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A Study on the Acceptance Factors of the Capital Market Sentiment Index (자본시장 심리지수의 수용요인에 관한 연구)

  • Kim, Suk-Hwan;Kang, Hyoung-Goo
    • Journal of Intelligence and Information Systems
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    • v.26 no.3
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    • pp.1-36
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    • 2020
  • This study is to reveal the acceptance factors of the Market Sentiment Index (MSI) created by reflecting the investor sentiment extracted by processing unstructured big data. The research model was established by exploring exogenous variables based on the rational behavior theory and applying the Technology Acceptance Model (TAM). The acceptance of MSI provided to investors in the stock market was found to be influenced by the exogenous variables presented in this study. The results of causal analysis are as follows. First, self-efficacy, investment opportunities, Innovativeness, and perceived cost significantly affect perceived ease of use. Second, Diversity of services and perceived benefits have a statistically significant impact on perceived usefulness. Third, Perceived ease of use and perceived usefulness have a statistically significant effect on attitude to use. Fourth, Attitude to use statistically significantly influences the intention to use, and the investment opportunities as an independent variable affects the intention to use. Fifth, the intention to use statistically significantly affects the final dependent variable, the intention to use continuously. The mediating effect between the independent and dependent variables of the research model is as follows. First, The indirect effect on the causal route from diversity of services to continuous use intention was 0.1491, which was statistically significant at the significance level of 1%. Second, The indirect effect on the causal route from perceived benefit to continuous use intention was 0.1281, which was statistically significant at the significance level of 1%. The results of the multi-group analysis are as follows. First, for groups with and without stock investment experience, multi-group analysis was not possible because the measurement uniformity between the two groups was not secured. Second, the analysis result of the difference in the effect of independent variables of male and female groups on the intention to use continuously, where measurement uniformity was secured between the two groups, In the causal route from usage attitude to usage intention, women are higher than men. And in the causal route from use intention to continuous use intention, males were very high and showed statistically significant difference at significance level 5%.

The Mediating Role of Perceived Risk in the Relationships Between Enduring Product Involvement and Trust Expectation (지속적 제품관여도와 소비자 요구신뢰수준 간의 영향관계: 인지된 위험의 매개 역할에 대한 실증분석을 중심으로)

  • Hong, Ilyoo B.;Kim, Taeha;Cha, Hoon S.
    • Asia pacific journal of information systems
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    • v.23 no.4
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    • pp.103-128
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    • 2013
  • When a consumer needs a product or service and multiple sellers are available online, the process of selecting a seller to buy online from is complex since the process involves many behavioral dimensions that have to be taken into account. As a part of this selection process, consumers may set minimum trust expectation that can be used to screen out less trustworthy sellers. In the previous research, the level of consumers' trust expectation has been anchored on two important factors: product involvement and perceived risk. Product involvement refers to the extent to which a consumer perceives a specific product important. Thus, the higher product involvement may result in the higher trust expectation in sellers. On the other hand, other related studies found that when consumers perceived a higher level of risk (e.g., credit card fraud risk), they set higher trust expectation as well. While abundant research exists addressing the relationship between product involvement and perceived risk, little attention has been paid to the integrative view of the link between the two constructs and their impacts on the trust expectation. The present paper is a step toward filling this research gap. The purpose of this paper is to understand the process by which a consumer chooses an online merchant by examining the relationships among product involvement, perceived risk, trust expectation, and intention to buy from an e-tailer. We specifically focus on the mediating role of perceived risk in the relationships between enduring product involvement and the trust expectation. That is, we question whether product involvement affects the trust expectation directly without mediation or indirectly mediated by perceived risk. The research model with four hypotheses was initially tested using data gathered from 635 respondents through an online survey method. The structural equation modeling technique with partial least square was used to validate the instrument and the proposed model. The results showed that three out of the four hypotheses formulated were supported. First, we found that the intention to buy from a digital storefront is positively and significantly influenced by the trust expectation, providing support for H4 (trust expectation ${\rightarrow}$ purchase intention). Second, perceived risk was found to be a strong predictor of trust expectation, supporting H2 as well (perceived risk ${\rightarrow}$ trust expectation). Third, we did not find any evidence of direct influence of product involvement, which caused H3 to be rejected (product involvement ${\rightarrow}$ trust expectation). Finally, we found significant positive relationship between product involvement and perceived risk (H1: product involvement ${\rightarrow}$ perceived risk), which suggests that the possibility of complete mediation of perceived risk in the relationship between enduring product involvement and the trust expectation. As a result, we conducted an additional test for the mediation effect by comparing the original model with the revised model without the mediator variable of perceived risk. Indeed, we found that there exists a strong influence of product involvement on the trust expectation (by intentionally eliminating the variable of perceived risk) that was suppressed (i.e., mediated) by the perceived risk in the original model. The Sobel test statistically confirmed the complete mediation effect. Results of this study offer the following key findings. First, enduring product involvement is positively related to perceived risk, implying that the higher a consumer is enduringly involved with a given product, the greater risk he or she is likely to perceive with regards to the online purchase of the product. Second, perceived risk is positively related to trust expectation. A consumer with great risk perceptions concerning the online purchase is likely to buy from a highly trustworthy online merchant, thereby mitigating potential risks. Finally, product involvement was found to have no direct influence on trust expectation, but the relationship between the two constructs was indirect and mediated by the perceived risk. This is perhaps an important theoretical integration of two separate streams of literature on product involvement and perceived risk. The present research also provides useful implications for practitioners as well as academicians. First, one implication for practicing managers in online retail stores is that they should invest in reducing the perceived risk of consumers in order to lower down the trust expectation and thus increasing the consumer's intention to purchase products or services. Second, an academic implication is that perceived risk mediates the relationship between enduring product involvement and trust expectation. Further research is needed to elaborate the theoretical relationships among the constructs under consideration.

