• Journal of Preventive Medicine and Public Health
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• v.20 no.1 s.21
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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.

• Journal of Nutrition and Health
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• v.49 no.3
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• pp.189-200
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• 2016

Purpose: This study analyzed job importance, job performance, and job satisfaction in 38 dietitians working at geriatric hospitals and elderly healthcare facilities in Jeju surveyed from September 15-24, 2014 with the aim of providing basic data for improving the quality of meals and nutrition management for elderly patients. Methods: Data were analyzed using descriptive analysis, ${\chi}^2$-test, t-test, ANOVA, and Pearson's correlation coefficients using the SPSS Win program (version 12.0). Results: Regarding job importance, the average score was 4.29 (out of 5), indicating that hygiene and safety management scored the highest at 4.77 (out of 5), and nutrition management scored the lowest at3.86. In terms of job performance of subjects, the average score was 2.87 (out of 5), indicating that cooking operation management scored the highest at 4.42 (out of 5). Regarding the Importance-Performance Analysis (IPA) of job importance and job performance, hygiene and safety management and cooking operation management scored high for importance and performance (B quadrant) menu management, human resource management, and nutrition management scored low for importance and performance (C quadrant) and purchasing management and financial management were included inD quadrant and A quadrant, respectively. For the level of job satisfaction of subjects, the average score was 3.37 (out of 5), indicating that relationships with colleagues scored the highest at 3.72, and improving professionalism scored the lowest at 2.95. Additionally, job importance and performance of subjects were positively correlated withjob satisfaction (r = 0.395, r = 0.386, both p < 0.05). Conclusion: In conclusion, scores for job importance and job performance of nutrition management were low, and job satisfaction of improving professionalism scored low. Therefore, continuous training and education programs of nutrition management should be provided to improve professionalism of dietitians at geriatric hospitals and elderly healthcare facilities.

• Journal of the Korean Society of School Health
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• v.5 no.2
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• pp.42-65
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• 1992

