Published papers

During the early period of COVID-19 pandemic, there was a serious shortage of personal protective equipments (PPEs), which caused difficulty in homecare agencies to make home visits to those (possible) positive COVID-19 cases. An organization with the help of several foundations started a special program to distribute PPEs to those agencies in which there was a possible case or those cases that had close contact with the positive cases. This study examined whether this voluntary activity contributed to increasing the sense of security in providing care among homecare workers. We conducted a survey with homecare agencies that received PPEs from the program between July 2020 and February 2021. The participants were agency managers who applied for PPEs. We conducted the survey twice, before and after receiving PPEs. In the questionnaire, we asked about the overall sense of security in providing care for those infected with COVID-19, reasons for applying for PPE, symptoms of the client or his/her family who caused the PPE request, and the agency’s and clients’ characteristics. We analyzed the data from 802 responses. Before PPE distribution, the sense of security was associated with the focal client having a cognitive impairment (β= −0.096), having cough (β= −0.088), fatigue (β= −0.085), or headache (β= −0.078). Agencies that did not visits those (possibly) positive cases (β= −0.123) had lower sense of security. Overall, the mean sense of security increased after receiving PPE. Factors that contributed to the increase in sense of security included a lower sense of security before the application (β= −0.529), visiting clients without dyspnoea (β= −0.109), the agency that did not visit positive cases before the application (β= −0.089), and with higher satisfaction with the days of PPEs received (β= 0.144). These results underline the benefit of the special PPsE distribution program.

This study investigated lifestyle changes and the self-reported mental health status of Japanese community residents during the COVID-19 pandemic. Differences in demography, daily lifestyle changes, and approaches to problem solving were analyzed in two age cohorts (<60 vs ≥60 years). The prevalence of moderate/increased psychological distress was 31.7%, with no significant difference between the cohorts. Compared with the pre-COVID-19 era, more than 80% of the participants stopped eating out and spent more time at home, and more than 70% used public transport less frequently. There were significant differences between the cohorts for the time spent at home, opportunities to eat meals outside of home, and shopping in stores. Participants aged under 60 years were less likely to use television and newspapers or to consult a family doctor. Those aged over 60 years were less likely to consult friends/ colleagues or to use the Internet/social networking services. Identifying the risk factors for psychological distress is warranted for implementing measures to maintain and improve the physical and mental health of residents.

Aim: This study aimed to identify factors related to the psychological safety of Japanese home care nurses (HCNs). Methods: This cross-sectional study recruited Japanese HCNs. The HCNs completed a questionnaire based on the Japanese version of the Psychological Safety Scale at their home care nursing agency (HCN agency) from May to July 2022; the responses were analyzed to determine the characteristics of the HCNs and HCN agencies. Multiple regression analysis was conducted to determine the factors associated with HCNs’ psychological safety. Results: This study included 145 HCNs from 73 HCN agencies. The mean age of the HCNs was 43.46 years, and the mean score on the Japanese version of the psychological safety scale was 27.19. Psychological safety was significantly associated with HCNs’ perceptions of follow-up systems for adverse events (β = .355, p < .001), perceptions of management’s attitude toward problem-solving (β = .309, p < .001), and management’s efforts to create a consultative environment (β = .183, p = .009). Furthermore, psychological safety was negatively correlated with agency-level factors, including the average number of visits per month by HCNs (β = −.184, p = .012) and the use of social networking services (SNS) for business communication in daily work (β = −.173, p = .018). Conclusions: Supportive management practices are crucial to shaping the psychological safety of Japanese HCNs, whereas heavy workloads and frequent SNS use for communication may hinder it; thus, organizational improvements and workload adjustments are necessary.

