Journal of Preventive Medicine and Public Health

Original Articles

Knowledge, Attitudes, and Practices Regarding Dengue Prevention Among Health Volunteers in an Urban Area – Malang, Indonesia: Alidha Nur Rakhmani, Lilik Zuhriyah; J Prev Med Public Health. 2024;57(2):176-184. Published online February 21, 2024; DOI: https://doi.org/10.3961/jpmph.23.484

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Abstract Summary PDF: Objectives
The dengue prevention program known as “One House One Mosquito Larva Inspector” involves health volunteers who play a crucial role in the surveillance of mosquito larvae and reporting their findings to local public health officials. This study aimed to identify factors related to the knowledge, attitudes, and practices (KAP) of dengue prevention behavior among these health volunteers.
Methods
A study was conducted in 5 sub-districts in Malang, an urban area in Indonesia. We employed a cross-sectional design and utilized a semi-structured questionnaire to assess the KAP of 400 health volunteers. Data were collected through face-to-face interviews.
Results
Multiple logistic regression analysis revealed that individuals with a more positive attitude (odds ratio [OR], 1.69; p<0.05) and those with family sizes greater than five persons (OR, 1.90; p<0.05) were more likely to engage in effective dengue prevention practices. Additionally, possesing good knowledge was significantly assocated with more positive attitude (OR, 2.24; p<0.001). Furthermore, 40% reduction in positive attitude was observed in those over 45 years (OR, 0.60; p<0.05). The best practices most frequently reported by the majority of respondents included always reporting their surveillance activities (75.8%) and cleaning the water container in the bathroom at least once a week (65.2%). However, only 52.2% of respondents regularly checked for mosquito larvae in their neighborhood.
Conclusions
Sustainable promotion and training for the “One House One Mosquito Larva Inspector” initiative are necessary, particularly among young health volunteers, to improve dengue prevention behaviors both within their own homes and in the surrounding environment.; Summary

Key Message
The study among health volunteers emphasizes that better knowledge and younger age < 45 were associated with a positive attitude. While a positive attitude and family size > 5 persons were associated with better dengue prevention practices. Therefore, there is a need for sustained promotion and training among health volunteers to enhance the knowledge and attitude that may shape good dengue prevention practices.

Teachers’ Negative Attitudes and Limited Health Literacy Levels as Risks for Low Awareness of Epilepsy in Turkey: Gulay Yilmazel; J Prev Med Public Health. 2023;56(6):573-582. Published online November 13, 2023; DOI: https://doi.org/10.3961/jpmph.23.330

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Abstract Summary PDF Supplementary Material: Objectives
For students with epilepsy, schools are a critical environment for managing the disease properly. This study examined awareness of epilepsy, attitudes toward epilepsy, and health literacy among school teachers in Turkey.
Methods
This study was conducted in a city in Turkey with 1408 public school teachers from June 2021 to September 2021.
Results
The median scores of the scales were 5, 29, and 32 for epilepsy awareness, epilepsy attitudes, and health literacy, respectively. Epilepsy awareness was higher in women, and epilepsy attitudes were more positive in women than men (p<0.05). While epilepsy awareness was higher in primary school teachers, epilepsy attitudes were more positive in secondary school teachers (p<0.05). Epilepsy awareness was lower in secondary school teachers (odds ratio [OR], 1.27; p<0.05), those who did not have an individual with epilepsy in their family/social environment (OR, 1.57; p<0.001), those who did not have a student with epilepsy in their class (OR, 1.45; p<0.05), and in those who had not witnessed an epilepsy seizure (OR,1.19; p<0.05). Compared to those with positive attitudes regarding epilepsy, epilepsy awareness was 1.36 times lower in those with negative attitudes (p<0.001). Epilepsy awareness was 1.92 times lower in those with limited health literacy than those with adequate health literacy (p<0.001).
Conclusions
In this study, low epilepsy awareness, negative epilepsy attitudes, and limited health literacy were common among teachers. The findings from this study suggest that panels, workshops, and health training on epilepsy should be organized for school teachers and included at regular intervals in certified first-aid practices.; Summary

Key Message
• This article examined school teachers' barriers to epilepsy awareness. • Awareness was low, negative attitudes were high, and health literacy level was limited. • Negative attitudes and limited health literacy were the most effective risks for poor awareness.

