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Lim, Lee, and Yang: The Trends in Research on the Health of North Korean Refugees
Original Article

J Korean Acad Community Health Nurs 2017;28(2):144-155.

Published online: 12 June 2017

DOI: https://doi.org/10.12799/jkachn.2017.28.2.144

The Trends in Research on the Health of North Korean Refugees

Hyun-Ju Lim1, Guna Lee2, Sook-Ja Yang2

1Graduate School, Ewha Womans University, Seoul, Korea

2College of Nursing, Ewha Womans University, Seoul, Korea

Corresponding author: Yang, Sook-Ja College of Nursing, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Korea. Tel: +82-2-3277-4652, Fax: +82-2-3277-2850, E-mail: yangsj@ewha.ac.kr

Received 6 April 2017       Revised 30 May 2017       Accepted 3 June 2017

Copyright © 2017 Korean Academy of Community Health Nursing

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

Purpose

This study aims to identify the general characteristics, subjects, and methods of research on the health of North Korean refugees through a systematic literature review.

Methods

A total of 140 studies on health were reviewed using the analytical framework developed by the researchers.

Results

The quantitative research comprised 90.7% of the studies, whereas the qualitative research were 7.9% of them. Approximately 81.4% of those reviewed have publication dates spanning 2006 to 2015. Only 13.6% of the studies were conducted with the approval of an institutional review board. The subjects of studies were psycho-social health (151.8%), behavioral health (28.5%), cognitive health (15.0%), physical health (12.2%), integrated health (7.8%), and spiritual health (2.8%). Within the quantitative studies reviewed, the most commonly used study design was survey research (86.0%). The two sampling methods used most often were convenience sampling (53.5%) and snowball sampling (19.4%), and the most commonly used data-collection method were questionnaires (94.6%). As for the qualitative studies, the most commonly used study design was phenomenology.

Conclusion

The results suggested that the reviewed studies focused on physical health more than psycho-social health, and physiological measurement more than questionnaires. Ethical considerations need to be expanded.

Keywords: Democratic people's republic of Korea, Health, Review

References

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Figure 1.
The flow diagram of study selection process.
jkachn-28-144f1.tif
Table 1.
Analysis of General Characteristics of Studies (N=140)
Characteristics Categories n(%)
Manuscript type General study 104 (74.3)
Funded study 36 (25.7)
Study type† Quantitative study 127 (90.7)
Qualitative study 11 (7.9)
Quantitative & qualitative study 2 (1.4)
Subject‡ Adult (male & female) 98 (70.0)
Male adult only 2 (1.4)
Female adult only 19 (13.6)
Child & child schooler 7 (5.0)
Middle & high school student 14 (10.0)
University (college) student 1 (0.7)
Middle and old aged adult 1 (0.7)
Selection criteria (residence period) ＞3 month 3 (2.1)
＞6 month 5 (3.6)
＞12 month 3 (2.1)
＞3 years 6 (4.3)
＞5 years Not suggested§ 4 119 (2.9) (85.0)
Ethical considerations IRB 19 (13.6)
Consent (written & verbal) 53 (37.9)
Not suggested 66 (47.1)
Not applicable 2 (1.4)
Author‡ Nursing 16 (11.4)
Medicine 30 (21.4)
Psychology 25 (17.9)
Social welfare Others|| 27 34 (19.3) (24.3)
Not suggested 17 (12.1)
Year of publication 2011~2015 61 (43.6)
2006~2010 53 (37.8)
2001~2005 20 (14.3)
1997~2000 6 (4.3)

IRB=Institutional review board; †Experimental studies (10 cases) included in total studies (129); ‡Duplicate classification was allowed; §Average residence period was 33months in the 62 studies among'not suggested' studies; ||food and nutrition, public health, childhood studies, tourism, hotel management, anthropology, sociology, and physical education.

