• 한국심리학회지 : 문화 및 사회문제
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• 제12권5호_spc
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• pp.45-79
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• 2006

필자와 공동연구자들(2002)이 선행연구에서 개발한 주관안녕척도를 사용하여 한국문화에서 주관안녕에 영향을 미치는 변인들을 알아낸 연구 결과들을 개관하고, 국내외 연구들과 비교하여 시사점을 논의하고, 장래 연구할 과제들도 제안하였다. 먼저 주관안녕에 영향을 미치는 선행요인들로 ① 개인차와 인구통계 변인들, ② 개인과정 요인들, ③ 대인과정 요인들 및 ④ 한국문화의 요인으로 사회규범에 따른 행동을 다룬 연구 결과들을 개관했다. 또한 노인을 대상으로 주관안녕이 동시점에서 신체건강의 예측에 기여하는 수준과 아울러 1년 이상이 경과한 시점에서 종단적으로 신체건강이나 생사에 어떤 영향을 미치는지도 알아냈다. 본 논문은 한국문화에서 필자와 공동연구자들이 수행한 실증연구의 결과들과 연결시켜서 주관안녕을 연구하는데 따르는 이론, 방법 및 과제들을 구체적으로 논의함으로써 장차 문화비교 연구와 아울러 국내 연구에 시사점들을 제시한데 의의가 있다.

• Journal of Preventive Medicine and Public Health
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• 제20권1호
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• pp.165-203
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• 1987

This project was a service-cum-research effort with a quasi-experimental study design to examine the health benefits of an integrated Family Planning (FP)/Maternal & Child health (MCH) Service approach that provides crucial factors missing in the present on-going programs. The specific objectives were: 1) To test the effectiveness of trained nurse/midwives (MW) assigned as change agents in the Health Sub-Center (HSC) to bring about the changes in the eight FP/MCH indicators, namely; (i)FP/MCH contacts between field workers and their clients (ii) the use of effective FP methods, (iii) the inter-birth interval and/or open interval, (iv) prenatal care by medically qualified personnel, (v) medically supervised deliveries, (vi) the rate of induced abortion, (vii) maternal and infant morbidity, and (viii) preinatal & infant mortality. 2) To measure the integrative linkage (contacts) between MW & HSC workers and between HSC and clients. 3) To examine the organizational or administrative factors influencing integrative linkage between health workers. Study design; The above objectives called for quasi-experimental design setting up a study and control area with and without a midwife. An active intervention program (FP/MCH minimum 'package' program) was conducted for a 2 year period from June 1982-July 1984 in Seosan County and 'before and after' surveys were conducted to measure the change. Service input; This study was undertaken by the Soonchunhyang University in collaboration with WHO. After a baseline survery in 1981, trained nurses/midwives were introduced into two health sub-centers in a rural setting (Seosan county) for a 2 year period from 1982 to 1984. A major service input was the establishment of midwifery services in the existing health delivery system with emphasis on nurse/midwife's role as the link between health workers (nurse aids) and village health workers, and the referral of risk patients to the private physician (OBGY specialist). An evaluation survey was made in August 1984 to assess the effectiveness of this alternative integrated approach in the study areas in comparison with the control area which had normal government services. Method of evaluation; a. In this study, the primary objective was first to examine to what extent the FP/MCH package program brought about changes in the pre-determined eight indicators (outcome and impact measures) and the following relationship was first analyzed; b. Nevertheless, this project did not automatically accept the assumption that if two or more activities were integrated, the results would automatically be better than a non-integrated or categorical program. There is a need to assess the 'integration process' itself within the package program. The process of integration was measured in terms of interactive linkages, or the quantity & quality of contacts between workers & clients and among workers. Intergrative linkages were hypothesized to be influenced by organizational factors at the HSC clinic level including HSC goals, sltrurture, authority, leadership style, resources, and personal characteristics of HSC staff. The extent or degree of integration, as measured by the intensity of integrative linkages, was in turn presumed to influence programme performance. Thus as indicated diagrammatically below, organizational factors constituted the independent variables, integration as the intervening variable and programme performance with respect to family planning and health services as the dependent variable: Concerning organizational factors, however, due to the limited number of HSCs (2 in the study area and 3 in the control area), they were studied by participatory observation of an anthropologist who was independent of the project. In this observation, we examined whether the assumed integration process actually occurred or not. If not, what were the constraints in producing an effective integration process. Summary of Findings; A) Program effects and impact 1. Effects on FP use: During this 2 year action period, FP acceptance increased from 58% in 1981 to 78% in 1984 in both the study and control areas. This increase in both areas was mainly due to the new family planning campaign driven by the Government for the same study period. Therefore, there was no increment of FP acceptance rate due to additional input of MW to the on-going FP program. But in the study area, quality aspects of FP were somewhat improved, having a better continuation rate of IUDs & pills and more use of effective Contraceptive methods in comparison with the control area. 2. Effects of use of MCH services: Between the study and control areas, however, there was a significant difference in maternal and child health care. For example, the coverage of prenatal care was increased from 53% for 1981 birth cohort to 75% for 1984 birth cohort in the study area. In the control area, the same increased from 41% (1981) to 65% (1984). It is noteworthy that almost two thirds of the recent birth cohort received prenatal care even in the control area, indicating that there is a growing demand of MCH care as the size of family norm becomes smaller 3. There has been a substantive increase in delivery care by medical professions in the study area, with an annual increase rate of 10% due to midwives input in the study areas. The project had about two times greater effect on postnatal care (68% vs. 33%) at delivery care(45.2% vs. 26.1%). 