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1 Journal the Korea AcademiaIndustrial cooper Society Vol. 14, No. 1 pp , 최미숙 1* 1 안동과학대학교치위생과 Change the Oral Health Status after Applying the Dental Health Educ Program for Internal Marriage Migrant Women MiSook Choi 1* 1 Department Dental Hygiene, Andong Science College 요약본연구는구강건강증진을위한구강건강신념의형성을위해서결혼이주여성들은대상으로구강보건교육프로그램을개발 실시하여구강보건교육실시전과실시후가구강건강지식및태도에어떤효과가있는지진단해보고실제적으로구강상태를조사하여구강건강증진어떤변화가있는지알아보고자한다. 다문화가족지원센터에서 2012년 3월 26일에서 2012년 6월 30일까지연구대상자는실험집단, 통제집단각각 51명으로구성되었고, 구강지식과인식을사전사후조사했으며인식에변화가있어치과를방문한사람을추후조사하여구강상태를조사하여대응표본t검증, 반복측정변량분석을실시하였다. 그결과구강보건인식에서는구강상식, 치주질환, 치아우식증, 잇솔질영역에서향상나타났고구강보건지식에서는치주질환, 치아우식증, 잇솔질, 불소, 구취영역에서구강보건인식에서향상나타났다. 우식경험영구지수 (DMFT index) 변화즉우식경험미처치치아수 (DT index) 가줄어들고우식경험처치치아수 (FT index) 늘어났다. 이상의결과와같이본연구에서개발한국제결혼이주여성을위한구강보건교육프로그램은결혼이주여성들의구강보건인식. 지식등의변화를가져왔으며지식의변화는행동의영향을주어치주상태, 우식경험영구치지수의변화도있었다. 이는결혼이주여성의구강보건을위한교육프로그램의중요성을보여주고있으며, 추후구강보건교육프로그램개발을위한정보를제공하여다양한측면에서구강보건교육프로그램이개발되어예방과치료를병행할수있게되어야할것이다. Abstract This study aims at finding which change there is promotion as investigating the status in quality, diagnosing which effects knowledge and attitude has before and after the educ as developing and conducting the educ program for internal marriage migrant women to form their belief for improving. This study consisted each 51 the experimental and the controlled at the multicultural family support center from 26 th March, 2012 to 30 th June, 2012 as the subjects, and pretopost investigated knowledge and cognition. Also as it took followup examin the clients who visited to the dentist with changing their cognition, conducted matchedpair sample ttest and analysis repeated measure variance. As the result, there were always the changes at the field knowledge about, periodontal and toothbrush in awareness, and at the field periodontal, dental caries, toothbrush, fluorine and bad breath in knowledge. change DMFT index, DT index has been reduced and FT index has been increased. As the result above, the educ program for internal marriage migrant women has led to change awareness and knowledge, and the change knowledge has influenced to a behavior, so there were the changes periodontal status and DMFT index as well. This has been showing the importance the program for internal marriage migrant women. Moreover, while the educ program is developed in various aspects by fering the inform for developing the educ program in future, it needs to run parallel prevention with treatment. Key Words: Dental Health Educ Program, Internal Marriage Migrant Women, Oral Health Status 본논문은 2012년도안동과학대학교교육역량강화사업학술연구비지원에의한연구임 * Corresponding Author : MiSook Choi (Andong Science College) Tel: cms9859@hanmail.net Received December 24, 2012 Revised January 8, 2013 Accepted January 10,

