Heui-Sug Jo

Improving the reliability of clinical practice guideline appraisals: effects of the Korean AGREE II scoring guide.

The Korean translated Appraisal of Guidelines for Research and Evaluation II (Korean AGREE II) instrument was distributed into Korean medical societies in 2011. However, inter-rater disagreement issues still exist. The Korean AGREE II scoring guide was therefore developed to reduce inter-rater differences. This study examines the effects of the Korean AGREE II scoring guide to reduce inter-rater differences. Appraisers were randomly assigned to two groups (Scoring Guide group and Non-Scoring Guide group). The Korean AGREE II instrument was provided to both groups. However, the scoring guide was offered to Scoring Guide group only. Total 14 appraisers were participated and each guideline was assessed by 8 appraisers. To evaluate the reliability of the Korean AGREE II scoring guide, correlation of scores among appraisers and domain-specific intra-class correlation (ICC) were compared. Most scores of two groups were comparable. Scoring Guide group showed higher reliability at all guidelines. They showed higher correlation among appraisers and higher ICC values at almost all domains. The scoring guide reduces the inter-rater disagreement and improves the overall reliability of the Korean-AGREE II instrument. Graphical Abstract

Awareness of Cancer and Cancer Screening by Korean Community Residents

The purpose of this study was through a survey of awareness of cancer and cancer screening of Korean community residents to identify the stereotypes of cancer and bases for development of improved screening programs for early detection. Subjects were residing in South Korea Gangwon-Province and were over 30 years and under 69 years old. The total was 2,700 persons which underwent structured telephone survey questionnaires considered with specific rates of gender, region, and age. For statistical analysis, PASW Statistics 17.0 WIN was utilized. Frequency analysis, the Chi-square (χ?) test for univariate analysis, and logistic regression analysis were performed. The awareness of cancer and cancer screening in subjects differed by gender, region and age. For the idea of cancer, women thought about death less than men (OR: 0.73, p<0.001). On the other hand, women had negative thoughts - fear/terror/suffering/pain/pain - more than their male counterparts (OR: 2.04, p<0.001). Next, for the idea of cancer screening, women recognized fear/terror more than men (OR: 1.38, p<0.01). The higher age, the more tension/anxiety/worry/burden/irritated/pressure (OR: 1.43, p<0.01, OR: 2.15, p<0.001, OR: 2.49, p<0.001)). People may be reminded of fear and death for cancer and of fear, terror, tension and anxiety for cancer screening. To change vague fear and negative attitudes of cancer could increase the rate of cancer screening as well as help to improve the quality of life for community cancer survivors and facilitate return to normal social life. Therefore, it is necessary to provide promotion and education to improve the awareness of cancer and cancer screening.

Factors Related to Condom Use Behavior Among Club-Working Women in South Korea Importance of Subjective Norms and Customer-Related Attitudes

The primary aim of this study was to understand factors associated with condom use behavior among club-working women and identify the most influential factors to be addressed in future health programs. A total of 158 club-working women were surveyed from 3 midsize cities in South Korea from July to September 2004. Survey questionnaires were developed based on the theory of planned behavior. A total of 7 distinct themes emerged: Health aspects, Customer related, Pleasure related, Finance related, Societal norm, Occupational norm, and Perceived control. The results indicated that the Customer-related theme, Societal norm, and Occupational norm were statistically significant factors affecting condom use. On the other hand, self-related factors such as health, pleasure, and finance are not significantly related to the condom use behavior of club-working women in South Korea, suggesting that the currently used knowledge-focused education programs may not be sufficient for this population.

