KIHASA has released the KCI-listed Health and Social Welfare Review, Vol. 43, No. 1. This issue carries 12 peer-reviewed articles and an editorial by Chon Yongho, Professor of Incheon National University on the topic "Integrated Community Care Should Continue to Be Emphasized as a National Policy."

Summary of the EDITORIAL: Integrated Community Care Should Continue to Be Emphasized as a National Policy

Integrated Community Care is a national policy aimed at creating practical conditions for the elderly, disabled, mentally ill, and homelss to be able to live in their own homes and communities rather than in closed institutions. As the government has placed emphasis on Integrated Community Care as a new paradigm, growing interest has been drawn to the policy and practice aspects of a 'community-based' health and social care system.

Civil servants taking part in the pilot Integrated Communicty Care project have worked across the frontlines, iedentifying care needs specific to their localities, and, working in collaboration with public and private actors, presented ideas for building a care system suitable for their community. Additionally, around 60 other localities that are not part of the ongoing pilot project have also started seeking ways to improve community care on their own, having realized that as the role of the family is waning in care provision despite the rapid aging of the population, the state should take the lead in providing care. Now, local government officials have become primary actors in the planning, design, and administration of health care and social welfare programs. The academic community has also become more active in its research on community care.

Advanced welfare states emphasize Integrated Community Care as a key national policy. They make significant efforts to enable the growing number of older people to live in their own homes and communities rather than in long-term care hospitals or facilities. These states also place considerable emphasis on promoting a network of relationships in the community, especially as the impact of the pandemic drags on, to prevent loneliness from leading to social isolation, suicide, or dying alone. Integrated Community Care is a path we should take to ensure ourselves a fee and humane life. And it is our scientific duty as researchers to systematically assess and improve the reality of Korea's deficient care system.

Article I: "Working Time Reduction and Life, Job Satisfaction," Ko Hye-Jin, KIHASA & Jung Hae-Sik, KIHASA

We investigate wage workers’ life satisfaction and job satisfaction changes after the introduction of reduced work hours using the Korean Labor and Income Panel Study. Considering the policies phased over several years, we adopted heterogeneity-robust DID, which can derive valid estimates even in a multiple-period setting. As a result, life and job satisfaction increased after the 2003 reform, especially with the 5-day work week. Changes in life satisfaction occurred later than changes in job satisfaction, where positive changes immediately showed. On the other hand, the impact of a 52-hour workweek on life and job satisfaction at a statistically significant level has yet to be captured.

Article II: "Analysis of Issues on COVID-19 Blues Using Big Data," Kim Yeon-Jung, Korea Nazarene University

The purpose of this study was to analyze big data related to the “COVID-19 blues” to explore major issues and public response. The data were collected using web crawling from January 2020 through March 2021 and analyzed using text mining analysis. The results indicated that the main keywords related to Corona blues were ‘overcoming,’ ‘anxiety,’ ‘person,’ ‘mind,’ ‘prolonged,’ ‘symptom,’ ‘stress,’ and ‘sequela.’ The main N-gram keywords in the data were depression-anxiety, depression-overcoming, and corona-sequela. In relation to COVID-19 blues, words with high co-occurrence frequencies were anxiety, blue, and depression. Our keyword correlation analysis found that the words most related to ‘corona’ were ‘blue’, ‘symptoms’, and ‘restoration’, and the words most related to ‘blues’ were ‘depression’, ‘friend’, and ‘thought’. Topic modeling indicated that 10 topics were ‘confusion due to working from home’, ‘nearby mental health services’, ‘symptoms of COVID-19 blues’, ‘transition to depression’, ‘withdrawal in interpersonal relationships’, ‘youth academic turmoil’, ‘psychological difficulties of youth’, ‘the aftereffects of COVID-19’, ‘birthday blues’, and ‘weight gain’. Big data analysis revealed the need for more inclusive strategies of mental support for COVID-19 blues. Implications for intervention and recommendations for further research are provided.

