본 연구는 농촌지역 퇴행성관절염 노인을 대상으로 계획적 행위이론에 근거한 운동수행 의도증진프로그램의 효과를 기존의 교육프로그램의 효과와 비교함으로써 퇴행성관절염 노인의 건강증진 향상에 효과적인 프로그램을 찾고자 시도된 비동등성 대조군 전후설계의 유사 실험연구이다. 자료 수집은 2012년 1월 16일 부터 2012년 4월 9일 까지 12주 동안 이루어졌다. 대상자는 강원도 C시 보건진료소 관할지역 노인으로 의료기관에서 퇴행성관절염으로 진단받았으며, 일상생활이 가능하고, 규칙적인 운동프로그램에 참여하지 않은 자로 실험군은 32명, 대조군은 34명으로 총66명이었다.
계획적 행위이론을 적용한 운동수행 의도증진프로그램은 12주의 중재프로그램으로 첫 주에 퇴행성관절염에 대한 관리방법과 운동교육을 2회에 걸쳐 실험군과 대조군에게 제공되었고, 실험군에게는 2주부터 12주까지 운동 수행에 대한 행위 신념과 결과 평가, 통제 신념 및 규범적 신념을 강화시킬 수 있는 의도증진프로그램을 적용하였다.
운동수행 의도증진프로그램의 효과는 계획적 행위이론 변인(운동에 대한 태도, 주관적 규범, 지각된 행위 통제, 운동수행 의도, 운동수행), 신체적 기능(통증, 뻣뻣함, 일상활동수행 정도, BMI, 유연성, 평형성, 근력) 및 심리적 기능(지각된 건강상태, 생활만족도)을 측정하였다. 수집된 자료는 SPSS Ver. 18.0 프로그램을 이용하여 Independent t-test, ANCOVA 및 χ²-test로 분석하였다.

연구결과는 다음과 같다.

1. 계획적 행위이론 변인
가설 1 : “실험군은 대조군보다 운동에 대한 태도가 긍정적일 것이다.”는 지지되었다(F=65.408, p<.001).
가설 2 : “실험군은 대조군보다 운동에 대한 주관적 규범 수준이 더 높을 것이다.”는 지지되었다(F=24.732, p<.001).
가설 3 : “실험군은 대조군보다 운동에 대한 지각된 행위 통제 수준이 더 높을 것이다.”는 지지되었다(F=64.951, p<.001).
가설 4 : “실험군은 대조군보다 운동수행 의도 수준이 더 높을 것이다.”는 지지되었다(F=107.619, p<.001).
가설 5 : “실험군은 대조군보다 운동수행 비율이 높을 것이다.”는 지지되었다(χ²=6.964, p=.008).

2. 신체적 기능
가설 6 : “실험군은 대조군보다 관절기능(통증, 관절 뻣뻣함, 일상활동수행의 어려움) 점수가 낮을 것이다.”에서 통증(F=50.744, p<.001), 관절 뻣뻣함(F=32.519, p<.001), 일상활동수행의 어려움(F=50.744, p<.001) 모두 지지되었다.
가설 7 : “실험군은 대조군보다 체질량 지수(Body Mass Index; BMI)가 낮을 것이다.”는 기각되었다((F=0.479, p=.492).
가설 8 : “실험군은 대조군보다 체력(유연성, 평형성, 근력) 점수가 높을 것이다.”에서 오른쪽 상체유연성(F=8.253, p=.007), 왼쪽 상체유연성(F=9.471, p=.004), 하체유연성(F=54.046, p<.001), 평형성(F=13.270, p=.001)은 지지되었으나, 근력(F=2.708, p=.105)은 기각되었다.

3. 심리적 기능
가설 9 : “실험군은 대조군보다 지각된 건강상태 점수가 높을 것이다.”는 지지되었다(F=4.910, p=.031).
가설 10 : “실험군은 대조군보다 생활만족도 점수가 높을 것이다.”는 지지되었다(F=10.856, p=.002).

이상과 같이 계획적 행위이론에 근거한 12주간의 운동수행 의도증진프로그램을 적용한 실험군은 교육프로그램을 적용한 대조군에 비해 운동에 대한 태도, 주관적 규범, 지각된 행위 통제, 운동 수행 의도 및 운동수행이 통계적으로 유의하게 증가하였다. 또한 관절의 통증, 뻣뻣함, 일상활동수행, 유연성, 평형성과 같은 신체적 기능과 지각된 건강상태, 생활만족도 등도 통계적으로 유의하게 향상되었다. 따라서 평생 자가 관리를 해야 하는 농촌지역 퇴행성관절염 노인들의 건강증진을 위한 중재방법으로 본 연구에서 수행한 운동수행 의도증진프로그램이 실무에서 유용하게 활용될 수 있을 것으로 기대된다.

