북한이탈주민의 문화적응스트레스, 우울, 헬스리터러시가 건강증진행위에 미치는 영향

Abstract

The purpose of the study was to identify the influence of North Korean Defectors’Acculturative Stress, Depression, and Health Literacy to their Health Promoting Behavior, and to provide evidence for North Korean defectors to improve their Health Promoting 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 November, 2022. The participants were 191 who agreed to participate in this study. The Acculturative Stress of North Korean defectors was measured using Multidimensional Acculturative Stress Inventory(MASI) Tool, which was developed by Rodriguez et al. (2002) and revised by Lee(2016). Depression was measured using Patient Health Questionnaire-9(PHQ-9) developed by Kroenke et al. (2001) and revised by Ahn et al. (2013). Health Literacy was measured using The Short Form of Korean Functional Health Literacy Test(S-KFHLT), which was developed by Kim and Lee (2008) and modified by Kim(2017). Health Promoting Behavior was measured using Health-Promoting Lifestyle Profile Ⅱ(HPLP-Ⅱ) developed by Walker et al. (1996) and revised by Hwang(2010). The collected data were analyzed using SPSS/WIN 26.0. Chi-squared test, Descriptive statistics, Independent t-test, ANOVA, Pearson’s correlation coefficients, and multiple linear regression were utilized. The results of this study are as follows: 1. The average Acculturative Stress score of North Korean defectors 2.72±1.01 out of 5. The average Depression score of North Korean defectors 0.92±0.71 out of 3. The average Health Literacy score of North Korean defectors 0.59±0.27 out of 1. Health Promoting Behavior scored an average of 2.06±0.74 out of 4. 2. The Health Promoting Behavior of North Korean defectors differed significantly depending on subjective economic conditions (t=3.255, p<.01), The degree of education in North Korea (F=10.768, p<.001), The degree of education in South Korea (F=18.641, p<.001), Duration of residence in Korea (F=3.831, p<.05), frequency of drinking (F=6.924, p<.001), frequency of exercise (F=25.750, p<.001), subjective health conditions (F=49.128, p<.001), level of social support (F=28.566, p<.001). The degree of Health Promoting Behaviors were higher 5 or more friends and 3-4 friends with whom you meet or contact at least once a month than 1 person or less, Subjective economic status is high-middle than low, The period of residence in Korea is 7 to 9 years, and 10 years or more is than 3 years or less, As for the level of education in North Korea, universities are higher than elementary middle schools and high middle schools, the level of education in South Korea, universities and colleges are than never went to school, Frequency of drinking is not drinking at all than once a week, subjective health status is healthy than Moderate and not healthy, exercise frequency is Twice a week or more, about once a week, no exercise at all, and sometimes (1-2 times a month) were found to be significantly higher. 3. The subject's Health Promoting Behavior had a statistically significant negative correlation with Acculturative Stress (r=-.545, p<.001), Depression (r=-.342, p<.001), and Health Literacy (r=.476, p<.001) showed a significant positive correlation. 