Healthcare Workers’ Knowledge and Attitudes Regarding the World Health Organization’s “My 5 Moments for Hand Hygiene”: Evidence From a Vietnamese Central General Hospital: Huy Van Nguyen, Hieu Trung Tran, Long Quynh Khuong, Thanh Van Nguyen, Na Thi Nhi Ho, An Thi Minh Dao, Minh Van Hoang; J Prev Med Public Health. 2020;53(4):236-244. Published online May 7, 2020; DOI: https://doi.org/10.3961/jpmph.19.319

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Abstract PDF

Objectives
Although the World Health Organization (WHO) initiative “My 5 Moments for Hand Hygiene” has been lauded as effective in preventing hospital-associated infections, little is known about healthcare workers (HCWs)’ hand hygiene behavior. In this study, we sought to assess knowledge and attitudes towards the concepts in this initiative, as well as associated factors, among Vietnamese HCWs at a general hospital.
Methods
A structured questionnaire was administered to HCWs at a central Vietnamese general hospital in 2015. Multiple logistic regression analysis was used to identify factors associated with HCWs’ knowledge and attitudes towards hand hygiene.
Results
Of 120 respondents, 65.8% and 67.5% demonstrated appropriate knowledge and a positive attitude, respectively, regarding all 5 hand hygiene moments. Logistic regression indicated better knowledge of hand hygiene in workers who were over 30 years old, who were direct HCWs (rather than managers), who had frequent access to clinical information, and who received their clinical information from training. Those who worked in infectious and tropical disease wards, who had frequent access to clinical information, and who received information from training were more likely to have a positive attitude towards hand hygiene than their counterparts.
Conclusions
Although many Vietnamese HCWs displayed moderate knowledge and positive attitudes towards the WHO hand hygiene guidelines, a key gap remained. Regular education and training programs are needed to increase knowledge and to improve attitudes and practices towards hand hygiene. Furthermore, a combination of multimodal strategies and locally-adapted interventions is needed for sustainable hand hygiene adherence.

Summary

Citations

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Improvement in knowledge and perception about the controlling of COVID-19: best practice of apothecary student
Chynthia Pradiftha Sari, Suci Hanifah, Yulianto Yulianto, Dian Medisa, Zahrotun Nafiah, Muhammad Alfian Lutfi
Journal of Advanced Pharmacy Education and Research.2023; 13(2): 6. CrossRef
Hand Hygiene Knowledge and Perception Survey for Healthcare Workers in Government Hospitals (GHs) in Bahrain
Saleh F Sowar, Rommel Acunin, Harold C Cabanalan, Tamer T Abo Arisheh, Safa Alkhawaja
Cureus.2023;[Epub] CrossRef
Level of Complete Knowledge on Five Moments of Hand Hygiene among Nurses Working at Integrated Nursing Care Service Wards
Eunhee Kim, Ihn Sook Jeong
Journal of Korean Academy of Nursing.2021; 51(4): 454. CrossRef

Patients’ and General Practitioners’ Views About Preventive Care in Family Medicine in Switzerland: A Cross-sectional Study: Christine Cohidon, Fabienne Imhof, Laure Bovy, Priska Birrer, Jacques Cornuz, Nicolas Senn; J Prev Med Public Health. 2019;52(5):323-332. Published online September 17, 2019; DOI: https://doi.org/10.3961/jpmph.19.184

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Abstract PDF

Objectives
The aim of this study was to describe general practitioners (GPs)’ opinions and practices of preventive care and patients’ opinions, attitudes, and behaviors towards prevention.
Methods
The data stemmed from a cross-sectional national survey on prevention conducted in Switzerland from 2015 to 2016. In total, 170 randomly drawn GPs and 1154 of their patients participated. The GPs answered an online questionnaire and the patients answered a questionnaire administrated by fieldworkers present at their practices.
Results
Both patients and GPs agreed that delivering preventive care is the dedicated role of a GP. It appeared that beyond classical topics of prevention such as cardiovascular risk factors, other prevention areas (e.g., cannabis consumption, immunization, occupational risks) were scarcely covered by GPs and reported as little-known by patients. In addition, GPs seemed to use a selective approach to prevention, responding to the clinical context, rather than a systematic approach to health promotion. The results also highlight possibilities to improve prevention in family medicine through options such as more supportive tools and public advertising, more time and more delegated tasks and, finally, a more recognized role.
Conclusions
Despite an unfavorable context of prevention within the healthcare system, preventive care in family medicine is reasonably good in Switzerland. However, some limitations appear regarding the topics and the circumstances of preventive care delivery. A global effort is needed to implement necessary changes, and the responsibility should be broadened to other stakeholders.

