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- Original Article Development of criteria for health examination of high-risk occupational groups and application to female fishers: Delphi study
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Hye-min Kim1
, Jungwon Kim2, Kunhyung Kim3, Hansoo Song1,* -
Annals of Occupational and Environmental Medicine 2026;38:e2.
DOI: https://doi.org/10.35371/aoem.2026.38.e2
Published online: January 8, 2026
1Department of Occupational and Environmental Medicine, Chosun University Hospital, Gwangju, Korea
2Department of Occupational and Environmental Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
3Department of Occupational and Environmental Medicine & Institute of Environmental and Occupational Medicine, Inje University Pusan Paik Hospital, Busan, Korea
- *Corresponding author: Hansoo Song Department of Occupational and Environmental Medicine, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju 61453, Korea E-mail: oemsong@chosun.ac.kr
• Received: June 3, 2025 • Revised: November 23, 2025 • Accepted: November 25, 2025
© 2026 Korean Society of Occupational & Environmental Medicine
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Abstract
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Background The objective of this study was to establish criteria for designing health examination programs and selecting appropriate examination items for high-risk occupational groups and to apply these criteria specifically to female fishers.
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Methods The first Delphi survey comprised five domains and 15 specific criteria for identifying relevant health screening items for high-risk occupations. The second survey included open-ended questions addressing inconsistencies identified in the first survey and sought suggestions for additional items. In the third Delphi survey, specific health screening items were proposed for female fishers, and experts directly evaluated these items according to the finalized selection criteria.
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Results Twenty-eight experts participated in this study. The first and second Delphi rounds facilitated the finalization of selection criteria for health screening items, consisting of five domains: Domain 1, Priority of target disease; Domain 2, Applicability of early detection and intervention; Domain 3, Scientific evidence of medical test method; Domain 4, Acceptability of medical test method; and Domain 5, Effectiveness of examination. Content validity ratios for these criteria ranged between 0.429 and 1.000. Based on the established criteria, experts evaluated eight proposed screening items for female fishers in the third round of the Delphi survey. Bone density, bioelectrical impedance analysis, cardiovascular disease risk factors, and fundoscopy were evaluated as appropriate; however, no agreement was reached on the early detection and intervention areas for degenerative lumbar disease, knee osteoarthritis, and upper extremity disease, as well as on the effectiveness for upper extremity disease and chronic obstructive pulmonary disease.
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Conclusions This study successfully established comprehensive criteria for selecting diseases targeted by health examinations in high-risk occupational groups. The practical application of these criteria proved effective in assessing the appropriateness of specific health screening items.
BACKGROUND
In Korea, special health examinations are conducted under the Occupational Safety and Health Act to monitor occupational diseases and protect the health of workers exposed to occupational risk factors.1 As of 2023, this system covers 2,669,267 workers from 104,366 workplaces, including 1,306,150 manufacturing workers, 348,150 construction workers, and 330,751 workers in health and social welfare services.2 However, there are important occupational groups that require occupational disease surveillance and are excluded from the Occupational Safety and Health Act. Representative examples include firefighters (66,659 as of 2022)3 and police officers (131,795 as of 2023).4 Additionally, agricultural, forestry, and fishery workers, who are largely self-employed, are also excluded from occupational disease surveillance despite their substantial numbers. As of 2023, there were 2,089,000 individuals engaged in the field of agriculture, 87,000 in sea fisheries, and 204,000 in forestry.5 Recently, recognizing the need for occupational disease surveillance among high-risk occupational groups, health examinations have been implemented among firefighters and police officers, respectively.6,7 Considering agricultural and fishery workers, health examination programs have been implemented for female agricultural and fishery workers pursuant to Article 11-3 of the Act on Fostering and Supporting Women Farmers and Fishers, and are supervised by the Ministry of Oceans and Fisheries.8 The National General Health Screening Program in Korea, managed by the National Health Screening Act, employs a principle-based national health screening program to ensure medical and scientific criteria management and quality assurance.9 However, explicit principles for selecting health examination items for high-risk occupational groups exposed to occupational risk factors are yet to be established. While the general principles for national health screening could be applied to select health examination items for high-risk occupational groups, additional considerations, such as accountability for exposure to occupational risk factors and addressing health disparities inherent to occupational diseases, must also be considered.10‒12
Fishing, together with agriculture and forestry, is recognized worldwide as one of the three most hazardous industries.13 Fishers are outdoor workers who must perform their duties under unstable weather conditions and at sea. Despite progressive mechanization, a substantial proportion of tasks still relies on manual labor involving repetitive movements and high physical workload.14,15 Moreover, fishers often reside in remote coastal areas with limited access to healthcare and welfare services, leaving them vulnerable in terms of health management.16 Among fishers, musculoskeletal disorders (MSDs) represent the most prevalent and significant occupational diseases, with both high prevalence and incidence. Studies conducted among Korean fishers further demonstrated an even greater burden of MSDs compared with farmers, with women showing disproportionately higher rates of disability than men.17-19 The authors recognized the importance of developing a framework to guide the selection of rational and reliable health examination items for high-risk occupational groups, addressing the gap between limited literature and policy interest from the government.20,21 Furthermore, given previous examples in which the Delphi method was applied to determine health examination,22,23 the authors judged that employing a Delphi study was appropriate for establishing such a framework. Therefore, the current study has two objectives. First, we established the principles for selecting appropriate health examination items for high-risk occupational groups exposed to occupational hazards. Second, we applied the established criteria specifically to female fishers. Consequently, this study developed evaluation criteria to verify the validity of specialized health examination items for female fishers and reported the evaluation results based on these criteria.
