Korean Journal of Health Promotion

Health Literacy and Its Related Factors in North Korean Refugees

Original Article

Published online: January 19, 2017

DOI: https://doi.org/10.15384/kjhp.2017.17.2.71

Health Literacy and Its Related Factors in North Korean Refugees

Youn Jung Son¹, Hyun Joon Kim¹, Hye Jin Jeong¹, In Young Hwang¹, Moo Young Kim¹, Soo Hyoung Lee¹, Ki Hyun Park¹, Kee Ho Park², Chae Bong Kim³, Hyang Im⁴, Ji Young Lee⁵

¹Department of Family Medicine, Seoul Medical Center, Seoul, Korea

²Cancer Policy Branch, National Cancer Center, Goyang, Korea

³Environmental and Health Research Institute, Seoul Medical Center, Seoul, Korea

⁴South and North Integrated Welfare Center, Seoul, Korea

⁵Graduate 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

Received April 14, 2017 Accepted June 19, 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.

ABSTRACT

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.

Key words: Health literacy; Democratic People's Republic of Korea; Refugees

Figure 1.

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.

Table 1.

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.

Table 2.

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.

Table 3.

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

Characteristics	North Korean refugees		Outpatient participants		p^a
Characteristics	Total score	P	Total score	P	p^a
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
Age^b, 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 income^b, 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 diseases^b		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.

^aP values for comperison of between North korean refugees and Outpatient participants

^bP values for linear trend.

Table 4.

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 period^a, 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.

^aP values for linear trend.

Table 5.

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.

Table 6.

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.

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