Table 2.
Analysis of the Health Subjects† (N=140)
Variables Categories n(%)
Integrated health QOL 9 (6.4)
Others 2(1.4)
Subtotal 11 (7.8)
Behavioral health Health behavior
   Food intake/nutrition 8 (5.7)
   Alcohol 6 (4.3)
   Smoking 3(2.1)
   Physical activity 1 (.7)
   Others 1 12 (8.6)
Coping 7(5.0)
Interpersonal relationship 3 (2.1)
Subtotal 40 (28.5)
Cognitive health Perceived health status 11 (7.9)
Knowledge 4 (2.9)
Self efficacy 3(2.1)
Problem solving 2 (1.4)
Attitude 1(0.7)
Subtotal 21 (15.0)
Physical health Physiological measurement 7 (5.0)
Disease 5 (3.6)
Others§ 5 (3.6)
Subtotal 17(12.2)
Psychosocial health Depression 50(35.7)
PTSD 25 (17.9)
Anxiety 24(17.1)
Stress 12 (8.6)
Social support 11 (7.9)
Acculturative stress 10(7.1)
Satisfaction|| 9 (6.4)
Somatization 8 (5.7)
Psychosis 7 (5.0)
Growth after PTSD 6(4.3)
Obsession 6 (4.3)
Traumatic experience 5 (3.5)
Hostility 5 (3.5)
Paranoia 5 (3.5)
Interpersonal sensitivity 5 (3.5)
Phobic anxiety 4 (2.9)
Self esteem 2(1.4)
Sense of alienation 2(1.4)
Impulsivity 2(1.4)
Hopelessness 2(1.4)
Suicidal idea 2 (1.4)
Humiliation 1 (0.7)
Sleeplessness 1 (0.7)
Self concept 1 (0.7)
Others1 8(5.7)
Subtotal 213 (151.8)
Spiritual health Meaning in life 1(0.7)
Loss 1(0.7)
Self enhancement 1(0.7)
Forgiveness 1(0.7)
Subtotal 4 (2.8)

QOL=quality of life; PTSD=post-traumatic stress disorder; ・uplicate classification was allowed; ⑨ealth promotion behavior (3 cases), prenatal care, newborn health, physician visits, prescription non-adherence, treatment-seeking behaviors, hygiene, conduct disorder; §Immunity, age at menarche, heart-rate variability; |Life satisfaction, leisure satisfaction, economic satisfaction; ¶Alexithymia, stigma, experiential avoidance, sensitivity, anger, hypomania, objective personality, personality.

Table 3.
Analysis of Quantitative Study (N=129)
Characteristics Categories n (%)
Study design† Survey research 111 (86.0)
Experimental study Intervention Health education 10 (7.8)
type Health education program 1
Psychological therapeutic program
Gestalt relationship improvement program 1
PTSD program 1
Therapeutic recreation progra 1
Korean mindfulness-based stress reduction 1
Music psychotherapy program 1
Art Therapy 1
MBTI self growth program 1
Play psychotherapy 1
Forgiveness education program 1
Participants Male & female adult 2
Male adult 1
Female adult 2
Child & schooler 5
Methodological study 3 (2.3)
Secondary data analysis 7(5.4)
Criteria for sample size Reported 7(5.4)
Not reported 122 (94.6)
Sampling† Simple random 2(1.6)
Stratified random 6(4.7)
Convenience 69(53.5)
Purposive 15(11.6)
Snowball 25 (19.4)
Not suggested 23 (17.8)
Not applicable 2(1.6)
Data collection† Questionnaire 122 (94.6)
Physiological measure 10 (7.6)
Interview 24 (18.6)
Literature or paper analysis 2(1.6)
Medical record analysis 4(3.1)
Measurement Validity or reliability Reported * 90(69.7)
Not Reported 28(21.7)
Permission for Reported 0 (0.0)
instrument use Not reported 118 (91.5)
Not applicable 11 (8.5)
Data analysis† Parametric t-test, paired t-test 68 (52.7)
ANoVa, repeated measured ANOVA 57(44.2)
Correlation 50 (38.8)
Regression 52 (40.3)
Logistic regression 9 (7.0)
ANCOVA 7(5.4)
Factor analysis 8(6.2)
SEM 5 (3.8)
Others 7(5.4)
x2 20 (15.5)
Non-parametric Fisher exact analysis 3 (2.3)
Mann Whitney U test 2(1.6)
Wilcoxon singed rank test 3 (2.3)
Kruskal Wallis test 3 (2.3)

PTSD=post-traumatic stress disorder; MBTI=myers-briggs type indicator; ・uplicated classification was allowed; ⑮ine studies were used proven tools such as MMPI, MBTI, CES-D and Rorschach test among the 90 studies.

Table 4.
Analysis of Qualitative Study (N=13)
Characteristics Categories n(%)
Study design Phenomenology 7 (53.8)
Grounded theory 2 (15.4)
Ethnography 0 (0.0)
Q-methodology 0 (0.0)
Qualitative content analysis 1 (7.7)
Not suggested 3 (23.1)
Philosophical background Reported 7 (53.8)
Not reported 6 (46.2)
Researcher training Reported 5 (38.5)
Not reported 8 (61.5)
Data collection In-depth interview 13 (100.0)
Observation 0 (0.0)
Other discussion, sentence 0 (0.0)
analysis
Credibility & dependability Both credibility and 6 (46.1)
dependability
Credibility or dependability 2 (15.4)
Not suggested 5 (38.5)
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