J Dent Hyg Sci Vol. 15, No. 2, 2015, pp.129-137 http://dx.doi.org/10.17135/jdhs.2015.15.2.129 RESEARCH ARTICLE 임신부의건강신념요인이구강건강관련행위에미치는영향 김미나ㆍ임도선ㆍ김명희ㆍ김아름ㆍ김성임ㆍ안용순 을지대학교보건대학원치위생학과 Effect of Health Belief Factor on Oral Health Related Behavior in Pregnant Woman Mi-Na Kim, Do-Seon Lim, Myoung-Hee Kim, A-Reum Kim, Sung-Im Kim, and Yong-Soon Ahn Department of Dental Hygiene, Graduate School of Public Health Science, Eulji University, Seongnam 461-713, Korea This study is conducted with the aim of providing basic data for oral health improvement of pregnant woman and development of oral health education program by analyzing factors influencing the oral health related behavior of pregnant woman applying health belief model which is theoretical model of explaining individual s behavior change. For 217 expectant mothers who visited 8 obstetrics and 1 maternity class located in Seoul, Gyeonggi and Incheon from August 1 to 31, 2014, data analysis was implemented using self-administered questionnaire. Before the completion of self-administered questionnaire, the subjects were fully informed of explanatory note and consented on taking part in the research for the consideration of ethical aspect. Collected materials were treated by PASW Statistics ver. 18.0 program and following results were acquired. Health belief factor which infuences oral health related behavior of pregnant woman resulted that perceived severity influences on oral examination during pregnancy and dental treatment during pregnancy, and perceived benefits influences on oral examination during pregnancy, and perceived barriers on toothbrushing after having a snack, toothbrush with rotation method and oral examination during pregnancy, and self-efficacy influences on use of oral hygiene products after toothbrushing and oral examination during pregnancy. With these research results, I suggest that perceived severity of health belief factor, perceived benefits, perceived barrier and self-efficacy influence oral health related behavior of pregnant woman. And specific oral health education program for pregnant woman is necessary to increase perceived severity of pregnant woman, perceived benefits and self-efficacy and to reduce perceived barriers. Key Words: Health belief model, Oral health related behavior, Pregnant woman 서론 임신은한생명을잉태한다는의미에서대단히경이롭고뜻깊은사건이다. 그러나임신기간동안에신체적, 정신적으로많은변화를경험하고임신부와태아에게위험을초래하거나건강상태를저하시킬수있는가능성이항상존재한다 1). 특히임신부의구강은입덧으로인한구강건강관리의소홀, 잦은간식의섭취, 음식에대한기호의변화, 호르몬변화등으로구강질환의발생가능성이높다 2). 임신부는 estrogen과 progesterone의호르몬변화로인해임신성치은염이발생되며임신후반기에가장심해진다 3). 