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    ๊ตญ๋ฏผ์ฃผ๊ฑฐ์•ˆ์ •์„ ์œ„ํ•œ ์ฃผํƒ์ •์ฑ… ๊ฐœํŽธ๋ฐฉ์•ˆ ์—ฐ๊ตฌ(A study on the improvement of housing policy measures in transforming housing policy regime)

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    ๋…ธํŠธ : ์ด ์—ฐ๊ตฌ๋ณด๊ณ ์„œ์˜ ๋‚ด์šฉ์€ ๊ตญํ† ์—ฐ๊ตฌ์›์˜ ์ž์ฒด ์—ฐ๊ตฌ๋ฌผ๋กœ์„œ ์ •๋ถ€์˜ ์ •์ฑ…์ด๋‚˜ ๊ฒฌํ•ด์™€๋Š” ์ƒ๊ด€์—†์Šต๋‹ˆ๋‹ค

    Korean-Voice Handicap Index(K-VHI): validation of an original version and development of new version

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    ์–ธ์–ด๋ณ‘๋ฆฌํ•™ ํ˜‘๋™๊ณผ์ •/๋ฐ•์‚ฌ[ํ•œ๊ธ€]์Œ์„ฑ ๋ฌธ์ œ๋ฅผ ํ‰๊ฐ€ํ•˜๊ณ  ์น˜๋ฃŒ์˜ ํ˜ธ์ „๋„๋ฅผ ์•Œ์•„๋ณด๊ธฐ ์œ„ํ•ด์„œ๋Š” ํ‰๊ฐ€์ž์˜ ์ฃผ๊ด€์  ๋ฐ ๊ฐ๊ด€์ ์ธ ํ‰๊ฐ€๋ฟ๋งŒ ์•„๋‹ˆ๋ผ ํ™˜์ž์˜ ์ฃผ๊ด€์ ์ธ ํ‰๊ฐ€๊ฐ€ ๋ณ‘ํ–‰๋˜์–ด์•ผ ํ•œ๋‹ค. ์šฐ๋ฆฌ๋‚˜๋ผ์—์„œ๋Š” ์ตœ๊ทผ์—์„œ์•ผ ์Œ์„ฑ์žฅ์• ์— ๊ด€๋ จ๋œ ์‹ฌ๋ฆฌ์ธก์ •์  ํ‰๊ฐ€(voice-related psychometric evaluation)๋„๊ตฌ๋ฅผ ์‚ฌ์šฉํ•˜๊ธฐ ์‹œ์ž‘ํ•˜์˜€์œผ๋‚˜, ์‹ ๋ขฐ๋„ ๋ฐ ํƒ€๋‹น๋„์— ๋Œ€ํ•œ ๊ฒ€์ฆ์ด ์•„์ง ์ด๋ฃจ์–ด์ง€์ง€ ์•Š์•˜๋‹ค.VHI(Voice Handicap Index)๋Š” ํ‘œ์ค€ํ™”๋œ ๋„๊ตฌ๋Š” ์•„๋‹ˆ์ง€๋งŒ, ์Œ์„ฑ์žฅ์• ํ™˜์ž์—์„œ ์‚ถ์˜ ์งˆ๊ณผ ์—ฐ๊ด€๋œ ์ฃผ๊ด€์ ์ธ ํ‰๊ฐ€๋กœ์„œ ๊ฐ€์žฅ ๋งŽ์ด ์‚ฌ์šฉ๋˜์–ด์˜จ ํ‰๊ฐ€๋„๊ตฌ์ด๋‹ค. ๋ณธ ์—ฐ๊ตฌ์—์„œ๋Š” ํ›„๋‘์•”์„ ์ œ์™ธํ•œ ์Œ์„ฑ์žฅ์• ํ™˜์ž 156๋ช…๊ณผ ์ •์ƒ๊ตฐ 66๋ช…์„ ๋Œ€์ƒ์œผ๋กœ ํ•˜์—ฌ, ํ•œ๊ตญ์–ดํŒ VHI 30๋ฌธํ•ญ(VHI-30) ๋ฐ VHI-10์˜ ์‹ ๋ขฐ๋„์™€ ํƒ€๋‹น๋„๋ฅผ ์ œ์‹œํ•˜์˜€๋‹ค. ๋˜ํ•œ, 30 ๋ฌธํ•ญ ์ค‘ ์ƒˆ๋กœ 10๋ฌธํ•ญ(nVHI-10)์„ ์ถ”๋ ค๋ณด๊ณ , ๋…ธ๋ž˜ ๋ถ€๋ฅด๊ธฐ 3๋ฌธํ•ญ์„ ์ฒจ๋ถ€ํ•˜์—ฌ ์ด 33๋ฌธํ•ญ ์ค‘ 10๋ฌธํ•ญ(sVHI-10)์„ ์ถ”๋ ค๋ณด์•„, ์–ธ์–ด ๋ฐ ๋ฌธํ™”์  ์ฐจ์ด๋กœ ์ธํ•œ ์„ค๋ฌธ ๊ฒฐ๊ณผ์˜ ์ฐจ์ด๊ฐ€ ์žˆ๋Š”์ง€ ์•Œ์•„๋ด„๊ณผ ๋™์‹œ์—, ์„ค๋ฌธ์— ๊ฐ€์žฅ ํšจ๊ณผ์ ์ธ ๋ฌธํ•ญ ๊ตฌ์„ฑ์„ ์ œ์‹œํ•ด ๋ณด๊ณ ์žํ–ˆ๋‹ค. ์‹œํ–‰๋œ ์„ค๋ฌธ์€ VHI-30, ํ•œ๊ตญ์˜ ๋ฌธํ™”์  ํŠน์„ฑ์„ ๋ฐ˜์˜ํ•œโ€˜๋…ธ๋ž˜ ๋ถ€๋ฅด๊ธฐโ€™์„ธ ๋ฌธํ•ญ, IPVI(Iowa Patientโ€™s Voice Index) 1๋ฒˆ ๋ฌธํ•ญ, SF(Short Form)-36์ด์—ˆ๋‹ค. ๊ฒฐ๊ณผ๋Š” ๋‹ค์Œ๊ณผ ๊ฐ™์•˜๋‹ค.