Research Korner

the effect of common skin disease on the QOL of patient in the local setting

My adviser wants me to modify the title from “quality of life of patient with skin disease in the local setting” to "the effect of common skin disease on the QOL of patient in the local setting” And my adviser also wants to modify the statement of the problem. Modifications are: STATEMENT OF THE PROBLEM 1.     What are the common dermatologic problems that patients seek for treatment @ Lucena Skin Center 2.     What extent does the dermatologic problem affects their life a.     performance of activities of daily living b.     relationship with people c.     how he perceives him self     3. Is there a significant difference among the 3 factors identified and the level of impairment?   Can you make those modifications for me in 7 days? Can you also limit the number of pages to 25 including the statistical computation, because of my budget limitations? Thankyou my advicer wanted our thesis change from comparative to descriptive correlational study.                                             Abstract STATEMENT OF THE PROBLEM:           This study aims to focus on the following research questions: 1.     What is the demographic profile of the respondents when they are grouped according to: a.     Age. b.     Gender c.     Diagnosis 2.     Is there any difference in the quality of life of patients with skin disease when respondents are grouped according to their demographic profile? 3.     Is there a difference in the level of the quality of life between those with skin disease and those without skin diseases?   LOCALE OF THE STUDY:           This study will be conducted among 263 patients with skin disease and 47 subjects without skin disease (controls) in Lucena Skin Center Clinic. A private dermatology clinic in Lucena City with a board certified dermatologist.               RESPONDENTS: The sampling technique used was criterion sampling. Both the inclusion and exclusion criteria for patient selection were adopted form the source. Consecutive patient's, age 15 and above, whether old or new, consulting for any skin problem were included in the study. The patient's companions whose ages were also 15 and above served as control subjects (Those who do not have skin diseases). The paramedical staffs were also recruited as control subjects. As in the original, the criteria for the selection of controls were that they should not have seen their general practitioner over the previous "3 months", they should have had no apparent disability. Excluded in the study were those who were illiterate or were unable to communicate in Filipino unless a reliable interpreter was present.   SIGNIFICANT FINDINGS:           The study was conducted among 263 respondent's patient and 47 controls (no skin disease) in Lucena Skin Center Clinic, Lucena City.           The demographic data were analyzed using descriptive statistics (N=263) for the patient and (N=47) for the controls. Majority of the patients where females, 142 (54%) and 121 (46%) were males. The respondents were aged from 15 to 78 years. 237 (90%) were aged less than 65 years where as 26 (10%) fell into the geriatric age group (age > = 65). For the control subset, 38 (81%) were female and 9 (19%) were males.           A total of 263 subjects responded to the IKPAS (Translated Dermatology Life Quality Index in Filipino). The average time to complete it was 5 minutes. Unanswered item was observed for item 9 on sexual activity. The difference of the mean score between 15-64 y/o group (mean score= 7.5) and 65-78 y/o group (mean score= 8.07) were not statistically significant however, the difference of the mean score between male (mean score= 7.4) and female (mean score= 26.19) were statistically significant. Among the diseases, the findings with the highest mean score (greatest effect on the quality of life) were seen in Atopic Dermatitis (11.5) and the lowest mean score in Viral Warts (4.5). IKPAS was also completed by 47 healthy control subjects. Reliability was measured in the translated instrument using the 's alpha Coefficient and it showed internal consistency with  alpha Coefficient of a=0.71 (acceptable is >0.7). There was a significant difference between       mean scores of patients (7.86) and healthy subjects (0.89) (p=0.000), demonstrating construct validity. Quality of life scores were higher in inflammatory skin diseases such as Atopic dermatitis, Contact dermatitis, Erythroderma and Lichen Simplex Chronicus as compared to Acne, Viral warts and Keloids.           The first null hypothesis was: "There is no difference in the Quality of Life of patients with skin disease when respondents were group according to their demographic profiles".           The researchers reject the first null hypothesis.           The second hypothesis is: "There is no difference in the quality of life of patients with skin disease and those without skin disease"           The studies second null hypothesis was also rejected by the researchers.                             CHAPTER ONE THE PROBLEM AND ITS SETTING   BACKGROUND OF THE STUDY: During our duties in clinics and hospitals, we often encounter patients with skin diseases. We have observed that these patients were irritable, restless, and shy. They were treated for their skin problems only.           The nurses were instructed by the Physician/ Dermatologist how to take care of the patient's skin lesions and rashes but their emotional and psychological problem were not taken into consideration.           We were wondering whether the stress of having the skin disease affect their quality of life.           The concept of quality of life was developed to interpret data obtained about the impact of diseases on patients well being. This was fostered by the World Health Organizations (WHO) view of health as not merely the absence of disease or infirmity, but the ability of the person to lead a productive and enjoyable life. It usually utilizes a patient- administered questionnaire with items evaluating the effect of a disease and its treatment on patient's symptoms, feelings and daily activities. (called domain) over a well-defined period of time. [3] The response options are arbitrary and employ a scoring system for interpretation. [4]           This study was undertaken to examine the quality of life of patients with skin disease against those who do not have skin diseases.           By studying the impact of skin diseases on the quality of life of patients with skin diseases, the researcher hope to be able to modestly contribute to the enhancement of not only the nursing profession but also the medical profession and as well as the improvement of patient care quality to uplift their quality of life.   STATEMENT OF THE PROBLEM:           This study aims to focus on the following research questions: 1.     What is the demographic profile of the respondents when they are grouped according to? a. Age           b. Gender           c. Diagnosis 2.     Is there any difference in the quality of life of patients with skin disease when respondents are grouped according to their demographic profile? 3.     Is there a difference in the level of the quality of life between those with skin disease and those without skin diseases?     