Journal of agricultural medicine and community health (농촌의학ㆍ지역보건)

Korean Society for Rural Medicine and Community Health (한국농촌의학지역보건학회)
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The Associations of Empowerment and Social Capital with Self-Rated Health in Communities with Poor Health

사망률이 높은 지역사회에서 임파워먼트 및 사회적 자본과 주관적 건강수준의 연관성

  • Kim, Jang-Rak (Department of Preventive Medicine, School of Medicine and Institute of Health Sciences, Gyeongsang National University) ;
  • Jeong, Baek-Geun (Department of Preventive Medicine, School of Medicine and Institute of Health Sciences, Gyeongsang National University) ;
  • Park, Ki-Soo (Department of Preventive Medicine, School of Medicine and Institute of Health Sciences, Gyeongsang National University) ;
  • Kang, Yune-Sik (Department of Preventive Medicine, School of Medicine and Institute of Health Sciences, Gyeongsang National University)
  • 김장락 (경상대학교 의학전문대학원 예방의학교실 및 건강과학연구원) ;
  • 정백근 (경상대학교 의학전문대학원 예방의학교실 및 건강과학연구원) ;
  • 박기수 (경상대학교 의학전문대학원 예방의학교실 및 건강과학연구원) ;
  • 강윤식 (경상대학교 의학전문대학원 예방의학교실 및 건강과학연구원)
  • Received : 2012.05.14
  • Accepted : 2012.09.07
  • Published : 2012.09.30
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Abstract

Objectives: This study was performed to identify the associations of empowerment and social capital (such as social participation and trust) with self-rated health in Korean communities with poor health. Methods: This study used the data from community health interviews conducted at 29 administrative sections (dong, eup, or myeon) with high mortality from August to October in both 2010 and 2011 as part of the Health Plus Happiness Plus Projects in Gyeongsangnam-do Province. The study subjects comprised 6,383 individuals composed of approximately 220 adults randomly sampled from each administrative section. The empowerment was measured with five-point Likert scale responses to seven perceived control questions (two at the individual level, five at the community level). The social participation was measured with 'participation in formal and/or informal group' and trust using responses to three questions about trust of others. Results: The high empowerment scores at both individual and community levels, social participation in informal groups, and high trust level had independent and significant associations with good self-rated health after adjusting for socio-demographic factors (sex, age, marital status, occupation, and food affordability) and health behaviors (smoking, alcohol drinking, and exercise) in the logistic regressions. There were weak but significant associations among empowerment, social participation, and trust levels. Conclusions: Empowerment, social participation, and trust were weakly inter-related and significantly associated with self-rated health. More studies are warranted for empowerment and other social capital indices in health promotion.

이 연구는 상대적으로 사망 수준이 높은 지역사회를 대상으로 인지된 통제력으로 측정된 임파워먼트 및 사회적 자본(사회적 참여와 신뢰)의 주관적 건강수준과의 연관성을 규명하고자 수행되었다. 경상남도에서 표준화사망비가 상대적으로 가장 높은 29개 읍, 면, 동에서 체계적 표본 추출로 선정된 220 가구의 구성원 중 가장 생월일이 빠른 19세 이상 성인을 대상으로 직접 면접 방법으로 자료를 수집하였다. 자료 수집 기간은 2010년과 2011년의 8-10월이었으며, 최종 자료 분석 대상자는 6,383명이었다. 임파워먼트 수준은 Israel 등이 개발한 인지된 통제력 설문(개인 수준 2개 항목, 지역사회 수준 5개 항목)에 대해 5점 응답(매우 그렇다, 그렇다, 보통이다, 그렇지 않다, 전혀 그렇지 않다)의 Likert 척도로 측정하였다. 사회적 참여는 공식 집단 또는 비공식 집단에 참여하는 여부로, 신뢰수준은 영국의 국립 사회조사센터의 신뢰 설문 3항목을 번역한 질문에 대한 긍정적 답변의 수로 구하였다. 평소 본인의 건강에 대해 좋거나 매우 좋게 생각하는 경우를 주관적 건강수준(self-rated health)이 좋은 것으로 구분하였다. 임파워먼트, 사회적 참여, 그리고 신뢰 간의 Spearman의 상관계수 값은 임파워먼트와 사회적 참여 간 0.20, 임파워먼트와 신뢰수준 간 0.15, 사회적 참여와 신뢰수준 간 0.11로 약한 연관성이 유의하였다. 로지스틱 회귀분석 결과 인구사회학적 및 건강행태 변수를 보정한 후에도 임파워먼트 점수가 둘 다 낮은 경우를 기준으로 할 때 주관적으로 좋은 건강에 대한 교차비는 개인 및 지역사회 수준 둘 다 높은 경우 1.21(95% 신뢰구간 1.03-1.42)로 유의하였다. 사회적으로 공식 및 비공식집단 둘 다 미참여하는 경우를 기준으로 할 때 주관적으로 좋은 건강에 대한 교차비는 비공식집단만 참여하는 경우 1.23(95% 신뢰구간, 1.07-1.43)으로 유의하였다. 신뢰수준의 경우에도 0인 경우를 기준으로 할 때 주관적으로 좋은 건강에 대한 교차비는 신뢰수준이 높을수록 높아져서, 신뢰수준이 3인 경우 1.29(95% 신뢰구간 1.09-1.52)로 유의하였다. 결론적으로 임파워먼트는 사회적 자본, 인구사회학적 변수, 그리고 건강행태와는 독립적으로 주관적 건강수준과 연관성이 있었으며, 사회적 자본인 사회적 참여와 신뢰 수준과도 약하지만, 유의한 연관성이 있었다. 건강증진 사업에서 임파워먼트 및 사회적 자본 지표에 대해서는 더 많은 연구가 필요하다.