4. The study area had better reproductive efficiency (wanted pregancies with FP practice & healthy live births survived by one year old) than the control area, especially among women under 30 (14.1% vs. 9.6%). The proportion of women who preferred the 1st trimester for their first prenatal care rose significantly in the study area as compared to the control area (24% vs 13%). B) Effects on Interactive Linkage 1. This project made a contribution in making several useful steps in the direction of service integration, namely; i) The health workers have become familiar with procedures on how to work together with each other (especially with a midwife) in carrying out their work in FP/MCH and, ii) The health workers have gotten a feeling of the usefulness of family health records (statistical integration) in identifying targets in their own work and their usefulness in caring for family health. 2. On the other hand, because of a lack of required organizational factors, complete linkage was not obtained as the project intended. i) In regards to the government health worker's activities in terms of home visiting there was not much difference between the study & control areas though the MW did more home visiting than Government health workers. ii) In assessing the service performance of MW & health workers, the midwives balanced their workload between 40% FP, 40% MCH & 20% other activities (mainly immunization). However, $85{\sim}90%$ of the services provided by the health workers were other than FP/MCH, mainly for immunizations such as the encephalitis campaign. In the control area, a similar pattern was observed. Over 75% of their service was other than FP/MCH. Therefore, the pattern shows the health workers are a long way from becoming multipurpose workers even though the government is pushing in this direction. 3. Villagers were much more likely to visit the health sub-center clinic in the study area than in the control area (58% vs.31%) and for more combined care (45% vs.23%). C) Organization factors (admistrative integrative issues) 1. When MW (new workers with higher qualification) were introduced to HSC, it was noted that there were conflicts between the existing HSC workers (Nurse aids with less qualification than MW) and the MW for the beginning period of the project. The cause of the conflict was studied by an anthropologist and it was pointed out that these functional integration problems stemmed from the structural inadequacies of the health subcenter organization as indicated below; i) There is still no general consensus about the objectives and goals of the project between the project staff and the existing health workers. ii) There is no formal linkage between the responsibility of each member's job in the health sub-center. iii) There is still little chance for midwives to play a catalytic role or to establish communicative networks between workers in order to link various knowledge and skills to provide better FP/MCH services in the health sub-center. 2. Based on the above findings the project recommended to the County Chief (who has power to control the administrative staff and the technical staff in his county) the following ; i) In order to solve the conflicts between the individual roles and functions in performing health care activities, there must be goals agreed upon by both. ii) The health sub·center must function as an autonomous organization to undertake the integration health project. In order to do that, it is necessary to support administrative considerations, and to establish a communication system for supervision and to control of the health sub-centers. iii) The administrative organization, tentatively, must be organized to bind the health worker's midwive's and director's jobs by an organic relationship in order to achieve the integrative system under the leadership of health sub-center director. After submitting this observation report, there has been better understanding from frequent meetings & communication between HW/MW in FP/MCH work as the program developed. Lessons learned from the Seosan Project (on issues of FP/MCH integration in Korea); 1) A majority or about 80% of the couples are now practicing FP. As indicated by the study, there is a growing demand from clients for the health system to provide more MCH services than FP in order to maintain the achieved small size of family through FP practice. It is fortunate to see that the government is now formulating a MCH policy for the year 2,000 and revising MCH laws and regulations to emphasize more MCH care for achieving a small size family through family planning practice. 2) Goal consensus in FP/MCH shouBd be made among the health workers It administrators, especially to emphasize the need of care of 'wanted' child. But there is a long way to go to realize the 'real' integration of FP into MCH in Korea, unless there is a structural integration FP/MCH because a categorical FP is still first priority to reduce the rate of population growth for economic reasons but not yet for health/welfare reasons in practice. 3) There should be more financial allocation: (i) a midwife should be made available to help to promote the MCH program and coordinate services, (in) there should be a health sub·center director who can provide leadership training for managing the integrated program. There is a need for 'organizational support', if the decision of integration is made to obtain benefit from both FP & MCH. In other words, costs should be paid equally to both FP/MCH. The integration slogan itself, without the commitment of paying such costs, is powerless to advocate it. 4) Need of management training for middle level health personnel is more acute as the Government has already constructed 90 MCH centers attached to the County Health Center but without adequate manpower, facilities, and guidelines for integrating the work of both FP and MCH. 5) The local government still considers these MCH centers only as delivery centers to take care only of those visiting maternity cases. The MCH center should be a center for the managment of all pregnancies occurring in the community and the promotion of FP with a systematic and effective linkage of resources available in the county such as i.e. Village Health Worker, Community Health Practitioner, Health Sub-center Physicians & Health workers, Doctors and Midwives in MCH center, OBGY Specialists in clinics & hospitals as practiced by the Seosan project at primary health care level.