SIGNIFICANCE OF THE STUDY:           Research is the best way to find solutions to nursing problems and to set standards for nursing practice. The problem that we have observed during our stints in hospitals and clinics led as to conceptualize a study that will answer our curiosity. The results of this study will therefore, benefit the following sectors; NURSES- Expertise will increase as additional knowledge will be gain when educators will formulate effective psychological and emotional counseling which will be incorporated in nursing curriculum because of the output of this study. NURSING EDUCATION- Nursing schools will be able to incorporate the results of this study into their nursing psychiatry curriculum. PATIENTS or CLIENTS- there will be increased patients care quality. This in turn, will create increased patient satisfaction and will reflect a positive view of the hospital or clinic by the community. MEDICAL EDUCATION- Medical schools will be able to incorporate results of this study into their medical psychiatry curriculum. MEDICAL PROFESSION- Dermatologist will now be more aware and sensitive about their patient emotional and psychological problem brought about by their skin condition.     SCOPE AND DELIMITATION OF THE STUDY:           This study is conducted among 263 patients with skin disease and 47 subjects without skin disease (controls) in Lucena Skin Center Clinic. A private dermatology clinic in Lucena City with a board certified dermatologist.           A primary limitation of the study is posed by the source of the sample population which is from one local clinic only.   DEFINITION OF TERMS: ·        Quality of Life- it refers to the satisfaction derived by the respondents in terms of their performance in the activities of daily living namely; shopping/ marketing, the way they dress, socializing, participation in sports activities, going to work and school and performing sexual activity and cognitive functioning. ·        Cognitive functioning- In some forms of psychometrics, particularly those related to the  Type Indicator, the cognitive functions (sometimes known as mental functions) are defined as different ways of experiencing and thinking about the             world. They are defined as "thinking", "feeling", "sensing" and "intuition". ·        Demographic profile-  refers to the gender and age of the patient                                       CHAPTER TWO THEORETICAL BACKGROUND   REVIEW OF RELATED LITERATURE AND STUDIES   RELATED LITERATURE:           Quality of Life is the degree of enjoyment or satisfaction experienced in everyday life. [5] In biblical times lepers had to live outside of society. In medieval times they had to ring a bell and call "unclean" wherever they went. Catching leprosy requires living in close contact for a long time and many labeled as lepers probably had diseases like eczema or psoriasis that are not infectious. The stigmatization of lepers was not a public health measure to control the spread but a reflection on how people view those with skin disease. Simply having skin disease is bad enough but the social response of others makes it much more difficult. [6]           As early as 1985, Quality of life has been employed as a major endpoint to evaluate and compare therapies along with clinical outcome measures such as efficacy and survival. [7] In cancer therapy, for instance, the emphasis is on the side-effect and quality of life. [8]           In dermatology where most patients are seen in the ambulatory, care setting survival is not a major end point [9] and because the therapeutic modalities here have comparable efficacies, the use of quality of life became even more important. Several well-validated dermatology-specific questionnaires have been developed, the first being 's Dermatology Life Quality Index in 1983.   RELATED STUDIES: The effect of skin diseases on quality of life in patients from different social and ethnic groups in Cape Town, South Africa. (.; ) Skin diseases can greatly affect the quality of life (QoL). Little is known, however, of their impact on QoL in the developing world. This study was designed to assess the effect of skin diseases in such a setting. A questionnaire survey of patients using the Dermatology Life Quality Index (DLQI) modified to the cultural needs of the population. The adapted instrument was translated into Afrikaans and Xhosa. Six hundred and seven patients attending general dermatology clinics at  Hospital and 53 controls were recruited. Influences on QoL of clinical severity, employment, education, age, sex, and home language were examined. Participants included 313 (52%) English-speaking, 215 (35%) Afrikaans-speaking, and 79 (13%) Xhosa-speaking dermatology patients. Independent risk factors for having a high disability score were dermatologists' assessment of severity, younger age, unemployment, and language (odds ratio, 0.13; 95% confidence interval (CI) of 0.03–0.5 for Xhosa speakers compared to Afrikaans speakers). Gender was not associated with a high score, but females were more likely to report effects of skin disease on self-esteem, clothing choice, treatment problems, and     In this multicultural setting, social class and language group, but not gender, influenced the impact of skin disease on overall QoL. Xhosa speakers were apparently less affected than other patients. This could be due to cultural differences in the experience of skin disease and in the perception of disability, or to biases in questionnaire responses. Anxiety and depression were relevant dimensions of QoL in this study and should be considered for inclusion in future research. The adapted and translated DLQI was valid and reliable. [10] Eczema impairs quality of life in children to same extent as kidney disease. Children with serious skin conditions feel their quality of life is impaired to the same extent as those with chronic illnesses such as epilepsy, renal disease and diabetes, according to research published in the July issue of British Journal of Dermatology. A team of Scottish researchers surveyed 379 five to 16 year-olds, who had been suffering from skin diseases like acne, eczema and psoriasis for more than six months, together with their parents. They asked the children and their parents how much the condition impaired the child’s quality of life when it came to factors such as pain, loss of sleep, dietary restrictions, interference with school and play, friendships, teasing and bullying and medical treatment.   They then compared the quality of life scores given by the parents of 161 children with chronic diseases in the same age group. Only six of the 546 parents approached by staff at Ninewells Hospital in Dundee and Perth Royal Infirmary preferred not to take part in the research. All the children included were attending outpatient clinics at the two hospitals.    Key findings included: ·        The children in the study said that psoriasis (red scaly patches) and eczema were the two skin conditions that caused them the greatest distress. Both resulted in 31 per cent impairment in their quality of life score. This was followed by urticaria (itchy allergic skin rash) at 20 per cent impairment and acne at 18 per cent impairment. ·        From the parent’s perspective, eczema was the biggest skin problem at 33 per cent, followed by urticaria at 28 per cent, psoriasis at 27 per cent and hair loss at 19 per cent. ·        When they compared the overall results for the children with skin diseases and chronic illnesses, the researchers found that the condition that had the worst affect on quality of life was cerebral palsy at 38%. Generalized eczema and kidney disease both scored 33%t. ·        Cystic fibrosis also made the top five (32%t), followed by urticaria and asthma (28%), psoriasis (27%), epilepsy and bed wetting (24 %), diabetes, hair loss and localized eczema (19%) and acne (16%). ·        When children with psoriasis, and their parents, were asked to chose the things that affected the child’s quality of life most, parents rated bullying third and children rated bullying fourth. ·        Teasing or bullying was also a key concern for the 11 children with hair loss, with six of the children and nine of the parents putting it first on their list.   ·        The biggest concern for children with eczema, psoriasis and uticaria was itching or pain, while children with acne or warts said that embarrassment was their main worry. “Our study shows that children with chronic skin diseases – and their parents – reported the same level of quality of life impairment as the parents of children with many other chronic illnesses” says lead author Dr Paula Beattie from the Royal Hospital for Sick Children in Glasgow.           “Skin diseases are often more obvious to other children than chronic diseases such as asthma or diabetes and are more likely to lead to alienation, name calling, teasing and bullying. “Some skin conditions can also disturb children’s sleep and cause lack of self-confidence, embarrassment and poor self-esteem, especially as they get older. “Although skin diseases may not shorten life in the same way as serious conditions like cystic fibrosis, they can cause children as much, if not more, distress in their everyday lives.” According to co-author Dr , Consultant Dermatologist at Ninewells Hospital, Dundee and British Skin Foundation spokesperson: Measuring quality of life can be a powerful political tool as it provides the patient’s perspective on the health impact of different diseases. “This is particularly important when arguing for vital resources, especially in dermatology, as skin diseases are not considered to have as much of an impact on people’s lives as other illnesses. “Our study clearly shows the profound effect skin diseases can have on children’s quality of life and we hope that our findings will raise awareness of the problems they face and encourage greater sensitivity towards them.”  of the British Skin Foundation agrees: “All too often, people think of skin diseases like eczema as nothing more than a mere annoyance. Sadly, this simply is not the case. “We frequently hear of children who cry all night because of their itchy, flaky skin. This in turn leads to a lack of sleep and extreme emotional upset for their parents too. “The psychological impact of visible skin diseases can be massive, with children facing bullying because of the way their skin looks. We even hear of children not wanting to swim or take part in sports because they don’t want to have to reveal their skin in the changing rooms. Of course, this can lead to enormous stress for the patient’s family also. “This is why as a charity we are dedicated to raising money for research to end the diseases that blight millions of people’s lives in the UK.” [11]   THEORETICAL & CONCEPTUAL FRAMEWORK: We theorize that skin diseases affect patients' well-being and their ability to perform activities of daily living just like any other medical problem in the local setting. The concept of quality of life was developed to interpret data obtained about the impact of disease on the patient's well being. This was fostered by the World Health Organization (WHO) view of health as not merely the absence of disease or infirmity, but the ability of the person to lead a productive and enjoyable life. We conceptualize that quality of life can be measured by asking patients to answer a questionnaire which measures the effect of skin disease and its treatment on a patient symptoms, feelings and daily activities over a specified time.           The theoretical framework guiding this research is the concept that skin disease has an adverse impact on the quality of life of the patient.   HYPOTHESIS:           The null hypothesis that was used to guide this study was: 1.     There is no difference in the quality of life of patients with skin diseases when respondents are grouped according to their demographic profile. 2.     There is no difference in the level of the quality of life of patients with skin diseases and those without skin diseases               CHAPTER THREE METHODOLOGY RESEARCH DESIGN:           This non-experimental study uses the prospective quality of life survey and analysis.   LOCALE OF THE STUDY:             The setting of the study was at the Lucena Skin Center. A Dermatology Clinic manned by a Fellow of the Phil. Dermatological Society and a Fellow of the Phil. Leprosy Society. The clinic is situated in Lucena City.   RESPONDENT AND SAMPLING PROCEDURE:           Respondents were consecutive patients, age 15 and above, whether old or new, consulting for any skin diseases were included in the study. The patients companions whose ages were also 15 and above served as the control (those who do not have skin diseases) subjects. Both the inclusion and exclusion criteria for patient's selection were adopted from the source. As in the original, the criteria for the selection of the controls were that they should not have seen their general practitioner over the previous "3 months", they should have had no skin problem or other systemic medical disease over this time; and, that they should have no apparent disability. Excluded in the study were those with intellectual impairment or a psychiatric disorder, and those who were illiterate or were unable to communicate in Filipino unless a reliable interpreter was present.   RESEARCH INSTRUMENT:           We reviewed 3 different well validated dermatology-specific quality of life tools for possible translation. Both developed in the U.S, the Dermatology Specific Quality of Life (DS8QL) [12] had 52 items for acne and contact dermatitis cohorts while the revised SKINDEX [13] had 29 item tests for patients with any skin disease. The revised Skindex Categorized domain/scale into emotion, symptom, and functioning, and had 5 responses choices. Dermatology Life Quality Index [14] [15] [16] (DLQI), a tool developed in UK, was similar to Skindex in terms of generic coverage, domains, and responses choices but consisted only of 10 items which fit on a single sheet of paper, and was those chose for translation. Quality of Life research measures the effect of a disease and its treatment on a patient's symptoms, feelings and daily activities over a specified time. The Dermatology Life Quality Index (DLQI) questionnaire is a non-skin disease specific Quality of Life tool developed by Dr. Finlay. It consist of 10 questions and can be analyzed under the following headings: Symptoms and feelings (items 1 and 2), daily activities (items 3 and 4), leisure (items 5 and 6), work and school (item 7), personal relationships (item 8 and 9), and treatment (item 10). It is calculated by summing the score of each question (scored from 0 to 3) resulting in a maximum of 30 for the 10 items and a minimum of 0. The higher the score, the more quality of life is impaired.   TRANSLATION:           The original questionnaire was sent to 4 independent bilingual (English and Filipino) translators and their output were later "translated-back" by a bilingual lay panel consisting of 2 persons. The first item refers to the Symptoms (itchiness, pain, discomforts) while the second item on "hiya", which loosely translates in English as "embarrassments". Item 3 evaluates the effect on shopping or household chores while item 4 in the way of dressing. The fifth item is on social and leisure and the sixth item on sports and exercise. Items 7, 8, 9 and 10 concerns on work, school, relationships, Sexual difficulty, and treatment respectively. The following modifications were noted: (1) the tool was renamed IKPAS (Indeks ng Kalidad ng Pamumuhay ng may sakit sa balat), (2) the general patient data was omitted on the questionnaire except age, sex, and diagnosis to save on space, (3) a confidentiality clause was inserted on the introductory statement and includes the aim of the study. (4) 2 Filipino words ("Gaano" and "Paano") were used to encompass "How much" in the original, (5) and although the attempt was to do a literal translation without any loss of the concept, for item on household chores of house keeping, buying at the market ("Pamamalengke") was included; for item on leisure activities, watching movie ("Panunuod ng Sine") was given as an example; For the item on sports, the word "Ehersisyo" (Exercise) was incuded; "Sex" was used in the context of sexual difficulties in the original; and on the item relationship, "Asawa" (Spouse) was used for "Partner". Response choices scales were structured similar to the original and used the same scoring system: "Sobra-sobra" (score=3), "Sobra" (score=2), "Medyo/Oo" (score=1), "Wala/Hindi" (score=0), "Walang kinalaman" (score=0), and no answer (score=0). A higher score (total=30) indicated a lower unfavorable quality of life.   