress. The Wilcoxon Signed-Ranks Test was conducted for data analysis using SPSS/WIN 10.0.
RESULTS
Statistically significant difference was found between the pretest and posttest in the mean score of the Breast-feeding knowledge. The mean scores of the experiment group and the control group were 31.44+/-5.51 and 37.06+/-4.27 respectively (p=.001). No statistically significant difference was found between the pretest and posttest in the mean score of the Maternal-fetal attachment (p=.315, p=.578).
CONCLUSIONS
Community health care providers must consider the emotional needs of Korean people and make efforts to adapt the Sophrologie Prenatal Education Program for a larger number of antepartum women in community.

Effects of Smoking Cessation Program applying Aromatherapy massage on Smoking cessation in female college students: Sung Hee Lee, Kyung Min Park, Young Sook Kwon; J Korean Acad Community Health Nurs. 2003;14(4):608-616. Published online December 31, 2003

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Abstract PDF: PURPOSE
The purpose of this study was to examine the effects of smoking cessation program applying aromatherapy massage on female college students' quitting of smoking.
METHODS
Forty-eight female college students were assigned to a smoking cessation program applying aromatherapy massage or a control group. The treatment group was taught to conduct a self hand massage with aroma essence oil. Lavender extra, Camomile roman and Bergamotte aroma essence oil were used for massage. The results of this study showed that the smoking cessation program applying aromatherapy massage resulted in significant effects on the number of cigarettes smoked per day, anxiety, smoking cravings and withdrawal symptoms.
CONCLUSIONS
The findings presented above suggest that the smoking cessation program applying aromatherapy massage may be an effective intervention for female college students attempting to quit smoking to alleviate smoking-related anxiety and to reduce the number of cigarettes smoked, smoking cravings and withdrawal symptoms.

A Structural Model on the Quality of Life and Natural Family Planning of Married Women: Hee Jung Choi; J Korean Acad Community Health Nurs. 2003;14(4):617-628. Published online December 31, 2003

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Abstract PDF: PURPOSE
This study was to analyze the quality of life of married women practicing a natural family planning method based on given parameters in order to obtain some specific basic data for developing holistic programs to enhance the quality of life of married women practicing natural family planning.
METHODS
The subjects of this study were selected from married women who had been practicing natural family planning over two years. Data were collected from May 20 2001 to March 5 2002 using a structured questionnaire and interviews. The total number of subjects was 239. Collected data were analyzed using PC-SAS, which utilized descriptive statistics. In addition, LISREL 8.0 program was used to utilize covariance matrix.
RESULTS
The hypothetical model was reasonably fitted to commonly accepted data. Revision was required for the x2 value and RMR, and the model was revised by eliminating 6 paths. The revised model was fit well for commonly accepted data (x2 = 86.26, GFI = 0.97, NFI = 0.98, NNFI = 0.99, AGFI = 0.96, RMR = 0.02, CN= 422). Variables that influence the practice of natural family planning were communication of spouses, knowledge about natural family planning, self-efficacy and perceived benefits. Variables that control the quality of life were self-efficacy, internal health locus of control, attitude toward natural family planning, communication of spouses, perceived benefits and natural family planning behaviors.
CONCLUSIONS
These findings prove that the quality of life of married women practicing natural family planning can be improved through developing programs that enhances communication of spouses, self-efficacy and perceived benefits.

The Effect of the Knowledge and Health Beliefs on Osteoporosis Preventive Health Behaviors among Middle-aged Women: Jong Kyung Lee; J Korean Acad Community Health Nurs. 2003;14(4):629-638. Published online December 31, 2003

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Abstract PDF: PURPOSE
This study investigated the effects of knowledge and health belief on osteoporosis preventive health behaviors.
METHODS
The subjects of this study were 266 middle-aged women. Data were collected using a self-reporting questionnaire with 101 questions. The period of data collection was from the 3rd of January to the 28th of February 2003. Data were analyzed using SPSS 10.0 PC+ program.
RESULTS
The results were summarized as follows: 1. The average score of knowledge about osteoporosis was 16.93 out of 27. Particularly, middle-aged women had knowledge more about osteoporosis prevention measures than about risk factors. 2. Knowledge, self efficacy and barriers were significantly correlated with osteoporosis preventive health behaviors. 3. As for the relationship between subjects' general characteristics and their health preventive behaviors, the size of living district, economic status, BMI. family history of osteoporosis and perception of health status were found to have significant effects on health preventive behaviors.
CONCLUSIONS
According to the results presented above, preventive health behaviors may be promoted by increasing knowledge and perceived self-efficacy as well as decreasing individuals' perceived barriers through health education.