Article III: "A Qulitative Case Study of Smartphone Overdependence among Out-of-school Adolesecents," Jeon HyeSook, Ewha Womans University

The purpose of this study was to explore the experience and measures to mitigate smartphone overdependence among out-of-school adolescents. The in-depth interviews were conducted with six out-of-school adolescents. The data were analyzed by the case study method, including contextual understanding and key issue identification for each case, and identification of common themes running across all cases. The following five themes were derived: 1) the killing time and what you do when you’re bored; 2) the connection with friends; 3) the ambivalence of opportunity and crisis; 4) the drug-like existence where anxiety and temptation coexist; 5) the helpful measures for reducing smartphone overdependence. According to the main findings, the following clinical implications for mitigating smartphone over-dependence among out-of-school adolescents were suggested: providing alternative activities; services for the improvement of friendship and parent-child relationships; providing information that enhances understanding of hazards and services related to smartphone over-dependence through enhancing accessibility of channels; individual counseling with parents; and providing activity-oriented group programs.

Article IV: "The Impact of Patient Safety Incident Experience on Length of Stay in Hospitals: Based on the In-Depth National Hospital Discharge Injury Survey Data 2016-2020," Kim Gyeong Chang, Soonchunghyan University & Lee Hyewon, Soonchunghyang University

The purpose of this study was to investigate the impact of patient safety incident(PSI) experience on length of stay(LOS) in hospitals. The study used the Korean National Hospital Discharge Injury Survey Data(KNHDIS) 2016-2020. When weights were considered, the study subjects were 15,057 patients who experienced PSI. As the study method, a Poisson regression analysis was performed to investigate the association with PSI and As a result of the Wilcoxon rank sum test, the LOS for patients with PSI was 20.8 days, and the LOS for patients without PSI was 3.4 days, showing a significant difference. As a result of regression analysis adjusting for demographic characteristics, clinical characteristics, and medical institution characteristics, a significant effect was confirmed between PSI experience and LOS in hospitals(RR=2.820 [95% CI=2.738-2.903]). When classified by type of PSI, the LOS for fall incident patients increased significantly(RR =3.018 [95% CI=2.922-3.117]). As a result of this study, it was confirmed that the experience of PSI had a significant effect on the increase in LOS in hospitals. Our findings can contribute to the establishment of preventive measures to reduce PSI.

Article V: "Effects of Happiness Growth on Acceptance of Disabilities, Self-Efficacy, and Positive Interpersonal Relationships in People with Physical Disabilities," Choi HeeCheol, Kwangju Women's University, Kim YoungMi, Kwangju Women's University, and Kim HyeRi, Joongbu University

This study examined the effects of happiness growth on acceptance of disabilities (AOD), self-efficacy (SE), and positive interpersonal relationships (PIR) in people with physical disabilities. The participants were 2130 people with physical disabilities. The data came from the 1st to 6th waves of the Panel Survey of Employment for the Disabled 2nd Wave (PESD). Trajectories of happiness growth were analyzed using latent growth curve modeling. The effects of happiness trajectories on AOD, SE, and PIR were analyzed using conditional latent growth curve modeling. The findings of the present study showed the following. First, a higher initial level of happiness and a higher slope of change in happiness exhibited a higher level of acceptance of disabilities. Second, a higher initial level of happiness and a higher slope of change in happiness exhibited a higher level of self-efficacy. Third, a higher initial level of happiness exhibited a higher level of positive interpersonal relationships, but a higher slope of change was not related to a higher level of positive interpersonal relationships. The results suggested that a higher initial level of happiness and a higher slope of change in happiness were beneficial to life outcomes (i.e., AOD, SE, and PIR).

Article VI: "The Trajectories and Determinants of Medical Service Utilization, Subjective Health Status, and Life Satisfaction in Middle-Aged and Elderly People with Chronic Disease," Ahn Junggeun, Seoul National University & Choi Heeseung, Seoul National University

This study aimed to identify the trajectory of changes in medical service utilization, subjective health status, and life satisfaction of middle-aged and elderly people with chronic diseases and examine the determinants. Using data from the 5th to the 7th years of the Korean Longitudinal Study of Ageing, 3,873 people aged over 45 who were diagnosed with chronic diseases were studied. Multivariate latent growth model analysis was conducted to verify the patterns, interrelationships, and determinants of the trajectory of changes. The medical service utilization and life satisfaction of middle-aged and elderly people with chronic diseases showed a significant increase over time, while subjective health status showed a significant decrease. The common determinants of the initial values of medical service utilization, subjective health status, and life satisfaction were subjective class consciousness, the depression level, the pain level, the number of chronic diseases, and the activities of daily living (ADL). The common determinant of the rate of change was the degree of pain. The determinants of trajectory change are diverse, and in particular, participation in economic activities continuously increases subjective health status and life satisfaction. Therefore, in order to improve the quality of life of middle-aged and elderly people suffering from chronic diseases, multifaceted interventions are needed.