2 1. 서론 2011년 1월결혼이민자는 211,458명으로 2010년도 (181,671명) 에비해 16.4% 증가하였으며, 성별로는여성이 89.2%, 국적취득자는 33% 이다. 국제결혼이주여성은매년증가하여 2010년 161,999명, 2011년 1월 188,580명이며, 출신국가는중국, 베트남, 필리핀순으로나타났다 [1]. 여성결혼이민자환자들중에서치료를잘받지못하고있는영역으로는, 정신과적영역 ( 우울증은치료수진율이 26.0%, 정신분열증은 32.7%) 과생활습관병영역 ( 고혈압은치료수진율이 32.2%, 고지혈증은 39.3%), 그리고부인과질환영역 ( 자궁근종은 35.4% 의수진율을보임 ) 들로조사되고있다 [2]. 이러한보고를반영하듯, 전신건강및정신건강상태에관련된연구 [3,4,5] 는많이이루어지고있는실정이다. 결혼이주여성들에게있어서취약할수있는전체적인전신적이고정신적인건강문제에대한연구들은다소활발하게이루어지고있지만, 구강건강상태에대한연구는거의없는실정이다 [6]. 구강건강은건강의필수적인요소이므로구강질환의고통에서벗어나일상생활에장애를받지않고행복하게살아가기위해서는건강의일부로서구강건강이적절히관리되어야하고강조되어야할영역이라할수있다 [7]. 현재결혼이주여성을대상으로한구강관련연구는구강건강상태및실태에그치고있는실정이다 [8,9,10]. 결혼이주여성의대부분이치아우식증및치주질환을경험하고있었고, 60% 이상에서충전, 치아발거, 보철물장착의등치과치료가필요하였다 [10]. 결혼이주여성들의구강건강을개선을위해서는구강건강증진행위가요구된다. 구강건강증진행위란구강건강을보호하는행동적환경적적응을촉진할수있도록조직적, 정책적, 경제적조치와구강보건교육이조합되어, 구강건강에기여하는행동을강화하고개인을질병이나사고의위험에노출시키는행동을약화시킨다. 이를위해교육적지원과환경적지원의조합이중요하다 [11]. 그러나아직까지우리나라는구체적이고체계적인결혼이주여성을위한구강보건교육프로그램운영이되지못하고있다. 주로결혼이주여성의임신, 출산, 건강및아동교육에대한교육프로그램이진행되고있는상황으로구강건강교육은국소적이며교육의기회를제공하는교육시설이없다는이유로구강보건의문제가심각함에도불구하고이루어지지못하고있다. 결혼이주여성의직접적이고물리적인의료관련지원도중요하지만장기적으로는결혼이주여성들이건강신념의변화를통해서주체적으로자신의건강을돌볼수있도록교육프로그램제공이매우필요하다고할수있다. 이러한건강신념변화및구강보건교육프로그램을살펴보기위한최근연구로는중년여성을위한구강보건교육프로그램을적용한효과 [12] 에대한연구가있다. 외국의연구로는미국에서이민자를위한구강보건교육프로그램의효과에대한논문으로 Brown, Canham, Cureton[13] 라틴계이민자부모를위한구강보건교육프로그램 (An Oral Health Educ Program for Latino Immigrant Parents) 이있다. 그러나아직까지우리나라는구체적이고체계적인결혼이주여성을위한구강보건교육프로그램운영이되지못하고있다. 주로결혼이주여성의임신, 출산, 건강및아동교육에대한교육프로그램이진행되고있는상황으로구강건강교육은국소적이며교육의기회를제공하는교육시설이없다는이유로구강보건의문제가심각함에도불구하고이루어지지못하고있다. 따라서본연구는구강건강증진을위한구강건강신념의형성을위해서결혼이주여성들은대상으로구강보건교육프로그램을개발 실시하여그효과를검증하여추후결혼이주여성을위한검증된구강보건교육프로그램개발에기초자료로활용되는데의의가있다. 2.1 연구대상 Perio d 1 st educ Objec tives Motiva tion for partici pating in the educati on program 2. 연구방법 본연구에서는 3개의다문화가족지원센터에서 2012년 3월 26일에서 2012년 6월 30일까지연구대상자는실험집단, 통제집단각각 51명으로구성되었고연구대상자의특성은 Table 1와같다. [Table 1] nature the subjects Contents Oral organiz and function importance dental Incisor eruption time Dental plaque risk How to teach and analysis variables educ40min. Presurvey ( real condition care, knowledge, awareness) Oral checkup Measurement simplified hygiene index (OHIS) *Instructled educ30min. 207