Basic Study for Selection of Factors Constituents of User Satisfaction for Micro Electric Vehicles (초소형전기차 사용자만족도 구성요인 선정을 위한 기반연구)

  • Jin, Eunju;Seo, Imki;Kim, Jongmin;Park, Jejin
    • KSCE Journal of Civil and Environmental Engineering Research
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    • v.41 no.5
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    • pp.581-589
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    • 2021
  • With the recent increase in the introduction of micro-electric vehicles in Korea, interest in micro-electric vehicle user satisfaction is increasing to revitalize related markets. In this paper, a basic study was conducted on the development of public services using micro-electric vehicle based on the constituent factors of user satisfaction. The survey includes: ① 'Analytic Hierarchy Process (AHP) for selecting the priority factors of user satisfaction of micro-electric vehicles', ② 'A survey of micro-electric vehicles image' to collect data in advance for providing users' preferences and transportation services for micro-electric vehicles, ③ In order to investigate the user satisfaction level of users who actually operated micro-electric vehicles, the order of 'user satisfaction survey of micro-electric vehicle drivers' was conducted. In the Analytic Hierarchy Process (AHP) analysis, it was found that users regarded as important in the order of 'user utilization data', 'vehicle movement data', and 'charging service data'. In the micro-electric vehicle image survey, users perceived micro-electric vehicles more positively in terms of "safety", 'durability', 'Ride comfort', 'design', 'MOOE (Maintenance and other operating expense)', and 'environment-friendly' when comparing micro-electric vehicles with electric motorcycles. In the survey on the user satisfaction of micro-electric vehicle drivers, the use of micro-electric vehicle did not directly affect work performance efficiency, and there was an experience of being disadvantaged on the road due to the size of the micro-electric vehicle, and driving in a cluster of micro-electric vehicle for outdoor advertisements. The city's public relations effect was great, but it was concerned about safety. In the future, based on the results of this study, we plan to build a user satisfaction structural equation model, preemptively discover feedback R&D for micro-electric vehicle utilization services in the public field, and actively seek to discover new public mobility support services.

Redefinition of the Concept of Fishing Vessel and Legislation Adjustment (낚시어선 개념의 재정립과 법제 정비에 관한 연구)

