건강신념모델에 근거한 노인 대상 식품안전·영양교육 프로그램 효과 평가

최정화(Jung-Hwa Choi),이은실(Eun-Sil Lee),이윤진(Yoon-Jin Lee),이혜상(Hye-Sang Lee),장혜자(Hye-Ja Chang),이경은(Kyung-Eun Lee),이나영(Na-Young Yi),안윤(Yoon Ahn),곽동경(Tong-Kyung Kwak) 한국식품영양과학회 2016 한국식품영양과학회지 Vol.45 No.9

노인은 면역취약집단으로 다른 인구 집단보다 만성질환과 식품매개 질병에 걸릴 위험이 크며 식행동은 오랜 세월 굳어져 왔기 때문에 변화하기가 쉽지 않다. 노인을 대상으로 건강신념모델을 적용하여 식품안전・영양교육 프로그램을 시범 적용하고 그 효과를 평가하였다. 식품안전·영양 시범 교육은 서울 마포, 충북 청주, 경북 의성, 충북 진천의 노인복지관을 이용하는 65세 이상 노인을 대상으로 2011년 7월 28일부터 9월 9일까지 총 5주간 매주 1회, 35~40분씩 교육을 시행하였다. 교육 전후 조사가 완료된 최종 연구대상은 교육군이 5회 교육 중 3회 이상 교육에 참여하고 교육 전후 평가를 마친 대상자로 137명, 대조군은 사후 설문조사를 하지 않거나 불성실한 응답자를 제외한 83명으로 총 220명이었다. 교육은 건강신념모델을 적용하여 노인들이 식습관을 변화하지 않을 경우 질병 가능성을 알려 심각성을 인지하도록 하였으며 노인들이 식행동 수정 시 얻게 되는 이들을 알려주고 행동을 실행할 수 있도록 자아효능감을 제공해주고자 하였다. 교육 후 식품안전·영양지식은 모든 항목에서 향상을 보였으며, 식품안전 영역 5문항 중 4문항, 영양 영역 3문항 중 2문항에서는 유의적인 향상을 보였다. 식행동은 교육군에서 ‘고기, 생선류는 조리 시 속까지 완전히 익힌다’를 제외한 모든 항목에서 유의적인 향상을 보였다. 건강신념은 식품안전의 영역에서는 인지된 심각성과 자아효능감, 영양 영역에서는 인지된 민감성, 인지된 장애, 자아효능감에서 유의적인 향상을 보였다. 지식, 식행동, 건강신념 변화량의 상관관계를 분석한 결과 건강신념의 변화량과 식행동의 변화 가능성 간의 유의적인 상관관계를 보였다(P<0.001). 본 연구의 참여 대상자들이 일반 재가 노인보다 복지관에서 봉사하거나 활동하는 노인이었기 때문에 표본의 대표성이 떨어져 결과를 일반화하기에 어려움이 있다. 또한, 교육기간이 5주로 비교적 짧았기 때문에 오랜 기간에 걸쳐 형성된 식행동이 쉽게 변화하거나 개선되기 어려우므로 장기간에 걸친 반복교육이 필요할 것으로 생각한다. 본 연구에서 개발된 교육 프로그램을 향후 보건소나 복지관 등을 통해 지속해서 시행된다면 노인의 식품안전・영양에 대한 인식을 높이고 바람직한 식행동 변화에 긍정적인 기여를 할 수 있을 것으로 생각된다. Most elderly have difficulties in managing food safety and nutrition by themselves. Various nutrition educations for the elderly have been developed, but food safety and nutrition education program and educational tools for the elderly are very limited. The aim of the study was to evaluate a food safety and nutrition education program based on the Health Belief Model (HBM) for the elderly. Education program was implemented for 220 seniors (137 educated group and 83 control group) aged over 65 years at senior welfare community centers. The intervention study was carried out on a weekly basis during each of 5 weeks, and each session lasted about 35 or 40 minutes. The effectiveness of the program was assessed with a questionnaire before and after education. Education program consisted of a 5 week program, and topics were ‘Dietary changes for the elderly"s healthy life’, ‘Prevention of food poisoning in everyday life’, ‘Safe food handling for my health’, ‘Healthy dietary life to prevent chronic disease’, and ‘Safety! nutrition! healthy dietary life’. Education program materials such as slides, handouts, videos, leaflet, and booklets were developed. As a result, there were score improvements in knowledge, dietary behaviors, and health belief after intervention in the intervention group, which were higher than those of the control group. In particular, there was a meaningful interrelation between dietary behavior and health belief (r=0.520, P<0.001). This finding suggests that changing beliefs is very important to make desirable dietary behavioral changes. For this reason, we can conclude HBM theory is an effective model to educate nutrition and food safety for the elderly. Furthermore, food safety and nutrition education programs are implemented and delivered continuously at various settings such as a health center or community welfare center, and those will contribute significantly to enhance perception and change their desirable dietary behaviors for the elderly.