METHODS
The number of experts targeted for this Delphi study was set to 36, considering the number of relevant field experts in Korea, their specialties, regional distribution, and gender balance. Experts were recruited by email based on recommendations from the Committee of Clinical Practice of the Korean Society of Occupational and Environmental Medicine, the Committee of Clinical Preventive Medical Care of the Korean Society for Preventive Medicine, and the Korean Association of Occupational and Environmental Physicians. Participants who provided informed consent were included in the study (Table 1).
The Delphi method was selected for its key methodological advantages: anonymity, which mitigates dominance bias; iterative rounds, which enable participants to revise their judgments in light of group feedback; and a structured approach to achieving expert consensus. These features are particularly well-suited to evaluating occupational health examination criteria, where diverse clinical, epidemiological, and policy perspectives must be integrated—perspectives that cannot be adequately captured through quantitative data alone.
The study was conducted in two phases: the first phase (Delphi rounds 1–2) developed criteria for selecting occupational health examination items, whereas the second phase (round 3) validated specialized items for female fishers. This two-step design reflects the recognition that establishing criteria through expert consensus does not guarantee their practical applicability. By applying the criteria to female fishers, we were able to identify limitations of the proposed items while at the same time demonstrating the usefulness of the criteria in guiding refinement.
Phase 1 of the Delphi survey comprised two rounds. In the first round, the questionnaire included questions regarding the experts’ background, demographic information, and opinions on the health examinations of high-risk occupational groups. Additionally, a structured questionnaire was provided based on the selection principles proposed by the researchers, consisting of five domains and 20 items, each evaluated on a 10-point scale. Open-ended questions were included to gather additional opinions on the study. The selection principles for the health examination items integrated the National Health Screening criteria and considerations from previous occupational health studies.24,25 The five established domains for the selection criteria were as follows: <Domain 1: The target disease has priority in high-risk occupational groups>, <Domain 2: Early detection and intervention can be applied to target diseases>, <Domain 3: The medical test method was based on scientific evidence>, <Domain 4: The medical test method has feasibility>, and <Domain 5: The direct or indirect benefit from the examination is greater than the cost(effectiveness)>. In the second round, the questions were revised based on the results of the first round, and the Delphi survey was administered using the same structured approach.
In Phase 2, the Delphi survey proposed specific health examination items for female fishers. Candidate health examination items were selected during an expert meeting for specialized health examinations for female fishers. The experts evaluated these items for validity according to the selection criteria agreed upon in Phase 1. Proposed examination items included: <Item 1: Bone density and bioelectrical impedance analysis for osteoporotic fractures>, <Item 2: Lumbar radiographs and physical examination for degenerative lumbar disease>, <Item 3: Both knee Rosenberg view and physical examination for knee osteoarthritis>, <Item 4: Both hand radiographs and physical examination for upper extremity disease (hand osteoarthritis, carpal tunnel syndrome, epicondylitis, rotator cuff disease)>, <Item 5: Waist circumference, blood pressure, hemoglobin A1c, and low-density lipoprotein (LDL) cholesterol for managing cardiovascular disease risk factors>, <Item 6: Pure-tone audiometry and otoscopy for noise-induced hearing impairment>, <Item 7: COPD-6 test for chronic obstructive pulmonary disease (COPD)>, <Item 8: Fundoscopy for vision-threatening eye disease (age-related macular degeneration, diabetic retinopathy, glaucoma)>. In Phase 2 of the Delphi survey, experts were provided with research evidence for each health examination item. This evidence outlines the evaluation of each item against five domains and details the health examination method developed by the research team. Specifically, it includes case and disease definitions, summaries of domestic epidemiological studies, risk factors, the rationale for health examination, specific testing methods, intervention strategies, and management objectives (Supplementary Data 1). The evaluation criteria for each item were assessed on a 5-point Likert scale (1 = strongly disagree; 2 = disagree; 3 = neutral; 4 = agree; 5 = strongly agree) covering priority, early detection and intervention, scientific evidence, feasibility, and effectiveness. Items with positive responses (‘agree’ or ‘strongly agree’) were classified as follows: ≥70.4% (The ratio corresponding to the minimum content validity ratios [CVR], when the number of experts is 27), good; ≥50% and <70.4%, fair; and <50%, poor.
Descriptive statistics were calculated, including mean scores and standard deviations for each item. Responses scored 7‒10 on a 10-point scale were considered positive. CVR were calculated using the following formula:26 CVR = (Ne – (N/2))/(N/2), where Ne represents the number of positive responses and N is the total number of respondents. The numerical validity of the CVR values was determined using Lawshe’s table.