연구결과에따르면임신부중에서 43.2% 4) 가임신성치은염이발생한다고보고하였으며임신초기에 67.5%, 임신중기에 74.2%, 임신말기에는 79.2% 로발병률이증가함을보고하였다 5). 임신성치은염을방치하게될경우에치아와치은사이에치주낭이형성되면서치주질환으로빠르게이행되는데, 치주질환이있는임신부는조산또는저체중아출산의가능성이높다 3). Siqueira 등 6) 은조산의위험이 1.8배, 저 Received: February 20, 2015, Revised: March 6, 2015, Accepted: March 6, 2015 ISSN 1598-4478 (Print) / ISSN 2233-7679 (Online) Correspondence to: Yong-Soon Ahn Department of Dental Hygiene, Graduate School of Public Health Science, Eulji University, 533 Sanseong-daero, Sujeong-gu, Seongnam 461-713, Korea Tel: +82-31-740-7228, Fax: +82-31-740-7352, E-mail: ahnys56@eulji.ac.kr Copyright 2015 by the Korean Society of Dental Hygiene Science This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
J Dent Hyg Sci Vol. 15, No. 2, 2015 체중아를출산할위험이 1.7배높아진다고보고하였다. 그리고치주질환을발생시키는병원체및독소는전신적으로도염증반응을야기하기때문에전신질환의위험요인으로제기되고있으며 7) 최근에는치주질환과임신성고혈압과단백뇨를초래하는자간전증 (preeclampsia) 의관련성이제시되고있다 8). 따라서임신부에게발생되는치주질환은자간전증의발생위험을높일수있고조산, 저체중아와같은비정상적인출산에영향을미친다. 한편, 임신부는태아의성장과함께위또는장의압박으로인한식사량의변화및음식에대한기호의변화를겪게되고 9) 오심또는구토를완화하기위해우식성식품을섭취하는경우가많다 3). 이로인해임신부의구강은치아우식증의원인균인 Streptococcus mutans가이상번식하며, 출산직후아이의 Streptococcus mutans의 80 90% 는모친의구강으로부터전염된다고보고되고있다 9). 따라서임신부의구강건강상태는아이의구강건강상태와도밀접한관련이있으므로임신기간동안에좋은구강환경을유지할필요가있다. 이와같이임신부의구강건강관련행위가매우중요함에도불구하고구강건강관리의인지도및실천도연구결과에따르면임신기간동안에구강건강관리의중요성에대해인지도는높은반면에실천도는낮았다. 그리고구강건강관리교육에대한높은요구도를보이고있는반면에교육의경험이없는것으로조사되었다 10,11). 따라서구강건강관리정보를접할수있는교육환경의마련과이를통해구강건강관련행위를높일수있는방법모색이필요하다. 구강건강관련행위는단순히생물학적인과정보다는사회심리학적인과정의특성을지닌다. 즉특정질환에대한증상또는증후가없을경우건강을유지하기위한제반행위또는증상이나증후가있을경우이를질환으로간주하고치료하거나회복하고자하는일련의행위들은생물학적인수준으로만이해될수있는부분이아니라사회심리학적인관점에서도파악해야한다는것이다 12). 사회심리학적요인이구강건강관련행위에영향을미친다고보는설명의틀을사회심리학적모형이라고하며주요변수는지식, 태도, 신념등으로이중신념은구강건강관련행위를좌우하는중요한요소로간주된다 13). 신념의역할을강조한건강신념모형은가장잘알려진개인의행동변화에대한이론적모형이다. 이모형에의하면자신에게어떠한건강문제가발생할가능성이높다고여길때, 그건강문제가자신에게심각한결과를가져올수있다고믿을때, 자신이하려는행위가그건강문제의발생가능성이나심각성을감소시켜줄것이라고믿을때, 예측되는이익이장애보다크다고믿을때, 행동을자극하는내적또 는외적인경험을하고, 자신이그건강행위를잘할수있다고믿는경우에자신의나쁜건강상태를피하거나감별해내기위해그리고건강상태를조절하기위해건강행위를하게되는것을말한다 14). 건강신념모형을적용한구강건강관련행위관련국내연구현황을살펴보면모친 12,13), 아동 13), 중ㆍ장년층 15), 초등학생 16), 고등학생 17), 대학생 18), 치과병원내원환자 19), 보건소내원환자 20), 택시운수종사자 21) 등을대상으로건강신념과구강건강관련행위의관련성에대해연구된바있으나임신부를대상으로한연구는많지않다. 따라서본연구는개인의행동변화를설명하는이론적모형인건강신념모형을적용해임신부의구강건강관련행위에영향을미치는요인을분석하여임신부의구강건강증진과구강보건교육프로그램개발의기초자료를제공하고자시행하였다. 연구대상및방법 1. 연구대상본연구는을지대학교기관생명윤리위원회에서윤리적인승인 (EU14-26) 을받은후, 2014년 8월 1일부터 8월 31 일까지서울특별시, 경기도, 인천광역시에소재한 8개의산부인과의원과 1개의산모교실을방문한임신부를편의표집 (convenience sampling) 해총 250명을대상으로자기기입식설문지를배부하였다. 총 243부가회수되었고응답이미비한 26부를제외한총 217부를최종분석에활용하였다. 자기기입식설문지를기입하기전, 연구대상자에게연구설명문숙지와연구참여동의를얻어연구대상자의윤리적인측면을고려하였다. 2. 연구도구일반적특성은연령, 학력, 직업유무및종류, 월평균가구소득, 결혼년수, 주관적건강상태, 주관적구강건강상태, 주관적치과치료필요도의총 8문항이며, 구강건강관련행위는매간식후칫솔질, 매칫솔질후구강위생용품사용, 치아에좋은식품섭취노력, 치아에나쁜식품섭취하지않으려는노력, 회전법칫솔질, 임신중구강검진, 임신전구강검진, 임신중치과치료유무의총 8문항으로임신기구강관리지침서 3) 를사용하여 한다 와 안한다 로구분하였다. 건강신념요인은인지된민감성 3문항, 인지된심각성 4문항, 인지된유익성 3문항, 인지된장애성 5문항, 자기효능감 4문항으로타당도와신뢰도가검증된 Cho 22) 와 Lee 23) 의설문문항과임신기구강관리지침서 3) 를사용하여본연구에맞게수정, 보완하였다. 본연구에서사용한건강신념요인 130
