사회경제적 취약계층의 건강불평등 해소를 위한 지역사회 건강증진사업 평가
Evaluation of community interventions to reduce health inequity in socioeconomically vulnerable populations
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Objectives: This study was to evaluate effectiveness of and challenges to community interventions to reduce health inequity in socioeconomically vulnerable populations. Methods: A total of 41 participants involved in community interventions related to a slum of Seoul were recruited using purposive and snowball sampling methods from June to September, 2015. Participants included residents and stakeholders working for governments, public hospitals, welfare institutions, civil societies, and faith-based organizations. We conducted semi-structured, one-on-one interviews with 18 stakeholders and three focus group interviews with 23 residents. Qualitative data were analyzed using thematic analysis. Results: Effective community interventions were community-driven, empowerment-based interventions followed by provision of home-visiting nurses, improvement of living conditions, and integrated health-social welfare services. Affordable health care services, including home-visits by community nurses and increase in housing quality and neighborhood safety were identified as important factors to address to reduce health inequalities. Challenges to community interventions are as follows: (1) unmet healthcare and social welfare needs, (2) insufficient livelihood welfare system, (3) lack of intersectoral collaboration. Conclusions: Community-driven, empowerment-based interventions and supportive social health policies could have the potential to improve health inequities, thereby enhancing community resilience and providing a seamless safety net for the socioeconomically vulnerable populations.
Abstract
Objectives: This study was to evaluate effectiveness of and challenges to community interventions to reduce health inequity in socioeconomically vulnerable populations. Methods: A total of 41 participants involved in community interventions related to a slum of Seoul were recruited using purposive and snowball sampling methods from June to September, 2015. Participants included residents and stakeholders working for governments, public hospitals, welfare institutions, civil societies, and faith-based organizations. We conducted semi-structured, one-on-one interviews with 18 stakeholders and three focus group interviews with 23 residents. Qualitative data were analyzed using thematic analysis. Results: Effective community interventions were community-driven, empowerment-based interventions followed by provision of home-visiting nurses, improvement of living conditions, and integrated health-social welfare services. Affordable health care services, including home-visits by community nurses and increase in housing quality and neighborhood safety were identified as important factors to address to reduce health inequalities. Challenges to community interventions are as follows: (1) unmet healthcare and social welfare needs, (2) insufficient livelihood welfare system, (3) lack of intersectoral collaboration. Conclusions: Community-driven, empowerment-based interventions and supportive social health policies could have the potential to improve health inequities, thereby enhancing community resilience and providing a seamless safety net for the socioeconomically vulnerable populations.
참고문헌 (27)
- Afulani, P. A., "Using community health workers in community-based growth promotion : what stakeholders think", Health Education Research, 27(6), pp.1005~1017 (2012)
- 6th Global Forum on Health Promotion: Health Promotion Preliminary Research Report, "Alliance for Health Promotion", ~ (2016)
- Anderson, L. M., "The community guide’s model for linking the social environment to health", American Journal of Preventive Medicine, 24(3), pp.12~20 (2003)
- Asthana, S., "What works in tackling health inequalities?: Pathways, policies and practice through the lifecourse" (2006), Policy Press
- Aubel, J., "Participatory program evaluation manual. Involving program stakeholders in the evaluation process" (1999), The United States Agency for International Development
- Boyatzis, R. E., "Transforming qualitative information:Thematic analysis and code development" (1998), Sage
- Braun, V., "Using thematic analysis in psychology", Qualitative Research in Psychology, 3(2), pp.77~101 (2006)
- Braveman, P., "The social determinants of health : coming of age", Annual Review of Public Health, 32, pp.381~398 (2011)
- Brugha, R., "Stakeholder analysis : a review", Health Policy and Planning, 15(3), pp.239~246 (2000)
- 조추용, "지방정부 복지거버넌스와 통합사례관리 체계", 한국케어매니지먼트 연구, (12), pp.121~146 (2014), 한국케어매니지먼트학회
- A Process Evaluation of Community-Based Health Promotion and Policy, "Chung, H", Korea Health Promotion Foundation, ~ (2015)
- Cousins, J. B., "Framing participatory evaluation", New Directions for Evaluation, 80, pp.5~23 (1998)
- Crishna, B., "Participatory evaluation (I) –sharing lessons from fieldwork in Asia", Child: Care, Health and Development, 33(3), pp.217~223 (2007)
- Dupre, M. E., "Place-based initiatives to improve health in disadvantaged communities : cross-sector characteristics and networks of local actors in North Carolina", American Journal of Public Health, 106(9), pp.1548~1555 (2016)
- "Seoul metropolitan government ordinance on the installation and operation of community health committee in the Nowon-gu community health center" (2016)[URL]
- Feuerstein, M. T., "Finding the methods to fit the people : Training for participatory evaluation", Community Development Journal, 23(1), pp.16~25 (1988)
- 허현희, "도시 빈곤지역 주민의 주변화와 건강불평등의 관계에 대한질적 연구", 보건과 사회과학, (43), pp.5~32 (2016), 한국보건사회학회
- 김원진, "보건 및 복지 연계서비스 모형개발을 통한 지역사회의 방문보건사업의 활성화 방안", 한국자치행정학보, 26(2), pp.245~260 (2012), 한국자치행정학회
- Kok, G., "The ecological approach in health promotion programs : a decade later", American Journal of Health Promotion, 22(6), pp.437~442 (2008)
- Merzel, C., "Reconsidering community-based health promotion: Promise, performance, and potential", American Journal of Public Health, 93(4), pp.557~574 (2003)
- Minkler, M., "Community-based research partnerships:Challenges and opportunities", Journal of Urban Health, 82, pp.ii3~ii12 (2005)
- 박정숙, "보건소 방문간호사의 이직의도와 관련요인", 농촌의학.지역보건, 39(2), pp.94~103 (2014), 한국농촌의학.지역보건학회[DOI]
- Health equity through intersectoral action: an analysis of 18 country case studies, "Public Health agency of Canada", Minister of Health of Canada, ~ (2008)
- Sanigorski, A. M., "Reducing unhealthy weight gain in children through community capacity-building : results of a quasi-experimental intervention program, Be Active Eat Well", International Journal of Obesity, 32(7), pp.1060~1067 (2008)
- 신영전, "건강형평정책과 사업: 건강 불평등 완화를 위한 접근", 한국사회정책, 18(4), pp.41~77 (2011), 한국사회정책학회
- Walt, G., "Doing health policy analysis : methodological and conceptual reflections and challenges", Health Policy and Planning, 23(5), pp.308~317 (2008)
- Closing the gap in a generation: Health equity through action on the social determinants of health, "WHO Commission on Social Determinants of Health", World Health Organization, ~ (2008)