사례 조사를 통한 한식 음식점의 주방면적 비율과 환기시설의 적정성 조사

장혜자,최경기,왕태환,곽동경,Chang, Hyeja,Choi, Gyunggi,Wang, Taehwan,Kwak, Tongkyung 한국식품조리과학회 2015 한국식품조리과학회지 Vol.31 No.1

For the globalization of Korean food restaurants, the kitchens should be equipped with proper ventilation systems and space to keep clean and ensure food safety. This study aimed to examine the ratio of kitchen to total space of restaurant and the suitability of the ventilation systems employed at Korean food restaurants. Data were collected by on-site survey of 12 Korean foods restaurants in Seoul. Length and width of the restaurants were measured with scale. Temperatures and air velocity around the heating equipment, working area, and hood were measured with a thermal imaging camera anemometer and thermometer. Statistical analyses were conducted with the SPSS program. The average space of the restaurants was $25.7m^2$. The ratio of kitchen to space was 0.22 for restaurants sized $32m^2$, 0.28 for $33-66m^2$, 0.21 for $66.1-99m^2$, 0.16 for $99.1-148.5m^2$, and 0.35 for those above $148.5m^2$. Average maximum and minimum air velocity around the hood were 0.28 m/sec and 0.22 m/sec, respectively. Under these conditions, the temperature of the working area was $41^{\circ}C$, presenting an uncomfortable indoor temperature for kitchen employees to work. When classifying 3 groups based on the minimum and maximum air velocity, the temperatures near the cooking area and in the hood of the restaurants showed significant differences among the three groups. When the maximum air velocity was over 0.3 m/sec, the temperature of the cooking area was as $30.1^{\circ}C$, showing a significantly lower temperature (p<0.01). Based on these results, the kitchen space rate of 0.25 to the total space and a ventilation system maintaining a maximum air velocity over 0.3 m/sec were recommended for ensuring the food safety of Korean foods restaurants sized 66 to $99m^2$.

사회인지이론 기반 중산층 노인 식품안전 교육 프로그램의 효과 평가

최정화(Jung-Hwa Choi),유효이(Hyo-E Yoo),정하림(Harim Chung),이혜상(Hye-Sang Lee),이민준(Min-June Lee),장혜자(Hye-Ja Chang),이경은(Kyung-Eun Lee),이나영(Na-Young Yi),곽동경(Tong-Kyung Kwak) 한국식품영양과학회 2018 한국식품영양과학회지 Vol.47 No.8

