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*

OBJECTIVES: This study was performed to explore customer royalty and the related factors. METHODS: 900 households(a 1% sample) were randomly selected from the total population of K city located in Kangwon province. An interview survey was performed with using a structured questionnaire for the subjects(923 persons) who had used medical service during the year before the survey, and the survey was done September, 2002. RESULTS: When comparing the relating factors related with customer royalty according to the sociodemographic characteristics, the older group showed a significantly higher level of recognition for service quality, service reputation, internal customers.attitudes and switching cost. The lower income group showed a higher level of recognition for service quality, service image and switching cost. The lower educated group showed a higher level of recognition for service reputation, service image and internal customers.attitudes. The higher educated group showed a higher level of recognition for perceived risk, and seeking variety. In addition, the expert group or the service and manufacturing workers group showed a higher level of recognition for service involvement. On multiple regression analysis, internal customers' attitudes, service image, service reputation, service quality, switching cost, and substitutability showed significant relations with customer loyalty. CONCLUSIONS: This study showed that customer loyalty was significantly influenced by service factors like internal customers' attitudes, service image, service reputation, and service quality, and by market factors like switching cost, and substitutability. The results of this study can be used as a baseline for developing strategies to create and keep customers with high loyalty.
Adult ; Consumer Participation ; Female ; Health Care Surveys ; *Health Services ; Humans ; Interviews as Topic ; Korea ; Male ; Middle Aged ; *Patient Satisfaction ; *Urban Population

OBJECTIVE: This study aimed to achieve expert consensus for the development of strategies emergency medical services system (EMSS) after reunification of Korean using the Delphi method. METHODS: The Delphi study was performed through several rounds from January to February in 2017. Experts who have experiences of emergency medical support in North Korea and developing countries participated in the study. Respondents were asked to express their level of agreement following 7 categories: (1) emergency medical manpower, (2) communication system, (3) emergency facilities, (4) patient transfer system, (5) consumer participation and public education, (6) insurance system, (7) disaster planning. Score 1–3 was classified as disagreement, 4–6 as medium agreement, and 7–9 as agreement and consensus was considered being achieved when more than two thirds of respondents agreed in each question. RESULTS: Response rate were 80% in the first round and 75% in the second round. Consensus was achieved in emergency medical manpower, communication system, emergency facilities, patient transfer system, and disaster planning for the important factors immediately after reunification within 5 years. Consensus was achieved in emergency medical manpower, communication system, emergency facilities, patient transfer system, consumer participation and public education, and disaster planning for the prior factors when the reunification would happen rapidly without enough preparation. CONCLUSION: Consensus was achieved in emergency medical manpower, communication system, emergency facilities, patient transfer system, disaster planning for the essential EMSS elements. The consensus was expected to utilize as a basic data for the development of EMSS preparing for reunification.
Consensus* ; Consumer Participation ; Delphi Technique* ; Democratic People's Republic of Korea ; Developing Countries ; Disaster Planning ; Education ; Emergencies* ; Emergency Medical Services* ; Expert Testimony ; Insurance ; Korea* ; Methods ; Patient Transfer ; Public Health ; Surveys and Questionnaires

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

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

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

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

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

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