4. The exercise frequency that affects the subject's health promotion behavior is about once a week (β=.213, p<.001), more than twice a week (β=.344, p<.001), and level of social support (β=.222, p<.001), and health literacy (β=.153, p<.01) were statistically significant positive (+) definitions of health promotion behaviors. It was found that drinking frequency was about once a week (β=-.151, p<.01), subjective health status was normal (β=-.307, p<.001), and not healthy (β=-.307, p<.001). =-.231, p<.001), and cultural adaptation stress (β=-.260, p<.001) had a significant negative (-) effect on health promotion behavior. The total explanatory power of the variables was 65.7%. As a result of the above study, exercise frequency, drinking frequency, subjective health condition, level of social support, cultural adaptation stress and health literacy were found to be factors influencing health promotion behavior, In other words, the group with exercise frequency of about once a week or more than twice a week was better than the group that did not exercise at all, and the group with more than 5 friends (neighbors) whom they met or contacted more than once a month were more health-promoting than the group with less than 1 person. It can be said that the higher the level of health literacy, the higher the degree of performance of health promoting behavior. In addition, the drinking frequency was about once a week, and the health promotion behavior level was lower than the non-drinking group, and the subjective health status was normal and unhealthy group was lower than the healthy group. It can be said that the higher the level of acculturation stress, the lower the performance of health promoting behavior. Therefore, in order to improve health promotion behavior, attention should be paid to their health-related characteristics such as exercise frequency, drinking frequency, subjective health status, and level of social support. Based on the assessed characteristics, interventions that can lower the level of acculturation stress and increase the level of health literacy are needed.;본 연구는 북한이탈주민의 문화적응스트레스, 우울, 헬스리터러시가 건강증진행위에 미치는 영향을 확인하여 북한이탈주민의 건강증진행위 향상을 위한 간호중재 마련에 기초자료를 제공하고자 하였다. 연구대상자는 탈북 후 수도권에 거주하는 만 19세 이상의 북한이탈주민 191명이었다. 2022년 11월 한 달 동안 임의표출한 북한이탈주민을 대상으로 구조화된 설문지를 사용하여 자료를 수집하였다. 문화적응스트레스는 The Multidimensional Acculturative Stress Inventory로, 우울은 The Patient Health Questionnaire-9으로, 헬스리터러시는 The Short Form of Korean Functional Health Literacy Test로, 건강증진행위는 Health-Promoting Lifestyle Profile Ⅱ로 측정하였다. 자료 분석은 SPSS/WIN 26.0 프로그램을 사용하여 Chi-squared test, 기술통계, t-test, ANOVA, Sheffé post hoc, Pearson’s correlation coefficients, multiple linear regression analysis를 시행하였다. 본 연구결과는 아래와 같다. 1. 북한이탈주민의 문화적응스트레스는 2.72±1.01점, 우울은 0.92±0.71점, 헬스리터러시는 0.59±0.27점, 건강증진행위는 2.06±0.74점이었다. 2. 북한이탈주민의 건강증진행위 정도는 사회적지지 수준(F=28.566, p<.001), 주관적 경제상태(t=3.255, p<.01), 한국에서의 거주기간(F=3.831, p<.05), 북한에서의 교육정도(F=10.768, p<.001), 남한에서의 교육정도(F=18.641, p<.001), 음주빈도(F=6.924, p<.001), 주관적 건강상태(F=49.128, p<.001), 운동빈도(F=25.750, p<.001)에 따라 유의한 차이가 확인되었다. 3. 대상자의 건강증진행위는 문화적응스트레스(r=-.545, p<.001), 우울(r=-.342, p<.001)과 통계적으로 유의한 음의 상관관계, 헬스리터러시(r=.476, p<.001)와는 유의한 양의 상관관계를 보였다. 4. 대상자의 건강증진행위에 영향을 미치는 변수는 주관적 건강상태(β=-.538, p<.001), 문화적응스트레스(β=-.260, p<.001), 음주빈도(β=-.151, p<.01), 헬스리터러시(β=.153, p<.01), 사회적지지 수준(β=.222, p<.001), 운동빈도(β=.557, p<.001) 순으로 유의미하였고, 변수의 총 설명력은 65.7%였다. 주관적 건강상태가 보통일수록, 문화적응스트레스 수준이 높을수록, 음주빈도가 일주일에 한번 이상일수록 건강증진행위 수행정도가 낮아졌고, 헬스리터러시 수준이 높을수록, 사회적지지 수준이 5명 이상일수록, 운동빈도가 일주일에 한번 이상일수록 건강증진행위 수행정도가 높아졌다. 이상의 연구 결과에서 운동빈도, 음주빈도, 주관적 건강상태, 사회적지지 수준, 문화적응스트레스와 헬스리터러시가 건강증진행위에 영향을 미치는 요인으로 나타났다. 따라서 건강증진행위를 향상시키기 위해 건강관련 특성인 운동빈도, 음주빈도, 주관적 건강상태, 사회적지지 수준에 주목해야한다. 또한 사정한 특성을 토대로 새로운 남한사회에 적응할 수 있는 환경을 조성하여 문화적응스트레스 수준을 낮추고, 일상생활에서 건강정보를 쉽게 활용할 수 있는 교육 프로그램을 개발 및 적용하여 헬스리터러시 수준을 높여야 한다.