J Dent Hyg Sci Vol. 15, No. 6, 2015, pp.807-814 http://dx.doi.org/10.17135/jdhs.2015.15.6.807 RESEARCH ARTICLE 대안학교고등학생의구강건강증진행위에관한연구 김영임 전주비전대학교치위생과 An Oral Health Promotion Behavior Model for Alternative High School Students Young-Im Kim Department of Dental Hygiene, Vision University of Jeonju, Jeonju 55069, Korea The purpose of this study is to create a hypothetical model that explains and predicts oral health promotion behavior of adolescents by reviewing preceding literature on Pender s Health Promotion Model, and to verify the model s validity and proposed hypothesis through PLS (partial least square) structural equation model analysis. This study was cross-sectional survey consisted of self-administration questionnaires. The subjects in this study were a total of 293 alternative high school students in Jeollabuk-do Province. They were selected by convenience sampling. In alternative high school students, perceived benefit, locus of control, self-efficacy, and self-esteem had an effect on their oral health promoting behavior. As a result of the indirect effects in black is subjectively good subjective oral health, oral health related behaviors well past the more oral health promotion behavior showed a high. The prediction model of oral health promotion for adolescences, which was made using Pender s Health Promotion Model, was considered to be useful in explaining and predicting alternative high school students oral health promotion behavior. Key Words: Alternative high school, Oral health promoting behavior, Pender s health promotion model, PLS (partial least square) structural equation model 서론 구강건강은사회적, 문화적, 경제적측면등다양한관점에서규정되고이해되어야하는동적인과정 1) 이며, 구강건강증진행위는생물학적인과정이라기보다는이차적인문화적, 사회적, 심리학적특성을지니고있다. 즉, 개인의구강건강과구강병의생의학적원인에서만이아니라구강건강증진행위에따라달라지며, 사회심리적인요소에의해서더큰영향을받는것이다 2). 이러한건강증진행위를설명하기위해많이사용되는것이 Pender의건강증진모형이다. Pender는건강증진행위를개인이나집단의안녕수준을증가시키고개인의자아실현이나성취를유지, 증진시키는방 향으로취해지는활동이며 3), 자아인식의향상, 자기만족, 기쁨그리고즐거움과같은긍정적인격려를최대화시킨다고하였다. 또한이행위는환경에의한위협이나외부의영향이라기보다는고도의건강을향해움직이도록인간스스로가자신의환경에반응하는것을의미한다고하였다 4). 구강건강증진행위에는구강내의질환이발생하기전의구강상태에서구강을계속건강한상태로유지하기위하여수행하는제반활동이포함되므로그행위의종류는매우다양하며 5,6), 구강건강이좋지않으면전신건강에도영향을미치므로구강건강증진행위에관한연구는매우중요한의의가있다. 따라서구강건강수준을향상시키려면구강보건실태를파악하고개개인의구강건강에대한관심, 태도및 Received: November 2, 2015, Revised: November 26, 2015, Accepted: November 26, 2015 Correspondence to: Young-Im Kim Department of Dental Hygiene, Vision University of Jeonju, 235 Cheonjam-ro, Wansan-gu, Jeonju 55069, Korea Tel: +82-63-220-4103, Fax: +82-63-220-4109, E-mail: yikim@jvision.ac.kr ISSN 1598-4478 (Print) / ISSN 2233-7679 (Online) 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. 