김미나외 : 임신부의건강신념요인이구강건강관련행위에미치는영향 의타당도와신뢰도를분석한결과는 Table 1과같다. 본연구에서의조작적정의로인지된민감성은임신기간동안에구강질환의발생가능성이많다고인지하는것, 인지된심각성은임신기간동안에구강질환을치료하지않고방치하게될경우비정상적인출산 ( 조산, 저체중아 ) 과태아에게좋지않은영향을미칠것이라는심각성을인지하는것, 인지된유익성은임신기간동안에구강건강관련행위는구강질환의조기발견및예방을하는데효과적이라고인지하는것, 인지된장애성은임신기간동안에구강건강관련행위를하는데있어구강건강관리정보부족, 시간, 비용, 신체적불편함, 걱정, 고통등부정적인측면을인지하는것, 자기효능감은임신기간동안에구강건강관련행위를잘해낼수있다는자신감을의미한다. 각문항은 전혀그렇지않다 1점, 대체로그렇지않다 2점, 보통이다 3점, 약간그렇다 4점, 매우그렇다 5점의등간척도로측정하였으며점수가높을수록인지된민감성, 인지된심각성, 인지된유익성, 자기효능감이높음을의미하고인지된장애성은역부호화 (reserve coding) 처리해점수가높을수록장애성이낮음을의미한다. 3. 분석방법수집된자료는 PASW Statistics ver. 18.0 (IBM Co., Armonk, NY, USA) 프로그램을이용하여분석하였다. 건강신념요인의타당도와신뢰도를분석하기위해탐색적요인분석 (exploratory factor analysis) 과크론바흐알파계수 (Cronbach s alpha coefficient) 를측정하였다. 연구대상자의일반적특성, 구강건강관련행위는빈도를산출하였으며건강신념의수준은평균과표준편차로산출하였다. 그리고건강신념요인과구강건강관련행위의상관관계는스피어만상관계수 (Spearman correlation coefficient) 를시행하였으며구강건강관련행위에영향을미치는건강신념요인을파악하기위해로지스틱회귀 (logistic regression) 분석을시행하였다. 결과 1. 건강신념요인의타당도및신뢰도건강신념요인의타당도와신뢰도를분석한결과는 Table 1과같다. 타당도분석결과, 일반적으로사회과학분야에서 Table 1. Validity and Credibility of Measurement Tool for Health Belief Factor Factor order Question No. Factor 1 Factor 2 Factor 3 Factor 4 Factor 5 Cronbach s Self-efficacy 21 0.736 0.123-0.026 0.164 0.097 0.683 22 0.686 0.052-0.141 0.058-0.092 23 0.672-0.038-0.118 0.276 0.158 24 0.620 0.041-0.064-0.017 0.163 Perceived severity 8 0.143 0.792-0.064-0.044 0.000 0.707 6 0.002 0.781 0.153 0.085 0.038 5-0.097 0.747 0.110-0.147 0.112 7 0.136 0.553-0.147 0.166 0.145 Perceived barriers 16-0.055 0.095 0.750 0.050-0.156 0.614 15 0.253-0.111 0.682 0.024-0.113 18-0.201 0.030 0.671-0.102 0.088 17-0.221 0.085 0.491 0.053 0.185 20-0.170-0.046 0.462-0.128 0.214 Perceived benefits 10 0.211-0.024 0.017 0.805 0.130 0.708 11 0.311-0.055-0.021 0.791 0.028 12-0.068 0.099-0.057 0.732 0.045 Perceived susceptibility 3 0.112 0.133 0.116 0.087 0.788 0.634 2 0.136 0.013-0.043-0.015 0.693 1 0.016 0.115 0.057 0.134 0.687 Eigen value 2.26 2.20 2.05 2.03 1.82 Percentage of variance 11.88 11.57 10.81 10.69 9.60 Cumulative percentage 11.88 23.45 34.26 44.95 54.55 Kaiser-Meyer-Olkin (KMO)=0.696, Bartlett test of sphericity=904.913*** Exploratory factor analysis was used for validity of health belief factor measurement tool and Cronbach s alpha coefficient was used for credibility. ***p<0.001. 131