Although COVID-19 vaccination was approved for younger children in Japan in October 2022, uptake rates remain critically low. This study aimed to investigate Japanese parents’ intentions, hesitators’ probability of positive intention change, and factors that motivate COVID-19 vaccination. Parents with a 6-month to 4-year-old child living in Japan participated in this internet-based, cross-sectional survey conducted from December 19, 2022, to January 4, 2023. The modified Poisson regression analysis was used to assess the probabilities of changing intention by each motivator when comparing the degree of hesitancy among hesitators, and the Poisson generalized estimating equations were used to compare the probabilities of changing intentions by potential motivators within hesitant individuals. Among 12,502 participants, 10,008 (80.1%) were hesitators. Parents with lower hesitancy levels were more likely to be motivated to vaccinate their children through potential motivators. Vaccine hesitators were motivated to vaccinate their children, particularly by proven vaccine effectiveness (including “protecting children from getting sick” with a probability ratio [PR] of 3.7 [95% confidence interval (CI) 3.5–3.9] and “less likely to infect adults” with a PR of 2.9 [95% CI 2.8–3.1]), as well as vaccine safety (including “safe vaccination of millions of children” with a PR of 3.1 [95% CI 3.0–3.3]) compared to injunctive norm (including “community leader recommendation”). Therefore, initially addressing parents with low hesitancy levels is an effective strategy that motivates COVID-19 vaccination. Also, providing evidence-based information about COVID-19 vaccine efficacy and safety that is consistent with parents’ needs is crucial.

Objective: As health problems become more diverse and complicated, the way public health nurses (PHNs) work is changing. Research at the conceptual level of professional identity of PHNs is lacking. This study aimed to explore the structure of the perceived professional identity of Japanese PHNs. Design and Sample: Grounded theory method was used. Twenty-five PHNs in Japanese municipalities were participated in the study. Measurements: Data were collected through semistructured interviews and analyzed using open, axial, and selective coding. Results: Three categories emerged: (1) providing support to the consulter directly, (2) working as a member of the administrative organization, and (3) working for all residents to improve community development. The modality of perceived professional identity showed interindividual and intraindividual differences and was either stable or unstable. The perceived professional identities coexisted, but there was a conflict between (1) and (2). Conclusion: PHNs should be made aware of the three identities revealed in our study and the possibility of a conflict between identities. Moreover, to ensure working for all residents to improve community development, a population-based approach to education is needed with cooperation of universities and clinical practice.

Adult day care (ADC) provides various services for meeting clients’ needs. Based on the mini-Delphi method with 46 ADC staff and the discussions with eight ADC administrators, this study developed and finalized a comprehensive logic model to represent the elements of ADC. For the three basic structures of a logic model—inputs/activities, outputs, and outcomes—the model contained seven core categories and 23 sub-categories. The ADC inputs/activities consisted of two core categories: “Place to stay” and “Intervention from staff”. These inputs/activities caused two kinds of outputs: “Clients’ experiences” and “Families’ experiences”. “Accumulating experiences” with repeated ADC visits was established as the link between the ADC outputs and outcomes, which were “Clients’ change” and “Families’ change”. ADC centers provide various experiences for their clients and their caregivers, ranging from the fulfillment of needs for fundamental care to psychiatric care and self-actualization. Improving various model-related inputs/interventions can produce better experiences and outcomes. The model can guide ADC administrators, policymakers, and researchers in the evaluation of a heterogeneous ADC service program that is community-based, thereby ensuring optimal care for clients with an efficient use of resources.

Objective: To examine the age in months at which infants visited outpatient clinics or emergency rooms for the first time for nonfatal injuries and to identify risk factors for the occurrence of these injuries. Study design: Retrospective cohort study. Methods: We used a health insurance claims database in Japan. Infants born between April 2012 and December 2014 were identified and followed until 12 months of age. We identified their first visit to outpatient clinics or emergency rooms because of nonfatal injuries (wounds/fractures, foreign bodies, and burns). Cox regression analysis was used to examine the association of nonfatal injuries with infants’ sex, birth order, and parental age. Results: We identified 46,431 eligible infants. Of these, 7606 (16.4%) were brought to an outpatient clinic or emergency room for nonfatal injuries within 12 months of birth. Of the 7,606, 21.7% were aged ≤4 months and 44.7% ​≤ ​7 months. First-born infants were more likely to have wounds/fractures and burns. Conclusion: One-fifth of first nonfatal infant injuries occurred within 4 months of age. Healthcare providers should provide early education about injury prevention, especially to caregivers of first-born infants.