• 한국농공학회지
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• 제15권3호
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• pp.3059-3088
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• 1973

본연구(本硏究)에서는 연구(硏究)의 대상(對象)을 저습답(低濕畓)에 두기보다는 지하수위(地下水位)가 낮은 점질토(粘質土)의 건답(乾畓)에 두고 이 점질토(粘質土)논에 대(對)한 수잉전(移秧前)의 처리(處理)에 있어서 심경(深耕)을 한 것 답면(畓面)을 건조(乾燥)시켜 구열발달(龜裂發達)을 기(期)하게한 것 및 암거(暗渠)가 설치(設置)된 곳에서의 답면(畓面)을 건조(乾燥)시켜 구열발달(龜裂發達)을 기(期)하게 한 것 중에서 어떤 처리방법(處理方法)을 적용(適用)한 것이 뿌리신장(伸長)이 심층화(深層化)되여 벼의 수량(收量)을 높일 수 있고 동시(同時)에 지하배수기능(地下排水機能)이 제대로 발휘(發揮)되여 수확작업(收穫作業)에 대형기계(大型機械)를 도입(導入)하였을 때 농업기계(農業機械)의 주행성면(走行性面)에서 유리(有利)한가를 발견(發見)코저 한 것이다. 그래서 시험구처리(試驗區處理)에 있어서는 (1)이앙(移秧) 39일전(日前)에 경운(耕耘)하여 풍건(風乾)시킨 것(경운구(區)) (2) 이앙(移秧) 39일전(日前)에 경운(耕耘)하여 물로 포화(飽和)시켜 쓰린후(後) 구열(龜裂)을 발생(發生)시켜 이앙(移秧) 2일전(日前)에 15cm 깊이로 경운(耕耘)한 것(균열구(區)) (3) 이앙(移秧) 39일전(日前)에 암거설치(暗渠設置)와 동시(同時)에 경운(耕耘)하여 물로 포화(飽和)시켜 쓰린후(後) 구열(龜裂)을 발생(發生)시켜 이앙(移秧) 2일전(日前)에 15cm 깊이로 경운(耕耘)한 것(균암구(區))의 3요인(要因)에 15cm. 25cm, 35cm 깊이의 3수준(水準)으로 하고 15cm 깊이 경운구(區)를 Control구(區)로 정(定)하였는데 이에 의(依)하여 얻은 시험결과(試驗結果)는 대략(大略) 다음과 같이 요약(要約)될 수 있다. 1. 소비수량(消費數量)은 균암구(區)에 있어서는 경운구(區) 및 균열구(區)보다도 소비수량(消費水量)을 나타냈다. 따라서 유효우량은 균암구(區)에서 가장 크고 경운구(區), 균열구(區)의 순(順)으로 작은값을 나타냈고 순용수량(純用水量)에 있어서는 여전(如前)히 균암구(區), 경운구(區), 균열구(區)의 순(順)으로 작어저 균암구(區)가 가장 큰 양(量)을 나타냈다. 심도(深度)에 불구(不拘)하고 순용수량(純用水量)의 크기는 균암구(區)에서 105cm 내외(內外), 경운구(區)에서 70cm 내외(內外), 균열구(區)에서는 45cm 내외(內外)를 나타냈다. 2. 뿌리중량(重量)이 구열최대심도(龜裂最大深度)에 예민(銳敏)하게 영향(影響)을 받고 있는 경향(傾向)으로 미루어 볼 때 뿌리 발달(發達)은 답면상(畓面上)의 구열(龜裂)에 의(依)하기 보다는 구열심도(龜裂深度)에 더 큰 영향(影響)을 받는 것으로 되어 있다. 따라서 깊은구(區)일수록 뿌리중량(重量)은 커지는 경향(傾向)을 가졌고 처리간(處理間)에는 균열구(區), 균암구(區), 경운구(區) 순(順)으로 증대(增大)하는 경향(傾向)을 가졌다. 3. 