3 한국산학기술학회논문지제 14 권제 1 호, nd educ Knowl edge period ontal tissue & attitude and behavi change cause periodontal (gum ) occurrence Progress periodontal A preventive method periodontal Distinction his dental plaque in one s Removal dental plaque with correct toothbrush A class with ppt Training toothbrushing * Formative evalu * Instructled educ (ppt and video) 30min. educ30min. Training toothbrushing (use dental colorant) Use interdental brush and dental floss Observ dental plaque with a microscope * Formative evalu Follo w up inves tigati on Knowl edge continu ous care & attitude and behavi change Identificatio n evalu the promotion and the management educ40min. Survey Toothbrushing, dental floss, interdental brush Oral checkup Simplified hygiene index (CHIS) 교육자는치과위생사를대상으로철저한사전준비를시켜총 5명이투입되었다. 현재보건소와산업체에치과위생사로근무하고있는자로서각영역에서최소 7년이상의경력을지닌자이다. 연구대상자들의특성을고려하여가능한쉬운용어사용과각종매체를최대활용하고, 간단한질문과요약을통하여이해수준을도울뿐만아니라각종문제 ( 예 : 한글이해, 구강보건행위등 ) 에대해적극대처하여, 대상자들의교육참여를적극적으로유도했다. 3 rd educ 4 th educ Knowl edge dental caries & attitude and changing behavi change Other dental and contin uous care cause dental caries(cavity) occurrence Dental plaque risk Progress dental caries a preventive method dental caries Tooth sealant necessity implant and care cause malocclusion and a problem cause cervical abrasion Oral and eating habits * Instructled educ (ppt and video) 30min. educ 30min. Training toothbrushing(use dental colorant) Use dental floss and tonng cleaner Experience the efficacy fluorine * Formative evalu educ40min. Postsurvey ( real condition care, knowledge, awareness) Oral checkup Measurement simplified hygiene index (OHIS) * Instructled educ30min. A class with ppt Training toothbrushing (use dental colorant) * Formative evalu 2.2 교육프로그램구성 [Table 2] contents the educ program Section Fre que ncy % Section Fre que ncy Philippine Philippine Vietnam Vietnam China China Cam bodia Thailand year 3years 4years 6years 7years 9years Over 10years Under 30years 30years 40 years Over 41years year 3years 4years 6years 7years 9years Over 10years Under 30years 30years 40 years Over 41years %

4 2.3 프로그램의실시 [Table 3] Evalu process this program, period and method. [Table 4] Composition questions research tool Section Contents Question number Remark Cronbach's α Evalu process Preliminary Applic the educ program Postinvestig Period Before the 1 st educ Sub jects Experimen tal Control 4times at Experimen intervals tal 2weeks Evaluatio n at the 8 th week Followup investig 15 weeks Experimen