J Dent Hyg Sci Vol. 15, No. 2, 2015 요인과문항의선택기준은고유값 (eigen value) 은 1.0 이상, 요인적재치 (factor loading) 는 0.40 이상의경우유의한변수로간주하므로 24) 본연구도이와같은기준으로하였다. 3 차례요인분석결과, 총 24개문항중요인적재치가 0.40 이하에해당되는 5개문항을제거하였다. 총 19개문항은 5개요인으로구분되었으며각각의요인명은요인 1은 자기효능감, 요인 2는 인지된심각성, 요인 3은 인지된장애성, 요인 4는 인지된유익성, 요인 5는 인지된민감성 으로명명하였다. 분산설명력은요인 1은 11.88%, 요인 2는 11. 57%, 요인 3은 10.81%, 요인 4는 10.69%, 요인 5는 9.60% 로 54.55% 의누적설명력을보였다. Kaiser-Meyer-Olkin (KMO) 값은 0.60 이상의경우요인분석을위한변수들의선정이적합하다고볼때 24) KMO=0.696, Bartlett의구형성검정의유의확률이 p<0.001로나타나요인분석모형이적합하다. 신뢰도분석결과, 5개요인모두 Cronbach s =0.60 이상으로일반적으로사회과학분야에서 0.60 이상의경우신뢰도가있다고인정되므로 24) 적합한신뢰도를보였다. 2. 연구대상자의일반적특성연구대상자의일반적특성은 Table 2와같다. 연령은 26 30세 가 45.2% 로가장많았고 31세이상 이 43.3%, 25세이하 11.5% 순이었으며학력은 대학교졸업이상 이 59.0% 로 전문대졸업이하 41.0% 에비해많은분포를보였다. 직업의유무는 있다 가 58.1% 로 없다 41.9% 에비해많았고직업이있는경우직업종류는 전문직 이 50.8%, 사무직 46.0%, 자영업 3.2% 순이었으며월평균가구소득은 200 399만원 이 46.5% 로가장많았고 400만원이상 이 41.0%, 199만원이하 12.4% 순이었다. 결혼년수는 1 3년 이 52.1% 로가장많았고 1년미만 32.3%, 4년이상 15.7% 의분포를보였으며주관적건강상태는 건강 Table 2. General Characteristics of Subject Characteristic n (%) Total 217 (100.0) Age (y) 25 25 (11.5) 26 30 98 (45.2) 31 94 (43.3) Level of education College 89 (41.0) University 128 (59.0) Existence of job No job 91 (41.9) Have job 126 (58.1) Type of job White-collar 58 (46.0) Self-employed 4 (3.2) Professional 64 (50.8) Monthly average house income (10,000 KRW) 199 27 (12.4) 200 399 101 (46.5) 400 89 (41.0) Duration of marriage (y) <1 70 (32.3) 1 3 113 (52.1) 4 34 (15.7) Subjective health condition Healthy 119 (54.8) Normal 82 (37.8) Unhealthy 16 (7.4) Subjective oral health condition Healthy 61 (28.1) Normal 79 (36.4) Unhealthy 77 (35.5) Subjective necessity of dental treatment Necessary 138 (63.6) Normal 62 (28.6) Unnecessary 17 (7.8) KRW: Korean Won. Table 3. Oral Health Related Behavior of Subject Characteristic Classification Yes No Total Brush teeth after having a snack 160 (73.7) 57 (26.3) 217 (100.0) Use oral hygiene products after toothbrushing 120 (55.3) 97 (44.7) 217 (100.0) Try to intake food which is good to tooth 166 (76.5) 51 (23.5) 217 (100.0) Try not to intake food which is bad to tooth 155 (71.4) 62 (28.6) 217 (100.0) Toothbrushing with rotation method 163 (75.1) 54 (24.9) 217 (100.0) Oral examination during pregnancy 36 (16.6) 181 (83.4) 217 (100.0) Oral examination before pregnancy 93 (42.9) 124 (57.1) 217 (100.0) Dental treatment during pregnancy 25 (11.5) 192 (88.5) 217 (100.0) Values are presented as n (%). 132