현대의학의 발달은 인간의 수명을 연장시키고 그 결과 노인인구 증가를 가져와 노인 의료비 문제가 사회적으로 대두되고 있다. 이에 적절한 방안으로는 노인들의 건강한 노화(healthy aging)를 도모하는 것이며, 이는 사회의 의료비용을 감소시킴으로써 사회 전체의 효율성을 제고시킬 수 있다. 본 연구는 중산계층 노인을 대상으로 사회인지이론 기반의 식품안전 관리 교육 프로그램을 적용하여 시범실시를 하여 교육 효과 평가를 실시하였다. 본 연구에서는 교육군 212명, 대조군 42명의 자료가 분석되었으며, 사전 사후 지식 총점의 변화는 교육군이 2.80점에서 3.80점으로 유의적으로 상승하였다(P<0.001). 교육군의 식품안전 식태도/건강신념의 교육 전과 후의 총점은 20점 만점에 15.28점에서 16.50점으로 유의적인 상승을 보였다(P<0.001). 대조군은 사전 15.21점에서 사후 15.29점으로 상승하였으나 유의적인 차이를 보이지 않았다. 노인의 식품안전 식행동은 교육군의 교육 전과 후의 총점이 28점 만점에 20.07점에서 22.50점으로 2.43점 상승하여 유의적인 향상을 보였다(P<0.001). 가정 내 식품 취급실태를 살펴보면 식품을 직접 구매한다고 한 응답자가 교육군의 87.3%, 대조군의 95.2%로 나타났으며, 식품 조리 여부 항목에 대해서는 교육군의 87.7%, 대조군의 95.2%가 직접 가정에서 조리한다고 응답하였다. 식태도/건강신념 변화와 식행동 변화값 간에 상관관계가 가장 높으며(r=0.447, P<0.001), 식행동 변화값과 지식의 변화 값과의 상관관계가 높은 것으로 나타났다(r=0.152, P<0.05). 경로별 교육 효과를 보기 위하여 사전, 사후 점수와 점수변화량을 비교 분석한 결과 지식, 식태도/건강신념, 식행동의 모든 경로에서 유의적인 향상을 보였다. 개발된 교육 프로그램의 효과 평가는 2차 시 교육의 사전, 사후 평가를 대조군의 평가 결과와 비교 분석하였는데, 교육의 기간이 2차시로 제한되어 있고 교육 후 행동 변화의 유지를 평가하지 못하였다. 또한, 교육경로와 대상자의 수가 적어 연구 결과를 일반화하기에는 무리가 있으며, 향후 교육의 확대를 통한 후속연구들이 진행되어야 할 것으로 사료된다. This study assessed the educational effectiveness of a developed food safety management education program based on social cognitive theory for elderly in the middle class. The subjects participated in the food safety education program two times at a public health center, community welfare center, senior citizens’ center, and center for children’s foodservice management. For food safety intervention education, data from the intervention group (212 subjects) and control group (42 subjects) were analyzed. Significant (P<0.001) differences in the scores for food safety knowledge, food attitude, and food behavior were observed in the intervention group before and after the study, but no significant difference was observed in the control group. A significant positive correlation also detected between knowledge, food attitude/health belief, and food behavior in the intervention group, which indicates that the study contributed to perception changes in the intervention group and eventually behavioral changes. Accordingly, this program can induce cognitive and behavioral changes by conducting food safety training for the elderly.

조리 중량 변화 계수 및 잔반계측법을 이용한 노인복지시설 이용자의 점심식사 영양섭취평가

장혜자(Chang Hye-Ja),이나영(Yi Na-Young),김태희(Kim Tae-Hee) 韓國營養學會 2009 Journal of Nutrition and Health Vol.42 No.7