The present study protocol was reviewed and approved by the Institutional Review Board of Chosun University Hospital (IRB No. 2022-08-002). Informed consent was submitted by all subjects when they were enrolled.
RESULTS
In total, 28 experts participated in this study: nine from the Committee of Clinical Practice of the Korean Society of Occupational and Environmental Medicine, seven from the Committee of Clinical Preventive Medical Care of the Korean Society for Preventive Medicine, and 12 from the Korean Association of Occupational and Environmental Physicians. The participants comprised 22 males and six females, all of whom responded to both Phase 1 and Phase 2 of the Delphi survey. According to Lawshe’s table, the minimum criterion for CVR was 0.357 for 28 participants and the minimum criterion for CVR was 0.407 for 27 participants. When surveyed regarding opinions on health examinations for high-risk occupational groups, 92.9% of experts agreed on the necessity of health examinations reflecting occupational characteristics. Experts withholding consent cited reasons such as the absence of methods to reduce occupational risk factors, unclear examination targets, and potential adverse effects if conditions already being treated were included in the health examination. However, these reservations were deemed compatible with the objectives of the study. Regarding health examination strategies, 60.7% preferred a combined population and high-risk group approach, whereas 39.3% targeted high-risk groups exclusively.27 Those advocating the combined approach believed that effectiveness could be enhanced by employing both strategies based on risk levels. In contrast, proponents of the high-risk-only approach emphasize cost-effectiveness and the need for focused targeting. Most experts agreed on the importance of post-examination management. Regarding the type of health examination, 60.7% considered a combined screening test and surveillance system to be appropriate, 28.6% preferred a surveillance system alone, and 10.7% supported screening tests alone. Opinions diverged based on judgments related to occupational characteristics, costs, test features, and feasibility of implementation. Advocates of health examination alone believe that the approach would be superior to others in terms of costs. Regarding the inclusion of musculoskeletal diseases in health examination, 64.3% supported its necessity owing to its high prevalence and disease burden. However, 21.4% were opposed, and 14.3% remained uncertain. Opponents argued that appropriate post-management systems were inadequately established, diagnostic methods were unsuitable, and limitations existed in the preventive strategies that could be achieved through early health examination. They suggested that exercise therapy or public health initiatives may be more appropriate. In the first round of the Delphi survey, <Criterion 1-4: In the high-risk occupational group, this disease has high social attention> under <Domain 1> and all items of <Domain 5> (<Criterion 5-1>, <Criterion 5-2>) failed to meet the minimum CVR criterion. <Criterion 1-4> was proposed as a criterion for selecting target diseases in high-risk occupational groups based on ‘social attention’ but was excluded owing to ambiguity and redundancy with other criteria. <Domain 5> was revised from ‘cost-effectiveness’ to ‘effectiveness,’ and <Criterion 5-2> was rephrased as <The cost-effectiveness of the examination program is acceptable>. Criterion 5-3: The examination program is effective in attaining health equity or improving health management in high-risk occupational groups (Table 2). The second round evaluated these revised items on a 0–10 scale, and all exceeded the minimum CVR criterion (range: 0.429–1.000) (Table 3). We additionally present a Korean version of Criteria (Supplementary Table 1).
A total of 27 experts responded to the survey. Among the eight examination items evaluated, seven, excluding COPD, were rated as ‘Good’ (positive response >70.4%) in terms of priority of the target disease. Applicability of early detection and intervention was rated as ‘Good’ for osteoporotic fracture, cardiovascular disease risk factor, and vision-threatening eye disease; ‘Fair’ (50% to <70.4%) for noise-induced hearing impairment, COPD, and vision-threatening eye disease; and ‘Poor’ (<50%) for degenerative lumbar disease and knee osteoarthritis. Scientific evidence of the examination method was rated as follows: ‘Good’ for bone density, bioelectrical impedance analysis, cardiovascular disease risk factors (waist circumference, blood pressure, hemoglobin A1c, and LDL cholesterol), pure-tone audiometry, and fundoscopy; and ‘Fair’ for radiography and physical examinations of the lumbar spine, knees, and upper extremities, and COPD-6 test. Feasibility of the examination method was rated as ‘Good’ for bone density, bioelectrical impedance analysis, MSD examination, and cardiovascular disease risk factors; and ‘Fair’ for COPD-6 test, fundoscopy, and pure-tone audiometry. The effectiveness of the examination was rated as ‘Good’ for osteoporotic fracture and cardiovascular disease risk factor; ‘Fair’ for degenerative lumbar disease, knee osteoarthritis, noise-induced hearing impairment, and fundoscopy; and ‘Poor’ for upper extremity disease and COPD (Table 4).
DISCUSSION
In this Delphi study, expert consensus was reached on five domains and 15 detailed criteria for health examination items targeted at high-risk occupational groups. These outcomes could serve as criteria for evaluating the validity of health examination programs specifically developed for high-risk occupational groups exposed to occupational risk factors, distinct from the general population health screening evaluation standards. This study highlights distinct issues compared to the general national health screening criteria. While general health screening primarily focuses on population-based strategies, occupational diseases require additional surveillance systems for occupational risk factors specific to particular job categories.