Summary

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Knowledge, Attitudes, and Practices Regarding Tuberculosis in Timor-Leste: Results From the Demographic and Health Survey 2016: Supa Pengpid, Karl Peltzer; J Prev Med Public Health. 2019;52(2):115-122. Published online February 18, 2019; DOI: https://doi.org/10.3961/jpmph.18.170

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Abstract PDF

Objectives
The aim of this study was to assess knowledge, attitudes, and practices regarding tuberculosis (TB) in the general population in Timor-Leste.
Methods
In the nationally representative cross-sectional 2016 Timor-Leste Demographic and Health Survey, 4622 men (aged 15-59 years) and 12 607 women (aged 15-49 years) were randomly selected using stratified multistage sampling and interviewed.
Results
Overall, 66.9% of men and 62.8% of women were aware of TB, 4.4% of men and 12.6% of women had TB courtesy stigma, and 83.3% of men and 88.6% of women reported intention to receive TB treatment. The mean±standard deviation overall TB knowledge score was 3.9±2.0 (out of 8) among men and 3.0±1.8 among women. In a multivariable linear regression analysis, among both men and women, older age, higher education, rural residence, and sources of TB information (family/friends, school/workplace, health care provider, Internet, television, and newspaper) were associated with higher TB knowledge scores. In addition, among women, higher wealth status and having heard about TB from the radio were associated with higher TB knowledge scores. Negative associations with TB courtesy stigma were found for urban residence and having heard about TB from family or friends among men, and for older age, higher TB knowledge, and TB information sources (family/friends and school/workplace) among women. Among both men and women, higher TB knowledge scores and having heard of TB from a health care provider were associated with intention to receive TB treatment.
Conclusions
This study identified socio-demographic risk factors for deficiences in population-based TB knowledge in Timor-Leste; these findings should be considered when designing TB communication, prevention, and control strategies.

Summary

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Special Article

Lessons From Healthcare Providers' Attitudes Toward Pay-for-performance: What Should Purchasers Consider in Designing and Implementing a Successful Program?: Jin Yong Lee, Sang-Il Lee, Min-Woo Jo; J Prev Med Public Health. 2012;45(3):137-147. Published online May 31, 2012; DOI: https://doi.org/10.3961/jpmph.2012.45.3.137

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Abstract PDF

We conducted a systematic review to summarize providers' attitudes toward pay-for-performance (P4P), focusing on their general attitudes, the effects of P4P, their favorable design and implementation methods, and concerns. An electronic search was performed in PubMed and Scopus using selected keywords including P4P. Two reviewers screened target articles using titles and abstract review and then read the full version of the screened articles for the final selections. In addition, one reference of screened articles and one unpublished report were also included. Therefore, 14 articles were included in this study. Healthcare providers' attitudes on P4P were summarized in two ways. First, we gathered their general attitudes and opinions regarding the effects of P4P. Second, we rearranged their opinions regarding desirable P4P design and implementation methods, as well as their concerns. This study showed the possibility that some healthcare providers still have a low level of awareness about P4P and might prefer voluntary participation in P4P. In addition, they felt that adequate quality indicators and additional support for implementation of P4P would be needed. Most healthcare providers also had serious concerns that P4P would induce unintended consequences. In order to conduct successful implementation of P4P, purchaser should make more efforts such as increasing providers' level of awareness about P4P, providing technical and educational support, reducing their burden, developing a cooperative relationship with providers, developing more accurate quality measures, and minimizing the unintended consequences.

Summary

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Original Article

Factors Affecting Public Prejudice and Social Distance on Mental Illness: Analysis of Contextual Effect by Multi-level Analysis: Hyeongap Jang, Jun-Tae Lim, Juhwan Oh, Seon-Young Lee, Yong-Ik Kim, Jin-Seok Lee; J Prev Med Public Health. 2012;45(2):90-97. Published online March 31, 2012; DOI: https://doi.org/10.3961/jpmph.2012.45.2.90

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Abstract PDF

Objectives

While there have been many quantitative studies on the public's attitude towards mental illnesses, it is hard to find quantitative study which focused on the contextual effect on the public's attitude. The purpose of this study was to identify factors that affect the public's beliefs and attitudes including contextual effects.