Internal Motivation, Perceived Health Competency, and Health Literacy in Primary and Secondary Cancer Prevention

Objective: The aim of this study was to identify associations of internal motivation, perceived health competency, and health literacy with primary and secondary cancer prevention. Methods: A telephone survey was conducted with a sample of 2,700, 30-69 year olds, proportionally extracted from Gangwon Province, South Korea. The dependent variables were actions in primary and secondary prevention and the explanatory variables were 13 questions in three areas: internal motivation (4 items), perceived health competency (4 items), and health literacy (5 items). Result: Multiple linear regression analysis showed that internal motivation, perceived health competency, and health literacy positively impacted primary prevention after controlling for gender and age. As internal motivation, perceived health competency, and perceived literacy increased by 1 point, primary prevention scores increased by 0.11, 0.11, and 0.07 points, respectively. In addition, logistic regression results for secondary prevention showed that health literacy had a positive impact on secondary behavior. As health literacy increased by 1 point, the odds ratio of the practice of secondary prevention was 1.4 times higher. Conclusion: This study suggests that primary and secondary prevention of cancer are significantly related to intrinsic motivation factors, perceived health competency, and actual health literacy. Health literacy concepts that cover the capacity of health management in comprehensive areas need to be applied to education and promotion for improvement of primary and secondary prevention of cancer.

The Development and Effect of Navigator Education Program for Cancer Screening on Women in the Community

* = Abstract = Objectives: This study was performed to evaluate the effect of navigator education program for cancer screening, which is designed for improvement in knowledge of cancer, perceived self efficacy and communication skill of the breast and cervical cancer screening for middle-aged and aged women in urban areas. Cancer screening navigator is lay health advisor who are educated for providing information, emotional support about cancer screening at the community. Methods: The subjects were 33 women at the age of 40-69 and educated for 12 hours through the education program. The control group subjects were 30 women. For statistical analysis, descriptive statistics and paired t-test were used with SPSS WIN 14.0. Results: Contents of education program were case of cancer early detection, benefit of breast cancer screening, benefit of cervical cancer screening, health care system for cancer screening, role of cancer screening navigator, communication skill, transtheoretical model and role play. Knowledge of cancer(t=4.267, p=0.000) and communication skill(t=4.947, p=0.000) of the women increased significantly after implementing the 12 hours education program. Conclusion: The results suggest that navigator education for cancer screening has an effect in increasing knowledge of cancer, and communication skill scores.

Factors affecting hand hygiene behavior among health care workers of intensive care units in teaching hospitals in Korea: importance of cultural and situational barriers

AbstractOriginal Article Factors affecting hand hygiene behavior among health care workers of intensive care units in teaching hospitals in Korea: importance of cultural and situational barriers 2 In Intensive Care Units (ICUs), where severely ill patients are treated, importance of reducing Hospital Acquired Infection (HAI) cannot be overstated. One of the sim-plest and most effective actions against HAI is proper hand hygiene (HH) behavior of Health Care Workers (HCWs). However, compliance varies across different cultures and different job types of HCWs (physicians, residents and nurses). This study aims to understand determinants of HH behavior by HCWs’ job types in Korea. Quali-tative analysis was performed based on Reasoned Action Approach style interviews with staff physicians, residents and nurses across 7 teaching hospitals. We found that all HCWs strongly believe HH is important in reducing HAI. There were, how-ever, job type-specific HH behavior modifying factors; staff physicians stated feeling pressure to be HH behavior role model. Residents identified Quality Improvement team that measured compliance as a facilitator; a notable barrier for residents was senior physicians not washing their hands, because they were afraid of appearing impudent to their seniors. Nurses designated their chief nurse as a key referent. All participants mentioned heavy workload and lack of access to alcohol-based sanitizer as situational barriers, and sore and dry hand as deterrents to HH compliance. Key wordsPatient safety, Hand Hygiene, Hospital acquired infec-tion, Intensive Care Unit (ICU), Safety culture, Rea-soned action approach

Development of Quality Management Systems for Clinical Practice Guidelines in Korea.

This study introduces the Clinical practice guidelines (CPGs) appraisal system by the Korean Academy of Medical Sciences (KAMS). Quality management policies for CPGs vary among different countries, which have their own cultures and health care systems. However, supporting developers in guideline development and appraisals using standardized tools are common practices. KAMS, an organization representing the various medical societies of Korea, has been striving to establish a quality management system for CPGs, and has established a CPGs quality management system that reflects the characteristics of the Korean healthcare environment and the needs of its users. KAMS created a foundation for the development of CPGs, set up an independent appraisal organization, enacted regulations related to the appraisals, and trained appraisers. These efforts could enhance the ability of each individual medical society to develop CPGs, to increase the quality of the CPGs, and to ultimately improve the quality of the information available to decision-makers.

