Journal of Preventive Medicine and Public Health

Original Articles

Knowledge, Attitudes, and Practices Regarding Influenza Vaccination Among Healthcare Workers in Saudi Arabia: A Cross-sectional Study: Laila M. Almutairi, Mona A. Almusawi, Abeer M. Albalawi, Musallam Y. Abu Hassan, Adel F. Alotaibi, Tariq M. Almutairi, Randah M. Alalweet, Abdullah M. Asiri; J Prev Med Public Health. 2024;57(6):586-594. Published online November 8, 2024; DOI: https://doi.org/10.3961/jpmph.24.283

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Abstract Summary PDF Supplementary Material: Objectives
Influenza vaccination is important for healthcare workers in order to prevent both the illness itself and transmission to patients. Previous studies in Saudi Arabia have revealed low influenza vaccine coverage among healthcare workers due to misconceptions. This study aimed to assess knowledge, attitudes, and practices regarding influenza vaccination among healthcare workers during 2021, addressing the current data gap.
Methods
A cross-sectional study was conducted, including 1273 healthcare workers from the Ministry of Health in Saudi Arabia. A self-administered questionnaire was distributed to participants via email.
Results
Most participants had an appropriate extent of knowledge, with 37.1% having a high level and 26.6% having a moderate level. Positive attitudes toward the influenza vaccine were observed in 41.2% of participants, and 80.2% demonstrated good vaccine practices. However, the vaccine coverage was 50.8% in the past 12 months. Factors associated with vaccine uptake included previous vaccination, workplace availability, awareness of guidelines, engagement in training programs, type of workplace settings, and having positive attitudes toward the vaccine. The most common reason for not getting vaccinated was the perception of being at low risk, making vaccination unnecessary.
Conclusions
Participants exhibited positive knowledge, attitudes, and practices regarding influenza vaccination. However, the observed vaccine uptake rate fell below the recommended coverage rate, indicating the presence of a knowledge-behavior gap. Targeted interventions are recommended to improve vaccination uptake among healthcare workers in Saudi Arabia.; Summary

Key Message
This study assesses knowledge, attitudes, and practices regarding influenza vaccination among healthcare workers in Saudi Arabia, and reveals that most participants had an appropriate extent of knowledge, positive attitudes toward the influenza vaccine, and good vaccine practices. However, the vaccine uptake rate was below the desired coverage target, indicating a knowledge-behavior gap. Our findings suggest implementing interventions that enhance accessibility, provide workplace support, conduct awareness campaigns, and tackle barriers impeding vaccination, to improve uptake rates among healthcare workers in Saudi Arabia.

Patients’ and General Practitioners’ Views About Preventive Care in Family Medicine in Switzerland: A Cross-sectional Study: Christine Cohidon, Fabienne Imhof, Laure Bovy, Priska Birrer, Jacques Cornuz, Nicolas Senn; J Prev Med Public Health. 2019;52(5):323-332. Published online September 17, 2019; DOI: https://doi.org/10.3961/jpmph.19.184

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Objectives
The aim of this study was to describe general practitioners (GPs)’ opinions and practices of preventive care and patients’ opinions, attitudes, and behaviors towards prevention.
Methods
The data stemmed from a cross-sectional national survey on prevention conducted in Switzerland from 2015 to 2016. In total, 170 randomly drawn GPs and 1154 of their patients participated. The GPs answered an online questionnaire and the patients answered a questionnaire administrated by fieldworkers present at their practices.
Results
Both patients and GPs agreed that delivering preventive care is the dedicated role of a GP. It appeared that beyond classical topics of prevention such as cardiovascular risk factors, other prevention areas (e.g., cannabis consumption, immunization, occupational risks) were scarcely covered by GPs and reported as little-known by patients. In addition, GPs seemed to use a selective approach to prevention, responding to the clinical context, rather than a systematic approach to health promotion. The results also highlight possibilities to improve prevention in family medicine through options such as more supportive tools and public advertising, more time and more delegated tasks and, finally, a more recognized role.
Conclusions
Despite an unfavorable context of prevention within the healthcare system, preventive care in family medicine is reasonably good in Switzerland. However, some limitations appear regarding the topics and the circumstances of preventive care delivery. A global effort is needed to implement necessary changes, and the responsibility should be broadened to other stakeholders.