  • Yeong-Tae Son
    • Journal of the Korean Society of Marine Environment & Safety
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    • v.29 no.6
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    • pp.639-652
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    • 2023
  • The fundamental background behind the introduction of the fishing vessel system is to allow petty small fishers to engage in pure fishery business activities with fishing vessels during normal times and engage in fishing vessel business only during specific periods (closed fishing season, etc.) thereby granting a qualification as an auxiliary tool for the economic activities of petty small fishers. In addition, fishing boats are allowed to engage in excursion ship activities using fishing vessels registered under the Fishing Vessels Act, the form of fishing vessels should also have a general and universal structure that is practically easy to engage in fishing activities in the field in accordance with the relevant regulations. However, most fishing vessel proprietors are currently focusing only on increasing income, and rather than building fishing vessels in a reasonable form suitable for the original purpose of general fishing vessels, they prefer an abnormal hull form equivalent to expediency, that is biased hull structure biased toward the fishing vessel business. As a result, it is causing serious problems in safety management as well as conflict [damaging relative equity in government support measures (tax-free oil supply, etc.), and depletion of livelihood-type fish stocks] with fishing vessel forces who consider the fishing vessel business only to be a part of the side job among all fishery business activities. Meanwhile, the most fundamental cause of this problem is that the current Fishing Management and Promotion Act, limits the concept of fishing vessels to fishing vessels registered under the Fishing Vessels Act, and applies survey standards accordingly. Accordingly, in this study, through analysis of the distribution status of fishing vessels, structural characteristics, operation status of fishing vessels, and the government's fishing promotion policies, etc., the relevant laws (regulations) have been reorganized to suit the current reality of the concept of fishing vessels to separate the current fishing vessel from fishing vessels and operate it as a fishing-only vessel.

Active Seniors' Organizational and Functional Entrepreneurial Competencies: Discovering Unobserved Heterogeneous Relationships between Entrepreneurial Efficacy and Entrepreneurial Intention using PLS-POS (액티브 시니어의 조직적과 기능적 창업역량: PLS-POS를 이용한 창업 효능감과 창업의지의 이질성 관계 확인)

  • Shin, Hyang Sook;Bae, Jee-eun;Chao, Meiyu;Lee, Yong-Ki
    • Asia-Pacific Journal of Business Venturing and Entrepreneurship
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    • v.17 no.2
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    • pp.15-31
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    • 2022
  • This study was conducted to suggest a start-up policy that includes start-up education and support for active seniors with various careers who try to change their careers before and after retirement. From this point of view, this study divided the factors affecting the entrepreneurial will of active seniors into entrepreneurship organizational and functional competency and identified the effect of these competencies on entrepreneurial efficacy and entrepreneurial intention. In the proposed model, start-up competency is divided into organizational competency (leadership, creativity problem-solving, communication, decision-making) and functional competency (management strategy, marketing, business plan). And this study examined the mediating role of entrepreneurial efficacy in the relationship between entrepreneurial competency factors and entrepreneurial intention. Meanwhile, PLS-POS analysis was performed to uncover the heterogeneity and pattern in the proposed structural model. The survey was conducted with the help of an online survey company from November 27 to December 15, 2020 for the active senior age group from 40 to under 65 years old. Data were collected from a total of 433 panelists and analyzed using SPSS 22.0 and SmartPLS 3.3.7 programs. The findings are as follows. First, the finding shows that the entrepreneurial organizational and functional competencies of active seniors had significant positive(+) effects on entrepreneurial efficacy. Second, the result shows that entrepreneurial organizational and functional competencies of active seniors had significant positive(+) effects on entrepreneurial intention. Third, the findings show that entrepreneurship efficacy had a significantly positive(+) effect on entrepreneurial intention. The findings of PLS-POS show that entrepreneurship education needs to be carried out by identifying the needs that require entrepreneurial organizational and functional competency when training for entrepreneurship competency. In summary, the findings of the current study are to determine what the competency factors are for the government (local government) to increase the policy direction necessary for establishing and implementing entrepreneurship education and training programs to develop policies to enhance the economic activity participation rate of active seniors.

The Structural Relationship between Entrepreneurial Competency, Entrepreneurial Opportunity Recognition on and Entrepreneurial Intentions of Middle-aged Eldery Office Workers (중·장년 직장인의 창업역량과 창업기회인식 및 창업의지의 구조적 관계)