Aim: To investigate the association between children and their families' daily life routines and the implementation of safety practices in their homes. Methods: A cross-sectional study was conducted using a self-administered questionnaire among parents of 3-year-old children, who visited a public health center in Tokyo for their health checkups. Associations between the implementation of safety practices and family and children's basic daily routines were assessed using a multivariate logistic regression. Results: Data from 336 parents were analyzed. Three items were found to be significantly related to the non-implementation of safety practices, such as “television-watching behavior: after 8:00 p.m.” (adjusted odds ratio = 1.88, p =.02), “washing hands: not every time after getting home” (adjusted odds ratio = 2.24, p =.02), and “Family Routines Inventory: lower score” (a measurement of the routinization of a family's daily life; adjusted odds ratio =.83, p =.01). Conclusion: The cumulative results suggest that the lack of safety practices implementation signify nonadherence to daily routine practices by parents.

Recently, many community gathering spaces (CGSs) have been built as platforms for senior citizens to socialize. This study constitutes an ethnographic examination of how senior citizens use a CGS in a public housing complex in Japan. The results depicted six characteristic styles in which senior citizens used the CGS: visiting a park, attending a school, using a library, using a meeting room, shopping for commodities, and participating in events. Frequency of CGS use and group cohesion were two properties that distinguished among the six styles. Moreover, environmental features of the CGS enabled senior citizens with various physical and social conditions to use the CGS.

Aim: Recreational walking benefits the health of the middle-aged population. Social norms might generate an intention–behavior gap, the state of people forming adequate intentions but failing to translate these intentions into action. People living in a community where the neighbors conform to the average behaviors of those who live in the neighborhood might restrict behaviors that stray from the neighborhood's social norms. This cross-sectional study was conducted in order to examine whether the degree of conformity to the neighbors modified the association between social norms and recreational walking among middle-aged adults in Japan. Methods: Using a questionnaire, data were collected from 730 participants in Japan. Among those who intended to recreationally walk, a multiple logistic regression was carried out separately for the participants with a high or low degree of conformity to the neighborhood social norms. Results: Of the total number of respondents, 511 (70%) reported recreational walking intentions. The descriptive norm was significantly associated with recreational walking only among the participants with a high degree of conformity. In contrast, there was no such association among the participants with a low degree of conformity. Conclusion: The results confirmed that people who live in a community where people tend to conform translated walking intentions into action when they saw their neighbors walk recreationally. Public health nurses should evaluate the degree of conformity in neighborhoods and neighbors’ descriptive norms when promoting walking.

Most violence by patients with mental illness is perpetuated against family members rather than the general public. However, there is insufficient research to reach a consensus on factors related to family violence for this population. Thus, the current study aimed to clarify factors related to physical violence by patients with schizophrenia towards their parents in Japan. A self-administrated survey was distributed through family groups to families with a relative with a psychiatric disorder. Questionnaires completed by 400 parents of patients with schizophrenia were analyzed. Of the 400 parents, almost two-thirds experienced “no physical violence” and close to one-third experienced “physical violence” during the past year. Results of a mixed-effects logistic regression revealed that physical violence was significantly related to the patients’ gender (female rather than male), multiple patient hospitalizations (3 or more times as compared to never hospitalized), low annual household income (less than US$20 K as compared to over US$40 K), and higher hostility and criticism of family interactions. Family violence maybe reduced through education on communication strategies for both parents and patients.