Article VII: "The Relationship among Diet Frequency, Protein Intake, and Falls in the Elderly: Focusing on Gender Differences," Kim Ji Hee, Seongnam Senior Industrial Innovation Center & Oh Young Sam, Pukyong National University

This study aims to analyze the relationship between the frequency of meals, protein intake, and falls among elderly individuals. The Seoul Aging Survey (2020) was utilized for this purpose, and a total of 2,382 elderly participants were selected as the final research subjects. A binary logistic regression analysis was conducted to examine the predictive factors influencing falls and the relationship between them. Falls were found to occur differently based on gender, and thus the analysis was conducted with models separated by gender. The results revealed that among elderly men, those who lived alone and had a poorer perception of their health were more likely to experience falls. On the other hand, elderly women were more likely to experience falls if they had lower income levels, a greater number of chronic diseases, a lower perception of their health, and a lower level of protein intake. This study confirmed that falls among elderly women were influenced by low levels of protein intake. There is a need to establish fall prevention education and strategies that consider gender differences.

Article VIII: "The Effects of Human Rights-friendly Service Experience on the Life Satisfaction of Inpatients with Psychiatric Disabilities: A Multi-Group Analysis of Health Care Status," Park Jong Eun, Seoul National University & Kahng Sang Kyoung, Seoul National University

One of the experiences individuals with psychiatric disabilities inevitably have in the process of their recovery is inpatient treatment at psychiatric institutions. This study examines the effects of human rights-friendly service (HRFS) experience on the life satisfaction of individuals with psychiatric disabilities admitted to psychiatric institutions. Specifically, this study looks at the effects of five HRFSs suggested by the WHO Quality Rights Tool Kit (i.e., adequate living and privacy, mental and physical health, self-determination, freedom from abuse and violence, and community integration services) on inpatients’ life satisfaction. It further examines whether the effects of HRFS on life satisfaction vary depending on the status of health care coverage. To address research questions, we conducted SEM and multi-group analysis on the data of 228 inpatients who participated in the National Human Resources Committee's Survey in 2022. The key findings are as follows. First, inpatients’ life satisfaction increases with more services for ensuring “adequate living and privacy”, “self-determination”, and “freedom from abuse and violence”. Second, the result of the multi-group analysis showed that the effects of all five HRFSs on inpatients’ life satisfaction vary depending on the status of health care coverage. Based on the results, we discussed practical and policy implications for improving the life satisfaction of inpatients with psychiatric disabilities.

Article IX: "Exploring Policy Challenges for Prevention and Management of Lonely Deaths: Using Delphi Method as a Central Methodology," Bae Eunkyung, Honam University; Chung Soondool, Ewah Womans University; Yoo Jaeeon, Gachon University; and Lee Hajin, Gachon University

The purpose of this study was to identify policy tasks for the prevention and management of lonely deaths using the Delphi method. A Delphi survey was conducted in three rounds, involving 50 experts in the field of lonely deaths prevention and management. The internal validity ratio was analyzed to verify the validity of the study, and an Importance-Performance Analysis (IPA) was conducted to determine the priority of policy tasks. The results revealed that the legal definition of lonely deaths is an important factor in setting the scope and target of related projects in policy implementation. In addition to personal factors, social structural changes were found to be influencing the causes and impact factors of lonely deaths. Policy tasks for preventing and managing lonely deaths were identified in the areas of investigation/statistics, systems, prevention, service support and linkage/resource development, post-management, and other areas. It was found that as the Act On The Prevention And Management Of Lonely Deaths was mainly focused on post-management and response, there is a great need to enhance the preventive aspect of lonely deaths. Based on these findings, implications for policy formulation for the prevention and management of lonely deaths were derived and provided from both a policy and academic perspective.