초장(草丈)의 신장(伸長)에 있어서는 어느구(區)를 막론(莫論)하고 생육초기(生育初期)(분얼최성기(分얼最盛期))에는 별(別)로 차이(差異)를 발견(發見)할 수 없으나 생육중기(生育中期)(분얼종료기(分얼終了期)부터 유수형성기(幼穗形成期) 사이에서는 심도(深度)가 깊은구(區)일수록 그 성장(成長)이 떨어지고 생육후기(生育後期)(수잉기)(穗잉期)에 접어들면서 부터는 도리여 심도(深度)가 깊은구(區)가 얕은구(區)보다 더 왕성(旺盛)한 신장(伸長)을 하였다. 이것은 시험처리별(試驗處理別)로 볼 때 생육중기(生育中期) 이후(以後) 균열구(區)는 어느 다른 구(區)보다 떨어지고 균암구(區)와 경운구(區) 간(間)에는 별차이(別差異)는 없으나 균암구(區)가 여간(與干) 초장신장(草丈伸長)이 우세(優勢)한 경향(傾向)을 나타냈다. 4. 경수(數)에 있어서는 전생육기간(全生育期間)을 통(通)하여 심도(深度)가 깊은구(區)일수록 그 수(數)가 적어지는 경향(傾向)을 나타냈고 이것을 시험처별(試驗處別)로 볼 때 균열구(區)는 늘 균암구(區)와 경운구(區)보다 떨어졌으며 또 경운구(區)는 균암구(區)보다 약간(若干) 우세(優勢)한 경향(傾向)을 나타냈다. 5. 수량(收量)(조곡중)(租穀重))에 있어서는 시험처리별(試驗處理別) 각(各) 시험구(試驗區)의 수량(收量)을 Control 구(區) 15-경운구(區)와 대비(對比)할 때 35-경운구(區)에 있어서는 17%, 35-암거구(區)에 있어서는 10% 기타구(其他區)에 있어서는 모두 Control구(區)와 같거나 떨어졌다. 그리고 전체적(全體的)으로 볼 때 심도(深度)가 깊은구(區)일수록 수량(收量)은 증가(增加)하였고 경운구(龜)는 균암구(區)보다, 균암구(區)는 균열구(區)보다 수량(收量)이 높았으며 심도구(深度區)에는 1%의 유의성시험처리(有意性試驗處理)에는 5%의 유의성(有意性)이 존재(存在)하였다. 6. 조곡중(粗穀重)에 더 많은 영향(影響)을 주는 감수심(減水深)은 후기감수심(後期減水深)이며 15cm 구(區)에서는 2.7cm/day 이내(以內)에서 25cm 구(區)에서는 3.0cm/day 이내(以內)에서 35cm 구(區)에서는 3.3cm/day이내(以內)의 범위(範圍)에서 감수심(減水深)이 증대(增大)하면 조곡중(粗穀重) 증대(增大)하였고 동시(同時)에 동일감수심(同一減水深)에서는 심도(深度)가 깊은구(區) 일수록 조곡중(粗穀重)은 증대(增大)하였다. 따라서 동일감수심도(同一減水深度)가 깊은구(區)일수록 수량면(收量面)에서 유리(有利)함을 암시(暗示)하고 있다. 7. 뿌리중량(重量)에서 비례(比例)하여 조곡중(粗穀重)은 증대(增大)하였으며 벼뿌리중량(重量)이 동일(同一)할때는 심도(深度)가 깊은구(區)일수록 조곡중(粗穀重)은 증대(增大)하는 경향(傾向)을 보여주고 있다. 또 시험처리별(試驗處理別)로 볼 때는 벼뿌리 중량(重量)은 균열구(區), 균암구(區), 경운구(區)의 순(順)으로 컸고 따라서 조곡중(粗穀重)도 역시(亦是) 같은 순(順)으로 컸다. 그리고 조곡중(粗穀重)은 중간낙수기간(中間落水期間)의 최소함수비(最少含水比)와 그때의 평균지온(平均地溫)에 관계(關係)되나 함수비(含水比)가 40%이하(以下)에서는 평균지온(平均地溫)은 함수비(含水比)에 비례(比例)하여 증가(增加)하는 경향(傾向)이 있음으로 주(主)로 최소함수비(最小含水比)에 영향(影響)을 받는바가 크다. 8. 