Ⅰ. Introduction

1. Necessity of study

Public health science is a human science based on the understanding of human phenomena and a practical science to change the phenomena.¹⁾ Studies of public health science mainly deal with understanding of human responses related to health and changing human phenomena of overall human problems. In performing research in public health science, research ethics is especially important to respect and protect its subject humans and sincerely conduct scientific research. In Korea, there has been rapid expansion of research (with consistent performance of research) by the graduates doing master's and doctoral courses over the last 4 decades.

Yet, awareness and culture regarding research ethics of public health researchers in Korea who conduct lots of research on public health and human subjects are still deemed to be inadequate.

First, it has been reported that subscription regulations of academic public health science journals do not emphasize ethicality of research and printed theses rarely mention it as well.²⁾

Second, in the case of education on research ethics, surveys showed that only a few professors of public health departments performed education on research ethics for 2 hours on average and, as a result, half of public health graduate students do not have enough understanding of such basic ethical concepts such as Belmont doctrine, forgery, falsification and plagiarism and express the necessity for education on research ethics.³⁾

Although the level of awareness, self-efficacy and knowledge of research ethics in current generation of public health scientists who are to publish theses on public health science would have great effect on the observance of research ethics in their these, little is known about preceding research and studies. Therefore, this study aimed to investigate the public health graduate students' level of awareness, self-efficacy and knowledge of research ethics which they should be equipped with as responsible researchers who conduct research on humans and to provide basic material for the development of programs to enhance research ethics of graduate students majoring in public health science.

2. Purpose of the study

The purpose of this study was to investigate the public health graduate students' level of awareness, self-efficacy and knowledge of research ethics which they should be equipped with as responsible researchers who conduct research on humans and to provide basic material for the development of program to enhance research ethics of public health graduate students. Detailed purposes of this study are as follows;

Ⅱ. Subjects and methods

1. Study design

This study is a cross-sectional and descriptive research to investigate the public health graduate students' level of awareness, self-efficacy and knowledge of research ethics.

2. Study subjects

The subjects of this study were graduate students who were on or completed master's or doctoral course at a university in Korea, voluntarily agreed to participate in this study selected by convenience sampling and wrote letter of agreement in writing. Since the number of the students required was calculated to be minimum 84 by using G power 3.0 (Heinrich-Heine-University, Dusseldorf, Germany) program based on Cohen's formula for power analysis with effect size of 0.20, significance level (α) of 0.05 and power of test (1-β) of 0.80. A total of 210 questionnaires were distributed and, among them, 205 questionnaires were collected (collection rate: 95%). Finally, except for one with incomplete answers, a total of 204 questionnaires were analyzed and thus, the size of the sample in this study was large enough to statistically confirm the relationship among variables.

3. Study tools

In order to investigate the public health graduate students' level of awareness, self-efficacy and knowledge of research ethics, self-administered questionnaires were used which were based on 9 core areas of Responsible Conduct of Research (RCR) suggested by National Science Foundation and Association of Graduate School in the U.S.A., which were acquisition, management, sharing and possession of data, responsibilities of mentor and educator, publishing behavior and being responsible authors, screening of colleagues, cooperative researches, protection of research subjects, researches on animals, misconduct in researches, conflict of interests and responsibilities, which our research team modified and complemented to fit the characteristics of public health research ethics. Face validity of the study was secured by having the contents reviewed by 3 professors of public health department and 3 students in doctoral course. This tool was composed of a total of 35 questions; specifically, researcher's awareness of research ethics (12 questions), self-efficacy to conduct ethical research (7 questions) and knowledge of research ethics (16 questions). Details are as follows;

1) Awareness of research ethics

Tool for awareness of research ethics was composed of a total of 12 questions such as 'standards for good researches', 'being a responsible author', 'protection of research subjects', 'misconduct in researches', 'management of data' and 'preparation for Institutional Review.' Each question was constructed with 5-point scale (‘knows very well’=5 points, ‘moderate'=3 points, ‘not know at all’=1 point). The higher the score is, the higher the level of awareness on research ethics. Value of Cronbach's alpha for reliability of internal consistency was 0.95.

2) Self-efficacy to conduct ethical research

Tool for self-efficacy of researcher's ability to conduct ethical research was composed of a total of 7 questions, which were 'ethical decision-making ability', 'critical thinking and problem-solving ability', 'conflict-resolving ability', 'mediation and coordination ability', 'stress management ability' and 'communication ability'. Each question was constructed with 5-point scale (‘very strong’=5 points, ‘moderate'=3 points, ‘not know at all’=1 point). The higher the score is, the higher the level of ability to conduct ethical researches recognized by the subjects is. Value of Cronbach's alpha for reliability of internal consistency of this tool was shown 0.94.