6, 2015 행동에영향을줄수있는구강보건교육을실시하여건강한행동양상을가질수있도록구강보건인식을향상시켜야한다 7). 건강을증진하고건강증진행위를실천하기위해서는이에영향을미치는다차원적인요인들을규명하기위해 Pender의건강증진모형의다양한변수들을사용하여여러요인에의해설명되는구강건강증진행위의모형을구축하고자한다. 이연구에서는주관적구강건강상태, 과거구강건강관련행위, 학업스트레스, 지각된유익성, 지각된장애성, 통제의소재, 자기효능감, 자아존중감, 사회적지지와종속변수인구강건강증진행위의잠재변수를조형지표로하였고, 구강건강증진행위가인간행위의한형태로여러복합적인요인에따라조절될수있다. 따라서이를설명하기위해여러요인이복합적인인간의행위를설명하기위해현재사용되고있는통계기법중하나인 PLS (partial least square) 구조방정식모형분석을이용하였다. 청소년들의학교는가정에서사회로범위가확대되는곳이고교사와친구관계가맺어지는사회관계의장이며, 학교에서의성취가앞으로의사회적응에까지도영향을미치므로청소년기에갖는성장과행복, 적응등의특히중요하다. 앞으로는학업보다는학생의소질, 개성, 적성등을고려하여흥미위주로학습활동을하는대안학교를선택할가능성도넓어지고있으며현재도적지않은청소년들이기존의학교와다른대안학교에서청소년기를보내고있으나, 대안학교청소년들의구강건강증진행위에대한연구는미비한실정이다. 이에대안학교고등학생을대상으로구강건강증진행위에관한연구를통해구강건강증진행위를설명하고예측하는구강건강증진모형을구축하고검증하여, 구강건강증진행위에대한올바른지식및태도를함양하고효과적인구강건강증진프로그램개발및교육, 홍보에적극참여할수있는토대를마련할목적으로이번연구를진행하였다. 연구대상및방법 1. 연구대상이연구의연구대상자는편의표본추출법에의해선정된전라북도지역의대안학교고등학생 350명을, 2012년 4월 16일부터 5월 31일까지개별자기기입법에의한설문조사법으로조사하였다. 이번조사가이루어진 2012년당시에는연구윤리심의위원회의심의를거쳐야한다는규정이없었기때문에별도의연구윤리심의위원회의승인절차는거치지않았으며, 담임교사의협조를얻어연구자의연구목적을설명한후설문지를배부하였고, 자발적으로연구참여에동의한학생들로하여금설문지를작성하도록한후담임교 사를통하여회수하였다. 설문지작성이미흡한경우를제외하고최종 293부 (83.7%) 를연구분석에사용하였다. 2. 측정도구조사항목은독립변수인주관적구강건강상태 6문항, 과거구강건강관련행위 8문항, 학업스트레스 10문항으로구성하였다. 매개변수로는지각된유익성 8문항, 지각된장애성 8문항, 통제의소재 8문항, 자기효능감 8문항, 자아존중감 8문항, 사회적지지 8문항으로구성되었다. 종속변수는구강건강증진행위 12문항으로구성되었으며, 조사대상자의일반적특성 6문항등, 총 90문항이었다. 조사대상자의일반적특성은부모의교육수준, 한달용돈, 학교성적등으로조사하였다. 3. 자료분석구조방정식모형은 SmartPLS Version 2.0. M3 (Ringle 등, Hamburg, Germany) 프로그램을이용하여분석하였다. PLS 구조방정식은자료의표본수가적은경우나조형지표 (formative indicators) 가이용된경우에사용될수있으며, 다변량정규분포를요구하지않는다 8). 따라서이연구에서는주관적구강건강상태, 과거구강건강관련행위, 학업스트레스, 지각된유익성, 지각된장애성, 통제의소재, 자기효능감, 자아존중감, 사회적지지와종속변수인구강건강증진행위의잠재변수가조형지표로이루어져있으므로 AMOS나 LISREL에서사용되는일반적인구조방정식모형보다 PLS 구조방정식모형이이연구에적합하다고판단하였다. PLS 구조방정식모형의경로계수의유의성검정은 Bootstrap 방법을이용하여표본을 1,000회추출하여분석하였다. Table 1. Reliability Measurement Model Factor Communality Composite reliability Cronbach s Subjctive oral health 0.326 condition Past oral health 0.193 related behavior Academic stress 0.401 0.842 0.791 Perceived benefits 0.249 Perceived barrier 0.303 Locus of control 0.526 Self efficacy 0.302 Self esteem 0.246 Social support 0.284 Oral health promotion behavior 0.169 808