In <Domain 1: Priority of target disease>, ‘high prevalence’ was included as an evaluation criterion. The high prevalence of certain diseases in specific occupational groups may be due to both occupational factors and sociodemographic characteristics. Nevertheless, workplace-based health management, which aims not only to manage work-related diseases but also to maintain overall worker health for optimal workplace adaptation, has been recognized as beneficial.28-30 <Domain 2: Applicability of early detection and intervention> included the term ‘detection of risk indicators prior to disease onset.’ Occupational disease surveillance encompasses medical indications, as well as early symptom detection, direct measurement of exposure levels, and reporting by workers themselves.31
Regarding <Domain 3: Scientific evidence of examination methods >, this is consistent with the principles used in national health screenings, although precise health examination intervals have yet to be explicitly addressed. Determining health examination intervals requires information on the disease incidence rates and latency periods. In Korea, examinations are generally conducted annually, often with shortened intervals depending on exposure levels or disease occurrence among workers. Typically, individuals with lower risk had longer intervals, whereas those with higher risk had shorter intervals.32,33 Therefore, flexible adjustment according to risk levels needs to be considered a crucial characteristic in occupational health examinations.
<Domain 4: Feasibility of examination methods> emphasized the impact of stigma and employment-related disadvantages. In employment relationships, diseases can be associated with reduced working capacity, harm to colleagues, and discrimination, potentially decreasing feasibility.34 Furthermore, the competence of examination physicians was emphasized as critical, given the need for specialized knowledge regarding occupational risk factors and related health effects. In Korea, special occupational health examinations are exclusively performed by occupational and environmental medicine specialists.35 Examination fees were also considered a critical factor, as inadequate fees could reduce the examination duration and limit opportunities for risk detection.
<Domain 5: Effectiveness of examination> was revised from the original ‘cost-effectiveness’ to ‘effectiveness.’ This shift indicates that cost-effectiveness, which was previously a mandatory criterion, was downgraded to a review criterion. The need for examination was recognized even when the cost-effectiveness analysis was challenging or yielded inadequate results, particularly in achieving goals such as improving health equity or reducing health disparities.36,37 Delphi responses further indicated that when economic efficiency conflicted with the public-health responsibility to protect socially disadvantaged, a substantial proportion of experts prioritized the latter. Nevertheless, this did not imply that the cost-effectiveness analysis was irrelevant but rather highlighted the need for at least minimal evidence of effectiveness.
The primary contention in evaluating specialized health examinations for female fishers was the health examination for MSDs. Approximately 47,000 female fishers constitute over half of the total fishing population in Korea and are frequently exposed to occupational risk factors, such as physically demanding tasks, outdoor activities, prolonged labor, noise, and vibration.
A high prevalence of MSDs has been reported among female fishers, underscoring the general agreement regarding the importance of these disorders. However, MSDs often lack clear distinctions between healthy and diseased states and do not align well with the standard preventive health examination model targeting asymptomatic conditions. Efforts have been made to address these issues by improving MSD examinations.38,39 In specialized health examinations for female fishers, the number of evaluated MSDs was limited to representative conditions, target disease states were operationally defined, examination methods were standardized, and follow-up management methods were presented. Although this protocol enabled the achievement of consensus regarding the ‘Feasibility of medical test method', consensus regarding the ‘Applicability of early detection and intervention’ and ‘Effectiveness of examination’ could not be reached. Effective improvement of MSDs requires follow-up management, such as ergonomic interventions and physical rehabilitation; however, it is impractical to expect self-employed fishers to achieve these improvements solely through education after examinations. Thus, it is necessary to develop preventive programs for MSDs and validate their effectiveness. Nevertheless, the effectiveness of all occupational health examination programs remains challenging.40
Feasibility by medical institutions was another critical issue. Coastal areas with residential female fishers often encounter shortages of occupational medicine specialists and widening urban-rural healthcare disparities, hindering the implementation of specialized health examination programs.
Ideally, health screening items should be included only if all evaluation criteria are met.
However, in this study, many health examination items for female fishery workers did not meet all established criteria, highlighting the need for careful selection and possible supplementation. The study’s proposed criteria can serve as both a framework for selecting appropriate tests and an evaluative tool for improving existing examinations. Furthermore, they offer policymakers evidence-based guidance on including or excluding specific tests.
This study has several limitations. First, it did not include quantitative analyses, such as estimations of disease burden or cost-effectiveness, which could have further informed the decision-making process. Second, as is inherent in all Delphi studies, the resulting consensus reflects the views of the selected expert panel at a specific point in time and may vary with different panel compositions or expertise. Third, differential weighting of criteria was not assessed; such weighting may be necessary in practice when clinical importance conflicts with feasibility or resource constraints. Despite these limitations, this study’s strength is its provision of expert-validated criteria that support systematic and practical occupational health policy decisions.
