kjhp Korean Journal of Health Promotion Korean J Health Promot 2234-2141 2093-5676 The Korean Society of Health Promotion and Disease Prevention 10.15384/kjhp.2017.17.2.71 kjhp-17-71 Original Article Health Literacy and Its Related Factors in North Korean Refugees SonYoun Jung 1 KimHyun Joon 1 JeongHye Jin 1 HwangIn Young 1 KimMoo Young 1 LeeSoo Hyoung 1 ParkKi Hyun 1 ParkKee Ho 2 KimChae Bong 3 ImHyang 4 LeeJi Young 5 Department of Family Medicine, Seoul Medical Center, Seoul, Korea Cancer Policy Branch, National Cancer Center, Goyang, Korea Environmental and Health Research Institute, Seoul Medical Center, Seoul, Korea South and North Integrated Welfare Center, Seoul, Korea Graduate School of Global Political Studies, Kyonggi University, Seoul, Korea Corresponding author : Moo Young Kim, MD Department of Family Medicine, Seoul Medical Center, 156 Sinnae-ro, Jungnang-gu, Seoul 02053, Korea Tel: +82-10-9912-4412, Fax: +82-2-2276-8533 E-mail: moowija@hanmail.net 012017 19012017 17271 79 14042017 19062017 Copyright © 2017 The Korean Society of Health Promotion and Disease Prevention 2017 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Background:

In September 2016, the number of North Korean refugees living in South Korea was 29,688. They have been struggling with health problems due to their poor health status and the differences in medical system and terminology between South and North Korea. We aimed to investigate the level of health literacy and its related factors in North Korean refugees.

 Methods:

This study was conducted with 142 patients who visited North Korean refugees' counseling center at Seoul Medical Center and National Central Medical Center and 100 South Korean patients who visited outpatient clinics or Health Promotion Center of Seoul Medical Center. General and health-related characteristics were surveyed through a questionnaire and health literacy was measured by using ‘Korean Adult Health Literacy Scale’.

 Results:

The average age of North Korean refugees was 48.92±11.49 years old. Almost 95% reported that their monthly income was less than 2 million KRW. The survey showed that North Korean refugees obtain health information mainly through TV, radio, and acquaintances and more than half (54.9%) said their health was bad or very bad. The mean score of North Korean refugees' health literacy was much lower than that of South Koreans (12.42±7.58 vs. 25.3±5.7, P<0.001). This discrepancy was maintained after adjusting related factors such as age, sex, and socioeconomic status with stratified analysis.

 Conclusions:

It suggest the urgent need for policies which support for futher researches and development of education system, which may lead to the improvememt of the health literacy of North Korean regugees.

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Comparisons of health literacy score between North Korean refugees and outpatient participants. All P values are <0.001. P values are calculated by t-test. A thin vertical line in the bar is the range of the lowest health literacy score and the highest health literacy score in each section and total score.

General characteristics of North Korean refugees and outpatient participants (n=242)

Characteristics North Korean refugees (n=142) Outpatient participants (n=100) P
Gender     0.225
Male 48 (33.8) 42 (42.0)  
Female 94 (66.2) 58 (58.0)  
Age, y     0.001
10-39 22 (15.5) 22 (22.0)  
40-59 104 (73.2) 52 (52.0)  
≥60 16 (11.3) 26 (26.0)  
Educational period, y     <0.001
≤12 107 (75.4) 47 (47.0)  
>12 35 (24.6) 53 (53.0)  
Occupation     <0.001
Office worker 10 (7.0) 2 (29.0)  
Sales position and services 7 (4.9) 14 (14.0)  
Technical position 9 (6.3) 7 (0.0)  
Housewife 48 (33.8) 18 (18.0)  
Unemployed 40 (28.2) 8 (8.0)  
Others 28 (21.5) 24 (24.0)  
Marital status     <0.001
Single 33 (23.2) 15 (15.0)  
Married 58 (40.8) 80 (80.0)  
Divorced 28 (19.7) 3 (3.0)  
Bereaved 23 (16.2) 2 (2.0)  
Living together family     <0.001
Yes 70 (49.3) 90 (90)  
Monthly income, 10,000 won     <0.001
≤99 94 (66.2) 17 (17.0)  
100-199 40 (28.2) 29 (29.0)  
200-299 6 (4.2) 24 (24.0)  
≥300 Values are presented as 2 (1.4) number (%). 30 (30.0)  

Values are presented as number (%). P values are calculated by chi-squared-test.

