한국노인의 사회계층별 건강상태와 사회적 지원의 영향에 관한 연구 = (A) study on health status by social class and the influence of social support among Korean elderly

다국어 초록 (Multilingual Abstract)

This study tried a comprehensive analysis in order to examine the relationship existing between social class and health considering psycho-social factors, such as social support, as a prime candidate for a central role in explaining disparities of social class in health among Korean elderly. This study suggests that psycho-social factors such as health behaviors, stress, and social support are critical links between social structure and health. It is considered that these psycho-social factors are linked more strongly to health than medical care and are related systematically to social class. The social distribution of these factors represent the patterned response of social groups to the conditions imposed on them by social structure. Accordingly the elimination of inequalities in health ultimately may require changes not only in psycho-social factors or health care delivery, but also in conditions of social structure. It means that adequate understanding of social class-health relationship is contingent on the empirical verification of the links between social structure and health.
First, under this premise, this study constructed an integrated theoretical model on the relationship between social class and health status and tested empirically the hypothesis that the effects of social class on health status would be mediated by social support. This was to explore the overall mechanisms and processes whereby social class of Korean elderly affects health status(functional, self-rated health) and to specify the psycho-social factors role, such as social support, (regarded as important in old age) that can intensify or mitigate the effects of social structure.
Second, this study analyzed the different influences of social support affecting health status among Korean elderly to see if the types of social support differently affects health status according to the social class of the Korean elderly. This study used level of interactions with adult-children, social activity participation and perceived satisfaction with instrumental and emotional support as the measure of how social support may intensify or buffer influences that social class has on the health of the elderly. In other words, active social interactions and positively perceived social support will protect an elderly individual from the health-damaging effects associated with social class.
The data were analyzed by frequency, t-test, ANOVA, Pearson Correlation, Regression Analysis, Path Analysis and Cluster Analysis using SPSS program package.
For the empirical analysis, this study used the data from a research project called "1998 Living Profile and Welfare Service Needs of Older Persons in Korea", which was undertaken by the Korea Institute for Health and Social Affair. Out of 10,683 households in the sampling frame, 9,355 households participated in the survey (87.6% completion rate for household survey), yielding 2,726 elderly respondents. Out of 2,726 elderly respondents, 2,224 elderly respondents over the age of 65 were included for analysis.
The major findings of this research are summarized as follows; 1. ANOVA was employed to test the mean difference of health and social support by social class and health differences by social support among the Korean elderly. In terms of health by social class, there have been statistically significant mean differences in health(functional, self-rated health) by social class. That is, the higher the social class of Korean elderly, the better their health status. In relation to health differences by social support, generally the higher the level of social support, the better their health status.
In terms of social support, there have been statistically significant mean differences by social class. That is, the higher the social class of Korean elderly, the more interactions with adult-children and social activity participation. In addition, the higher the social class of the elderly, the more positively they perceive social support given.
2. Path analysis was employed to test the causal relationships between the social class and health considering the social support as an intervening variable. In relation to the functional health, education, wealth and sex affected functional health through only the social activity participation among the four types of social supports. That is, 'education level, wealth and sex → social activity participation→functional health' proved to be a main path. In contrast, interactions with adult-children and the perceived instrumental emotional support did not have a mediating effect.
In relation to the self-rated health, variables of social class affected self-rated health through the social activity participation and perceived instrumental support. Also, it was proved that sex and age had an indirect effect on self-rated health through the social support, such as the perceived instrumental support.
3. Path analysis through cluster analysis was done to see if the types of social support differently affect health status according to social class of Korean elderly. In relation to functional health, the result showed that any variables that consist of social support did not have a significant influence on the functional health in <cluster 1>, which classified the group as having relatively the higher class. In contrast, interactions with adult-children and social activity participation had a significant influence on the functional health in <cluster 2>, which classified the group as having relatively the lower class, meaning that the interactions with adult-children and the social activity participation have protective effects on the health of Korean elderly in lower class.
In relation to the self-rated health, the result showed that interactions with adult-children and perceived emotional support affected positively the self-rated health of the elderly in <cluster 1> showing that interactions with adult-children and perceived emotional support intensify the self-rated health by their higher class. In contrast, except for the perceived emotional social support, all types of social supports-interactions with adult-children, social activity participation and perceived instrumental support-were significant variables affecting positively the self-rated health of the elderly in <cluster 2>, meaning that social support such as interactions with adult-children, social activity participation and perceived instrumental support is mitigating the health-damaging effects associated with the lower class.
This findings lend further support for the effect of social support in health status in old age. Because changes in potentially modifiable psycho-social factors such as social support are associated with health status of the elderly, early intervention program would be beneficial, thus reducing the negative health effects and ultimately health care costs. In addition, specified social support system needs to be developed considering that the types of social support affected differently health status according to the social class of Korean elderly.
From this research, it is implied that future research should attempt to develop a more refined model on the relationship between social class and health status of the elderly and to elaborate the measure related to the social support.

목차 (Table of Contents)

• 목차 = ⅰ
• 제1장 서론 = 1
• 제1절. 연구목적 = 1
• 제2절. 연구문제 및 논문의 구성 = 6
• 제2장. 이론적 배경 = 9
• 제1절. 노년기 사회계층과 사회적 지원 = 9
• 1. 노년기 사회계층 = 9
• 2. 사회계층과 사회적 지원 = 22
• 제2절. 건강상태의 다차원성 = 27
• 제3절. 사회계층 및 사회적 지원과 건강상태 = 31
• 1. 사회계층과 건강상태 = 31
• 2. 건강상태에 대한 사회계층의 영향 = 35
• 3. 건강상태에 대한 사회적 지원의 영향 = 44
• 제3장 연구문제 및 분석방법 = 51
• 제1절. 연구모형 및 연구가설의 설정 = 51
• 1. 연구모형의 구성 = 51
• 2. 연구가설의 설정 = 56
• 제2절. 분석변수의 정의와 측정방법 = 57
• 1. 사회계층 변수의 정의와 측정 = 57
• 2. 사회적 지원 변수의 정의와 측정 = 59
• 3. 건강상태의 정의와 측정 = 62
• 제3절. 분석대상 및 자료 = 65
• 제4절. 분석방법 = 66
• 제4장 분석결과 = 67
• 제1절. 연구대상자의 일반적 특성과 상관관계분석 = 67
• 1. 연구대상자의 일반적 특성 = 67
• 2. 변수들간의 단순상관관계분석 = 70
• 제2절. 사회적 지원 및 건강상태의 차이 분석 = 74
• 1. 사회계층별 사회적 지원의 차이 = 74
• 2. 사회계층별 건강상태의 차이 = 83
• 3. 사회적 지원의 수준별 건강상태 = 90
• 제3절. 사회계층, 사회적 지원과 건강상태에 대한 관계 분석 = 94
• 1. 경로분석 결과 = 94
• 2. 군집분석 결과 = 113
• 3. 군집별 경로분석 결과 = 117
• 제5장. 결론 및 논의 = 127
• 참고문헌 = 137
• 부록 = 150
• ABSTRACT = 174