북한이탈주민의 문화적응, e-헬스 리터러시, 사회적지지가 약물오남용행위에 미치는 영향

Abstract

2020년 기준 남한 내 북한이탈주민은 33,658명으로 꾸준히 증가하는 추세이다. 남북한 체제와 문화적 차이로 북한이탈주민은 약물오남용 경향이 높고 복약 순응도가 낮아 건강문제를 자주 경험하게 된다. 전 국민의 건강수준 향상과 건강형평성을 위해 북한이탈주민의 약물오남용행위 개선이 필요함에도 약물오남용행위 관련 간호사정 및 중재는 부재하다. 이에 본 연구는 북한이탈주민의 문화적응, e-헬스 리터러시, 사회적지지가 약물오남용행위에 미치는 영향을 파악하기 위해 시행한 서술적 조사연구를 시행하였다. 북한이탈주민 211명을 대상으로 2021년 4월 14일부터 5월 15일까지 문화적응 척도, 한국판 인터넷 건강정보 이해능력 측정도구, 지각된 사회적지지의 다차원적 척도, 약물오남용예방행위 도구로 구성된 구조화된 설문지를 이용하여 자료를 수집하였다. 수집한 자료는 SPSS/WIN 22.0 프로그램을 이용하여 기술통계, t-test, ANOVA, Scheffé post hoc, Pearson's correlation coefficients, Multiple linear regression analysis를 이용하여 분석하였다. 본 연구결과는 다음과 같다. 1. 대상자의 문화적응은 남한문화적응이 평균 62.53±15.35/90점, 북한문화적응이 46.41±15.76/90점이었다. e-헬스 리터러시는 평균 28.66±6.66/40점, 사회적지지는 평균 44.40±10.37/60점, 약물오남용행위는 평균 4.56±3.14/13점이었다. 2. 북한이탈주민의 약물오남용행위는 성별(F=3.08, p=.002), 현재 직업(F= 2.27, p=.024), 주관적 건강상태(F=19.11, p<.001), 설문조사유형(F=-3.27, p<.001)에서 유의한 차이가 있었다. 남성보다 여성인 경우, 현재 직업이 있는 것보다 없는 경우, 주관적 건강상태가 나쁠수록, 온라인 설문지보다 서면 설문지에 응답한 경우 약물오남용행위 점수가 높았다. 3. 대상자의 약물오남용행위는 e-헬스 리터러시(r=-.22, p=.002), 사회적지지(r=-.30, p<.001)와 부적 상관관계가 있었다. 4. 대상자의 약물오남용행위에 영향을 미치는 변수는 사회적지지(β=-.20, p=.012), 성별(β=-.18, p=.018), 주관적 건강상태(β=-.17 p=.039), 북한문화적응(β=.16, p=.041) 순으로 유의미하였고, 변수의 총 설명력은 18.0%였다. 남성보다 여성이, 주관적 건강상태가 나쁠수록, 북한문화적응이 높을수록, 사회적지지가 낮을수록 약물오남용행위 정도가 심화되었다. 결론적으로 북한이탈주민의 약물오남용행위 정도는 중간 이하였으나 재북 당시 질병에 대한 자가 진단, 약물 처방 및 복용이라는 북한문화적응 정도가 높을수록 약물오남용행위가 심화되었다. 또한 여성인 경우, 건강상태가 나쁘다고 인식할수록, 지각된 사회적지지 정도가 낮을수록 약물오남용행위가 심화됨이 확인되었다. 따라서 북한이탈주민의 약물오남용행위 감소를 위한 지지체계 마련과 함께 문화적응 정도를 고려한 중재방안을 모색하되 약물오남용행위의 사정, 그에 따른 올바른 정보 제공, 치료적의사소통이 가능한 간호사의 적극적인 활용이 필요하겠다.;This descriptive study aimed to identify the influence of North Korean Defectors’ Acculturation, e-health literacy and social support to their drug abuse behavior, and to provide evidence for North Korean defectors to improve their Drug abuse behavior. This study compiled snowball sampling of North Korean defectors aged 19 years or older who completed Settlement Support Center for North Korean refugees (Hanawon) education and live in the community. Data collection was conducted from April to May, 2021. The participants were 211 who agreed to participate in this study. The Acculturation of North Korean defectors was measured using Vancouver Index Acculturation (VIA) Tool, which was developed by Ryder et al. (2000) and revised by Kim & Kwon (2009). E-Health Literacy (e-HL) was measured using eHealth Literacy Scale (eHEALS) developed by Norman & Skinner (2006) and revised by Jang et al. (2018). Social Support was measured using the Multi-dimensional Scale of Perceived Social Support (MSPSS), which was developed by Zimet et al. (1988) and revised by Jeon & Jung (2019). Drug Abuse Behavior was measured using the drug misuse and abuse prevention behavior scale developed by Lee & Park (2000). The collected data were analyzed using SPSS/WIN 22.0. Descriptive statistics, Independent t-test, ANOVA, Pearson’s correlation coefficients, and Multiple regression were utilized. The results of this study are as follows: 1. The Acculturation score was calculated for each subject; then, these scores were classified into two subtypes according to the degree of adaptation to South Korean culture and North Korean culture. South Korean acculturation averaged 62.53±15.35/90, and North Korean acculturation 46.41±15.76/90. The average e-health literacy score of North Korean defectors averaged 28.66±6.66/40. The average score for social support was 44.40±10.37/60. Drug abuse behavior scored an average of 4.56±3.14/13. 2. The drug abuse behavior of North Korea defectors differed significantly depending on gender (F=3.08, p=002), current occupation (F= 2.27, p=.024), self-rated health (F=19.11, p<.001) and the type of questionnaire(F=-3.27, p<.001). The degree of drug abuse behavior was higher among those women than men, among those unemployment than there is current job. the worse the self-rated health, the worse among those written questionnaires than online questionnaires, the higher the score of drug abuse behavior. 3. Drug abuse bahavior has negative correlation with e-health literacy (r=-.22, p=.002) and social support (r=-.30, p<.001). 4. The drug abuse behavior affected by the social support (β=.20, p=.012), gender (β=-.18, p=.018), self-rated health (β=-.17, p=.039) and north korean cultural adaptation (β=.16, p=.041). The variables were shown to affect the drug abuse behavior in order social support, gender, self-rated health and north korean cultural adaptation. The explanatory power of total variable’s was 18.0%. More women than men, worse the self-rated health, the higher the north korean cultural adaptation, the lower the social support, the higher the drug abuse behavior. In conclusion, North Korean defectors were less than moderate in drug abuse behavior, but the higher the degree of north korean cultural adaptation including self-diagnosis, drug prescription, and drug abuse, the deeper the drug abuse behavior. More women than men, worse the self-rated health, the deeper the drug abuse behavior. In addition, it has been confirmed that the lower the perceived social support level, the more serious drugs abuse behavior. Therefore, it is necessary to prepare a support system considering acculturation to reduce drug abuse behavior among North Korean defectors. We should actively utilize nurses who can assess drug abuse behavior and provide accurate information and offer therapeutic communication to them.