DATA COLLECTION:           The researchers collected the data from Lucena Skin Centers Clinic. Both the inclusion and exclusion criteria for patient selection were adopted from the source. Consecutive patients, age 15 and above, whether old or new, consulting for any skin disease were included in the study. The patients' companions whose ages were also 15 and above served as control subjects. The paramedical staffs were also recruited as control subjects. As in the original, the criteria for the selection of controls were that they should not have seen their general practitioner over the previous "3 months", they should have had no skin problem on other systemic medical disease over this time; and, that they should have no apparent disability. Excluded in the study were those with intellectual impairment or a psychiatric disorder, and those who were illiterate or were unable to communicate in Filipino unless a reliable interpreter was present.           The time needed to complete the questionnaire ranged from 1 to 36 minutes with the mean at 5.23 minutes. However, it is significant to note that 205 respondents (78%) took less than 5 minutes and another 39 (15%) took between 5 and 10 minutes to answer the questionnaire. This leaves only 19 (7%) who took more than 10 minutes to answer the questionnaire.   DATA PROCESSING AND ANALYSIS           Consecutive patients who passed the entire inclusion and exclusion criterion were politely asked to answer the IKPAS (translated questionnaire) after giving their permission.           When all the data were at hand, we computed the reliability of our translated questionnaire using the 's alpha Coefficient and then we analyze our findings on the effect of the skin disease on the quality of life of patients with skin disease and compare the findings with those without skin diseases. There was a significant difference between scores of the patients (6.89, SD: 4.55) and controls (0.89, SD: 1.8) (p=0.000), demonstrating construct validity.   RELIABILITY TEST TOOL:           When analyzing the reliability of your instrument, the best is to retest the subjects using the same instrument to see if the subjects are consistent with their answer. But researchers have devised a formula to compute the reliability of a survey instrument. The reliability test is called 's alpha coefficient. Its formula is:

the effect of common skin disease on the QOL of patient in the local setting

My adviser wants me to modify the title from “quality of life of patient with skin disease in the local setting” to "the eff...

Changes in Korean Family Structure and the Conflicts of Ideology and Practice in Early Socialization

Changes in Korean Family Structure and the Conflicts of Ideology and Practice in Early Socialization Chung Byung-Ho Introduction With rapid industrialization and urbanization, the Korean family has undergone tremendous change in both structure and function. Family size is continuously decreasing, and the number of extended families is decreasing, too. One-generation and two-generation families have increased, and the increase in one-person households is remarkable. Divorce has increased explosively, and more than half of married women join the labor force. Family values and ideologies have not changed enough to meet with the changes in family structure. Modern values of an industrial society such as independence, freedom, and achievement have been gaining more and more importance in people’s lives, especially in the formal sectors such as schools, the workplace, and other formal organizations. Where the family is concerned, however, traditional values such as parental authority, children’s filial piety, and gender-role differentiation are still widely emphasized, and the virtues of the tradi- tional family are highly praised. Dominant values in today’s Korea still favor family care of infants and young children. However, during the last decade, Korea built an extensive day-care system in order to allow mothers to take employment outside the home. Under the surface of the monolithic image of Korean child rearing, which assumes the presence of a family and a “professional housewife,” in reality, there is a significant cleavage in the environments of early socialization between children reared at home and those in full-day child-care centers. Since the dominant discourses still emphasize the “modal” practice of child rearing and the role of the “proper” mother, the children in the centers and their working mothers are often considered either to be exceptions or an insignificant few who form a sort of cultural minority. Cleavages in the paths of early socialization often overlap with the divisions among social classes and differences in the conceptions of “proper” gender roles. Full-day child-care centers supposedly are for the children of working mothers who are either forced or willing to take outside occupations despite the dominant social norms. In this regard, the rapid expansion of the day-care system is not only a reflection of large scale economic changes but also a potential challenge to the official model for how Koreans are supposed to live. Traditional Ideologies and Current Problems Changes in Family Structure Over the last few centuries industrialization and urbanization have brought about changes in family structure all over the world. All these changes have occurred in modern Korea very drastically within the range of just a few decades. Table 1 shows these changes in some basic social indicators. The changes in family structure have occurred in accordance with the socioeconomic conditions. Table 2 presents the changes in household types. Table 2. Changes in Household Types (Unit: %) 1960 2000 One-generation 5.4 14.2 Two-generation 64.0 60.8 Three- and more generation 28.5 8.4 One-person 2.3 (1966) 15.5 Not blood related 2.1 1.1 Source: KNSO (2000b) As shown in Table 2, within a period of 40 years, extended families of three or more generations have decreased to less than one third, and one-generation families have almost tripled. The increase in oneperson households is even more remarkable. As the divorce rate has gone up from 2.5% in 1960 to 25% in 2000, single-parent families have also increased sharply. These statistics show the drastic changes in the Korean family structure over the last 40 years, and the trend will continue in the future for some time with the ongoing changes in the Korean society toward higher economic development, democratization, individualism, and longer life expectancy. Table 1. Korean Social Indicators 1960 2000 Per capita GNP ($) 79.6 9,628 Urbanization (%) 28.6 86.2 Life expectancy 52.6 74.9 Source: KNSO (2000a) Ideological Conflicts: “Normal” and “Abnormal” Family There is a cultural lag between practice and ideology. This situation produces psychological dissonance and creates adjustment problems of various kinds. The dissonance between the dominant traditional family values and widespread family practices can make people think that they are “abnormal” or even “immoral.” Ironically, the majority of family practices can be categorized as “abnormal” (Chung Byung- Ho 1995). The dissonance between the older and younger generations within a family is very serious, too. They have different ideas about whom to live with, what role to play, and how to interact and communicate. It is a source of heavy stress for both parties. The