김영임 : 대안학교고등학생의구강건강증진행위에관한연구 Table 2. The Validity of the Measurement Model Factor Question Loading t-value Subjctive oral health condition a1 a2 a3 a4 a5 a6 Past oral health related behavior b1 b2 b3 b4 b5 b6 b7 b8 Academic stress c1 c3 c4 c5 c6 c8 c9 Perceived benefits d1 d2 d3 d4 d5 d6 d7 d8 Perceived barrier e1 e2 e3 e4 e5 e6 e7 e8 Locus of control f1 f2 결과 0.594 0.279 0.112 0.102 0.067 0.219 0.004 0.119 0.509 0.421 0.129 0.319 0.159 0.209 0.614 0.619 0.668 0.659 0.683 0.589 0.681 0.340 0.359 0.301 0.372 0.219 0.192 0.309 0.162 0.194 0.119 0.232 0.019 0.292 0.329 0.363 0.029 0.921 0.242 5.811*** 2.464*** 1.345 1.211 1.125 3.043*** 0.065 1.694 7.709*** 6.212*** 1.809 5.121*** 1.929 3.389*** 12.121*** 11.793*** 17.042*** 14.826*** 17.975*** 13.899*** 14.987*** 3.549*** 4.012*** 3.499*** 4.289*** 2.819** 2.154* 4.109*** 2.211* 2.766** 1.749 2.789** 0.125 4.286*** 5.098*** 5.879*** 0.439 27.794*** 2.890** 1. 측정모형의신뢰성분석 PLS 구조방정식을이용한자료분석은측정모형분석과구조모형분석으로구성된다. 구조모형분석에앞서측정모형분석에서는반영지표 (reflective indicators) 인측정변수 Table 2. Continued Factor Question Loading t-value Self efficacy g1 g2 g3 g4 g5 g6 g7 g8 Self esteem h1 h2 h3 h4 h5 h6 h7 h8 Social support i1 i2 i3 i4 i5 i6 i7 i8 Oral health promotion behavior j1 j2 j3 j4 j5 j6 j7 j8 j9 j10 j11 j12 *p<0.05, **<0.01, ***<0.001. 0.246 0.109 0.012 0.212 0.647 0.039 0.243 0.059 0.382 0.164 0.112 0.426 0.021 0.439 0.062 0.109 0.127 0.278 0.109 0.071 0.109 0.573 0.247 0.189 0.021 0.197 0.346 0.386 0.272 0.019 0.117 0.326 0.164 0.021 0.123 0.034 3.976*** 1.649 0.169 2.698** 10.796*** 0.467 3.528*** 0.669 3.824*** 2.276* 1.589 5.971*** 0.294 4.568*** 1.102 1.754 1.223 2.767** 1.413 1.026 1.300 7.896*** 2.942** 2.576** 0.178 3.876*** 6.156*** 7.014*** 5.267*** 0.198 1.677 6.123*** 2.387* 0.351 2.174* 0.617 들의신뢰성을분석하였다. 측정모형에관한분석결과, 반영지표인학업스트레스의결합신뢰도는 0.842, Cronbach s alpha는 0.791로확인되었다 (Table 1). 2. 측정모형의타당성분석측정모형반영지표의판별타당성은요인적재값으로확인하였다. 반영지표인학업스트레스의요인적재값이모두 0.5 이상으로매우높고유의하게나타나판별타당성이존재하는것으로확인되었다 (p<0.001). 809
J Dent Hyg Sci Vol. 15, No. 6, 2015 조형지표인주관적구강건강상태, 과거구강건강관련행위, 지각된유익성, 지각된장애성, 통제의소재, 자기효능감, 자아존중감, 사회적지지와구강건강증진행위에서주관적구강건강상태는 a1 (p<0.001), a2 (p<0.05), a6 (p< 0.01) 가유의하게형성하는것으로나타났으며, b3 (p< 0.001), b4 (p<0.001), b6 (p<0.001), b8 (p<0.001) 은과거구강건강관련행위를유의하게형성하는것으로나타났다. 지각된유익성은모든변인이유의한영향을주었으며, 지각된장애성은 e1 (p<0.01), e3 (p<0.01), e5 (p< 0.001), e6 (p<0.001), e7 (p<0.001), 통제의소재는모든요인이유의하게형성하는것으로드러났다. 자기효능감에서 g1 (p<0.001), g4 (p<0.01), g5 (p<0.001), g7 (p< 0.001) 의 4개항목이자기효능감을유의하게형성하는것으로나타났다. 자아존중감에서는 h1 (p<0.001), h2 (p< 0.05), h4 (p<0.001), h6 (p<0.001) 의 4개항목이사회적지지는 i2 (p<0.01), i6 (p<0.001), i7 (p<0.01), i8 (p< Table 3. Structural Model Fit Factor R 2 Redundancy Goodness-of-Fit Perceived benefits 0.259 0.012 Perceived barrier 0.303 0.034 Locus of control 0.108 0.011 Self efficacy 0.324 0.041 0.292 Self esteem 0.305 0.062 Social support 0.259 0.019 Oral health promotion behavior 0.506 0.026 0.01) 의 4개항목이유의하게형성하였다. 