Article X: "A Categorization of Time Guarantee in Work-Life Balance," Noh Hye-Jin, Gangseo University

In a situation where the problem of time poverty is becoming visible and labor market policies are expanding as a way of reorganizing working hours, this study started with the question of what time sovereignty means. In this study, the concept of “time guarantee” is defined as a state in which time is invested in a balanced way in various dimensions of life, such as work and family, and in this process, time is divided into two areas: working time and family time. Each area has four common categories: the amount of time needed to provide an adequate level of input in a given dimension of life; accessibility to participation; relevance to income; and a policy environment that guarantees time balance. This study divided working time into 15 indicators and family time into 11 indicators. Through a standardization process, the degree of guarantee of work-life balance time in 31 OECD countries was indexed, and classification was attempted based on this. The results of the study are as follows. First, I analyzed the 31 countries based on 26 indicators and classified them into four types: high in both family time-oriented security and working time-oriented security; high in only family time-oriented security; high in only working time-oriented security; low in both working time-oriented security and family time-oriented security. Second, 10 out of the 31 countries showed high levels of time guarantee in both areas, and 9 countries showed low levels of time guarantee in all areas. Korea was classified as a type with low levels of family time and working time guarantees. Third, as a result of analyzing time satisfaction and leisure time by classification type, both time satisfaction and leisure time were the longest in the country group with high guarantees of work and family time. Based on these results, this study proposed short working hours, a society in which both couples raising children can work, and the creation of a labor market environment with a low-level risk of low wages. In the long term, the introduction of a working-time savings account system based on the participation of workers was proposed.

Article XI: "Stakeholders' Experiences on the Case Determination Committee in the Child Care System," Jung Sun Wook, Duksung Women's University; Kim Hyoung Tae, Seoul Christian University; Kim Meesook, ChildFund Korea; Kong Young Sook, Busan Metropolitan City; and Yi Soo Cheon, Gangseo University

The purpose of this study is to understand the case determination committee, whose establishment in every Si-Do and Si-Gun-Gus has been made mandatory since June 31st, 2021, and to devise measures to improve its system to guarantee the best interests of the child. A Focus Group Interview was conducted five times with the stakeholders in the child case system, such as case determination committee members, the directors of the child care team, and child care officials. The key findings are as follows. First, the stakeholders of the child care system consider that the case determination committee performs formal as well as procedural and practical functions for the best interests of the child. Second, as for the qualifications of the committee members, they value professionalism in the field of child care the most. Third, it was found that some improvements are needed in several matters, including conducting internal case management meetings, preparing review documents for the committee meetings, and proceeding with the committee meetings. Based on these findings, this study proposed the clarification of the functions (roles) of the committee, the revision of the contents of on-the-job training for the directors of the child care team and the child care officials, the development of curriculum for the committee members, the consideration of the inclusion of the general public as well as parties in composing committee members, and making guidelines for operating the committee meetings.

Article XII: "Public Participation Process in Healthcare Prioritization: A Scoping Review," Ha Jiwoo, Institute of Health & Environment, Seoul National University; Kim Chanki, Seoul National University; Kim Jin-Hwan, Institute of Health & Environment; Kim Saerom, Seoul National University; and Kim Chang-yup, Seoul National University

Ensuring citizen participation in the health sector has been recognized not only as an important goal, but also as a way to achieve the primary values of the health system. In particular, healthcare prioritization encompasses conflicts of various values and interests, which make substantive participation of citizens and stakeholders essential. Therefore, this scoping review was conducted to provide evidence for the design and implementation of participatory prioritization processes following PRISMA Extension for Scoping Reviews (PRISMA-ScR). The literature published between January 2000 and April 2022 from four databases (Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science) were selected, and the data on various aspects, such as participatory methods, types of participants and consideration of marginalized groups, operational procedures, and evaluation and utilization, were analyzed. The analysis identified the need for participatory processes at the local level, flexible design based on context and objectives, sufficient preparation, and methods to incorporate the issues of inequity and diversity along multiple dimensions. The significance of this study lies in its synthesis and presentation of a rationale for the design and implementation of participatory healthcare prioritization processes.