dissonance also exists within a single individual. Many people experience the conflict between their psychological need for freedom, independence, and equality, and the internalized cultural norms within oneself. This dissonance or inconsistency can lead to mental health problems, interpersonal conflict, and moral dilemmas (Chung Jean-Kyung 1996). These problems occur in any society to some extent, but they are more acute in Korea because of the rapidity of its industrialization. Korea’s tremendous economic development over the last three decades has attracted a lot of attention from all over the world. But economic blessings are not without a price. The changes in family structure occurred drastically without allowing enough time for adaptation or adjustment. Current Problems Traditional Korean family values are undergoing a change, but not fast enough to meet the changing family structure. In May of every year, which is designated the “family month,” the mass media laments the deterioration of the traditional family values, gives out prizes to those who kept the good tradition of filial piety (hyo), and prompts people to revive the good virtues. Clearly, one of the reasons Changes in Korean Family Structure and the Conflicts of Ideology and . . . 127 for the gap between family ideology and practice is that the high speed of changes in family structure did not allow people the time they needed to adjust their thinking. There are other reasons, however, that are more specific to Korean culture itself. Korea has been described as one of the most collectivist cultures (Bond 1988; Han and Ahn 1994; Hofstede 1980). People in collectivist cultures live in strong and cohesive in-groups and value ingroup solidarity, harmony, and duty. In-group norms are strictly followed, a practice which makes the members reluctant to stand out. Therefore, even when the pattern of family life has changed for many, they do not want to speak out for the new values in the face of the dominant majority. In a way, it is analogous to the concept of pluralistic ignorance, in that even though the new values are held privately by a lot of people, they tend not to surface and make changes in the cultural discourse unless the people realize that there are many others who feel like themselves. Another reason for the persistence of traditional family values can be found in Korea’s modern history. Since the nineteenth century, Korean society has experienced a dissolving of the traditional social stratification system, peasant uprisings, and a number of wars. With the Japanese occupation, many were deprived of their land, forced to leave the community, or drafted to the army and forced labor. During this period of turmoil, the people had to survive social insecurity, economic poverty, and cultural confusion, and the family was often the only resource and protection they had. Losing the protection of the government altogether, “family-centered survival” (Jo Hye-jeong 1988) became the life goal of most people. The external threats to the family elicited a strong reactive response. It enhanced the cohesiveness of the family as a unit, strengthened its ability to survive in the face of hardship, and consequently reinforced the sentiment of “familism” with all the traditional family values that go with it. 1) Obsessions of “Blood” and Extreme Infant Sex-ratio The most striking example is the phenomenon called “boy preference.” The sex-ratio of boys to girls at birth was 115.2:100 in Korea in 1994, the highest in the world (Newsweek 1995). The traditional value of continuing the patrilinear descendence with at least one son and the contemporary practice of having a small number of children found a solution in selective abortion, using the modern medical technology such as ultra-sonograms. The law prohibits selective abortion (in 1999, the sex-ratio lowered to 109.6:100), but the ratio tells how widely it has been practiced. For the fourth child, the ratio of girls to boys is less than 50 percent. A married woman is likely to be under some pressure from her husband and in-laws, either openly or covertly, to give birth to a son. The pressure from the husband’s family, however, is not the only factor. Often, it is the wish of the woman herself. This is where the problem gets more complicated. Women these days cannot and do not expect their sons to behave like the sons in the traditional family, obeying parents, living with them, and supporting them in their old age. They have observed that the number of elderly who live with and are supported by the oldest son, or any son, has decreased. Boy or girl, children these days have become an economic burden on the family rather than an economic asset or an insurance against old age. Furthermore, in modern nuclear families, the love and intimacy between husband and wife is not structurally interfered with. In this respect, the boy preference in contemporary Korea does not have the instrumental or sentimental basis it had in the past. The only meaningful aspect of the boy preference that is still effective is the symbolic power and status that bearing a son gives a woman in the husband’s family. The factors that comprise boy preference and influence a woman’s decision to have a selective abortion need further investigation. The immorality of the selective abortion is mitigated and rationalized with the excuse that it is done “for the family,” giving a good example of how the “familism” sometimes comes before morality. But, for many women who go through selective abortions, the psychologi cal hurt remains. Even when it is their own decision, the guilt and pain from “killing a baby girl, a daughter that might have been,” troubles them for a long time. It goes against their basic moral values, and creates a dissonance that does not go away easily (Chung Jean-Kyung 1996) 2) Private Competition and Erosion of Early Childhood Under circumstances in which the family unit becomes smaller and the value of domestic labor drops, the social realization of self for the married women becomes even more imperative, not only as a personal goal but also as a social necessity. However, patriarchical family ideology blocks any paths open to married women for self-realization in the social or official spheres.1 Frustrated married women are often susceptible to many pathological problems, and they, as an oppressed cultural minority, may cause numerous social problems, especially in relation to education and childcare. Children’s education becomes one important arena where women compete with a concentration of their personal ability and social resources. Being restricted from many socially meaningful activities, mothers seldom find ways to fulfill their social self other than realizing it indirectly through their children. On the other hand, it is considered to be one of the most acceptable and surest investments, one that is closely related to traditional strategies for establishing one’s place within the existing social stratification. As such, it is a serious social power game, with the future at stake, in which mothers become major players. In view of a familism based exclusively on blood ties, children cannot be separated from the family, and thus, they are expected to function as a means of reproduction of family, status, and property. As the number of children in the nuclear family decreases, the traditional expectation becomes an intolerable pressure on the children. It often leads to collective child abuse, as a kind of new cultural practice, to which the contemporary Korean society at large has yet to be sensitized. Compared to the past, today’s younger children in Korea are blessed with material abundance. However, they are deprived of spontaneous social relationships and cultural experiences. They are typically confined to the apartment of the nuclear family, especially with their mothers who are usually isolated from relatives, neighbors, and larger communities in their daily interactions. Limited spaces in institutional group settings for education and care do provide experiences to interact with others. However, these invaluable opportunities are often eroded by collective class-room activities which promote competitive early learning and talent training. Due to their parents’ ambition and strong desire to see their children achieve much at an early age, many young children find themselves spending long, passive hours every day in talent-training classes. Field (1992) describes a similar phenomenon caused by parental obsession in Japan, and argues that it is an example of forced “labor” upon children. For the children, it results in the “erosion of childhood” (Suransky 1982), taking away the experiences and happiness they deserve during their childhood. 