여성노인의 건강불평등 현황과 측정 : 통합방법론(Mixed Methodology)의 적용 = Measuring the Health Disparity of Older Women in South Korea: Using Mixed Methods

다국어 초록 (Multilingual Abstract)

Measuring appropriate socioeconomic positions(SEP) to capture health inequality among older women has always been a challenging issue. This study sought to explore mixed methods to better understand health disparity and its causes among Korean women. We followed a sequential explanatory design, in which two data collection methods - qualitative (12 Korean elderly women residing in Seoul with in-depth interviews) and quantitative (564 women with a nationally representative survey), were employed to understand and identify appropriate ways to measure SEPs of older Korean women and its implications on the health disparity. Qualitative interview data were checked, coded and interpreted through an iterative process of discussion and in-depth analyses. Survey data were analyzed for descriptive statistics and of the effect of each SEP and health. In the multi-methods analysis stage, we used a concurrent triangulation design strategy and illustrated the major findings, according to ‘corroboration of findings’, ‘elaboration for deeper meanings’, and ‘initiation of new issues’ steps. In both quan/qual data, most elder women were found to be reporting their health to be poor, often with diabetes, arthritis, and hypertension. Stress related mental problems were also found to be a major precursor to poorer physical health in these women. According to the findings, low education, financial problems, physically demanding work experience, and lack of social support (ie: relationship with children, existence of friends) resulted in poorer self rated health, chronic diseases, limited activity, and depression. Findings from quantitative approach were further supplemented and elaborated with in-depth interpretations of data from face-to-face interviews. We found the cultural meanings of SEP for elder women and cultural specific reasons for their roles in determining health, particularly in regards to the education of and occupations of Korean women. Older women in Korea were often found to have been deprived of educational opportunities regardless of familial affluence. The educational levels of their male siblings, rather than their own, may better reflect the familial economic condition in the childhood of these Korean older women. Also, we found that the quantitative scores of health status and SEP did not linearly match with verbal descriptions. Often the middle category in verbatim could encompass a very wide range of scores. Self-reported health status and SEPs among Korean older women may have different meanings from those for the younger population and should be interpreted with caution. In addition to redefining and expanding the traditional definition of the subjects’ health status, own education, occupation, and income, other SEP indicators of older women for health policy should be taken into account, whilst employing multiple methods. The mixed methods, using both quantitative and qualitative approaches, could go some way towards explaining the health disparity in Korean older women.

국문 초록 (Abstract)

이 연구는 여성노인의 건강불평등 측정을 위한 사회경제적 위치 지표와 관련하여 동일한 주제에 두가지 이상의 방법을 적용하는 통합 연구 방법의 적용가능성을 살펴보았다. 연구 자료 수집은 순차적 방식(sequential approach)에 따라 12명 여성노인을 심층 면접하는 질적연구를 우선 수행한 후, 전국에서 60세 이상 여성 564명을 대상으로 설문조사를 실시하였다. 분석은 동시적 삼각측량방법(concurrent triangulation design) 기준에 따라 양적/질적 자료를 통합적으로 적용하여 다양한 자료와 증거를 통한 기존 이론 확인(확증, corroboration), 이면에 숨겨져 있던 상세한 내용 발견(정교화, elaboration), 새로운 주제발견(창시, initiation) 등 3가지 단계로 나누어 분석하였다. 설문조사 결과에 의하면 여자노인의 낮은 교육수준, 경제적 어려움, 육체적으로 힘든 노동경험, 낮은 수준의 사회적 지지 등은 자가평가 건강수준을 낮추고 만성질환, 활동장애, 우울수준을 높이는 방향으로 관련성을 보였다. 심층면접 자료는 이러한 양적조사 결과를 확인해주었고, 더하여 우리나라 현재 여성노인이 겪었던 시대적 배경으로 인한 교육기회박탈이나 다양한 노동경험 등, 여성노인들의 교육과 직업에 대한 심층적이고 다양한 해석을 찾아주었다. 또한 남자형제의 교육수준이 여자노인 자신의 교육수준보다 유년기 가정형편을 더욱 잘 반영할 수 있다는 시사점이나 여성노인들이 소득이나 건강수준을 평가할 때 넓은 범주의 ‘보통’이라는 응답 이면의 재해석적 시각의 중요성을 제시하였다. 이 연구는 노년기 여성의 건강불평등을 설명하는 도구로서 통합연구방법을 유용성을 제시한다. 노년기 연구 분야에서 보다 다양한 접근의 통합에 대한 학문적 논의와 관심이 필요하다.