์ฒซ์งธ, ๋‚ด์šฉํƒ€๋‹น๋„๋ฅผ ๊ฑฐ์นœ VHI-30์˜ ๋ฒˆ์—ญ๋ณธ์— ๋Œ€ํ•œ ์‹ ๋ขฐ๋„๋Š” ํ”ผํ—˜์ž ๋‚ด ์ผ์น˜๋„๊ฐ€ ๋†’์•˜๊ณ (r=.971, p<0.01), ๋ฌธํ•ญ๋‚ด์ ์ผ๊ด€์„ฑ๋„ ๋งค์šฐ ๋†’์•˜๋‹ค(Cronbachโ€™s ฮฑ=0.969). ๋˜ํ•œ ํƒ€๋‹น๋„์—์„œ๋Š” ํ™˜์ž๊ตฐ์ด ์ •์ƒ๊ตฐ์— ๋น„ํ•ด ์œ ์˜ํ•˜๊ฒŒ ์ด์ ์ด ๋†’๊ณ , ๋ฌธํ•ญ๋ณ„ ์ ์ˆ˜์™€ ์ด์  ๊ฐ„์˜ ์ƒ๊ด€์„ฑ์ด ๋†’์•˜์œผ๋ฏ€๋กœ(r=0.583~0.846, p<0.01), ์Œ์„ฑ ๋ฌธ์ œ์— ๋Œ€ํ•œ ๋ณ€๋ณ„๋ ฅ์ด ๋†’์€ ๊ฒ€์‚ฌ ๋„๊ตฌ์ž„์„ ๋ณด์˜€๋‹ค. ๊ณต์ธํƒ€๋‹น๋„๋ฅผ ๋Œ€์‹ ํ•˜์—ฌ IPVI์˜ 1๋ฒˆ ๋ฌธํ•ญ(r=0.664, p<0.01)๊ณผ SF-36 ๊ฐ„์˜ ์ƒ๊ด€์„ฑ(r=0.372, p<0.01)์€ ๋ชจ๋‘ ์„ ํ–‰ ์—ฐ๊ตฌ์™€ ๊ฐ™์€ ์ •๋„์˜ ์ƒ๊ด€์„ฑ์„ ๋ณด์˜€๋‹ค. ๋˜ํ•œ, ์š”์ธ๋ถ„์„ ์ƒ ์„ธ ๊ฐ€์ง€์˜ ํ•˜์œ„ํ•ญ๋ชฉ์œผ๋กœ ๊ตฌ๋ถ„์ด ๊ฐ€๋Šฅํ•˜์˜€๋‹ค.๋‘˜์งธ, ์Œ์„ฑ์žฅ์•  ์งˆํ™˜๊ตฐ์— ๋”ฐ๋ผ VHI-30 ์ด์ ์— ์œ ์˜ํ•œ ์ฐจ์ด๋ฅผ ๋ณด์—ฌ, ์ง‘๋‹จ ๊ฐ„ ๋น„๊ต๊ฐ€ ๊ฐ€๋Šฅํ•จ์„ ๋ณด์˜€๋‹ค. ์งˆํ™˜๊ตฐ์€ ์‹ ๊ฒฝํ•™์  ์žฅ์• , ๊ธฐ๋Šฅ์  ์žฅ์• , ๊ตฌ์กฐ์  ์žฅ์• , ์—ผ์ฆ์„ฑ ์žฅ์• ๋กœ ๋‚˜๋ˆ„์–ด ๋น„๊ตํ•˜์˜€๊ณ , ์„ ํ–‰์—ฐ๊ตฌ์™€ ๋งˆ์ฐฌ๊ฐ€์ง€๋กœ ์‹ ๊ฒฝํ•™์  ์žฅ์• ๋Š” ๊ธฐํƒ€ ์žฅ์• ๊ตฐ๋ณด๋‹ค ์Œ์„ฑ์žฅ์• ๋กœ ์ธํ•œ ์‚ถ์˜ ์งˆ์ด ๊ฐ€์žฅ ๋‚ฎ์€ ์ง‘๋‹จ์ž„์„ ๋‚˜ํƒ€๋‚ด์—ˆ๋‹ค.์…‹์งธ, VHI-30๊ณผ MDVP(Multi-Dimensional Voice Program) ํŒŒ๋ผ๋ฏธํ„ฐ๋“ค ๊ฐ„์˜ ์ƒ๊ด€์„ฑ์€ ์—†๊ฑฐ๋‚˜ ๋‚ฎ์•˜์œผ๋ฏ€๋กœ, ํ™˜์ž์˜ ์ฃผ๊ด€์  ์Œ์„ฑ ๋ฌธ์ œ ์ธ์‹ ์ •๋„์™€ ๊ฐ๊ด€์  ํ‰๊ฐ€์— ์˜ํ•œ ์Œ์„ฑ ๋ฌธ์ œ ์ •๋„๋Š” ๊ทธ ๊ธฐ์ค€์— ์ฐจ์ด๊ฐ€ ์žˆ์Œ์„ ๋ณด์˜€๋‹ค.๋„ท์งธ, VHI-10 ๋˜ํ•œ VHI-30๊ณผ ๋งˆ์ฐฌ๊ฐ€์ง€๋กœ ๊ฒ€์ฆ์„ ํ†ตํ•ด ์‹ ๋ขฐ๋„ ๋ฐ ํƒ€๋‹น๋„๊ฐ€ ์žˆ๋Š” ํ‰๊ฐ€๋„๊ตฌ์ž„์„ ํ™•์ธํ•˜์˜€๋‹ค. VHI-30๊ณผ VHI-10 ๊ฐ„์˜ ์ƒ๊ด€์„ฑ์€ ๋งค์šฐ ๋†’์•˜๋‹ค(r=0.968, p<0.01). VHI-10 ํ‰๊ท  ์ด์  ๊ฐ’ ๋Œ€ VHI-30 ํ‰๊ท  ์ด์  ๊ฐ’ ๋น„์œจ์ด 0.333๋ณด๋‹ค ๋†’์€ 0.368์ด์—ˆ๋‹ค. VHI-10์€ ์š”์ธ๋ถ„์„ ์ƒ ๋‹จ์ผํ•ญ๋ชฉ์„ ๋ณด์˜€๋‹ค.๋‹ค์„ฏ์งธ, VHI-30 ๋ฌธํ•ญ์—์„œ ํƒ€๋‹น์„ฑ์ด ๋†’์€ 10๊ฐœ์˜ ๋ฌธํ•ญ์„ ์ƒˆ๋กœ ์ถ”๋ ค๋ณธ ๊ฒฐ๊ณผ, nVHI-10์— ํ•ด๋‹นํ•˜๋Š” ๊ฒƒ์€ P13, E23, P10, P14, P20, E25, E24, P26, E7, F16์ด์—ˆ๋‹ค. ์ด ์ค‘ ๊ธฐ์กด VHI-10๊ณผ ์ค‘๋ณต์ด ๋˜๋Š” ๋ฌธํ•ญ์€ 5๊ฐœ์ด์—ˆ๋‹ค. nVHI-10 ํ‰๊ท  ์ด์  ๊ฐ’ ๋Œ€ VHI-30 ํ‰๊ท  ์ด์  ๊ฐ’ ๋น„์œจ์ด 0.408๋กœ, ๊ธฐ์กด VHI-10์˜ ๋น„์œจ(0.368)๋ณด๋‹ค ๋†’์•˜๋‹ค.