Keywords

References

  1. Laverack G. Building capable communities: experiences in a rural Fijian context. Health Promotion International 2003;18(2):99-106 https://doi.org/10.1093/heapro/18.2.99
  2. Gibson CH. A concept analysis of empowerment. J Adv Nurs 1991;16(3):354-361 https://doi.org/10.1111/j.1365-2648.1991.tb01660.x
  3. Eisen A. Survey of neighborhood-based, comprehensive community empowerment initiatives. Health Education Quarterly 1994;21(2):235-252 https://doi.org/10.1177/109019819402100208
  4. Minkler M, Wallerstein N, Wilson N. Improving health through community organization and community building. In: Glanz K, Rimer BK, Viswanath K, editors. Health behavior and health education. San Francisco, John Willey & Sons, Inc., 2008, p.287-288, p.298-299
  5. Laverack G. Improving health outcomes through community empowerment: a review of the literature. J Health Popul Nutr 2006;24(1):113-120
  6. CART Project Team. Community action for health promotion: a review of methods and outcomes 1990-1995. Am J Prev Med 1997;13(4):229-239
  7. Wallerstein N. Empowerment to reduce health disparities. Scand J Public Health 2002;30(Suppl. 59):72-77 https://doi.org/10.1177/14034948020300031201
  8. Laverack G, Wallerstein N. Measuring community empowerment: a fresh look at organizational domains. Health Promotion International 2001;16(2): 179-185 https://doi.org/10.1093/heapro/16.2.179
  9. Israel BA, Checkoway B, Schulz A, Zimmerman M. Health education and community empowerment: conceptualizing and measuring perceptions of individual, organizational, and community control. Health Education Quarterly 1994;21(2):149-170 https://doi.org/10.1177/109019819402100203
  10. Wallerstein N. What is the evidence on effectiveness of empowerment to improve health? Copenhagen, WHO, 2006 [cited 2012 July 23]. Available from: URL:http://www.euro.who.int/_data/assets/pdf_file/0010/74656/E88086.pdf
  11. Parker EA, Lichtenstein RL, Schulz AJ, Israel BA, Schork MA, Steinman KJ, James SA. Disentangling measures of individual perceptions of community social dynamics: results of a community survey. Health Education & Behavior 2001;28(4):462-486 https://doi.org/10.1177/109019810102800407
  12. Becker AB, Israel BA, Schulz AJ, Parker EA, Klem L. Age differences in health effects of stressors and perceived control among urban African American women. J Urban Health 2005;82(1):122-141 https://doi.org/10.1093/jurban/jti014
  13. Morgan A, Swann C, editors. Social capital for health : issues of definition, measurement and links to health. Health Development Agency, 2004, p.2-3, pp.19-20, p.144, p.148
  14. 이명순, 김장락, 조종희, 강민정, 황영신, 이경혜, 인은주, 이지영, 김종헌. 건강증진을 위한 지역사회 주민 참여전략 및 방법 개발: 도시지역 주민자치센터의 참여를 기반으로. 성균과대학교 의과대학, 건강증진사업지원단, 2008, p. 16
  15. Ronconi L, Brown TT, Scheffler RM. Social capital and self-rated health in Argentina. Health Econ 2012;21(2):201-208 https://doi.org/10.1002/hec.1696
  16. Nieminen T, Martelin T, Koskinen S, Aro H, Alanen E, Hyyppa MT. Social capital as a determinant of self-rated health and psychological well-being. Int J Public Health 2010;55(6):531-542 https://doi.org/10.1007/s00038-010-0138-3
  17. Nummela O, Sulander T, Karisto A, Uutela A. Self-rated health and social capital among aging people across the urban-rural dimension. Int J Behav Med 2009;16(2):189-194 https://doi.org/10.1007/s12529-008-9027-z