  • Choi, In Woo
    • Asia-Pacific Journal of Business Venturing and Entrepreneurship
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    • v.17 no.5
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    • pp.169-185
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    • 2022
  • This study analyzed the effect of entrepreneurial competency on entrepreneurial intentions by using the entrepreneurial opportunity recognition as a mediator for middle and middle-aged office workers. The sub-variables of entrepreneurial competency are classified into management competency, technology competency, business competency and funding competency. 222 copies of questionnaires collected from middle-aged and elderly office workers residing across the country centered on the metropolitan area were used for empirical analysis. Based on a simple mediating model with singular mediator using SPSS v22.0 and PROCESS macro v4.0. was analyzed. As a result of the analysis, first, among entrepreneurial competencies, business competency and funding capacity were found to have a positive (+) significant effect on the entrepreneurial intentions, but management and technical competency did not have a significant effect. The higher the business competency and funding competency. Second, it was found that all of the sub-variables of entrepreneurial competency had a significant effect in the positive (+) direction on the recognition of entrepreneurial opportunities. It was confirmed that management competency has the greatest influence on the entrepreneurial opportunity recognition and technology competence has the smallest effect. Third, it was found that the entrepreneurial opportunity recognition had a significant effect on entrepreneurial intentions. The discovery of an opportunity recognizing opportunities for start-up is a prerequisite for entrepreneur. Fourth, it was found that the entrepreneurial opportunity recognition mediates between the management competency, technological competency, business competency, funding competency, and entrepreneurial intention. It suggests that opportunity discovery by recognizing opportunities for entrepreneurship is a prerequisite for start-up. As implications of this study, it suggests that in order to inspire middle-aged and elderly office workers to start their own business, it is necessary to have indirect experience with education and to establish and promote a government support system for financing.. Second, It suggests that education on leadership and organizational management is particularly necessary to strengthen the opportunity recognition. Third, it suggests that the discovery of opportunities to recognize opportunities for start-up is a prerequisite for entrepreneur. Therefore, it is necessary to prepare a manual and conduct training on opportunity search, recognition, evaluation, and utilization according to the stage of opportunity development. Fourth, it suggests that in order to strengthen the intention to start a business, ALso, it is necessary to manage both the entrepreneurial competency and entrepreneurial opportunities recognition at the same time. By presenting the practical directions that can be given differentially, we intend to contribute to the provision of practical directions and policy establishment for the promotion of entrepreneurial activities of office workers who can give vitality to the ecosystem.

Study on Characteristic Factors of Female Entrepreneurs for Vitalization of Female Entrepreneurship: Focusing on Case Studies (여성창업 활성화를 위한 여성창업가의 특성요인에 관한 연구: 사례연구를 중심으로)

  • Kim, Yun-Sun;Lee, Il-Han
    • Asia-Pacific Journal of Business Venturing and Entrepreneurship
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    • v.17 no.5
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    • pp.49-65
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    • 2022
  • This study conducted an exploratory study based on in-depth interviews to understand the characteristics and capabilities of female entrepreneurs to promote women entrepreneurship. Therefore, in this study, through in-depth interviews with eight female entrepreneurs, the main contents of entrepreneurial attitudes (need for independence, development desire, favorable conditions), start-up entry rate, start-up motivation, start-up activities and constraints were analyzed. As a result, first, it was found that the entrepreneurial attitude of female entrepreneurs has a strong motivation for successful management based on a feeling of self-satisfaction, has characteristics that prioritize independence and self-actualization, and favorable conditions for starting a business are important. Second, it was found that women's individual differences from men and social structural factors had no significant effect on the entry rate of women. Third, it was found that the most important entrepreneurship motivation for women is the spirit of challenge, self-satisfaction, and the desire to balance work and family. Fourth, female entrepreneurs showed little difference in perception between male and female entrepreneurs in terms of resource access, but there was some discrimination in the network. Fifth, the main industries of female entrepreneurs are small businesses, and there is a tendency to be concentrated in industries with low profit margins and low growth and sales. Finally, it was found that barriers to women's entrepreneurship still exist. Based on the results of this study, the following implications are suggested. First, this study is differentiated in that it mainly identified the characteristics of women's experiences and social environments while starting a business and running a business. Second, in the case of female entrepreneurs, there is a need to spread a positive awareness of women entrepreneurship by arguing that the barriers to entrepreneurship unique to women are not high and can be sufficiently overcome. Lastly, although opportunistic start-ups based on women's social experience or management ability in work life are important for women's entrepreneurship, government support policies are needed to promote professional technology start-ups.