The purposes of this study were to investigate one portion size of menus served and to evaluate nutrient intake of lunch at three elderly care facility food services located in Seoul. A weighed plate method was employed to measure plate wastes and consumption of the menus served. Yield factors were calculated from cooking experiments based on standardized recipes, and were used to evaluate nutrient intake. One hundred elderly participated in this study for measuring plate waste and were asked to complete questionnaire. Nutrient analyses for the served and consumed meal were performed using CAN program. The yield factors of rice dishes after cooking are 2.4 regardless of rice dish types, 1.58 for thick soups, 0.60 to 0.70 for meat dishes, and 1.0 to 1.25 branched vegetable. Average consumption quantity of dishes were 235.97 g for rice, 248.53 g for soup, 72.83 g for meat dishes, 39.80 g for vegetables and 28.36 g for Kimchi. On average the food waste rate is 14.0%, indicating the second highest plate waste percentage of Kimchi (26.2%), and meat/fish dish (17.3%). The evaluation results of NAR (Nutrition Adequacy Ratio) showed that iron (0.12), calcium (0.64), riboflavin (0.80), and folic acid (0.97) were less than 1.0 in both male and female elderly groups, indicating significant differences of NAR among three facilities. Compared to the 1/3 Dietary Reference Intake (DRIs) for the elderly groups, nutrient intake analysis demonstrated that calcium (100%) and iron (100%), followed by riboflavin, vitamin A, and Vitamin B? did not met of the 1/3 EAR (Estimated Average Requirement). For the nutritious meal management, a professional dietitian should be placed at the elderly care center to develop standardized recipes in consideration of yield factors and the elderly’s health and nutrition status.

노인복지시설의 급식서비스 품질 요소 규명 및 급식서비스 만족도 향상 전략

장혜자(Hye Ja Chang) 대한지역사회영양학회 2008 대한지역사회영양학회지 Vol.13 No.1

This study was designed to develop the strategy plans for the customer satisfaction on foodservice in the senior care facilities. For this, we examined the level of the customer satisfaction and foodservice quality. Additionally, the association between service quality, customer satisfaction, and social, psychological, physical factors of the aged were tested. Data from convenience samples from 3 senior care facilities were collected by using a questionnaire. Exploratory factor analyses were completed on 20 attributes for the food and service quality and 7 items for the social and psychological states of the aged, respectively. Cronbach`s α was estimated for reliability, and Pearson correlation and multiple regression analysis were used for statistical analyses. The level of the satisfaction on foodservice was 4.01 of 5.0. The satisfaction on foodservice did not show the significant differences by gender, education level, BMI, and socio-psychological satisfaction. But the foodservice quality and the satisfaction showed significant difference by income and physical problem, and the goal of life of the eldely, respectively. Multiple regression analyses revealed that the determinants of the customer satisfaction on foodservice were the core quality of product, confidence, professionalism of employees and secondary quality of products. Especially, the kindness of employee is the most important attribute of the foodservice. Based on these results, we can set the strategy plans as follow: (1) the introduction of the foodservice evaluation system (2) the deployment of the event activities for offering fun to the customer (3) the continuous training of employees for ensuring the professional and kind service system, and (4) the introduction of selective menu system and take-out service of menu. (Korean J Community Nutrition 13(1) : 69~79, 2008)

학교급식 시설 설계 모델

장혜자(Hye Ja Chang),장선희(Sun Hee Jang) 대한지역사회영양학회 2011 대한지역사회영양학회지 Vol.16 No.1

This study aimed to suggest a 1300 scale of a middle school foodservice facility floor plan which was compliant to the principle of HACCP, as well as ensuring food and work safety, and the flow of personnel and food materials. which consisted of 46 nutrition teachers and 6 experts, responded with a questionnaire on the relationship of functional area and space. Using their opinions, key principles for the design of the facility were single direction movement of food materials, customers and workers; minimization of the cross-contamination through the separation of functional space; and securement of customer-focused efficiency; staff-centered convenience and efficiency; and work and food safety. After the completion of an adjacency diagram, bubble diagram and program statement, the functional areas of a 1300 scale middle school food-service facility were allocated as follows: 9.9 m2 for the receiving area, 56.1 m2 for the pre-preparation area, 10.5 m2 for the food storage area, 6.0 m2 for the supplies storage area, 97.8 m2 for the cooking area, 33.6 m2 for the service area, 52.5 m2 for dish washing area, cafeteria 410.5 m2, 4.5 m2 for the front room, for a total of 725.8 m2. Expert groups have pointed to limitations within this model as there are no windows in the office for the influx of fresh outside air and a need for the straight line installation of steam-jacket and frying kettles on the sides of windows. This study can be useful as the guidelines for estimating the investment cost of the facility and placing the placement of functional areas and equipment in the renovation of the facility. It can be also useful data for a methodology of foodservice facility design. (Korean J Community Nutr 16(1) : 98~112, 2011)