A survey was made of 976 students who were selected among students of 5 middle schools at Taegu so that it could furnish basic knowledge about sex education of adolescents by analyzing students recognition of sex, acquaintance with the opposite-sex, sex-education, The survery took a month from Nov. 1, to Nov 30, 1991. The results of this study are summarized as follows. 1. The general characteristics of the surveyed students. The survey consisted of 332 boys middle school student & 325 girls middle school students, 157 male & 162 female students of coeducational middle schools. 32.9% of them were from the first grade, 33.2% from the second grade & 33.9% from the third grade. 35.7% of them believed in Buddhism, 19% Christianism and the mode of their living standard, 86.7%, fell on 34.7% of their parents engaged in commerce and they were followed by salary man and public officals, 93.1 % of the students, parents were alive. 44.9% of their fathers were graduates of high school and 42.2% of their mothers middle school. 2. Sexual maturity 89.1 % of the surveyed girls had experienced menstruation. The mode of first menstruation, 48.2%, was at the age of 13 and the mean of it was 12.9, 3.7% the surveyed boys had exprienced a wet drem before. The mode of the first wet dream, 40.0%, was at the age of 14 and the mean was 13.4. 21.3% of surveyed students had the experience of masturbation but the number of girls fell far short of that boys. The mode of the first masturbation, 37.0%, was at the age of 14 and the mean was 13.4. 3. The acquaintance and sexual relations with the opposite sex 1) Analyzing the students actual conditions with the opposite, I found out that 52.3% of them wanted to have any kind of relations with the opposite and that 30.25 had already had some kind of relations. 73.2% of the students having relations with the opposite thought the other sex merely as a friend and the number of students who were thinking that way was distributed evenly among schools. 28.8% of the students had got acquainted with the other sex through their frieds and there were not much difference between boys and girls in the method of getting acquainated with the opposite. About 35.2% of the students having relations with the opposite came from the third grade. 47.8% of them answered that the meeting place was not fixed and 26.4% answered that they were meeting their parthers outdoors. 60.7% replyed that they were not disturbed in their studies by the relations with the other sex. 2) Most of the students 79.4%, answered that they had never had sexual relations and 16.3% of the rest said that thery were expressing their feelings by grasping each other's hand. 3) 16.6% of the surveyed students asid that they had the exprience of smoking, 1.1 % of an illusion caused by inhaling chemical addhesives, 44.0% of drinking and 41.4% of warching pornographic films. 4. The knowledge and attitude about the sex 1) The distribution and analysis according to schools and grades : 64.8% of the surveyed students answered correctly to the questions about mensturation, 49.3 % did so about wet dreams, 94.3 % did so about conception, 60.6% did so about child birth, 73.9% did so about AIDS and 50.1 % did so about sexual diseases. Roughly speaking, they had not much knowledge of sexual diseases. 2) The recognition of sex according to schools and grades : 39.0% of the students said that they had worries about sex. 33.1 % of what they worried was concerned with their bodies and 26.8% was about the acqaintance and relationship with the opposite sex. The girls were much more concerned about the former and the boys the latter. 51.1 % of the students asid that they had no specific opinion of masturbation but 19.2% said that's alright if self-restrained. About the sexual intercourse before marriage, 75.7% said negatively. 5. The need for sex education most of the students, 99.4% said they needed sex education and there was not much difference in that thought among schools. And 49.7% answered that schools, families, and societies were equlally important in sex education. About half of the students, exactly 50.2%. considered it as the main reason of sex education to prevent accidents cauesd by ignorance of sex. 81.4% said that they had had some kind of sex education. Most of the educations, 87.0%, had taken place at schools but 5.2% said they were getting most of the knowledge about sex from therir friednds, juniors and seniors. 59.5% of the students who had ever had a sex education said "Just so, so" when asked of the level of their contentment but the number of students who said "satisfied" was only a few, 16.1 %. 20.7% of the survered answered that thery wanted sex education to be made in the course of home life, and 26.6 % of the students most wanted to know about the acquaintance and relationship with the oppostie sex, 29.0% preferred nurse teachers as proper councellors of sex education. The mode of their present councellors, 42.0%, was friends but only 7.6% answered they dicussed with teachers. 6. The correlation analysis between general characteristcs and sexual behaviors of the surveyed students revealed that sex had a signigicant(P<0.001) positive correlation with parents' love toward students(P<0.01), the experience of masturbation, smoking, an illusion caused by inhaling chemical adhesives and the experience of watching pornographic films. And the standard of living had a significant(P<0.01) positive correlation(P<0.01) with grade point average, parents' existence(P<0.01) and parents' love, but a significant(P<0.01) negative correlation with sexual worries. grade point average had a significant(P<0.01)negative correlation with the experience of an illusion caused by chemical adhesives(P<0.01) and smoking. Parents' existence had significant(P<0.01) positive correlations with parents' love and smoking but a significant(P<0.01) negative correlation with the experience of an illusion by chemical adhesives. There was a significant(P<0.01) negative correlations between parents' love and the experience of an illusion by chemical adhesives, and a significant(P<0.001) positive correlation among masturbation and sexual worries, smoking, an illusion by chemical adhesives and the experience of watching pornographic films. There was a significant(P<0.001) positive correlation among acquaintance with the opposite sex, smoking, the experience of an illusion by chemical adhesives and watching pornographic films. Sexual worries had significant(P<0.01) positive correlations with smoking, the experience of an illusion by chemical adhesives and watching pornographic films. smoking had a significant positive correlation with drinking the experirence of, an illusion by chemical adhesives and watching pornographic films. Finally, there was a significant(P<0.01) positive correlation between the drinking experience and the illusion experience by chemical adhesives. According to the results mentioned above, the fact is certain that there is a great need for sex education of adolescents. Therefore, it is desirable that the schools teach sexual physiology and normal positively and that sex education including hygien education be an independant course in the curriculums. Furthermore, it is essential that the schools should have enough nurse teachers to take up sex education, expand training opportunities for them and that they develop educational materials. Considering the unbalance of the level of sex educations between boys and girls, I want to suggest that all boys and girls have sex education evenly and lead happy lives by correction irrational thought about sex, that is to say, sex discrimination, Sex education programs, especially of middle school students, should be reexamined if it is to give the students effective and profitable knowledge about sex. In addition, the government should establish a policy of adolescents' sex education to have healthy opinions of sex settled nationwide.