The main purposes of the study were to develop and test a model which explains the dynamic relationship among factors reported as affecting to the quality of life of individuals with rheumatoid arthritis and to examine the relationship between self-help response and quality of life. Data for the study were collected from March 1996 to December 1996 from 153 female patients who regularly visited a clinic for people with rheumatism. The Patients were introduced to the investigators by nurses who worked at that clinic, and then the investigator interviewed the patients for 30 to 40 minutes to collect the data. Instruments used in the study were modified self-report questionnaires from the ones which were already developed in previous studies of from related literature. Data analysis were performed using LISREL(Lineal Structural Relations) 8 Program to test whether the proposed hypothesized model fit the collected data. To test fitablity of the hypothesized model both a general fit measure and a detailed fit measure were used. Based on the test results from the various fit measures, the hypothesized model was found to be well suited to the real data. As characteristics related to illness becomes severe, the feasibility for uncertainty about the illness tend to increase, but, the direct effects from the illness characteristics(such as level of physical symptoms, sense of social-psychologic change, limitations of action) as they are related to the other intrinsic variables(self-efficacy or self-help behavior and quality of life), were found to be not significant. It was found that uncertainty had a direct effect on self-efficacy but did not have a direct effect on self-help behavior or quality of life. Also, it is noted that self-efficacy had a positive effect on self-help behavior and quality of life and there was a bilateral relationship between self-efficacy and self-help behavior. Lastly, the hypothesis proposed from the theoretical model in this study was supported basis of the results that self-help behavior provides both direct and positive effects to quality of life. Particularity, since a bilateral relationship was also found between self-help behavior and quality of life in the modified model, as self-help behavior increased, so did quality of life. And, reversely, as quality of life increased, so did self-help behavior. In conclusion, the results of this study suggest that focusing on both acquirement and reinforcement of adjustment factors or self-help behavior is more efficient than focusing on the characteristics of illness in establishing the strategies for improving quality of life of individuals with rheumatoid arthritis.

In this paper, the study model, which presents the patterns of how the changing mechanisms are adopted to the changing stages of smoking cessation, was developed modifying the integrative model of Prochaska et al.(1983) with including seven changing mechanisms which were identified by Oh and Kim(1996). Then the developed study model was exploratively tested with 155 University student between 20 and 29 years of age subjects. According to the study results, among the five mechanisms, which are significant in explaining the differences between stages, DUNCAN post-comparison showed that the least applied ones were Stimulus Control, Self Determinism, Cognitive Restructuring in the precompletion stage, and Reinforcement and Dramatic Relief, in the relapsed stage. In the contemplation stage, it was observed that Dramatic Relief is used most frequently and that the other two mechanisms, Information Management and Cognitive Restructuring, showed different results from those inferred in the study hypothesis. In the case of Information Management, it was excluded from the analysis it was not included in explaining significant difference among changing stages, but Cognitive Reconstruction turns out to be a more frequently used mechanism in the action stage rather than in the contemplation stage. Helping Relationship was also excluded in the post-comparison analysis since it was not included in explaining significant difference among changing stages and Reinforcement was a more frequently used mechanisms in the contemplation stage. Stimulus Control turns out to be the connecting mechanism which was most frequently used in both the contemplation and action stages. Self Determination was most frequently used in the action stage rather than in both the contemplation stage and action stage, differing from the presumption of the model. Lastly, subjects in the relapsed stage were utilizing Stimulus Control and Self Determination at the same level as subjects in the precontemplation stage, and the utilization of both Reinformcement and Dramatic Relief was lower than that of the precontemplation stage, that is at the lowest level. Only Cognitive Restructuring was used of the same level as the contemplation stage. The relapsed stage in this study did not represent the preparation for action stage as presumed in the model of Prochaska et. al.(1983) but did show a pattern similar to the initial stage of smoking cessation, However, since this interpretation about the relapser was based on only a small number of relapsers(n=5), this conclusion may not be reliable.

The average smoking rate for Adults' in our country is 40.6%: It is 74.2% for men and 5.0% for women. Particularly, the smoking rate for men is reported higher than that of men in U. S. A. or Japan. Since the first report on the association between smoking and cancer appeared, 370 thousand smokers have succeeded in smoking cessation and over 90% of them have responded that they depended on a self-help smoking cessation approach. Despite this positive evidence about self-help approaches for smoking cessation, most studies on smoking cessation have focused on evaluation of formal treatment programs that are provided by clinics. Reports on the smoking cessation process used by smokers in our country could not be found. However, it is believed that the situation in our country would be quite similar to that in U.S.A. as far as approaches to successful smoking cessation are concerned. This study was conducted to classify the smoking stage to which they smoker belong and which changing mechanisms could be included at each changing stage (precontemplation stage, comtem-plation stage, action stage) with a sample of 155 college students between 20 and 29 years old. And it also identified which variables related both to smoking pattern and to health, which ones were significantly discriminating in the changing stages. From the results of the data analysis it was found that Self-Determination is the most influential variable as one of the changning mechanisms which can discriminate three changing stages. And as the next significant mechanisms were Reinforcement, Dramatic Relief, Cognitive Restructuring, Helping Relationship, and Information Management in that order. Among variables related to the smoking pattern, years of regular smoking, whether smoking is continued or not even when they are sick, the number of attempts to stop smoking, number of cigarettes smoked per day, and whether they have smoked over 100 cigarettes up to now, but not the time of the first cigarette after waking-up, were the significant factors to descriminate changing stages. It was confirmed that among variables related to health that, perceived control for health, confidence of health maintence ability, and self confidence in smoking cessation, were significant variables in determinating changing stages. The most influential variables among them was self-confidence in smoking cessation. Conclusively, it was shown that smoking cessation is the process of attempting to change smoking habits through the various changing processes. Also it can be shown that a few factors smoking habit, self-confidence of smoking cessation, and belief in self control of his/her health, were influential in discriminating the changing stages of the smoking habit.