김미나외 : 임신부의건강신념요인이구강건강관련행위에미치는영향 한편이다 가 54.8% 로가장많았고 보통이다 37.8%, 건강하지못한편이다 7.4% 순이었다. 주관적구강건강상태는 보통이다 가 36.4% 로가장많았고 건강하지못한편이다 35.5%, 건강한편이다 28.1% 순이었으며주관적치과치료필요도는 필요하다 가 63.6% 로가장많았고 보통이다 28.6%, 필요하지않다 가 7.8% 의분포를보였다. 3. 연구대상자의구강건강관련행위연구대상자의구강건강관련행위를살펴본결과는 Table 3과같다. 매간식후칫솔질은 한다 가 73.7% 로 안한다 26.3% 에비해많았으며매칫솔질후구강위생용품사용은 한다 가 55.3% 로 안한다 44.7% 에비해많았다. 치아에좋은식품섭취노력은 한다 가 76.5% 로 안한다 23.5% 에비해 3배이상많았고치아에나쁜식품을섭취하지않으려는노력은 한다 가 71.4% 로 안한다 28.6% 에비해많았다. 회전법칫솔질은 한다 가 75.1% 로 안한다 24.9% 에비해 3배정도많았으며임신중구강검진은 안한다 가 83.4% 로 한다 16.6% 에비해 5배이상많았다. 그리고임신전구강검진은 안한다 가 57.1% 로 한다 42.9% 에비해약간많았으며임신중치과치료는 안한다 가 88.5% 로 한다 11.5% 에비해매우많았다. 5. 건강신념요인과구강건강관련행위의상관관계건강신념요인과구강건강관련행위의상관관계를살펴본결과는 Table 5와같다. 인지된심각성은치아에좋은식품섭취노력, 임신중구강검진과양의상관관계를보였다. 그리고인지된유익성은임신중구강검진과양의상관관계를나타냈다. 역부호화된인지된장애성은매간식후칫솔질, 회전법칫솔질, 임신중구강검진, 임신전구강검진과음의상관관계를보였다. 자기효능감은매칫솔질후구강위생용품사용, 임신중구강검진과양의상관관계를보였다. 6. 건강신념요인이구강건강관련행위에미치는영향건강신념요인이구강건강관련행위에미치는영향을파악하기위해연령, 학력, 월평균가구소득을보정해로지스틱회귀 (logistic regression) 분석을시행한결과는 Table 6 과같다. 인지된심각성이한단위증가함에따라임신중구강검진, 임신중치과치료를할교차비는각각 2.06, 1.77로나타났으며인지된유익성이한단위증가함에따라임신중구강검진을할교차비는 2.59였다. 그리고역부호화된인지된장애성이한단위증가함에따라매간식후칫솔질, 회전법칫솔질, 임신중구강검진을할교차비는각각 1.93, 4. 연구대상자의건강신념수준연구대상자의건강신념수준을살펴본결과는 Table 4와같다. 건강신념의수준은총 3.61점이었으며인지된유익성이 4.37점으로가장높았고그다음으로자기효능감이 4.04 점, 인지된민감성이 3.98점, 인지된장애성이 3.15점순이었으며인지된심각성이 2.91점으로가장낮았다. Table 4. Subjectʼs Level of Health Belief Characteristic Mean±standard deviation Perceived susceptibility 3.98±0.71 Perceived severity 2.91±0.81 Perceived benefits 4.37±0.69 Perceived barriers 3.15±0.74 Self-efficacy 4.04±0.65 Total 3.61±0.39 Table 5. Correlation between Health Belief Factor and Oral Health Related Behavior Characteristic Perceived susceptibility Perceived severity Perceived benefits Perceived barriers b Self-efficacy Brush teeth after having a snack a -0.041 0.081 0.097 0.225** 0.081 Use oral hygiene products after toothbrushing a 0.104 0.087 0.081 0.042 0.150* Try to intake food which is good to tooth a 0.061 0.136* -0.024 0.017 0.125 Try not to intake food which is bad to tooth a -0.080 0.081 0.049 0.016 0.024 Toothbrushing with rotation method a -0.040-0.050 0.017 0.159* 0.050 Oral examination during pregnancy a 0.087 0.201** 0.171* 0.211** 0.177** Oral examination before pregnancy a -0.013 0.116 0.108 0.134* 0.121 Dental treatment during pregnancy a 0.024 0.125 0.032-0.046-0.001 a Dummy coding: 1=Yes, 0=No. b Reversed coding was used for perceived barriers. Therefore, it means having negative (-) correlation when the values are plus (+). p-value was determined from spearman correlation coefficient. *p<0.05, **p<0.01. 133