3) Knowledge of research ethics

Tool to measure knowledge of research ethics was composed of a total of 16 questions, which were 1 question on voluntary agreement, 7 questions on misconduct in researches, 2 questions on correct statistical treatment, 1 question on data management, 2 questions on being an author, 2 questions on publication ethics and 1 question on the protection of research subjects. Each question was constructed to answer 'yes' or 'no.' Right and wrong answer for each question was given ‘1’ and '0' point, respectively. Total score was calculated and the range of score was 0-16 meaning that the higher the score is, the higher the level of knowledge represents.

4) General characteristics

To find out subjects' general characteristics, a total of 7 questions were prepared on gender, age, kind of graduate course and semester, type of institutions to which subjects currently belong, research experience, experience of having taken ethics courses and experience of having published a thesis.

4. Procedure of data collection and ethical considerations

After fully explaining the purpose of the experiment and the test method in writing to the subjects who participated in the study, consent was obtained and the test was conducted. In order to promote research subjects' voluntary participation, emails with the purpose and schedule of ethics education on public health research to public health graduate students and posters for this study were prepared and posted on the 7 spots in the campus. The chief of research explained purpose, necessity and process of this study, method of data collection, use of data, guarantee of anonymity and possible retraction anytime if desired and had them sign a letter of agreement specifying above contents.

5. Data analysis

Collected questionnaire data were coded and analyzed by using PASW Statistic 18.0 Window (SPSS Inc, Chicago, IL, USA) program. Subjects' general characteristics, awareness of research ethics, self-efficacy and level of knowledge were also analyzed by technical statistics such as frequency, percentage, mean and standard deviation respectively. For awareness of research ethics and self-efficacy, mean and standard deviation were acquired for all subjects and for level of knowledge, rate of correct answer and number of respondents were counted. For differences among variables based on general characteristics, t-test analysis was performed with characteristic of each variable. The relationship between awareness of research ethics, self-efficacy and level of knowledge was analyzed with Pearson's correlation coefficients and significance level for statistical verification was set at 0.050.

Ⅲ. Results

1. Subjects' general and clinical characteristics

Majority of subjects in this study were women (75.0%, n=153) with mean age of 30.0 (±4.3). 45.1% (n=92) of them were on graduate course for raising public health researchers and educators while 54.9% (n=112) were on public health graduate course to raise professional medical technicians as clinical experts. 77.5% (n=158) of the subjects were on master's course and half (64.7%, n=132) were currently working in medical institutions. 57.8% (n=118) responded they had research experience with mean of 2.2 times. 24.5% (n=50) had experience of having published theses with mean of 1.9 times. In the meantime, 74.5% (n=152) have not taken research ethics courses (Table 1).

2. Subjects' level of awareness, self-efficacy and knowledge of research ethics

1) Level of awareness of research ethics

The level of awareness of research ethics recorded overall mean of 2.90 (standard deviation, SD=0.89), which is lower than 'moderate.' In detail items, 'protection of research subjects and guarantee of confidentiality' was the highest with mean of 3.70 points (1.15) followed by misconduct in research with 3.23 points (1.06) and copyright of the research with 3.21 points (1.17). Item with the lowest awareness was 'protection of invention patents' with mean of 2.57 points (0.98) followed by 'being an author in a joint research' with 2.64 points (0.94) and sharing of research data with 2.68 points (0.99) (Table 2).

2) Level of self-efficacy related to ethical researches

Subjects' level of self-efficacy to conduct ethical research was overall mean of 3.14 points (SD=0.73), which is moderate.

In detailed items, 'communication ability' was the highest with mean of 3.33 points (0.80) while 'ability to control stress' was the lowest with mean of 2.99 points (0.88) (Table 3).

3) Level of knowledge of research ethics

Subjects' knowledge on research ethics showed mean score of 10.59 points (SD=1.90) out of 16 or 66.1 points out of 100, which is very low. In detail, the level of knowledge on specific practical standards of being an author and methods to write a thesis to avoid plagiarism was low (Table 4).

3. Difference in awareness of research ethics, self-efficacy and knowledge based on subjects' characteristics

The results of analysis on the differences between variables based on general characteristics are presented in (Table 5). Students in general graduate courses, working in educational or research organizations, with experience of having taken ethics courses and published theses had statistically significantly high level of awareness of research ethics, self-efficacy and knowledge (p<0.050). In addition, students over 3rd semesters of doctoral courses with experience of researches had statistically significantly high level of awareness and knowledge (p<0.050). Although there was no statistical difference in the kind of research experience, students with experience of having led a research tended to generally have high level of awareness of research ethics, self-efficacy and knowledge.

