BACKGROUND: The purpose of this exploratory study is to explain where, when and how the introduction of user fee system works in low and middle income countries using context, mechanism, and outcome configuration. METHODS: Considering advanced research in realist review approach, we made a review process including those following 4 steps. They are identifying the review question, initial theory and mechanism, searching and selecting primary studies, and extracting, analyzing, and synthesizing relevant data. RESULTS: User fee had a detrimental effect on medical utilization in low and middle income countries. Also previous and current interventions and community participation were critical context in user fee system. Those contexts were associated with intervention initiation and recognition and coping strategies. Such contexts and mechanisms were critical explanatory factors in medical utilization. CONCLUSION: User fee is a series of interventions that are fragile and dynamic. So the introduction of user fee system needs a comprehensive understanding of previous and new intervention, policy infrastructure, and other factors that can influence on medical utilization.
Consumer Participation ; Fees and Charges*

This paper is a result of experimental studies on family planning in Koyang county, a rural setting of Korea. The Koyang experience has shown that the acceptance of IUD is heavily dependent on two factors: the distance from the village to the IUD service clinic and the extent of side reactions: and unfavorable rumors about its use in the community. While the problem of distance was solved by sending out mobile teams or by establishing new clinics in the villages, the problem of side reaction and unfavorable rumors still remained. This study was set up to see whether the organization of mothers' classes could be a means to promote the acceptance and retention of IUDs. The mothers' class was organized in each village (hamlet), and the membership was opened to every women in the village. It was hypothesized that the mothers, class with the proper educational materials will work as an adequate educational program to offset rumors and to make a favorable social climate for accepting and retaining the IUD. The field experiment was conducted according to the "before-after" design with a control group. It was found that the educational program in the mothers' class was effective in promoting the acceptance and retention of contraceptive practice, particularly the IUD.
Adult ; Consumer Participation* ; Consumer Satisfaction* ; Family Planning ; Female ; Health Education* ; Human ; Intrauterine Devices*/standards ; Korea ; Middle Age

The healthy cities approach emphasizes the role of the leadership of local governments in promoting the health of the population in city settings. The concept emerged from public health strategies declared in the Ottawa Charter for Health Promotion, and reflects the characteristics of the third public health revolution. The Korean healthy cities movement, characterized by voluntary participation of local governments in the Alliance for Healthy Cities, has grown rapidly in recent years. A strong push of the healthy cities movement by a local government without a profound commitment to the vision may hinder the effective and sustainable development of the movement. By reviewing the historical background and significance of the healthy cities movement and its underlying concepts, and illustrating the main strategies and goals of the movement, that is, the development of partnerships, community participation and empowerment, and working in networks for stimulating change, this article argues that the healthy cities movement is a potent vehicle for implementing the new paradigm of public health introduced to local governments. We also argue that the Korean healthy cities movement needs more active participants and more support of the central government and other related stakeholders.
Consumer Participation ; Health Promotion ; Korea ; Local Government ; Natural Resources ; Power (Psychology) ; Public Health ; Vision, Ocular

OBJECTIVE: This experiment is to study how elderly group and their various lifestyles interact with health functional foods, according to their selection behavior. Different lifestyles will be observed closely, as well as how different health conditions and consumer involvements will affect critical decision making in selecting health functional foods. METHOD: Theories and discoveries from original advanced research were compared parallel to the new study. RESULTS: First, cluster analysis and exploratory analysis were performed amongst different elder lifestyles. Lifestyle exploratory analysis was used for healthy, unique, leisure, and economical-style elders. Cluster analysis was used for material trend oriented, health oriented, complacent oriented-style elders. Health Functional Foods' selection trait Exploratory Factor Analysis showed that product's originality (function, uniqueness, specialty, compatibility, distributor, expiration date), quality (amount, daily dose, visual representation, accessibility, portability, natural ingredients), and popularity (product container, brand image, taste and smell, advertised product, domestic or import, well-known function) were the three main causes. Secondly, the amount of benefits for the elderly group health lifestyle were affected by 'Interest in health', 'Notability of the health functional food', and 'Functionality approved mark'. Specifically, the importance of, 'Interest in health', 'Notability of health functional food', and 'Functionality approved mark' were noticeably high within health oriented elders. Lastly, after examining the data from elder lifestyle's relationship with health functional food selection trait, all three different results showed equal importance. If you closely examine material trend oriented elderly group, selection trait showed distinctively high regards in 'Fundamental Attribute', 'Typical Attribute', and 'Cognitive Attribute'. Health oriented elders showed their distinctively high regards in 'Natural Attribute', and less consideration in 'Typical Attribute' and 'Cognitive Attribute'. Complacent oriented-style elderly group showed less focus on 'Fundamental Attribute', and even less in 'Typical Attribute', and 'Cognitive Attribute'. Health oriented elderly group concluded with above data from the fact that they showed most importance and involvement in health beneficial products that are scientifically proven. Material trend oriented elderly group showed balanced traits in their concluded data, showing that they prefer function, safety, as well as the brand image and their reputation. Also, they consider the products' outer elements, such as design and product name, in order to sense inner functions. CONCLUSION: So, Silver Business corporations must develop products to fulfill the market demands, and strategize marketing plans to better target the correct audience.
Aged* ; Commerce ; Consumer Participation ; Decision Making ; Functional Food* ; Humans ; Leisure Activities ; Life Style* ; Marketing ; Silver ; Smell