CONCLUSIONS
The principles for health examinations targeting high-risk occupational groups exposed to occupational risk factors were developed to complement general health screening principles for the broader population and reflect the unique characteristics of occupational health examination. Ensuring the reliability and validity of occupational health examinations is critical for preventing work-related diseases, and these criteria provide a framework to validate existing programs. Such evaluations may indicate that several existing occupational health examinations fail to comprehensively meet these validity criteria. However, this conclusion should not be interpreted as a justification for discontinuing health examination programs. Importantly, these criteria should serve as tools to identify deficiencies in occupational health examinations, thereby guiding improvements toward more effective and practical occupational health examination practices.
Abbreviations
COPD
chronic obstructive pulmonary disease
CVR
content validity ratios
LDL
low-density lipoprotein
MSD
musculoskeletal disorders
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Competing interests
Jungwon Kim and Hansoo Song, contributing editors of the Annals of Occupational and Environmental Medicine, were not involved in the editorial evaluation or decision to publish this article. All remaining authors have declared no conflicts of interest.
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Author contributions
Conceptualization: Song H. Data curation: Song H, Kim HM. Methodology/formal analysis/validation: Song H, Kim J, Kim K. Project administration: Song HS. Funding acquisition: Song H. Writing - original draft: Song H, Kim HM. Writing - review & editing: Song H, Kim HM, Kim J, Kim K.
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Acknowledgments
The authors would like to thank the Ministry of Oceans and Fisheries of the Republic of Korea for its support.
NOTES
SUPPLEMENTARY MATERIAL
Supplementary Table 1.
Korean version of Criteria for Health Examination of High-Risk Occupational Groups.
Supplementary Data 1.
Literature-based evidence for specialized health examinations for women fishers.
Table 1.
Characteristics of the study subjects
| Category | Value |
|---|---|
| Affiliation | |
| The Korean Society of Occupational and Environmental Medicine, Committee of Clinical Practice | 9 (32.1) |
| The Korean Society for Preventive Medicine, Committee of Clinical Preventive Medical Care | 7 (25.0) |
| The Association of Occupational & Environmental Physicians for Workplace Health | 12 (42.9) |
| Sex | |
| Male | 22 (78.6) |
| Female | 6 (21.4) |
| Specialtya | |
| Occupational disease | 16 (57.1) |
| Preventive and health projects | 19 (67.9) |
| Health examination | 21 (75.0) |
| Age (years) | 44.8 ± 4.9 (37‒55) |
| Career | |
| Occupational disease | 9.7 ± 8.5 (0‒25) |
| Preventive and health projects | 9.3 ± 7.2 (0‒25) |
| Health examination | 9.7 ± 7.1 (0‒23) |
Table 2.
Delphi study for selecting health examination items for high-risk occupations (first round)
Table 3.
Delphi study on principles for selecting health examination items for high-risk occupations (second round)
Table 4.
The Delphi study for selecting examination items for female fishers (third round)
| Target diseases (type of health examination) | Examination | Criteria | Mean ± SD | Positive response (%) |
|---|---|---|---|---|
| Osteoporotic fracture (screening only) | 1) Bone density (DEXA) | Priority | 4.14 ± 0.71 | 89.3 |
| 2) Skeletal muscle mass (BIA) | Early detection and intervention | 4.07 ± 0.72 | 85.7 | |
| 3) Falls risk questionnaire | Scientific evidence | 4.00 ± 0.67 | 85.7 | |
| Feasibility | 4.21 ± 0.63 | 96.4 | ||
| Effectiveness | 4.00 ± 0.72 | 82.1 | ||
| Degenerative lumbar disease (screening and surveillance) | 1) Lumbar radiography | Priority | 4.29 ± 0.46 | 100.0 |
| 2) Physical examination | Early detection and intervention | 3.07 ± 0.90 | 39.3 | |
| 3) ODI | Scientific evidence | 3.43 ± 0.88 | 64.3 | |
| Feasibility | 3.79 ± 0.83 | 75.0 | ||
| Effectiveness | 3.32 ± 0.82 | 50.0 | ||
| Knee osteoarthritis (screening and surveillance) | 1) Both knees, Rosenberg view | Priority | 4.29 ± 0.81 | 96.4 |
| 2) Physical examination | Early detection and intervention | 3.25 ± 0.84 | 46.4 | |
| 3) WOMAC short form | Scientific evidence | 3.50 ± 0.84 | 60.7 | |
| Feasibility | 3.93 ± 0.77 | 85.7 | ||
| Effectiveness | 3.43 ± 0.84 | 53.6 | ||
| Upper extremity diseasea (screening and surveillance) | 1) Both hand radiography | Priority | 4.14 ± 0.76 | 85.7 |