마지막으로종속변수인구강건강증진행위에서는 j2 (p< 0.001), j3 (p<0.001), j4 (p<0.001), j5 (p<0.001), j8 (p< 0.001), j9 (p<0.05), j11 (p<0.05) 의 7개항목이구강건강증진행위를유의하게형성하는것으로나타났다 (Table 2). 3. PLS 구조모형의분석잠재변수들의경로를설정한구조모형의적합도는 Redundancy값, R 2 값, 그리고 Goodness of Fit 테스트로평가하였다. PLS 구조방정식모형분석결과, 모든내생변수들의 Redundancy값은양수의값을가지는것으로나타나구조방정식모형이적합한것으로나타났다. 다음으로내생변수의 R 2 값으로 PLS 구조모형에대한평균적인적합도를평가하였다. 통제의소재는 10.8% 로낮은설명력을보이고있으나, 지각된유익성은 25.9%, 사회적지지는 25.9% 로중간정도의설명력을가지고있고, 지각된장애성은 30.3%, 자아존중감은 30.5%, 자기효능감은 32.4% 으로상의설명력을나타내고있다. 종속변수인구강건강증진행위의구조모형의결정계수가 0.506이며, 구강건강증진행위를설명하는설명력의 R 2 값이 50.6% 로 PLS 구조방정식모형은적합한것으로나타났다. 마지막으로 R 2 의평균값과 communality의평균값곱의제곱근으로 PLS 구조방정식모형의전반적인적합도 (Goodness of Fit) 를평가하였다. 이연구의 Goodness of Fit값은 0.292로 PLS 구조방정식모형의적합도가중이상이므로, PLS 구조방정식모형이적합한것으로나타났다 (Table 3). Fig. 1. PLS (partial least square) structural equation modeling analysis. *p<0.05, **<0.01, ***<0.001. 810
김영임 : 대안학교고등학생의구강건강증진행위에관한연구 4. PLS 구조방정식모형분석 PLS 구조방정식모형분석결과, 주관적구강건강상태가좋을수록지각된장애성은낮고 (B= 0.187, p<0.05), 자기효능감 (B=0.219, p<0.01), 사회적지지 (B=0.197, p< 0.05) 는유의하게높아지는것으로나타났다. 과거구강건강관련행위를잘할수록지각된유익성 (B=0.518, p<0.001), 통제의소재 (B=0.274, p<0.001), 자기효능감 (B=0.484, p< 0.001), 자아존중감 (B=0.392, p<0.001), 사회적지지 (B= 0.439, p<0.001) 가높아지며, 지각된장애성 (B= 0.308, p<0.001) 은유의하게낮아지는것으로나타났다. 학업스트레스가높을수록통제의소재 (B= 0.135, p<0.05) 는낮아지며, 지각된장애성 (B=0.282, p<0.001) 은높아지는것으로나타났다. 구강건강증진행위에미치는영향에서지각된유익성이높을수록 (B=0.225, p<0.01), 통제의소재가높을수록 (B=0.195, p<0.05), 자기효능감이높을수록 (B=0.304, p<0.01), 자아존중감이높을수록 (B=0.218, p< 0.01) 구강건강증진행위가높아지는것으로나타났다. 간접 효과를검정한결과에서는주관적구강건강상태가좋을수록 (B=0.138, p<0.05), 과거구강건강관련행위를잘할수록 (B=0.415, p<0.001) 구강건강증진행위가높아지는것으로나타났다 (Fig. 1, Table 4). 고찰 청소년기의정착된올바른구강건강습관은성인이된후건강한삶의기반이됨에도불구하고 9,10), 청소년기의고등학생들은성인에비해상대적으로구강건강습관이확고히형성되지않아구강건강증진행위의수정이필요하다. 따라서이시기에구강건강증진행위실천정도를파악하여긍정적인구강건강증진행위를유도하는것은매우중요하다 11). 하지만청소년을대상으로한구강건강증진행위에관한선행연구를살펴보면구강건강증진행위에관련된변수들의상관관계를밝히는정도이며, 칫솔질방법과시기등실제행위에관한연구들만이루어져, 청소년구강건강증진행위 Table 4. Impact of Oral Health Behavior and Characteristics on Oral Health Beliefs Hypothesis Direct effect Indirect effects Subjctive oral health condition Perceived benefits 0.043 Subjctive oral health condition Perceived barrier 0.187* Subjctive oral health condition Locus of control 0.011 Subjctive oral health condition Self efficacy 0.219** Subjctive oral health condition Self esteem 0.261 Subjctive oral health condition Social support 0.197* Past oral health related behavior Perceived benefits 0.518*** Past oral health