P273 Effects Of Korean-Agree Scoring Guide On Improving The Reliability Of The Scores

Background The Korean translated AGREE II instrument has been distrubuted to Korean medical societies in 2011. But inter-rater disagreement issues still existed. The Korean AGREE II scoring guide was therefore developed to reduce inter-rater differences. Objectives To examine effects of the Korean AGREE II scoring guide on reduction of the inter-rater differences. Methods Appraisers were randomly assigned to group A or B. The Korean AGREE II instument was provided to all participants, but the Korea AGREE II scoring guide was offered to only group A. Total of 14 appraisers participated and each gudeline was assessed by 8 appraisers. To evaluate the reliability of the Korean AGREE II scoring guide, correlation of scores among appraisers and domain-specific intra-class correlation (ICC) were calculated. Results Most scores of two groups were comparable. And scoring guide user group showed higher reliability at all guidelines. It showed higher correlation among appraisers and higher ICC values at almost all domains (from 0.272∼0.792 to 0.667∼0.888 in CPG A, from 0.273∼0.682 to 0.424∼0.815 in CPG B). Discussion Scoring guide reduces the inter-rater disagreement and improves the overall reliability of the Korean-AGREE II instrument. Implications for Guideline Developers/Users This study identified the performance and utility of the scoring guide as a useful guidance to Korean-AGREE II instrument users.

P281 Applying The Re-Aim Framework To Evaluate Dissemination And Implementation Of Clinical Practice Guideline For Sexually Transmitted Infections In Korea

Background Clinical practice guideline for Sexually Transmitted Infections were developed in 2011 by The Korean Urological Association supported financially by the Korean government. It is necessary to establish the theory-based strategy to disseminate and implement guideline more effectively. Objectives To evaluate dissemination and implementation of clinical practice guideline for Sexually Transmitted Infections in primary health care in Korea. Methods The RE-AIM framework in terms of reach, effectiveness, adoption, implementation and maintenance was applied. Structured questionnaire was formulated. Survey was performed by e-mailing to physicians working at primary health care clinics from 1st Nov – 30thNov 2012 and 305 physicians responded. Results Of the total respondents, 37.5% answered ‘Reach’- no problem for the accessibility of clinical guidelines, cognitive level, and adoption. For Effectiveness measurement, the use of practice guidelines would help the determination of the direction of treatment and communication with patients (52.2%). For the Adoption-environment to apply clinical practice guidelines, there were no problems (50.6%). For Implementation-the degree of application with Practice Guidelines, 17.8% of respondents frequently used the guidelines and, 91.0% of respondents are willing to use them in the future. For Maintenance, 54.8% of respondents used the clinical practice guidelines for more than 6 months. Discussion The reach has been low and even in the respondents with the guideline, the rate of clinical application has been low as well. Implications for Guideline Developers/Users RE-AIM framework is a useful tool to evaluate the effect of using guidelines and develop strategies to disseminate them.

Evaluation of obesity clinic program in public community health centers in South Korea.

The purpose of this study was to evaluate the obesity clinic program in the public community health centers in Korea in 2006-2007. The authors conducted a telephone questionnaire survey for participants to evaluate the outcome of the program. Samples were selected through convenient sampling: 30 persons per one public health center among 2560 participants. The level of improvement in obesity, regular exercise, and the effort for calorie reduction of the participants were analyzed. There were significant differences: The participants who were provided continuously the information of obesity clinic program reduced calories for weight loss (odds ratio [OR] = 2.37, 95% confidence interval [CI] = 1.34-4.19, P < .01), and showed concern about body weight (OR = 2.17, 95% CI = 1.07-4.41, P < 0.05). This study found that when the program information was provided continually and the participants were motivated, the community obesity program goals could be achieved.