| 2) Physical examination | Early detection and intervention | 3.25 ± 0.75 | 42.9 | |
| 3) QuickDASH | Scientific evidence | 3.43 ± 0.74 | 50.0 | |
| Feasibility | 3.86 ± 0.65 | 78.6 | ||
| Effectiveness | 3.36 ± 0.68 | 46.4 | ||
| Cardiovascular disease risk factors (screening only) | 1) Waist circumference | Priority | 4.57 ± 0.50 | 100.0 |
| 2) Blood pressure | Early detection and intervention | 4.50 ± 0.51 | 100.0 | |
| 3) Hemoglobin A1c | Scientific evidence | 4.54 ± 0.51 | 100.0 | |
| 4) Low-density lipoprotein cholesterol | Feasibility | 4.50 ± 0.51 | 100.0 | |
| 5) Questionnaire (alcohol, smoking, physical activity) | Effectiveness | 4.36 ± 0.68 | 89.3 | |
| Noise-induced hearing impairment (screening and surveillance) | 1) Pure-tone audiometry | Priority | 3.86 ± 0.65 | 75.0 |
| 2) Otoscopy | Early detection and intervention | 3.68 ± 0.77 | 64.3 | |
| 3) Hearing impairment questionnaire | Scientific evidence | 4.07 ± 0.72 | 82.1 | |
| Feasibility | 3.82 ± 0.86 | 67.9 | ||
| Effectiveness | 3.64 ± 0.73 | 60.7 | ||
| COPD (screening and surveillance) | 1) COPD-6 testb | Priority | 3.75 ± 0.70 | 67.9 |
| 2) Dyspnea questionnaire | Early detection and intervention | 3.57 ± 0.69 | 60.7 | |
| Scientific evidence | 3.61 ± 0.79 | 57.1 | ||
| Feasibility | 3.36 ± 0.83 | 50.0 | ||
| Effectiveness | 3.39 ± 0.69 | 42.9 | ||
| Vision-threatening eye diseasesc (screening only) | 1) Amsler grid testd | Priority | 3.86 ± 0.59 | 75.0 |
| 2) Funduscopy | Early detection and intervention | 3.68 ± 0.72 | 71.4 | |
| Scientific evidence | 3.71 ± 0.76 | 71.4 | ||
| Feasibility | 3.50 ± 0.88 | 64.3 | ||
| Effectiveness | 3.50 ± 0.79 | 64.3 |
SD: standard deviation; DEXA: dual-energy X-ray absorptiometry; BIA: bioelectrical impedance analysis; ODI: Oswestry Disability Index; WOMAC: Western Ontario and McMaster Universities Osteoarthritis Index; QuickDASH: Quick Disabilities of the Arm, Shoulder and Hand Questionnaire; COPD: chronic obstructive pulmonary disease.
aUpper extremity disease includes four conditions: hand osteoarthritis, carpal tunnel syndrome, epicondylitis, and rotator cuff disease;
bCOPD-6 presents the forced expiratory volume in 1 second value as determined using a spirometry instrument measured in primary care, but does not represent the forced vital capacity; instead, it presents the forced expiratory volume in 6 seconds value;
cVision-threatening eye diseases include age-related macular degeneration, diabetic retinopathy, and glaucoma, which are major causes of vision impairment and blindness worldwide;
dThe Amsler grid refers to a checkerboard pattern with a dot in the center and confirms symptoms due to retinal abnormalities by checking the lines that appear distorted or faint.
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XML DownloadDevelopment of criteria for health examination of high-risk occupational groups and application to female fishers: Delphi study
Development of criteria for health examination of high-risk occupational groups and application to female fishers: Delphi study
| Category | Value |
|---|---|
| Affiliation | |
| The Korean Society of Occupational and Environmental Medicine, Committee of Clinical Practice | 9 (32.1) |
| The Korean Society for Preventive Medicine, Committee of Clinical Preventive Medical Care | 7 (25.0) |
| The Association of Occupational & Environmental Physicians for Workplace Health | 12 (42.9) |
| Sex | |
| Male | 22 (78.6) |
| Female | 6 (21.4) |
| Specialty |
|
| Occupational disease | 16 (57.1) |
| Preventive and health projects | 19 (67.9) |
| Health examination | 21 (75.0) |
| Age (years) | 44.8 ± 4.9 (37‒55) |
| Career | |
| Occupational disease | 9.7 ± 8.5 (0‒25) |
| Preventive and health projects | 9.3 ± 7.2 (0‒25) |
| Health examination | 9.7 ± 7.1 (0‒23) |
| Principle | Mean ± SD | CVR | |
|---|---|---|---|
| Domain 1 | The target disease has priority in high-risk occupational groups | 8.86 ± 1.16 | 1.00 |
| 1-1. The prevalence of the target disease is higher in the high-risk occupational group than in the general population | 7.82 ± 2.02 | 0.71 | |
| 1-2. The target disease has a high severity in the high-risk occupational group | 7.96 ± 1.84 | 0.64 | |
| 1-3. The target disease has a high disease burden in the high-risk occupational group | 7.96 ± 1.82 | 0.71 | |
| 1-4. In the high-risk occupational group, this disease has high social attention. | 6.11 ± 1.88 | 0.07 | |
| Domain 2 | Early detection and intervention can be applied to target diseases | 7.96 ± 2.23 | 0.71 |