related behavior Perceived barrier 0.308*** Past oral health related behavior Locus of control 0.274*** Past oral health related behavior Self efficacy 0.484*** Past oral health related behavior Self esteem 0.392*** Past oral health related behavior Social support 0.439*** Academic stress Perceived benefits 0.043 Academic stress Perceived barrier 0.282*** Academic stress Locus of control 0.135* Academic stress Self efficacy 0.061 Academic stress Self esteem 0.047 Academic stress Social support 0.064 Perceived benefits Oral health promotion behavior 0.225* Perceived barrier Oral health promotion behavior 0.067 Locus of control Oral health promotion behavior 0.195* Self efficacy Oral health promotion behavior 0.304** Self esteem Oral health promotion behavior 0.218** Social support Oral health promotion behavior 0.075 Oral health promotion behavior Oral health promotion behavior 0.138* Past oral health related behavior Oral health promotion behavior 0.415*** Academic stress Oral health promotion behavior 0.015 *p<0.05, **<0.01, ***<0.001. 811
J Dent Hyg Sci Vol. 15, No. 6, 2015 에관한구체적인인과관계를확인한연구는거의없는실정이다. 이에이연구에서는청소년기중에서소질과적성및능력이유사한학생을대상으로특정분야의인재양성을목적으로하는대안학교고등학생들의구강건강증진행위에영향을미치는요인에대한개념적틀과선행연구를토대로가설적모형을구성하여이들간의실증적인인과관계를검증하여이들간의관계를연구하고자하였다. 이연구의모형구성을위한독립변수는주관적구강건강상태, 과거구강건강관련행위, 학업스트레스로구성하였으며, 매개변수로는지각된유익성, 지각된장애성, 통제의소재, 자기효능감, 자아존중감, 사회적지지가있고, 종속변수로는구강건강증진행위의변수를설정하여이들간에가설적모형을구축한후 PLS 구조방정식모형분석을이용하였다. PLS 구조방정식의구조모형의적합도검정은 3개의방법, Redundancy값, R 2 값그리고, 적합도 (Goodness of Fit) 값으로평가했다. 모든내생변수들의 Redundancy값은양수의값을가지는것으로나타나구조방정식모형이적합한것으로나타났다. Cohen 12) 에의하면, R 2 값의효과는 0.26 이상일경우상, 0.13 이상에서 0.26 미만은중, 0.02 이상에서 0.13 미만은하로분류하며, Chin 13) 은 R 2 값의변화정도를 0.02, 0.15, 0.35를기준으로하여영향력을소 (small), 중 (medium), 대 (large) 로구분하였다. 이연구에서통제의소재는낮은설명력을보이나, 지각된유익성은 25.9%, 사회적지지는 25.9% 로중간정도의설명력을가지고있고, 지각된장애성은 30.3%, 자아존중감은 30.5%, 자기효능감은 32.4% 으로상의설명력을나타내고있다. 종속변수인구강건강증진행위의구조모형의결정계수가 0.506이며, 구강건강증진행위를설명하는설명력의 R 2 값이 50.6% 로 PLS 구조방정식모형은적합한것으로나타났다. 종속변수인구강건강증진행위를설명하는설명력이 41.4% 로나타나, R 2 값에의한 PLS 구조방정식모형은적합한것으로나타났다. 마지막으로전반적인적합도 (Goodness of Fit) 값을평가한결과, 이적합도의크기는최소 0.1 이상이어야하며, 0.36 이상은상, 0.25 이상에서 0.36 미만은중, 0.1 이상에서 0.25 미만은하로분류되었다 14). 이연구의 Goodness of Fit 값은 0.292로서 PLS 구조방정식모형의적합도가중간이상인것으로나타나, PLS 구조방정식모형에관한측정모형과구조모형이모두적합한것으로나타났다. 따라서이모형은대안학교고등학생의구강건강증진행위를예측하고설명하기에적합한것으로판단하였다. 이연구에서대안학교고등학생의주관적구강건강상태가좋을수록지각된장애성은낮고, 자기효능감, 사회적지 지는유의하게높아지는것으로나타났다. Kim과 Lee 15) 는주관적구강건강상태가구강건강증진행위를설명하는데직간접적인영향을주며, 주관적구강건강상태는지각된유익성, 지각된장애성, 자아존중감, 사회적지지에도직접적인영향을미치는것으로나타났다. Im 16) 과 Kim 17) 의연구에서는지각된건강상태는자기효능감과지각된장애성에직접적인영향을주고이를통해건강증진행위에간접적인영향을주는것으로나타났다. 