3) Working Mothers and the Need for Socialized Childcare Unlike our image of Korean mothers as “professional housewives” who rear their children and stay at home, a significant number of mothers are fully incorporated into paid work outside the home, and a large percentage of children are reared in institutional settings. In the year 2000, 77.9% of married women worked, while 27.3% of mothers with 0-5 year-old children (33.9% with 3-5 year-olds; 20.5% with 0-2 year-olds) had jobs, numbers that run counter to the dominant values which still insist that the mother should care for infants and younger children in the home. Further, three out of four full-time housewives, ages between 25-29 years old, want to have jobs outside the home, if they can find a proper arrangement for the care of their children (Hankyoreh 21 2001). In other words, today’s Korean mothers favor more socialized childcare than family care. The problem is that the society is not able to recognize nor to respond to their demands properly yet. Figure 1 shows the dynamic changes of the women’s participation in the labor force during the years from 1960 to 1995. The participation rate has more than doubled since the 1960s. The rapid expansion of the Korean economy and the ever increasing demands for labor have been considered as the main causes of this radical change. But, it also needs to be examined from the supply side, from the changes in women’s lives. Marital status, child birth, and education are the major factors that affect the women’s participation to the labor market. All of these areas have changed drastically. First of all, the total birth rate dropped from 4.8 children in 1965 to 1.7 in 1985, and it has remained at this level to the present (KWDI 1997). It means that women have been somewhat freed from the demands of repeated pregnancy and child birth during their marriages. It also affects families’ investment into girls’ education. Second, the average number of years of formal education for women increased from 3 years in 1960 to 9.3 years in 1995. The increase in the education of younger women had been so rapid that, by 1995, there was no difference in average length of education between men and women under 30 years old (Jang 1998). During the initial period of industrialization, in the 1960s and 1970s, undereducated young girls as unskilled cheap laborers in the factory had been the symbol of women in the labor force. Now, more and more women with higher education want to find jobs with the potential for a life-time career. Third, the average age for a woman’s initial marriage gradually increased from 21.5 years old in 1960 to 26 in 1995 (ibid., 1998). Prolonged education must have affected the delay of initial marriage. At the same time, many young women see marriage as a less appealing option that would disrupt their individual social lives, and would rather extend unmarried life with a career as long as possible. Even after marriage, they tend to delay childbirth. The sharp valley in the M-curve of the women’s age-cohort labor pattern (Figure 1) reveals the reality of the labor market. It represents both how the labor market pushes women out at the time of mar- riage, childbirth, and child rearing, and how the society is not supportive of them. Dominant ideologies concerning the family and the role of the mother lay the cultural foundations for these discriminatory social practices against women. The establishment of the socialized child-care system will be an effective tool for further social change. Dual Responses: “Education” and “Care” Families, homes, and mothers are still considered to be major agents for the early socialization of children in Korea. However, rapid industrialization and urbanization have created emergent new needs for early socialization outside the home. The speed of change has been so fast that the society has failed to respond to them in time. The traditional view of education as a means of social competition has eroded the childhood experience by being extended to younger children. The lack of understanding of the need for social childcare has made the children of some working mothers the victims of fire when they were locked in tiny one-room apartments. Still, Korean society has difficulty in acknowledging the contemporary problems of childcare and education as social responsibilities. Children under the ages for compulsory education are believed to be in the hands of mothers, and thus, the expenses of their education and care are considered to be solely family matters. Even the advocates and policymakers, who argue for the governmental support for early socialization, find their rationale in the traditional perspectives on competitive schooling and the welfare of the poor. Early Education: Domestic and International Competition Kindergarten education in Korea started out as an exotic form of early socialization for the children of elite families. As an import for the privileged, it displayed many distinctively foreign cultural forms that became the dominant mode of early education. Not only the material settings such as buildings, classes, and educational materi- als, but also the songs, dances, and ways of speech and interaction patterns were modeled after the dominant foreign practices. During the colonial period, the prewar Japanese kindergarten practices laid the foundations of the kindergarten culture in Korea. Uniforms, collective activities, and ritualized interactions between teachers and children are still visible in many kindergartens as a legacy of the past. After the liberation and the Korean war, American culture added a new layer to the kindergarten life. Some kindergartens, usually affiliated to universities, started to emphasize more liberal approaches for individual freedom and development. However, their influence has been limited to a few experimental institutions because of the societal obsession for the competitive education. Still, popular perception of early education as fundamentally foreign and advanced has been confirmed and widespread. Even today, many early educational institutions display the names of foreign scholars, theories, and practices as their models. Until 1975, kindergarten enrollment of the 5 year-old children had remained under 2.8%. It rose to 45% in 1997.3 This marks a significant shift from the education of the few to that of the masses. However, the modes of education have not changed much. Kindergartens in contemporary Korea are mainly for the children of nonworking mothers. With only morning-hour programs (four hours a day as a standard, usually with a 9:00 A.M. to 1:00 P.M. daily schedule) and with long vacations, kindergartens assume the existence of full-time housewife mothers. A very limited number of kindergartens in urban areas have started to provide after-hour services for the children of working mothers, but few of them are willing to extend their programs into the long vacations. In short, they are