This study was a quasi experimental research with a nonequivalent control group pretest posttest design. The purpose was to identify the effects of a program for promotion of health in elders suffering from degenerative arthritis and to compare the "program- promoting intention to exercise" based on planned behavior theory to existing education programs for elders in rural areas suffering from degenerative arthritis. Data collection was done for 12 weeks between January 16 and April 9, 2012. The participants were 66 elders living in the district of the health service center of C city in Gangwon province. They had been diagnosed with degenerative arthritis but were able to continue daily lives. They were not participating in regular exercise programs. Thirty-two elders were assigned to the experimental group and 34 to the control group.
The "program promoting intention to exercise" was provided as a 12-week mediating program which provided methods for management of degenerative arthritis and exercise training for the experimental group and control group twice in first week then from second to the twelfth week, the intention promoting program was provided for the experimental group enabling them to reinforce behavioral beliefs and evaluation outcomes, control beliefs and normative belief related to doing exercise.
To test effects of the program, variables of planned behavior theory (attitude toward exercise, subjective norms, perceived behavior control, intention to do exercise, and exercising), physical function (pain, stiffness, degree of performing activities of daily living, BMI, flexibility, balancing, and muscular strength) and mental function (perceived health condition, and degree of satisfaction with life) were measured. Collected data was analyzed using independent t-test, ANCOVA and χ²-test with the SPSS Ver. 18.0 program.

The study results are as follows.

1. Effects of the theory of planned behaviour variables
Hypothesis 1 that “Participants in the experimental group would be more positive in their attitude toward exercise than those in the control group.” (F=65.408, p<.001) was supported.
Hypothesis 2 that “Level for subjective norm for exercise for participants in the experimental group would be higher than for those in the control group.”(F=24.732, p<.001) was supported.
Hypothesis 3 that “Levels of perceived behavioral control for exercise by participants in the experimental group would be higher than for those in the control group.”(F=64.951, p<.001) was supported.
Hypothesis 4 that “Level of intention to exercise by participants in the experimental group would be higher than those in the control group.”(F=107.619, p<.001) was supported.
Hypothesis 5 that “The rate of exercising by participants in the experimental group would be higher than those in the control group.” (χ²=6.964, p=.008) was supported.

2. Effects of physical function
Hypothesis 6 that “The level of Joint function (pain, joint stiffness, difficulty in activities of daily life) would be lower for participants in the experimental group than those in the control group.” Pain(F=50.744, p<.001), joint stiffness(F=32.519, p<.001), difficulty in activities of daily life(F=50.744, p<.001) were all supported.
Hypothesis 7 that “The Body Mass Index (BMI) would be lower for participants in the experiment group than for those in the control group.”(F=0.479, p=.492) was rejected.
Hypothesis 8 that “The level of physical strength (flexibility, balancing, muscular strength) for participants in the experimental group would be higher than for those in the control group.” was partially supported. Upper body flexibility on the right side (F=8.253, p=.007), upper body flexibility on the left side (F=9.471, p=.004), lower body flexibility (F=54.046, p<.001), and balancing (F=13.270, p=.001) were supported, but muscular strength (F=2.708, p=.105) was rejected.

3. Effects of psychological function
Hypothesis 9 that “The level of perceived health condition would be higher for participants in the experimental group than for those in the control group.”(F=4.910, p=.031) was supported.
Hypothesis 10 that “The level of life satisfaction would be higher for participants in the experiment group than for those in the control group.” (F=10.856, p=.002) was supported.

As shown above, attitude toward exercise, subjective norm, perceived behavioral control, intention to exercise and exercising increased significantly for participants in the experimental group who participated in the 12week "program promoting intention to exercise" based on planned behavior theory, compared to those in control group who participated in an education program only. In addition, physical function such as joint pain, stiffness, performance of activities of daily life, flexibility, balancing and perceived health state, and satisfaction with life also had a statistically significantly increase.
The results indicate that the "program promoting intention to exercise" described in this study is useful in practice as a mediating method to promote health in elders in rural areas suffering from degenerative arthritis who have managed their lives by themselves for their whole life.