과거구강건강관련행위를잘할수록지각된유익성, 통제의소재, 자기효능감, 자아존중감, 사회적지지가높아지며, 지각된장애성은유의하게낮아지는것으로나타났다. Kim과 Kim 18) 은과거구강건강관련행위는구강건강증진행위에직간접적인영향을주는것으로보고하였으며, 지각된유익성, 지각된장애성, 자아존중감, 자기효능감, 사회적지지에직접적인영향을준다고하면서, 과거구강건강관련행위의중요성을강조하였다. 이연구에서대안학교고등학생의과거구강건강관련행위는구강건강증진행위에중요한요인임을알수있었으므로, 앞으로여러변수를통한직간접적인연구가계속적으로이루어져야할것으로판단되었다. 학업스트레스가높을수록통제의소재는낮아지며, 지각된장애성은높아지는것으로나타났다. Bae 19) 의연구에서는학생의스트레스가낮을수록자아존중감이높고구강건강상태도건강하다고인지하는것으로나타났으며, Kang과 Jung 20) 의고등학생을대상으로한연구에서는학업스트레스가정신건강에부정적인영향을미치는것으로보고하였다. 이연구에서학업스트레스와여러변수간의효과분석을통해학업스트레스와구강건강증진행위간의관련성이있다는것을알수있었고, 학업스트레스가낮을수록구강건강증진행위가높아지는것으로나타났다. 앞으로대안학교고등학생의학업스트레스를감소시킬수있는방안이개발되어야할것으로판단되었다. 구강건강증진행위에미치는영향에서지각된유익성이높을수록, 통제의소재가높을수록, 자기효능감이높을수록, 자아존중감이높을수록구강건강증진행위가높아지는것으로나타났다. Lee 21) 의대학생을대상으로한연구에서는예방치료여부, 구강건강통제의소재, 자기효능감이영향을주며, Jung 22) 의연구에서도자기효능감과구강건강통제의소재가주로영향을미치는변수로나타났다. Stewart 등 23) 의연구에서건강증진개념과마찬가지로구강건강증진의개념에서도가장중요한영향을미치는요인은자기효능감으로나타났으며, 구강건강에대한자기효능감이구강건강증진행위라는결과를기대할수있는중요한요 812
김영임 : 대안학교고등학생의구강건강증진행위에관한연구 인으로나타났다. Pender 4) 는자기효능감은직접적으로건강증진행위를동기화시키며행동의시행이나유지에직접적으로영향을미친다고보고하였다. 이연구의제한점은, 연구대상이한지역의일반대안고교로집중된점이집단의대표성에한계를가질수있으며, 형태와대상이다양한대안학교의특성상대안학교청소년의표준적집단으로서일반화에는다소무리가있다는점이다. 추후조사대상을확대하여인문계고등학생과대안학교고등학생을비교하고차이를분석함으로써 Pender의구강건강증진모형의확대와일반화에이바지하며, 청소년의구강건강증진을위해체계적인교육프로그램을지속적으로운영하고활성화해야할것이다. 요약 이연구는횡단면조사연구로 Pender (1996) 의건강증진모형에관한선행문헌고찰을통해청소년의구강건강증진행위를설명, 예측하는가설적모형을구성하고, 모형의적합성과제시된가설을 PLS 구조방정식모형분석을통하여검증하여다음과같은결론을얻을수있었다. 대안학교고등학생의구강건강증진행위에미치는영향에서지각된유익성, 통제의소재, 자기효능감, 자아존중감이높을수록구강건강증진행위가높아지는것으로나타났다. 간접효과를검정한결과에서는주관적구강건강상태가좋을수록, 과거구강건강관련행위를잘할수록구강건강증진행위가높아지는것으로나타났다. Pender의건강증진모형을이용하여구성한대안학교청소년의구강건강증진예측모형은구강건강증진행위를설명하고예측하는데유용한것으로판단되었다. 따라서향후에는구강건강증진예측모형에입각한구강건강증진방안이개발되어야할것이다. References 1. Lee HS, Kim GS: Oral health behavior of economically active women in Chollabuck do, Republic of Korea: 2. oral preventive behavior. J Korean Acad Dent Health 23: 287-299, 1999. 2. 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. 3. Pender NJ: Health promotion in nursing practice. 2nd ed. Appleton and Lange, Stanford, pp.201-289, 1987. 4. Pender NJ: Expressing health through lifestyle pattern. Nurs Sci Q 3: 115-122, 1990. 5. Kegeles SS: Why people seek dental care: a test of a conceptual formulation. J Health Hum Behav 4: 166-173, 1963. 6. Kegeles SS: Some changes required to increase the public's utilization of preventive dentistry. J Public Health Dent 28: 19-26, 1968. 7. Song SH: A study on the recognition and attitude of oral health in Korean college students. Unpublished master's thesis, Wonkwang University, Iksan, 2003. 