Methods

We analyzed survey on the public's beliefs and attitudes towards mental illness in Korea with multi-level analysis. We analyzed the public's beliefs and attitudes in terms of prejudice as an intermediate outcome and social distance as a final outcome. Then, we focused on the associations of factors, which were individual and regional socio-economic factors, familiarity, and knowledge based on the comparison of the intermediate and final outcomes.

Results

Prejudice was not explained by regional variables but was only correlated with individual factors. Prejudice increased with age and decreased by high education level. However, social distance controlling for prejudice increased in females, in people with a high education level, and in regions with a high education level and a high proportion of the old. Therefore, social distance without controlling for prejudice increased in females, in the elderly, in highly educated people, and in regions with a high education and aged community.

Conclusions

The result of the multi-level analysis for the regional variables suggests that social distance for mental illness are not only determined by individual factors but also influenced by the surroundings so that it could be tackled sufficiently with appropriate considering of the relevant regional context with individual characteristics.

Summary

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English Abstracts

Awareness and Attitude Toward Suicide in Community Mental Health Professionals and Hospital Workers.: Soung Nam Kim, Kang Sook Lee, Seon Young Lee, Jae Hee Yu, A Rum Hong; J Prev Med Public Health. 2009;42(3):183-189.; DOI: https://doi.org/10.3961/jpmph.2009.42.3.183

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Abstract PDF

OBJECTIVES
The purpose of this study was to evaluate community mental health professionals and hospital workers attitude and awareness towards suicide. METHODS: This study investigated 264 community mental health professionals and 228 hospital workers. SOQs (Suicidal Opinion Questionnaires) were used from July 2007 to September 2007. After a factor analysis for the attitude towards suicide, the items on ethics, mental illness, religion, risk, and motivation were included in the subsequent analysis. RESULTS: There were significant differences in the attitude towards suicide according to religion, age, educational background, the marriage status, the economic position, and different professional licenses. Hospital workers' view was different from the community workers'. The hospital workers judged that suicide was due to mental illness, and suicide was high for the people in a special environment and who lacked motivation, which caused them to fall in a dangerous situation. For the lower educational group, they thought that suicide was attributable to mental illness. The awareness for suicide was significantly higher in the group with a postgraduate education, unmarried people, mental health professionals and the persons who had concern and experience with suicide. The factors that had an influence on the awareness of suicide were the items of mental illness, religion, risk and motivational factors. CONCLUSIONS: This study suggested that the factors to increase the awareness and attitude for suicide were the experience of increased education and case management of suicide. Therefore, education dealing with suicide and reinforcement of crisis management programs should be developed.

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Disparities in Participation in Health Examination by Socio-economic Position among Adult Seoul Residents.: Eun Jeong Chun, Soong Nang Jang, Sung Il Cho, Youngtae Cho, Ok Ryun Moon; J Prev Med Public Health. 2007;40(5):345-350.; DOI: https://doi.org/10.3961/jpmph.2007.40.5.345

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OBJECTIVES
To determine the disparity in the rate people undergo health examinations according to socioeconomic position (SEP) and the changes in this disparity with time. METHODS: Seoul citizens}health profile data from 1997 to 2005 were analyzed. The study subjects were 40 years old and over, and the total number of subjects was 6,601 in 1997, 8,994 in 2001, and 8,819 in 2005. Those aged 60 years and over were eliminated from the analysis of subjects}occupation. We used education, family income and occupation as indicators of SEP. The age-standardized health examination attendance rate for each year was calculated according to the education, family income and occupation. The odds ratios (ORs) from multiple logistic regressions were adjusted for age. RESULTS: The disparity in the rate of attendance according to the SEP decreased from 1997 to 2005 but still existed. Even though the disparities among the subgroups according to education, family income and occupation were not that high, the disparity between the group with the highest SEP and the other groups was considerable. CONCLUSIONS: Our findings suggest that unequal access to health examination services according to socioeconomic position still exists. This disparity has decreased recently but the disparity according to level of education was the greatest.