건강기능성 우렁이 만두제품의 마켓 테스트

장혜자(Hye Ja Chang),황윤경(Yoon Kyung Hwang) 대한지역사회영양학회 2006 대한지역사회영양학회지 Vol.11 No.5

Recently, according to increase in production of pond snails resulting from the widespread organic farming, organic farmers are showing a lot of interests in the promotion of consumption and extending the market of pond snails. This study was performed to suggest the process of product development of the ready-to-eat pond-snail Mandu as a health food, to show the results of market test of the pilot product, and to investigate the change of the sensory characteristics during storage periods. For the market test of pond-snail Mandu, the survey was developed and delivered to consumers. The questionnaire consisted of 3 parts such as respondents demographic characteristics, customer`s perception of pond-snail Mandu before tasting, and customer`s perception of that after tasting. And the market test was carried out with university students, welfare institution residents and apartment residents in the Seoul and Gyeonggi areas. As a result of the test, the most important purchasing factors were determined in the order of taste (49.5%), hygienic quality (12.5%), nutritional value (10%) and price (9%). And only 4.2% of respondents selected brand name as an important purchasing factor. After tasting pond-snail Mandu, consumers had suggested the better taste (t = 6.986, p < 0.000) and price (t = 2.082, p < 0.05) than those of before tasting. In response to favorable impression of pond-snail Mandu, 54.5% of total respondents evaluated positively. The favorable impressions came from iron-rich Mandu (27.6%), high protein and nutritious Mandu (24.4%), calcium-rich Mandu (17.9%), diet Mandu (13.3%), and delicious Mandu (12.5%) respectively. Sensory characteristics of pond-snail Mandu were evaluated by professional panels in terms of the softness of Mandu skin, chewiness, moistness, toothpacking, color, aroma, saltiness, and degree of plain, taste, and aftertaste. The evaluation of sensory characteristics on a 7-point scale, showed that softness of mandu skin (4.44) and aftertaste (4.11) got a low scores. The statistical difference of the tastes (p > 0.05) was not founded by storage period of 7, 14, 21 and 28 days. Based on the result, the improvement of these characteristics are desired in developing the pond-snail Mandu. Research method applied to this study can be useful for developing a new product. (Korean J Community Nutrition 11(5) : 650 ~ 660, 2006)

연구논문 : 한식 상품화를 위한 내,외국인의 한식에 대한 선호도 및 상품 개발 견해

장혜자 ( Hye Ja Chang ),최보람 ( Bo Ram Choi ),이나영 ( Na Young Yi ),박보석 ( Bo Seock Park ),김희선 ( Hee Sun Kim ) 한국식품조리과학회 2010 한국식품조리과학회지 Vol.26 No.4