| 2-1. There are methods that can detect signs before they occur - in acute disease - or diagnose an early stage of the disease - in chronic disease | 7.61 ± 2.14 | 0.64 | |
| 2-2. There are proven treatments or interventions to stop the onset or exacerbation of the disease | 7.68 ± 2.17 | 0.50 | |
| Domain 3 | The medical test method was based on scientific evidence. | 8.07 ± 1.60 | 0.79 |
| 3-1. The medical test method has reliability (it shows consistent results in repeated tests) | 7.54 ± 1.59 | 0.50 | |
| 3-2. The medical test method has validity (sensitivity and specificity are acceptable) | 7.64 ± 1.52 | 0.64 | |
| 3-3. The examination cycle is determined considering the natural history and characteristics of the disease | 7.29 ± 1.92 | 0.57 | |
| Domain 4 | The medical test method has feasibility | 8.46 ± 1.38 | 0.86 |
| 4-1. The medical test method has lower objections (stigma effect, employment penalty, invasive testing) to the subjects | 8.29 ± 1.79 | 0.79 | |
| 4-2. Most examination institutions can secure the test equipment and health facilities required for the examination | 8.25 ± 1.35 | 0.71 | |
| 4-3. Examination doctors are expected to have the ability to evaluate and interpret examination items. | 8.57 ± 1.42 | 0.79 | |
| 4-4. The examination fee is appropriate for the examination institution to maintain and manage this examination. | 8.43 ± 1.47 | 0.79 | |
| Domain 5 | The direct or indirect benefit from the examination is greater than the cost (effectiveness) | 7.00 ± 2.43 | 0.29 |
| 5-1. The positive effect of examination can be explained by objective indicators (indicator) | 6.79 ± 2.37 | 0.29 | |
| 5-2. The expected effect is greater than the cost of the examination (cost-effectiveness) | 6.82 ± 2.56 | 0.21 | |
| Principle | Mean ± SD | CVR | |
|---|---|---|---|
| Domain 1 | The target disease has priority in high-risk occupational groups | 8.89 ± 0.90 | 0.929 |
| 1-1. The prevalence of the target disease is higher in the high-risk occupational group than in the general population | 8.14 ± 1.27 | 0.714 | |
| 1-2. The target disease has a high severity in the high-risk occupational group | 7.82 ± 1.23 | 0.571 | |
| 1-3. The target disease has a high disease burden in the high-risk occupational group | 8.32 ± 1.00 | 0.857 | |
| Domain 2 | Early detection and intervention can be applied to target diseases | 7.86 ± 1.92 | 0.571 |
| 2-1. There are methods that can detect signs before they occur - in acute disease - or diagnose an early stage of the disease - in chronic disease | 7.82 ± 1.77 | 0.643 | |
| 2-2. There are proven treatments or interventions to stop the onset or exacerbation of the disease | 7.54 ± 1.59 | 0.500 | |
| Domain 3 | The medical test method was based on scientific evidence. | 8.21 ± 1.29 | 0.786 |
| 3-1. The medical test method has reliability (it shows consistent results in repeated tests) | 8.21 ± 1.24 | 0.786 | |
| 3-2. The medical test method has validity (sensitivity and specificity are acceptable) | 8.29 ± 1.25 | 0.857 | |
| 3-3. The examination cycle is determined considering the natural history and characteristics of the disease | 8.21 ± 1.08 | 0.929 | |
| Domain 4 | The medical test method has feasibility | 8.82 ± 0.97 | 1.000 |
| 4-1. The medical test method has lower objections (stigma effect, employment penalty, invasive testing) to the subjects | 8.71 ± 0.84 | 1.000 | |
| 4-2. Most examination institutions can secure the test equipment and health facilities required for the examination | 8.32 ± 1.31 | 0.786 | |
| 4-3. Examination doctors are expected to have the ability to evaluate and interpret examination items | 8.82 ± 0.85 | 1.000 | |
| 4-4. The examination fee is appropriate for the examination institution to maintain and manage this examination | 8.75 ± 1.12 | 0.929 | |
| Domain 5 | The examination program has direct (reducing medical cost) or indirect effects (improving indirect costs, time loss, and low productivity) on the health improvement of high-risk occupational groups | 8.07 ± 1.16 | 0.857 |
| 5-1. Reasonable indicators can be created to monitor the effectiveness of screening | 7.64 ± 1.44 | 0.643 | |
| 5-2. The cost-effectiveness of the examination program is acceptable | 7.00 ± 1.98 | 0.429 | |
| 5-3. The examination program is effective in attaining health equity or improving health management in high-risk occupational groups | 7.79 ± 1.08 | 0.786 | |
| Target diseases (type of health examination) | Examination | Criteria | Mean ± SD | Positive response (%) |
|---|---|---|---|---|
| Osteoporotic fracture (screening only) | 1) Bone density (DEXA) | Priority | 4.14 ± 0.71 | 89.3 |