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A Nationwide Survey on the Hand Washing Behavior and Awareness.: Jae Sim Jeong, Jun Kil Choi, Ihn Sook Jeong, Kyong Ran Paek, Hye Kyung In, Ki Dong Park; J Prev Med Public Health. 2007;40(3):197-204.; DOI: https://doi.org/10.3961/jpmph.2007.40.3.197

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OBJECTIVES
This study was conducted to evaluate the public's awareness of the importance of hand washing and to compare perceptions on the habit of hand washing with actual hand washing behavior. METHODS: Data were collected by observing 2,800 participants washing their hands after using public restrooms in seven cities nationwide and by surveying 1,000 respondents (age > 14 years) through telephone interviews using a structured questionnaire. RESULTS: Although 94% of the survey respondents claimed to mostly or always wash their hands after using public restrooms, only 63.4% of the observed participants did wash their hands after using public restrooms. Significant factors related to increased adherence to hand washing were female gender, approximate ages of 20 to 39 years by their appearance, and the presence of other people from the observation. About 79% of the survey respondents always washed their hands after using bathrooms at home, 73% washed their hands before handling food, and 67% washed their hands upon returning to their home. However, 93.2% and 86.3% of the survey respondents did not wash their hands after coughing or sneezing and after handling money, respectively. Although most of the survey respondents (77.6%) were aware that hand washing is helpful in preventing communicable diseases, 39.6% of the survey respondents did not do so because they were 'not accustomed' to washing their hands and 30.2% thought that washing their hands is 'annoying'. CONCLUSIONS: This is the first comprehensive report on hand washing behavior and awareness of the general population in Korea. The result of this study in terms of individual behavior and awareness of hand washing are comparable with similar studies conducted in other countries. However adherence to hand washing is still low and needs to be increased. The results of this study can be used as a baseline in setting up strategies and activities to Bpromote adherence to hand washing.

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Original Articles

Customer's Intention to Use Hospital-based Health Promotion Services.: Myung Il Hahm, Myung Geun Kang, Choon Sun Park, Woo Hyun Cho; Korean J Prev Med. 2003;36(2):108-116.

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Abstract PDF: OBJECTIVE
To determine the relationships between customer's attitude, the subjective norm and the intention to use hospital-based health promotion services. METHODS: This study was based on the theory of reasoned action, suggested by Fishbein and Ajzen. The subjects of this study were 501 residents of Seoul, Bun-dang, Il-san and Pyung-chon city, under 65 years, who were stratified by sex and age. A covariance structural analysis was used to identify the structural relationships between attitude towards health promotion programs or services, their subjective norm and their intention to use the aforementioned services. RESULTS: The subjective norm for using the health promotion programs or services provided by hospitals was a significant predictor of the intention to use, but the attitude towards the services was not significant. CONCLUSIONS: Our results suggest that a customer's reference group affects their use of the hospital-based health promotion services. Because the subjects of this study were restricted to specific urban areas, there are limitations to generalizing the study results. Despite the limitations of these results, they can serve as baseline information for the understanding of consumer's behavior toward hospital-based health promotion services.; Summary

Attitudes toward Complementary and Alternative Medicine in Suwon City.: Mi Sook Song, Ki Hong Chun, Hyun Jong Song, In Whee Park, Seung Chul Yoo; Korean J Prev Med. 1999;32(2):162-169.

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Abstract PDF: OBJECTIVES
The aim of this study was to investigate the attitudes toward complementary and alternative medicine among 1,490 residents(339 households) in Suwon city. METHODS: All respondents were asked about types, frequency, effects, side-effects, views, and cost of complementary or alternative medicine through a questionnaire from July 24th to 27th. Six therapies were investigated: diet; acupuncture/ massage/ chiropractic etc.; mind control such as Ki/ Yoga/ spiritual therapy/ relaxation therapy etc.; nutritional supplements, cultural remedies; and Herb medications. RESULTS: The results of this survey were as follows: 35.6% of respondents had experiences with at least one or more types of complementary and alternative medicine. The average number of different types of therapies used was 3.4. More experience with various types of therapies were found among those respondents of higher education, older age group, higher income, married group, religious group than among the opposite groups of respondents. Herb medications were used most frequently(39.8%), followed by minor grains(37.9%), Ginseng(23.8%), Boshintang(21.5%), acupuncture(20.3%), Gaesojou (15.3%), Gingko nut(12.0%), mushroom(11.5%), Cupping therapy(10.2%), and black goat(0.0%). Acupuncture and Herb medications were used for treatment of hypertension the most frequently; minor grains or silkworm for treatment of diabetic mellitus; vegetables for treatment of obesity; acupuncture, Cupping Therapy, Herb medications for treatment of rheumatism; and acupuncture, Herb medications, or exercises for treatment of Cerebro Vascular Accident(CVA). The average costs of treatment were 108,000 Won for hypertension, 87,200 Won for diabetic mellitus, 16,800 Won for obesity, 68,800 Won for rheumatism, and 87,500 Won for CVA. Among 10.9% of respondents, there were 13 cases of side-effects with acupuncture, Herb medications, and Gaesojou. Among the cases of side-effects, majority was due to Herb medications. Respondents reported that Cupping Therapy was the most effective, followed by acupuncture, Ginseng, Gingko nut, Boshintang, black goat, minor grains, Gaesojou, Herb medications, vegetables, and mushroom. In response to the views of complementary and alternative medicine which they had used, they recommended minor grains first, followed by Ginseng, acupuncture, Gingko nut, Cupping Therapy, vegetables, Boshintang, black goat, mushroom and Herb medications. In contrast, they did not recommend Herb medications, acupuncture, nor Gaesojou. CONCLUSIONS: These findings indicate that many people use various complementary and alternative medicine without any guidelines for treatment of serious chronic diseases not even to invigorate themselves. It is, therefore, suggested that medical doctors or scientists verify the true effects or side-effects from the most common complementary or alternative therapies through experiments. Also medical doctors should provide a comfortable atmosphere for discussion among doctors and patients who would like to try these therapies.; Summary