  18. Fujiwara T, Kawachi I. Social capital and health. A study of adult twins in the U.S. Am J Prev Med 2008;35(2):139-144 https://doi.org/10.1016/j.amepre.2008.04.015
  19. Lee HY, Jang SN, Lee S, Cho SI, Park EO. The relationship between social participation and self-rated health by sex and age: a cross-sectional survey. Int J Nurs Stud 2008;45(7):1042-1054 https://doi.org/10.1016/j.ijnurstu.2007.05.007
  20. Giordano GN, Jonas Bjork J, Lindstrom M. Social capital and self-rated health - A study of temporal (causal) relationship. Social Science & Medicine 2012; doi:10.1016/j.socscimed.2012.03.011
  21. Jylha M. What is self-rated health and why does it predict mortality? Towards a unified conceptual model. Soc Sci Med 2009;69(3):307-316 https://doi.org/10.1016/j.socscimed.2009.05.013
  22. Idler EL, Benyamini Y. Self-rated health and mortality: a review of twenty-seven community studies. J Health Soc Behav 1997;38(1):21-37 https://doi.org/10.2307/2955359
  23. Jeong BG, Kim JR, Kang YS, Park KS, Lee JH, Jo SR, Seo GD, Sang-Jun Joo SJ, Oh ES, Kim SJ, Jo SJ, Kim SM, Yeum DM, Sim MY. The strategies to address regional health inequalities in Gyeongsangnam-Do : Health Plus Happiness Plus projects. J Agric Med Community Health 2012;37(1):36-51 (Korean) https://doi.org/10.5393/JAMCH.2012.37.1.036
  24. Korea National Statistical Office. 2005 Life tables for provinces. Daejon, National Statistical Office, 2007, p.11 (Korean)
  25. Bajekal M, Purdon S. Social capital and social exclusion: development of a condensed module for the Health Survey for England. London, National Center for Social Research, 2001, p.37
  26. Babor HF, Higgins-Biddle JC, Saunders JB, Monteiro MG. The alcohol use disorders identification test. WHO, 2001[cited 2012 April 4], Available from: URL:http://whqlibdoc.who.int/hq/2001/who_msd_msb_01.6a.pdf
  27. Lima-Costa MF, Cesar CC, Chor D, Proietti FA. Self-rated health compared with objectively measured health status as a tool for mortality risk screening in older adults: 10-year follow-up of the Bambuı' Cohort Study of Aging. Am J Epidemiol 2012;175(3):228-35 https://doi.org/10.1093/aje/kwr290
  28. Wiggins N. Popular education for health promotion and community empowerment: a review of the literature. Health Promotion International doi:10.1093/heapro/dar046 [cited 2012 May 7]. Available from: URL:http://heapro.oxfordjournals.org/content/early/2011/08/11/heapro.dar046.abstract
  29. Paeng KY. The influence of individuallevel social capital on self-rated health [dissertation]. Jinju, Gyeongsang National University, 2011 (Korean)
  30. Cramm JM, Nieboer AP. The influence of social capital and socio-economic conditions on self-rated health among residents of an economically and health-deprived South African township. Int J Equity Health 2011;10:51 doi:10.1186/1475-9276-10-51
  31. Becker AB, Israel BA, Schulz AJ, Parker EA, Klem L. Predictors of Perceived Control Among African American Women in Detroit: Exploring Empowerment as a Multilevel Construct. Health Education & Behavior 2002;29(6):699-715 https://doi.org/10.1177/109019802237939
  32. CSDH. Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. Geneva, World Health Organization, 2008, pp.1-2

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