보육시설의 영양사 배치를 통한 영양교육 및 효과 평가

장혜자(Hye Ja Chang),고은선(Eun Seon Ko) 대한지역사회영양학회 2007 대한지역사회영양학회지 Vol.12 No.3

The purpose of this study was to evaluate the effectiveness of nutrition education with nutrition services provided by dietitians who were placed in child care facilities from the Korean Dietetic Association. For this, we investigated the levels of nutrition knowledge and dietary intakes of children who attended child-care centers as well as dietary practices of children assessed by their parents. The treatment for children consisted of nutrition education and food service activities that are provided by the dietitian who have 3 to 5 years experience. Nutrition education was implemented during 10 weeks, 20 times, and a total 400 min and it`s effectiveness was evaluated by questionnaire. Data were obtained for 123 children aged 4 to 5 years old who attended four child-care centers, one for a control group and 3 for intervention groups. Dietary intakes were investigated by measuring one-serving size and plate waste a of child for one-day dietary records before and after nutrition education. The levels of nutrition knowledge of children improved showing 70.80 points before to 83.45 points after nutrition education (p < 0.001). Dietary intakes of the children after nutrition service increased significantly on cooked rice (133.66 g), Kimchi (19.41 g), side dish of meat/fish (48.40 g), and side dish of vegetables (24.88 g). Dietary practices of children after treatment also improved especially ``eat diverse meat, fish, egg, and bean`` and ``never leave plate waste``. To summarize, this study pointed out that nutrition service and nutrition education provided by dietitians had influences on increases of the nutrition knowledge, dietary intake, and dietary practices. Therefore, placement of dietitians needs to extend to child care facilities from the 100 persons-over-capacity facility to the 50 persons-over-capacity facility, for providing professional service such as nutrition education and nutrition counseling. (Korean J Community Nutrition 12(3) : 299~309, 2007)

영유아 보육기관 급식 및 영양정보서비스에 관한 학부모의 만족도 및 인식도 조사

장혜자(Chang Hye-Ja),김정화(Kim Jung-Wha) 한국영유아보육학회 2009 한국영유아보육학 Vol.0 No.58

본 연구는 유아보육기관의 학부모 185명을 대상으로 기관에서 제공하는 급식에 대한 인식도, 만족도 및 개선요구사항 등을 설문지를 통해 조사하였다. 연구 결과, 첫째, 학부모들은 기관급식이 유아의 영양과 식습관에 크게 영향을 미친다고 인식하였다. 급식서비스에 관한 학부모들의 만족도는 높게 나타났으나(4.07점/5점), 음식 양에 관해서는 낮은 만족도(3.88점)를 보여 유아 급식에 적정 1인 분량 설정 및 이에 준한 급식관리가 요구되었다. 둘째, 대부분의 부모가 보육기관에서 영양정보를 받아본 경험이 있으며 그 내용은 주로 영양교육에 관한 내용이며, 식품안전, 이유식 프로그램 등의 교육이 영양전문가에 의해 제공될 필요성이 제기되었다. 셋째, 자녀 식습관 평가에서 특히 식사예절문제, 편식습관, 불규칙적인 운동이 개선되어야 할 항목으로 평가되었다. 넷째, 학부모들은 급식의 질 향상을 위하여 ‘정부의 재정적 지원 확대’를 지적하였고, 영양사에 의한 위생, 영양, 급식관리가 필요함을 지적했다. 이상의 결과를 토대로 영양전문가를 활용하여 이유식 프로그램 개발, 식사예절, 편식교정을 위한 영양정보서비스 제공은 물론이고 유아교육이 필요하며, 식품위생을 확보할 수 있는 급식 품질 개선활동을 지속적으로 전개함으로써 보육기관의 성공적인 운영에 만전을 기할 것을 제언한다. The study aimed to identify the parents' perception and satisfaction on the food service and needs for its improvement in child-care center. 185 subjects whose children had attended in 3 child-care centers were responded through the questionnaire. The results showed as the followings. First, parents perceived the food service as an important factor influencing nutritional states and eating habits of children. Parents rated highly the satisfaction on the foodservice as 4.07 out of 5.00, but the amount of meal(3.88) was rated as the lowest attribute, suggesting needs for setting one serving size of meals. Second, the majority of parents have experienced nutritional information from the facilities. In addition, in terms of dietary habits of children, table manner, unbalanced diets, and irregular exercise were revealed as factors needing corrections. Lastly, parents pointed out the elements needed the urgent improvement for the foodservice as the extending the financial supports from the government, and professional food and nutrition service by dietitians. Based on the result, for the successful operation of the child-care facilities we recommended that food and nutrition activities such as development of baby meal program, and nutrition education should be provided by dietitian and continuous quality management for ensuring food safety of meals should be deployed.