tal Control Experimen tal Control How to evaluate Questionn aire, checkup Questionn aire, checkup Whether one visits to the dentist Contents Awareness, knowledge, status (DT,FT,MT index) Awareness, knowledge, status (DT,FT,MT index), calculus index Calculus, status (DT,FT,MT ) General matters Awareness Knowledg e Nality, age, the length residency in Korea Knowledge about, periodontal, dental caries, toothbrushing Knowledge about, periodontal, dental caries, toothbrushing Oral status Change (DT,FT,MT periodontal ), Calculus status 3 Multiple choice Total 연구결과 Likert scale Likert scale 설문지구성및타당화연구도구개발을위해결혼이주여성의구강보건지식에대한항목은 Lang[14] 가개발한측정도구를, 구강보건인식과행위에대한문항은장정유 [12], 백대일 [15], 이홍수 [16], 신경희 [17] 등에서사용한측정도구를수정 보완하여질문지문항을구성하였다. 설문지구성을살펴보면, 조사대상자의인구사회학적특성 3문항, 구강보건인식에관한 16문항구강보건지식에관한 22문항으로구성하였다. 그리고치주상태변화에대한설문지도첨가되었다. 이연구에서사용한연구도구의문항구성은 Table 4 과같다. 2.5 자료분석자료분석으로는먼저연구대상자의특성을파악하기위해빈도분석을실시하였으며, 실험집단과통제집단간의구강보건인식, 구강보건지식, 효과를사전사후검증위해대응표본t 검증을실시하였다. 구강상태를파악하기위해서사전 사후 추후검사간의차이를반복측정변량분석 (Repeated Measure ANOVA) 을실시하였다. 3.1 구강보건인식의변화 결혼이주구강보건교육프로그램후구강보건인식에서는구강상식, 치주질환, 치아우식증, 잇솔질영역에서향상나타났고이는통계적인유의미한차이가있었다. [Table 5] result matched pair sample ttest Items Preliminary M (SD) Postinvesti g (M±SD) Knowledge about 3.96 (0.60) 4.69 (0.34) Periodont al 3.10 (0.78) 3.63 (0.51) Dental caries 3.06 (0.44) 3.70 (0.52) Toothbrush 3.55 (0.64) 4.30 (0.45) Malocclu sion 3.26 (1.15) 3.29 (0.84) Whole 3.39 (0.47) 3.92 (0.23) t p 209

5 한국산학기술학회논문지제 14 권제 1 호, 구강보건지식의변화 결혼이주구강보건교육프로그램후구강보건지식에서는치주질환, 치아우식증, 잇솔질, 불소, 구취영역에서구강보건인식에서향상나타났고이는통계적인유의미한차이가있었다. [Table 6] result matched pair sample ttest knowledge Items DT Items Knowledge about Periodontal Dental caries Toothbrush Fluorine Bad breath Malocclusion Whole Section Experiment al Controlled Preliminary M (SD) 2.38 (0.48) 2.56 (0.26) 2.31 (0.24) 2.10 (0.22) 2.22 (0.41) 2.55 (0.59) 2.70 (0.56) 2.36 (0.18) 3.3 추후조사결과 Prelimi nary Postinv estig Followup investig M (SD) M (SD) M (SD) 3.33 (2.08) 3.04 (1.98) Postinves tig (M±SD) 2.49 (0.31) 2.71 (0.27) 2.72 (0.26) 2.52 (0.41) 2.90 (0.23) 2.93 (0.27) 2.90 (0.30) 2.74 (0.14) 1.27 (2.08) 2.80 (2.09) t 1.25 (2.02) 2.73 (2.12) p 구강보건교육을실시한후구강보건인식에변화가있어치과에직접방문한대상자를추적하여구강상태및구강위생지수의변화를살펴보았다 구강상태의변화 다음은구강보건교육프로그램이구강상태에미치는영향을살펴보기위해구강상태를집단과검사시점의평균과표준편차를산출하였다 [Table 7]. [Table 7] mean status and the standard devi FT MT Experiment al Controlled Experiment al Controlled 1.27 (2.08) 1.25 (1.34) 1.41 (2.16) 1.10 (2.14) 3.20 (2.10) 2.06 (1.79) 1.39 (2.14) 1.04 (1.65) 3.19 (2.09) 2.00 (1.78) 1.41 (2.17) 1.03 (1.63) 구강상태의우식경험미처치치아수 (DT ), 우식경험처치치아수 (FT ), 우식경험상실치아수 (MT ) 의집단간, 검사시점, 집단과검사시점의상호작용을판단하기위해반복측정분산분석을실시하였고그결과는다음의 <Table 8> 과같다. 