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Perspective

Proposal to Revise the Screening Test for Latent Tuberculosis Infection in Close Contacts at Elementary Schools in Korea: Jong-Myon Bae; J Prev Med Public Health. 2019;52(4):272-275. Published online May 8, 2019; DOI: https://doi.org/10.3961/jpmph.19.043

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Abstract Summary PDF Supplementary Material: The 2018 National Guideline for Tuberculosis Control, which was published by the Korea Centers for Diseases Prevention and Control (KCDC), mandates conducting an epidemiological survey among close contacts of active tuberculosis patients at public institutions such as schools. In the procedure for these surveys, the tuberculin skin test (TST) is mandated as the screening test for latent tuberculosis infection in elementary school students. However, several guidelines recommend using the interferon-gamma releasing assay (IGRA) for contacts aged over 5 years with a Bacillus Calmette–Guérin vaccination history. The main reason for this is that IGRA has a higher specificity and lower false positive rate than TST. In addition, IGRA requires only a single visit to draw blood and the results are available within 24 hours. These advantages could promote cooperation from both parents and students in conducting these surveys. Thus, these findings regarding the benefits of IGRA for surveys of close contacts at elementary schools should be incorporated into the KCDC guideline.; Summary

Korean summary
집단시설에서의 결핵환자 발생시 수행하는 역학조사 지침에는 잠복결핵감염자의 검진을 위해 초등학생에게 투베르쿨린 피부반응검사 (TST)를 시행하도록 되어 있다. 그러나, 6세 이상의 초등학생들은 필수적으로 BCG 예방접종을 받았다는 점과, 역학조사 수행의 협조 등을 고려할 때 TST 대신 인터페론감마 분비검사 (Interferon-gamma releasing assay, IGRA)를 우선 시행하는 것이 보다 더 근거중심적, 가치중심적 으로 타당하다.

Special Article

Strategies for Appropriate Patient-centered Care to Decrease the Nationwide Cost of Cancers in Korea: Jong-Myon Bae; J Prev Med Public Health. 2017;50(4):217-227. Published online June 16, 2017; DOI: https://doi.org/10.3961/jpmph.17.069

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Abstract PDF Supplementary Material

In terms of years of life lost to premature mortality, cancer imposes the highest burden in Korea. In order to reduce the burden of cancer, the Korean government has implemented cancer control programs aiming to reduce cancer incidence, to increase survival rates, and to decrease cancer mortality. However, these programs may paradoxically increase the cost burden. For examples, a cancer screening program for early detection could bring about over-diagnosis and over-treatment, and supplying medical services in a paternalistic manner could lead to defensive medicine or futile care. As a practical measure to reduce the cost burden of cancer, appropriate cancer care should be established. Ensuring appropriateness requires patient-doctor communication to ensure that utility values are shared and that autonomous decisions are made regarding medical services. Thus, strategies for reducing the cost burden of cancer through ensuring appropriate patient-centered care include introducing value-based medicine, conducting cost-utility studies, and developing patient decision aids.

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Original Articles

Nurse-perceived Patient Adverse Events and Nursing Practice Environment: Jeong-Hee Kang, Chul-Woung Kim, Sang-Yi Lee; J Prev Med Public Health. 2014;47(5):273-280. Published online September 12, 2014; DOI: https://doi.org/10.3961/jpmph.14.019

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Abstract PDF

Objectives
To evaluate the occurrence of patient adverse events in Korean hospitals as perceived by nurses and examine the correlation between patient adverse events with the nurse practice environment at nurse and hospital level. Methods: In total, 3096 nurses working in 60 general inpatient hospital units were included. A two-level logistic regression analysis was performed. Results: At the hospital level, patient adverse events included patient falls (60.5%), nosocomial infections (51.7%), pressure sores (42.6%) and medication errors (33.3%). Among the hospital-level explanatory variables associated with the nursing practice environment, ‘physician- nurse relationship’ correlated with medication errors while ‘education for improving quality of care’ affected patient falls. Conclusions: The doctor-nurse relationship and access to education that can improve the quality of care at the hospital level may help decrease the occurrence of patient adverse events.

