Yang Heui Ahn

Lifestyle advice for Korean Americans and native Koreans with hypertension

AIM This paper is a report of a comparison of advice on lifestyle given by healthcare providers and subsequent action by recipients between Korean Americans and native Koreans with hypertension. BACKGROUND High blood pressure is controllable by having a healthy lifestyle, such as weight control, dietary change, exercise, low-sodium diet, alcohol restriction and smoking cessation, and by taking medication. Healthcare providers play an important role in teaching individuals with hypertension on healthy lifestyles. METHOD This descriptive comparative study was conducted with a convenience sample of 100 Korean Americans and 100 native Koreans with hypertension. They were interviewed between May 2003 and June 2004 on the advice they received from healthcare providers on lifestyle and their subsequent action in terms of taking medication, weight control, dietary change, exercise, low-sodium diet, smoking cessation, alcohol restriction and tension reduction. Nutrient profiles were examined using the 24-hour dietary recall method. FINDINGS Korean Americans received advice on lifestyle less than did native Koreans, but more Korean Americans followed healthy lifestyle advice on dietary change and exercise than did native Koreans (P<0.001). Weight control was the least adhered to behaviour among the Korean Americans, although almost two-thirds of them were overweight or obese. Both groups exceeded the Dietary Reference Intakes of sodium, but perceived their sodium consumption as low. CONCLUSION Native Korean participants need to pay closer attention to carrying out the advice, whereas healthcare providers to Korean Americans need to give more advice on culturally acceptable healthy lifestyles, particularly on dietary changes and weight control. Both groups need to monitor their sodium intake more realistically. It is not only advice from healthcare providers that is integral to control of hypertension, but also that patients should follow that advice.

Multilevel Analysis of Health Care Service Utilization among Medical Aid Beneficiaries in Korea

PURPOSE The current study was done to identify individual- and group-level factors associated with health care service utilization among Korean medical aid beneficiaries by applying multilevel modeling. METHODS Secondary data analysis was performed using data on health care service reimbursement and medical aid case management progress from 15,948 beneficiaries, and data from 229 regions were included in the analysis. RESULTS Results of multilevel analysis showed an estimated intraclass correlation coefficient (ICC) of 18.1%, indicating that the group level accounted for 18.1% of the total variance in health care service utilization, and that beneficiaries within the region are more likely to share common features with regard to health care service utilization. At the individual level, existence of disability and types of medical aid beneficiaries showed a significant association, while, at the group level, social deprivation index, and the number of beneficiaries and case managers within the region showed a significant association with health care service utilization. CONCLUSION The significant influence of group level variables in health care service utilization found in this study indicate a need for group level approaches, such as policy change and/or promotion of community awareness.

Factors affecting unmet healthcare needs of older people in Korea

BACKGROUND Despite the fact that the National Health Insurance programmes have ensured universal coverage for Koreans, disparities in access to health care and unmet healthcare needs still exist in Korea. AIM The purpose of this study was to analyse factors affecting unmet healthcare needs of older people in Korea. METHODS This study had a cross-sectional, descriptive design using secondary data taken from the Korean National Health and Nutrition Survey conducted in 2007-2009. A complex sampling design was used, and the participants included a nationally representative sample of 3943 people older than 64 years. Socio-demographic variables, subjective health, existence of chronic diseases, quality of life and unmet healthcare needs were included in the study instruments. Logistic regression analyses were performed in order to examine the relationship between unmet healthcare needs and independent variables. RESULTS According to the results, 29.4% of older women and 14.0% of older men had not visited clinics or hospitals when they needed to obtain healthcare services (unmet healthcare needs) during the past 12 months. Older women [odds ratio (OR) = 1.831, 95% confidence interval (CI) = 1.428-2.347] and those with poor subjective health (OR = 1.708, 95% CI = 1.371-2.126) and arthritis (OR = 1.278, 95% CI = 1.029-1.586) were more likely to have unmet healthcare needs than their counterparts. CONCLUSIONS Efforts to decrease unmet healthcare needs, targeting high-risk groups (especially for older women), are needed in order to prevent disability, decrease mortality and promote the quality of life of older people.

Validation of a Needs Assessment Tool for Case Management in Korean Medical Aid Beneficiaries

PURPOSE The purpose of this study was to validate the Needs Assessment Tool for Case Management (NATCM) for use with Korean medical aid beneficiaries. METHODS Psychometric testing was performed with a sample of 645 Korean medical aid beneficiaries, which included 41 beneficiaries who were selected using proportional sampling method, to examine intraclass correlation coefficients (ICC). Data were evaluated using item analyses, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), Cronbachs alpha, and ICC. RESULTS Through psychometric testing the final version of NATCM was found to consist of two subscales: 1) Appropriateness of Health Care Utilization (5 items) and 2) Self Care Ability (6 items). The two subscale model was validated by CFA (RMSEA=.08, GFI=.97, and CFI=.93). Internal consistency measured by Cronbachs alpha was .82, and subscale reliability ranged from .79 to .84. The ICC of the NATCM between case managers was .73 and between case managers and health care professionals. .82. CONCLUSION This study suggests that the final version of NATCM is a brief, reliable, and valid instrument to measure needs of Korean medical aid beneficiaries. Therefore, the NATCM can be effectively utilized as an important needs assessment as well as outcome evaluation tool for case management programs in Korea.

Gender differences in chewing discomfort in older South Koreans

AIMS The purpose of this study was to identify gender differences in chewing discomfort among elderly Koreans. METHODS This study used data from 56 616 (weighted sample: 5 638 394) subjects aged over 65 years who participated in the 2011 Community Health Survey in Korea. Of them, 23 059 (weighted sample: 2 368 200, 42.0%) were men and 33 357 (weighted sample: 3 270 194, 58.0%) were women. Data were analysed using chi-square tests and hierarchical logistic regression analyses, with SPSS 20.0. Chewing discomfort was set as the dependent variable, and independent variables were divided into socio-economic factors (place of residence, age, education, monthly household income, basic living security stipend, private insurance, economic activity, living arrangements), general health factors (hypertension, diabetes) and oral health factors (tooth defects, denture use, subjective periodontal health status). RESULTS A greater proportion of women (50.2%) than men (42.6%) exhibited chewing discomfort (P < 0.001). In men, place of residence, monthly household income, private health insurance, tooth defects and periodontal health were associated with chewing discomfort (P < 0.05). In women, age, education level, basic living security stipend and denture use were associated with chewing discomfort (P < 0.05). CONCLUSIONS Elderly Korean women experience more severe chewing discomfort than their male counterparts. The factors associated with chewing also differ by gender.

Factors Associated With Medication Adherence Among Medical-Aid Beneficiaries With Hypertension.

The purpose was to examine factors associated with medication adherence among medical-aid beneficiaries with hypertension using the Expanded Behavioral Model of Health Services Utilization. A cross-sectional study was conducted with a convenient sample of 289 patients. The instruments included scales to measure medication adherence, health literacy, general self-efficacy, and pros and cons of chronic disease management. Data collection was performed between February and March 2011. A hierarchical regression analysis was performed. The study found that 25.6% to 34.6% had low motivation and low knowledge regarding medication adherence. Those with higher health literacy and higher self-efficacy scores were more likely to have higher medication adherence, whereas widowed and those who perceived more cons of chronic disease management were more likely to have lower medication adherence than their counterparts (p < .05). Interventions incorporating significant factors associated with medication adherence are required to enhance medication adherence and to prevent complications associated with medication non-adherence.