우식경험미처치치아수 (DT Inedex) 는집단간차이 (F(1,100)=5.743, p<.001), 시점의주효과 (F(1,100)=44.057, p<.001), 시점 * 집단상호작용 (F(1,100)=23.835, p<.001) 로나타나유의미한차이를보였다. 이는우식경험을가진연구대상자가치료기관을통해우식경험이있는치아를치료받았다는의미로구강보건교육을통해자신의치아상태및구강관리에대한중요성을인식하고치료를받았다고볼수있을것이다. 우식경험처치치아수 (FT ) 는우식경험미처치치아수 (DT ) 와상반되게치료를받았을경우그값이상승하는하게된다. 분석결과집단간차이 (F(1,100)=5.270, p<.001), 시점의주효과 (F(1,100)=41.271, p<.001), 시점 * 집단상호작용 (F(1,100)=8.033, p<.01) 으로유의미한차이를보였다. 이는치료과정을통해서만상승되는측면을고려할때구강보건교육프로그램이치료의중요성을적절하게인식하게하였음을보여주는결과로볼수있다. 우식경험상실치아수 (MT ) 는 bridge, Implant 등의치료과정이필요한차아로실험집단과통제집단사이의집단간, 시점의주효과, 시점 * 집단의상호작용에서유의미한차이를보이지않았다. [Table 8] Repeated measure ANOVA status Subfactors DT Ind ex Betwee n Sum square (SS) Degree freedom (df) mean sum square (MS) Group * Error Time *** Time* *** Error F 210

6 FT Ind ex Betwee n Betwee n MT Inde x Group *** Time *** Time* ** Error Group Time Time* Error [Table 10] Repeated measure ANOVA calculus index Subfactors Calc ulus *** p <.001 Bet ween With in Group Error Time Time* Sum square (SS) Degr ee freedo m (df) 1 mean sum square (MS) Error F *** *** *** *** p < Calculus 변화 먼저구강보건교육프로그램이결혼이주여성의간이구강위생지수에미치는효과를알아보기위해집단과검사시기간의평균과표준편차를측정하였다 [Table 9]. [Table 9] mean calculus index and the standard devi Items Calculus Section Experi mental controlled Preliminary Postinves tig Follow up investi g M (SD) M (SD) M (SD) 1.89(0.47) 0.27(0.46) 0.27(0.45) 2.07(0.32) 2.05(0.31) 1.79(0.72) Calculus 의경우집단간차이 (F(1,100) = , p<.001), 시점의주효과 (F(1,100) = , p<.001), 시점 * 집단상호작용 (F(1,100) = , p<.001) 으로나타나유의미를차이를보여구강보건프로그램이구강관리를수준을높였다고볼수있다 [Table 10]. 4. 결론 본연구는경상북도일부지역안동, 예천에소재하는다문화가족지원센터에서교육을받고있는결혼이주여성들을대상으로구강보건교육을실시한후구강보건지식과인식에미치는효과를알아보고, 실제교육프로그램후치과병원을방문한사람을추적하여구강상태를조사하였다. 첫째, 결혼이주구강보건교육프로그램후구강보건인식에서는구강상식, 치주질환, 치아우식증, 잇솔질영역에서향상나타났고구강보건지식에서는치주질환, 치아우식증, 잇솔질, 불소, 구취영역에서구강보건인식에서향상나타났다. 이는구강보건교육프로그램이구강보건인식과지식에긍정적인영향을주는것으로나타났다. McGrath[18] 가구강보건의식과구강보건상태는연관성이있다고한결과와일치한다. 둘째, 추후조사의다른항목인우식경험미처치치아수 (DT ) 와우식경험처치치아수 (FT ) 가유의미한차이를보였다. 일반적으로는 6개월이지나야우식경험영구치지수 (DMFT index) 가변화는것으로알려져있다. 본연구에서변화의효과가나타난것은구강검진으로대상자들이본인의상태를알게되었고, 구강보건교육을통한조기치료의강조로인해나타난결과라판단된다. 본연구에서우식경험영구지수 (DMFT index) 변화즉우식경험미처치치아수 (DT index) 가줄어들고우식경험처치치아수 (FT index) 늘어난것은구강보건교육을하는동안예방및조기치료를강조하여나타난결과라할수있다. 조 [10] 의연구에서는국제결혼이주여성의구강상태는 211

