Purpose: This study was done to identify strategies for the reform of the primary health care delivery system in rural areas. Methods: Official documents on changes in the rural health care environment were reviewed along with previous articles on reform of the health care delivery system in rural areas. Results: The primary health care system in rural areas of South Korea has not been well developed by the government. The government has mainly invested in hardware like facilities and equipment but, not in software like the delivery system or personnel. Nowadays every country is confronted with an aging society, which means an increase in the prevalence of chronic disease. Thus they have again become interested in primary health care delivery system. Further, characteristics of the primary health care system have changed to be more comprehensive and to focus on chronic disease. The primary health care system in rural areas should have basic health care functions and a visiting medical officer(doctor) connected with basic health care. Conclusions: The primary health care delivery system is the best strategy when adjusted to the characteristic of the chronic diseases that are prevalent today. Cooperation of the central government and local government is important if these changes are to be realized.

Purpose: To compare of health inequalities between rural and urban areas in term of health status, health behaviors and medical care utilization by using national-wide data. Method: The data came from the 2000 and 2005 census data, 2004 death certification statistics and 2001 national health and nutrition survey. The health indicators used in this study were mortality, perceived health status, health related behaviors, morbidity, accidents and suicides, mental health-related factors, health care accessibility. Korean rural areas have been experiencing a rapid aging process and there are demographic differences between rural and urban populations. Thus, both of crude rates and age-adjusted rates were compared. Result: Although the degrees decreased after adjustment for age, health inequalities between areas still existed. The people who lived in rural areas suffer from higher mortality, morbidity and unhealthy behavior compared to people in urban areas. Especially, regional health inequalities for women were significant. Health care accessibility in rural areas was also lower and medical indirect costs for rural residents were higher than those of urban residents. Conclusion: To reduce health inequalities between geographical areas, political efforts to tackle health inequalities in the rural areas are required.

Purpose: This purpose of this study was to examine the effect of a walking exercise program on blood pressure and related factors in older patients with hypertension living in rural areas. Method: The participants were 233 patients with hypertension, 60years or age or over, who were registered at one of 36 public health centers in North Chung Cheong Province and agreed to participate in this study. The program was implemented for 12 weeks from Dec. 2005to Feb. 2006. The data were collected before and right after the program and paired t-test was used to analyze the data. Analysis was done with the SPSS program. Result: Systolic pressure (t=7.460, p=0.000) and diastolic pressure (t=5.309, p=0.000) decreased significantly. Total cholesterol l (t=-9.991, p=0.000), LDL cholesterol and HDL cholesterol (t=-3.180, p=0.000) all increased significantly. There was no change in weight or obesity level. Blood sugar (t=2.218, p=0.028) decreased significantly. Knowledge of hypertension increased significantly as did the self-care behavior of these patients with hypertension. Conclusion: The walking exercise program was found to be effective to control blood pressure in older patients with hypertension in rural areas and to help HDL cholesterol, knowledge of hypertension, and self-care behavior of hypertension increase greatly, while blood sugar level decreased.

Purpose: The purpose of this study was to identify how heat therapy influences pain and sleep in rural elders who have osteoarthritis (OA). Method: A non-equivalent control group pretest-posttest design was used. Participants were 61 elderly farmers and they were assigned to an experimental group (31) or control group (30). The participants were living within the district boundaries of a public health clinic in North Choong Chung Province. The research was conducted from April 1, to 28, 2006. Results: The results of this study demonstrate that heat therapy is effective in reducing pain and promoting sleep in rural elders who have osteoarthritis. Conclusion: Heat therapy reduced pain, and improved sleep in rural elders, with osteoarthritis.

Purpose: This study was done to identify the experience of stress and burn-out in caregivers of patients with senile dementia. Method: To evaluate the degree of stress and burn-out in caregivers of patients with senile dementia, 64 caregivers and matched to 64 patients with senile dementia at a Primary Health Care Post in South Kyung Sung Province were selected. The study was carried out from March 6 to March 30, 2001. Data on the degree of dementia in the patients was measured by the MMSE-K (Mini-Mental State Examination-Korea) and caregiver characteristics such as, sex, age, marital status, educational level, job, socioeconomic status, religion, number in family, relationship with patient, duration of care, and chronic disease in caregiver were collected by direct interview with a questionnaire. Results: Of 64 patients with senile dementia, 15.6% were classified as mild dementia (MMSE score 20-24) and 84.4%, as severe dementia. There were no significant characteristics of caregivers associated with the degree of stress and burn-out experience. The degree of burn-out in these caregivers of patients with severe dementia (mean value 94.3) was significantly higher than the 81.4 for those caring for patients with mild dementia (p<0.05). However, the degree of stress was not significantly related with the degree of dementia. The proportion experiencing severe burn-out (above score 4) was 54.7% in the physical domain, 90.6% in the emotional domain, and 73.4% in psychiatric domain, respectively. Conclusion: The above findings suggest that the degree of stress and burn-out experienced by caregivers of patients with senile dementia are high. Also the degree of burn-out experienced by in caregivers of patients with severe dementia was higher than for those caring for patients with mild dementia.

Purpose: This study was done to investigate the effects of **the Thera-band exercise program on the lower extremities muscle strength and balance in rural female farmers. Method: The participants were 19 rural women age of 40 or over who were living in the area within the jurisdiction of a public health center in North Chung Province and who agreed to participate in the study. The Thera-band exercise program was implemented for 10 weeks from Jan 17. to Mar 31. 2005. Total time was 60 minutes, 5 times a week. Paired t-test was used to analyze the data using the SPSS program. Result: The results of study showed that thigh muscle strength(t= 6.718, p <.001) and the dynamic balance(t=4.934, p <.001) decreased significantly. Ankle muscle strength(t=-6.739, pp <.001) and static balance (t=-2.395, p=.025) increased significantly. Conclusion: The results suggest that the Thera-band exercise program could be effective in improving thigh muscle strength, ankle muscle strength, the static balance, and the dynamic balance of rural female farmers. Further study is needed to compare strength and balance before and after the exercise program and to use a control group for comparison. Also it is needed to do more study on the appropriate length of time that the intervention should be given in order to achieve maximum results.

Purpose: This study was done to identify the effect of a group walking exercise program on weight, obesity, blood pressure and cholesterol in elderly patients with hypertension. Method: From the population of elderly people in Hwasung city, 80 people with hypertension were selected as participants in this study. Frequencies and paired t-test were used to analyze the data. Results: The group walking exercise program lowered weight, obesity, blood pressure, and cholesterol. And such a change appeared to be effective statistically. Conclusion: Therefore, it is important to develop a program and environment that promotes group walking exercise in elderly patients with hypertension.