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Influence of the Nursing Practice Environment on Job Satisfaction and Turnover Intention: Sang-Yi Lee, Chul-Woung Kim, Jeong-Hee Kang, Tae-Ho Yoon, Cheoul Sin Kim; J Prev Med Public Health. 2014;47(5):258-265. Published online September 12, 2014; DOI: https://doi.org/10.3961/jpmph.14.002

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Abstract PDF

Objectives
To examine whether the nursing practice environment at the hospital-level affects the job satisfaction and turnover intention of hospital nurses. Methods: Among the 11 731 nurses who participated in the Korea Health and Medical Workers’ Union’s educational program, 5654 responded to our survey. Data from 3096 nurses working in 185 general inpatient wards at 60 hospitals were analyzed using multilevel logistic regression modeling. Results: Having a standardized nursing process (odds ratio [OR], 4.21; p<0.001), adequate nurse staffing (OR, 4.21; p<0.01), and good doctor-nurse relationship (OR, 4.15; p<0.01), which are hospital-level variables based on the Korean General Inpatients Unit Nursing Work Index (KGU-NWI), were significantly related to nurses’ job satisfaction. However, no hospital-level variable from the KGU-NWI was significantly related to nurses’ turnover intention. Conclusions: Favorable nursing practice environments are associated with job satisfaction among nurses. In particular, having a standardized nursing process, adequate nurse staffing, and good doctor-nurse relationship were found to positively influence nurses’ job satisfaction. However, the nursing practice environment was not related to nurses’ turnover intention.

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English Abstract

A Nationwide Survey on the Hand Washing Behavior and Awareness.: Jae Sim Jeong, Jun Kil Choi, Ihn Sook Jeong, Kyong Ran Paek, Hye Kyung In, Ki Dong Park; J Prev Med Public Health. 2007;40(3):197-204.; DOI: https://doi.org/10.3961/jpmph.2007.40.3.197

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OBJECTIVES
This study was conducted to evaluate the public's awareness of the importance of hand washing and to compare perceptions on the habit of hand washing with actual hand washing behavior. METHODS: Data were collected by observing 2,800 participants washing their hands after using public restrooms in seven cities nationwide and by surveying 1,000 respondents (age > 14 years) through telephone interviews using a structured questionnaire. RESULTS: Although 94% of the survey respondents claimed to mostly or always wash their hands after using public restrooms, only 63.4% of the observed participants did wash their hands after using public restrooms. Significant factors related to increased adherence to hand washing were female gender, approximate ages of 20 to 39 years by their appearance, and the presence of other people from the observation. About 79% of the survey respondents always washed their hands after using bathrooms at home, 73% washed their hands before handling food, and 67% washed their hands upon returning to their home. However, 93.2% and 86.3% of the survey respondents did not wash their hands after coughing or sneezing and after handling money, respectively. Although most of the survey respondents (77.6%) were aware that hand washing is helpful in preventing communicable diseases, 39.6% of the survey respondents did not do so because they were 'not accustomed' to washing their hands and 30.2% thought that washing their hands is 'annoying'. CONCLUSIONS: This is the first comprehensive report on hand washing behavior and awareness of the general population in Korea. The result of this study in terms of individual behavior and awareness of hand washing are comparable with similar studies conducted in other countries. However adherence to hand washing is still low and needs to be increased. The results of this study can be used as a baseline in setting up strategies and activities to Bpromote adherence to hand washing.

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Original Articles

Differences in Health Behaviors among the Social Strata in Korea.: Tae Ho Yoon, Ok Ryun Moon, Sang Yi Lee, Baek Geun Jeong, Sin Jae Lee, Nam Sun Kim, Won Ki Jhang; Korean J Prev Med. 2000;33(4):469-476.