์—ฌ์„ฏ์งธ, VHI-30 ๋ฌธํ•ญ๊ณผ ํ•œ๊ตญ์˜ ๋ฌธํ™”์  ํŠน์„ฑ์„ ๋ฐ˜์˜ํ•œโ€˜๋…ธ๋ž˜ ๋ถ€๋ฅด๊ธฐโ€™์˜ ์„ธ ๋ฌธํ•ญ์„ ํฌํ•จํ•˜์—ฌ ๋ฌธํ•ญ ๋ถ„์„์„ ํ•œ ๊ฒฝ์šฐ์—, sVHI-10์— ํ•ด๋‹นํ•˜๋Š” ๊ฒƒ์€ P13, E23, P17, P10, P14, P20, E25, E24์™€ ์‹ ์ฒด์ ์ธ ๋ฉด์˜ S31(โ€˜๋…ธ๋ž˜ ๋ถ€๋ฅด๊ธฐ๊ฐ€ ํž˜๋“ค๋‹คโ€™) ๋ฐ ๊ธฐ๋Šฅ์ ์ธ ๋ฉด์˜ S32(โ€˜์‚ฌ๋žŒ๋“ค๊ณผ ์–ด์šธ๋ฆด ๋•Œ ๋…ธ๋ž˜๋ฅผ ์ž˜ ๋ถ€๋ฅด์ง€ ๋ชปํ•ด ๋ถˆํŽธํ•  ๋•Œ๊ฐ€ ์žˆ๋‹คโ€™)์ด์—ˆ๋‹ค. sVHI-10 ํ‰๊ท  ์ด์  ๊ฐ’ ๋Œ€ VHI-30 ํ‰๊ท  ์ด์  ๊ฐ’ ๋น„์œจ์ด 0.456์œผ๋กœ, ๊ธฐ์กด VHI-10์˜ ๋น„์œจ(0.368) ๋ฐ nVHI-10์˜ ๋น„์œจ(0.408)๋ณด๋‹ค ๋†’์•˜๋‹ค.์ด์ƒ์˜ ๊ฒฐ๊ณผ๋กœ, ํ•œ๊ตญ์–ดํŒ VHI-30 ๋ฐ VHI-10์€ ์Œ์„ฑ์žฅ์•  ์‹ฌ๋ฆฌ์ธก์ •์  ํ‰๊ฐ€๋„๊ตฌ๋กœ์„œ ์‹ ๋ขฐ๋„ ๋ฐ ํƒ€๋‹น๋„๊ฐ€ ์žˆ์Œ์„ ๋ฐํ˜”๋‹ค. ๊ธฐ์กด์˜ VHI-10์— ๋น„ํ•˜์—ฌ ๋ณธ ์—ฐ๊ตฌ์—์„œ ์ œ์‹œํ•œ nVHI-10๊ณผ sVHI๊ฐ€ ์ƒ๋Œ€์ ์œผ๋กœ ๋ฏผ๊ฐ๋„๊ฐ€ ๋” ๋†’์•˜์œผ๋ฏ€๋กœ, ์–ธ์–ด ๋ฐ ๋ฌธํ™”๊ถŒ์˜ ์ฐจ์ด๋กœ ์ธํ•œ ๋ฌธํ•ญ ์„ ์ • ๊ธฐ์ค€์— ์ฐจ์ด๊ฐ€ ์žˆ์Œ์„ ์ œ์‹œํ•ด๋ณด์•˜๋‹ค. ๋”ฐ๋ผ์„œ ํ–ฅํ›„ ์Œ์„ฑ์žฅ์• ์— ๊ด€๋ จ๋œ ๋ฌธํ•ญ ์ œ์ž‘์„ ํ•˜๊ฑฐ๋‚˜, ๊ฒฐ๊ณผ๋ฅผ ํ•ด์„ํ•  ๊ฒฝ์šฐ์—๋Š” ์–ธ์–ด ๋ฐ ๋ฌธํ™”๊ถŒ์˜ ์ฐจ์ด์— ๋Œ€ํ•œ ๊ณ ๋ ค๋ฅผ ํ•˜๋Š” ๊ฒƒ์ด ๋ฐ”๋žŒ์งํ•˜๋ฆฌ๋ผ ์ƒ๊ฐํ•œ๋‹ค. [์˜๋ฌธ]In evaluations of the severity of voice problems and in order for treatment for dysphonic patients to be effective, clinicians should conduct not only examinerโ€™s subjective and objective evaluations, but also a subjective evaluation with the patient. Voice-related psychometric evaluations have been used in recent years for patientโ€™s subjective evaluations, but the reliability and validity of this technique, when conducted in the Korean language, have yet to be evaluated.The VHI(Voice Handicap Index) is one of the most psychometrically robust and well-studied instruments among the various instruments for