Health-related characteristics of North Korean refugees and outpatient participants (n=242)

Characteristics North Korean refugees (n=142) Outpatient participants (n=100) P
Number of diseases     <0.001
0 29 (20.4) 48 (48.0)  
1 80 (56.3) 32 (32.0)  
2 18 (12.7) 16 (16.0)  
≥3 15 (10.5) 4 (4.0)  
Number of medications     <0.001
0 33 (23.2) 54 (54.0)  
1 68 (47.9) 27 (27.0)  
2 26 (18.3) 11 (11.0)  
≥3 15 (10.5) 8 (8.0)  
Frequency of hospital visit     <0.001
Once per week Above twice per month 27 (19.0) 40 (28.2) 9 (9.0) 18 (18.0)  
Once per month 37 (26.1) 29 (29.0)  
Once per 2-3 months 20 (34.1) 44 (44.0)  
Others 18 (12.7) 0 (0.0)  
Smoking status     0.033
Smoking 32 (22.5) 19 (19.0)  
Non-smoking Drinking status 110 (77.5) 81 (81.0) <0.001
Non-drinking 92 (64.8) 40 (40.0)  
Drinking 50 (35.2) 60 (60.0)  
Health information source     <0.001
TV/radio 39 (27.5) 45 (45.0)  
Internet 17 (12.0) 30 (30.0)  
Health care provider 33 (23.2) 13 (13.0)  
Acquaintances 37 (26.1) 2 (2.0)  
Others 16 (11.2) 10 (10.0)  
Awareness of health condition     <0.001
Good 10 (7.0) 19 (19.0)  
Average 54 (38.0) 69 (69.0)  
Bad Very bad 59 (41.5) 19 (13.4) 9 (9.0) 3 (3.0)  

Values are presented as number (%). P values are calculated by chi-squared-test.

Health literacy total score of North Korean refugees and outpatient participants according to general and healthe related characteristics

Characteristics North Korean refugees Outpatient participants pa
Total score P Total score P
Gender   0.001   0.112  
Male 9.58±6.65   24.29±6.20   <0.001
Female 13.86±7.66 　 26.16±5.41 　 <0.001
Ageb, y   0.919   <0.001  
10-39 12.68±7.85   28.18±4.11   <0.001
40-59 12.28±7.84   25.90±5.02   <0.001
≥60 12.94±5.64 　 21.92±6.89 　 <0.001
Educational period, y   0.789   0.001  
≤12 12.32±7.05   23.32±5.95   <0.001
>12 12.71±9.01 　 27.19±5.05 　 <0.001
Occupation   0.251   0.172  
Office worker 10.00±7.92   27.03±4.46   <0.001
Sales position and services 15.14±11.18   24.93±5.36   0.013
Technical position 10.67±7.63   25.29±5.99   0.001
Housewife 14.23±7.53   25.89±5.13   <0.001
Unemployed 11.90±6.38   20.88±9.42   0.002
Others 10.79±7.93 　 24.75±6.10 　 <0.001
Marital status   0.730   0.049  
Single 11.88±7.81   27.60±4.90   <0.001
Married 12.88±7.79   25.29±5.72   <0.001
Divorced 11.32±7.37   22.33±4.16   0.018
Bereaved 13.35±7.26 　 16.50±10.61 　 0.571
Monthly incomeb, 10,000 won   0.805   0.945  
≤99 11.64±7.39   27.06±5.71   <0.001
100-199 13.98±8.22   23.21±6.66   <0.001
200-299 14.00±4.43   25.46±5.31   <0.001
≥300 13.00±11.31 　 26.43±4.91 　 0.001
Number of diseasesb   0.288   <0.001  
0 10.66±8.27   26.54±4.89   <0.001
1 12.59±7.25   24.75±6.36   <0.001
2 14.17±8.18   25.56±4.12   <0.001
≥3 12.80±7.32 　 15.50±8.74 　 0.536
Smoking status   <0.001   0.659  
Smoking 8.16±4.28   25.84±5.06   <0.001
Non-smoking 13.65±7.90 　 25.26±5.98 　 <0.001
Drinking status   0.037   0.939  
Non-drinking 13.39±7.78   25.43±6.97   <0.001
Drinking 10.62±6.93 　 25.33±4.93 　 <0.001
Health information source   0.110   0.030  
TV/radio 15.00±9.12   23.76±6.55   <0.001
Internet 12.94±8.31   27.30±3.78   <0.001
Health care provider 11.76±6.76   28.00±3.32   <0.001
Acquaintances 10.54±5.61   24.00±2.83   0.002
Others 11.25±7.39 　 23.70±7.72 　 <0.001
Awareness of health condition   0.609   0.662  
Good 14.70±6.38   25.11±5.57   <0.001
Average 12.67±7.81   25.10±6.22   <0.001
Bad 12.32±7.68   27.56±2.83   <0.001
Very bad 10.79±7.37 　 26.67±3.51 　 0.002