4. Relationship between the level of awareness of research ethics, self-efficacy and knowledge

Results of analysis on the relationship between the level of awareness of research ethics, self- efficacy and knowledge are presented in (Table 6). There were significantly positive relationships between awareness of research ethics and level of selfefficacy (r=0.403, p<0.001) and level of knowledge (r=0.509, p<0.001) and between self-efficacy and the level of knowledge (r=0.280, p=0.004).

Ⅳ. Consideration

So far, education on research ethics has tended to be conducted in informal and customary ways. Thus, there have been many cases in which researchers violate research ethics due to lack of knowledge as well as cases where they commit violation intentionally.⁴⁾ In particular, sufficient understanding and prior knowledge is critical considered the characteristics of public health science which focuses its researches on human life and health. In addition, as graduate courses are not a simple continuation of undergraduate courses but they focus on raising researchers in academic and clinical settings, it is essential to perform systematic education on research ethics for graduate students who just start their research careers.⁵⁾ Therefore, the purpose of this study was to investigate public health graduate students' level of awareness, self-efficacy and knowledge of research ethics and to provide basic material for the development of educational programs on.

Recently, with the increasing social awareness on the observance of research ethics and emphasis on education of research ethics all across academic fields, educations on research ethics are being provided in various forms including complementary educations and workshops by academic societies as well as formal courses.⁶⁾ Although there is no definite consensus on the domains and scope of research ethics, ORI (office of research integrity) of the U.S.A. and Ministry of Science, ICT and Future Planning in Korea emphasize that researches should be conducted based on the standards of integrity, exactness, efficiency and objectivity.⁷⁾ Even with these guidelines and principles being presented for the observance of research ethics, misconducts in researches and violation of basic principles of research ethics are being continuously reported. This reflects the fact that research ethics has not taken firm root in the minds of researchers in Korea yet.

From 2006, fact-finding survey on activities of research ethics has been conducted by domestic universities and government-subsidized researches every 2 years, which demonstrates that academic systems have gradually improved over the years.⁸⁾ According to report on 'Survey and analysis on activities of research activities in Korea' conducted in 2006, educations were performed in 8 universities (3.7%) among a total of 217 universities and in 21 (7.5%) among 280 academic societies while, in 2008, 59 universities (43.4%) among a total of 136 universities, 135 (21.9%) among 616 academic societies and 25 (86.2%) among 28 governmentfunded research institutions performed education and, in 2010, 56.5% of universities, 33.2% of academic societies and 70.0% of governmentfunded research institutions performed education to establish awareness on research ethics.

Consistent violations of research ethics in spite of these improvements of systems imply that educational institutions do not sufficiently reflect demands of the field. Even universities practicing ethics education mainly focus on bioethics and systematic education on research ethics are not yet fully implemented.⁹⁾ This situation suggests that to improve awareness on research ethics, it is necessary to provide formal educations for practical research ethics which are specialized for each academic discipline.

In a study on 267 researchers in the area of bio-science in Korea,¹⁰⁾ 32.2% of them replied that the lack of research ethics in Korea is caused by the lack of standards for performance and awareness and 31.1% indicated lack of education while 96.6% responded that education on research ethics is necessary. This result implies that despite researchers' awareness on the necessity of education on research ethics, there is still practical lack of opportunities to attend systematic formal education on research ethics.

74.5% of the subjects of this study had no experience of having taken courses on research ethics and the level of awareness on research ethics scored average 2.90 points of 5-point scale, exhibiting less than moderate. While students' awareness on protection of research subjects and misconduct in research such as plagiarism, forgery and falsification were high, awareness on interests in research ethics such as sharing of research data, role in joint research or protection of invention patents was relatively low. Although interest is an area emphasized in research ethics today, awareness on this area recently introduced looks still incipient.

Considering that awareness on research ethics was shown significantly high in the subjects of this study who are on research-focused general graduate courses and those with higher degree and experience of having published thesis, in order to raise awareness on research ethics, it is deemed necessary to provide students with opportunities to practically experience researches in addition to educations to deliver knowledge to them. Overseas universities conduct practical case-centered ethics education as a part of formal curriculums in undergraduate and graduate courses and most universities and research institutions run independent supervisory organizations such as RIC (Research Integrity Committees), providing implications for graduate education field in Korea.

Especially, given that graduate students are beginning to conduct and participate in research in earnest, it is vital to develop and run educational programs to raise their awareness on research ethics. Although there are preceding study reporting¹¹⁾ that a limited number of universities and research institutions have developed curriculums on research ethics, most of them are implemented as short-term seminars, workshops or elective courses and most are not tailored to nursing science. Thus, as they have limitations to provide systematic education, improvement needs to be made.