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Abstract PDF: OBJECTIVES
To analyze differences in health behaviors among the social strata in Korea by using the 1995 National Health and Health Behavior Survey Data. METHODS: Study participants numbered 2,352 men and 1,016 women aged between 15-64 years old, with housewives, students and non-waged family workers excluded. Health behaviors in this study were defined according to the recommendations of the Alameda 7 study. The measure of health behaviors was based on the Health Practices Index(HPI; 0-5 range, with the exclusion of snacking between meals and regularly eating breakfast) developed by the Alameda County research. The significance of the relationship between social strata and HPI was assessed by considering the adjusted means from the multi-variate model. RESULTS: For men, incidence rates of never having smoked, no/moderate use of alcohol, regular exercise, and regular 7-8 hours sleep per night were higher in the upper social strata. Meanwhile, for women, incidence rates of never having smoked, no/moderate use of alcohol, appropriate weight, regular exercise, and regular 7-8 hours sleep per night were higher in the upper strata. HPI varied significantly among social strata in both sexes (p<0.001), a result which held true when adjusted for age, education, income, social insurance type, marital status and region. CONCLUSIONS: Health behaviors assessed by Health Practices Index(HPI) varied significantly among social strata for both sexes. Therefore, the existing gap in health behaviors among social strata can be corrected more effectively by target oriented health promotional activities.; Summary

Factors Affecting Health Practice of Primary School Students: Based on Health Promotion Model.: Kyung Won Kwon, Sin Kam, Ki Soo Park; Korean J Prev Med. 2000;33(2):137-149.

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Abstract PDF: OBJECTIVES
The purpose of this study was to examine the factors related to children's health behavior. METHODS: A self-administered questionnaire survey was carried out for 431 (boys; 227, girls; 204) children, 6th grade students, in Taegu from December 14 to 18 in 1998. This study employed health promotion model as a hypothetical model. Collected data were analysed through the chi-square test, ANOVA, and path analysis. RESULTS: By univariate analysis, in case of boys, health practice was related to perceived self efficacy, perceived health status, perceived benefits of health-promoting behaviors, and perceived barriers, and in girls, health practice was related to perceived self efficacy, perceived benefits of health-promoting behaviors, perceived barriers, and cues to action. By path analysis, in case of boys, the better economic status, the younger mothers' age, the higher score of family cohesion and adaptability, healthier, the more perceived benefits, and the less perceived barriers were, the more health behaviors were practiced. Girls did the more health practice, in case of living with parents only, the higher score of family cohesion and adaptability, the more perceived self-efficacy, the less perceived barriers, and the more cues to action. Family cohesion had the most important effect on health practice of primary school students. CONCLUSIONS: In order to promote health behavior of primary school students, a good family environment as well as health education might be very important. That is, we have to try together in home and as well as in school.; Summary

Structural Relationships among Health Concern, Health Practice and Health Status of the Disabled.: Ki Soo Park, Byung Yeol Chun, Sin Kam, Min Hae Yeh, Yun Sik Kang, Keon Yeop Kim, Jae Hee Son, Young Suk Lee; Korean J Prev Med. 1999;32(3):276-288.

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Abstract PDF: OBJECTIVES
This study was performed to determine the relationships among Health concern, health practice and health status of the disabled. METHODS: A self-administered questionnaire survey was carried out for 1,662 disabled persons in Taegu city from April to July, 1997. RESULTS: Health concern had a significant and positive relationship with health practice(p<0.05) and health practice also had a significant and positive relationship with self-rated health status(p<0.05) in men and women. To determine the structural model of the Health concern, health practice, health status and sociodemographic variables, the covariance structural analysis was used. In men, age, economic status, medical security type, educational level and type of disability had significant direct effects on Health concern(T>2.0). Educational level and type of disability had significant direct effects on health practice(T>2.0). And Economic status, medical security type and job status had significant direct effects on health status(T>2.0). In women, economic status and educational level had significant direct effects on Health concern(T>2.0). However there was no variable which had a significant direct effect on health practice. Job status had a significant direct effect on health status(T>2.0). In men and women, health practice was significantly increased with increasing Health concern and the more health practice, the higher health status(T>2.0). CONCLUSIONS: It is recommended that the institutional approach which improve the economic status of the disabled with understanding their behavior and attitude should be established to increase health status, in addition, the health policy for encouraging the disabled, such as health education, consulting and health promotion program, should be done.; Summary

Meta-analysis of the Korean Literatures for Developing Clinical Practice Guidelines of Benign Prostatic hyperplasia.: Seung Hum Yu, Chun Bae Kim, Myung Geun Kang, Jae Mann Song; Korean J Prev Med. 1997;30(3):643-664.