measuring quality of life in patients suffering from voice disorders. However, the VHI has yet to be established as a gold standard for such testing. The primary objectives of this study were 1) to validate the Korean-translated versions of the VHI-30 and the VHI-10, and 2) to develop a new VHI version considering the cross-cultural differences. One hundred fifty-six Korean adult patients, all of whom had symptoms of dysphonia without laryngeal cancer, as well as 66 normal Korean adults participated in this study. The survey was conducted using the VHI-30, three โ€˜singingโ€™ items, the IPVI(Iowa Patientโ€™s Voice Index)-(1) and the SF(Short Form)-36. Acoustic analysis with the MDVP (Multi-Dimensional Voice Program) was conducted only in the patient group. The results were as follows.1. With regard to the reliability of the VHI-30, Pearson correlations in test-retest were very high(r=0.971, p<0.01). Cronbachโ€™s ฮฑ in internal consistency was 0.969. The control group received significantly lower scores than did the patient group. For the concurrent validity of the VHI-30, with regard to the total score of the patient group, Spearman correlations between the VHI-30 and the IPVI(1) were high(r=0.664, p<0.01), and the correlations between the VHI-30 and the SF-36 were low(r=0.372, p<0.01). With regard to the construct validity, the VHI-30 was divided into three components via factor analysis.2. Patients with neurogenic voice disorders evidenced worse VHI-30 scores than those suffering from any other voice disorders(functional, structural, and inflammatory disorders) and the controls. Those with neurogenic laryngeal disease evidenced the most severe impairments, supporting the conclusions of previous studies. This result suggests that a group study of laryngeal diseases could be achieved using the VHI-30.3. Correlations between