참고문헌 (Reference)

• 1 우해봉, "한국노인의 인구사회학적 특성별 건강지위와의 차이" 9 (9): 67-106, 2001
• 2 정최경희, "한국 노인의 당뇨병과 소년기 굶주림 경험" 한국보건교육건강증진학회 27 (27): 81-89, 2010
• 3 강민아, "통합 연구 방법 적용 가능성에 대한 탐색 연구: 지역 보건 정책 결정을 위한 주민 의견 조사에 설문 조사와 포커스 그룹 방법의 통합적 적용" 한국행정학회 41 (41): 425-427, 2007
• 4 천희란, "여성 노인의 건강인식에 관한 질적 연구" 한국여성연구원 27 (27): 3-41, 2010
• 5 김미숙, "양적 방법과 질적 방법의 통합에 대하여" 한국교육사회학회 16 (16): 43-64, 2006
• 6 박경숙, "삶의 기회" 부산:동아대학교출판부 2006
• 7 최용준, "건강 불평등 연구에서 사회경제적 위치 지표의 이념과 활용" 대한예방의학회 40 (40): 475-486, 2007
• 8 Johnson, R. B., "Toward a definition of mixed methods research" 1 (1): 112-133, 2007
• 9 Greene, J. C., "Toward a conceptual framework for mixed-methods evaluation designs" 11 (11): 255-274, 1989
• 10 Grundy, E., "The socioeconomic status of older adults: How should we measure: it in studies of health inequalities" 55 : 895-904, 2001
• 11 House, J. S., "The social stratification of aging and health" 35 (35): 213-234, 1994
• 12 Denzin N.K, "The research act:A theoretical introduction to sociological methods" New York:McGraw-Hill 1978
• 13 Knodel,J, "The design and analysis of focus group studies: A proactical approach In: Successful Focus Groups: Advancing the State of the Art" Newbury Park. CA: Sage Publications 1993
• 14 Bryman,A, "The debate about quantitative and qualitative research In: Qualitative Research" London: Sage Publications 1999
• 15 Huisman, M., "Socioeconomic inequalities in morbidity among the elderly; a European overview" 57 (57): 861-873, 2003
• 16 Link, B. G., "Social conditions as fundamental causes of disease" 80-94, 1995
• 17 Smith,J.K, "Quantitative versus qualitative research: An attempt to clarity the issue" 12 (12): 6-13, 1983
• 18 Morse, "Principles of mixed methods and multimethod research design In: Handbook of Mixed Methods in Social and Behavioral Research" Thousand Oak. Calif: SAGE Publications 2003
• 19 Morgan,D.L, "Paradigms lost and pragmatism regained: Methodological implications of combining qualitative and quantitative methods" 1 (1): 48-76, 2007
• 20 Rossman, G. B., "Numbers and words: Combining quantitative and qualitative methods in a single-large-scale evaluation study" 9 (9): 627-643, 1985
• 21 Lincoln, Y. S., "Naturalistic Inquiry" Beverly HIlls, Calif: Sage Publication 1985
• 22 Meijer, P. C., "Multi-method triangulation in a qualitative study on teachers’ practical knowledge: An attempt to increase internal validity" 36 : 145-167, 2002
• 23 Jick,T.D, "Mizing qualitative and quantitative methods: Triangulation in action" 24 (24): 602-611, 1979
• 24 Victor,C.R, "Inequalities in health in later life" 18 : 387-391, 1989
• 25 Galobardes, B, "Indicators of socioeconomic position In: Methods in Social epidemiology" San Francisco, Calif: John Wiley and Sons 2006
• 26 Strauss, A., "Grounded theory methodology: An overview In: Handbook of Qualitative Research" London: Sage 275-285, 1994
• 27 Huisman, M., "Educational inequalities in cause-specific mortality in middle-aged and older men and women in eight western European populations" 365 (365): 493-500, 2005
• 28 Manor, O., "Educational differentials in mortality from cardiovascular disease among men and women: The Israel Longitudinal Mortality Study" 14 (14): 453-460, 2004
• 29 Ross, C. E., "Education, Age, and the Cumulative Advantage in Health" 37 (37): 104-120, 1996
• 30 Johnson,R.B, "Editorial: Note from the guest editor" 13 (13): 5-6, 2006
• 31 Marmot, M. G., "Do socioeconomic differences in mortality persist after retirement? 25 Year follow up of civil servants from the first Whitehall study" 313 : 1177-1180, 1996
• 32 Creswell, J. W., "Designing and conducting mixed methods research" London:Sage 2007
• 33 Campbell,D.T, "Definitional vs. multiple operationalism In: Methodology and Epistemology for Social Science" Chicago: University of Chicago Press 1988
• 34 Thomas,R.M, "Blending qualitative and quantitative research methods in theses and dissertations" Thousand Oks, CA:Corwin 2003
• 35 Bryman,A, "Barriers to integrating quantitative and qualitative research" 1 (1): 8-22, 2007
• 36 Carlson, R.G., "Attitudes toward needle “Sharing” among injection drug users: Combining qualitative and quantitative research methods" 55 (55): 361-369, 1996
• 37 House, J. S., "Age, socioeconomic status, and health" 68 (68): 383-411, 1990
• 38 Stycos,J.M, "A critique of focus group and survey research: The Machismo case" 12 (12): 450-456, 1981
• 39 정경희, "2004년 전국 노인생활실태 및 복지욕구조사" 한국보건사회연구원 2005