School years are highly significant for establishing lifelong healthy habits. According to the 11^th adolescent health behavior online survey which analyzed health behavior in school-age youth in Korea, an average of 20.0% males and 13.1% females were smokers, and the obesity rate was 14.2% and 7.3%, respectively [1]. The recent MERS epidemic emphasized the importance of healthcare education such as student health care and infectious disease prevention education in schools, which were otherwise unfamiliar with safety accidents [2]. In order to efficiently manage a recurrence of this problem, a systematic school healthcare program led by health educators is required.

Accordingly, in 2009, Korea expanded the existing curriculum of medical treatment and health advice-oriented role by reorganizing the curriculum of elementary, middle school and high school students to receive healthcare education more than 17 hours per year. However, based on the 2014 data, the average number of health educators placed per school is 0.70 for elementary, 0.51 for middle, and 0.68 for high school [3]. In order to efficiently accomplish multiple tasks with this lack of manpower, securing long-term human resources is essential, but it is more important to obtain the assistance of an appropriate information system in the current scenario. Introduction of a school nursing information system is one of the most effective ways to monitor the health status of students, as well as maintain health-related records [4]. In an attempt to make healthcare education efficient, various systems have been employed globally: School Health Management Information Systems (MIS) in the U.S [5] and School Nurse Information System (SNIS) in Australia and Taiwan [6].

For the purpose of alleviating the workload of teachers and improving the efficiency of education business administration, the Government started computerizing school records in 1997, and further developed the system into a National Education Information System (NEIS). Recently, the establishment and operation of education information system, such as business process transaction by the information system, have been added in the education act in 2005 [5]; it also mentions that the duties of the health educators require information and computerization skills.

Since increasing school healthcare problems can spread into the community, health educators need to identify the public health problems, such as influenza, meningitis, enteritis virus, and MERS, and proceed to be the main barrier against the spread of these diseases. They should be able to efficiently manage the health of students and the community, and also provide regular information on the latest infectious disease outbreaks and healthcare by systematic management of health conditions, immunization, etc. This requires diverse skills. Among these, informatics competencies refer to the ability to search literature, healthcare information and health-related data to be used in conjunction with education [6].

Due to the trend of medical technology development and the rapid rise of the disease diversity and healthcare information [7], we are unable to apply NEIS, which is used as a current information system, to school teachers. In fact, as one of the unit tasks of NEIS, 'healthcare' belongs to the health educators and is classified as the sole management of student data, health record, and patients with infectious diseases. However, it is urgent to develop an information system for school healthcare business administration, because the health educators are very limited to leverage work in conjunction with the NEIS, owing to performing a variety of tasks, including education, counseling, screening, vaccination, direct healthcare task, etc. Meanwhile, a study on domestic nursing informatics competencies was done to primarily identify the relevant factors and check nursing informatics competencies of hospital nurse [8-10], nursing students [11] and public healthcare nurses [12]. There is no previous study for identifying informatics competencies targeting school health educators. Therefore, this study was conducted to serve as the basis of the future system development for healthcare nursing, by investigating the nursing informatics competencies of health educators. The specific objectives of the study are as follows.

1) Investigate health educators’ NEIS utilization and satisfaction. 2) Investigate differences in nursing information competency according to the characteristics of health educators. 3) Investigate the relationship between nursing information competency and NEIS utilization and satisfaction.

The purpose of this study is to obtain basic data for the improvement and development of school healthcare services information system, by identifying the status of nursing informatics competencies, NEIS utilization and satisfaction. In terms of the education level of subjects of this study, the number of the university graduates is 79 (59.8%), and graduates is 43 (32.6%), which showed higher education level compared to the previous study for nurses [8] working at community healthcare centers. In terms of the information-related characteristics, the number of nurses who have informatics related certificate is 88(66.7%) and nurses [8] who work at community healthcare center is 48(30.0%). In the previous study, hospital nurses [10, 11] having informatics related certificates showed a higher percentage, as compared to 4~5% of the previous study. Informatics related education experience showed much higher percentage at 66.7%, compared to 52.5%∼66.1% of hospital nurses [10, 11] and 28.1% of community healthcare center nurses. This is because the working environment is favorable and stable to study and to gain certificates. Even though health educators are nurses, their teaching duty requires continuous study and relevant certification. Also, 86.8% of the subjects of this study replied that informatics education program is necessary, which was much higher as compared to the previous study [10-12] for the hospital nurses.

NEIS utilization and satisfaction result was 3.5 points of a total of 5. In the detailed area of NEIS utilization, student health records management showed high point of 4.06(±0.98), followed by student information management of 3.61(±1.10). On the other hand, in the case of education administration management, which is a major task for the health educator, utilization gained 3.38(±1.22) and product management showed lowest utilization points. Scores of utilization and satisfaction of NEIS were above average; however, in the descriptive reply, 59% of the respondents mentioned that system improvement is urgent because the current system does not meet the standards of actual work. Therefore, a repeated and expanded study is needed. In the overseas cases of Taiwan [4, 15], recognition of the school nursing information system, recognition of easy instruction, training completion status, and workload are found to be related with school nursing information system [16]. Furthermore, it mentioned that workload should be reduced and satisfaction should be increased in future, so that eventually information system is designed towards improving the work performance.