Determinants Affecting Organizational Open Source Software Switch and the Moderating Effects of Managers' Willingness to Secure SW Competitiveness (조직의 오픈소스 소프트웨어 전환에 영향을 미치는 요인과 관리자의 SW 경쟁력 확보의지의 조절효과)

  • Sanghyun Kim;Hyunsun Park
    • Information Systems Review
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    • v.21 no.4
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    • pp.99-123
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    • 2019
  • The software industry is a high value-added industry in the knowledge information age, and its importance is growing as it not only plays a key role in knowledge creation and utilization, but also secures global competitiveness. Among various SW available in today's business environment, Open Source Software(OSS) is rapidly expanding its activity area by not only leading software development, but also integrating with new information technology. Therefore, the purpose of this research is to empirically examine and analyze the effect of factors on the switching behavior to OSS. To accomplish the study's purpose, we suggest the research model based on "Push-Pull-Mooring" framework. This study empirically examines the two categories of antecedents for switching behavior toward OSS. The survey was conducted to employees at various firms that already switched OSS. A total of 268 responses were collected and analyzed by using the structural equational modeling. The results of this study are as follows; first, continuous maintenance cost, vender dependency, functional indifference, and SW resource inefficiency are significantly related to switch to OSS. Second, network-oriented support, testability and strategic flexibility are significantly related to switch to OSS. Finally, the results show that willingness to secures SW competitiveness has a moderating effect on the relationships between push factors and pull factor with exception of improved knowledge, and switch to OSS. The results of this study will contribute to fields related to OSS both theoretically and practically.

Correlates of Subjective Well-being in Korean Culture (한국문화에서 주관안녕에 영향을 미치는 사회심리 요인들)