J Dent Hyg Sci Vol. 15, No. 2, 2015 Table 6. Influence of Health Belief Factor on Oral Health Related Behavior Dental treatment during pregnancy Oral examination before pregnancy Oral examination during pregnancy Toothbrushingrotation method Try not to intake food which is bad to tooth Try to intake food which is good to tooth Use oral hygiene products after toothbrushing Brush teeth after having a snack Characteristics Perceived susceptibility 0.93 (0.59 1.46) 1.37 (0.92 2.02) 1.27 (0.81 2.00) 0.71 (0.45 1.11) 0.86 (0.54 1.36) 1.30 (0.75 2.26) 0.83 (0.55 1.26) 1.14 (0.61 2.13) Perceived severity 1.33 (0.90 1.96) 1.23 (0.88 1.72) 1.48 (0.98 2.22) 1.23 (0.85 1.80) 0.90 (0.61 1.32) 2.06 (1.27 3.34)** 1.28 (0.90 1.83) 1.77 (1.04 3.02)* Perceived benefits 1.51 (0.99 2.32) 1.34 (0.90 2.02) 0.78 (0.46 1.31) 0.87 (0.55 1.38) 0.88 (0.55 1.41) 2.59 (1.19 5.64)* 1.30 (0.84 2.02) 1.27 (0.63 2.53) Perceived barriers 1.93 (1.21 3.08)** 1.13 (0.77 1.65) 1.03 (0.66 1.61) 1.03 (0.67 1.57) 1.84 (1.16 2.94)* 2.24 (1.31 3.81)** 1.26 (0.85 1.89) 0.99 (0.54 1.79) Self-efficacy 1.37 (0.85 2.20) 1.60 (1.04 2.47)* 1.49 (0.91 2.44) 1.01 (0.63 1.60) 1.14 (0.71 1.84) 2.19 (1.15 4.20)* 1.51 (0.95 2.41) 1.00 (0.51 1.94) Values are presented as odds ratio (95% confidence interval). Each odds ratio adjusted for age, level of education and monthly average house income simultaneously. p-value was determined from logistic regression analysis. *p<0.05, **p<0.01. 1.84, 2.24였으며자기효능감이한단위증가함에따라매칫솔질후구강위생용품사용, 임신중구강검진을할교차비는각각 1.60, 2.19로나타났다. 즉인지된심각성, 인지된유익성, 자기효능감이높을수록인지된장애성이낮을수록긍정적인구강건강관련행위를할확률이높았다. 고찰 구강건강관련행위는사회인구학적, 사회경제적, 문화적, 사회심리학적요인등다양한요인에의해좌우된다. 사회심리학적요인이구강건강관련행위에영향을미친다고보는설명틀을사회심리학적모형이라고하며, 이모형에따르면신념은구강건강관련행위를좌우하는중요한요소로간주된다. 사회심리학적모형은기본적으로개인의사결정차원의모형이므로왜그러한행위가일어났는지이유를설명하는데매우적합하다. 집단적인차원에서는사회인구학적, 사회경제적, 문화적요인등을분석하여구강건강관련행위를상당부분예측할수있다. 그러나동일한조건을갖추고있더라도구강건강관련행위가모든사람에게일어나지는않으며어떤사람은구강건강관련행위를하지않고또어떤사람은구강건강관련행위를하게된다. 이러한행위의차이를사회심리학적모형에서는개인의심리적요소때문이라고판단한다. 사회심리학적모형의하나인건강신념모형은그이유를신념으로설명한다 13). 따라서본연구는건강신념모형을적용해임신부의구강건강관련행위에영향을미치는요인을분석하여임신부의구강건강증진과구강보건교육프로그램개발의방법모색에활용하고자시도되었다. 본연구결과, 구강건강관련행위중임신기간동안에구강검진과치과진료를받지않는경우가많은것으로조사되었다. 그이유는태아에게좋지않은영향을미치게될까염려하는것으로보고된바있다 10,25). 그러나임신 4 6개월기간에는비교적안전하게대부분의치과진료를받을수있음에도불구하고 3) 잘이행되지않으므로임신부를위한구강보건교육환경이제공해야할것으로생각된다. 임신부의건강신념수준은인지된유익성이가장높았고인지된심각성이가장낮았다. 즉임신기간동안에구강건강관련행위는구강질환을예방하는데유익성이많다고높게인지하는반면에구강질환을방치할경우비정상적인출산을하게되거나태아에게좋지않은영향을미치게될것이라는심각성의인지수준은낮았다. 따라서앞으로의구강보건교육내용에이를포함시켜강조해야할것으로사료된다. 이와같은건강신념수준의결과는 Park 18) 의연구결 134