Senior Medical Students' Attitudes toward and Knowledge about Breastfeeding.: Mi Young Lee, Mi Jung Kang, Choong Won Lee, Kyu Bok Jin, Eun Jung Suh, Jae Suk Ahn, Suk Kwon Suh; Korean J Prev Med. 1999;32(1):95-100.

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Abstract PDF: OBJECTIVES
This study surveyed medical students attending clerkship to assess their attitude toward and knowledge about breastfeeding, and self-confidence to manage common breast-feeding problems. METHODS: A self-report questionnaire was administered to the 323 medical students at four medical colleges in Taegu in May 1997. The response rate was 92.9%, but the respondents used in the final data analysis were 245 (75.8%) due to missing variables. RESULTS: Overall, respondents showed equivocal attitudes toward breastfeeding (mean score 2.9 on a 6-point scale). Knowledge about breastfeeding was substantially low with the median % correct 39.2%. Of nine knowledge areas, weak areas were especially "contraindications and barriers to breastfeeding", "use of breastfeeding aids", "expression and storage of breast milk". Those reported to be confident to manage common breastfeeding problems were only 25.7%. Correlations between knowledge and self-confidence were not statistically significant except in college A (r=0.35, p<0.05). Correlations between knowledge and attitude were not significant. CONCLUSIONS: These results suggest that medical students attending clerkship in Taegu show equivocal attitudes toward breastfeeding, low self-confidence to manage common breastfeeding problems and have substantially limited level of knowledge. There should be more concerted efforts to improve this situation on the part of those involved in breastfeeding education.; Summary

Decision-making process and satisfaction of pregnant women for delivery method.: Hae Ri Jun, Jung Han Park, Soon Woo Park, Chang Kyu Huh, Soon Gu Hwang; Korean J Prev Med. 1998;31(4):751-769.