The UK Department of Health reported that school nurses played an important role in finding and managing hidden health problems of students, bullying, and truancy; therefore, their role should be expanded and strengthened in future. Also, they should be supported with School and Public health nurses’ Association as the center [17]. In this way, system satisfaction and utilization is critical for efficient work performance of health educators. However, in the domestic scenario, NEIS healthcare management features are limited to only three categories: student data management, health record management, and infectious disease management. Hence, there is a gap between the actual duties of the health educators and current system. System renovation, based on specific studies on the duties of the health educators, is necessary to solve and improve this situation.

Studies on the job analysis of health educators have been studied very briefly, such as a job analysis of elementary and middle school [6]. On the other hand, very active discussions on the job analysis, such as the amount of job hours and job necessities [5] of other courses, are underway. Therefore, system improvement to define the duties of health educators is necessary.

For example, as one of the duties of the health educators, establishment and connection of the ‘infectious disease patient care’ database is an urgent issue to deal with identifying student patients by connecting other schools’ database at the level of city-county, since management of vulnerable children at the time of frequent disasters and calamity is important beyond the current system of only reporting the number of student patients.

As a public healthcare center performing a business which is designed for the local customers, school healthcare should not overlook that it is centered around the local community. If an elementary school is located in an area suffering from atopic dermatitis, it needs to select subjects related to that disease for healthcare education, which will be very useful and can attract parent participation. If the student patients are managed by connecting with the information system, nursing quality will be improved continuously with the evaluation and feed-back collected during the school nursing period.

The average of a health educator’s nursing informatics competencies was 3.47(±0.51); this is above the average and slightly higher than that of hospital nurse in the previous study [12, 15] It is considered to be a similar result since the health educators have much more educational experiences and possess a high degree of certification. It can be interpreted that meaningful experiences and acquisitions of certification resulted in informatics competencies. Evaluating the nursing informatics competencies, it was found that informatics knowledge competencies and computer technology showed similar points of 3.5 each, while the informatics technology showed 3.3 points. This result showed a high similarity with the previous study [7, 8, 11, 13], which mentioned that informatics knowledge competencies are higher than technology competencies. However, health educators showed higher technology competencies than public healthcare center and hospital nurses. This is because the health educators prepare for the class and have frequent media exposure. As mentioned above, health educators are regarded to have informatics competencies and can improve nursing informatics competencies if the system is revamped and appropriate training is imparted.

Nursing informatics competencies based on general characteristics showed no significant results. The previous study reported a strong correlation with age, and variables such as education level [17] and years of service were statistically significant and different from the current study result. The health educators were older than other subjects of the study, and education level and years of service were relatively high; thus, it is limited to compare horizontally with other subjects. Future studies involving diverse areas and an expanded number of subjects are needed.

The average time of computer usage per day showed a positive (+) correlation with nursing information characteristics. This result supports the report [10, 18-20] which mentioned that the average time to use a computer per week affects computer competencies. Also, subjects who have experience in nursing informatics training showed high nursing informatics competencies. In the previous study of using hospital nurses as a subject, the need for informatics education and hospital information system affected the information system utilization. Therefore, by identifying the needs of work of health educators, opening a new educational program to improve nursing informatics competencies is required.

The need for education content as one of the questionnaires of this study was surveyed in the narrative questions section. Of the total subjects, 38(28.8%) respondents replied that statistics education is necessary; other comments included the necessity for gaining access to the national statistics for the various duties of health educators. Statistics were included in the middle school curriculum from 2016, so it needs to be actively utilized in healthcare education and the establishment of the system. Especially, basic epidemiologies such as incidence, morbidity rate and prevalence of local community where the school is located is essential to diagnose the local community and fulfill appropriate nursing intervention.

In the US, school healthcare programs have been organized to reflect the various tasks performed by the actual health educator. For example, reflection of regional and national needs where the school is located, monitoring of local community healthcare program, matters of health, reflection of policy, management and evaluation of the generated problems, are all included. Furthermore, to perform the broad range of healthcare duties, school health records are digitalized and systemized to be managed [3]. Similarly in Korea, to enable the simple task of maintaining records, the operation of a system that can connect various duties of the health educators is urgent.

The study shows a strong positive correlation between NEIS utilization, satisfaction and nursing informatics competencies. It suggests a program improvement to reflect duties which can be actively utilized. In this study, subjects were selected only from the health educators in some areas of Chungcheong Province and Seoul, so careful consideration is required for exaggerated interpretation and generalization. Also, there is a limitation to the reliability for the subjective questions and on recollection because of the self-report questionnaires method. This study has the advantage over the healthcare education and practical aspects, since it improved the information system and provided basic resources for quality improvement of the school healthcare duties by identifying the NEIS utilization and informatics competencies of health educators.

The study result revealed that the health educators have above average healthcare informatics competencies. Also, they revealed above average competencies in sub-area such as computer literacy, informatics knowledge, and informatics technology. Furthermore, health educators are considered to have basic knowledge and capabilities for strong informatics competencies since they have accumulated educational experience and have higher education level. However, NEIS, as an information system that can improve informatics competencies, has the limited ability to reflect fully utilized or reflect school health activities. This study has significance in that it provided data to improve the program for information technology by identifying the information competency of teachers for the first time in Korea. This study suggests standardization of duties of health educators and system improvement and education.