| 2) Skeletal muscle mass (BIA) | Early detection and intervention | 4.07 ± 0.72 | 85.7 | |
| 3) Falls risk questionnaire | Scientific evidence | 4.00 ± 0.67 | 85.7 | |
| Feasibility | 4.21 ± 0.63 | 96.4 | ||
| Effectiveness | 4.00 ± 0.72 | 82.1 | ||
| Degenerative lumbar disease (screening and surveillance) | 1) Lumbar radiography | Priority | 4.29 ± 0.46 | 100.0 |
| 2) Physical examination | Early detection and intervention | 3.07 ± 0.90 | 39.3 | |
| 3) ODI | Scientific evidence | 3.43 ± 0.88 | 64.3 | |
| Feasibility | 3.79 ± 0.83 | 75.0 | ||
| Effectiveness | 3.32 ± 0.82 | 50.0 | ||
| Knee osteoarthritis (screening and surveillance) | 1) Both knees, Rosenberg view | Priority | 4.29 ± 0.81 | 96.4 |
| 2) Physical examination | Early detection and intervention | 3.25 ± 0.84 | 46.4 | |
| 3) WOMAC short form | Scientific evidence | 3.50 ± 0.84 | 60.7 | |
| Feasibility | 3.93 ± 0.77 | 85.7 | ||
| Effectiveness | 3.43 ± 0.84 | 53.6 | ||
| Upper extremity disease |
1) Both hand radiography | Priority | 4.14 ± 0.76 | 85.7 |
| 2) Physical examination | Early detection and intervention | 3.25 ± 0.75 | 42.9 | |
| 3) QuickDASH | Scientific evidence | 3.43 ± 0.74 | 50.0 | |
| Feasibility | 3.86 ± 0.65 | 78.6 | ||
| Effectiveness | 3.36 ± 0.68 | 46.4 | ||
| Cardiovascular disease risk factors (screening only) | 1) Waist circumference | Priority | 4.57 ± 0.50 | 100.0 |
| 2) Blood pressure | Early detection and intervention | 4.50 ± 0.51 | 100.0 | |
| 3) Hemoglobin A1c | Scientific evidence | 4.54 ± 0.51 | 100.0 | |
| 4) Low-density lipoprotein cholesterol | Feasibility | 4.50 ± 0.51 | 100.0 | |
| 5) Questionnaire (alcohol, smoking, physical activity) | Effectiveness | 4.36 ± 0.68 | 89.3 | |
| Noise-induced hearing impairment (screening and surveillance) | 1) Pure-tone audiometry | Priority | 3.86 ± 0.65 | 75.0 |
| 2) Otoscopy | Early detection and intervention | 3.68 ± 0.77 | 64.3 | |
| 3) Hearing impairment questionnaire | Scientific evidence | 4.07 ± 0.72 | 82.1 | |
| Feasibility | 3.82 ± 0.86 | 67.9 | ||
| Effectiveness | 3.64 ± 0.73 | 60.7 | ||
| COPD (screening and surveillance) | 1) COPD-6 test |
Priority | 3.75 ± 0.70 | 67.9 |
| 2) Dyspnea questionnaire | Early detection and intervention | 3.57 ± 0.69 | 60.7 | |
| Scientific evidence | 3.61 ± 0.79 | 57.1 | ||
| Feasibility | 3.36 ± 0.83 | 50.0 | ||
| Effectiveness | 3.39 ± 0.69 | 42.9 | ||
| Vision-threatening eye diseases |
1) Amsler grid test |
Priority | 3.86 ± 0.59 | 75.0 |
| 2) Funduscopy | Early detection and intervention | 3.68 ± 0.72 | 71.4 | |
| Scientific evidence | 3.71 ± 0.76 | 71.4 | ||
| Feasibility | 3.50 ± 0.88 | 64.3 | ||
| Effectiveness | 3.50 ± 0.79 | 64.3 |
Table 1. Characteristics of the study subjects
Values are presented as number (%) or mean ± standard deviation (min‒max). These three specialties can be answered in duplicate. Therefore, the total sum did not correspond to 28.
Table 2. Delphi study for selecting health examination items for high-risk occupations (first round)
Subjects number: 28. Minimum criterion for CVR = 0.357. Affirmative answers: 7‒10 on a 10-point scale. SD: standard deviation; CVR: content validity ratio.
Table 3. Delphi study on principles for selecting health examination items for high-risk occupations (second round)
Subjects number: 28. Minimum criterion for CVR = 0.357. Affirmative answers: 7–10 on a 10-point scale. SD: standard deviation; CVR: content validity ratio.
Table 4. The Delphi study for selecting examination items for female fishers (third round)
SD: standard deviation; DEXA: dual-energy X-ray absorptiometry; BIA: bioelectrical impedance analysis; ODI: Oswestry Disability Index; WOMAC: Western Ontario and McMaster Universities Osteoarthritis Index; QuickDASH: Quick Disabilities of the Arm, Shoulder and Hand Questionnaire; COPD: chronic obstructive pulmonary disease. Upper extremity disease includes four conditions: hand osteoarthritis, carpal tunnel syndrome, epicondylitis, and rotator cuff disease; COPD-6 presents the forced expiratory volume in 1 second value as determined using a spirometry instrument measured in primary care, but does not represent the forced vital capacity; instead, it presents the forced expiratory volume in 6 seconds value; Vision-threatening eye diseases include age-related macular degeneration, diabetic retinopathy, and glaucoma, which are major causes of vision impairment and blindness worldwide; The Amsler grid refers to a checkerboard pattern with a dot in the center and confirms symptoms due to retinal abnormalities by checking the lines that appear distorted or faint.