Smoking is considered to be one of the important risk factors associated with various health problems. Thirty seven million people in America quit smoking in the past decade, with 90% quitting on their own(Americal Heart Association, 1986). According to McAlister(1975), 70% of smokers reported that they adopted a self-help smoking cessation approach rather than a formal treatment program. In our country, although, auccessful exsmokers have used, are not available, concerns about smoking cessation have increased, recently, due to changes in social and political attitudes to health promotion. This study was conducted to help smokers who had made a decision to adopt a self-helf smoking cessation approach instead of depending on a formal treatment program. It provided a structurd way for sucessful smoking cessation by identifying change mechanism factors which have been commonly used by smokers. The subjects selected for this study were 155 university students between 20 and 29. Years of age the results from the analysis of the collected data showed that seven factors in the self-help change processes significant, and they are named, Stimulus Control, Self-Determination, Information Management, Reinforcement Management, Helpful Relationships, Dramatic Relief and Cognitive Restructuring. All of the factors except Self-Determination represent the same change mechanisms which are proposed by Prochaska et al. (1988). Self-Determination uniformly includes items belonging to various change processes. Therefore, it might be an transitional factor including strategies related to both cognitive and behavioral dimensions. In spite of this, noted that one item which gives meaning of Self-Determination shows the highest factor loading, it is named Self-Determination.

This study was performed to examine the effect of a 7-week comprehensive health promotion program for improving pain, depression, and disability by employing a quasi-experimental design. The subjects were regular out-patients of a RA aclinic in an University Hospital in Inchon from November 11. 1998 to December 24. 1998. The Experimental group included 18 patients who participated in an arthritis health promotion program, and the control group included 18 patients who did not. The 7-week health promotion program, which had the objective to enhance health promoting skills, was provided to patients. The effects of this program on the patients' pain, depression, and functional disability were examined. According to the study results, a significant group difference was found on these dependent variables (Hotelling's T =.30, F=3.11, p=.04). To examine which dependent variables had significant effects, one-way ANOVAs were performed. There were significant group differences in pain (F=4.35, p=.05) and in depression (F=4.22, p=.05) However, no significant group differences on functional disability (F=.04, p=.84) were found. Conclusively, the arthritis health promotion program, which was designed to enhance 11 health promoting skills, can be evaluated as successfully achieving the ultimate goal of enhancing the patients' quality of life. It can also be contended that the improvement of the patients' quality of life was enabled by relieving pain and reducing depression.

In this study, domains, contents, and effects of pre-existed intervention programs for individuals with arthritis were meta-analyzed to develop arthritis health promotion program based on Holistic Model. The developed program includes strategies of cognition, environment, and behavior, and also generates positive changes in the physical, psychological, and social demensions. Then needs assessment on conveniently selected 153 women who visited a university hospital in Seoul or in Inchon are conducted to identify the objective domains of arthritis health promotion program. According to the study results, target health problems of the arthritis health promotion program were shown as pain, disability, depression, and role impediment in social domain. These objectives could be achieved by including the strategies of changing cognition, the strategies of changing behavior through learning the skill related to the health promoting behavior, and the strategies of changing environment in the health promotion program. That is, it is analyzed that the contents of program are not exclusive one another in physical, psychological, and social demensions, and also are not exclusive one another in aspect of cognition, behavior, and environment. The necessary methods to achieve the desired objectives for the developed arthritis health promotion program and evaluation subjects are as follows : (1) In the arthritis health promotion program, knowledge on management of arthritis, efficacy related to arthritis management, skill for pain management, skill for exercise, establishment of positive self-concept, enhancement of positive thinking, stress management, skill for problem solving, skill for setting goals, skill for requesting help, and skill for communication are all included. Through the improvement of all those strategies, intermediate objectives, such as "joint protection, and maintenance of pain management behavior", "maintenance of regular exercise", and "promotion of coping skill in psychosocial dimension" are achieved. (2) These intermediate objectives are also the methods for achieving objectives in next stage. It implies that through the intermediate objectives, the final objectives such as "minimization of physical symptoms and signs", "maximization of psychological function", and "maximization of role performance in social domain" could be achieved. Each of these final objectives reflects the different dimension of quality of life, respectively. When these objectives are achieved, the quality of life that client perceives is improved. Therefore, through evaluation of these final objectives, the level of achieving final outcome of arthritis health promotion such as quality of life is determined.