8. Rai A, Patnayakuni R, Seth N: Firm performance impacts of digitally enabled supply chain integration capabilities. MIS Quarterly 30: 225-246, 2006. 9. Yarcheski A, Mahon NE: A causal model of positive health practices: the relationship between approach and replication. Nurs Res 38: 88-93, 1989. 10. Fardy PS, White RE, Calrk LT, et al.: Health promotion in minority adolescents: A health people 2000 pilot study. J Cardulm R 15: 65-72, 1995. 11. Hwang JM, Han JH: A study on the oral health promotion behavior of high schoolers in a part. J Dent Hyg Sci 9: 197-202, 2009. 12. Cohen J: Statistical power analysis for the behavioral sciences. 2nd. Hillsdale Lawrence Erlbaum Associates, New Jersey, pp.25-26, 1988. 13. Chin WW: The partial least squares approach for structural equation modeling. 1st. In: Marcoulides GA, ed. Modern methods for business research. Lawrence Erlbaum Associates Inc, New Jersey, pp.295-336, 1998. 14. Tenenhaus M, Vinzi VE, Chatelin YM, Lauro C: PLS path modeling. Comput Stat Data Anal 48: 159-205, 2005. 15. Kim SH, Lee JH: Test of a hypothetical model for health promoting behavior in school-aged children. J Korean Acad Child Health Nurs 14: 22-34, 2008. 16. Im MY: Determinants of health promoting behavior of college students in Korea. Unpublished master's thesis, Yonsei National University, Seoul, 1998. 17. Kim YM: Predictive factors of health promotion behaviors of industrial shift workers. Korean J Occup Health Nurs 11: 13-30, 2002. 18. Kim SK, Kim YS: An oral health promotion behavior model for primary school children. J Korean Acad Oral Health 32: 563-574, 2008. 813
J Dent Hyg Sci Vol. 15, No. 6, 2015 19. Bae JS: A predictive model and factors influencing to the oral health promotion behaviors of elementary school students in rural area. Unpublished doctoral dissertation, Chungnam National University, Daejeon, 2005. 20. Kang SH, Jung EJ: A study on the relationship among stress, academic achievement and mental hygiene of high school students. J Educ Psychol 13: 405-424, 1999. 21. Lee SH: A study on factors associated with the oral health promotion behaviors of college students. J Dent Hyg Sci 6: 187-192, 2006. 22. Jung EJ: A study on factors affecting the oral health promotion behavior of dental hygiene and non-dental hygiene students. J Dent Hyg Sci 10: 1-9, 2010. 23. Stewart JE, Strack G, Graves P: Development of oral hygiene self-efficacy and outcome expectancy questionnaries. Community Dent Oral Epidemiol 25: 337-342, 1997. 814