schools and they have all the characteristic rhythms of formal educational institutions. There has been an even more explosive expansion in the field of early education parallel to the kindergarten. This has been the expansion of the private institutions for early talent training. It is sometimes called the “early education industry,” since most of these institutions clearly show a profit-motivation by running institutions with business-like management skills. In these institutions, children from very early ages are supposed to learn any specific subjects such as reading and writing, math, foreign languages, drawing, dance, swimming, and taegwondo. Every possible subject in education is for sale. In this field, discourses on the success and the failure in education are consumed extensively among educators and both working and nonworking mothers. Competition is the key factor that makes mothers most deeply afraid. Earlier learning is widely believed to be the only effective tool for success in the realms of domestic and international competition. It is no wonder that many advocates and policymakers emphasize international competition as a reason for further governmental investment in early education. Child-care Priority: Class or Gender The government’s delayed response to childcare was not simply due to inefficient bureaucratic arrangements, but was mainly due to dissonance in the cultural concepts (or political ideologies), especially among the policymakers, concerning the roles of the government and the family. In 1981, the First Lady of the President who had come to the power through the military coup launched an ambitious campaign, called the “New Village Kindergarten” (saemaeul yuawon), for early childhood education. She transformed all of the full-day child-care institutions (hundreds of children’s homes or eorini jip) into half-day kindergartens for the early education for the poor. This project systematically up-rooted the child-care system while Korean society was well into its rapid industrialization. The ideas behind full-day childcare were often thought to be “communistic.” At the same time, the practice of institutional childcare was legally blocked until the democratization of 1987. However, even today, this period is highly praised in the history of education as one of drastic development from the “simple care” to the “advanced early education.” Any systematic response to the child-care needs had been delayed in Korea until there occurred a series of accidents in which infants and toddlers who had been locked inside the house were killed in fires while their parents were out working. Such accidents occurred repeatedly in the years between 1989 and 1991 and were considered to be clear evidence of policy failures in which the necessity of state-supported childcare had been consistently ignored. It was at that time that the general public finally realized that society and the government should assume responsibility of childcare since many individual nuclear families were no longer able to provide the necessary care themselves. Finally, the Infant and Childcare Law was passed in 1991. Immediately, the child-care system rapidly expanded to such an extent that in 1997 the total number of institutions became 15,375 (public, 1,158; private, 8,172; workplace, 158; family, 5,877), enough to care for 520,859 children (Ministry of Health and Welfare 1998). These were neither the natural fruits of economic development nor the mechanical outcomes of policymaking by state bureaucracies. Childcare advocates and some progressive women’s organizations had to struggle for the establishment of today’s day-care system. Various forms of struggle such as rallies, sit-ins, fund raisers, signature collections, law petitions, and political campaigns had to be carried out to make even a minimal child-care system available. At the same time, the labor market demands on working mothers also pressed conservatives to make a bargain with progressives over the expansion of day care. Suffering from an extreme labor shortage beginning in the late 1980s, the Korean economy began to rely on imported foreign labor. As a means of exploiting available domestic labor, the day-care system was implemented for the integration of young mothers into the labor force.4 This was when the Ministry of Labor decided to step into the day-care business. However, there were limits to how far the system could expand and in what directions. The system itself ran counter to the dominant family values. The notion that financial support for childcare is only for the underprivileged class (or “broken” families) was firmly set in policy from the beginning. The government and conservatives held the view that most “ordinary” (or middle-class) families should carry the financial burden since the primary role of day care is child rearing. It is fundamentally a welfare program for the poor families in which mothers are forced to work outside home. The government only supports the public centers, which are supposedly located in underprivileged communities, and it provides subsidies for the children of families who receive social welfare. All private and family care centers operate only on the tuition.5 As private businesses, it is natural that most of these centers seek profit. However, childcare is fundamentally less profitable than education because of regulations prescribing “proper” teacher-children ratios for the care of younger children for the full day. The contradictions between policy and practice are the source of current problems which result in a lack of infant and toddler care in most centers. Many centers even demand the softening of regulations in order to have the kindergarten-like large classes but with fewer teachers. Unlike the stereotypical images of childcare as a form of social welfare for the poor, the actual need of childcare has been emerging across classes and regions. After such rapid social change, it is now almost evenly distributed among the entire population, as a significant proportion of women of all ages and classes participate in (or, at least, want to participate in) work outside the home. The only difference is whether this need is visible to the society or it is obfuscated by the sacrifices of individual family members. The need itself is not homogeneous any more. It is diverse and depends on the types of work and the life cycles of mothers. Further, as the divorce rate increases, not only the types of families but also the life-style choices of families also increase, and thus diversify the needs of childcare. The recently established Ministry of Gender Equality views childcare as mainly a gender issue rather than a class one. It seeks the establishment of a more comprehensive child-care system that would greatly enhance women’s participation to, and status in, the society. On the other hand, the Ministry of Health and Welfare, which still has full control over the system, insists on extending the system to support the poor and the working class. Debate in Practice From 1996, the kindergarten advocates have proposed to make the education for all 5-year-old children as part of the national compulsory schooling. By comparing Korea’s percentage of preschool enrollment with those of other OECD countries, the advocates have persuaded the government, and the proposal was accepted. It means that the establishment of half-day preschool education has now become the top national priority for early socialization. It also proposes the establishment of a nationally standardized education system for children over three years and a national care system for the infants and toddlers under age three. The advocates for “care” have resisted these proposals. They view them as a uniform application of educational policy to address radically different demands in early socialization. Further, they