김미나외 : 임신부의건강신념요인이구강건강관련행위에미치는영향 과와유사하였으나 So와 Choi 16) 의연구결과와는유사하지않았다. 이는조사대상자가상이하므로건강신념수준의차이를보이는것이며동일한결과를보였다고하더라도건강신념의측정내용과방법이상이하므로결과해석에유의해야할것으로생각된다. 임신부의구강건강관련행위를구체적으로파악하기위해 8가지항목으로구분하여건강신념요인과구강건강관련행위의관련성을분석하였다. 그결과, 인지된심각성은임신중구강검진, 임신중치과치료에긍정적인영향을미치는것으로나타났다. 이는구강질환을방치하게될경우에발생되는비정상적인출산또는태아에게좋지않은영향을미칠것이라는심각성을높게인지할수록임신중구강검진, 임신중치과치료를할가능성이높음을의미한다. 대학생을대상으로한 Park 18) 의연구결과에의하면구강건강문제에대해심각하게인지할수록치과의료이용이높다고보고해본연구결과와유사하였다. 앞서언급한본연구결과, 임신부의건강신념수준은인지된심각성이매우낮았으며임신기간동안에구강검진과치과진료를잘이행하지않은것으로조사되었다. 따라서임신기간동안에구강검진과치과진료를높이기위해서는심각성에대한내용을인지시킬필요가있다고생각된다. 인지된유익성은임신중구강검진에영향을미치는요인으로나타났다. 즉구강질환의조기발견과예방의유익성을높게인지할수록임신중구강검진을할확률이높았다. 이는임신기간동안에구강검진을하는이유는구강건강을위한예방적인측면을고려하는것이기때문에인지된유익성이긍정적인영향을미치는것으로생각된다. 인지된장애성은매간식후칫솔질, 회전법칫솔질, 임신중구강검진에긍정적인영향을미치는것으로나타났다. 이는구강건강관련행위를이행하는데있어구강건강관리정보, 시간, 비용, 신체적불편감, 걱정, 고통등부정적인측면을낮게인지할수록매간식후칫솔질, 회전법칫솔질, 임신중구강검진을할가능성이높아짐을의미한다. 본연구결과에서인지된장애성이매간식후칫솔질, 회전법칫솔질, 임신중구강검진에영향을미치는이유는임신기간동안에신체적불편감이덜할수록칫솔질을하는데어려움이없고구강건강관리정보를접할수록회전법칫솔질을잘하는것으로생각된다. 그리고치과방문에대한심리적인부담감이적을수록구강검진을잘이행하는것으로생각된다. 대학생을대상으로한 Hwang 26) 의연구결과에의하면치과방문의이동거리, 공포감, 시간부족등어려움을낮게인지할수록칫솔질횟수가많았으며이는치과진료또는구강검진을위해치과방문이많아짐에따라구강건강의인식 이높아져칫솔질을많이하게되는것이라고보고하였다. 자기효능감은매칫솔질후구강위생용품사용, 임신중구강검진에긍정적인영향을미치는요인으로나타났다. So 와 Choi 16) 의연구결과에의하면초등학생의구강건강관련행위에가장큰영향을미치는요인은자기효능감이며구강건강관련행위를잘할수있다는자신감이높을수록긍정적인구강건강관련행위를보인다고하였다. 본연구결과에서도이와같은맥락으로구강질환의예방을위해구강건강관련행위를잘할수있다는자신감이높을수록매칫솔질후구강위생용품사용, 임신중구강검진을할확률이높았다. 본연구결과, 임신부의구강건강관련행위중임신중구강검진은매우낮은결과를보여임신기간동안에구강검진을높이기위해서는자기효능감을고취시킬수있는교육내용이필요할것으로생각된다. 따라서건강신념은임신부의구강건강관련행위와관련성이있으며각각의구강건강관련행위에영향을미치는건강신념요인은다르기때문에구강건강관련행위를높이기위한방법은행위항목에따라고려해야한다. 그러나임신전구강검진, 치아에좋은식품섭취노력, 치아에나쁜식품을섭취하지않으려는노력과건강신념요인은관련성이없었다. 이는임신전구강검진의경우신념보다는그외사회인구학적및경제적요인과관련성이더큰것으로생각된다. 그리고식이조절은생활태도, 신체적피로감, 임신으로인한스트레스등이영향을미치는요인으로보고되고있고 27) 신념과는관련성이적은것으로생각된다. 위와같은본연구결과는임신부를대상으로한국내연구가미흡해동일한조사대상자와비교할수없었다. 따라서건강신념과임신부의구강건강관련행위의관련성에대한후속연구가필요하며이를통해면밀하게검토해야한다. 그리고건강신념요인의측정방법은연구자또는조사대상자에따라측정내용과방법이상이하고조사대상자와분야에적절한측정도구가없어 28) 타당도와신뢰도를갖춘측정도구의개발이필요하며이를통해보다연구결과의정확성을기하여야할것이다. 본연구의한계점은서울특별시, 경기도, 인천광역시에소재한임신부를대상으로임의로선정하였기때문에일반화하기어렵다는것이다. 그리고자기기입식설문지를통해자료를수집하였으므로설문지의내용해석과응답자의태도에따라실제적인인지수준을정확히반영한다는보장은없다. 따라서심층면접, 인터뷰, 사례연구등의연구방법을보완한후속연구가필요하다. 위와같은한계점이있음에도불구하고우리나라에서아직시도되지않은건강신념과임신부의구강건강관련행위의관련성을밝히고자한점에 135
J Dent Hyg Sci Vol. 15, No. 2, 2015 본연구의의의를둔다. 요약 본연구는개인의행동변화를설명하는이론적모형인건강신념모형 (health belief model) 을적용해임신부의구강건강관련행위에영향을미치는요인을분석하여임신부의구강건강증진과구강보건교육프로그램개발의기초자료를제공할목적으로시행하였다. 2014년 8월 1일부터 8월 31일까지서울특별시, 경기도, 인천광역시에소재한 8개의산부인과의원과 1개의산모교실을방문한임신부총 217명을대상으로자기기입식설문지를배부하였다. 수집된자료는 PASW Statistics ver. 18.0 프로그램을이용하여다음과같은결론을얻었다. 임신부의건강신념수준은총 3.61점이었으며인지된유익성이 4.37점으로가장높았고자기효능감 4.04점, 인지된민감성 3.98점, 인지된장애성 3.15점순이었으며인지된심각성이 2.91점으로가장낮았다. 건강신념요인과구강건강관련행위의상관관계로인지된심각성은치아에좋은식품섭취노력, 임신중구강검진과양의상관관계를보였으며인지된유익성은임신중구강검진과양의상관관계를보였다. 인지된장애성은매간식후칫솔질, 회전법칫솔질, 임신중구강검진, 임신전구강검진과음의상관관계를보였으며자기효능감은매칫솔질후구강위생용품사용, 임신중구강검진과양의상관관계를보였다. 