  • Hahn, Doug-Woong
    • Korean Journal of Culture and Social Issue
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    • v.12 no.5_spc
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    • pp.45-79
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    • 2006
  • The purpose of this paper was to review the results of the subjective well-being(swb) studies performed by Hahn and coworkers in Korean culture. As the correlates of swb, we dealt with demographic/individual difference variables, intrapersonal variables, interpersonal process variables, and Korean cultural variables. We proposed that the components of swb were consisted of quality of life(cognitive swb) and overall happy feelings about one's own life(emotional swb). It was also assumed that a measure of total swb could be calculated by summated mean of cognitive swb and emotional swb measures. The data of the swb studies were analyzed and interpreted according to the above three measures of swb. The results of a nationwide survey(Hahn, 2004) from age of 19 to 75 years ald(n=2,230) showed significant simple correlation coefficients between the following demographic/individual difference variables and swb: Gender difference in swb was found(total swb r=.08, p<.001; life satisfaction r=.10, p<.001; overall emotional swb r=.05, p<.05). Men were happier than women in terms of all three measures of swb. It was also found that women appeared to experience greater positive and negative emotions. Correlation between age and emotional swb(r=.09, p<.001) was significant, but life satisfaction was not significant(r=.04, n.s). Correlations between economic status and swb were also significant(total swb r =.23, p<.001; life satisfaction r=.15 p<.001; overall emotional swb r=.15, p<.001l). Although existence of father was negatively related to emotional swb(r=-.05, p<.05), the existence of mother was not related to any of swb measures. Similarly existence of brothers was related positively to overall emotional swb, but existence of sisters was not. Though existence of son was not related to swb, daughter contributed negatively to swb(total swb -.12, p<.01; life satisfaction -.09, p<.05; emotional swb r=-.12, p<.01). We assumed that family member-in-Iaw also contributed to swb because the extended dose social networks were important in Korean culture. The results showed that the following family member-in-law variables were related to swb: Parents-in-law(total swb r=.11, p<.01; life satisfaction r=.10, p<.01; emotional swb r=.10, p<.01), father-in-law(total swb r=.11, p<.01; life satisfaction r=.11, p<.01; emotional swb r=.06, n.s). The result suggested that especially father-in-law contributed to swb through financial and social support. Correlations between emotional experiences in everyday life and swb were also presented. The range of correlation coefficients between the positive emotion measures and swb were r=.30~.48(p<.001) when the above two measures obtained at same time. But the range decreased to r=.19~32(p<.001) when the swb measure was obtained 9 month later longitudinally. Intercorrelations between positive emotional experience; and life satisfaction were r=.37~58(p<.001) when two measures were obtained at same time. We also examined the effects of the intrapersonal cognitive responses to the most stressful life event upon swb. The results of nationwide survey(n=1,021) showed that self-disclosure(total swb r=.09, p<.010; life satisfaction r=.10, p<.01; emotional swb r=.07, p<.01), rumination(total swb r=-.17, p<.001), thought avoidance(total swb r=.12, p<.001; life satisfaction r=-.08; emotional swb r=-.12, p<.001) and suppression(total swb r=-.13, p<.001; life satisfaction r=-.08, p<.05: emotional swb r=-.13, p<.001) contributed to swb. It was also suggested that mismatch between self-guide and regulatory focus contributed negatively to emotional swb. It was also found that social comparison motives and fulfillment of the motives contributed to swb. The results of a survey research(n=363 college students) revealed that the higher the general social comparison motive, the lower the swb(total swb r=-.15, P<.01: life satisfaction r=-.17. p<.01; emotional swb r=-.10, p<.05). It was also found that satisfaction level of self-evalution motive contributed positively to swb(total swb r=-.14. p<.01: life satisfaction r=-.12, p<.05; emotional swb r=.15, p<.001). Both of self-improvement motive(r=.13, p<.05) and satisfaction level of self-improvement motive(r=.12, p<.05) contributed positively to emotional swb, respectively. The above results suggested that swb was depended upon the interaction effect of social comparison motive; and level of fulfillment of the motives. We also reported the significant multiple predictors of swb in a sample of age from 60years to 89years olds. The results of multiple regression analysis showed that the significant multiple predictors of swb were past illness(β=.174, p<.001), economic status(β=.418, p<.001), marital satisfaction(β=.0841, p<.001), satisfaction of offsprins(β=.065, p<.01), expectation level of social support from offsprings(β=-.049, p<.001), and negative emotions(β=-.454. p<.001) among 16 social psychological factors. It was also found that swb was an important multiple predictors of physical health. This finding was replicated in a longitudinal study. Both of positive and negative emotional experiences were significant multiple predictors of physical health one year later. The results of the discriminant analysis showed both of total swb and positive emotional experiences contributed to discriminate the happy and healthy olds from unhappy and unhealthy olds. We paper also examined the effects of the nonnative social behaviors upon swb in Korean culture. The main hypotheses of the study(Hahn, 2006, in press) was that the important nonnative behaviors would influence on swb through both of the mediation processes of adjustment to social relationships and psychological stress. The survey data were collected from 2,129 adults age of 19 to 75, from 7 regional areas in Korea. The results of the study revealed that almost all of correlation coefficients between 15 normative social behaviors and the above three criteria w-ere significant. The fitness test results of the covariance structural equation model showed that all of the fitness indices were satisfactory (GFI=.974, AGFI=.909, NNFI=.922, NFI=.973, CFI=.974. RMR=.049, RMSEA=.073). The results of the analysis revealed that the following five path coeffi6ents from behaviors to social adjustment were significant; behavior tor family and family members(t=5.87, p<.001), courteous behavior(t=4.39, p<.001), faithful behavior (t=2.15. p<.05). collectivistic behavior(t=8.31, p<.001). Seven path coefficients from the normative behaviors to psychological stress were significant; behavior for family and family members (t=-4.63, p<.001), faithful behavior(t=-3.86, p<.001). suppression of emotional expression(t=3.99, p<.001), trustworthy and dependable behavior(t=-2.21, p<.05), collectivistic behavior(t=3.72, p<.001), effortful and diligent behavior(t=2.94, p<.001), husbandry and saving behavior(t=3.40, p<.001). The above results suggested that four normative behaviors among seven behaviors contributed negatively to psychological stress in current Korean society. The results abo confirmed the hypothesized paths from social adjustment (t=10.40, p<.001) to swb and from psychological stress(t=-19.74, p<.001) to swb. The important results of the study were discussed in terms of the Confucian traditions and recent social changes in Korean culture. Finally limitations of this review paper were discussed and the suggestions for the future study were also proposed.

An Intervention Study on Integration of Family Planning and Maternal/Infant Care Services in Rural Korea (가족계획과 모자보건 통합을 위한 조산원의 투입효과 분석 -서산지역의 개입연구 평가보고-)

  • Bang, Sook;Han, Seung-Hyun;Lee, Chung-Ja;Ahn, Moon-Young;Lee, In-Sook;Kim, Eun-Shil;Kim, Chong-Ho
    • 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.

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