argue for the urgent extension of the child-care system to school-age children. The issue of the “unification of kindergarten and the day-care system” has been a central theme of the debate among the people in both camps, and in the related offices of government. In terms of theory and principle, it is rather a clear and simple demand, since both institutions serve overlapping age groups (from three to five, that is, preschoolers), and everyone agrees that for these children, education and care should not be separated. But, it is often speculated that conflicts of interest in the two camps and between the related government offices act as major obstacles to the unification. The two parties never come to terms with one another, since the kindergartens want to see a “kindergartenization” of the day-care centers, and, on the other hand, the day-care centers prefer a process of expanding the “full-day” care function to the kindergartens. However, the current situation can also be viewed as a reflection of social and cultural divisions at a deeper level. There are many layers of larger divisions in society that would directly influence the division of the two systems—such as divided concepts of mothering, radically different views on childhood, and different ideas about early socialization in institutional settings. Furthermore, there are fundamental policy differences regarding these institutions among three government offices: the Ministry of Education, the Ministry of Health and Welfare, and the Ministry of Gender Equality. Each system is supposed to respond to one set of needs and expectations of a different segment of the population. Sometimes, the arbitrary division of the system dictates the choice of the people who are less dichotomized than the governmental definitions. The division itself guarantees a dichotomized experience for the children. How far can this division between “education” and “care” go? Is the current situation a process of polarization of early socialization, or a process of eventual integration of the two systems and concepts? The answers remain, in large part, dependent on changes in the larger society: changes in the nature of women’s participation in social labor, changes in the mother’s role in the domestic sphere, and changes in society’s view of educational institutions and education itself. However, there are groups of people who believe in the power of social action to make and accelerate changes through their efforts, especially in the day-care field. In order to challenge the dominant cultural patterns and social structure in Korea, some individuals and organizations, with progressive ideologies of class and gender issues, utilize day care as transformative institution for socializing a new generation—children who will acquire alternative values and behaviors—and for inducing concomitant sociopolitical change. While the majority of kindergartens and day-care centers in contemporary Korea still effectively carry out conservative functions by practicing the collectivist and discipline-oriented process of socialization, some centers, such as the “cooperative childcare” (gongdong yuga) centers, challenge them by developing a radically permissive pedagogy that emphasizes activities in nature and at a tempo of daily life rather than a tightly organized school-like schedule in the classroom (Chung Byung-Ho 1994). Through daily interaction, these experimental centers perform mediating functions by developing strong bonds between child-care practitioners and parents, and among the parents. Based on this social bond and these consciousness-raising efforts, the adults are politicized through their involvement in institutional child-care practices, and become organized to participate in various communitylevel social movements and engage with important concurrent social issues. They have opened the day-care field as a new arena where the dominant concepts and patterns of early socialization are constantly challenged and transformed. In this context, theory and practice in the Cooperative Centers have become an excercise of “cultural politics” (Giroux 1991) intervening in power structures. Conclusion Research on early socialization in Korea has mainly focused on childhood experiences in the home and familial relationships. The strong ties between mother and child have been considered crucial in formulating the later personalities, interpersonal relationships, and adult social participation. Such conceptions of universal experience in early socialization are mostly based on conceptions of Korea in which a homogeneous national culture, patriarchal family structure, and rigid gender-role division are supposed to dictate social life. However, like families in any society that has undergone rapid industrialization, Korean families have also gone through all the characteristic changes attendant to the processes of industrialization and urbanization. The current problems emerge mainly from the rapidity of these changes. The speed of these societal changes has created serious dissonance between the traditional family ideology and the already diversified modes of family lives. Working mothers and the issues of socialized childcare constitute one of the most dynamic fields in which the contradictions of contemporary Korea can be seen. The dominant ideologies still dictate that mothers stay in the home, but, in reality, the majority of mothers work outside the home. The hegemonic exercise of cultural perceptions such as “full-time housewife and mother” pushes women to leave the labor market during the childbirth and child rearing only to return to it later and receive much lower wages and positions. According to the dominant values, children under age five should be reared in the home by family members, but, in practice, institutional modes of collective child rearing are rapidly becoming popular among many families across different classes and regions. As in other industrial societies, Korea, too, developed its childcare system initially to put mothers into the labor force (Chung Byung-Ho 1992b). But, during the last decade, the focus of the system has gradually shifted from the mothers to the socialization of the children. What children learn or experience in a child-care facility has become a greater concern, since it touches on a variety of issues: equality (or equal opportunity) between children at home (or in a half-day kindergarten) and children in a full-day child-care center; the nature of the center, whether as a place for early schooling or for communal living; and the role of the center, whether as a socializer of dominant values or of alternative ideals. Socialized childcare itself has been considered to be a fundamentally subversive practice to the traditional family ideology. Now, like the heated debate of “education” and “care” for children of the same age group, the questions of who controls, what kind of program, for whom, and for what are more explicitly confronted and debated in many fields of early socialization by groups with varied and often contradicting expectations for future generations. REFERENCES Bond, Michael Harris. 1988. “Finding Universal Dimensions of Individual Variation in Multicultural Studies of Values: The Rokeach and Chinese Value Surveys.” Journal of Personality and Social Psychology 55: 1009- Choe, Jae-seok. 1983. Hanguk gajok jedosa yeon-gu (The History of the Korean Family). Seoul: Iljisa Publishing House. Chung, Byung-Ho (Jeong, Byeong-ho). 1992a. “Childcare Politics: Life and Power in Japanese Day Care Centers.” Ph. 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Changes in Korean Family Structure and the Conflicts of Ideology and Practice in Early Socialization

Changes in Korean Family Structure and the Conflicts of Ideology and Practice in Early Socialization Chung Byung-Ho Introduction Wi...