the VHI-30 scores and the results of MDVP parameters were in relatively weak agreement. The VHI-30 and acoustic measurements provided independent information supporting the results of previous studies.4. Also for the VHI-10, statistical analyses revealed high reliability and validity values. The correlations of total scores between the VHI-30 and the VHI-10 were high(r=0.968, p<0.01). The mean ratio of total scores between the VHI-10 and the VHI-30 were 0.368. The items on the VHI-10 were more sensitive than those of the VHI-30, supporting the results of previous studies. VHI-10 had a single component according to the results of factor analysis.5. Ten questionnaire items as aโ€˜new VHI-10โ€™(nVHI-10) items were selected from the VHI-30. Five items from the original VHI-10 were remained in the nVHI-10. The mean ratio of the nVHI-10 to the VHI-30 was 0.408. The items on the nVHI-10 were more sensitive than those of the VHI-10.6. In order to reflect the cross-cultural differences, โ€˜singing VHI-10โ€™ (sVHI-10) was developed by including eight items of the VHI-30 and 2 singing items (S31 as a physical factor: โ€˜My voice problem makes it difficult for me to singโ€™, and S32 as a functional factor: โ€˜My singing difficulties restrict social lifeโ€™). The mean ratio of the sVHI-10 to the VHI-30 was 0.456. The sVHI-10 were more sensitive than those of the VHI-10 and the nVHI-10. These results confirmed that cross-cultural differences exist with regard to the selection of survey items.The validity and reliability of VHI-30 and VHI-10 questionnaires are maintained even after translating into Korean. In order to conduct the voice-related psychometric evaluation questionnaire or to decipher its results, cross-linguistic and cross-cultural differences should be considered.ope

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