Values are presented as mean ± standard variation. P values are calculated by t-test and ANOVA test.

P values for comperison of between North korean refugees and Outpatient participants

P values for linear trend.

Health literacy total score according to the special characteristics of North Korean refugees

Characteristics N (%) Total score P
Total refugee period∗, y     0.818
<3 16 (11.3) 14.63±8.00  
3-5 31 (21.8) 12.16±7.32  
5-10 38 (26.8) 12.71±7.09  
>10 56 (39.4) 14.39±7.92  
South Korea residence perioda, y     0.640
<3 32 (22.5) 14.19±7.18  
3-5 32 (22.5) 11.53±6.45  
5-10 45 (31.7) 14.93±8.19  
>10 33 (23.2) 12.58±7.78  
Occupation     0.902
Administrative position 3 (2.1) 15.67±3.28  
Office worker 20 (14.1) 12.35±8.47  
Sales position and services 11 (7.7) 13.09±10.49  
Technical position 13 (9.2) 13.92±9.96  
Housewife 37 (26.1) 12.89±6.71  
Unemployed 6 (4.2) 10.67±7.31  
Others 52 (36.6) 11.60±6.82  

Values are presented as mean±standard variation or number (%). P values are calculated by ANOVA test.

P values for linear trend.

Multiple regression anaysis to identify the indepen-dant related factors of North Korean refugees on health literacy total score

Characteristics Coefficient t P
Age 0.008 0.099 0.922
Gender      
Male 0.000    
Female 0.248 2.523 0.013
Educational period, y ≤12 0.000 　 　
>12 -0.025 -0.197 0.767
Drinking status      
Non-drinking 0.000    
Drinking -0.045 -0.466 0.642
R2 (adjust R2) 0.074 (0.047)

P values are calculated by multiple regression analysis. Adjusted by age, gender, educational period, drinking status.

Multiple regression anaysis to identify the indepen-dant related factors of outpatient participants on health literacy total score

Characteristics Coefficient t P
Age -0.419 -3.571 0.001
Gender      
Male 0.000    
Female 0.190 2.014 0.047
Educational period, y ≤12 0.000 　 　
>12 0.186 1.800 0.075
Marital status      
Single 0.000    
Married 0.160 1.419 0.159
Divorced Bereaved -0.021 -0.035 -0.221 -0.352 0.826 0.726
Number of diseases      
0 0.000    
1 0.087 0.881 0.381
2 0.151 1.516 0.133
3 -0.222 -2.317 0.023
R2 (adjust R2) 0.373 (0.310)  

P values are calculated by multiple regression analysis. Adjusted by age, gender, educational period, marital status, number of diseases.