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Abstract PDF: This study is to provide evidence-based recommendations for the most-effective treatments of benign prostatic hyperplasia based on patient preference or clinical need, and to meta-analyze the Korean literatures for the development of BPH treatment guidelines. For these analyses, extensive literature searches (208 articles), with priority given to the Korean Journal of Urology, were conducted from 1960 to August, 1996. Meta-analysis, like all statistical analysis, has two main functions: data summarization (qualitative meta-analysis) and smoothing or pattern recognition (quantitative meta-analysis). As well, critical reviews and syntheses with the mean and 90-percent confidence intervals for the likelihood were used to evaluate empirical evidence and significant outcomes of the BPH treatment literatures (106 articles). For this task, the Methodologic Panel for BPH Guidelines was composed of multidisciplinary experts in the field. The results of the study were summarized as follows: For all that watchful waiting is an appropriate treatment strategy for the majority of patients with prostatism, we couldn't find the Korean literatures which carried this article. The literatures on alpha-1-adrenergic receptor blockers provide no evidence to suggest that any one alpha blocker is more effective than another. The finasteride reduces the size of the prostate, on average, and leads to a small yet perceptible reduction in sysptoms. Of all treatment options, prostate surgery with transurethral resection of the prostate (TURP), transurethral incision of the prostate (TUIP), and so on, offers the best chance for symptom improvement. However, surgery also has the highest rates of significant complications. Therefore, surgery need not always be a treatment of last resort. Balloon dilation of the prostatic urethra is clearly less effective than surgery in relieving symptoms, but it is associated with fewer complications. Emerging technologies for treating BPH include lasers, coils, stents, thermal therapy and hyperthermia. Established technologies will also be reanalyzed as results of new trials are reported. Although this study has some limitations due to lacking for good quality literatures, it provides a cornerstone for our medical research. It represents the most current scientific knowledge regarding the clinical epidemiology including treatment of BPH. It will be revised and updated as needed.; Summary

Health related practices and morbidity among adult in rural area.: Jue bok Song, Boo Ouk Rhee, Hai Rim Shin, Kap Yeol Jung, Joon Youn Kim; Korean J Prev Med. 1997;30(2):342-355.

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Abstract PDF: This research was carried out to determine the performance rate of health related practices, to measure the agreement between morbidity by doctor's diagnosis and morbidity by 'subject' self-reported and the degree of association between health related practices and morbidity rate by doctor's diagnosis, to identify their effects on morbidity among rural area populations. The data were gathered by volunteer residents(over the age of 20) of Haman Myeon, Haman Gun, Kyeongsangnam Do in Korea, from June 10, 1993 to June 12, 1993 (369 male and 516 female). Face to face interview, lab, chest P-A, EKG and physical examination were completed. Descriptive statistics, agreement analysis and multiple logistic regression procedures were employed for analyses. The results of the study were summarized as follows : 1) Age adjusted morbidity rates by doctor's diagnosis and self-reported were 38.5% (male:37.3%, female:36.5%), 26.4% (male:33.3%, female:27.5%), respectively. Kappa coefficient between morbidity by doctor's diagnosis and morbidity by self-reported was 0.21 (male:0.21, female:0.22). 2) The frequency of disease by doctor's diagnosis was as follows: hypertension (15.3%), gastritis (9.6%), diabetes mellitus (8.5%), liver disease (8.1%), and degenerative arthritis (6.2%) in the study population. 3) Order of health practice performance rate was as follows: Males- normal body weight (62.1%), non-heavy alcohol consumption (57.5%), 7-8 hours of sleeping (50.1%), non-smoking (21.7%), and exercise (19.8%). Females- non-heavy alcohol consumption (97.3%), non-smoking (84.7%), normal body weight (57.8%), 7-8 hours of sleeping (45.0%), and exercise (9.9%). 4) There was no significant relationship between health related practice and morbidity except exercise among health related practices. 5) Health related practice index which was recategorized by high, medium, and low had effects on the probability of developing morbidity.; Summary

Health Behavior Patterns of Korean.: Soon Young Lee, Seon Woo Kim, Ju Won Park; Korean J Prev Med. 1997;30(1):181-194.