Analysis of the Use of Personal Protective Equipment Based on the Theory of Planned Behavior: Hye Sun Jung, Mee Young Gee, Jung Wan Koo, Won Gi Jhang; J Korean Acad Community Health Nurs. 2003;14(4):639-645. Published online December 31, 2003

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Abstract PDF: This study was purposed to apply Ajzen's Theory of Planned Behavior to workers using personal protective equipment. For this purpose, occupational health nurses conducted a survey of 173 male workers who were working at 6 different factories during the perid from August to October 2003. The score of each variable related to the Theory of Planned Behavior was calculated: attitude (3.74); subjective norm(4.10); and perceived behavioral control(3.48). Four preceding factors were also assessed: behavioral belief(3.63); outcome evaluation (4.05); normative belief (4.20); and motivation to comply(4.03). Analysing the results, we found that two factors of the Theory of Planned Behavior are important in this case, which were subjective norm and perceived behavioral control that were found to be in a strong positive linkage with the use of personal protective equipment. Thus enhancing subjective norm and perceived behavioral control must be the most important goal of health education for workers who must use personal protective equipment. In addition, though behavioral intention, an intermediate factor of the Theory of Planned Behavior, was not measured in this study, subsequent studies are expected to include the factor in their models.

Sexual Life of Older Adults in Rural Community: Young Ran Han, Young Hee Kim; J Korean Acad Community Health Nurs. 2003;14(4):646-656. Published online December 31, 2003

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Abstract PDF: PURPOSE
The Purpose of this study was to investigate how elders in rural communities maintain their sexual life.
METHODS
Data were collected through in-depth interviews with 20 participants who were 65 years old or older, and either were married couples or were continuing the sexual relationship though widowed. Data were analyzed based on Strauss and Corbin's (1990) Grounded Theory Methodology.
RESULTS
The core category of experiences of the elderly's sexual life was identified with "changeable sexual life at husband's mercy". This process could be divided into 3 stages, which were the stage of recognition of sex difference and obstacle in sexual life, the stage of observation of partner's attitude and the stage of husband's lead in sexual life.
CONCLUSIONS
This study found that sexuality was an important aspect for the elderly although their sexual interests and activities declined along with aging. In addition, the husband's sexual and economic capabilities and sexual difference were very important factors in the elderly's sexual life. It is suggested to consider sexuality as a normal aspect of life for the elderly when nurses plan for their care.

A Study on Self-Efficacy, Family Support and Health Promoting Behavior of the Aged in a Community: In Hee Choi; J Korean Acad Community Health Nurs. 2003;14(4):657-666. Published online December 31, 2003

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Abstract PDF: PURPOSE
This study was conducted to investigate the relationship between selfefficacy, family support and health promotion behavior of the elderly in a community.
METHOD
The sample consisted of 208 elderly and data was collected from November 18 to December 21, 2002. The instrument of this study was a structured questionnaire including health promoting behaviors, self-efficacy, family support, general characteristics. Analysis of the data was done by use of descriptive statistics, t or F, Pearson Correlation Coefficient, Stepwise multiple regression.
RESULTS
1. The general characteristics related to health promoting behavior were gender, family structure, education level and monthly pocket money. 2. The general characteristics related to self efficacy were gender, age, family structure, education level, religion and monthly pocket money. 3. The general characteristics did not affect family support. 4. Health promoting behavior score was the highest in the interpersonal support (2.72) and in order was nutrition(2.65), stress management(2.31), self actualization(2.30), exercise(2.05), health responsibility(1.86). 5. There was a significantly high correlation between health promoting behavior and self efficacy(r=.605, p=.000), and family support(r=.500, p=.000) and between self-efficacy and family support were correlated relatively high(r=.498, p=.000) 6. Stepwise multiple regression analysis revealed that the most powerful predictor of health promotion behavior in elderly was self-efficacy (39.6%). A combination of self-efficacy, family support, monthly pocket money, education level and present illness status explained 48.5% of the variance for health promoting behavior. In conclusion, the results of this study showed that self-efficacy and family support are very important variables in explaining the health promoting behaviors in elderly. Therefore, these variables should be considered in nursing intervention development and education, especially, self-efficacy improving programs that considered exercise and health responsibility are expected to effect the health promoting behavior in elderly.

