Journal List > J Korean Acad Nurs > v.43(4) > 1002930

Lee and Park: Development and Effects of a Health Education Program for North Korean Preschool Defectors



This study was conducted to develop a health education program for preschoolers who have defected from North Korea with their mothers, and to evaluate the effects on health knowledge and behavior.


A non-equivalent control group pre-post test design was used with 58 preschoolers who were assigned to either the experimental or control group (29 for each group). The program was composed of five sessions in health education and contracts. To test the effectiveness of the intervention, health knowledge and behaviors, and total bacterial colony counts on hands were measured at one pretest and two post tests (1 week and 4 weeks after the intervention ended). Data were analyzed using the SAS program.


Health knowledge and behavior in the experimental group increased significantly compared to the control group. The effects of the intervention were evident even at 4 weeks after the intervention ended. Total bacterial colony counts in the experimental group decreased significantly at the 1 and 4 week posttest intervention compared to the control group.


Results indicate that this program is effective in improving health knowledge and behavior in these children and therefore can be utilized to ensure efficient management their health care.

Figures and Tables

Table 1
Homogeneity Test for General Characteristics and Measurement Variables between Experimental and Control Groups

Exp.=Experimental group; Cont.=Control group; CFU=Colony Forming Unit; *by Fisher's exact test; by Wilcoxon rank sum test.

Table 2
Effects of the Health Education Program on Variables

Exp.=Experimental group (n=29); Cont.=Control group (n=29); CFU=Colony Forming Unit;

Posttest 1=1 week after intervention trials ended; Posttest 2=4 weeks after intervention trials ended;

*by t-test or by Wilcoxon signed rank test with Bonferroni's adjustment; by ANOVA; by repeated measures ANOVA; §by Wilcoxon rank sum test.


This manuscript is based on a part of the first author's doctoral dissertation from The Catholic University of Korea.


1. Burkhart PV, Rayens MK, Oakley MG, Abshire DA, Zhang M. Testing an intervention to promote children's adherence toasthma self-management. J Nurs Scholarsh. 2007; 39(2):133–140.
2. Dubbert PM, Dolce J, Richter W, Miller M, Chapman SW. Increasing ICU staff handwashing: Effects of education and group feedback. Infect Control Hosp Epidemiol. 1990; 11(4):191–193.
3. Edaily. UNICEF "Suffering from diarrhea, North Korea 19% of infants and toddlers". 2010. Retrieved September 11, 2010. from
4. Kim GR. Effects of hand washing education of primary school children. Seoul: Hanyang University;2009. Unpublished master's thesis.
5. Kim YY. An evaluation of the health status of children from North Korea. Nurs Sci. 2006; 17(2):55–63.
6. Korea Centers for Disease Control & Prevention. Hand washing advertising and promotional materials. 2008. Retrieved March 4, 2009. from|s_name|s_subject|&strSearchWord.
7. Lee IS, Park HR, Kim YS, Park HJ. Physical and psychological health status of North Korean defector children. J Korean Acad Child Health Nurs. 2011; 17(4):256–263. 94/jkachn.2011.17.4.256.
8. Lee MY. Microbiological evaluation of students' hand hygiene based on sanitation training in elementary schools in Busan. Busan: Dong-A University;2007. Unpublished doctoral dissertation.
9. McGinley KJ, Larson EL, Leyden JJ. Composition and density of microflora in the subungual space of the hand. J Clin Microbiol. 1988; 26(5):950–953.
10. McKenzie JE, Priest P, Audas R, Poore MR, Brunton CR, Reeves LM. Hand sanitisers for reducing illness absences in primary school children in New Zealand: A cluster randomised controlled trial study protocol. Trials. 2010; 11:7.
11. Ministry of Education and Science Technology. 2007 revised national kindergarten curriculum 2: Healthy living, social life. 2008. Retrieved March 2, 2009. from
12. Ministry of Unification. The status of North Korean defectors. 2013. Retrieved June 15, 2013. from
13. Monroe RA. Health promotion of the preschooler and family. In : Hokenberry MJ, Wilson D, editors. Wong's essentials of pediatric nursing. 8th ed. St. Louis, MO: Mosby;2009. p. 437–452.
14. Myers R, Larson E, Cheng B, Schwartz A, Da Silva K, Kunzel C. Hand hygiene among general practice dentists: A survey of knowledge, attitudes and practices. J Am Dent Assoc. 2008; 139(7):948–957.
15. Park HR, Koo HY, Cho MN. Effect of preeducation and health contract on adaptability and anxiety during spinal puncture in children with leukemia. J Korean Acad Child Health Nurs. 2006; 12(4):462–469.
16. Pinfold JV, Horan NJ. Measuring the effect of a hygiene behaviour intervention by indicators of behaviour and diarrhoeal disease. Trans R Soc Trop Med Hyg. 1996; 90(4):366–371.
17. Plummer M. Community health for Rwandan refugees. Can Nurse. 1995; 91(11):45–46.
18. Ramseier CA, Leiggener I, Lang NP, Bagramian RA, Inglehart MR. Short-term effects of hygiene education for preschool (kindergarten) children: A clinical study. Oral Health Prev Dent. 2007; 5(1):19–24.
19. Randall P. Child behaviour problems: Contracting with parents. Prof Care Mother Child. 1994; 4(2):42–44.
20. Ratnapradipa D, Quilliam D, Wier L, Rhodes DL. Food safety education: Child-to-parent instruction in an immigrant population. J Environ Health. 2011; 73(6):70–75.
21. Simor AE, Lee M, Vearncombe M, Jones-Paul L, Barry C, Gomez M, et al. An outbreak due to multiresistant Acinetobacter baumannii in a burn unit: Risk factors for acquisition and management. Infect Control Hosp Epidemiol. 2002; 23(5):261–267.
22. Tousman S, Arnold D, Helland W, Roth R, Heshelman N, Castaneda O, et al. Evaluation of a hand washing program for 2nd-graders. J Sch Nurs. 2007; 23(6):342–348.[0342:eoahwp];2.
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