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Abstract PDF: The purpose of this study was to identify population subgroups with similar patterns of diet quality, physical activity, alcohol consumption and cigarette smoking of Korean. The cluster analysis was conducted using the data from Korea National Health Survey(KNHS) in 1995, which consisted of 5,805 persons. We identified six health behavior typologies: 32.9% of the sample had a good diet but sedentary activity level(good diet lifestyle), 7.2% had high activity level but less diet quality(fitness lifestyle). Individuals in the passive lifestyle cluster(39.1%) had no active health promoting activities but tended to avoid risk taking health behavior such as cigarette smoking and alcohol drinking. 1.1% of the sample were in a drinking cluster, 17.2% in a smoking cluster and 2.5% had a hedonic lifestyle characterized by heavy drinking and smoking. The other characteristics of these lifestyle clusters could be presented by demographic and socioeconomic factors.; Summary

Knowledge, Attitude and Practice according to Types of Occupational Health Management.: Sung Hee Kim, Hae Ryeun Shin, Sang Woo Kim, Kuck Hyeun Woo, Wan Seoup Park, Jae Yong Park; Korean J Prev Med. 1996;29(3):579-596.

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Abstract PDF: The first purpose of this study was to compare the mean Knowledge, Attitude & Practice(KAP) scores concerning major occupational Health between two types of occupational health management in small & medium-scale textile factories. Sample number was 1,138 workers. In small & medium factories with 300 workers or less, they have two alternatives for occupational health management; Individual Health Management or Vicarious Health Management. The second purpose was to determine if there was a relationship between duration of Vicarious health management and mean kap scores for 694 workers from the Vicarious Health Management group. We used self-administered questionnaires for measuring KAP. The results of this study were; 1. There was significant difference concerning all socioeconomic & occupational variables(gender, age education level, marital status, Blue/White collar, working duration of present factory, working duration of total factories) except for shift. 2. There was no significant difference of mean scores of Knowledge and attitude between the Individual Health Management Group and the Vicarious Health Management. But, the mean score of Practice was significantly different. 3. According to multiple regression analysis, the mean score of Knowledge significantly increased with age, education level, working duration of all factories increased. The mean score of Attitude significantly increased with age, education level and married. The mean score of Practice significantly increased with age, education level, working duration of all factories, married and men. 4. In conclusion, The type of Health management did not significantly affect the mean KAP scores concerning major occupational Health problems. 5. But, the Duration of Vicarious Health management significantly increased the mean KAP scores.; Summary

Structural Modeling of Health Concern, Health Practice and Health Status of Koreans.: Soon Young Lee, Myong Sei Sohn, Chung Mo Nam; Korean J Prev Med. 1995;28(1):187-206.

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Abstract PDF: The purpose of this study was to determine the relationships among the health concern, health practice and health status of Koreans. This study utilized the data from Korean individuals(1,304 male and 1,495 females), whose ages were between 20 and 59. The data were analyzed using SAS version 6.04 and LISREL version 7.13. The analytic methods for the study were chi-square analysis and covariance structural analysis. The results of the study were as follows. (1) There were significant positive relationships between health concern level and health practice index, and between health practice index and self-perceived health status. (2)There were negative relationships between practice index and chronic illness, and between health practice index and acute illness only in female. (3) Based on the findings, the structural model of the health concern, health practice, health status and socioeconomic variables was established and then the covariance structural analysis was used. The higher educational level and economic status were, the higher the health concern was. And urban residents were much more concerned with their health than rural residents. The more persons were concerned with health, the more they did health practices. And the more the health practice was, the higher the health status was. The younger the persons were and the higher the health status of one's family was, the higher the health status was. In female, the higher the economic status was, the higher the health status was.; Summary

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