성인병 건강검진 순응도에 영향을 미치는 요인 -한 지역의료보험조합 피보험자들을 대상으로-

Abstract

Background : Recently preventive clinical care has been proved important to the health. A number of recommendations or programs for preventive health services have been developed. The government made laws for health promotion of the people and for medical check-up for the insured in the district medical insurance association, who had been alienated from reimbursement for periodic health examination. As a result, above 95% of Korean people could took the periodic health check-up by this legislation. According to the national data, however, about 20% of the insured participated in the health screening program which was carried for the first time by the district medical insurance association in 1995. The reason that the compliance of health screening program was much lower than expected has not been clear yet. The purpose of this study is to define the facors affecting on the compliance of the health screening program.

Methods : Two hundreds of compliers and as many non-compliers of the health screening program was selected by the stratified sampling in one district medical insurance association which consisted of one town and eight township within the National Capital region. The telephone survey was performed from June 1 to 15 in 1996. The questionnaire was framed by health belief model with other demographic data. The data was analyzed by chisquare test, wilcoxon rank sums test, and logistic regression for the comparison of the characteristics between compliers and non-compliers.

Results : There was no difference of demographic data and medical history of chronic disease between compliers and non-compliers. 73.3% of the subjects knew they had been the expectant examinee of the health examination, and among them, 68% took the health examination. However, 53% of non-compliers did not know that they had been the expectant examinee. The most common reason that non-compliers didn't took the health examination was "they didn't know"(43.5%). Among 73 families of compliers which had more than 2 expectant examinees of the health screening program, 44 families(60.3%) had more complier other than study subjects. In contrast, among 74 families of non-compliers, only 7 famiies(9.5%) had more complier other than study subjects. Compliers showed lower reliability of the health screening program than non-compliers. Non-compliers had more perception about the severity of the target disease for the examination and had more confidence about self health status than compliers. There was no difference of the answer about the benefit of the health examination, perceived susceptibility about target disease, sue to action, and perceived barriers. The odds ratio of compliance of other family member was 21.2, perceived severity, 0.70, and cue to action, 1.36.

Conclusion : The main reason of low compliance of health screening program for the insured in the district medical insurance association was lack of public information. By the fact that non-compliers had more perception about the severity of the target disease and there was no difference of perceived benefit of the health examination between two groups, public information should be focused on the benefit and efficacy of periodic health of the health examination between two groups, public information should be focused on the benefit and efficacy of periodic health check-up than severity and susceptibility of target disease. Because the health screening program on study subjects was carried for the firt time, only compliers had experience of the examination. The fact that compliers relied on the examination less than non-compliers meant that the examinees was satisfied much less than expected. Therefore, further study of the expectation of the examinees about the health examination is expected.