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Abstract PDF: This study was conducted to assess the attitude of pregnant women toward delivery method, understanding of the reason for determining her own delivery method, participation in decision-making process and satisfaction with delivery method after labor. Study subjects were 693 pregnant women who had visited obstetric clinic for prenatal care in the last month of pregnancy in one general hospital and one obstetrics-gynecology specialty hospital in Taegu city from February 1 to March 31 in 1998. A questionnaire was administered before and after labor and a telephone interview was done one month after labor. Proportion of women who had health education and/or counselling about delivery method during prenatal care was 24.0% and this proportion was higher for women who had previous c-section(35.5%) than others. Women thought vaginal delivery is better than c-section for both maternal and baby's health regardless of previous delivery method. About 90% of primipara and multiparous women who had previous vaginal delivery wanted vaginal delivery for the index birth, while 85.6% of multiparous women who had previous c-section wanted repeat c-section. Reasons for choosing c-section in pregnant women who preferred vaginal delivery before labor were recommendation of doctors(81.9%), recommendation of husband(0.8%), agreement between doctor and pregnant woman(4.7%), and mother's demand(12.6%). Reasons for choosing vaginal delivery were mother's demand(30.6%) and no indication for c-section(67.2%). Reasons for choosing c-section in pregnant women who preferred c-section before labor were recommendation of doctors(76.2%), mother's demand(20.0%), recommendation of husband(1.3%), and agreement between doctor and pregnant woman(2.5%). Of the pregnant women who had c-section, by doctor's recommendation, the proportion of women who had heard detailed explanation about reason for c-section by doctor was 55.1%. Mother's statement about the reason for c-section was consistent with the medical record in 75.9%. However, over 5% points disparities were shown between mother's statement and medical record in cases of the repeat c-section and mother's demand. In primipara and multiparous women who had previous vaginal delivery, the delivery method for index birth had statistically significant association with the preference of delivery method before labor(p<0.05). All of the women who had previous c-section had delivered the index baby by c-section. Among mothers who had delivered the index baby vaginally, 84.9% of them were satisfied with their delivery method immediately after labor and 85.1% at 1 month after labor. However, mothers who had c-section stated that they are satisfied with c-section in 44.6% immediately after labor and 42.0% at 1 month after labor. Preferred delivery method for the next birth had statistically significant association with delivery method for the index birth both immediately after labor and in 1 month after labor. The proportion of mothers who prefer vaginal delivery for the next birth increased with the degree of satisfaction with the vaginal delivery for the index birth but the proportion of mothers who prefer c-section for the next birth was high and they did not change significantly with the degree of satisfaction with the c-section for the index birth. These results suggest that the current high technology-based, physician-centered prenatal and partritional cares need to be reoriented to the basic preventive and promotive technology-based, and mother-fetus-centered care. It is also suggested that active involvement of pregnant woman in decision-making process for the delivery method will increase the rate of vaginal birth after c-section and decrease c-section rate and improve the degree of maternal satisfaction after delivery.; Summary

The Difference in Attitude toward Medical Care between Patients and Physicians.: Myung Geun Kang, Jong Ku Park, Han Joong Kim, Myong Sei Sohn, Dal Rae Kim; Korean J Prev Med. 1998;31(3):516-539.

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Abstract PDF: The objective of this study is to identify the difference in attitude toward medical care between patients who visited a university hospital or an oriental medical hospital of oriental medical college, and physicians who engaged in the same hospitals. The subjects of this study were 397 cases who agreed to respond the prepared questionnaire, including 288 patients(146 university hospital utilizers and 142 utilizers for an oriental medical hospital) and 109 physicians(76 physicians and 33 oriental medical doctors). The attitude toward medical care was measured by the structured questionnaire developed for this study, which had high validity and reliability according to factor analysis, item discriminant validity, and Cronbach's alpha coefficients. On the criteria of mean value of care and cure score, the attitude toward medical care was classified into 4 groups encompassing a group with dependent attitude on medical care, a group with skeptical attitude toward it, a group with cure-oriented attitude, and a group with care- preferred attitude. The results of chi-square test, discriminant analysis, and logistic regression analysis were as follows; patients who visited a university hospital, patients who visited an oriental hospital, physicians, and oriental medical doctors included in the group with dependent attitude, the group with cure-oriented attitude, the group with skeptical attitude, and the group with care-preferred attitude, retrospectively. Among the subdomains of care and cure domains, which classified in reference to the result of factor analysis on pilot study, those that patients ranked more importantly than physicians were 'the importance of medical equipment for diagnosis and treatment', 'authority of physician, 'aggressiveness of treatment', 'information giving', 'personal interest' in the case of western medicine. In the case of oriental medicine, those were 'the importance of equipment for diagnosis and treatment', 'aggressiveness of treatment', 'amenities and accessibility', 'coordination of medical staff'. Both physicans and patients put the subdomain, 'physicians' medical knowledge and skillfulness' on the highest rank. The differences in ranking the important attributes of medical care between patients and physicians were apparent in the area of an 'importance of medical equipment for diagnosis and treatment' and so on. It meant that patient had over-expectation on medical care and suggested that the policy on demand side such as the development and dissemination of an evidence-based recommendation protocol for health care consumers might be important in Korea. In addition, regarding the attitude of physicians, during the medical education and training it may be necessary to emphasize the aspect of 'care' of medical care rather than 'cure'. In planning on heath care delivery system, it should be considered that there is a difference in the attitude toward medical care between western medicine and oriental medicine as well as between health care providers and consumers. We expect that more valid measurement tool be developed in this area, which may be major limitation of this study and that this kind of research be expanded into the non-academic settings.; Summary

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