The Healthy Cities program is being actively pursued worldwide under the leadership of the World Health Organization as an effort to improve urban health through changes in the physical and social environment. As the core of the Healthy Cities program, governance establishes and implements diverse health plans and healthy public policies through political support, intersectoral cooperation, community participation, and multilevel networks. With the development of Healthy Cities programs, governance has evolved in the direction of autonomy, equity, and integration. These governance orientations should be continuously reflected in Healthy Cities strategies in order to successfully improve citizens' health.
Consumer Participation ; Leadership ; Public Policy ; Social Environment ; Urban Health ; World Health Organization

OBJECTIVES: This study examined variations in the perceptions of dioxin risk among social groups defined by geographical living location, environmental education, and occupation. Dioxin risk perceptions were analyzed according to values, risk awareness, knowledge, and behavioral preferences. METHODS: A quasi-experimental survey was designed and conducted on individuals from seven experimental groups in Jeonju city, South Korea, including: people living near incineration facilities; people living far from incineration facilities; governmental experts; nongovernmental organization members; office workers in developmental institutes or banks; students who were enrolled in environmental-related classes; and students who were enrolled in business-related classes. RESULTS: The results show variations among groups in values, awareness and behavioral preferences. Particular attention should be given to the result that groups with higher connectedness- to-nature values show higher willingness-to-act (WTA) for risk reduction. Result s can be summarized as follows. First, awareness is associated with one's geographical setting. Second, values and WTA behaviors are related to one's environmental-related education and occupation. Third, values are significantly related to WTA behaviors. CONCLUSIONS: Different cultures, in terms of values or worldview, among groups influence their perceptions of dioxin risk and choices of risk reduction behaviors. It is important to consider values in communicating complicated long-term risk management involving public participation. Further research should be continuously conducted on the effects of multiple dimensions of values on one's WTA for risk reduction behaviors.
Academies and Institutes ; Consumer Participation ; Education ; Humans ; Incineration ; Jeollabuk-do ; Korea ; Occupations ; Risk Management ; Risk Reduction Behavior

OBJECTIVE: To describe perceived participation among persons with first stroke and to identify the predictors based on the International Classification of Functioning, Disability and Health (ICF) concept of participation after stroke. METHODS: A total of 121 participants completed 4 questionnaires: the Impact on Participation and Autonomy (IPA), Personal Resource Questionnaire (PRQ2000), Hospital Anxiety and Depression Scale (HADS), and personal history. They were evaluated for their balance, motor function, functional and walking ability. RESULTS: The majority of participants perceived participation restriction in family role as poor to very poor. The best predictors of participation included social support, walking and balance, functional ability, number of secondary health problems and affected side, account for 66.6% of the variances in participation. CONCLUSION: The study highlights the importance of social support, walking and balance performance, functional ability in daily living, and number of secondary health problems after stroke. These factors that facilitate participation after stroke should be addressed by health personnel during rehabilitation.
Anxiety ; Consumer Participation* ; Depression ; Health Personnel ; Humans ; International Classification of Functioning, Disability and Health ; Rehabilitation ; Stroke* ; Thailand* ; Walking