Self-efficacy of research means having belief or self-confidence that they can successfully perform tasks necessary for responsible researches and it is highly related to a researcher's competency in performing a good researches. In a study on medical graduate school students, self-efficacy whether researchers can take ethical aspects into considerations was 2.33 points out of full mark of 4 points, which is moderate level.¹²⁾

Subjects' self-efficacy on performance of ethical researches in this study was 3.14 points out full mark of 5, displaying similar results to those of preceding studies. In detailed items, subjects' responses that they can do well in stress management, management of human resources and coordination ability were relatively low. Considering that students in higher semester of degree courses and with experience of having taken ethics courses and having published theses have relatively high level of self-efficacy, intervention strategies are deemed to be required to form self-efficacy in early stages by coordinating curriculums so that students can take courses on research ethics and by providing them with opportunities to have research and publishing experiences through vitalization of professor-student researches.

Subjects' level of knowledge of research ethics in this study was 10.59 out of full mark of 16, which is converted to be 66.1 points out of 100, similar to the results of preceding studies. As the result of measuring the level of American graduate students knowledge for performance of responsible researches, the score ranged from the lowest 26.7 points to 83.3 points with mean score of 59.5 and level of knowledge was similar among students whether they belonged to master's course, doctoral course or post doctoral course.¹³⁾ In a preceding study on 267 researchers on bio-science in Korea, those who responded that their knowledge is sufficient were as low as 4.9%.¹⁴⁾

Although subjects of this study were well aware of simple definitions on plagiarism, forgery and falsification, rate of correct answer to the question "common-sense sentences and contents do not require use of quotation marks and not need to credit the author" in the knowledge on quotations was the lowest 22.5%. That is, students relatively lacked practical knowledge on cases of misconduct in research such as plagiarism, forgery and falsification and on solutions to conflicts of interests such as granting of authorship and joint research. This requires practical educational methods such as discussions with actual cases of misconducts in research or conflicts of interests or actual writing of quotations rather than education centering on simple delivery of theories.

In addition, detailed contents should also be tailored to public health science by reflecting the demands of public health graduate students. Although Center for Research Ethics Information (CRI) in Korea provides various cases of educational materials on research ethics on its website, there is still lack of specific cases which is specialized in public health science.

As graduate students can avoid unintentional misconducts and unethical academic behaviors when they possess clear understanding on research ethics as responsible scientists working on humans, systematic educations for research ethics are required. Educations on research ethics are mainly implemented in graduate courses but they are mostly performed as a part of courses on public health research methods and bioethics for 2-3 hours a semester rather than as independent formal courses.¹⁵⁾ Thus, there are limitations in raising research ethics and good researchers to perform responsible research.

Under the current circumstances when education on research ethics is strongly demanded across domestic and overseas academic circles, development of curriculums on research ethics tailored to public health graduate students and introducing them into formal courses of graduate schools may satisfy these educational demands and, additionally, vitalize education and researches related to research ethics though interdisciplinary networks among medical professionals involved in research ethics and ultimately contribute to practicing, distributing and spreading a higher level of research ethics and forming and establishing desirable research culture as researchers live up to public expectations and national goals through firm establishment of research ethics.

Ⅴ. Conclusion and suggestions

This study analyzed 204 public health graduate students' level of awareness, self-efficacy and knowledge of research ethics and relationship between them. Public health graduate students' level of awareness of research ethics showed less than moderate (2.90 points, full mark of 5 points) and self-efficacy was a moderate the level (3.14 points, full mark of 5 points) while level of knowledge marked 66.1 points (those calculated based on full mark of 100 points). These scores were lower than expected even with a national approach and investments for desirable research performances. Students who are enrolled in research-centered courses and completed various academic activities such as participation in researches and publication of thesis had higher level of variables related to research ethics. In addition, subjects' awareness (r=0.509, p<0.001) and self-efficacy (r=0.280, p<0.004) of research ethics had significantly positive relationship with their level of knowledge.

Based on these results, this study suggests ways to vitalize the education of research ethics for public health graduate students as follows;

First, as the level of awareness, self-efficacy and knowledge of research ethics vary according to public health graduate students' general characteristics, follow-up studies are required to confirm various levels of public health researchers' competency for research ethics.

Second, it is necessary to develop and apply tailored education programs of research ethics centering on practical cases which can enhance the level of public health graduate students' awareness, self-efficacy and knowledge of research ethics.

Third, more active educational activities on research ethics are required by opening formal courses on research ethics in graduate curriculums.