7 한국산학기술학회논문지제 14 권제 1 호, 2013 치주질환74.6%, 우식치율71.4%, 결손치율 52.4% 로높은편이었으며, 반면보철물장착율 36.5%, 충전치율 38.1% 와유사하게치주질환의이환율과결손치아비율이높았고, 보철물장착율과충전치율은낮았다. 윤등 [19] 의연구에서는치과방문여부가없을수록고정성보철물수는적은것으로나타났고, 구강건강교육이적을수록고정성보철물수가적으로나타났다. 치주질환유무 의치과방문여부가없을수록치주질환이있을확률이높게나타났다. 충전치아수 역시치과방문여부가없을수록충전치아수가적은것으로나타났다. 위의선행연구에서알수있듯이결손치아수와충전치아수는치과방문여부와구강보건교육여부와의관련성이매우높다. 이는우식경험을가진연구대상자가구강보건교육을통해자신의치아상태및구강관리에대한중요성을인식하고치료를받았다고볼수있을것이다. 결국구강보건교육프로그램이구강보건에관한인식과지식의변화와더불어적절한치료의중요성을가지게하였고, 이를통해적시에치료가되었음을의미한다. 즉구강보건교육프로그램이구강상태에긍정적인영향을주었다고할수있다. 이는 Hoogstraten와 Moltzer[20] 의연구내용과일치되는것으로구강보건교육은학습자로하여금구강보건에관한지식과이해를갖도록하는데첫번째목적이있고지식의습득에따라태도및행동의변화를일으켜이를습관화하게된다는것을보여주고있다. 여기서하나간과해서는안되는사실은, 국제결혼이주여성의구강보건교육프로그램내용선정시에는의료지원서비스를받을수있는정보를제공해야한다는점이다. 구강보건교육을통해서치과방문등에대한인식이형성되었음에도불구하고제정적, 물리적인환경의이유로실제적인치과방문이어려울수있는경우가있다. 남 [6] 은국제결혼이주여성대상자의 60.0% 가치과진료의필요성을인식하고있었는데 50.0% 가경제적으로부담이되어서치과치료를받지못한다고한사실이다. 구강보건교육프로그램을개발운영할때에국가별, 사회계층별, 연령별고려하고재정적인부분에서의실제적인정보도같이제공해야한다는점을명심해야한다. 이상의결과와같이본연구에서개발한국제결혼이주여성을위한구강보건교육프로그램은결혼이주여성들의구강보건인식. 지식등의변화를가져왔으며치주상태, 우식경험영구치지수의변화도있었다. 추후국가별, 사회계층별, 연령별에따른각특징이반영된세부적인국제결혼이주여성을위한구강보건교육프로그램의기획이연구될것을제언한다. 또한결혼이주여성의구강보건교육프로그램이활성화되어예방과치료를병행할수있게되어야하며또한치주질환의가장기본적인스켈링에관한 프로그램도개발된다면보다많은효과가있을것으로기대된다. 5. 요약 다문화가족지원센터를이용하는결혼이주여성을대상으로구강보건교육프로그램을실시한효과는다음과같다. 첫째, 구강보건인식에서는구강상식, 치주질환, 치아우식증, 잇솔질영역에서향상나타났다. 둘째, 구강보건지식에서는치주질환, 치아우식증, 잇솔질, 불소, 구취영역에서구강보건인식에서향상나타났다. 셋째, 우식경험처치치아수 (FT ) 는우식경험미처치치아수 (DT Inedex) 와상반되게치료를받았을경우그값이상승하였다. 넷째, 구강보건프로그램이결혼이주여성의구강관리를수준을높였다고볼수있다 References [1]Ministry Public Administr and Security, Municipalities Foreign Residents Survey Results", Seoul, [2]Health, Welfare and Family Affairs, 2006 Nal Oral Health Survey", Seoul, [3]YooJin Hwang, A study on the knowledge and the perception for educ teachers in special schools", Master's sis, Graduate School Yonsei University, [4]HyeLyun Kim, Maternal Health and Nutritional Status MarriageBased Women Immigrants in Korea and Policy Directions", Health and welfare policy forum, Vol. 151, pp. 2952, [5]YangHeui Ahn, Development and Testing a Health Educ Program for Immigrant Women Married to Koreans", Journal Korea community mursing academic Society, Vol. 22, No. 2, pp , [6]JiYoung Nam, Oral Health Related Quality Life Women among Multicultural Families", Master's sis, Graduate School Kyungbook University, [7]KyoungHee Song, A study on the evalu 212

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서론 34 2

서론 34 2 34 2 Journal of the Korean Society of Health Information and Health Statistics Volume 34, Number 2, 2009, pp. 165 176 165 진은희 A Study on Health related Action Rates of Dietary Guidelines and Pattern of