짚조곡중비(粗穀重比)는 심도(深度)가 얕은구(區)일수록 커지는 경향(傾向)을 보였고 또 벼뿌리중량(重量)에 역지수함수적(逆指數函數的)으로 증대(增大)하였다. 또 같은 심도(深度)의 구(區)에서는 15cm 구(區)를 제외(除外)하고는 짚조곡중비(粗穀重比)는 감수심(減水深)에 비례(比例)하여 증대(增大)하였다. 감수심(減水深)이 어느 한도(限度)까지 증대(增大)됨에 따라 조곡중(租穀重)이 증대(增大)하지만 동시(同時)에 짚조곡중비(粗穀重比)도 증대(增大)함을 보여주고 있다. 9. 동일토성(同一土性)에서 구열량(龜裂量)은 기상조건(氣象條件) 특(特)히 증발량(蒸發量)의 증대(增大)에 따라 증대(增大)하며 답면건조도중(畓面乾燥途中)에 강우(降雨)가 있으면 답면구열량(畓面龜裂量)은 현저(顯著)히 감소(減小)한다. 점질토(粘質土)의 구열량(龜裂量)은 대체(大體)로 함수비(含水比)가 25% 이상(以上)에서는 함량비(含量比)에 역지수적(逆指數的)으로 증가(增加)하는 경향(傾向)을 보였고 구열(龜裂)의 최대(最大) 심도(深度)는 31% 이하(以下)의 함수비(含水比)에서는 일정(一定)한 값을 유지(維持)하는 경향(傾向)이있다. 10. Cone 지수(指數)는 어느 한도(限度)까지는 구열량(龜裂量)에 비례(比例)하는 경향(傾向)이있으나 구열량(龜裂量)이 어느 한도(限度)를 넘으면 약간(若干) 구열량(龜裂量)에 역비례(逆比例)하는 경향(傾向)을 보여주고 있다. 그 한도(限度)의 함수비(含水比)는 25% 근처가 될 것이다. 11. 최종낙수후 (最終落水後)의 Cone 지수(指數)의 경시적(經時的) 증대(增大)는 생육후기(生育後期)의 감수심(減水深)에 비례(比例)하는 경향(傾向)을 보였고 동일감수심(同一減水深)에서 균암구(區)는 다른 두 구(區)보다 큰Cone지수(指數)를 나타냈고 경운구(區)는 심도(深度)가 깊은구(區)일수록 균열구(區)보다 작은 Cone 지수(指數)를 나타냈는데 특(特)히 35-경운구(區) Cone의 지수(指數)는 현저(顯著)하게 작은 값을 나타냈다. 12. 최종낙수후(最終落水後)의 답면건조(畓面乾燥)에 있어서는 함수비(含水比)의 감소상황(減少狀況) 및 Cone 지수(指數)의 증대상황(增大狀況)에 비추어 볼 때 시험처리별(試驗處理別)로는 균암구(區)가 다른 두 구(區)보다 밟르고 경운구(區)는 가장 늦어지고 심도(深度)가 깊은 구(區)에서는 더욱 늦어지고 있다. 농업기계(農業 機械)의 주행(走行)에 지장(支障)을 가져오지 않을 정도(程度)의 Cone 지수(指數)($2.5kg/cm^2$)로 답면건조(畓面乾燥)를 시키자면 최종낙수시기(最終落水時期)를 잡는 시기(時期) 및 낙수기간(落水期間)동안의 강우(降雨)의 유무(有無)에 따라 다르게지만 강우(降雨)가 전혀 없다면 누계계기증발량(累計計器蒸發量)을 기준(基準)으로 잡을 때 균암구(區)에서는 누계계기증발량(累計計器蒸發量)으로 약(約) 44mm가 필요(必要)하고 기타구(其他區)에서는 50mm 이상(以上)이 필요(必要)하게 됨으로 균암구(區)에서의 답면건조진행(畓面乾燥進行)은 대체(大體)로 경운구(區), 균열구(區)보다 2일이상(日以上)이 빠르며 35-경운구(區)와 비교(比較)하면 5일(日) 이상(以上)이나 빠르게 될 것이다.