OBJECTIVE: The objective of this study was to evaluate the association of social support with health status and health behavior. METHODS: This study was conducted with 79 elderly people in Gunja-ri, Dongsan-myun, Chuncheon. We performed face to face interview which was composed of socio-demographic characteristics, social support, health status and health behavior. The association between social support and result variables was analysed by Chi-square test and logistic regression. We used SAS ver9.1 for statistic analysis. RESULTS: Mean age of the study population was 72.0+/-7.0, social support score was 14.3+/-4.7 with full marks of 20 and 36.25% of the total population were shown to have depression. When the social support score was changed, depression (p=0.0007) and physical exercise (p=0.0312) showed significant difference. The self-rated health status was significantly related to the relationship with family members (OR=0.25, 95% CI=0.07-0.95) and the quality of sleep was also significantly associated to the relationship with family members (OR=0.21, 95% CI=0.06-0.73). The physical exercise was done significantly less in the group 'without' close friends than in the group with 'many' close friends (OR=0.21, 95% CI=0.05-0.94) and the depression was significantly more in the group without community participation than in the group with community participation (OR=4.79, 95% CI=1.62-14.15). CONCLUSIONS: Through this study, we could conclude that the social support factors are associated with health status and health behavior. Therefore, to improve the health status of rural elderly, we need to approach to develop social support.
Aged ; Consumer Participation ; Depression ; Exercise ; Friends ; Health Behavior ; Humans ; Logistic Models ; Phenothiazines ; Rural Health ; Sociology

OBJECTIVES: The purpose of this study was to develop and execute the village heath worker(VHW) training program which based on short term overseas medical volunteer and medical mission. METHODS: Through case studies of previous VHW program and review articles about the state of medical volunteer and medical mission, we developed the VHW training program. Pilot test of the program was carried out in Tugeugarao city, Phillipines on July, 2008. The subject were 32 persons from 15 villages around Tuguegarao city. After training we surveyed regarding the satisfaction of training and the degree of getting knowledge and skills. RESULTS: Through article review, we got the common subjects of previous VHW training program and the limitations of overseas medical volunteer and medical mission. We developed VHW training program aiming to community health promotion through community participation and community change. The main text was "Where There Is No Doctor" of Hesperian Foundation. The program executed through 1 day intensive lecture and practice. The satisfaction of the program was 8.95+/-1.70 on 10 point rating scale. CONCLUSIONS: We strongly expect VHW training program can be available as new model of short overseas medical volunteer as well as medical mission if we could systemize it with the confirming subject before training, management after training and continuous support through connection with the field.
Community Health Workers ; Consumer Participation ; Health Education ; Health Promotion ; Humans ; Missions and Missionaries ; Philippines ; Primary Health Care

BACKGROUND: Due to the asymmetry of information and knowledge and the power of bureaucrats and medical professionals, it is not easy for citizens to participate in health care policy making. This study analyzes the case of the insured organization participating in the Health Insurance Policy Committee (HIPC) and provides a basis for discussing methods and conditions for better public participation. METHODS: Qualitative analysis was conducted using the in-depth interviews with the participants and document data such as materials for HIPC meetings. Semi-structured interviews were conducted with purposively sampled six participants from organizations representing the insured in HIPC. The meanings related to the factors affecting participation were found and categorized into major categories. RESULTS: The main factors affecting participating in the decision making process were trust and cooperation among the participants, structure and procedure of governance, representation and expertise of participants, and contents of issues. Due to limited cooperation, participants lacked influence in important decisions. There was an imbalance in power due to unreasonable procedures and criteria for governance. As the materials for meetings were provided inappropriate manner, it was difficult for participants to understand the contents and comments on the meeting. Due to weak accountability structure, opinions from external stakeholders have not been well received. The participation was made depending on the expertise of individual members. The degree of influence was different depending on the contents of the issues. CONCLUSION: In order to meet the values of democracy and realize the participation that the insured can demonstrate influence, it is necessary to have a fair and reasonable procedure and a sufficient learning environment. More deliberative structure which reflects citizen's public perspective is required, rather than current negotiating structure of HIPC.
Consumer Participation ; Decision Making ; Delivery of Health Care ; Democracy ; Insurance, Health ; Learning ; Negotiating ; Policy Making ; Social Responsibility