The Comparative Study on Health-promoting Behavior, Life Satisfaction and Self-esteem between Korean Elderly and American-Korean Elderly: Yeon Hee Choi; J Korean Acad Community Health Nurs. 2003;14(4):667-675. Published online December 31, 2003

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Abstract PDF: PURPOSE
This study was purposed to provide basic data for developing future health promotion programs by comparing health-promoting behavior, life satisfaction and self-esteem between the Korean elderly and the American-Korean elderly.
METHODS
The subjects were volunteer participants of 120 elders in the Gyeongsan City in Korea and 120 elders in the state of Washington in the U.S. Tools used in this study were Health Promoting Lifestyle Profile (47 items), Life Satisfaction Scale (20 items) and Self-Esteem Scale (10 items). To analyze data, this study used frequency, percentage, chi-square test, t-test, Kendal tau test, Pearson's correlation coefficient with SPSS program.
RESULTS
1) The average score of health-promoting behaviors was 3.21 in Koreans and 3.50 in American-Koreans, showing a significant difference between the two groups. 2) The sub-scales that got the highest score of health-promoting behaviors were self-actualization and nutrition (M=3.41) in Koreans and nutrition (M=3.61) in American-Koreans, and that with the lowest score was exercise in both groups (2.89 in Koreans and 3.02 in American-Koreans). 3) The average score for life satisfaction was 2.76 in Koreans and 3.06 in American-Koreans, showing a significant difference between the two groups. 4) The average score for self-esteem was 3.39 in Koreans and 3.09 in American-Koreans, showing a insignificant difference between the two groups. 5) Health-promoting behaviors were positively related to life satisfaction and self-esteem. Life satisfaction was positively related to self-esteem in both groups.
CONCLUSIONS
According to the results of this study, the health-promoting behaviors of Korean and American-Korean elders strongly correlated with life satisfaction and self-esteem. Therefore, health promoting programs that enhance life satisfaction and self-esteem should be developed in order to promote the elderly's healthy lifestyle.

A Survey on Activities and Fear of Falling in the Home-dwelling Elderly in Seoul and Gyonggi-do: Kyeong Yae Sohng, Jung Soon Moon; J Korean Acad Community Health Nurs. 2003;14(4):676-685. Published online December 31, 2003

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Abstract PDF: PURPOSE
To investigate the abilities to act and fear of falling in home-dwelling elderly.
METHODS
This study interviewed 351 home-dwelling elders residing in Seoul and Gyonggi-do using a Survey of Activities and Fear of Falling in the Elderly.
RESULTS
Of the 351 subjects, 203 (57,8%) had activity restrictions. The main three activities that the subjects could not perform were going out when it is slippy, reaching something overhead and walking crowded places outside. According to general characteristics, performable activities were significantly fewer in subjects perceiving that their health status was low that those perceiving that their health status was high. On a scale of 3 points for fear of falling, the average score of the subjects was 1.46. The highest score of fear of falling was 2.62 for the activity of going out when it is slippery, next 1.87 for the activity of reaching something overhead. There was a significant inverse relationship between subjects' abilities to act and fear of falling.
CONCLUSIONS
The significant variables associated with fear of falling were gender (female), educational background, economic status (low-income), and experience of falls during the last one year. Thus further study is necessary, focused on the vulnerable population in order to prevent falls and to reduce fear of falling.

Burden and Quality of Life in Main Caregivers of Cancer Patients Treated with Chemotherapy: Duck Mi Na, Young Chung, Kyung Mi Yang; J Korean Acad Community Health Nurs. 2003;14(4):686-698. Published online December 31, 2003

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Abstract PDF: No abstract available.

A Study on the Fatigue and Health Promoting Behavior of Public Health Nurses and Hospital Nurses: Sun Ok Kim, Hee Young So, Hyun Li Kim; J Korean Acad Community Health Nurs. 2003;14(4):699-706. Published online December 31, 2003

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Abstract PDF: The objective of this study is to find out the difference in perceptional fatigue and health promoting behavior between hospital nurses and public health nurses. The subjects of this study were 141 hospital nurses and 73 public health nurses in Daejeon. Data were collected using a self-reporting questionnaire during the period from the 5th to 16th of March 2003. Collected data were analyzed using SPSS program. Real number, percentage, mean and standard deviation were calculated, and chi2-test and t-test, ANOVA, Pearson's correlation coefficient, stepwise multiple regression procedures were carried out. The findings of this study as follows: 1. The mean score of health promoting behavior was 2.71. 2. There were statistically significant differences in health promoting behavior according to age, marital status, family status, residency, educational level, income, the length of work experience and the field of work.(p<0.05) 3. There were statistically significant differences in fatigue according to age, marital status, family status, educational level, income, the length of work experience, perceived health status and the field of work.(p<0.05) 4. The fatigue was found to be in significant negative correlations with health promoting (r=-0.358, p<0.000) and self efficacy (r=-0.314, p<0.000). On the contrary, a significant positive correlation was found between fatigue and perceived barriers (r=0.210, p<0.01). 5. There were five predictors affecting health promoting behavior, which were self-efficacy, income, perceived benefit, fatigue and family support. The most influential factor was self-efficacy that made 31% of prediction, followed by income (6%), perceived benefit (5.2%), fatigue (2.2%) and family support (1.7%) in their order. As a whole, these factors made 46.1% of prediction of health promotion behavior.

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