구강건강관련행위에영향을미치는건강신념요인으로인지된심각성은임신중구강검진, 임신중치과치료에, 인지된유익성은임신중구강검진에, 인지된장애성은매간식후칫솔질, 회전법칫솔질, 임신중구강검진에, 자기효능감은매칫솔질후구강위생용품사용, 임신중구강검진에영향을미치는요인으로나타났다. 이상의연구결과로건강신념요인의인지된심각성, 인지된유익성, 인지된장애성, 자기효능감이임신부의구강건강관련행위에영향을미치는요인임을제시하며, 임신부의인지된심각성, 인지된유익성, 자기효능감을높이고인지된장애성을낮출수있는임신부를위한구체적인구강보건교육프로그램개발이필요하다. References 1. Cha H: A study on the factors affecting prenatal care of pregnant women. Unpublished master s thesis, Ewha Womans University, Seoul, 1999. 2. Kim JS, Go EH, Kim CH: A study of oral hygiene status for pregnant women in some areas. J Dent Hyg Sci 6: 101-105, 2006. 3. Ministry of Health and Welfare: Oral care during a pregnancy period. 1th ed. Ministry of Health and Welfare, Seoul, pp. 21-26, 2001. 4. Kumar A, Basra M, Begum N, et al.: Association of maternal periodontal health with adverse pregnancy outcome. J Obstet Gynaecol Res 39: 40-45, 2013. 5. Hu CZ, Guo JJ, Yang YZ, Wang B, Tao Q, Zhou XY: Investigation and analysis of pregnancy gingivitis in 700 pregnancy women. Shanghai Kou Qiang Yi Xue 8: 15-17, 1999. 6. Siqueira FM, Cota LO, Costa JE, Haddad JP, Lana AM, Costa FO: Intrauterine growth restriction, low birth weight, and preterm birth: adverse pregnancy outcomes and their association with maternal periodontitis. J Periodontol 78: 2266-2276, 2007. 7. Seymour GJ, Ford PJ, Cullinan MP, Leishman S, Yamazaki K: Relationship between periodontal infections and systemic disease. Clin Microbiol Infect 13: 3-10, 2007. 8. Boggess KA, Lieff S, Murtha AP, Moss K, Beck J, Offenbacher S: Maternal periodontal disease is associated with an increased risk for preeclampsia. Obstet Gynecol 101: 227-231, 2003. 9. Kabaya S, Hwang YS: Unexpected dental common sense you should know, just brushing your teeth well can prevent obesity and dementia. 1st ed. Door Book, Seoul, pp.97-98, 2014. 10. Lee SY: The influence that dental hygiene awareness and practice has before and after childbirth. Unpublished master's thesis, Dankook University, Yongin, 2010. 11. Lee KH: Influence of awareness of necessity of oral health management during pregnancy and childbirth on oral health. Unpublished master s thesis, Daegu Catholic University, Gyeongsan, 2012. 12. Oh YB, Lee HS, Kim SN: Children s dental health behavior in relation to their mother s socioeconomic factors and dental health beliefs. J Korean Acad Dent Health 18: 62-83, 1994. 13. Lee HS: Association between dental health belief and dental health related behavior in mothers and childrens. J Korean Acad Dent Health 20: 11-30, 1996. 136
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